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PubMed2003

Assessment of subjective outcome of hearing aid fitting: getting the client's point of view.

This paper provides an overview of the measurement of hearing aid fitting outcomes in real life using self-report methods. Three topics are addressed: (1) why we should measure real-life outcomes; (2) seven different types of self-report outcome data; and (3) issues to consider in self-report outcome measurement. It is stressed that self-report data provide a unique view of the way that clients function and feel in their daily lives with regard to their hearing health. Self-report outcome data are multidimensional, and the different domains are only moderately correlated. When these types of data are gathered, it is essential to control relevant variables to safeguard validity and reliability.

Extraversion, Psychological↗
PubMed2005

A 3D finite element model of an implanted scapula: importance of a multiparametric validation using experimental data.

In order to help to understand the loosening phenomenon around glenoïd prostheses, a 3D finite element model of a previously tested implanted scapula has been developed. The construction of the model was done using CT scans of the tested scapula. Different bone material properties were tested and shell elements or 8 nodes hexaedric elements were used to model the cortical bone. Surface contact elements were introduced on one hand between the bone and the lower part of the plate of the implant, and on the other, between the loading metallic ball and the upper surface of the implant. The results of the model were compared with those issued from in vitro experiments carried out on the same scapula. The evaluation of the model was done for nine cases of loading of 500 N distributed on the implant, in terms of strains (principal strains of six spots around peripheral cortex of the glenoïd) and displacement of four points positioned on the implant. The best configuration of the model presented here, fits with experiments for most of the strains (difference lower than 150microdef) but it seems to be still too stiff (mainly in the lower part). Nevertheless, we want, in this paper, to underline the importance of doing a multiparametric validation for such a model. Indeed, some models can give correct results for one case of loading but bad results for another kind of loading, some others can give good results for one kind of compared parameters (like strains for instance) but bad results for the other one (like displacements).

Aged↗
PubMed1997

Fitting hearing aids in children with severe hearing loss.

Because of limited initial data about the hearing loss of children and the difficulties in getting an optimal prescription, every fitting has to incorporate a procedure verifying or validating the final fitting. Fitting hearing aids should be focused on optimal speech recognition, even in children with very severe or profound hearing loss. When the MTS test is used, it is possible to optimize the gain and frequency response that gives the best possible prospects for speech recognition. The abilities for speech perception are a function of the PTA. For a hearing loss exceeding about 110 dB there are hardly any possibilities for adequate speech perception with hearing aids. Also, training on basal sound identification abilities shows no improvements. This is in contrast to hearing aid users with PTA between 90 and 110 dB.

Child, Preschool↗
PubMed2002

Impact biomechanics and pelvic deformation during insertion of press-fit acetabular cups.

Five fresh cadaver pelves were cleaned of soft tissue and instrumented with strain gauges. The acetabula were reamed, and a cementless cup, oversized at the periphery, was inserted. The applied force and cup acceleration were measured during insertion and used to calculate an effective mass of the cup, insertion device, and pelvis during each impact. Periacetabular strains increased variably during cup seating. After the cups were seated, strains continued to increase with postseating impacts. The effective mass remained constant throughout the test, indicating that cup seating is not associated with a change in acceleration. This finding implies that an accurate assessment of cup seating cannot be inferred by surgeon proprioception during impaction, and use of an apical hole in the cup is necessary to determine when the cup has seated.

Acetabulum↗
PubMed2005

An amplitude-bandwidth expansion method for hearing-aid adjustment.

The basic concept for a technique that facilitates the adjustment of a hearing aid by a person of normal hearing is proposed. The technique involves processing using an amplitude-bandwidth expansion method to expand the hearing-aid output to fit to the user's hearing requirements and loudness recruitment. The expansion is a reversal of the cochlear compression model. As the expansion method introduces distortion of the waveform and a reduction of the expansion rate, the support technique presented here includes solutions to these problems. The difference between the original speech signal and the expanded output generated from the compressed output of the original signal is virtually inaudible. This technique, which effectively simulates a patient's hearing characteristics in order to allow an audiologist to set up a patient's hearing aid, is worth further investigation.

Acoustic Stimulation↗
PubMed1995

Corneal topography in contact lens wearers following penetrating keratoplasty.

