To meet the need for an objective self-test for hearing screening. a new Dutch speech-in-noise test was developed. Digit triplets were used as speech material. The test was made fully automatic, was controlled by a computer, and can be done by telephone. It measures the speech reception threshold (triplet SRT(n)) using an adaptive procedure, in about 3 min. Our experiments showed no significant influence of telephone type or listening environment. Measurement errors were within 1 dB. which makes the test accurate. In additional experiments with hearing-impaired subjects (76 ears of 38 listeners), the new test was compared to the existing sentence SRT(n) test of Plomp and Mimpen, which is considered to be the standard. The correlation between both SRT(n)s was 0.866. As expected, correlations between the triplet SRT(n) test by telephone and average pure-tone thresholds are somewhat lower: 0.732 for PTA(0,5,1,2), and 0.770 for PTA(0,5,2,4). When proper SRT(n) values were chosen for distinguishing between normal-hearing and hearing-impaired subjects, the triplet SRT(n) test was found to have a sensitivity of 0.91 and a specificity of 0.93.
A speech-in-noise test which uses digit triplets in steady-state speech noise was developed. The test measures primarily the auditory, or bottom-up, speech recognition abilities in noise. Digit triplets were formed by concatenating single digits spoken by a male speaker. Level corrections were made to individual digits to create a set of homogeneous digit triplets with steep speech recognition functions. The test measures the speech reception threshold (SRT) in long-term average speech-spectrum noise via a 1-up, 1-down adaptive procedure with a measurement error of 0.7 dB. One training list is needed for naive listeners. No further learning effects were observed in 24 subsequent SRT measurements. The test was validated by comparing results on the test with results on the standard sentences-in-noise test. To avoid the confounding of hearing loss, age, and linguistic skills, these measurements were performed in normal-hearing subjects with simulated hearing loss. The signals were spectrally smeared and/or low-pass filtered at varying cutoff frequencies. After correction for measurement error the correlation coefficient between SRTs measured with both tests equaled 0.96. Finally, the feasibility of the test was approved in a study where reference SRT values were gathered in a representative set of 1386 listeners over 60 years of age.
Keypoints * The Dutch National Hearing Test is a reliable and very successful functional hearing-screening test by telephone. An internet version of the National Hearing Test was also implemented. * The National Hearing Test is a fully automatic adaptive speech-in-noise test that uses digit-triplets as speech material. The result of the test is given as 'good,''insufficient,' or 'poor.' * The test by telephone performs better in reaching older subjects, who are more likely to suffer from hearing loss, than the test by internet. * More than 50% of the participants who scored 'insufficient' or 'poor' followed the recommendation to visit a GP, hearing-aid dispenser, ENT specialist or Audiological Center. * The tests contribute to increase the identification and treatment of older hearing-impaired subjects.
The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice.
Hearing status is negatively associated with higher distress, depression, somatization, and loneliness in young and middle-aged adults. The associations are different in different age groups. The findings underline the need to seriously address the adverse effects of limited hearing among young and middle-aged adults both in future research and in clinical practice.
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