Background: Several self-report measures exist that target different aspects of outcomes for hearing aid use. Currently, no comprehensive questionnaire specifically assesses factors that may be important for differentiating outcomes pertaining to hearing aid style. Purpose: The goal of this work was to develop the Style Preference Survey (SPS), a questionnaire aimed at outcomes associated with hearing aid style differences. Two experiments were conducted. After initial item development, Experiment 1 was conducted to refine the items and to determine its psychometric properties. Experiment 2 was designed to cross-validate the findings from the initial experiment. Research Design: An observational design was used in both experiments. Study Sample: Participants who wore traditional, custom-fitted (TC) or open-canal (OC) style hearing aids from 3 mo to 3 yr completed the initial experiment. One-hundred and eighty-four binaural hearing aid users (120 of whom wore TC hearing aids and 64 of whom wore OC hearing aids) participated. A new sample of TC and OC users (n 5 185) participated in the cross-validation experiment. Data Collection and Analysis: Currently available self-report measures were reviewed to identify items that might differentiate between hearing aid styles, particularly preference for OC versus TC hearing aid styles. A total of 15 items were selected and modified from available self-report measures. An additional 55 items were developed through consensus of six audiologists for the initial version of the SPS. In the first experiment, the initial SPS version was mailed to 550 veterans who met the inclusion criteria. A total of 184 completed the SPS. Approximately three weeks later, a subset of participants (n 5 83) completed the SPS a second time. Basic analyses were conducted to evaluate the psychometric properties of the SPS including subscale structure, internal consistency, test-retest reliability, and responsiveness. Based on the results of Experiment 1, the SPS was revised. A cross-validation experiment was then conducted using the revised version of the SPS to confirm the subscale structure, internal consistency, and responsiveness of the questionnaire in a new sample of participants Results: The final factor analysis led to the ultimate version of the SPS, which had a total of 35 items encompassing five subscales: (1) Feedback, (2) Occlusion/Own Voice Effects, (3) Localization, (4) Fit, Comfort, and Cosmetics, and (5) Ease of Use. The internal consistency of the total SPS (Cronbach'sa5 .92) and of the subscales (each Cronbach'sa..75) was high. Intraclass correlations (ICCs) showed that the test-retest reliability of the total SPS (ICC5.93) and of the subscales (each ICC..80) also was high. TC hearing aid users had significantly poorer outcomes than OC hearing aid users on 4 of the 5 subscales, suggesting that the SPS largely is responsive to factors related to style-specific differences. Conclusions: The results suggest that the SPS has good psychometric properties and is a valid and reliable measure of outcomes related to style-specific, hearing aid preference.

Background: Several self-report measures exist that target different aspects of outcomes for hearing aid use. Currently, no comprehensive questionnaire specifically assesses factors that may be important for differentiating outcomes pertaining to hearing aid style. Purpose: The goal of this work was to develop the Style Preference Survey (SPS), a questionnaire aimed at outcomes associated with hearing aid style differences. Two experiments were conducted. After initial item development, Experiment 1 was conducted to refine the items and to determine its psychometric properties. Experiment 2 was designed to cross-validate the findings from the initial experiment. Research Design: An observational design was used in both experiments. Study Sample: Participants who wore traditional, custom-fitted (TC) or open-canal (OC) style hearing aids from 3 mo to 3 yr completed the initial experiment. One-hundred and eighty-four binaural hearing aid users (120 of whom wore TC hearing aids and 64 of whom wore OC hearing aids) participated. A new sample of TC and OC users (n 5 185) participated in the cross-validation experiment. Data Collection and Analysis: Currently available self-report measures were reviewed to identify items that might differentiate between hearing aid styles, particularly preference for OC versus TC hearing aid styles. A total of 15 items were selected and modified from available self-report measures. An additional 55 items were developed through consensus of six audiologists for the initial version of the SPS. In the first experiment, the initial SPS version was mailed to 550 veterans who met the inclusion criteria. A total of 184 completed the SPS. Approximately three weeks later, a subset of participants (n 5 83) completed the SPS a second time. Basic analyses were conducted to evaluate the psychometric properties of the SPS including subscale structure, internal consistency, test-retest reliability, and responsiveness. Based on the results of Experiment 1, the SPS was revised. A cross-validation experiment was then conducted using the revised version of the SPS to confirm the subscale structure, internal consistency, and responsiveness of the questionnaire in a new sample of participants Results: The final factor analysis led to the ultimate version of the SPS, which had a total of 35 items encompassing five subscales: (1) Feedback, (2) Occlusion/Own Voice Effects, (3) Localization, (4) Fit, Comfort, and Cosmetics, and (5) Ease of Use. The internal consistency of the total SPS (Cronbach'sa5 .92) and of the subscales (each Cronbach'sa..75) was high. Intraclass correlations (ICCs) showed that the test-retest reliability of the total SPS (ICC5.93) and of the subscales (each ICC..80) also was high. TC hearing aid users had significantly poorer outcomes than OC hearing aid users on 4 of the 5 subscales, suggesting that the SPS largely is responsive to factors related to style-specific differences. Conclusions: The results suggest that the SPS has good psychometric properties and is a valid and reliable measure of outcomes related to style-specific, hearing aid preference.

