Optimising outcomes for children with hearing impairment (HI) requires a family centred approach that prioritises parent involvement. Families must be provided with information to encourage participation; and meet their need for emotional support and knowledge. Diagnostic audiology reports can help provide this information, but their delivery alone is insufficient. If these reports are not readable and comprehendible they cannot meet national and international legal standards, nor can they support the health literacy of parents. The majority of New Zealand adults have insufficient health literacy skills, a concerning fact given the strong association between poor health literacy and negative health outcomes. The aim of this study was to evaluate a paediatric diagnostic audiology report, revise it and verify the revision. A mock audiology report was evaluated via a readability analysis and semi-structured interviews with parent participants. Results confirmed that the report was difficult to read and understand. Next, the report was revised using best practice guidelines and parental recommendations. Verification of the revision process with 32 participants revealed that parents who read the revised report had significantly greater comprehension, self-efficacy and perception ratings than parents who read the unrevised report. Additionally, the report’s readability was markedly improved. These results may have critical implications for parents and their children with HI. Incomprehensible audiology reports fail to support parental health literacy, promote understanding, encourage participation or offer emotional support. Because knowledge is power for these families, it is hoped that the findings of this study will be recognised and implemented into clinical practice.

Hearing impairment (HI) is a growing health issue in today’s ageing society. Research has suggested that individuals with HI may experience increased levels of anxiety. Previous research has mainly focused on anxiety as a trait; recent research, however, has looked at state anxiety in the hearing impaired population. Cognitive anxiety is a state anxiety that occurs when people encounter a situation which does not lie within their construct system. As a result, they may experience anxiety as they are unable, or only partially able, to interpret the event meaningfully and are therefore unable to judge the implications of this event. The following study aimed to use the Cognitive Anxiety Scale to investigate relationships between cognitive anxiety and client variables in hearing impaired individuals, adding to the small amount of research currently available in this area. The following research questions were investigated: (1) Is there a relationship between cognitive anxiety level and (a) age, (b) gender, (c) audiometric variables, and (d) quality of life? (2) Is there a significant difference between the level of cognitive anxiety for the participants who purchased and kept hearing aids and those who did not? Twenty-five hearing impaired individuals who were consulting an audiologist for the first time participated in this study, with the cognitive anxiety interview conducted prior to the audiological assessment. The results indicated that cognitive anxiety was significantly related to an ability to understand speech in noise and quality of life, and that hearing aid adopters exhibited greater levels of cognitive anxiety than non-adopters. These results confirm that cognitive anxiety is indeed experienced by adults with HI, and suggest that it may be a factor which motivates people to adopt hearing aids. Further research is needed to confirm and further investigate the relationships with client variables. By listening for signs of cognitive anxiety, an audiologist may be able to gauge if a client is ready for rehabilitation, and encourage the process by exploring the effects of HI on communication situations, employing speech in noise testing, and including the significant other in the process.

identity play an important role in how they communicate and interact with other individuals. One group in which identity construction and navigation is a difficult process is the hearing impaired population. In an effort to understand how these individuals construct their identity and navigate their hearing impairment, this study utilizes Communication Theory of Identity. Through the use of interactive interviews, the researcher was able to examine how 11 participants manage their identity as hearing impaired individuals. The interviews provided insight into the four layers of identity proposed by CTI – personal, relational, enacted, and communal – in the hearing impaired individual. The author discusses the themes within each of the four layers and the gaps present between the layers that emerged as the hearing impaired participants discussed how they navigate their hearing impairment. Furthermore, the implications of these themes and gaps within the hearing impaired individual’s identity, such as feeling disconnected from both the Deaf and hearing communities, are examined.

