No description available.

AIMS: This study investigated the perception of generic and disease-specific Health-Related Quality of Life (HRQoL) for adults living with hearing impairment (HI) in Aotearoa/New Zealand (NZ). This study aimed to answer three questions: (1) What is the perception of HRQoL amongst adults with hearing impairment in NZ? (2) How do these perceptions compare to adults with HI living in other countries for which we have data? (3) What are the demographic and audiometric variables related to device ownership? METHOD: HRQoL, demographic, and audiometric information was collected from 126 adults in NZ. The following demographic information was collected: age, relationship length, hours worked per week, income, ancestry, sex, level of education, city size, and sexual orientation. The following audiologic information was also collected: ownership of hearing aids (HA), ownership of hearing assistance technology (HAT), better-ear pure-tone average (BEPTA), worse-ear pure-tone average (WEPTA), and signal-to-noise ratio loss (SNR loss). HRQoL information was collected using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; Ware & Sherbourne, 1992), and the Hearing Handicap Inventory (HHI) for both elderly (HHIE) and adults (HHIA; Ventry & Weinstein, 1982; Newman, Weinstein, Jacobson, & Hug, 1991). Variables discriminating HA and HAT owners from non-owners were also analysed. RESULTS: The relationship between demographic variables and HRQoL scores revealed that only age and income were significant. Audiometric variables had significant relationships with disease-specific HRQoL scores, as well as HA and HAT ownership. Finally, disease-specific HRQoL scores and all audiometric variables differentiated HA owners from non- owners, but demographic variables did not. Generic HRQoL scores and all audiometric variables differentiated HAT owners from non-owners. CONCLUSIONS: These results suggest that the negative impacts of HI on HRQoL as reported overseas are also present in NZ, and that not only do audiometric variables including SNR loss are related to HRQoL, but HRQoL is a significant predictor for HA and HAT ownership. Further QoL research is warranted amongst the HI population in NZ to identify and understand any causal relationships present amongst these variables. Furthermore, HRQoL instruments and a test of speech understanding in noise have been shown to provide additional meaningful information, and therefore clinicians might consider including them during consultation.

Objetivo: comparar o reconhecimento de fala na situação de silêncio e ruído com a prótese auditiva de orelha média totalmente implantável Esteem® em relação à prótese auditiva. Descrever a satisfação auditiva e as complicações cirúrgicas encontradas. Desenho do Estudo: estudo exploratório, prospectivo, intragrupo, sujeito como seu próprio controle. Pacientes: usuários de prótese auditiva com perda neurossensoraial moderada a severa bilateral. Intervenção: dez pacientes submetidos a cirurgia para colocação da prótese totalmente implantável Esteem®. Aplicação de questionário SADL no pré- e pós-operatório. Desfechos: reconhecimento de fala no silêncio e ruído, resultados do SADL e complicações do procedimento foram avaliadas. Resultados: Não houve diferença estatisticamente significante entre reconhecimento de fala nas condições de silencio e ruído em relação as próteses auditivas (p=0,23 e p= 0,0438). Houve diferença estatisticamente significante no score do SADL pré- e pós-operatório (p= 0,0076). Houve três necessidades de reintervenção cirúrgica, em uma delas a prótese precisou ser removida. Conclusões: Melhora da satisfação auditiva, tendência a melhora no reconhecimento de fala nas situações de silêncio e ruído. Procedimento deve ser realizado por cirurgiões otológicos experientes. / Objective: to compare speech discrimination in silence and in noise with the Esteem® totally implantable hearing device versus hearing aids, and to describe satisfaction with amplification and surgical complications in patients undergoing implantation of the Esteem® device. Study Design: this was an exploratory, prospective, within-group, subject-as-own-control study. Setting: tertiary referral center. Patients: hearing aid users with moderate to severe bilateral sensorineural hearing loss. Interventions: ten patients underwent placement of the Esteem® totally implantable hearing device. The Satisfaction with Amplification in Daily Life (SADL) questionnaire was administered pre- and postoperatively. Main Outcome Measures: speech discrimination in silence and noise, SADL scores, and complications were evaluated. Results: there were no statistically significant differences between hearing aids and the Esteem® device in speech discrimination in silence (p=0.23) or noise (p=0.0438). There was a significant difference between pre and postoperative SADL scores (p=0.0076). Three patients required reintervention, and one ultimately required explantation of the device. Conclusions: Use of the Esteem® device was associated with improved satisfaction with amplification and a trend toward improvement in speech discrimination in silence and noise. Implantation of the device is challenging and should be performed by experienced otologic surgeons.