Data from earlier studies that presented 70 words at 24 to 0 dB signal-to-babble (S/B) ratios indicated that most young listeners with normal hearing required 0 to 6 dB S/B ratios to attain 50% correct word recognition. Older listeners with hearing loss often required a >12 dB S/B ratio to attain 50% correct word recognition. In our study, we converted the Words in Noise test from one 70-word list into two 35-word lists for quicker administration by clinicians. Using baseline data from previous studies, we used two strategies to randomize the 35-word lists: based on recognition performance at each S/B ratio and based on recognition performance only. With the first randomization strategy, the 50% correct word-recognition points on the two lists differed by 0.5 dB for 72 listeners with hearing loss. With the second randomization strategy, 48 listeners with hearing loss performed identically on the two lists.

According to the WHO world health organization, more than five percent of the world population needs rehabilitation for hearing loss, HL. Hearing loss is known to cause many negative health implications, including cognitive decline, and social isolation. The present study has been conducted to find out the impact of Bone anchored hearing aids, BAHA, on the Quality of Life in Adults, for this purpose, a systematic literature review was carried out among three databases, CINAHL, Pub Med, and Web of Science to identify the most relevant journal articles published over the last ten years between January 2012 till January 2022. There were seven studies selected based on inclusion and exclusion criteria. The study results were synthesized, and it was found that overall BAHA shows a positive impact on Quality-of-Life QoL among its users. It has been recommended that future research should be carried out with longitudinal studies and large study samples to establish the authenticated relationship between BAHA and its positive impact on Quality of Life

For children with hearing loss, spoken language development often requires the use of hearing aids. Young children often have to rely on their parents or other adults to confirm that their hearing aids are functioning correctly; however, less than 50% of parents check their child’s hearing aids every day. Because of the significant likelihood that a hearing aid malfunction could go unnoticed, it is recommended that children learn hearing aid self-management skills in elementary school and become independent with these skills by middle school. Using the ICF Model of disability, self-management skills should include more than just hearing aid skills, but also skills such as self-advocacy; these can be grouped under one umbrella as “hearing loss self-management skills”. Pediatric self-management skills are associated with improved outcomes for other complex health conditions and have been shown to be responsive to pediatric-focused interventions. While there have been studies to design engaging ways of increasing these hearing loss self-management skills in adults, few have involved children. This study seeks to answer the following two research questions: the first, “What are the baseline hearing loss self-management skills in middle school-aged children?”; the second, “Are educational videos an effective way to increase hearing loss self-management skills in middle school-aged children?”. To answer the first question, children between the ages of 11 and 14 who use at least one hearing aid were asked to answer questions based on the Audiology Self-Advocacy Checklist – Middle School (ASAC-MS) on a scale of “Never/Rarely/Sometimes/Almost all the Time”, to observe their baseline self-reported skills. To answer the second question, a playlist of seven narrated videos with subtitles and visible faces for lipreading was created to address the different topics of the ASAC-MS. The participants were asked to watch these videos and answer the ASAC-MS again. While data collection is not complete, the research team anticipates that most participants will rate their skills in the Rarely or Sometimes categories in the pre-intervention ASAC-MS, and anticipates that the post-intervention ASAC-MS scores will be higher than the pre-intervention ASAC-MS scores. Answering these two research questions is an important step in identifying the needs of current young hearing aid users and identifying ways to meet these needs. Improved hearing loss self-management skills may result in improved speech and language for children with hearing loss in the future.

