Outside of major metropolitan areas, Arizona has limited options for hearing healthcare. The Arizona Affordable Hearing Aid Task Force proposed the development of a statewide program to provide low-cost hearing aids and audiologic care to low-income residents. The purpose of this review was to determine the status of the literature on the clinical outcomes of teleaudiology services for evaluations and hearing aid fittings which could be used to serve inhabitants of rural counties and address the goals of the Task Force. A literature search was performed to identify articles with original research in teleaudiology in the areas of evaluation and treatment and yielded 234 results. After exclusion criteria were applied, there were 15 articles for review; 10 articles focused on audiological evaluation and 5 articles focused on verification, validation, and counseling for hearing aid fittings. Evaluation-related articles showed that pure-tone air conduction testing was generally within the ± 5 dB acceptable range of variability, with little evidence on bone conduction or speech testing reliability. Studies reporting real-ear measurements with probe microphones were shown to yield similar results in traditional and teleaudiology fitting sessions and validation measures documented similar or better outcomes from teleaudiology fittings. Based on the literature, it is concluded that the use of teleaudiology is feasible for hearing aid fittings and counseling in rural areas, if associated barriers related to costs and limitations related to the availability of technology are overcome.

Abstract Hearing aid (HA) rehabilitation was studied in northern Finland. The costs of HA fitting were examined at two hospitals, Kainuu Central Hospital and Oulu University Hospital. The patients were visited and interviewed at their home and use of HAs was charted. The benefit of HAs was evaluated using generic and disease-specific questionnaires. The effect of follow-up counselling of HA users on HA use and on the benefit of HAs was studied. The proportion of all HA possessors that are regular users has clearly increased during the past twenty years, and the number of non-users, in particular, has decreased significantly. Only 5.3% of first fitted HAs were not in use in 2001. The costs of HA fitting in 2000 were approximately € 900. There was not much difference in the costs between Kainuu Central Hospital and Oulu University Hospital. The price of a HA accounted for somewhat less than half of the total hospital costs, and the costs of the audiology personnel made up roughly a third of the overall costs. Emotional problems of HA users were significant before HA fitting, but six months after HA fitting the number of patients who felt handicapped by their hearing problems had decreased significantly. This could be seen in the results of both the social and the emotional items of the disease-specific health-related quality-of-life (HRQOL) measure, the short version of the Hearing Handicap Inventory for the Elderly (HHIE-S). The benefit could not, however, be shown with the generic HRQOL instrument, the EuroQol questionnaire (EQ-5D), which apparently lacks sensitivity for measuring changes brought about by audiological intervention. Follow-up counselling of HA users can significantly increase HA use and decrease the number of non-users. It can also significantly increase the users' handling skills. The cost of follow-up counselling is approximately € 83 per fitted HA, which is an 8.7% increment to the calculated cost of fitting a HA.

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<p> Nonlinear amplification schemes for hearing aids have been developed to deal primarily with the problem of loudness recruitment. The most commonly used form of nonlinear amplification is wide-dynamic-range compression (WDRC). Unfortunately, finding WDRC characteristics that satisfactorily deal with loudness recruitment while maintaining good speech intelligibility has proven difficult. An alternative nonlinear scheme, Advanced Dynamic Range Optimization (ADRO), has been shown in several studies to provide better speech intelligibility and listening comfort than fast-acting WDRC. ADRO uses a set of fuzzy-logic rules to make gain changes to optimize audibility, comfort, protection against loud sound, and noise attenuation. The "hearing protection" gain rule acts instantaneously, whereas the audibility and comfort rules adjust the gain slowly, such that ADRO provides linear amplification most of the time.</p> <p> The goal of this study is to examine the physiological basis for the relative performance of linear amplification, WDRC, and ADRO. Sentences from the TIMIT Speech Database were processed by each algorithm. In the case of WDRC, both single-channel and multi-channel schemes with fast and slow dynamics were tested. Speech signals were presented at 52, 62, 74, and 82 dB SPL (sound pressure level) with various noise levels and types, to simulate real-life environments. The simulations first use an auditory-periphery model to generate a "neurogram" of the auditory nerve's representation of the test speech material. The spectral and temporal modulations in the neurogram are then analyzed by a model of cortical speech processing. The effects of the background noise, the presentation level, the hearing loss and the amplification scheme are evaluated by comparing the cortical model response for a given condition (the "test" response) to the cortical model response to the same TIMIT sentence presented in quiet at 65 dB SPL to the normal-hearing model (the "template" response). From the difference between the test and template responses, a spectro-temporal modulation index (STMI) value is calculated. High STMI values predict good speech intelligibility, while low values predict poor intelligibility. Results show that ADRO is better at restoring the neural representation of speech than the other algorithms tested, even when the WDRC algorithms utilize slow time constants. In the case of no background noise, all the algorithms perform similarly well. However, when background noise is added, STMI values for higher SPLs drop notably for all the algorithms except for ADRO, which sustains a stable value throughout the range of SPLs test.</p> / Thesis / Master of Engineering (MEngr)