No description available.

Objetivo: comparar o reconhecimento de fala na situação de silêncio e ruído com a prótese auditiva de orelha média totalmente implantável Esteem® em relação à prótese auditiva. Descrever a satisfação auditiva e as complicações cirúrgicas encontradas. Desenho do Estudo: estudo exploratório, prospectivo, intragrupo, sujeito como seu próprio controle. Pacientes: usuários de prótese auditiva com perda neurossensoraial moderada a severa bilateral. Intervenção: dez pacientes submetidos a cirurgia para colocação da prótese totalmente implantável Esteem®. Aplicação de questionário SADL no pré- e pós-operatório. Desfechos: reconhecimento de fala no silêncio e ruído, resultados do SADL e complicações do procedimento foram avaliadas. Resultados: Não houve diferença estatisticamente significante entre reconhecimento de fala nas condições de silencio e ruído em relação as próteses auditivas (p=0,23 e p= 0,0438). Houve diferença estatisticamente significante no score do SADL pré- e pós-operatório (p= 0,0076). Houve três necessidades de reintervenção cirúrgica, em uma delas a prótese precisou ser removida. Conclusões: Melhora da satisfação auditiva, tendência a melhora no reconhecimento de fala nas situações de silêncio e ruído. Procedimento deve ser realizado por cirurgiões otológicos experientes. / Objective: to compare speech discrimination in silence and in noise with the Esteem® totally implantable hearing device versus hearing aids, and to describe satisfaction with amplification and surgical complications in patients undergoing implantation of the Esteem® device. Study Design: this was an exploratory, prospective, within-group, subject-as-own-control study. Setting: tertiary referral center. Patients: hearing aid users with moderate to severe bilateral sensorineural hearing loss. Interventions: ten patients underwent placement of the Esteem® totally implantable hearing device. The Satisfaction with Amplification in Daily Life (SADL) questionnaire was administered pre- and postoperatively. Main Outcome Measures: speech discrimination in silence and noise, SADL scores, and complications were evaluated. Results: there were no statistically significant differences between hearing aids and the Esteem® device in speech discrimination in silence (p=0.23) or noise (p=0.0438). There was a significant difference between pre and postoperative SADL scores (p=0.0076). Three patients required reintervention, and one ultimately required explantation of the device. Conclusions: Use of the Esteem® device was associated with improved satisfaction with amplification and a trend toward improvement in speech discrimination in silence and noise. Implantation of the device is challenging and should be performed by experienced otologic surgeons.

