Bimodal Programming: A Survey of Current Clinical Practice.

PURPOSE: The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? METHOD: An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. RESULTS: Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. CONCLUSIONS: Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

Functional performance in older adults with hearing loss: Application of the International Classification of Functioning brief core set for hearing loss: A pilot study.

OBJECTIVES: The beta version of the International Classification of Functioning, Disability, and Health (ICF) brief core set for hearing loss in adults was developed and recommended to be validated through the audiologic rehabilitation clinical practice. The aims of this pilot study were to validate the ICF brief core set by examining the dimensions of hearing performance measures used in a standard care university clinic specializing in amplification, and seeing if those dimensions support the structure provided by the core set. DESIGN: ICF linking, classification, and qualifier coding procedures were applied on a data set identified from clinical records and two paper-pencil questionnaires; and completed by consensus of two experienced audiologists. STUDY SAMPLE: Forty-nine participants were recruited from an out-patient population at an audiology clinic. RESULTS: Eighteen of 27 items from the brief core set were able to be linked and validated. Four factors were identified, and confirmed the structure of ICF concept: Auditory function, Other functions, Activities/contextual interaction, and Third-party disability. Further, three predictors significantly discriminated performance in 28 participants: the use of hearing assistive devices, speech-reading, and active social life. CONCLUSIONS: The ICF brief core set is a valuable tool for use in audiologic rehabilitation clinical practice and research design.

Evaluation of Speech Perception via the Use of Hearing Loops and Telecoils.

A cross-sectional, experimental, and randomized repeated-measures design study was used to examine the objective and subjective value of telecoil and hearing loop systems. Word recognition and speech perception were tested in 12 older adult hearing aid users using the telecoil and microphone inputs in quiet and noise conditions. Participants were asked to subjectively rate cognitive listening effort and self-confidence for each condition. Significant improvement in speech perception with the telecoil over microphone input in both quiet and noise was found along with significantly less reported cognitive listening effort and high self-confidence. The use of telecoils with hearing aids should be recommended for older adults with hearing loss.

Speech based optimization of cochlear implants.

OBJECTIVE: This study describes an innovative method to optimize cochlear implant (CI) devices for individual patients using speech stimuli. DESIGN: Baseline performance of clinically created CI settings was evaluated objectively (CNC and BKB-SIN) and subjectively (listening situation questionnaire). Participants underwent the Clarujust optimization procedure during two sessions, each two weeks apart, allowing for acclimatization and experience with each group of programs. Outcome testing was completed on both optimization settings during the two week follow-up session. CNC and BKB-SIN scores were compared within participants across test sessions. STUDY SAMPLE: Twenty adult experienced CI users were reprogrammed using the Clarujust™ fitting procedure. RESULTS: Significant improvements (p < 0.05) on CNC words and BKB-SIN sentences were observed with optimized maps compared to maps programmed using standard methods. Subjective performance also showed increased satisfaction with the optimized maps. The maps for individual users varied significantly and no single fitting applied for all patients. CONCLUSIONS: The Clarujust optimization method of programming CIs shows promise to improve patient performance and increase patient satisfaction in a shorter clinical test time.

The effect of a hearing conservation program on adolescents' attitudes towards noise.

Crandell et al., reported that education programs such as hearing conservation programs (HCPs) represent the most common and well-recognized procedure in reducing the incidence of noise-induced hearing loss (NIHL). The purpose of this study was to assess the effectiveness of an HCP in changing knowledge and attitudes toward exposures to high intensity sounds or noise among adolescents aged 12-14 years. Local middle school students in physical education classes were recruited for participation. Sixty-four middle school students between the ages of 12 and 14 received pre- and post-test measures and participated in the HCP. The pre-test measure had 24 questions that included 5 demographic questions and 19 Likert-type questions [modified from the Youth Attitude to Noise Scale] that assess adolescents' attitudes towards noise; and a post-test measure included the identical 24 questions of the pre-test measure in addition to three subjective questions. A Wilcoxon signed rank test and a Two-Factor Analysis of Variance were completed to assess changes in knowledge and attitudes toward noise among the study population after receiving the HCP. A statistically significant reduction (P< 0.003) in pro-noise attitudes among the adolescents was present after the intervention. It was established that an HCP facilitated a change in pro-noise attitudes among adolescents. Further, the students thought this program facilitated learning of the auditory system and healthy hearing behaviors.

Perceived hearing status and attitudes toward noise in young adults.

