The participants in the Eriksholm Workshop on "Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids" debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self-report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health-care delivery systems. A set of seven core items is proposed for further study.

Some properties and applications of the N1-P2 complex (100-200 ms latency) are reviewed. N1-P2 is currently the auditory-evoked potential (AEP) of choice for estimating the pure-tone audiogram in certain subjects for whom a frequency-specific, non-behavioural measure is required. It is accurate in passively cooperative and alert older children and adults. Although generally underutilized, it is an excellent tool for assessment of functional hearing loss, and in medicolegal and industrial injury compensation claimants. Successful use of N1-P2 requires substantial tester training and skill, as well as carefully designed and efficient measurement protocols. N1-P2 reflects conscious detection of any discrete change in any subjective dimension of the auditory environment. In principle, it could be used to measure almost any threshold of discriminable change, such as in pitch, loudness, quality and source location. It is established as a physiologic correlate of phenomena such as the masking level difference. Thus, N1-P2 may have many applications as an Objectiveʺ proxy for psychoacoustic measures that may be impractical in clinical subjects. Advances in dipole source localization and in auditory-evoked magnetic fields (AEMFs) have clarified the multiple, cortical origins of Nl and P2. These potentials are promising tools for the neuro-physiologic characterization of many disorders of central auditory processing and of speech and language development. They also may be useful in direct “functional imaging’ of specific brain regions. A wide variety of potential research and clinical applications of N1 and P2, and considerable value as part of an integrated, goal- directed AEP/AEMF measurement scheme, have yet to be fully realized.

This document describes the protocol for the provision of amplification to infants and preschool children registered with the Ontario infant hearing program (OIHP) in Canada. The provision of amplification includes the prescription and dispensing of hearing instruments to infants and preschool children identified with permanent childhood hearing impairment (PCHI) in the province of Ontario. The first section deals with the structure and processes of the program, while the second section specifies the clinical procedures that are applied in providing hearing instruments to infants and young children with hearing impairment.

This brief review article addresses the quality of self-report rating scale outcome measures in relation to audiological rehabilitation with hearing aids. It is intended to assist those who may wish to evaluate, select, or adapt existing self-report measurement tools, or to develop new ones. The focus is not on specific scales but on the key issues in scale development and evaluation. A modern perspective is presented. Areas addressed include measurement goal definition, specification of the target population, the importance of conceptual frameworks, evaluation of reliability, validity and responsiveness, and production of norms. Reliability includes internal consistency and test-retest reliability concepts, related statistical measures such as the standard error of measurement, confidence intervals and critical differences, and some specific numerical criteria. Validity includes construct, content, face and criterion validities. Responsiveness includes some principles in the measurement of change, causes of poor responsiveness, reliability of change measures, and effect size. Concluding remarks touch on the practicality of self-report scales. It is emphasized that measurement goals and target population characteristics must be defined precisely, that existing measures should be evaluated carefully before undertaking new development, that the properties of any measure may depend strongly on its purpose and context of use, and that quantitative statistical criteria should guide the evaluation of measures as well as the design of experiments or clinical trials.

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Thirty "new" lists of monosyllabic words were created at the University of Melbourne and recorded by Australian and American English speakers. These new lists and the ten original CNC lists (Peterson and Lehiste, 1962) were used during the feasibility study of the Nucleus Research Platform 8 Cochlear Implant System (Holden et al, 2004). Performance was similar across original and new lists for six implanted Australian subjects; for four implanted U.S. subjects, mean performance was 23 percentage points lower with the new than with the original lists. To evaluate differences between original and new lists for the American English recording, 22 CI recipients were administered all 40 CNC lists (30 new and 10 original lists). The overall mean word score for the new lists was significantly lower (22.3 percentage points) than for the original lists. Acoustic analysis revealed that decreased performance was most likely due to reduced amplitudes of certain initial and final consonants. The new CNC lists can be used as more difficult test material for clinical research.

The clinical utility of auditory evoked potentials for validation of the pure tone audiogram in adult compensation claimants and medicolegal patients is examined. Large sample comparisons of evoked potential and conventional pure tone thresholds showed that the slow vertex response can estimate true hearing levels within 10 dB in almost all patients. Given adequate tester skills, it is the tool of choice, and it merits more widespread implementation. Properly used, it can improve and abbreviate the assessment battery for detection and quantification of nonorganic hearing loss. The 40-Hz middle latency response is useful as a secondary tool, but at present, cochlear nerve and brain stem potentials have limited audiometric value in this population.

In a study of 3466 claimants for noise-induced occupational hearing loss tinnitus was reported by half of the patients. Its characteristics in this select group were different from tinnitus seen in other groups. Specifically, tinnitus prevalence seemed to be independent of age, state of hearing and duration of noise exposure if greater than 10 years. The reasons for these differences are unclear, though the possibility of financial motivation by some claimants is raised. Further work in this area is urgently required to achieve standardization and objectivity. Being a subjective complaint these aims will be difficult to accomplish. However not until then can a fair handicap scale be developed for workers who develop this disquieting symptom as a result of their occupation.