Earlier studies of persons with deafness (D) and/or deafblindness (DB) have primarily focused on the mobility and communication problems. The purpose of the present study was to develop technology for monitoring aids to improve the ability of persons with D and/or DB to detect, identify, and perceive direction of events that produce sounds in their surroundings. The purpose was achieved stepwise in four studies. In Study I, the focus was on hearing aids for persons with residual low frequency hearing. In Study II-IV, the focus was on vibratory aids for persons with total D. In Study I, six signal processing algorithms (calculation methods) based on two principles, transposition and modulation, were developed and evaluated regarding auditory identification of environmental sounds. Twenty persons with normal hearing listened to 45 environmental sounds processed with the six different algorithms and identified them in three experiments. In Exp. 1, the sounds were unknown and the subjects had to identify them freely. In Exp. 2 and 3, the sounds were known and the subjects had to identify them by choosing one of 45 sounds. The transposing algorithms showed better results (median value in Exp. 3, 64%-69%) than the modulating algorithms (40%-52%) did, and they were good candidates for implementing in a hearing aid for persons with residual low frequency hearing. In Study II, eight algorithms were developed based on three principles, transposition, modulation, and filtration – in addition to No Processing as reference, and evaluated for vibratory identification of environmental sounds. The transposing algorithms and the modulating algorithms were also adapted to the vibratory thresholds of the skin. Nineteen persons with profound D tested the algorithms using a stationary, wideband vibrator and identified them by choosing one of 10 randomly selected from the list of 45 sounds. One transposing algorithm and two modulating algorithms showed better (p<0.05) scores than did the No Processing method. Two transposing and three modulating algorithms showed better (p<0.05) scores than did the filtering algorithm. Adaptation to the vibratory thresholds of the skin did not improve the vibratory identification results. In Study III, the two transposing algorithms and the three modulating algorithms with the best identification scores in Study II, plus their adapted alternative, were evaluated in a laboratory study. Five persons from Study II with profound D tested the algorithms using a portable narrowband vibrator and identified the sounds by choosing one of 45 sounds in three experiments (Exp. 1, 2, and 3). In Exp. 1, the sounds were pre-processed and directly fed to the vibrator. In Exp. 2 and 3, the sounds were presented in an acoustic test room, without or with background noise (SNR=+5 dB), and processed in real time. Five of the algorithms had acceptable results (27%-41%) in the three experiments and constitute candidates for a miniaturized vibratory aid (VA). The algorithms had the same rank order in both tests in the acoustic room (Exp. 2, and 3), and the noise did not worsen the identification results. In Study IV, the portable vibrotactile monitoring aid (with stationary processor) for detection, identification and directional perception of environmental sounds was evaluated in a field study. The same five persons with profound D as in Study III tested the aid using a randomly chosen algorithm, drawn from the five with the best results in Study III, in a home and in a traffic environment. The persons identified 12 events at home and five events in a traffic environment when they were inexperienced (the events were unknown) and later when they were experienced (the events were known). The VA consistently improved the ability with regard to detection, identification and directional perception of environmental sounds for all five persons. It is concluded that the selected algorithms improve the ability to detect, and identify sound emitting events. In future, the algorithms will be implemented in a low frequency hearing aid for persons with low frequency residual hearing or in a fully portable vibratory monitoring aid, for persons with profound D or DB to improve their ability to sense the environment.

Instructional design is a science that has received little attention from residential universities and educational practices. Instructional design is regarded as a prerequisite for designing, delivering and optimising flexi-learning programmes and should be part of the curricularising processes of universities. There is furthermore an increasing awareness, both internationally and nationally, of the need for distance education. The paradigm shift towards more learner centred study, independent of time and place, necessitates the redesigning and development of learning material at tertiary institutions. This study applies the parameters of instructional design and distance teaching to the field of hearing aid acoustics. The stages utilised in the instructional design of a distance teaching program for hearing aid acousticians were the following: planning through an analysis of the situation, design and development of the program, implementing the postgraduate Diploma in Hearing Aid Acoustics and the utilisation and management of the program through continuous assessment of the program. In the planning phase an analysis of the situation was conducted by means of questionnaires to the major role players, viz. hearing aid dispensers in practice and their adult and geriatric clients with a hearing loss. A total of 144 respondents were included in the study. In the planning document the expected outcomes and main traits of the potential learners were identified. The best system for the delivery of the program was also selected. The results of the analysis phase were used to develop and implement a two year post-graduate distance teaching diploma in hearing aid acoustics. A major challenge was to effectively facilitate the practical skills required of hearing aid acousticians within a distance teaching program. Selected contact periods are therefore used for practising practical skills. In the final phase of instructional design, the program was evaluated. It was indicated that instructional design is indeed a prerequisite for specifying conditions for learning, based on sound teaching principles. / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

