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The literature contains articles which report that the deterioration of hearing is increased by the use of hearing aids, and others which show that there is no increase. The results of our experience with 261 patients over a ten-year period show that there is no increase in hearing loss in the aided ear which can be attributed to the use of a hearing aid.
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Hearing aids are obtained or provided with the primary objective of diminishing the handicapping effect of hearing impairment. The benefit obtained from amplification by an individual can be assessed in many different ways. The amount of use made of the hearing aid has the merits of reasonable accuracy, relevance and simplicity in determination. Poor use of hearing aids may be a result of many factors. Modern instruments are technically adequate to the needs of most candidates provided they are correctly fitted. The reasons for disuse and under-use nowadays appear to be more related to the attitude of the potential user. To investigate this aspect of hearing aid provision, questionnaires have been sent to hearing aid candidates prior to the supply of the instrument. These questionnaires have been designed to assess such factors as failure to come to terms with the hearing loss, perceptions of stigma associated with hearing aids, lack of support or even overt hostility from close relatives, and withdrawal from social contacts. The relationships between these attitude measurements and outcome in terms of daily use of the aid 4 months later have been investigated. The findings of this study support the concept that attitude is a significant determinant of hearing aid use, and also suggest that aberrant attitudes can, in many individuals, be modified by counselling such that a better outcome can be achieved.
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Hearing aids with signal processors use advanced circuitry to enhance speech recognition in noise. The effectiveness of these processors has not been well established. The purpose of this study was to evaluate performance on a speech recognition in noise task for listeners wearing a Zeta signal processor aid with the processor turned on and with the processor turned off. In addition, comparisons were made to performance while unaided and aided with a conventional hearing aid. A simple adaptive procedure and a psychometric function were the procedures used. Results for normal-hearing subjects indicate performance was usually better without a hearing aid. Performance when aided was similar for the processor on and the conventional aid. Performance in both of these conditions was clearly better than with the signal processor off. Although results for the hearing-impaired subjects varied widely, there was a trend for better performance with the conventional aid and with the signal processor on than for the signal processor off condition.
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Hearing aids currently available on the market with both omnidirectional and directional microphone modes often have reduced amplification in the low frequencies when in directional microphone mode due to better phase matching. The effects of this low-frequency gain reduction for individuals with hearing loss in the low frequencies was of primary interest. Changes in sound quality for quiet listening environments following gain compensation in the low frequencies was of secondary interest. Thirty participants were fit with bilateral in-the-ear hearing aids, which were programmed in three ways while in directional microphone mode: no-gain compensation, adaptive-gain compensation, and full-gain compensation. All participants were tested with speech in noise tasks. Participants also made sound quality judgments based on monaural recordings made from the hearing aid. Results support a need for gain compensation for individuals with low-frequency hearing loss of greater than 40 dB HL.
Hearing aids with multi-channel compression are often fitted on the basis of loudness scaling data obtained using narrow bands of noise or tones. Here, we report the development and evaluation of an alternative fitting procedure based on the use of speech signals. The parameters of the hearing aid (the gains in each channel for high and low input levels) are adjusted adaptively under computer control on the basis of the listener's responses. The goal is that speech at 85 dB SPL should be judged as 'loud', speech at 60 dB SPL should be judged as 'quiet', and speech at both levels should be judged as 'neither tinny nor boomy'. The procedure was evaluated using a two-channel compression hearing aid, the remote control of which allowed two programs to be stored. One program was based on our fitting procedure. The other was either based on the manufacturer's recommended full fitting procedure (which included loudness scaling with bands of noise), or was based on the audiogram alone, using the manufacturer's algorithm. After an acclimatization period of at least two weeks, subjects were then asked to fill in a questionnaire about their experiences with the two programs in different listening situations. The results generally indicated a preference for the program based on our adaptive fitting procedure. We also conducted laboratory measurements of speech intelligibility, in quiet and in a background of a single competing talker. These showed no clear difference between programs, although scores overall were very high. We conclude that our adaptive procedure gives very satisfactory results in everyday life. Parameter values giving good comfort also give good intelligibility. The procedure typically takes between five and 10 minutes per ear, which is quicker than most loudness scaling procedures.
