Aspects of Hearing Aid Fitting Procedures

Sensorineural hearing loss is a common and chronic disorder that affects almost ten percent of the world population. In the Netherlands, it is also the major disorder in the working population [NCvB, 2008]. Hearing loss leads to restriction in the interaction with others and withdrawal from participation in (social) activities. Due to the size of the problem and the vast impact on the function, hearing rehabilitation is an important issue. Although hearing rehabilitation focuses on many more aspects such as learning of communication strategies and adaptation to the acoustical environment, hearing aid fitting is one of its first essential steps. Hearing aids have to amplify sound to a level above the hearing threshold to utilize the residual hearing capacity of the ear as much as possible. In the 20th century, a number of technological advances have taken place in amplification devices. These started from nonelectronic ear horns that were replaced by electronic hearing aids. Amplification was initially achieved by analogue circuits, while from the 1990s digital signal processors have entered the market. An enormously wide variety of hearing aid models has become available since [Bentler & Duve, 2000]. Aside from differences that have to do with the sound that is being produced, hearing aids can be classified with respect to type. While the technological development started with body-worn hearing aids, we nowadays distinguish behind-the-ear (BTE), in-the-ear (ITE) and hearing aids that fit partly or completely in the ear canal (CIC). These types are available in a wide variety of models, colours and sizes and are of various brands. A classical feature is the telecoil for use with induction loops. Options that are available for modern hearing aids are remote controls, infrared and fm-receivers, the use of multiple programs and water resistant housings. Last but not least, every hearing aid has its own price. It is obvious that the search for the hearing aid that is most suitable for the individual patient can be regarded as a real challenge. It is not only based on measures like speech perception but may also be determined by listening comfort, wearing comfort and functionality. This is all devised during the selection phase of a hearing aid fitting. Aside from differences in the exterior and the above-mentioned features, hearing aids can be distinguished with respect to the sound that they produce. For a long time the amount of amplification and the frequency characteristic were the main issues. Later on, electronic compression circuits were added to limit the maximum output and/or gain of the hearing aid. More recently developed features are feedback reduction, noise cancellation and the use of directional microphones. To adjust the various controls of the hearing aid in order to optimally compensate for the affected cochlea is a challenge on its own. This is done during the adjustment phase of a hearing aid fitting. Procedures for hearing aid fitting have been invented in parallel with the development of hearing aid technology

Contributing Determinants to Hearing Loss in Elderly Men and Women: Results from the Population-Based Rotterdam Study

To contribute to a better understanding of the etiology in age-related hearing loss, we carried out a cross-sectional study of 3,315 participants (aged 52-99 years) in the Rotterdam Study, to analyze both low- and high-frequency hearing loss in men and women. Hearing thresholds with pure-tone audiometry were obtained, and other detailed information on a large number of possible determinants was collected. Hearing loss was associated with age, education, systolic blood pressure, diabetes mellitus, body mass index, smoking and alcohol consumption (inverse correlation). Remarkably, different associations were found for low- and high-frequency loss, as well as between men and women, suggesting that different mechanisms are involved in the etiology of age-related hearing loss

Hearing Impairment Is Associated with Smaller Brain Volume in Aging

Although recent studies show that age-related hearing impairment is associated with cerebral changes, data from a population perspective are still lacking. Therefore, we studied the relation between hearing impairment and brain volume in a large elderly cohort. From the population-based Rotterdam Study, 2,908 participants (mean age 65 years, 56% female) underwent a pure-tone audiogram to quantify hearing impairment. By performing MR imaging of the brain we quantified global and regional brain tissue volumes (total brain volume, gray matter volume, white matter (WM) volume, and lobe-specific volumes). We used multiple linear regression models, adjusting for age, sex, head size, time between hearing test and MR imaging, and relevant cognitive and cardiovascular covariates. Furthermore, we performed voxel-based morphometry to explore sub-regional differences. We found that a higher pure-tone threshold was associated with a smaller total brain volume [difference in standardized brain volume per decibel increase in hearing threshold in the age-sex adjusted model: -0.003 (95% confidence interval -0.004; -0.001)]. Specifically, WM volume was associated. Both associations were more pronounced in the lower frequencies. All associations were consistently present in all brain lobes in the lower frequencies and in most lobes in the higher frequencies, and were independent of cognitive function and cardiovascular risk factors. In voxel-based analyses we found associations of hearing impairment with smaller white volumes and some smaller and larger gray volumes, yet these were statistically non-significant. Our findings demonstrate that hearing impairment in elderly is related to smaller total brain volume, independent of cognition and cardiovascular ris

