Impact of Hearing Aids on Language Outcomes in Preschool Children With Mild Bilateral Hearing Loss

This study aimed to investigate the role of hearing aid (HA) usage in language outcomes among preschool children aged 3-5 years with mild bilateral hearing loss (MBHL). The data were retrieved from a total of 52 children with MBHL and 30 children with normal hearing (NH). The association between demographical, audiological factors and language outcomes was examined. Analyses of variance were conducted to compare the language abilities of HA users, non-HA users, and their NH peers. Furthermore, regression analyses were performed to identify significant predictors of language outcomes. Aided better ear pure-tone average (BEPTA) was significantly correlated with language comprehension scores. Among children with MBHL, those who used HA outperformed the ones who did not use HA across all linguistic domains. The language skills of children with MBHL were comparable to those of their peers with NH. The degree of improvement in audibility in terms of aided BEPTA was a significant predictor of language comprehension. It is noteworthy that 50% of the parents expressed reluctance regarding HA use for their children with MBHL. The findings highlight the positive impact of HA usage on language development in this population. Professionals may therefore consider HAs as a viable treatment option for children with MBHL, especially when there is a potential risk of language delay due to hearing loss. It was observed that 25% of the children with MBHL had late-onset hearing loss. Consequently, the implementation of preschool screening or a listening performance checklist is recommended to facilitate early detection.

The Influence of Forced Social Isolation on the Auditory Ecology and Psychosocial Functions of Listeners With Cochlear Implants During COVID-19 Mitigation Efforts

OBJECTIVES

The impact of social distancing on communication and psychosocial variables among individuals with hearing impairment during COVID-19 pandemic. It was our concern that patients who already found themselves socially isolated (Wie et al. 2010) as a result of their hearing loss would be perhaps more susceptible to changes in their communication habits resulting in further social isolation, anxiety, and depression. We wanted to better understand how forced social isolation (as part of COVID-19 mitigation) effected a group of individuals with hearing impairment from an auditory ecology and psychosocial perspective. We hypothesized that the listening environments would be different as a result of social isolation when comparing subject's responses regarding activities and participation before COVID-19 and during the COVID-19 pandemic. This change would lead to an increase in experienced and perceived social isolation, anxiety, and depression.

DESIGN

A total of 48 adults with at least 12 months of cochlear implant (CI) experience reported their listening contexts and experiences pre-COVID and during-COVID using Ecological Momentary Assessment (EMA; methodology collecting a respondent's self-reports in their natural environments) through a smartphone-based app, and six paper and pencil questionnaires. The Smartphone app and paper-pencil questionnaires address topics related to their listening environment, social isolation, depression, anxiety, lifestyle and demand, loneliness, and satisfaction with amplification. Data from these two-time points were compared to better understand the effects of social distancing on the CI recipients' communication abilities.

RESULTS

EMA demonstrated that during-COVID CI recipients were more likely to stay home or be outdoors. CI recipients reported that they were less likely to stay indoors outside of their home relative to the pre-COVID condition. Social distancing also had a significant effect on the overall signal-to-noise ratio of the environments indicating that the listening environments had better signal-to-noise ratios. CI recipients also reported better speech understanding, less listening effort, less activity limitation due to hearing loss, less social isolation due to hearing loss, and less anxiety due to hearing loss. Retrospective questionnaires indicated that social distancing had a significant effect on the social network size, participant's personal image of themselves, and overall loneliness.

CONCLUSIONS

Overall, EMA provided us with a glimpse of the effect that forced social isolation has had on the listening environments and psychosocial perspectives of a select number of CI listeners. CI participants in this study reported that they were spending more time at home in a quieter environments during-COVID. Contrary to our hypothesis, CI recipients overall felt less socially isolated and reported less anxiety resulting from their hearing difficulties during-COVID in comparison to pre-COVID. This, perhaps, implies that having a more controlled environment with fewer speakers provided a more relaxing listening experience.

Contributions to Speech-Cue Weighting in Older Adults With Impaired Hearing

Purpose In a previous paper (Souza, Wright, Blackburn, Tatman, & Gallun, 2015), we explored the extent to which individuals with sensorineural hearing loss used different cues for speech identification when multiple cues were available. Specifically, some listeners placed the greatest weight on spectral cues (spectral shape and/or formant transition), whereas others relied on the temporal envelope. In the current study, we aimed to determine whether listeners who relied on temporal envelope did so because they were unable to discriminate the formant information at a level sufficient to use it for identification and the extent to which a brief discrimination test could predict cue weighting patterns. Method Participants were 30 older adults with bilateral sensorineural hearing loss. The first task was to label synthetic speech tokens based on the combined percept of temporal envelope rise time and formant transitions. An individual profile was derived from linear discriminant analysis of the identification responses. The second task was to discriminate differences in either temporal envelope rise time or formant transitions. The third task was to discriminate spectrotemporal modulation in a nonspeech stimulus. Results All listeners were able to discriminate temporal envelope rise time at levels sufficient for the identification task. There was wide variability in the ability to discriminate formant transitions, and that ability predicted approximately one third of the variance in the identification task. There was no relationship between performance in the identification task and either amount of hearing loss or ability to discriminate nonspeech spectrotemporal modulation. Conclusions The data suggest that listeners who rely to a greater extent on temporal cues lack the ability to discriminate fine-grained spectral information. The fact that the amount of hearing loss was not associated with the cue profile underscores the need to characterize individual abilities in a more nuanced way than can be captured by the pure-tone audiogram.

Sequential stream segregation with bilateral cochlear implants

Sequential stream segregation on the basis of binaural 'ear-of-entry', modulation rate and electrode place-of-stimulation cues was investigated in bilateral cochlear implant (CI) listeners using a rhythm anisochrony detection task. Sequences of alternating 'A' and 'B' bursts were presented via direct electrical stimulation and comprised either an isochronous timing structure or an anisochronous structure that was generated by delaying just the 'B' bursts. 'B' delay thresholds that enabled rhythm anisochrony detection were determined. Higher thresholds were assumed to indicate a greater likelihood of stream segregation, resulting specifically from stream integration breakdown. Results averaged across subjects showed that thresholds were significantly higher when monaural 'A' and 'B' bursts were presented contralaterally rather than ipsilaterally, and that diotic presentation of 'A', with a monaural 'B', yielded intermediate thresholds. When presented monaurally and ipsilaterally, higher thresholds were also found when successive bursts had mismatched rather than matched modulation rates. In agreement with previous studies, average delay thresholds also increased as electrode separation between bursts increased when presented ipsilaterally. No interactions were found between ear-of-entry, modulation rate and place-of-stimulation. However, combining moderate electrode difference cues with either diotic-'A' ear-of-entry cues or modulation-rate mismatch cues did yield greater threshold increases than observed with any of those cues alone. The results from the present study indicate that sequential stream segregation can be elicited in bilateral CI users by differences in the signal across ears (binaural cues), in modulation rate (monaural cues) and in place-of-stimulation (monaural cues), and that those differences can be combined to further increase segregation.

