Discontinued hearing-aid use is caused by a number of factors, most of which may lead to low hearing-aid self-efficacy (i.e. low confidence in one's ability to B a successful hearing-aid user). This paper describes the development of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA), which was constructed in accordance with published recommendations for self-efficacy questionnaire development. The psychometric properties of the MARS-HA were evaluated with new and experienced hearing-aid users. The results revealed strong internal consistency and good test-retest reliability in both groups, with the following subscales identified both for the new users and the experienced users: (1) basic handling, (2) advanced handling, (3) adjustment to hearing aids, and (4) aided listening skills. Validity was established through the examination of expected differences based on group comparisons, training effects, and the impact of particular hearing aid features. The MARS-HA is a reliable and valid measure of hearing-aid self-efficacy and can be used to assist clinicians in identifying areas of low confidence that require additional audiologic training.

Purpose: The purpose of this study was to examine in listeners with normal hearing and listeners with sensorineural hearing loss the within- and between-group differences obtained with 4 commonly available speech-in-noise protocols. Method: Recognition performances by 24 listeners with normal hearing and 72 listeners with sensorineural hearing loss were compared for 4 speech-in-noise protocols that varied with respect to the amount of contextual cues conveyed in the target signal. The protocols studied included the Bamford-Kowal-Bench Speech-in-Noise Test (BKB-SIN; Etymōtic Research, 2005; J. Bench, A. Kowal, & J. Bamford, 1979; P. Niquette et al., 2003), the Quick Speech-in-Noise Test (QuickSIN; M. C. Killion, P. A. Niquette, G. I. Gudmundsen, L. J. Revit, & S. Banerjee, 2004), and the Words-in-Noise test (WIN; R. H. Wilson, 2003; R. H. Wilson & C. A. Burks, 2005), each of which used multitalker babble and a modified method of constants, as well as the Hearing in Noise Test (HINT; M. Nilsson, S. Soli, & J. Sullivan, 1994), which used speech-spectrum noise and an adaptive psychophysical procedure. Results: The 50% points for the listeners with normal hearing were in the 1- to 4-dB signal-to-babble ratio (S/B) range and for the listeners with hearing loss in the 5- to 14-dB S/B range. Separation between groups was least with the BKB-SIN and HINT (4-6 dB) and most with the QuickSIN and WIN (8-10 dB). Conclusion: The QuickSIN and WIN materials are more sensitive measures of recognition performance in background noise than are the BKB-SIN and HINT materials.

Purpose: The purpose of this tutorial is to provide a comprehensive overview of the self-efficacy framework and its application to audiologic rehabilitation. Method: A literature review was conducted on self-efficacy and its relevance to successful interventions in several health domains. Specific recommendations were presented for audiologic rehabilitation procedures that will enhance self-efficacy. Conclusions: As is the case in other health domains, clinical intervention by audiologists will be more effective when incorporating a self-efficacy framework in the audiologic rehabilitation process.

The relationship between hyperlipidemia and sensorineural hearing loss remains obscure. In this study, we elucidate for the first time the cochlear morphological and auditory alterations and their relationships with hyperlipidemia, atherosclerosis, and endothelial dysfunction in apolipoprotein-E knockout (ApoE-KO) mice. Ten-week-old ApoE-KO mice were fed either atherosclerotic diet (1.25% cholesterol) or normal diet. Wild type mice (C57BL/6J) served as normal controls. Fourteen weeks later, marked hyperlipidemia, atherosclerosis, endothelial dysfunction, and hearing impairment, especially in the high frequencies, had developed in ApoE-KO mice as compared with C57BL/6J mice (P < 0.001). A high positive correlation between hearing loss and the extent of atherosclerosis and plasma total cholesterol levels was found. Hearing loss, especially at high frequencies, was detected in all ApoE-KO mice. Hair cell loss mainly at the base turn, thickening of vascular intima, and lumen stenosis of the spiral modiolar artery (SMA) in cochlea were also found; these histological changes were exacerbated by the atherosclerotic diet. Furthermore, endothelial nitric oxide synthase (eNOS) in aortic wall and cochlea was distinctly reduced in ApoE-KO mice. These results demonstrate that hyperlipidemia and atherosclerosis can induce alterations in cochlear morphology and function. The stenosis of SMA, which may cause cochlear ischemia and hypoxia, endothelial dysfunction, and low eNOS activity, may contribute to hearing loss.