A summary of the results shows that with 5 of the 9 subjects the high-frequency consonant scores indicated the same aid for the patient that the NU-6 scores indicated. In 2 cases the NU-6 indicated amplification was appropriate whereas the high-frequency consonant scores indicated amplification was not appropriate. Obviously, the high-frequency consonant scores should be considered supplemental to the NU-6 scores and not as a replacement for the NU-6. The combination of the NU-6 and the high-frequency consonant results for Subject 1 may indicate that the patient should have received further counseling and should have been taught how to communicate more effectively without an aid. The high-frequency consonant scores obtained by 2 of the subjects indicated different aids than the ones indicated by the NU-6 test and the patient preference. Perhaps the reason the patient chose an aid other than the one that would most benefit him was that he was most comfortable with the aid that allowed him to hear in the manner to which he was accustomed, even if he did not do as well with it. If a person had become accustomed to not hearing the high-frequency sounds, an aid that suddenly allowed him to hear those sounds might disturb him. The addition of high-frequency amplification might have made speech sound foreign to him. It would have been much easier for him to choose the aid that he was most comfortable with.(ABSTRACT TRUNCATED AT 250 WORDS)

<p>Sensorineural hearing loss imparts two serious hearing deficits in hearing-impaired people: reduced dynamic range of hearing and reduced frequency selectivity. Psychophysically, these deficits render loss of speech audibility and speech intelligibility to a hearing-impaired person. Studies of an impaired cochlea in cats have shown that the hearing loss originates from damage to or complete loss of inner and outer hair cells. Neurophysiology of an impaired cochlea in cats shows that the tuning curves of the auditory nerve fibers become elevated and broadened. Amplification in hearing aids has been used to restore audibility in hearing-impaired people. Multiband compression has been commercially available in conventional hearing aids to compensate for the reduced dynamic range of hearing. However, little has been achieved to improve the intelligibility of speech in the hearing-impaired people. The aim of this thesis is to restore not only the speech audibility in a hearing-impaired person, but also to improve their speech intelligibility through some hearing-aid signal processing. The compensation technique used in this thesis for speech intelligibility is based on the hypothesis that a narrowband response of the auditory nerve fibers to speech signals ensure phonemic discriminability in the central nervous system.</p><p>Miller et al. [1999] have proposed contrast-enhancing frequency shaping ( CEFS) to compensate for the broadband responses of the fibers to first and second formants (Fl and F2) of a speech stimulus. Bruce [2004] has shown that the multiband compression can be combined with CEFS without counteracting each other. In Bruce's algorithm, a multiband compressor is serially combined with a time-domain CEFS filter. The MICEFS algorithm, herein presented, is a combination of multiband compression and an improved version of CEFS implemented in the frequency domain. The frequency domain implementation of MICEFS has improved the time delay response of the algorithm by 10 ms as compared to series implementation proposed by Bruce. The total time delay of the MICEFS algorithm is 16 ms, which is still longer than the standard time delay of 10 ms in hearing aids. The MICEFS algorithm was tested on a computational model of auditory periphery [Bruce et al., 2003] using a synthetic vowel and a synthetic sentence. The testing paradigm consisted of five conditions: 1) unmodified speech presented to a normal cochlea; 2) speech modified with halfgain rule presented to an impaired cochlea; 3) CEFS modified speech presented to the impaired cochlea; 4) speech modified with MICEFS presented to the impaired cochlea, and; 5) MICEFS-modified speech with some added noise in the formant estimation presented to an impaired cochlea. The spectral enhancement filter used in MICEFS has improved the synchrony capture of the fibers to the first three formants of a speech stimulus. MICEFS has also restored the correct tonotopic representation in the average discharge rate of the fibers at the first three formants of the speech.</p> / Thesis / Master of Applied Science (MASc)