Hearing aid fitting and developmental outcomes of children fit according to either the NAL or DSL prescription: fit-to-target, audibility, speech and language abilities

OBJECTIVE

This study examined the influence of prescription on hearing aid (HA) fitting characteristics and 5-year developmental outcomes of children.

DESIGN

A randomised controlled trial implemented as part of a population-based study on Longitudinal Outcomes of Children with Hearing Impairment (LOCHI).

STUDY SAMPLE

Two-hundred and thirty-two children that were fit according to either the National Acoustic Laboratories (NAL) or Desired Sensation Level (DSL) prescription.

RESULTS

Deviation from targets and root-mean-square error in HA fitting revealed no significant difference between fitting prescriptions. Aided audibility quantified by using the Speech Intelligibility Index (SII) model showed that DSL provided higher audibility than NAL at low and medium input levels but not at high input level. After allowing for hearing loss desensitisation, differences in audibility between prescription groups were significant only at low input level. The randomised trial of prescription that was implemented for 163 children revealed no significant between-group differences in speech production, perception, and language; but parent-rated functional performance was higher for the DSL than for the NAL group.

CONCLUSIONS

Proximity to prescriptive targets was similar between fitting prescriptions. The randomised trial revealed differences in aided audibility at low input level between prescription groups, but no significant differences in speech and language abilities.

School-aged Children with Mild Bilateral and Unilateral Hearing Loss: Parents' Reflections on Services, Experiences, and Outcomes

Following the establishment of newborn hearing screening programs, age of identification and length of time before receiving interventions has been reduced for children, including those with milder degrees of hearing loss who were previously not identified until school age. This population of early-identified children requires new support programs for parents. Although literature is emerging on how parents experience the initial years, there is limited information on support needs during early school years. The objectives were to gain insights into parents' experiences with services during the early period of identification until early school years, as well as their perceptions of the consequences of hearing loss on their child's overall development. A qualitative research design informed by Interpretive Description was employed. Individual semi-structured interviews were conducted with 12 parents of children identified with mild hearing loss. Transcripts were analyzed using a constant comparative method. Four themes emerged from the data: early experiences with services and hearing technology, effects of hearing loss on social functioning, effects of hearing loss on language and academics, and experiences in early school years. From parents' perspectives, more support during the early school years is needed to help ensure academic success.

Predicting the Future: A Case Study in Prognostication

PURPOSE

Clinicians are regularly asked to make long-term prognoses. The aim of the current report was to present one systematic approach to doing so. A case example from a malpractice case involving a child fitted with a cochlear implant was presented. Implantation occurred at age 17 months (activation 1 month later), but due to a procedural error, the implant was not functional for 19 months. The problem was ultimately rectified, but the legal case hinged largely on whether the child would be able to make up for the lost time.

METHOD

A review of the literature on long-term outcomes in children with cochlear implants was conducted. Using 4 studies measuring outcomes 7-10 years later, outcomes were compared between children implanted at age 17-18 months and those implanted at age 36-37 months.

RESULTS

Analysis suggested no potential impact on nonverbal cognitive skills. However, analysis in the areas of speech perception, word comprehension, speech intelligibility, and reading suggested that after 7-10 years, this child would potentially continue to be approximately 1-2 years behind where she might otherwise have been.

CONCLUSIONS

This case illustrated the possibility of deriving a long-term prognosis using a systematic examination of the existing outcomes literature. Such an approach is consistent with our mandate to engage in evidence-based practice.

Examination of a hybrid beamformer that preserves auditory spatial cues

A hearing-aid strategy that combines a beamforming microphone array in the high frequencies with natural binaural signals in the low frequencies was examined. This strategy attempts to balance the benefits of beamforming (improved signal-to-noise ratio) with the benefits of binaural listening (spatial awareness and location-based segregation). The crossover frequency was varied from 200 to 1200 Hz, and performance was compared to full-spectrum binaural and beamformer conditions. Speech intelligibility in the presence of noise or competing speech was measured in listeners with and without hearing loss. Results showed that the optimal crossover frequency depended on the listener and the nature of the interference.

Music perception improves in children with bilateral cochlear implants or bimodal devices

The objectives of this study were to determine if music perception by pediatric cochlear implant users can be improved by (1) providing access to bilateral hearing through two cochlear implants or a cochlear implant and a contralateral hearing aid (bimodal users) and (2) any history of music training. The Montreal Battery of Evaluation of Musical Ability test was presented via soundfield to 26 bilateral cochlear implant users, 8 bimodal users and 16 children with normal hearing. Response accuracy and reaction time were recorded via an iPad application. Bilateral cochlear implant and bimodal users perceived musical characteristics less accurately and more slowly than children with normal hearing. Children who had music training were faster and more accurate, regardless of their hearing status. Reaction time on specific subtests decreased with age, years of musical training and, for implant users, better residual hearing. Despite effects of these factors on reaction time, bimodal and bilateral cochlear implant users' responses were less accurate than those of their normal hearing peers. This means children using bilateral cochlear implants and bimodal devices continue to experience challenges perceiving music that are related to hearing impairment and/or device limitations during development.

The effect of tone-vocoding on spatial release from masking for old, hearing-impaired listeners

Old, hearing-impaired listeners generally benefit little from lateral separation of multiple talkers when listening to one of them. This study aimed to determine how spatial release from masking (SRM) in such listeners is affected when the interaural time differences (ITDs) in the temporal fine structure (TFS) are manipulated by tone-vocoding (TVC) at the ears by a master hearing aid system. Word recall was compared, with and without TVC, when target and masker sentences from a closed set were played simultaneously from the front loudspeaker (co-located) and when the maskers were played 45° to the left and right of the listener (separated). For 20 hearing-impaired listeners aged 64 to 86, SRM was 3.7 dB smaller with TVC than without TVC. This difference in SRM correlated with mean audiometric thresholds below 1.5 kHz, even when monaural TFS sensitivity (discrimination of frequency-shifts in identically filtered complexes) was partialed out, suggesting that low-frequency audiometric thresholds may be a good indicator of candidacy for hearing aids that preserve ITDs. The TVC difference in SRM was not correlated with age, pure-tone ITD thresholds, nor fundamental frequency difference limens, and only with monaural TFS sensitivity before control for low-frequency audiometric thresholds.

