The Speech, Spatial and Qualities of Hearing Scale (SSQ) is designed to measure a range of hearing disabilities across several domains. Particular attention is given to hearing speech in a variety of competing contexts, and to the directional, distance and movement components of spatial hearing. In addition, the abilities both to segregate sounds and to attend to simultaneous speech streams are assessed, reflecting the reality of hearing in the everyday world. Qualities of hearing experience include ease of listening, and the naturalness, clarity and identifiability of different speakers, different musical pieces and instruments, and different everyday sounds. Application of the SSQ to 153 new clinic clients prior to hearing aid fitting showed that the greatest difficulty was experienced with simultaneous speech streams, ease of listening, listening in groups and in noise, and judging distance and movement. SSQ ratings were compared with an independent measure of handicap. After differences in hearing level were controlled for, it was found that identification, attention and effort problems, as well as spatial hearing problems, feature prominently in the disability–handicap relationship, along with certain features of speech hearing. The results implicate aspects of temporal and spatial dynamics of hearing disability in the experience of handicap. The SSQ shows promise as an instrument for evaluating interventions of various kinds, particularly (but not exclusively) those that implicate binaural function.

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.

A cochlear implant in one ear and a hearing aid in the other ear can provide binaural advantages. The patient who did not show a clear binaural advantage had the poorest hearing aid alone performance. The absolute and relative levels of performance at each ear are likely to influence the potential for binaural integration.

Objective-To develop and evaluate a 12-item version of the Speech, Spatial and Qualities of Hearing Scale for use in clinical research and rehabilitation settings, and provide a formula for converting scores between the full (SSQ49) and abbreviated (SSQ12) versions.Design-Items were selected independently at the three centres (Eriksholm, MRC Institute of Hearing Research, University of New England) to be representative of the complete scale. A consensus was achieved after discussion.Study Sample-The data set (n=1220) used for a factor analysis (Akeroyd et al., submitted) was re-analysed to compare original SSQ scores (SSQ49) with scores on the short version (SSQ12).Results-A scatter-plot of SSQ12 scores against SSQ49 scores showed that SSQ12 score was about 0.6 of a scale point lower than the SSQ49 (0-10 scale) in the re-analysis of the Akeroyd et al. data. SSQ12 scores lay on a slightly steeper slope than scores on the SSQ49. Conclusions-The SSQ12 provides similar results to SSQ49 in a large clinical research sample. The slightly lower average SSQ12 score and the slightly steeper slope reflect the composition of this short form relative to the SSQ49.

The Speech, Spatial and Qualities of Hearing Scale (Gatehouse & Noble, 2004) was applied to three independent clinical groups: 144 people prior to being fitted with amplification; 118 people with six months experience with unilateral amplification; and 42 people with six months experience with bilateral amplification. For traditional speech hearing contexts (one-on-one, in groups, in quiet, in noise) there was benefit with one aid, and no further benefit with two. By contrast, hearing speech in demanding contexts (divided or rapidly switching attention) showed benefit with one aid and further benefit with two. In the spatial domain, directional hearing showed some benefit with one hearing aid, and particular further benefit in distance and movement discrimination from fitting with two. There was some benefit from unilateral fitting for elements of the qualities domains (clarity, naturalness, recognisability, segregation of sounds), with no consistent sign of further benefit from two. Bilateral fitting added benefit with respect to listening effort. Two hearing aids offer advantage in demanding and dynamic contexts; these contexts are argued as significant in the maintenance of social competence and emotional wellbeing. The present results go toward establishing the real-world advantages of bilateral hearing aid fitting and suggest that previous, inconclusive clinical findings reflect inquiry limited to more traditional areas of hearing function.

The Tinnitus Primary Function Questionnaire is valid, reliable, and sensitive and can be used to determine the efficacy of clinical trials.

Patients fitted with one (CI) versus two (CI+CI) cochlear implants, and those fitted with one implant who retain a hearing aid in the non-implanted ear (CI+HA), were compared using the speech, spatial, and qualities of hearing scale (SSQ) (Gatehouse & Noble, 2004). The CI+CI profile yielded significantly higher ability ratings than the CI profile in the spatial hearing domain, and on most aspects of other qualities of hearing (segregation, naturalness, and listening effort). A subset of patients completed the SSQ prior to implantation, and the CI+CI profile showed consistently greater improvement than the CI profile across all domains. Patients in the CI+HA group self-rated no differently from the CI group, post-implant. Measured speech perception and localization performance showed some parallels with the self-rating outcomes. Overall, a unilateral CI provided significant benefit across most hearing functions reflected in the SSQ. Bilateral implantation offered further benefit across a substantial range of those functions.

A series of comparative analyses is presented between a group with relatively similar degrees of hearing loss in each ear (n = 103: symmetry group) and one with dissimilar losses (n = 50: asymmetry group). Asymmetry was defined as an interaural difference of more than 10dB in hearing levels averaged over 0.5. 1, 2 and 4kHz. Comparison was focused on self-rated disabilities as reflected in responses on the Speech, Spatial and Qualities of Hearing Scale (SSQ). The connections between SSQ ratings and a global self-rating of handicap were also observed. The interrelationships among SSQ items for the two groups were analysed to determine how the SSQ behaves when applied to groups in whom binaural hearing is more (asymmetry) versus less compromised. As expected, spatial hearing is severely disabled in the group with asymmetry; this group is generally more disabled than the symmetry group across all SSQ domains. In the linkages with handicap, spatial hearing, especially in dynamic settings, was strongly represented in the asymmetry group, while all aspects of hearing were moderately to strongly represented in the symmetry group. Item intercorrelations showed that speech hearing is a relatively autonomous function for the symmetry group, whereas it is enmeshed with segregation, clarity and naturalness factors for the asymmetry group. Spatial functions were more independent of others in the asymmetry group. The SSQ shows promise in the assessment of outcomes in the case of bilateral versus unilateral amplification and/or implantation.