Fragestellungen • Welchen Signalertrag kann ein Kraftsensor auf Basis eines Einkristallpiezo im Incudostapedialgelenk liefern? • Welchen Einfluss haben die anatomisch variierenden Randbedingungen des Mittelohres sowie Variationen der Positioniergenauigkeit? • Welche Leistungsparameter kann ein Wandler erreichen welcher das Sensorkonzept um ein stapesseitiges Aktorelement erweitert? • Welche prospektive medizinische Indikation lässt sich aus den Leistungsparametern abschätzen? Material und Methode Untersucht wurden sowohl Sensoren als auch Sensor-Aktor-Elemente, im Folgenden Wandler genannt, zum Einsatz im ISG des Mittelohres. Die Abmessungen betrugen jeweils 4.5x2.5x1 mm. Die Einkristallpiezos wurden dabei innenliegend auf je eine dünne ovale Biegeplatte aus Titan geklebt. Mit einer entsprechenden Durchführung der Anschlusskabel durch das Gehäuse ist eine hermetische Dichtung und damit die Biokompatibilität der Gesamtbaugruppe realisierbar. Durch die Bauform entspricht die Wirkungsweise von Sensor- und auch Aktor-element hauptsächlich einem Biegewandler. Der Sensor ist ein Kraftsensor. Der Aktor arbeitet abhängig von der Kettenvorspannung als eine Mischung aus Weg- und Kraftgeber. Die Elemente lagen jeweils als aufgebautes Testmuster vor. Sie konnten sowohl in einem physikalischen Modell des Mittelohrs als auch in Humanpräparaten untersucht werden. Als Eingangssignal kam jeweils ein Schallsignal über einen Geber im Gehörgang zum Einsatz, welches mit einem Mikrofon vor dem Trommelfell als Referenz gemessen wurde. Ein Maß für den Höreindruck der hypothetischen Patienten/Patientinnen stellt, wie bei Untersuchungen am Felsenbein üblich, die Bewegung der Steigbügelfußplatte dar. Diese kann im Felsenbein mit einem Laser Doppler Vibrometrie (LDV) und im Modell mit einem Mikrofon in einer Hohlkammer unter der Membran, auf welcher der künstliche Steigbügel sitzt, gemessen werden. Das dynamische Messsignal des Sensors wurde als elektrische Spannung aus dem Piezoelement nach einer Vorverstärkung von einer Messkarte im PC erfasst. Die Signalverarbeitung im kombinierten Sensor-/Aktorbetrieb erfolgte mit einem Field Programmable Gate Array (FPGA). Das Aktorelement wurde ebenfalls von diesem angesteuert. Durch einen Vergleich der Stapesfußplattenschwingung bei Aktoranregung und Anregung mit Schalldruck im Gehörgang konnte jeweils auf einen äquivalenten Schalldruck zurückgerechnet werden. Für den kombinierten Wandlerbetrieb wurde ein Least Mean Square (LMS) zur Rückkopplungsunterdrückung auf dem FPGA implementiert. Der Sensor wurde in zehn Felsenbeinen untersucht, der kombinierte Wandler kam in sechs Felsenbeinen (zwei ohne und vier mit mittels CO2-Laser erweitertem Gelenkspalt) zum Einsatz. Der Zugang erfolgte dabei über eine posteriore Tympanotomie mit Auftrennung des ISGs. Dies und die Insertion von Sensor oder Wandler erfolgte mit Standardinstrumentarium. Weitere fünf Felsenbeine wurden entlang der Normalenebene zur Stapeslängsachse auf Höhe des ISGs gespalten um Kraft-Weg-Messungen mit Kraftmesszelle und Lasertriangulationssensor durchführen zu können. Der laterale Schalleitungsapparat (Gehörgang, Trommelfell, Hammer-Amboß-Komplex) und der mediale Teil (Stapes, rundes und ovales Fenster, Innenohr) blieben hierbei intakt. Dadurch konnte die Vorspannung auf den Sensor nach Einbau und die amboss- und sensorseitige statische Steifigkeitsvariation der Kette bei Auslenkung untersucht werden. In einem Finite-Elemente-Methode (FEM) Modell des Mittelohrs und des Sensors konnten zur Validierung der Messergebnisse vergleichende Simulationen durchgeführt werden. Da das Simulationsmodell auf dynamische Felsenbeinmessungen gefittet ist sind sowohl quasistatische Untersuchungen als auch Aussagen über das Verhalten der Kette bei Vorspannung nur eingeschränkt möglich. Die Ergebnisse der Wandlermessungen wurden in ein Audiogramm eingetragen und mit Literaturdaten für typische Formen der Hörschädigung verglichen. Hiermit konnte eine erste Einschätzung über eine mögliche zukünftige medizinische Indikation getroffen werden. Ergebnisse und Schlussfolgerungen Das Sensorelement des Wandlers erzielte bei Schallanregung mit 1 Pa am Trommelfell Signalerträge von 0.1 mV bis 1 mV im audiologischen Frequenzbereich. Der Sensor nutzt einen Teil der natürlichen Übertragung im Gehörorgan (Gehörgang, Trommelfell, Hammer, Amboss). Die Übertragung des Signals erfolgt auf dem natürlichen Übertragungsweg. Dies kann einen positiven Einfluss auf Parameter wie das Klangbild oder das Richtungshören haben. Der Sensor zeigte sich robust gegenüber verschiedenen äußeren Einflussfaktoren. Kleine Variationen