We examined the effects of contact lens wear on corneal topography following penetrating keratoplasty (PK). We present the long-term follow-up of 23 eyes of 22 patients who underwent PK and rigid gas permeable contact lens fitting. Computerized corneal topography, manual keratometry, and refraction were conducted prior to contact lens fitting and then at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year post-fitting. At least 6 months follow up was obtained for 23 eyes of 22 patients, and at least 12 months follow-up was obtained for 18 eyes of 17 patients. Seventy four percent of the eyes were stable (+/- 1.00 D) by manual keratometry, computerized corneal topography, and refraction (both spherical equivalent and cylinder). Those patients who changed showed a trend toward a small decrease in refractive cylinder and spherical equivalent. Measurements obtained from both computerized corneal topography and manual keratometry showed a small but significant amount of flattening (P < 0.003 and P < 0.04, respectively).

Contact Lenses↗
PubMed2000

Reverse geometry contact lens wear after photorefractive keratectomy, radial keratotomy, or penetrating keratoplasty.

PURPOSE: To determine if a super diffusion coefficient of lens/lens thickness (Dk/L) reverse geometry gas permeable (steep peripheral and flatter central curve) contact lenses can be successfully worn after excimer photorefractive keratectomy (PRK), radial keratotomy (RK), or penetrating keratoplasty (PK). METHODS: Patients with residual ametropia after PRK, RK, or PK were fitted with reverse geometry lenses (Plateau lens in SF-P material; Menicon USA, Inc, Clovis, CA, U.S.A.). Contact lens fit characteristics and comfort were assessed. Lens centration, visual quality, and ocular surface status were graded and visual acuity charted. RESULTS: Thirteen eyes of 11 patients were fitted; eight eyes with PRK, one eye with RK, and four eyes with PK previously performed. The mean follow up of the patients was six months. The visual acuity prior to lenses ranged from 6/12 to counting fingers, and the acuity with lenses ranged from 6/6 to 6/30. Eight of the 11 patients wore the lenses the whole day without problems; 3 patients discontinued lens wear due to discomfort or unsatisfactory vision. CONCLUSIONS: The combination of super Dk/L and reverse geometry lenses facilitate lens wear and is associated with good visual acuity.

Adult↗
PubMed1997

Sound quality judgment during acclimatization of hearing aid.

This study included 10 subjects with sensorineural hearing loss. They had not previously used hearing aids. The hearing aid fitting with "behind-the-ear' aids was based on the NAL method. Judging the sounds in their ordinary home environment, three sound situations (programmes) were selected, permitting the subjects to listen to one programme with speech, another with music and a third with "background noise'. For the group as a whole, significant differences were found between the sound quality judgements with and without the hearing aid. When the judgements of the programmes with background noise were excluded in the analysis, there were significant differences over time in the group as a whole on the scales for clarity and total impression.

Follow-Up Studies↗
PubMed1997

A randomized, controlled trial of the efficacy of a communication course for first time hearing aid users.

Many centres include a communication course as part of their auditory rehabilitation. These usually take the form of a small group and include discussion of the effects of hearing loss, use of the hearing aid, hearing tactics and lip reading. To investigate the efficacy of such a rehabilitation programme a randomized, controlled trial of a communication course was undertaken. All subjects were first time hearing aid users; handicap was measured using the Quantified Denver Scale of Communication Function (QDS) at the time of hearing aid fitting, and then 13 weeks later. All subjects had a hearing aid follow-up appointment, but the treatment group (n = 22) also underwent a four-week communication course, while the control group (n = 25) had no further rehabilitation. The reduction in handicap measured by the change in QDS was significantly greater for the treatment group than for the control group (Mann Whitney U test, tied p value = 0.014). This indicates that such a communication course is efficacious in reducing handicap. Further research is required to identify the populations that will benefit most from such a course.

Aged↗
PubMed2000

Marginal fit of metal ceramic restorations subjected to a standardized postsoldering technique.

The fit of a fixed partial denture (FPD) is fundamental for the clinical success of a restoration. When a postsoldering procedure is needed, a high-precision laboratory technique is necessary to not affect the fit of the FPD. This article evaluates whether a standardized postsoldering technique affected the marginal fit of a 3-unit high palladium alloy FPD. One hundred and eight measurements were made of 3-unit FPDs, fabricated in a high palladium alloy (2% Au-79% Pd-10% Cu-8% Ga) and constructed on 9 tin dies in vitro. After the castings were fabricated, specimens were measured at 3 specific points per abutment (distal, labial, lingual) before and after soldering. Differences were found in the marginal opening of both copings, before soldering (49.9 microm) and after soldering (48. 3 microm). There was no significant difference in the adaptation of the copings after the soldering procedure (P<.05).