Use of a glimpsing model to understand the performance of listeners with and without hearing loss in spatialized speech mixtures

In many situations, listeners with sensorineural hearing loss demonstrate reduced spatial release from masking compared to listeners with normal hearing. This deficit is particularly evident in the "symmetric masker" paradigm in which competing talkers are located to either side of a central target talker. However, there is some evidence that reduced target audibility (rather than a spatial deficit per se) under conditions of spatial separation may contribute to the observed deficit. In this study a simple "glimpsing" model (applied separately to each ear) was used to isolate the target information that is potentially available in binaural speech mixtures. Intelligibility of these glimpsed stimuli was then measured directly. Differences between normally hearing and hearing-impaired listeners observed in the natural binaural condition persisted for the glimpsed condition, despite the fact that the task no longer required segregation or spatial processing. This result is consistent with the idea that the performance of listeners with hearing loss in the spatialized mixture was limited by their ability to identify the target speech based on sparse glimpses, possibly as a result of some of those glimpses being inaudible.

Effects of Noise on Speech Recognition and Listening Effort in Children With Normal Hearing and Children With Mild Bilateral or Unilateral Hearing Loss

PURPOSE

This study examined the effects of stimulus type and hearing status on speech recognition and listening effort in children with normal hearing (NH) and children with mild bilateral hearing loss (MBHL) or unilateral hearing loss (UHL).

METHOD

Children (5-12 years of age) with NH (Experiment 1) and children (8-12 years of age) with MBHL, UHL, or NH (Experiment 2) performed consonant identification and word and sentence recognition in background noise. Percentage correct performance and verbal response time (VRT) were assessed (onset time, total duration).

RESULTS

In general, speech recognition improved as signal-to-noise ratio (SNR) increased both for children with NH and children with MBHL or UHL. The groups did not differ on measures of VRT. Onset times were longer for incorrect than for correct responses. For correct responses only, there was a general increase in VRT with decreasing SNR.

CONCLUSIONS

Findings indicate poorer sentence recognition in children with NH and MBHL or UHL as SNR decreases. VRT results suggest that greater effort was expended when processing stimuli that were incorrectly identified. Increasing VRT with decreasing SNR for correct responses also supports greater effort in poorer acoustic conditions. The absence of significant hearing status differences suggests that VRT was not differentially affected by MBHL, UHL, or NH for children in this study.

Children With Mild Bilateral and Unilateral Hearing Loss: Parents' Reflections on Experiences and Outcomes

Children with mild bilateral and unilateral hearing loss are now commonly identified early through newborn hearing screening initiatives. There remains considerable uncertainty about how to support parents and about which services to provide for children with mild bilateral and unilateral hearing loss. The goal of this study was to learn about parents' experiences and understand, from their perspectives, the impact of hearing loss in the mild range on the child's functioning. Parents of 20 children in Ontario, Canada, participated in the study. The median age of identification of hearing loss was 4.6 months (interquartile range: 3.6, 10.8). Parents appreciated learning early about hearing loss, but their experiences with the early process were mixed. Parents felt that professionals minimized the importance of milder hearing loss. There was substantial uncertainty about the need for hearing aids and the findings suggest that parents need specific guidance. Parents expressed concerns about the potential impact of hearing loss on their child's development, particularly at later ages.

Which ear should we choose for cochlear implantation in the elderly: The poorer or the better? Audiometric outcomes, quality of sound, and quality-of-life results

CONCLUSIONS

Cochlear implantation in the poorer ear of an elderly patient does not predict poorer post-operative audiological, quality-of-life (QoL), and quality of sound results.

OBJECTIVES

To determine whether choosing the 'better' or the 'poorer' ear for cochlear implantation impacts performance outcome in an elderly population.

METHODS

Forty-two out of 73 elderly (≥ 60 years) cochlear implant users with some residual hearing in at least one ear were selected. Three criteria were used to group the patients as 'better' or 'poorer' ear implanted; (C1) based on previous use of hearing aid, (C2) pre-operative PTA, and (C3) pre-operative speech discrimination. The Glasgow Benefit Inventory (GBI) and the Hearing Implant Sound Quality Index (HISQUI) were used to measure QoL and quality of sound, respectively.

RESULTS

The mean post-operative PTA was 38.7 ± 7.2 dBHL. In quiet, the mean disyllabic SDS at 65dBSPL was 75.4 ± 18.5, whereas the discrimination of sentences was 95.0% ± 6.9. The mean total GBI score was 30.9 ± 21.8, 92.9% of patients reporting a positive score. The mean HISQUI score was 111.3 ± 36.0, which corresponds to 'moderate' sound quality. No significant differences were found between both groups in terms of audiological outcomes, HISQUI scores or GBI scores when considering each of the three criteria.

Consonant identification in noise using Hilbert-transform temporal fine-structure speech and recovered-envelope speech for listeners with normal and impaired hearing

Consonant-identification ability was examined in normal-hearing (NH) and hearing-impaired (HI) listeners in the presence of steady-state and 10-Hz square-wave interrupted speech-shaped noise. The Hilbert transform was used to process speech stimuli (16 consonants in a-C-a syllables) to present envelope cues, temporal fine-structure (TFS) cues, or envelope cues recovered from TFS speech. The performance of the HI listeners was inferior to that of the NH listeners both in terms of lower levels of performance in the baseline condition and in the need for higher signal-to-noise ratio to yield a given level of performance. For NH listeners, scores were higher in interrupted noise than in steady-state noise for all speech types (indicating substantial masking release). For HI listeners, masking release was typically observed for TFS and recovered-envelope speech but not for unprocessed and envelope speech. For both groups of listeners, TFS and recovered-envelope speech yielded similar levels of performance and consonant confusion patterns. The masking release observed for TFS and recovered-envelope speech may be related to level effects associated with the manner in which the TFS processing interacts with the interrupted noise signal, rather than to the contributions of TFS cues per se.

Comparing auditory filter bandwidths, spectral ripple modulation detection, spectral ripple discrimination, and speech recognition: Normal and impaired hearing

Some listeners with hearing loss show poor speech recognition scores in spite of using amplification that optimizes audibility. Beyond audibility, studies have suggested that suprathreshold abilities such as spectral and temporal processing may explain differences in amplified speech recognition scores. A variety of different methods has been used to measure spectral processing. However, the relationship between spectral processing and speech recognition is still inconclusive. This study evaluated the relationship between spectral processing and speech recognition in listeners with normal hearing and with hearing loss. Narrowband spectral resolution was assessed using auditory filter bandwidths estimated from simultaneous notched-noise masking. Broadband spectral processing was measured using the spectral ripple discrimination (SRD) task and the spectral ripple depth detection (SMD) task. Three different measures were used to assess unamplified and amplified speech recognition in quiet and noise. Stepwise multiple linear regression revealed that SMD at 2.0 cycles per octave (cpo) significantly predicted speech scores for amplified and unamplified speech in quiet and noise. Commonality analyses revealed that SMD at 2.0 cpo combined with SRD and equivalent rectangular bandwidth measures to explain most of the variance captured by the regression model. Results suggest that SMD and SRD may be promising clinical tools for diagnostic evaluation and predicting amplification outcomes.

Improving behavior using child-directed interaction skills: A case study determining cochlear implant candidacy

OBJECTIVE AND IMPORTANCE

Children with hearing loss (HL) are at increased risk of developing externalizing behavior problems (e.g., hyperactivity, attention problems). These problems can lead to cascading effects on children's overall development. However, few studies have identified evidence-based interventions for this population.