der Sensorposition oder zusätzliche Kontaktpunkte mit umliegenden Strukturen an Ambossfortsatz oder Hammergriff gehen mit einem Signalverlust von etwa 5 dB einher. Ein zusätzlicher Kontakt am Promontorium erzielt durch die verbesserte Lagerung des Sensors einen Signalgewinn von 5 dB. Die Leistung des Wandlers, insbesondere des Aktorelements, ist sehr stark von der Vorspannung in der Ossikelkette abhängig, welche bei der Wandlerinsertion hervorgerufen wird. Durch ein Aufweiten des Gelenkspalts versteift sich die Ossikelkette stapesseitig mehr als ambossseitig. Mit Hilfe künstlich erweiterter Gelenkspalte im Felsenbeinexperiment konnte das Verhalten zukünftiger miniaturisierter Wandlerelemente studiert werden. Der Dynamikbereich des Wandlers erstreckt sich experimentell zwischen einer sensorseitigen Hörschwelle mit breitbandig 30 dB Sound Pressure Level (SPL) und einem maximalen äquivalenten Aktorpegel von tieffrequent 70 dB SPL bis zu hochfrequent 120 dB SPL. Die Verstärkungsleistung innerhalb dieses Dynamikbereichs liegt hochfrequent bei 30 dB. Eine zukünftige medizinische Indikation des Wandlers kann im Bereich der Hochtonschwerhörigkeit und damit auch der klassischen Altersschwerhörigkeit liegen. Eine Behandlung von Patienten mit einer typischen Lärmschädigung ist ebenfalls denkbar. Der Sensor erscheint bereits für verschiedene Applikationen anwendbar während es für den kombinierten Wandler noch einige offene Fragen gibt, nichtsdestotrotz das Konzept bereits erfolgversprechend ist. Während die Leistungsfähigkeit des Wandlers prinzipbedingt durch die schwebende Lagerung nicht über den kompletten Frequenzbereich vollständig auf dem gleichen Niveau anderer implantierbarer Hörsysteme liegt, zeichnet sich das Konzept besonders durch einen vergleichsweise einfachen und prinzipiell reversiblen Eingriff aus.:I Einleitung II Inhalt und thematischer Zusammenhang der Publikationen III Publikation 1: Influence of the middle ear anatomy on the performance of a membrane sensor in the incudostapedial joint gap IV Publikation 2: Examination of a mechanical amplifier in the incudostapedial joint gap: FEM simulation and physical model V Publikation 3: Fully implantable hearing aid in the incudostapedial joint gap VI Ergebnisse und Diskussion VII Zusammenfassung VIII Summary / Background Implantable hearing systems have been a research topic for some time. Because of the im proving technology especially in terms of electronics miniaturisation and power supply fully implantable devices become the focus of attention. The performance parameters of existing components often meet the technical requirements but lack medical practicability. The insertion of the devices is often a very complex procedure and causes non-reversible changes in the patient’s anatomy. A new transducer system for sensor and actuator elements is introduced. It attempts to account for a reversible minimally invasive approach and feasible handling. The main idea is to insert a transducer into the Incudostapedial Joint (ISJ) gap. The design consists of a titanium housing with one or two titanium bending plates which are internally equipped with single crystal piezos for signal-acquisition or -generation. The attachment of the transducer is free floating in the joint gap without additional fixation points in the tympanic cavity. This concept enables a reduced sensitivity to body noise. The publications deal with the analysis of possible performance parameters of the transducers components in experiment and simulation. A further emphasis of the studies is how the humans highly variable anatomy affects the results. Questions • Which signal yields a force sensor based on a bending plate single crystal piezo in the ISJ? • How does the anatomical variation and the position accuracy influence the results? • What performance is to be expexted of a combined sensor/actuator transducer? • What is the prospective medical indication of the proposed transducer design? Material and methods A sensor and a transducer consisting of a sensor and an actuator element for application inside the ISJ gap were studied. Both could be prospective components of future Cochlea Implants (CIs) or Active Middle Ear Implants (AMEIs). The dimensions are 4.5x2.5x1 mm. The single crystal piezos are glued inside a thin oval titanium plate, with a proper lead of the wires out of the hermetically sealed housing ensuring biocompatibility of the whole assembly. The sensor- and actuator element mainly act in bending mode. The actuator works in a mix between force- and displacement actuator dependending on the