An exploratory investigation of speech recognition thresholds in noise with auralisations of two reverberant rooms

Objective Speech-in-noise tests are widely used in hearing diagnostics but typically without reverberation, although reverberation is an inextricable part of everyday listening conditions. To support the development of more real-life-like test paradigms, the objective of this study was to explore how spatially reproduced reverberation affects speech recognition thresholds in normal-hearing and hearing-impaired listeners. Design Thresholds were measured with a Finnish speech-in-noise test without reverberation and with two test conditions with reverberation times of similar to 0.9 and 1.8 s. Reverberant conditions were produced with a multichannel auralisation technique not used before in this context. Study sample Thirty-four normal-hearing and 14 hearing-impaired listeners participated in this study. Five people were tested with and without hearing aids. Results No significant differences between test conditions were found for the normal-hearing listeners. Results for the hearing-impaired listeners indicated better performance for the 0.9 s reverberation time compared to the reference and the 1.8 s conditions. Benefit from hearing aid use varied between individuals; for one person, an advantage was observed only with reverberation. Conclusions Auralisations may offer information on speech recognition performance that is not obtained with a test without reverberation. However, more complex stimuli and/or higher signal-to-noise ratios should be used in the future.Peer reviewe

Sisäkorvaistute - kokeellisesta hoidosta arkipäivän kuntoutukseksi

Sisäkorvaistutehoito sopii sekä synnynnäisen vaikea-asteisen kuulovian että etenevän kuulovian hoidoksi. Istutteella voidaan saavuttaa hyvä puheentunnistuskyky vaikea-asteisessa kuulonalenemassa. Hoito on osoitettu kustannusvaikuttavaksi kaikissa ikäryhmissä. Nuorimmat potilaat ovat olleet 8–10 kuukauden ja vanhimmat yli 80 vuoden ikäisiä. Vanhusväestössä on paljon vaikea-asteisesta kuuloviasta kärsiviä potilaita, jotka hyötyisivät istutehoidosta. Heitä tulisi ohjata nykyistä aktiivisemmin leikkausarvioon.Peer reviewe

The development and evaluation of the Finnish digit triplet test

Objectives: The aim of the study was to develop a reliable and easily accessible screening test for primary detection of hearing impairment.Methods: Digits 0-9 were used to form quasirandom digit triplets. First, digit specific intelligibility functions and speech recognition thresholds (SRTs) were determined. To homogenize the test material digits with steep intelligibility function slopes were chosen and level correction up to 2dB were applied to the digits as needed. Evaluation measurements were performed to check for systematic differences in intelligibility between the test lists and to obtain normative reference function for normal-hearing listeners.Results: The mean SRT and the final slope of the test lists were -10.8 +/- 0.1dB signal-to-noise ratio (SNR) and 21.7 +/- 1.8%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and slope of the test subjects were -10.8 +/- 0.5dB SNR and 23.4 +/- 5.2%/dB (measurements at constant level; inter-subject variability). The mean SRT for normal-hearing young adults for a single adaptive measurement is -9.8 +/- 0.9dB SNR.Conclusion: The Finnish digit triplet test is the first self-screening hearing test in the Finnish language. It was developed according to current standards, and it provides reliable and internationally comparable speech intelligibility measurements.Peer reviewe

Suomenkielinen puheaudiometria ja uudet hälypuhetestit

Väestön ikääntyessä kuulonalenemien esiintyvyys ja tarve vaikuttavaan kuulonkuntoutukseen kasvavat. Hyvän yleiskäsityksen kuulosta antavat äänieriön hiljaisuudessa tehtävät perustutkimukset, äänesaudiometria ja puheaudiometria. Ne eivät kuitenkaan välttämättä kuvasta kuulonaleneman aiheuttamaa haittaa hälyisissä tilanteissa. Uuden suomenkielisen hälylausetestin avulla voidaan tutkia aiempaa paremmin aikuisten kuntoutuspotilaiden kuulonvaraista selviämistä arjessa. Suomenkielisen lasten hälypuhetestin validointi on meneillään.Peer reviewe

Improvements in Hearing and in Quality of Life after Sequential Bilateral Cochlear Implantation in a Consecutive Sample of Adult Patients with Severe-to-Profound Hearing Loss

Bilateral cochlear implantation is increasing worldwide. In adults, bilateral cochlear implants (BICI) are often performed sequentially with a time delay between the first (CI1) and the second (CI2) implant. The benefits of BICI have been reported for well over a decade. This study aimed at investigating these benefits for a consecutive sample of adult patients. Improvements in speech-in-noise recognition after CI2 were followed up longitudinally for 12 months with the internationally comparable Finnish matrix sentence test. The test scores were statistically significantly better for BICI than for either CI alone in all assessments during the 12-month period. At the end of the follow-up period, the bilateral benefit for co-located speech and noise was 1.4 dB over CI1 and 1.7 dB over CI2, and when the noise was moved from the front to 90 degrees on the side, spatial release from masking amounted to an improvement of 2.5 dB in signal-to-noise ratio. To assess subjective improvements in hearing and in quality of life, two questionnaires were used. Both questionnaires revealed statistically significant improvements due to CI2 and BICI. The association between speech recognition in noise and background factors (duration of hearing loss/deafness, time between implants) or subjective improvements was markedly smaller than what has been previously reported on sequential BICI in adults. Despite the relatively heterogeneous sample, BICI improved hearing and quality of life

Development of otology specific outcome measure : Ear Outcome Survey-16 (EOS-16)

Purpose: An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases. Methods: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis. Results: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months. Conclusions: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument. (C) 2021 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.Peer reviewe

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.Peer reviewe

Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16)

PurposeAn important outcome measure of patient care is the impact on the patient’s health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases.MethodsA preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients’ responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis.ResultsThe relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months.ConclusionsEOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.</p

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design:Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.</p