CLINICAL PRESENTATION

A 6-year-old boy with bilateral HL presented to the clinic with significant behavioral challenges. These challenges (e.g., fatigued quickly, poor attention, and hyperactivity) were affecting the reliability of audiological testing to determine cochlear implant candidacy. Thus, the child was referred for Parent-Child Interaction Therapy (PCIT) to address these behavioral challenges.

INTERVENTION AND TECHNIQUE

PCIT is an evidence-based intervention that has been shown to significantly improve externalizing behavior problems. This study describes how the Child-Directed Interaction phase of PCIT was tailored for a child with bilateral HL. The goal of the intervention was to reduce externalizing behaviors in order to reliably complete a cochlear implant evaluation. Post-intervention, significant improvements were noted in behavior, including a decrease in disruptive behavior to normal levels. This led to completion of previously unsuccessful audiological testing and determination of cochlear implant candidacy.

CONCLUSION

This study illustrates how PCIT was successfully tailored to one child with an HL. This is critical as children with HL are at risk for behavior problems, and effective interventions for disruptive behaviors in children with HL may lead to significant improvements in medical and psychosocial outcomes for children with HL and their families.

Hearing loss in adult patients with Fabry disease treated with enzyme replacement therapy

INTRODUCTION

Data on prevalence, natural history, and effect of enzyme replacement therapy (ERT) on hearing loss (HL) in Fabry disease (FD) are scarce.

METHODS

This is a retrospective study with cross-sectional and longitudinal analyses. Low and high-frequency HL in the Dutch FD cohort was studied in four groups: classical and non-classical FD patients with or without ERT. To study effects of ERT, longitudinal data, corrected for age and gender according to ISO-1999 guidelines, were analyzed with mixed models.

RESULTS

In the cross-sectional analysis, 107 FD patients (41 males), median age 47.6 years (18.8-80.6) were analyzed. At baseline, i.e., before start of ERT, HL was present in 18 patients (16.8 %), of whom four had bilateral sensorineural HL. HL was more often present in patients with the classical phenotype than non-classical patients (p < 0.01). Likewise, males had more often HL than females. Compared to the general population, FD patients show a median HL of 8.2 dB at low frequencies (p < 0.01) and 29.5 dB at ultra-high frequencies (p < 0.01). Longitudinal analyses (n = 91) revealed that ERT treated patients show a similar rate of decline, not significantly different from healthy controls.

CONCLUSION

Adult FD patients, especially classical affected males, show impaired hearing. Longitudinal analyses during ERT in these patients demonstrates a decline of HL similar to healthy controls, but HL present before initiation of therapy cannot be reversed. Whether early therapy can prevent hearing loss is unknown.

Better-ear glimpsing in hearing-impaired listeners

When competing speech sounds are spatially separated, listeners can make use of the ear with the better target-to-masker ratio. Recent studies showed that listeners with normal hearing are able to efficiently make use of this "better-ear," even when it alternates between left and right ears at different times in different frequency bands, which may contribute to the ability to listen in spatialized speech mixtures. In the present study, better-ear glimpsing in listeners with bilateral sensorineural hearing impairment, who perform poorly in spatialized speech mixtures, was investigated. The results suggest that this deficit is not related to better-ear glimpsing.

Synchrony, complexity and directiveness in mothers' interactions with infants pre- and post-cochlear implantation

This study investigated effects of profound hearing loss on mother-infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother-infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age=13.6 months); and Time 2 (mean age=23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers' utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants' access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants' word use, all within seven months of cochlear implant activation.

Typical consonant cluster acquisition in auditory-verbal children with early-identified severe/profound hearing loss

Early-identified severe/profound hearing loss (HL) following universal newborn hearing screening (UNHS) has been associated with improved speech and language outcomes. However, speech outcome reports have typically been based on broad measures of speech intelligibility and/or singleton consonant accuracy, with little known about production of consonant clusters. Using a prospective design, the range and accuracy of consonant clusters produced by a homogenous cohort of 12 children early-identified with severe/profound HL aged 3- and 4-years were examined. All children demonstrated bilateral aided thresholds within a range of 15-25 dB HL across all frequencies, were optimally amplified with cochlear implants (11/12) or hearing aids (1/12), and attended auditory-verbal (AV) early intervention. Standardized speech and language assessments were administered. Consonant clusters were strategically sampled in single-word and conversational speech contexts. All standard scores for speech, receptive, and expressive language were within normal limits. All children produced consonant clusters commensurate with expectations for typically-developing hearing peers at 3- and 4- years-of-age. Children's production of phonetically complex morphophonemes (final consonant clusters marking grammatical morphemes) was also in keeping with developmental expectations. Factors which contributed to these encouraging outcomes require further investigation.

Auditory and tactile gap discrimination by observers with normal and impaired hearing

Temporal processing ability for the senses of hearing and touch was examined through the measurement of gap-duration discrimination thresholds (GDDTs) employing the same low-frequency sinusoidal stimuli in both modalities. GDDTs were measured in three groups of observers (normal-hearing, hearing-impaired, and normal-hearing with simulated hearing loss) covering an age range of 21-69 yr. GDDTs for a baseline gap of 6 ms were measured for four different combinations of 100-ms leading and trailing markers (250-250, 250-400, 400-250, and 400-400 Hz). Auditory measurements were obtained for monaural presentation over headphones and tactile measurements were obtained using sinusoidal vibrations presented to the left middle finger. The auditory GDDTs of the hearing-impaired listeners, which were larger than those of the normal-hearing observers, were well-reproduced in the listeners with simulated loss. The magnitude of the GDDT was generally independent of modality and showed effects of age in both modalities. The use of different-frequency compared to same-frequency markers led to a greater deterioration in auditory GDDTs compared to tactile GDDTs and may reflect differences in bandwidth properties between the two sensory systems.

Phoneme recognition in modulated maskers by normal-hearing and aided hearing-impaired listeners

This study measured the influence of masker fluctuations on phoneme recognition. The first part of the study compared the benefit of masker modulations for consonant and vowel recognition in normal-hearing (NH) listeners. Recognition scores were measured in steady-state and sinusoidally amplitude-modulated noise maskers (100% modulation depth) at several modulation rates and signal-to-noise ratios. Masker modulation rates were 4, 8, 16, and 32 Hz for the consonant recognition task and 2, 4, 12, and 32 Hz for the vowel recognition task. Vowel recognition scores showed more modulation benefit and a more pronounced effect of masker modulation rate than consonant scores. The modulation benefit for word recognition from other studies was found to be more similar to the benefit for vowel recognition than that for consonant recognition. The second part of the study measured the effect of modulation rate on the benefit of masker modulations for vowel recognition in aided hearing-impaired (HI) listeners. HI listeners achieved as much modulation benefit as NH listeners for slower masker modulation rates (2, 4, and 12 Hz), but showed a reduced benefit for the fast masker modulation rate of 32 Hz.

