Rationale, Theoretical Underpinnings, and Design of HEAR-aware: Providing Adults With Hearing Loss With Tailored Support to Self-Manage Their Hearing Problems via a Smartphone App, as an Alternative to Hearing Aids.

Purpose An alarming two thirds of adults aged 50 years or over with hearing impairment who could benefit from hearing aids do not own any, leaving these adults with no support to self-manage their hearing problems. In the HEAR-aware project, it is hypothesized that self-management can be facilitated via a smartphone app if its educational content is tailored to a person's dynamic stage of readiness to take action on their hearing (stage of change) and to a person's dynamic acoustical situations (as measured via a wearable microphone) and associated challenges (as captured via ecological momentary assessment). As such, the HEAR-aware app would be an ecological momentary intervention. This research note describes the rationale and theoretical underpinnings of the app, as well as the rationale for planning a series of studies to develop and evaluate it. Study Designs After a preparatory phase, Study 1 includes qualitative group interviews to assess user needs. Next, a creative session will be held, in which all stakeholders involved will work toward a specified version of the app. Subsequently, prototypes of the app will be developed and pilot-tested (Pilot Studies 2A and 2B). Users' usage and ratings (usability and quality indicators) of the app's elements will be examined and processed in the app. Lastly, the effectiveness of the app's final version will be examined in a randomized controlled trial (Study 3). Discussion The project's merits and challenges will be discussed.

The precedence effect for lateralization for the mild sensory neural hearing impaired.

Using dichotic signals presented by headphone, stimulus onset dominance (the precedence effect for lateralization) was investigated for six sensorineural hearing-impaired subjects. Stimuli were based on 2400-Hz lowpass-filtered 5-ms noise bursts. We used the paradigm, as described by Goverts et al. (2000, Hear. Res. 148, 88-94), in which a single noise burst is divided into leading and lagging parts, with opposite lateralization cues (viz. an interaural time delay of 0.2 ms). The occurrence of onset dominance was investigated by measuring the lateral perception of the stimulus ('left' or 'right') with fixed, equal durations of leading and lagging parts, while decreasing the absolute signal level or adding a filtered white noise. The dominance of the leading part was quantified by measuring the lateral perception of the stimulus as a function of the relative duration of the leading (and thus the lagging) part. This was done at about 40 dB sensation level (SL) in quiet and in filtered white noise, at a signal-to-noise ratio resulting in a SL of about 6 dB. Results are compared to normal hearing reference data at various SLs. Hearing-impaired data show a large variance and overall a decreased precedence effect in terms of both occurrence and quantification, which cannot be explained on basis of reduced audibility. Mean performance of the hearing-impaired subjects at 40 dB in quiet was similar to normal hearing performance in masking noise at a signal-to-noise ratio of 0 dB.