Objective: To determine safe output sound pressure levels (SPL) for sound amplification devices to preserve hearing sensitivity after usage. Design: A mathematical model consisting of the Modified Power Law (MPL) (Humes & Jesteadt, 1991) combined with equations for predicting temporary threshold shift (TTS) and subsequent permanent threshold shift (PTS) (Macrae, 1994b) was used to determine safe output SPL. Study sample: The study involves no new human subject measurements of loudness tolerance or threshold shifts. PTS was determined by the MPL model for 234 audiograms and the SPL output recommended by four different validated prescription recommendations for hearing aids. Results: PTS can, on rare occasion, occur as a result of SPL delivered by hearing aids at modern day prescription recommendations. The trading relationship of safe output SPL, decibel hearing level (dB HL) threshold, and PTS was captured with algebraic expressions. Better hearing thresholds lowered the safe output SPL and higher thresholds raised the safe output SPL. Conclusion: Safe output SPL can consider the magnitude of unaided hearing loss. For devices not set to prescriptive levels, limiting the output SPL below the safe levels identified should protect against threshold worsening as a result of long-term usage.

The purpose of the study was to develop and examine a list of potential variables that may account for variability in the dispensing rates of four common hearing aid features. A total of 29 potential variables were identified and placed into the following categories: (1) characteristics of the audiologist, (2) characteristics of the hearing aids dispensed by the audiologist, (3) characteristics of the audiologist?s patient population, and (4) evidence-based practice grades of recommendation for each feature. The potentially associative variables then were examined using regression analyses from the responses of 257 audiologists to a dispensing practice survey. There was a direct relation between price and level of hearing aid technology with the frequency of dispensing product features. There was also a direct relation between the belief by the audiologist that a feature might benefit patients and the frequency of dispensing that feature. In general, the results suggested that personal differences among audiologists and the hearing aids audiologists choose to dispense are related more strongly to dispensing rates of product features than to differences in characteristics of the patient population served by audiologists. An additional finding indicated that evidence-based practice recommendations were inversely related to dispensing rates of product features. This finding, however, may not be the result of dispensing trends as much as hearing aid manufacturing trends.

Objective: To investigate the predicted threshold shift associated with the use of nonlinear hearing aids fitted to the NAL-NL2 or the DSL m[i/o] prescription for children with the same audiograms. For medium and high input levels, we asked: (1) How does predicted asymptotic threshold shifts (ATS) differ according to the choice of prescription? (2) How does predicted ATS vary with hearing level for gains prescribed by the two prescriptions? Design: A mathematical model consisting of the modified power law combined with equations for predicting temporary threshold shift (Macrae, 1994b) was used to predict ATS. Study sample: Predicted threshold shift were determined for 57 audiograms at medium and high input levels. Results: For the 57 audiograms, DSL m[i/o] gains for high input levels were associated with increased risk relative to NAL-NL2. The variation of ATS with hearing level suggests that NAL-NL2 gains became unsafe when hearing loss > 90 dB HL. The gains prescribed by DSL m[i/o] became unsafe when hearing loss > 80 dB HL at a medium input level, and > 70 dB HL at a high input level. Conclusion: There is a risk of damage to hearing for children using nonlinear amplification. Vigilant checking for threshold shift is recommended.