Use of high-rate envelope speech cues and their perceptually relevant dynamic range for the hearing impaired

The ability of hearing-impaired (HI) listeners to use high-rate envelope information in a competing-talker situation was assessed. In experiment 1, signals were tone vocoded and the cutoff frequency (f(c)) of the envelope extraction filter was either 50 Hz (E filter) or 200 Hz (P filter). The channels for which the P or E filter was used were varied. Intelligibility was higher with the P filter regardless of whether it was used for low or high center frequencies. Performance was best when the P filter was used for all channels. Experiment 2 explored the dynamic range over which HI listeners made use of high-rate cues. In each channel of a vocoder, the envelope extracted using f(c) = 16 Hz was replaced by the envelope extracted using f(c) = 300 Hz, either at the peaks or valleys, with a parametrically varied "switching threshold." For a target-to-background ratio of +5 dB, changes in speech intelligibility occurred mainly when the switching threshold was between -8 and +8 dB relative to the channel root-mean-square level. This range is similar in width to, but about 3 dB higher in absolute level than, that found for normal-hearing listeners, despite the reduced dynamic range of the HI listeners.

Localization in speech mixtures by listeners with hearing loss

The ability of listeners with bilateral sensorineural hearing loss to localize a speech source in a multitalker mixture was measured. Five simultaneous words spoken by different talkers were presented over loudspeakers in a small room, and listeners localized one target word. Errors were significantly larger in this group compared to a control group with normal hearing. Localization of the target presented alone was not different between groups. The results suggest that hearing loss does not impair spatial hearing per se, but degrades the spatial representation of multiple simultaneous sounds.

Functional gain and speech understanding obtained by Vibrant Soundbridge or by open-fit hearing aid

CONCLUSION

There is no significant difference in speech recognition scores obtained with the Vibrant Soundbridge and the open-fit hearing aid. However, the Vibrant Soundbridge may be superior to open-fit hearing aids in improving hearing at high frequencies (4-8 kHz).

OBJECTIVES

To assess whether an improvement in speech recognition conferred by Vibrant Soundbridge is more marked than that afforded by open-fit hearing aids in patients with sloping high frequency sensorineural hearing loss (SNHL).

METHODS

This study had a self-control prospective design. Seven patients aged 21-62 years with sloping high frequency SNHL were recruited into the study. Each patient received a Vibrant Soundbridge middle ear implant (Vibrant MED-EL) and wore an open-fit hearing aid (Danavox, DOT 10). Speech recognition tests were performed according to protocols suggested by árpád Götze's speech definition test in Hungarian language. In the first session, conventional hearing thresholds (unaided pure tone thresholds) were measured. In the second session, the aided sound-field threshold, speech understanding score and functional gain obtained using middle ear implants and open-fit hearing aids were determined after programming of the devices.

RESULTS

Regarding speech recognition scores, there were no significant differences between data obtained with the middle ear implant and those with the open-fit hearing aid.

Social and emotional characteristics of adults seeking a cochlear implant and their spouses

OBJECTIVES

Because past research has shown that benefits of cochlear implantation may include a significant decrease in psychological and emotional difficulties, this study examined whether persons seeking cochlear implants in recent years differed psychologically from those referred in the early 1980s. A second objective was to explore mechanisms by which profound deafness could contribute to psychological and emotional difficulties for implant candidates and their spouses.

METHODS

178 cochlear implant candidates referred from 1981 to 1998 at the University of Iowa Hospitals completed a standard battery of psychological tests and questionnaires. The sample was divided into six 3-year cohorts and compared on standardized measures of psychological and emotional adjustment, and in participation in social and non-social activities. Spouses of implant candidates completed a similar assessment.

RESULTS

The sample was characterized by elevations in depression, social introversion, suspiciousness, and social anxiety and loneliness. There were no significant differences among cohorts across time except for an increase in expectations for implant success. Spouses also evidenced elevated levels of psychological distress. Hearing status was associated with significant differences in social activity participation. A paradoxical interaction was found between marital status and deafness.

CONCLUSIONS

There was no evidence that the psychological status of implant candidates is changing across time, suggesting continued psychological benefit for persons receiving cochlear implants. Both candidates and their spouses participated in fewer social activities than normal controls. Findings underscore the complex relation between marital status, deafness, and engagement and participation in positive activities.

Quality of life in children with unilateral hearing loss: a pilot study

PURPOSE

The objective of this pilot study was to investigate the health-related quality of life (HRQOL) of children with unilateral hearing loss (UHL).

METHOD

The study was conducted in 2 stages among children age 6-17 years. In Stage 1, the authors conducted focus groups of children with UHL and their parents to elicit perceptions of how UHL affected the lives of these children. In Stage 2, a generic pediatric quality of life survey was used to measure HRQOL quantitatively in children with normal hearing, UHL, and bilateral hearing loss. Participants were recruited from the clinical and research populations of an academic otolaryngology department.

RESULTS

The focus groups revealed that the children with UHL experienced barriers due to their hearing loss but learned to adapt. Quantitatively, statistically significant differences between groups were not observed on the 3 main HRQOL scales (Total, Psychosocial, and Physical). Children with UHL had a significantly larger variance on the social functioning score than children with normal hearing and bilateral hearing loss.

CONCLUSIONS

UHL may affect the HRQOL of children; this possibility should be included when counseling parents. However, further research is warranted to determine whether the authors' findings are generalizable to other children with UHL.

Localization cues with bilateral cochlear implants

Selected subjects with bilateral cochlear implants (CIs) showed excellent horizontal localization of wide-band sounds in previous studies. The current study investigated localization cues used by two bilateral CI subjects with outstanding localization ability. The first experiment studied localization for sounds of different spectral and temporal composition in the free field. Localization of wide-band noise was unaffected by envelope pulsation, suggesting that envelope-interaural time difference (ITD) cues contributed little. Low-pass noise was not localizable for one subject and localization depended on the cutoff frequency for the other which suggests that ITDs played only a limited role. High-pass noise with slow envelope changes could be localized, in line with contribution of interaural level differences (ILDs). In experiment 2, processors of one subject were raised above the head to void the head shadow. If they were spaced at ear distance, ITDs allowed discrimination of left from right for a pulsed wide-band noise. Good localization was observed with a head-sized cardboard inserted between processors, showing the reliance on ILDs. Experiment 3 investigated localization in virtual space with manipulated ILDs and ITDs. Localization shifted predominantly for offsets in ILDs, even for pulsed high-pass noise. This confirms that envelope ITDs contributed little and that localization with bilateral CIs was dominated by ILDs.