ossicular chain pretension. The elements used were manually constructed prototypes. Measurements were performed with the elements inserted into a physical model of the middle ear as well as in human temporal bones. A sound generator’s signal in the auditory canal was the input into the system. The sound signal was measured in front of the tympanic membrane by a reference microphone. The movement of the stapes footplate was used as a measurement for the theoretical hearing sensation. It was measured either by Laser Doppler Vibrometry (LDV) for the temporal bone measurements or with a small microphone inside a cavity beyond the physical models plastics membrane equipped with the artificial stapes. The dynamic signal of the sensor in the form of an electrical voltage from the piezo element was preamplified and subsequently acquired by a data acquisition card. The signal conditioning and processing for the combined sensor- actuator-transducer was realised with an Field Programmable Gate Array (FPGA) card. With a comparison of the stapes footplate movement at actuator-excitation and sound-excitation a equivalent sound pressure could be calculated. For the combined transducer-operation a Least Mean Square (LMS) was established to suppress the feedback between sensor and actuator. The sensor was examined in ten temporal bones, the combined transducer was evaluated in six temporal bones (two unaltered and four with a joint gap extended by a CO2-laser). The access was untertaken in terms of a posterior tympanotomie with separation of the ISJ with needle or sickle knife. The insertion of sensor or transducer was done with standard instruments. Further five temporal bones were split normal to the stapes long axis at the level of the ISJ gap to measure force-displacement relations with load cell and laser triangulation sensor. The lateral sound conducting apparatus (auditory canal, tympanic membrane, malleus-incus-complex) remained intact as well as the medial part (stapes, inner ear with round and oval window). Therefore the pretension on the sensor element after insertion and the variation of the stiffness on both parts of the ossicular chain could be observed. In an Finite-Elemente-Method (FEM) model of the middle ear and the sensor the measurement results could be validated. Because the simulation model is fitted to dynamic temporal bone measurements the prediction of the systems behaviour is has some restrictions for quasistatic examinations and the analysis of the ossicular chain under pretension. The results of the transducer measurements are endorsed in an audiogram and compared with literature und typical forms of hearing impairment. This is sufficient for a first estimation of the prospective medical indication. Results and conclusion The transducer’s sensing element shows a signal yield from 0.1 mV to 1 mV for a sound pressure excitation of 1 Pa at the ear drum. The sound transmission occurs on the natural pathway. This could be beneficial to parameters like acoustic pattern and directional hearing could operate normally. The sensor is resilient against several factors. Small variations in the sensor position or additional contact points with the surrounding anatomy at long process of incus or malleus evoke a signal loss of up to 5 dB. An additional contact point with the promontory cause a signal gain of 5 dB due to the improved sensor fixation. The performance of the transducer and especially the actuator element depends strongly on the ossicular chain pretension which is induced during transducer insertion. The ossicular chain is stiffening much more on the stapes-side than on the incus-side during the stretch of the joint gap. By means of artificially widended joint gaps in temporal bone experiments the behavior of future miniaturised transducers could be studied. The experimental dynamic range of the presented transducer ranges from a sensor’s broadband hearing threshold level of 30 dB Sound Pressure Level (SPL) up to an actuator’s maximum an equivalent sound pressure level of 70 dB SPL low frequency respectively 120 dB SPL for high frequencies. The amplification performance of the transducer within this dynamic range is located at about 30 dB for high frequencies. A prospective medical indication of the transducers could be the treatment of high frequency hearing loss and therefore also presbyacusis. A treatment for patients with typical noise induced hearing loss seems to be equally feasible. At this stage in development, it seems feasible to implant the sensor-only concept in a number of applications, while the