The purpose of this study was to examine the feasibility of using digit triplets in multitalker babble as a paradigm to measure the ability of patients to understand speech in background noise. Nine digits (one to ten, excluding seven) were randomized into triplet sets and embedded in multitalker babble at 6- to -20-dB signal-to-babble (S/B) ratios. Recognition performances by 24 listeners with normal hearing and 48 listeners with sensorineural hearing loss were measured for the digit triplets and for monosyllabic words both in multitalker babble presented at 80-dB SPL. There was essentially no overlap between the distributions of performances by the two groups of listeners on either of the materials. For both groups of listeners, the difference between performances on the materials at the 50% point was approximately 18 dB. Both the word and digit materials in a background of multitalker babble are sensitive to the inabilities of listeners with hearing loss to understand speech in background noise.

The relationship between diabetes mellitus (DM) and the auditory/vestibular system has been investigated for more than a century. Most population-based investigations of hearing loss in persons with diabetes (PWD) have revealed a slow progressive, bilateral, high-frequency sensorineural hearing loss. Despite the growing research literature on the pathophysiology of DM-related hearing loss using various animal models and other human studies, knowledge of specific mechanism of the degenerative changes of the inner ear and/or auditory nerve is far from full elucidation. Recent investigations of the mechanisms underlying the association between hearing loss and DM suggest complex combined contributions of hyperglycemia, oxidative stress resulting in cochlear microangiopathy, and auditory neuropathy. An even lesser understood complication of DM is the effect on the vestibular system. Here we provide an overview of animal and human evidence of pathophysiological changes created by DM and its effects on auditory-vestibular anatomy and function.

The modified Goodman scale, a hearing loss classification scale, is commonly used to describe audiometric findings for both children and adults (Haggard & Primus, 1999). This scale uses one or two word descriptors for hearing level categories and is based on a pure tone average (PTA), the average of hearing thresholds at 500, 1000, and 2000 Hz. Although these categories were developed from clinical and educational observations (Goodman, 1965), degree of hearing loss has not been shown to reliably predict the educational or language performance of children with hearing impairment (Martin & Clark, 1996). This study was designed to evaluate how the presentation modality (hearing loss simulation vs. using a term to describe the hearing loss using the Goodman scale) affects predictions of children's communication difficulties in the classroom by graduate speech-language pathology students. The perceptions of graduate speech-language pathology students were of interest because this population had not been included in earlier investigations, despite the fact that they often work with hearing-impaired children in the school systems. Three levels of hearing loss (mild, moderate, and severe) were introduced using two different presentation conditions. In one condition, a descriptive term from the Goodman scale was used to describe the hearing loss. In the other presentation conditions, a simulated hearing loss was presented to the participants. Following each presentation of each hearing loss, the participants rated the potential communication difficulty a child with that loss may have in the classroom using a questionnaire composed of nine different communication-related tasks (Appendix A). In general, participants predicted significantly greater difficulty when presented with the simulated hearing loss, than when presented with the descriptive term for the same degree of hearing loss with a few exceptions. The results of this study indicated that the standard method of classifying hearing loss results in underestimation of the impact a hearing loss might have for a child.

This study adds to the existing body of research by (a) including a comprehensive analysis of published reviews and primary studies investigating the effects of early identification of hearing loss and intervention on language outcomes; and (b) using advanced statistical techniques to further examine existing data on nearly 5,200 children with hearing loss. Analysis of reviews of primary studies showed these reviews exhibited severe sampling bias, lacked systematic methods for analyzing studies, and did not include a common metric for comparing results across studies nor a mechanism for analyzing how findings from primary studies covaried with other important factors such as parental involvement, fidelity of intervention, or study quality. Without a more rigorous analysis of primary studies, the conclusions drawn from these reviews are questionable. The review of primary studies revealed many methodological problems including weak experimental designs, small sample sizes, attrition or questionable sample selection methods, differences in length of treatment and characteristics of the participants, and inadequate reporting. Many researchers unjustifiably concluded that earlier intervention produced better developmental outcomes. However, almost half of the studies in which children were assessed at older ages showed no relationship between age at identification or intervention and language outcomes. Use of structural equation modeling (SEM) with the SKI*HI National Data Set did not result in models that adequately fit the underlying data. As such, these methods did not result in findings from which we can draw strong conclusions regarding the relationship between age at identification of hearing loss or intervention and child outcomes. To conclude, we know too little about whether earlier identification and intervention is better for children born with hearing loss or who acquire it at young ages. In addition to stronger research designs with sufficient sample sizes, use of reliable measures to collect a broader array of data related to important covariates, better collection of data, and measurement of intervention characteristics, perhaps we should also be asking different questions. We need to know more about what interventions, in which order, provided by whom, and in what ways are most effective for improving developmental outcomes for children with hearing loss.