In this study, a "virtual hearing aid" was used to compare different types of hearing aids. A digital hearing aid (Oticon DigiFocus Compact) and an analogue, automatic reference hearing aid were compared in a group of 17 schoolchildren (median age: 10 years) with moderate to severe, symmetrical, sensorineural hearing loss. Differences in performance were assessed using routine diagnostic methods (speech recognition performance tests, loudness scaling), subjective assessments (questionnaires) and the "virtual hearing aid". Guaranteeing double-blind testing conditions, the "virtual hearing aid" offers the possibility to directly compare individual in-situ recordings of different hearing aids. In contrast to the clear subjective preferences for the digital hearing aid, we could not obtain any significant results with routine diagnostic methods. Using the "virtual hearing aid", the subjective comparison and speech recognition performance tasks yielded significant differences. The "virtual hearing aid" proved to be suitable for directly comparing different hearing aids under double-blind testing conditions.
OBJECTIVE: To examine auditory brainstem evoked responses (ABRs) of children with Cornelia de Lange syndrome (CDLS) to evaluate hearing and the utility of hearing aids in hearing impaired cases. SUBJECTS AND METHODS: Thirteen Japanese infants and children with CDLS were studied. Behavioral observation audiometry and ABR were used to evaluate hearing. RESULT: Four different ABR patterns at 85 dB clicks were observed: no response in either ear (6 patients); clear ABRs in both ears (2 patients); no response in one ear but ABRs recorded in the other ear (3 patients); and no peaks after wave III in one ear and ABRs recorded in the other ear (2 patients). However, in 2 patients with no response in either ear at the first measurement, ABRs were recorded in one ear within 2 years. Three out of 13 patients exhibited better responses to sound through the use of hearing aids and auditory training. CONCLUSIONS: The fitting of hearing aids and early consistent training have a significant effect on auditory development in CDLS children in terms of making them aware of sound localization and the different types of environmental sound.
The purpose of hearing aid fitting is to improve the communication of the hearing impaired. Despite rigorous efforts to optimize hearing aid fitting there are still some patients who remain unsatisfied. The subject of research was to find improved methods of measuring, to increase the correlation between subjective information from the patient and objectively measurable data. With this goal in mind the variation of temporal resolution in hearing aid fitting was investigated in 88 patients comparing unaided and aided hearing basing on the method of determining the temporal resolution factor TRF at 500 Hz, 1500 Hz and 4000 Hz under free sound field conditions, as previously described by Schorn and Zwicker. The method is based on masking period patterns but measures only their maximum and minimum using continuous and 30-Hz square-wave amplitude modulated masking noise. The following three values of interest are measured: Threshold in quiet using interrupted continuous tones (500 ms on, 500 ms off) with the masker off; threshold masked by a continuous masker (octave-wide continuous noise) and threshold masked by a rectangulary modulated masker using 14 Hz, so that periods of 72 ms and pauses of 36 ms occur. TRF was defined as the ratio between the level differences derived from the three measured values. For normal hearing subjects this factor is about 1. The results show significant variation of the TRF comparing the data of the patients with and without hearing aids. The values for TRF unaided were 0.5 and 0.6 as well as under hearing aid.(ABSTRACT TRUNCATED AT 250 WORDS)
Four experienced hearing aid users were evaluated using a frequency transposition (TranSonic) hearing system. Following a trial period, the Abbreviated Profile of Hearing Aid Performance (APHAB) and a variety of speech audiometric measures were used to compare the frequency transposition fitting with each subject's conventional hearing aids. A single-subject study design with a series of repeated measures permitted statistical analysis of differences in performance with the various amplification strategies. Two of the four subjects demonstrated statistically significant benefit with the frequency transposition device. Results show the efficacy of frequency transposition in improving speech understanding and quality of life in some individuals with severe-to-profound hearing loss. Overall, results suggest the need for evaluating the benefit of frequency transposition on an individual basis.
Four experienced hearing aid users were evaluated using a frequency transposition (TranSonic) hearing system. Following a trial period, the Abbreviated Profile of Hearing Aid Performance (APHAB) and a variety of speech audiometric measures were used to compare the frequency transposition fitting with each subject's conventional hearing aids. A single-subject study design with a series of repeated measures permitted statistical analysis of differences in performance with the various amplification strategies. Two of the four subjects demonstrated statistically significant benefit with the frequency transposition device. Results show the efficacy of frequency transposition in improving speech understanding and quality of life in some individuals with severe-to-profound hearing loss. Overall, results suggest the need for evaluating the benefit of frequency transposition on an individual basis.