transducer concept faces some questions to resolve but is nevertheless promising. The transducers performance is not on the same level like other approaches in terms of technical characteristics for the whole frequency range but the concept stands out regarding feasible insertion and minimal invasivity.:I Einleitung II Inhalt und thematischer Zusammenhang der Publikationen III Publikation 1: Influence of the middle ear anatomy on the performance of a membrane sensor in the incudostapedial joint gap IV Publikation 2: Examination of a mechanical amplifier in the incudostapedial joint gap: FEM simulation and physical model V Publikation 3: Fully implantable hearing aid in the incudostapedial joint gap VI Ergebnisse und Diskussion VII Zusammenfassung VIII Summary

Thesis (M Speech Path)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Various approaches to the communication-development of the young child with a hearing impairment exist, of which the auditory-verbal approach is one. This approach is based on the principle that the child with a hearingimpairment develops speech- and language skills by using his/her residual hearing that is appropriately strengthened with the use of a hearing aid and/or cochlear implant. One of the most important requirements for the successful application of this approach is the appropriate transfer of the techniques and strategies that is used in institution-based intervention to the child’s home environment. Parents, teachers, speech-language therapists and audiologists are responsible for facilitating the transfer of intervention methods and acquired skills to the home environment and it is important that all team members are aware of his/her own, as well as each other’s roles, in the application of this approach. The principal aim of the proposed research project was to describe and explain the perceptions of parents/caregivers, teachers, speech-language therapists and audiologists, that are involved in the intervention of the hearing impaired child, regarding the auditory-verbal approach to education. Semi-structured interviews were conducted with nine parents of hearing impaired children younger than the age of four, and with four teachers that are involved in the education of the said children. Lastly, semi-structured interviews were held with four speech-language therapists and two audiologists that are involved in the provision of the intervention to hearing impaired children younger than four years. All the participants were affiliated with a specific centre for children with hearing impairment in the Western Cape province of South Africa. All the participants noted that parents must take part in the decision-making process with regards to the selection of the most suitable communication approach for their child with a hearing loss. Participants also agreed that most parents choose the auditory-verbal approach to communication development of their child because speech as a communication medium, is familiar to them and it is also associated with normality. Parents also indicated that the auditory-verbal approach is the most suitable approach for all children with a hearing loss. Teachers, speech-language therapists and audiologists did not completely agree with the parents as they mentioned some aspects, e.g. the presence of additional disabilities must be taken into account before a decision can be made regarding whether the child with hearing loss could follow the auditory-verbal approach to communication development. All participants displayed a positive attitude towards the auditory-verbal approach and it appears that parents, teachers, speech-language therapists and audiologists have good insight into the principles and outcomes of this approach. / AFRIKAANSE OPSOMMING: Daar bestaan verskeie benaderings tot kommunikasie-ontwikkeling by die jong kind met gehoorverlies waarvan die ouditief-verbale benadering een opsie is. Hierdie benadering is gebaseer op die beginsel dat die kind met gehoorverlies spraak- en taalvaardighede ontwikkel deur gebruik te maak van hulle residuele gehoor wat deur middel van die gebruik van ‘n gehoorapparaat en/of kogleêre inplanting toepaslik versterk word. Een van die belangrikste vereistes vir die suksesvolle toepassing van die benadering is toepaslike oordrag van die tegnieke en strategieë wat in terapie gebruik word, na die kind se tuisomgewing. Ouers, onderwysers, spraak-taalterapeute en oudioloë speel ‘n baie belangrike rol om hierdie oordrag na alledaagse kontekste te fassiliteer en dit is belangrik dat elke spanlid bewus is van sy/haar