Corrigendum: Hearing impairment is associated with smaller brain volume in aging

In the original article, Roshchupkin et al. (2016) was not cited in the article. The citation has now been inserted in Materials and Methods, subsection Brain MRI Acquisition and Processing, second paragraph and should read: Voxel based morphometry (VBM) was performed according to an optimized VBM protocol (Good et al., 2001) and was previously described (Roshchupkin et al., 2016). FSL software (Smith et al., 2004) was used for VBM data processing, all GM and WM density maps were non-linearly registered to the standard ICBM MNI152 GM and WM template (Montreal Neurological Institute) with a 1 mm × 1 mm × 1 mm voxel resolution. Subsequently, a spatial modulation and smoothing procedure with 3 mm (FWHM 8 mm) isotropic Gaussian kernel were applied to all images. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

Comparison of speech intelligibility in quiet and in noise after hearing aid fitting according to a purely prescriptive and a comparative fitting procedure

We compared two different types of hearing-aid fitting procedures in a double-blind randomized clinical study. Hearing aid fittings based on a purely prescriptive procedure (the NAL-RP formula) were compared to a comparative fitting procedure based on optimizing speech intelligibility scores. Main outcome measures were improvement of speech intelligibility scores in quiet and in noise. Data were related to the real-ear insertion responses that were measured after fitting. For analysis purposes subgroups were composed according to degree of hearing loss, characterized by unaided speech intelligibility in quiet, previous experience with hearing aids, unilateral or bilateral fittings and type of hearing aid. We found equal improvement of speech intelligibility in quiet, while fitting according to the prescriptive formula resulted in a somewhat better performance as expressed by the speech-to-noise ratio in comparison to the comparative procedure. Both procedures resulted in comparable real-ear insertion responses

A value-based healthcare approach: Health-related quality of life and psychosocial functioning in women with Turner syndrome

Objective: As part of the value-based healthcare programme in our hospital, a set of patient-reported outcome measures was developed together with patients and implemented in the dedicated Turner Syndrome (TS) outpatient clinic. This study aims to investigate different aspects of health-related quality of life (HR-QoL) and psychosocial functioning in women with TS in order to establish new possible targets for therapy. Design/Participants: A comprehensive set of questionnaires (EQ-5D, PSS-10, CIS-20, Ferti-QoL, FSFI) was developed and used to capture different aspects of HR-QoL and psychosocial functioning in a large cohort of adult women with Turner syndrome. All consecutive women, ≥18 years, who visited the outpatient clinic of our tertiary centre were eligible for inclusion. Results: Of the eligible 201 women who were invited to participate, 177 women (age 34 ± 12 years, mean ± SD) completed at least one of the validated questionnaires (88%). Women with TS reported a lower health-related quality of life (EQ-5D: 0.857 vs 0.892, P =.003), perceived more stress (PSS-10:14.7 vs 13.3; P =.012) and experienced increased fatigue (CIS-20: P <.001) compared to the general Dutch population. A relationship between noncardiac comorbidities (eg diabetes, orthopaedic complaints) and HR-QoL was found (R =.508). Conclusions: We showed that TS women suffer from impaired HR-QoL, more perceived stress and increased fatigue compared to healthy controls. A relationship between noncardiac comorbidities and HR-QoL was found. Especially perceived stress and increased fatigue can be considered targets for improvement of HR-QoL in TS women