Crowns↗
PubMed2004

Bone-anchored hearing aid: comparison of benefit by patient subgroups.

OBJECTIVES/HYPOTHESIS: The osseointegrated bone-anchored hearing aid, using the Branemark system, is well established and has proven benefit. The aim was to study quality of life benefits within patient subgroups using the validated Glasgow Benefit Inventory (GBI). STUDY DESIGN: Retrospective questionnaire study. METHODS: Ninety-four consecutive patients were enrolled into the study. Mean patient age was 49 years, with a female-to-male ratio of 1.1:1. Patient subgroups were discharging mastoid cavities, chronic active otitis media, congenital ear problems, otosclerosis, and acoustic neuroma and other unilateral hearing losses. RESULTS: The response rate was 73%. The score for total benefit of bone-anchored hearing aid fitting for the entire group was +33.3 (95% confidence interval [CI], 25-42). Glasgow Benefit Inventory scores for each subgroup were all greater than +20. The congenital atresia group scored highest with +45 (95% CI, 28-61). Variation in benefit across the subgroups has been demonstrated. Fitting of BAHA following acoustic neuroma surgery was shown to be of benefit with a score of +22.2. General benefits scored highest in all subgroups compared with physical and social benefits. CONCLUSION: The study demonstrated the differences in benefit within patient subgroups. Its results can be used to give patients a predictive value at the time of preoperative counseling. The study identified congenital ear disorders as the group likely to obtain maximal benefit. Notably, for the first time, the study demonstrated the documented benefit of restoring stereo hearing to patients who have acquired unilateral hearing loss following acoustic neuroma surgery using a BAHA.

Bone Conduction↗
PubMed1998

Comparing the performance of the Widex SENSO digital hearing aid with analog hearing aids.

Differences in performance were evaluated between the Widex SENSO and several analog hearing aids currently worn by 50 hearing-impaired subjects. Subjects were initially fit with the SENSO using the manufacturer's recommended procedure. After wearing the hearing aids for 1 week, the adjustable parameters were fine-tuned based on subjective comments. Differences in performance between the SENSO and the subjects' current hearing aids were assessed using the Speech Perception in Noise administered at overall levels of 50, 65, and 80 dB SPL; the Hearing in Noise Test in which the background noise was presented at 50, 65, and 80 dBA; the Abbreviated Profile of Hearing Aid Benefit; and two questionnaires relating to overall preference between the SENSO and the subjects' current hearing aids.

Adult↗
PubMed1995

Syme ankle disarticulation in peripheral vascular disease and diabetic foot infection: the one-stage versus two-stage procedure.

A prospective randomized trial compared performing a Syme ankle disarticulation using a one-stage versus Wagner's two-stage technique. Surgery was performed at two University Medical Centers where patients underwent amputation surgery for gangrene or nonsalvageable diabetic foot infection. Those undergoing surgery subsequent to trauma or congenital anomaly were eliminated. Initially, 21 patients were randomized into one-stage and two-stage surgery. The randomization was stopped for ethical reasons when the results of both procedures appeared to be similar. The next 22 consecutive patients underwent 23 Syme ankle disarticulations in one-stage surgery. Selection of amputation level was based on clinical examination, transcutaneous oximetry as a measure of vascular inflow, serum albumin as a measure of tissue nutrition, and total lymphocyte count as a measure of immunocompetence. As a total group, 31 of 44 amputations progressed to amputation wound healing and prosthetic limb fitting. In the randomized group, 9 of 13 one-stage and 5 of 8 two-stage surgeries healed. In the subsequent consecutive group, 17 of 23 healed. In all, 26 of 36 one-stage and 5 of 8 two-stage surgeries healed successfully. We concluded from this study that Syme ankle disarticulation may be performed as safely in one stage as in two stages in properly selected patients and, therefore, recommend the one-stage Syme ankle disarticulation in those patients suitable for this level amputation.

Adult↗
PubMed1995

Measurement of speech quality as a tool to optimize the fitting of a hearing aid.