Bakgrund: Personer i åldersspannet 65 till 85 år utgör en stor del av alla hörselskadade iSverige idag. Dessa utgör därmed en stor patientgrupp inom hörselvården. Således är detrelevant att inventera deras förväntningar på hörapparater eftersom förväntningar hos denblivande hörapparatanvändaren kan påverka resultatet vid hörapparatutprovningen. Patientermed höga förväntningar blir oftare nöjdare med sina hörapparater. Genom att ha ett brabemötande och vara lyhörd för patientens förväntningar och önskemål, samt ge patientenadekvat information, kan audionomen hjälpa patienten att uppnå en mer lyckadhörselrehabilitering.Syfte: Syftet med studien var att undersöka vilka förväntningar äldre blivandehörapparatanvändare i åldrarna 65 till 85 år har på hörapparater och hörapparatutprovningen.Metod: Elva blivande hörapparatanvändare intervjuades i en kvalitativ intervjustudie medsemistrukturerade frågor. Insamlade data analyserades sedan med en kvalitativinnehållsanalys.Resultat: Analysen av förväntningarna resulterade i fyra olika teman: förväntade effekter påhörandet, förväntningar på hörapparater, förväntade effekter på livssituationen ochförväntningar på hörapparatutprovningen.Slutsats: De uttryckta förväntningarna på hörapparater och hörapparatutprovningen vargenerellt positiva. Kärnan i förväntningarna handlar om förbättrad kommunikation och ökadlivskvalitet. Det finns också en medvetenhet om hörapparaters begränsningar. Audionomenförväntas kunna ge ett bra bemötande och sprida sina kunskaper till patienterna. För att göradetta behöver audionomen få verktyg för att identifiera och träna på att bemöta patientersförväntningar och på så sätt säkerställa nöjda hörapparatanvändare. / Background: Patients aged between 65-85 years is a large group of patients in the hearinghealth care. Hence, it is important to learn what their expectations may be comprised ofbecause expectations in potential hearing aid users may affect the result of the hearing aidfitting. Patients with high expectations are often more satisfied with their hearing aids. Theaudiologist can, by being responsive to patient's expectations and wishes, and give patientsadequate information, help patients to reach a more successful hearing rehabilitation.Purpose: The purpose of the study was to investigate expectations on hearing aids andhearing aid fitting in elderly (65-85 years) potential hearing aid users.Study design: Eleven participants were individually interviewed in a qualitative interviewstudywith semi-structured questions. Collected data were analysed with a qualitative contentanalysis.Result: The analysis of the expectations resulted in four different themes: expected effects onhearing, expectations on hearing aids, expectations on the life situation and expectations onhearing aid fitting.Conclusion: The expressed expectations on hearing aids and hearing aid fitting weregenerally positive. The core of the expectations contains improved communication andimproved quality of life. There is an awareness of hearing aid limitations. Audiologists areexpected to have a good reception and spread their knowledge to their patients. To do this, theaudiologist need to get tools to identify and practice meeting patients' expectations and thusensure satisfied hearing aid users.

Introduction: This study investigated hearing aid (HA) satisfaction among adult with hearing impairment (HI) in New Zealand. This study aimed to answer three questions: 1) What are the current HA satisfaction levels amongst adult HA users in New Zealand? 2) How do the satisfaction findings of this study compare with other HA satisfaction data? 3) What client factors are related to HA satisfaction? Method: Participants were recruited prospectively. They completed a questionnaire prior to HA fitting and a questionnaire three months post-fitting. Information was collected on: age, gender, HA experience, HI severity, hearing ability, change in hearing ability, hearing handicap, communication self-efficacy, change in communication self-efficacy, HA self-efficacy, HA usage, and number of appointments. HA satisfaction was measured via the Satisfaction with Amplification in Daily Life questionnaire (SADL; Cox & Alexander, 1999). Results: Data were collected for 47 participants. Of these, 91.5% fell within or above the normative range for global satisfaction established by Cox & Alexander (1999). The mean SADL scores were predominantly high compared to previous research. Satisfaction with negative features of HAs was especially high in this study. However satisfaction with the service and cost of HAs was low compared to other research. SADL scores were found to significantly relate to age, gender, change in hearing ability, hearing handicap, communication self-efficacy, change in communication self-efficacy, and HA self-efficacy. Conclusions: Results differed from previous research indicating that HA satisfaction may differ over time and across countries. Assessing HA satisfaction in a comprehensive standardised way, as opposed to with a single-item measure, can help identify important related factors. Targeting identified variables such as communication and HA self-efficacy may lead to improved treatment efficacy.