abstract: It is well understood that many people who experience hearing loss do not realize the extent of their loss and often do not seek help. This resistance to intervention puts them at risk of social isolation, depression and even serious neurological issues such as dementia. This research explores first, the attitudes that people have toward hearing loss and how these attitudes affect the adoption of products and services that could help them. This may not seem like a design question, but it is paramount to designers who seek to improve the quality of life for this population. It is no longer enough to create beautiful, functional products. In order to make a difference in people’s lives, designers need to understand the underlying motivations that drive behavior. This informs the second question this study seeks to answer, what changes can be made to current products and services on the market in order to increase adoption. Through a series of qualitative interviews with seniors experiencing hearing loss, this study finds that the main factors in their attitudes towards hearing loss are their feelings towards aging in general, their susceptibility to stigma, and their perceptions of the cost and functionality of the hearing devices available. However, the most important factor found in this study is a lack of awareness. Awareness of their own level of hearing loss. Awareness of the risks associated with putting off intervention. And awareness of the products and services available to help. Thus, design solutions that focus on visibility of services and patient education will have the most meaningful impact on quality of life for those who suffer from hearing loss. / Dissertation/Thesis / Masters Thesis Design 2019

Indiana University-Purdue University Indianapolis (IUPUI) / Age-related hearing loss is an acute health problem affecting people worldwide, often arising due to defects in the proper functioning of sensory hair cells in the inner ear. The apical surface of sensory hair cells contains actin-based protrusions known as stereocilia, which detect sound and head movements. Since hair cells are not regenerated in mammals, it is important to maintain the functioning of stereocilia for the life of an organism to maintain hearing ability. The actin filaments within a stereocilium are extensively crosslinked by various actin crosslinking proteins, which are important for stereocilia development and maintenance. Multiple studies have shown that the stereocilia actin core is exceptionally stable whereas actin is dynamic only at the tips of stereocilia. However, whether the actin crosslinking proteins, which are nearly as abundant as actin itself, are similarly stable or can freely move in and out of the core remains unknown. Loss or mutation of crosslinkers like plastin-1, fascin-2, and XIRP2 causes progressive hearing loss along with stereocilia degeneration while loss of espin prevents stereocilia from even developing properly. Do these phenotypes stem from an unstable stereocilia core? Does crosslinking confer stability to the core? To address these questions, we generated novel transgenic reporter lines to monitor the dynamics of actin in mice carrying fascin-2R109H mutation and espin null mice and also to study the dynamics of actin crosslinkers, in vivo and ex-vivo. We established that actin crosslinkers readily exchange within the highly stable F-actin structure of the stereocilia core. In addition, we determined that stereocilia degeneration in mice carrying fascin-2R109H mutation and espin null mice could possibly occur due to a less stable actin core. These studies suggest that dynamic crosslinks stabilize the core to maintain proper stereocilia functioning. Future work warrants understanding the reason behind the importance of dynamic crosslinks within a stable stereocilia core. Actin stability not only depends on actin crosslinkers, but also on actin filament composition as evident from distinct stereocilia degeneration and progressive hearing loss patterns in hair-cell specific knockout of actin isoforms. Although beta- and gamma- actin polypeptide sequences differ by only 14 four amino acids, whether the latter determine the unique function of each cytoplasmic actin isoform was previously unknown. Here we determined that these four critical amino acids determine the unique functional importance of beta-actin isoform in sensory hair cells. Taken together, our study demonstrates that actin cytoskeletal proteins are important for the morphogenesis and maintenance of stereocilia.