Relationship between Intraoperative eCAP Thresholds and Postoperative Psychoacoustic Levels as a Prognostic Tool in Evaluating the Rehabilitation of Cochlear Implantees

A sufficient correlation between objective (e.g. eCAP of the auditory nerve) and psychoacoustic data has not yet been possible due to high interindividual variability in cochlear implantees. Therefore, the application of objective data in the evaluation of speech rehabilitation after cochlear implantation was investigated. eCaps of all electrodes were measured intraoperatively. The 'threshold' and 'comfort' levels, speech recognition and pure tone thresholds were determined at follow-up. The correlation coefficient was calculated between eCap thresholds and psychoacoustic levels. This correlation coefficient was ranked with other individual items in relation to their influence on the development of speech recognition. Only the duration of preimplant deafness, the pure tone hearing threshold and the correlation between eCAP and psychoacoustic levels have a significant influence on the rehabilitation within this selection of variables. Based on these results, an individualized mathematical modeling approach was introduced to predict the development of postoperative speech recognition by incorporating objective data.

Assessment of expressive vocabulary outcomes in hearing-impaired children with hearing aids: do bilaterally hearing-impaired children catch up?

Objective: To evaluate expressive vocabulary growth in hearing-impaired preschool children wearing hearing aids.

Design: Prospective analysis of the outcomes of children included in the 1994 German ‘Goettinger Hoer-Sprachregister’ (GHR) series, using a repeated-measures paradigm in six- to nine-month intervals (t1–t3).

Subjects: Twenty-seven children (aged 2.0–4.4 years) with bilateral sensorineural hearing loss (with averages at frequencies of 0.5, 1, 2 and 4 kHz of >20 to >90 dB in the better ear) from the 1994 GHR series. The children were diagnosed at a mean age of 31.4 months (standard deviation (SD) 10.6 months) and fitted with a binaural hearing aid at a mean age of 32.3 months (SD 10.5 months). Nonverbal intelligence was average (five missing data entries). Standardized, age-appropriate picture naming tests (the ‘Sprachentwicklungstest für 2-jährige Kinder’, the Kaufman Assessment Battery for Children subtest vocabulary, and the ‘Aktiver Wortschatztest für drei- bis sechsjährige Kinder’) were carried out at three time points and results compared with data from children with normal hearing. The test raw scores were converted to T scores (mean = 50; SD = 10).

Results: On average, the children scored far below the normative population at t1 (mean = 28.9; SD = 11.3) and slowly improved as they got older (at t3, mean = 34.1; SD = 16.1; p = 0.010). Children with mild or moderate hearing loss improved most notably (mean difference t1–t3; p = 0.001), except for one child of deaf parents. Two of the five mildly hearing-impaired children and two of the eleven moderately hearing-impaired children caught up with their normal hearing peers with regards to expressive vocabulary. Such expressive vocabulary achievements were not seen in any children with >70 dB hearing loss or in six of the eleven children (55 per cent) with a 40–70 dB hearing loss, despite receiving adequate personal amplification.

Conclusion: Testing expressive vocabulary size is a useful clinical tool in assessing linguistic lexical outcome.

Experience with the SOUNDTEC implantable hearing aid

OBJECTIVE

To assess the efficacy, morbidity, and patient satisfaction of the SOUNDTEC semi-implantable hearing aid.

STUDY DESIGN

Retrospective case review.

SETTING

Two tertiary referral centers (the Silverstein Institute and the Atkins Institute).

PATIENTS

Sixty-four (four bilateral placements) patients with bilateral moderately severe sensorineural hearing loss: 47 patients had previously worn hearing aids.

INTERVENTIONS

After separating the incudostapedial joint, a magnet encased in a titanium canister with a ring was introduced onto the stapes neck. Gelfoam or adipose tissue was used to stabilize the magnet. After 3 months, the external processor was fitted.

MAIN OUTCOME MEASURES

At 1 month, audiometric testing was performed and functional gain was assessed. Patient acceptance and implant performance were measured by a visual analogue questionnaire.

RESULTS

The device produced an average functional gain of 26 dB. Fifty-five percent of patients complained of magnet movement; this was eliminated in 80% of Silverstein Institute patients when the external processor was worn and fat was used to stabilize the magnet.

CONCLUSION

The SOUNDTEC direct device is well tolerated in the majority of patients, with a significant increase in functional gain. Magnet instability and noise were the most frequent complaints and improved with processor placement and anchoring the magnet with fat. This electromagnetic semi-implantable hearing aid confers greater functional gain over conventional hearing aids and reduces occlusion effect and feedback.

The BAHA Softband. A new treatment for young children with bilateral congenital aural atresia

OBJECTIVE

To evaluate the validity of a bone-anchored hearing aid (BAHA) Softband (fitted unilaterally and bilaterally) in young children with bilateral congenital aural atresia.

SUBJECTS

Two children with severe bilateral congenital conductive hearing loss, who had been fitted with a transcutaneous BAHA Softband at the age of 3 and 28 months, respectively. The latter child had been fitted with a conventional bone-conduction hearing aid at the age of 3 months; at 28 months, this child had received the BAHA Softband and after 5 months of unilateral application, the BAHA Softband was fitted bilaterally. Follow-up in the two children was 31 and 17 months, respectively.

METHODS

Using the artificial mastoid, gain and maximum output were studied in this new transcutaneous application of the BAHA, with the BAHA Classic and the BAHA Compact as sound processor. Results were compared to those obtained with a conventional bone-conduction device (Oticon E 300 P). Aided thresholds and sound lateralization scores were assessed with double visual reinforcement audiometry (VRA). To test the validity of the BAHA Softband, the speech and language development of the children was assessed by means of age-appropriate tests (the preverbal Symbolic play test and the Dutch non-speech test for receptive and expressive language and the Dutch version of the Reynell language test).

RESULTS

The electro-acoustic measurements showed minor differences in gain between the three devices. At a reduced volume setting, the mean input level at which the output levelled off was largely comparable between the BAHA Classic and the conventional device, but somewhat poorer with the BAHA Compact. Both children showed speech and language development that was in accordance with their cognitive development.

CONCLUSIONS

The BAHA Softband was a valid intervention in children with congenital bilateral aural atresia who were too young for percutaneous BAHA application.

Adaptation of Japanese Version of the Hearing Handicap Inventory for Adults (HHIA)

We used social and emotional approaches to psychologically evaluate hearing disorders, translating the Hearing Handicap Inventory for Adults (HHIA) into Japanese and using it to evaluate Japanese adults with sensorineural hearing loss. The HHIA is a 25-item self-assessment scale composed of 2 subscales, emotional and social/situational, which has been used to evaluate adult patients with hearing disorders in Europe and North America. The test-retest reliability of the Japanese version and its screening version (HHIA-S) were excellent (kappa coefficients were 0.912 and 0.842). Due to the limitation of social/situational items, test-retest reliability was only good (0.6 < kappa coefficient < 0.8), possibly because of problems in translating these items. We discovered that the average of scores of the HHIA Japanese version was higher in bilateral hearing disorder patients than in those with unilateral hearing disorder. This score peaked in 2 to 10 years after onset and decreased thereafter in bilateral hearing disorder patients. The correlation coefficient between the average hearing level of 7 frequencies and scores of the test was highest among the 4 audiological evaluations. The HHIA Japanese version is thus useful for following up patients with hearing disorders.