Hearing aids with new technological features offer the promise of novel speech-processing and loudness-control capabilities. Full exploitation and assessment of these capabilities will call for the acceptance of fitting and evaluation strategies different from those currently used for traditional linear hearing aids. Until an appropriate set of procedures comes into relatively widespread use, it will be difficult to draw definitive conclusions about the desirability and effectiveness of the new options in amplification systems. This paper reviews some of the issues that should be considered as new evaluation procedures are explored.
OBJECTIVE: Monaural hearing imposes constraints under many listening conditions. The authors compared the effects of a semi-implantable bone conductor, the Entific bone anchored hearing aid, with conventional contralateral routing of offside signal amplification to assess rehabilitative benefit in adults with unilateral deafness. DESIGN: Prospective trials of subjects with unilateral deafness using benefit surveys, source identification testing, and hearing in noise testing. SETTING: Tertiary referral center, outpatient surgical and audiologic services. PATIENTS: Adults with unilateral deafness (pure tone average >90 dB, SD <20%) after acoustic neuroma excision (n = 7), meningitis (n = 1), sudden sensorineural hearing loss (n = 1), and sudden sensorineural hearing loss with chronic suppurative otitis media (n = 1). Entry criteria included normal hearing in the contralateral ear (pure tone average <25 dB, SD >80%). INTERVENTION: Subjects were fitted with contralateral routing of offside signal amplification devices for 1 month and tested with contralateral routing of offside signal before mastoid implantation of the deaf ear, fitting, and testing for bone anchored hearing aid. OUTCOME MEASURES: Subjects' assessment of experience with their devices and patterns of use, 2) source azimuth identification in noise test, and 3) speech discrimination in quiet and in noise under conditions of noise-front, noise-to-normal-ear, and noise-to-deaf-ear. RESULTS: There was consistent satisfaction with bone anchored hearing aid implantation and amplification, and poor acceptance of contralateral routing of offside signal amplification. Sound localization was poor at baseline and with both bone anchored hearing aid and contralateral routing of offside signal. Relative to baseline, contralateral routing of offside signal and bone anchored hearing aid produced significantly better speech recognition in noise under most conditions. The bone anchored hearing aid enabled significantly better speech recognition than contralateral routing of offside signal in quiet and in a composite of noise conditions. The advantages may relate to averting the interference of speech signals delivered to the better ear, as occurs with conventional contralateral routing of offside signal amplification. CONCLUSIONS: Preliminary data in subjects with normal monaural hearing indicate that vibromechanical stimulation with the bone anchored hearing aid overcomes some of the negative head shadow effects in unilateral deafness. The bone anchored hearing aid system, when placed on the side of a deaf ear, yields greater benefit in subjects with normal monaural hearing than does contralateral routing of offside signal amplification. It seems that this rehabilitative approach can expand the sound field of monaural listeners in further enhancing speech understanding. Observations suggest that further understanding of bone conduction as implemented in transcranial stimulation will guide further options for patients with monaural hearing. Longer follow-up will help to determine whether communicative skill improvements with the bone anchored hearing aid outweigh the disadvantages of implantation surgery, costs, and device maintenance.
Measuring curves and psycho-acoustical measurements are used for an investigation of the extent to which the bone-conduction hearing aid is equivalent to the air-conduction hearing aid. It can be shown that basically there is no objection against the use of a bone-conduction hearing aid (ear-level aid) for patients suffering only from sound-conduction hearing defects. The air-conduction hearing aid significantly superior in those cases where the requirements to be met by the hearing aid with respect to the frequency range (music) are higher. If the sound conduction disorder is accompanied by a sound paralgia, this means that the essentially reduced dynamic range of the bone-conduction hearing aid significantly restricts the possible applications of the bone-conduction hearing aid.
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.
The Birmingham bone-anchored hearing aid programme began in 1988 and by autumn 2000 a total of 351 patients had been fitted with such an aid. The aim of this study was to assess the effectiveness of hearing rehabilitation with the bone-anchored hearing aid. This was a prospective interview-based questionnaire study carried out in the autumn 2000. A total of 84 adult patients were interviewed. Each patient had worn their BAHA for more than one year. The questionnaire used during these interviews was the Glasgow hearing aid benefit profile (GHABP) and the Glasgow hearing aid difference profile (GHADP). This was first derived and validated by Gatehouse in 1999. The use of bone-anchored hearing aids was found to reduce the level of disability and handicap and provided the most patient benefit and satisfaction.