Introdução: Embora alucinações auditivas sejam consideradas manifestações psicopatológicas, a alucinação musical vem sendo descrita em indivíduos sem antecedentes de psicose e com sintomas otológicos. Assim como ocorre com o zumbido, acredita-se que a perda auditiva seja o principal fator predisponente para o aparecimento da alucinação musical. Até o momento, a alucinação musical tem-se mostrado refratária aos tratamentos usualmente propostos na literatura. Objetivos: 1. Primário: avaliar o efeito do uso de aparelho de amplificação sonora individual, pelo período de um ano, em pacientes com zumbido e alucinação musical, associados à perda auditiva; 2. Secundários: a. avaliar a coexistência de doenças otológicas, neurológicas e psiquiátricas; b. verificar associação entre a melhora do zumbido e a da alucinação musical com uso de aparelho de amplificação sonora individual. Métodos: pela raridade do fenômeno, realizou-se um ensaio clínico não-randomizado que incluiu os primeiros 14 pacientes com zumbido e alucinação musical matriculados no Grupo de Pesquisa em Zumbido do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, adultos, de ambos os gêneros. Todos foram submetidos à avaliação multidisciplinar pela mesma equipe de otorrinolaringologistas, neurologistas e psiquiatras. Todos pacientes tinham critério audiológico para uso de aparelho de amplificação sonora individual e não haviam melhorado dos sintomas com abordagem medicamentosa. O grupo experimental contou com 9 participantes que receberam orientação sobre seus três sintomas auditivos e adaptaram o aparelho de amplificação sonora individual, enquanto o grupo controle contou com 5 participantes que receberam a mesma orientação sobre os sintomas, mas recusaram-se a submeter-se à adaptação do aparelho de amplificação sonora individual. O zumbido foi avaliado antes e após um ano pelo Tinnitus Handicap Inventory e a alucinação musical, pela escala numérica. Resultados: O grau de perda auditiva mostrou-se adequadamente pareado em ambos os grupos, sendo severo a profundo em cerca de 80% dos casos. A avaliação cognitiva mostrou déficit de atenção leve em 33,3% (grupo experimental) e 20% (grupo controle). Atividade epileptiforme esteve presente em 11,1% (grupo experimental) e 20% (grupo controle). A avaliação psiquiátrica evidenciou episódio depressivo em 66,6% (grupo experimental) e 80% (grupo controle), ansiedade generalizada em 11,1% (grupo experimental) e 0% (grupo controle) e ausência de diagnóstico psiquiátrico em 22% (grupo experimental) e 20% (grupo controle). Após um ano, pacientes de ambos os grupos apresentaram melhora do grau de incômodo do zumbido, porém a melhora no grupo experimental foi significativamente maior do que no grupo controle e somente os indivíduos do grupo experimental apresentaram melhora do incômodo com a alucinação musical. Não houve associação entre a melhora do zumbido e da alucinação musical. Conclusão: A alucinação musical, nesta amostra, apresentou-se expressivamente associada ao sexo feminino, aos idosos e à presença dos transtornos de humor. A avaliação multidisciplinar (otológica, psiquiátrica e neurológica) deve ser oferecida a pacientes que apresentem alucinação musical para refinar o diagnóstico. Após um ano de acompanhamento, a amplificação sonora promovida pelo uso de aparelho de amplificação sonora individual, associada à orientação específica sobre zumbido, alucinação musical e perda auditiva foi mais efetiva no controle do zumbido e da alucinação musical que a orientação isolada / Introduction: Although auditory hallucinations are considered psychopathological phenomena, musical hallucinations have been reported in individuals without history of psychosis but with otologic symptoms. As is the case for tinnitus, hearing loss is thought to be the main predisposing factor for the emergence of musical hallucinations. To date, musical hallucinations have remained refractory to the treatment approaches typically recommended in the literature. Objectives: 1. Primary: to assess the effect of one year of hearing aid use in patients with both tinnitus and musical hallucinations associated with hearing loss; 2. Secondary: a. to investigate the coexistence of otologic, neurologic and psychiatric diseases; b. to verify the association between improvement of tinnitus and musical hallucinations using hearing aid. Methods: given the rareness of the phenomenon, a nonrandomized clinical trial was conducted including the first 14 consecutive adult patients of both genders with tinnitus and musical hallucinations enrolled at the Tinnitus Research Group of the Clinicas Hospital of the University of São Paulo School of Medicine. All patients were assessed by the same multidisciplinary team of ENT specialists, neurologists and psychiatrists. All patients met audiologic criteria for use of a hearing aid and had shown no improvement in symptoms after treatment with medications. The experimental group comprised 9 participants who were given counseling on their three auditory symptoms and fitted with hearing aids. The control group comprised 5 subjects given the same counseling but who declined to have hearing aids fitted. Tinnitus was assessed at baseline and again at 1- year follow-up using the Tinnitus Handicap Inventory whereas musical hallucinations were assessed by a numeric scale. Results: The two groups proved suitably matched for deafness, with 80% of the both groups presenting with severe to profound hearing loss. The cognitive assessment revealed mild attention deficit in 33.3% (experimental group) and 20%(control group). Epileptiform activity was detected in 11.1% (experimental group) and 20% (control group). The psychiatric assessment revealed depressive episodes in 66.6% (experimental group) and 80% (control group). Generalized anxiety was found in 11.1% (experimental group) and 0% (control group) and absence of psychiatric diagnoses in 22% (experimental group) and 20% (control group). Patients from both groups showed improved tinnitus handicap grades at 1-year follow-up, although experimental group subjects had a significantly greater improvement than control group subjects. Only individuals from the experimental group improved on musical hallucination handicap. No correlation was found between improvement in tinnitus and improvement in musical hallucinations. Conclusion: In the sample studied, musical hallucination was found in females and elderly adults and was associated with mood disorders. Patients presenting with musical hallucinations should be submitted to a multidisciplinary assessment (otologic, psychiatric and neurologic) to refine the diagnosis. Sound amplification using a hearing aid, combined with specific counseling on tinnitus, musical hallucinations and hearing loss, proved more effective for controlling tinnitus and musical hallucinations after one year than specific counseling alone