Early intervention and language development in children who are deaf and hard of hearing

OBJECTIVE

The primary purpose of this study was to examine the relationship between age of enrollment in intervention and language outcomes at 5 years of age in a group of deaf and hard-of-hearing children.

METHOD

Vocabulary skills at 5 years of age were examined in a group of 112 children with hearing loss who were enrolled at various ages in a comprehensive intervention program. Verbal reasoning skills were explored in a subgroup of 80 of these children. Participants were evaluated using the Peabody Picture Vocabulary Test and a criterion-referenced measure, the Preschool Language Assessment Instrument, administered individually by professionals skilled in assessing children with hearing loss. A rating scale was developed to characterize the level of family involvement in the intervention program for children in the study.

RESULTS

A statistically significant negative correlation was found between age of enrollment and language outcomes at 5 years of age. Children who were enrolled earliest (eg, by 11 months of age) demonstrated significantly better vocabulary and verbal reasoning skills at 5 years of age than did later-enrolled children. Regardless of degree of hearing loss, early-enrolled children achieved scores on these measures that approximated those of their hearing peers. In an attempt to understand the relationships among performance and factors, such as age of enrollment, family involvement, degree of hearing loss, and nonverbal intelligence, multiple regression models were applied to the data. The analyses revealed that only 2 of these factors explained a significant amount of the variance in language scores obtained at 5 years of age: family involvement and age of enrollment. Surprisingly, family involvement explained the most variance after controlling for the influence of the other factors (r =.615; F change = 58.70), underscoring the importance of this variable. Age of enrollment also contributed significantly to explained variance after accounting for the other variables in the regression (r = -.452; F change = 19.24). Importantly, there were interactions between the factors of family involvement and age of enrollment that influenced outcomes. Early enrollment was of benefit to children across all levels of family involvement. However, the most successful children in this study were those with high levels of family involvement who were enrolled early in intervention services. Late-identified children whose families were described as limited or average in involvement scored >2 standard deviations below their hearing peers at 5 years of age. Even in the best of circumstances (eg, early enrollment paired with high levels of family involvement), the children in this study scored within the low average range in abstract verbal reasoning compared with hearing peers, reflecting qualitative language differences in these groups of children.

CONCLUSIONS

Consistent with the findings of Yoshinaga-Itano et al,(1) significantly better language scores were associated with early enrollment in intervention. High levels of family involvement correlated with positive language outcomes, and, conversely, limited family involvement was associated with significant child language delays at 5 years of age, especially when enrollment in intervention was late. The results suggest that success is achieved when early identification is paired with early interventions that actively involve families.

[Developmental problems and risks of children and adolescents with severe hearing impairment--a challenge for intervention by child and adolescent psychiatrists]

Considering special developmental risks and burdens of this group of children the dimensions of the multiaxial classification system prove to be a useful diagnostic framework. Especially severe and multiple communication impairments are important specific abnormal psychosocial circumstances for deaf and severe hard-off hearing children and adolescents. Finally some modest but nevertheless important tasks for child and youth psychiatrists are pointet out.

Speech concerns of hard-of-hearing adults

Speech concerns of adults with hearing loss were identified in a sample of 75 members of Self Help for Hard of Hearing People. A majority of subjects had noticed changes in their speech and were interested in speech conservation services.

Skilled speechreading: a single-case study

In a case study the cognitive characteristics of a skilled visual speechreader (SJ) was examined and compared to a group. SJ is a 56 year old woman, skilled in visual speechreading. She differs from most of the 119 individuals in the control group, as she uses a particular speechreading strategy in which she attempts to repeat overtly each spoken word as soon as it has been uttered, and to summarize and fill in missing pieces of information whenever it is possible (e.g., during pauses) during the conversation. SJ outperformed the control group on three types of tasks; a reading span task, performance in the asymptote level in the serial position curve, and verbal inference-making. SJ's results were discussed with respect to (a) how they related to the general case (i.e., models based on group-data) and to (b) her speechreading strategy. From a clinical perspective it was suggested that it might be possible to practice the strategy as such, but any possible improvement is dependent on the individual's capability to process information in this way.

Relationships among psychoacoustic judgments, speech understanding ability and self-perceived handicap in tinnitus subjects

Tinnitus is often a disturbing symptom which affects 6-20% of the population. Relationships among tinnitus pitch and loudness judgments, audiometric speech understanding measures and self-perceived handicap were evaluated in a sample of subjects with tinnitus and hearing loss (THL). Data obtained from the THL sample on the audiometric speech measures were compared to the performance of an age-matched hearing loss only (HL) group. Both groups had normal hearing through 1 kHz with a sloping configuration of < or = 20 dB/octave between 2-12 kHz. The THL subjects performed more poorly on the low predictability items of the Speech Perception in Noise Test, suggesting that tinnitus may interfere with the perception of speech signals having reduced linguistic redundancy. The THL subjects rated their tinnitus as annoying at relatively low sensation levels using the pitch-match frequency as the reference tone. Further, significant relationships were found between loudness judgment measures and self-rated annoyance. No predictable relationships were observed between the audiometric speech measures and perceived handicap using the Tinnitus Handicap Questionnaire. These findings support the use of self-report measures in tinnitus patients in that audiometric speech tests alone may be insufficient in describing an individual's reaction to his/her communication breakdowns.

Hearing handicap as a function of central auditory abilities in the elderly

The relationship between central auditory nervous system dysfunction and hearing handicap was investigated in 30 older adults with mild losses of hearing sensitivity. Self-perceived hearing handicap was assessed with the Hearing Handicap Inventory for the Elderly. The degree of central auditory nervous system involvement was determined based on the magnitude of the discrepancy between the maximum scores obtained for PB-50 word lists and the Synthetic Sentence Identification test. Significant correlations were observed between self-perceived hearing handicap and central auditory nervous system status. These relationships were significant even while controlling for auditory sensitivity and age.

Visual speech processing: word-decoding and word-discrimination related to sentence-based speechreading and hearing-impairment

Two aspects of visual speech processing in speechreading (word decoding and word discrimination) were tested in a group of 24 normal hearing and a group of 20 hearing-impaired subjects. Word decoding and word discrimination performance were independent of factors related to the impairment, both in a quantitative and a qualitative sense. Decoding skill, but not discrimination skill, was associated with sentence-based speechreading. The results were interpreted such that, in order to represent a critical component process in sentence-based speechreading, the visual speech perception task must entail lexically induced processing as a task-demand. The theoretical status of the word decoding task as one operationalization of a speech decoding module was discussed (Fodor, 1983). An error analysis of performance in the word decoding/discrimination tasks suggested that the perception of heard stimuli, as well as the perception of lipped stimuli, were critically dependent on the same features; that is, the temporally initial phonetic segment of the word (cf. Marslen-Wilson, 1987). Implications for a theory of visual speech perception were discussed.