rol asook die ander lede se rolle in die toepassing van die benadering. Die hoofdoelwit van die voorgestelde navorsingsprojek was om ouers/versorgers, onderwyseresse, spraaktaalterapeute en oudioloë, betrokke by die intervensie en opvoeding van die kind met gehoorverlies, se persepsies rakende die ouditief-verbale benadering tot opvoeding te beskryf en te verduidelik. Tydens die studie is daar semi-gestruktureerde onderhoude gevoer met onderskeidelik nege ouers van kinders, jonger as vier-jaar oud, met gehoorgestremdheid en met vier onderwyseresse wat betrokke is by die die opvoeding van genoemde ouers se kinders met gehoorverlies. Laastens is daar ook semi-gestruktureerde onderhoude gevoer met vier spraak-taalterapeute en twee oudioloë wat betrokke is by die verskaffing van intervensie aan kinders met gehoorverlies, jonger as vier-jaar oud. Al die deelnemers was verbonde aan ’n spesifieke sentrum vir kinders met gehoorverlies in die Wes-Kaap provinsie van Suid Afrika. Al die deelnemers het aangedui dat ouers betrek word by die besluitnemingsproses rakende die keuse van die mees geskikte kommunikasie-benadering vir die kind met gehoorverlies. Deelnemers het almal saamgestem dat ouers meestal die ouditief-verbale benadering tot kommunikasie-ontwikkeling vir hulle kind kies omdat spraak as kommunikasiemedium bekend is aan die ouers en verband hou met normaliteit. Ouers het aangedui dat die ouditief-verbale benadering die mees toepaslike benadering is vir enige kind met gehoorverlies. Onderwyseresse, spraak-taalterapeute en oudioloë het nie volkome saam met die ouers gestem nie en hulle het genoem dat daar sekere aspekte, byvoorbeeld die teenwoordigheid van bykomende gestremdhede, is wat oorweeg moet word voor daar besluit word of die kind die ouditief-verbale benadering tot kommunikasieontwikkeling moet volg. Deelnemers het oor die algemeen ‘n positiewe houding getoon teenoor die ouditief-verbale benadering en dit wil voorkom asof ouers, onderwyseresse, spraak-taalterapeute en oudioloë goeie begrip toon van die beginsels en uitkomstes van die benadering.

Research evidence indicates that hearing aids and auditory trainers worn by school children routinely malfunction. Ensuring properly functioning amplification is a preferred educational practice and is required by PL 94-142 regulations. Research was needed to determine if schools were complying with the regulations and recommended educational procedures. This study described and evaluated procedures used by educational agencies to monitor and maintain amplification units worn by hearing-impaired students. Two examiner-developed survey intruments were mailed to residential and public day school teachers and administrators to collect data and answer 11 research questions pertaining to: (1) monitoring and maintenance procedures, (2) relationships between demographic, personnel, and placement characteristics and preferred monitoring and maintenance practices, and (3) monitoring and maintenance practices compared with a model of preferred practice. Personnel were surveyed in one residential school for the deaf in each state and a stratified random sample of 200 public day schools. A total of 310 (63%) surveys were returned from 164 (65.6%) administrators and 146 (58.4%) teachers. Results indicated that the majority of programs had some system of monitoring and maintaining amplification units, but only 54.1% (73) performed daily checks of hearing aids and 58.3% (67) performed daily checks of auditory trainers. Teachers in 76.9% of the sample reported that electroacoustic analysis was available as one part of audiologic evaluation, but not usually scheduled on a routine basis. Teachers were responsible for monitoring activities in over 75% of programs, regardless of the educational model: self-contained, resource, or itinerant. Significant positive relationships were found between (1) program size and one preferred monitoring and maintenance variable, (2) full-time audiologist and three preferred variables, (3) residential school placement and four preferred variables, (4) inservice training and three preferred variables, (5) full-time audiologist and program size and (6) full-time audiologist and residential school placement. These and additional findings suggest that while some improvement in monitoring and maintenance practices has occurred since the implementation of PL 94-142, full compliance by employing preferred professional practices has not been achieved. Recommendations are made for improving personnel preparation, monitoring and maintenance practices, and research.