With the introduction of universal newborn hearing screening (UNHS) the need for quality early hearing intervention (EHI) services became critical. Screening is but the avenue to EHI services. Without appropriate intervention infants with hearing loss are at risk for language delay which might subsequently adversely influence academic success and vocational choices later on in life. The numerous socio-economic, cultural and healthcare barriers associated with developing countries such as South Africa, do not negate or diminish the need for optimal outcomes for infants with hearing loss through quality EHI services. The principle of quality EHI services, aligned with international standards, is endorsed by the HPCSA (2003: 2). In order to assure quality in EHI, service evaluation is critical. The necessary first step when evaluating service provision is to measure current service delivery. The main aim of this study was to determine whether South African audiologists provide EHI and support services aligned with international professional best practice to infants following the diagnosis of hearing loss. The first part of this study reviews the evidence available in EHI. The guidelines derived from the international evidence were stated as benchmarks against which South African EHI services were measured. These benchmarks were categorised using the so-called six M variation categories. These categories are: Man, machine (equipment), method (systemaric procedures), measurements, material (amplification devices) and Mother Nature. During the empirical research a descriptive design was followed comprising of questionnaire surveys to audiologists in different working sectors rendering EHI services to infants with hearing loss. The questionnaire survey explored the nature and scope of the EHI services offered to infants with hearing loss with regard to all the components (categorised in the six M categories) of the EHI programme of 40 South African audiologists. The results of this study indicate that respondents often do not use evidence-based measurements or methods during EHI services. Results suggest that undergraduate training in areas regarding the selection and fitting of amplification to infants with hearing loss is often inadequate (>20 respondents indicated that they are not trained). Evidence-based measurements are not typically performed when fitting amplification to infants (29 respondents do not perform probe-microphone or elctroacoustic measurements). Many respondents indicated that they do not have the necessary equipment to do these measurements. EHI services often (50% of respondents) do not provide A/R directly, but refer to other team members. From the results there seems to be significant delays in the rendering of EHI services to infants with hearing loss. Financial constraints of the family of the infants, accessibility problems, as well as a lack of infant support from their families often influence the EHI programmes of respondents. The implications of this study were discussed. Recommendations include the development of South African guidelines, aligned with international guidelines but taking into account the challenges posed by the unique South African context. Other recommendations include: Centres of excellence, relevant continuing education programmes and the evaluation of undergraduate training programmes. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted

This thesis report is about designing a prototype and establishing audio communication between a computer and Digital Signal Processor (DSP) using two preamp circuits using both auxiliary and USB connection. The paper gives the reader an overview on how audio is transmitted from a computer, through the system and to the desired output. The reader should also get a better understanding of how an AD-converter samples the incoming signal to the Discrete plane and how an AUX or phone connector works. This information can be used for designing preamp circuits to communicate between a computer and the DSP. The DSP circuit uses an STM32 processor to control the incoming and outgoing signals with the use of ADC and DAC conversion. The DSP also uses microphones to capture surrounding sound. An addition is to make a prototype on how to use these microphones to  send the signal upstream to the computer. The microphone is then benchmarked with the use of Matlab, calculating Total Harmonic Distortion. Management and optimization of code structure and resources is done in the source files of the project. Using imperative C programing, large functions are broken down into smaller functions to ease readability and control flow. The result is a prototype circuit that can communicate audio signals with both audio jack and USB between computers input and output to the DSP. Using CubeMX in conjunction with CubeIDE to add additional ADC channels to be able to incorporate an automatic source control when the audio jack or USB is connected. / Denna avhandling handlar om att designa en prototyp och etablera ljudkommunikation mellan en dator och en digital signalprocessor (DSP) med hjälp av två förstärkarkretsar genom både aux- och USB-anslutning. Rapporten ger läsaren en översikt över hur ljud skickas från en dator, genom systemet och till önskad utgång. Läsaren bör också få en bättre förståelse för hur en AD-omvandlare fungerar för att sampla den inkommande signalen till tidsdiskreta planet och hur en AUX- eller telekabel fungerar. Målet är att använda denna information för att skapa förstärkare som kan kommunicera mellan en dator och DSP:en. DSP-kretsen använder en STM32-processor för att hantera de inkommande och utgående signalerna med användning av ADC- och DAC-omvandling. DSP:en använder också mikrofoner för att fånga omgivande ljud. Ett tillägg är att skapa en prototyp för hur man kan använda en av mikrofonerna för att skicka signalen till datorn. Mikrofonen jämförs sedan med hjälp av Matlab genom att beräkna total harmonisk distorsion. Hantering och optimering av kodstruktur och resurser görs i projektets källkodsfiler. Genom att använda imperativ C-programmering bryts stora funktioner ned i mindre funktioner för att underlätta läsbarheten och styrningen av flödet. Resultatet är en prototypkrets som kan kommunicera ljudsignaler med både ljuduttag och USB mellan datorns in- och utgång och DSP:en. Genom att använda CubeMX tillsammans med CubeIDE läggs ytterligare ADC-kanaler för att möjliggöra automatisk källkontroll när ljuduttaget eller USB-anslutningen är ansluten.