Detection of hearing impairment in early childhood

The parents of 21 hearing-impaired children (hearing loss greater than or equal to dB HL for the average of 500, 1,000, and 2,000 Hz) volunteered to participate in the present investigation. This was performed in order to clarify who first suspects the hearing impairment; to describe some of the signs arousing suspicion of hearing dysfunction; describe some of the psychological problems encountered by parents of hearing-impaired children. An extensive questionnaire formed the basis for a personal follow-up interview, which was tape-recorded for further evaluation. In 57%, family members were the first to suspect the hearing impairment. In only 29% did systematic hearing screening by the BOEL-test detect the children. The signs and signals from the child arousing parental suspicion of hearing impairment are related to the child's behaviour patterns. It was found that most parents are acquainted with children's motoric and language development, but have a superficial knowledge of normal perceptual development. In order to improve the early detection, it is proposed to strengthen the non-professional screening resources present in the general population. In order to reduce the parents feeling of grief and anxiety, it is proposed that psychologists cooperate with physicians within the audiological units and support the parents in their recognition and acceptance of their child's handicap. Thereby can be obtained an improved treatment of the 'hearing-impaired family'.

Some developmental and behavioral problems associated with bilateral otitis media with effusion

Results from otological and audiological examination of 879 children are reported. A group of 47 children with bilateral otitis media with effusion (OME) was compared with those who were otologically normal (N = 355) to determine whether they differed in background characteristics, speech articulation, language or motor development, and intelligence or reported behavioral problems. The results showed that while the children with bilateral OME did not differ in terms of background characteristics, they were significantly disadvantaged in speech articulation ability, verbal comprehension, motor development, and intelligence. They also had significantly more behavior problems. The finding that OME was associated with developmental and behavior problems in children suggests a need to identify this problem in children as a first step toward therapeutic intervention.

[A case of hysterical deafness]

A forty years old woman with hysterical deafness is reported. Chief complaints were bilateral hearing loss. Nothing particular was found in her past and family history. In 1977, on the 11th day of May, she was admitted to A city hospital because of headache and paresis of right limb. As angiography revealed an aneurysms of her anterior communicating artery, she was undertaken the surgery of clipping and coating of the aneurysms. Post-operatively, left hemiparalysis appeared and paresis of right limb developed because of spasm of right middle cerebral artery. On the 14th day of August, ventricular-peritoneal shunt's operation was performed. As soon as she recovered from postoperative coma, she complained of bilateral hearing loss. Because pure tone audiometry demonstrated complete loss of her hearing, she was referred to ENT department of Teikyo University Hospital. Findings were as follows: 1) She had a queer way of hearing because she could understand to hear limited persons' speech (her doctor and husband). 2) Pure tone audiometry showed complete loss of her hearing but the thresholds of auditory brain stem responses were 15 dB and those of slow vertex responses were 45 dB. These results suggested no lesion in cochlea and brain stem. 3) Rorschach test and sentence complete test were performed. The results of these tests suggested hysterical state or neurotic state. 4) Total intelligent quotients by WAIS were 69 which indicated borderline level. However, this value appeared to be incorrect because she was uncooperative. 5) CT scan revealed low density areas at right temporo-parietal lobes and left temporal lobe which were localized and small. Our findings suggested hysterical deafness but not auditory agnosia. During three years, she was referred to several hospitals for rehabilitation but didn't become well at all. On the third year of the onset, her husband became sick and admitted to her room of the same hospital. During that period, suddenly, she talked her hearing to improve and the pure tone audiometry demonstrated decrease in threshold. In conclusion, this event could give a final diagnosis of hysterical deafness but not auditory agnosia.

Acceptance of deafness in deaf adolescents: a repertory grid study

The study investigated the acceptance and definition of deafness adolescents. A repertory grid (RG) technique was administered to 27 moderately to profoundly impaired subjects identified with neither deaf nor hearing persons, thereby denying their own deafness. Subjects also described deaf individuals (DI's) negatively but maintained positive self-concepts and displayed inadequate definitions of themselves and deafness. These findings have distinct implications for the management of the DI, with regard both to assessment and therapy. Results further demonstrated that the RG technique is an effective means to investigate the psychology of deafness.

Effect of noise and reverberation on binaural and monaural word identification by subjects with various audiograms

The Modified Rhyme Test (MRT) (Bell, Kreul, + Nixon, 1972; Kreul, Nixon, Kryter, Bell, Land, + Schubert, 1968) was used to test the word-identification ability of subjects with bilateral sensorineural hearing losses. The subjects were tested in a room with reverberation times, T, of .1 and .5 sec while listening monaurally, binaurally, aided, and unaided at various speech-to-noise ratios, S/N. A babble of 20 voices was used as a masker. Significant individual differences were found in a group of 15 subjects with various audiograms. The differences were not significant when a group was reduced to seven subjects with similar audiograms. The advantage of the binaural over monaural listening was significant and did not depend on reverberation or the use of hearing aids. Both the effects of S/N and T were significant. The effects on word-identification scores caused by a decrease in S/N from "quite" to +5 dB and by an increase in T from .1 sec to .5 sec were moderately correlated for individuals. There were individual differences in susceptibility to noise and reverberation, with subjects having asymmetrical audiograms being most susceptible. The analysis of consonant errors in noise or reverberation revealed no significant difference for the MRT. A significant difference emerged between consonant errors in the initial and final positions of the test words in both noise and reverberation.

Emotional disturbance in hearing clinic patients

A group of outpatients scheduled for hearing evaluation were screened for psychiatric morbidity using the General Health Questionnaire (GHQ-30). There was an association between objective hearing loss and elevated GHQ-30 score. An association was also found between the presence of tinnitus and vestibular symptoms and elevated GHQ-30 score.

Consonant similarity judgments by normal and hearing-impaired listeners

This investigation attempted to identify listener strategies or perceptual modes that might be adopted by hearing-impaired listeners when making similarity judgments among pairs of speech sounds. Further, an attempt was made to describe the relationship between similarity judgments and auditory confusions for such listeners. Subjects provided similarity ratings and recognition responses to consonant pairs. The resulting similarity judgments were organized into a variety of similarity matrices and analyzed via multidimensional scaling and hierarchical clustering, as well as by traditional descriptive and interpretative statistics. The analyses of the similarity ratings between consonants showed that hearing-impaired listeners apply phonemic labels to the stimuli and base their ratings on these labels rather than on the unlabeled acoustic characteristics of the speech sounds. Analysis of the recognition data indicated that those consonants which are most confused are not necessarily the most conceptually similar to the listener.