PURPOSE: To estimate the prevalence of perceived hearing loss, tinnitus, and temporary threshold shift (TTS) in community college students and to see whether those students' attitudes toward noise affected their perception of their own possible hearing loss, tinnitus, and TTS. METHOD: Young adults (N = 245; age 18-27) completed 3 questionnaires: the Hearing Symptom Description, Youth Attitude to Noise Scale, and Adolescents' Habits and Hearing Protection Use. RESULTS: Perceived TTS and pain associated with loud noise were the most common hearing related factors, followed by perceived tinnitus and hearing loss. The students' attitudes toward noise in their daily environment showed the most negative response, whereas attitudes toward noise and concentration indicated a more positive, or less harmful, response. Chi-square analysis indicated a significant correlation between perceived hearing loss and respondents' overall attitudes toward noise exposure. Hearing protection use was limited for all participants, with the majority reporting never having used hearing protection. CONCLUSION: Approximately 6% of respondents reported perceived hearing loss, and 13.5% reported prolonged tinnitus. In general, participants had neutral attitudes toward noise. Over 20% of participants reported ear pain, tinnitus, and/or TTS after noise exposure at least sometimes. Coincidentally, few participants reported consistent use of hearing protection.

Mean and median hearing thresholds among children 6 to 19 years of age: the Third National Health And Nutrition Examination Survey, 1988 to 1994, United States.

OBJECTIVE: The objective of this study was to provide the first national representative values for mean and median hearing thresholds among US children 6 to 19 yrs of age. METHODS: Hearing thresholds were obtained from 6166 children in the Third National Health and Nutrition Examination Survey (1988 to 1994), a national, population-based cross-sectional survey with household interview and audiometric testing at 0.5 to 8 kHz. Means, medians, and standard errors of the mean were obtained and reported by ear, frequency, sex, and age. RESULTS: The mean and median thresholds ranged from 3.0 to 11.8 dB HL and -1.0 to 10.8 dB HL, respectively. The highest (poorest) thresholds were obtained at test frequencies above 4000 Hz. Similar mean and median thresholds were found between boys and girls at all frequencies. CONCLUSIONS: These data indicate that the mean thresholds fall below the standard screening guidelines recommended by the American Speech-Language-Hearing Association (< or =20 dB HL for the frequencies from 1000< or =20 dB HL for the frequencies from 2000, and 4000 Hz). The results of this study suggest the need to include the test frequency of 6000 Hz in screening protocols for children.

Analysis of prefitting versus postfitting hearing aid orientation using the Glasgow Hearing Aid Benefit Profile (GHABP).

Results of this study demonstrate the advantages of both pre- and postfitting hearing aid orientation (HAO) sessions. This study demonstrated that HAO counseling is helpful in expediting hearing aid benefit and satisfaction through the education of our clients and that this benefit and satisfaction is age dependent as measured by the Glasgow Hearing Aid Benefit Profile (GHABP) (Gatehouse, 1997). Patients with greater initial disability, as identified by item 1 of the GHABP, receive significant benefit from prefitting and/or postfitting counseling as compared to patients receiving no counseling. Implications of these findings are discussed.

Bilateral amplification for the elderly: are two aids better than one?

This paper reviews the advantages and disadvantages of bilateral amplification as opposed to unilateral hearing use for older persons with bilateral symmetric hearing loss. Binaural advantages, such as improved localization and speech recognition in noise, are presented as they pertain to the older population. In addition, contraindications, such as binaural interference, increased costs, cosmetic concerns, decreased manipulation skills, and additional hearing aid management issues, are discussed. A case study is provided in which unilateral hearing aid fitting was more beneficial to a patient than two hearing aids. It is concluded that bilateral amplification should be attempted for all elderly patients with symmetric hearing loss, unless a contraindication is suspected.

Doctor of Audiology program at the University of Florida.

The University of Florida on-campus AuD program is described. To date, 63 students have been enrolled in this program. Sixteen doctoral-level audiology faculty teach in this program, either in the classroom or clinically. Coursework spans all areas included in the audiology scope of practice. The curriculum also has classes taught by faculty in other related disciplines, such as medicine, neuroscience, pharmacology, and counseling. Clinical practicum experiences throughout the program occur in a major health science center on campus, along with a number of other clinical sites. With the support of a large faculty and the availability of a wide variety of clinical placements, the University of Florida AuD program provides the necessary knowledge and skills for students to become autonomous professionals.

Personal style and hearing aid fitting.

Why do I have to drag information out of some patients? Why is another patient so talkative? Why didn't this patient like the XYZ 2002 digital hearing aid when she had the same degree, type, and configuration of hearing impairment as the patient I successfully fit last month? Could the answer be as basic as a difference in personality?