Introduction: Auditory neuropathy spectrum disorder (ANSD) is a disorder characterized by impaired temporal coding of acoustic signals due to a deficiency in neural synchrony or neural transmission. Despite variations in speech perception outcomes within both patients and studies, current evidence demonstrates that children with ANSD, who use hearing aids (HAs) or cochlear implants (CIs), generally achieve speech perception performance comparable to peers with sensorineural hearing loss (SNHL). However, limited studies have reported factors that have prognostic value for auditory intervention outcomes. The objectives of this doctoral thesis, consisting of three consecutive associated projects on children with ANSD, were (1) to determine factors with predictive value for post-intervention (CIs and/or HAs) outcomes through a retrospective study, (2) to systematically summarize and critically appraise existing evidence of the prognostic value of early auditory electrophysiologic tests and MRI findings for CI outcomes through a systematic review (SR), and (3) to systematically overview, summarize, and critically appraise evidence of CI outcomes through an umbrella review of current SRs (overview of SRs). -- Methods: For the first project, the records of 38 children with ANSD between 5 and 18 years old, 63.20% males, who used CIs (71%) and/or HAs, identified at the Children's Hospital of Eastern Ontario (CHEO) were reviewed. For the second and third projects, the SRs were guided by the PRISMA 2020 statement, and electronic databases were searched without restrictions on language, publication status, or year of publication. In the second project, studies on children with ANSD (including those with cochlear nerve deficiency [CND]), cochleovestibular nerve (CVN) abnormalities, or SNHL reporting the relevance of preoperative and/or postoperative electric compound action potential (eCAP), electric auditory brainstem response (eABR), and/or MRI results to CI outcomes were included. The methodological quality and strength of evidence were assessed using the Crowe Critical Appraisal Tool (CCAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool, respectively. In the third project, all SRs that reported CI outcomes in children with ANSD were included. The methodological quality of the selected SRs was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist, and the risk of bias in evidence was assessed using the Risk of Bias in Systematic Reviews (ROBIS) tool. -- Results: In the retrospective chart review (first project), ages at HL diagnosis and CI activation and the length of follow-up with CI/HA showed a significant relationship with open-set speech perception outcomes (i.e., the scores of Phonetically Balanced Kindergarten [PBK] test with word and phoneme speech materials and Hearing in Noise Test [HINT] in quiet and noise conditions). Using a Forward Linear Multiple Regression Model, the length of follow-up with CI/HA and bilateral amplification showed prognostic value for speech perception performance. In the second project, 25 papers were included in the review. While it was difficult to draw a firm conclusion about the eCAP findings, current evidence strongly supports the prognostic value of eABR and MRI for post-CI speech perception outcomes. According to the eight SRs selected for the third project, children with ANSD achieve CI outcomes comparable to their peers with SNHL. However, in children with postsynaptic ANSD (i.e., those with CND), cochlear nerve hypoplasia is associated with better speech recognition outcomes compared to cochlear nerve aplasia, especially in the absence of additional disabilities and/or medical comorbidities (ADs/MCs). -- Conclusion: Children with ANSD, especially those without cochlear nerve aplasia and ADs/MCs, achieve speech perception outcomes comparable to their peers with SNHL. In addition, age at HL diagnosis, age at CI activation, the length of follow-up with CI/HA, bilateral amplification, and eABR and MRI findings are associated with or have predictive value for intervention outcomes. The findings of the SRs should be interpreted with caution given the low quality of evidence and risk of bias in the studies selected for SRs.