The purpose of the present research was to develop a theoretical basis for the adjustment of hearing aid frequency response based on speech quality measurements. Speech quality measurements were made using continuous discourse and a category rating procedure for the following dimensions: intelligibility, pleasantness, loudness, effort, noisiness, and total impression. Speech quality ratings were obtained from a group of listeners with hearing loss who wore hearing aids. The stimulus conditions simulated hearing aid frequency response alterations within a frequency response range where intelligibility was held constant at or near 100%. The subject ratings revealed that (a) different listeners interpreted the individual dimensions in different ways; (b) within listeners, most of the dimensions were unique; that is, they were rated differently; and (c) across listeners, pleasantness was the dimension most highly correlated with total impression.

Adult↗
PubMed1997

A digital filterbank hearing aid. Improving a prescriptive fitting with subjective adjustments.

Two fitting algorithms for linear hearing aids were compared using a wearable digital hearing aid in a one-month blind field test: a prescriptive method (POGO II) and a new algorithm, LinEar. Both used seven bands for frequency shaping, and two channel compression limiting. When fitting LinEar, the subjects individually adjusted the frequency response according to specified criteria. LinEar used a lower compression threshold setting than prescribed by POGO II. Eight subjects tested the two algorithms in a one-months blind field test as well as in the laboratory. The individual LF- and HF-gain adjustments of the frequency response in LinEar showed rather large variations compared to the POGO II prescription. Measures of S/N for speech did not show any significant differences between LinEar and POGO II, while overall sound quality ratings in laboratory and field test showed that LinEar was rated significantly higher than POGO II.

Adult↗
PubMedDate not supplied

Effect of die spacers on precementation space of complete-coverage restorations.

The authors measured the precementation space achieved in vivo with varying layers of die spacer. Two hundred and ninety-one castings were fabricated in the Advanced Education Program in Prosthodontics at New York University College of Dentistry, New York, New York. Each of four clinician groups applied one layer of Taub Die Hardener and from one to four layers of die spacer to within 0.5 to 1.0 mm of the dies' finishing line. The resultant castings were adjusted using GC Fit-Checker. After final seating of the casting, the Fit-Checker was removed, sectioned buccolingually, and measured using a micrometer at three locations (midocclusally, midaxially, and on the bevel) for a total of 657 readings. Only after data collection were the specimens identified by group. Analysis of variance demonstrated a significance for group and location. Post hoc one-way analysis of variance and Sheffe tests (P < .1) demonstrated that: (1) one or two layers of die spacer demonstrated smaller precementation spaces than three or four layers; (2) the midocclusal precementation space was greater than the midaxial precementation space; (3) on the bevel area where no die spacer was used, the most consistent and minimal precementation space was measured.

Analysis of Variance↗
PubMed2001

Cementless cup fixation in total hip arthroplasty after 5-8 years.

A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography.

Adult↗
PubMed2001

A comparison of two methods of evaluating cornea-to-contact lens base curve fluorescein patterns in keratoconus.

PURPOSE: The purposes of the study were as follows: (1) to compare the apical fitting relationship of habitual contact lens fluorescein patterns in keratoconus as determined by clinician assessment of on-eye patterns to those determined by photograph readers looking at slides of fluorescein patterns and (2) to determine the validity of the techniques used in assessing the apical fitting relationships of rigid corneal contact lenses on keratoconic corneas. METHODS: Central fluorescein patterns of rigid contact lens-wearing keratoconus patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study were graded as "definite touch," "touch," "clearance," or "definite clearance" by certified clinicians. Photographs of these patterns were evaluated independently by certified, masked photograph readers using the same grading scale. RESULTS: Agreement between "re-reads" of the same fluorescein pattern slides by the photograph readers was substantial (weighted kappa = 0.751). Agreement between assessments of habitual fit fluorescein patterns at the baseline vs. the repeat visits was poor for the photograph readers (weighted kappa = 0.254) and moderate for the clinicians (kappa = 0.480). Agreement between clinicians' and photograph readers' assessment of the habitual contact lens fluorescein pattern at the baseline visit was fair (weighted kappa = 0.382). CONCLUSIONS: Repeatability and validity of this technique were fair to excellent. Many factors influence fluorescein pattern interpretation, and improvement of the objective method of fluorescein pattern assessment by photograph readers will require improved methodology that takes these factors into consideration.

Contact Lenses↗