Hearing loss has a negative effect on the daily life of 10-15% of the world’s population. One of the most common ways to treat a hearing loss is to fit hearing aids which increases audibility by providing amplification. Hearing aids thus improve speech reception in quiet, but listening in noise is nevertheless often difficult and stressful. Individual differences in cognitive capacity have been shown to be linked to differences in speech recognition performance in noise. An individual’s cognitive capacity is limited and is gradually consumed by increasing demands when listening in noise. Thus, fewer cognitive resources are left to interpret and process the information conveyed by the speech. Listening effort can therefore be explained by the amount of cognitive resources occupied with speech recognition. A well fitted hearing aid improves speech reception and leads to less listening effort, therefore an objective measure of listening effort would be a useful tool in the hearing aid fitting process. In this thesis the Auditory Inference Span Test (AIST) was developed to assess listening effort by measuring an individual’s cognitive spare capacity, the remaining cognitive resources available to interpret and encode linguistic content of incoming speech input while speech understanding takes place. The AIST is a dual-task hearing-innoise test, combining auditory and memory processing, and requires executive processing of speech at different memory load levels. The AIST was administered to young adults with normal hearing and older adults with hearing impairment. The aims were 1) to develop the AIST; 2) to investigate how different signal-to-noise ratios (SNRs) affect memory performance for perceived speech; 3) to explore if this performance would interact with cognitive capacity; 4) to test if different background noise types would interact differently with memory performance for young adults with normal hearing; and 5) to examine if these relationships would generalize to older adults with hearing impairment. The AIST is a new test of cognitive spare capacity which uses existing speech material that is available in several countries, and manipulates simultaneously cognitive load and SNR. Thus, the design of AIST pinpoints potential interactions between auditory and cognitive factors. The main finding of this thesis was the interaction between noise type and SNR showing that decreased SNR reduced cognitive spare capacity more in speech-like noise compared to speech-shaped noise, even though speech intelligibility levels were similar between noise types. This finding applied to young adults with normal hearing but there was a similar effect for older adults with hearing impairment with the addition of background noise compared to no background noise. Task demands, MLLs, interacted with cognitive capacity, thus, individuals with less cognitive capacity were more sensitive to increased cognitive load. However, MLLs did not interact with noise type or with SNR, which shows that different memory load levels were not affected differently in different noise types or in different SNRs. This suggests that different cognitive mechanisms come into play for storage and processing of speech information in AIST and for listening to speech in noise. Thus, the results suggested that a test of cognitive spare capacity seems to be a useful way to assess listening effort, even though the AIST, in the design used in this thesis, might be too cognitively demanding to provide reliable results for all individuals.

Tyrimo tikslas - įvertinti vaikų su klausos negalia brandumą mokyklai, su tuo susijusius socialinius-demografinius veiksnius ir sąsajas su mokymosi sėkme pirmoje klasėje. Tyrime dalyvavo 16 iš maždaug 24 parengiamosios ir pirmos klasės mokinių iš trijų kurčiųjų ir neprigirdinčiųjų ugdymo centrų Lietuvoje: 10 parengiamosios ir 6 pirmos klasės mokiniai. Jų amžiaus vidurkis - 7,5 metų. 11 vaikų buvo kurti, 5 - neprigirdintys; 11 vaikų tėvai taip pat turi klausos sutrikimus, 5 - tėvai girdintys; 11 vaikų gerai kalba gestų kalba, 5 - prastai; visi vaikai lankė ikimokyklines įstaigas. Tiriamieji dalyvavo dviejų sesijų individualiuose brandumo mokyklai vertinimuose, kurių metu buvo vertinamas intelektinis brandumas (intelektinis lygis pagal Raven spalvotųjų progresuojančių matricų testą, dėmesingumas, žodinė ir vaizdinė trumpalaikė atmintis, matematinis suvokimas), fizinis pasirengimas ir socialinis-emocinis brandumas pagal Galių ir sunkumų klausimyną. Tyrimo rezultatai parodė, kad vaikų su klausos negalia intelektiniam brandumui didėjant, jų rezultatai kitose vertinamose pasirengimo mokyklai srityse taip pat gerėja, ypač vaikų žodinė atmintis, dėmesingumas, fizinis ir socialinis-emocinis brandumas. Klausos negalią turinčių tėvų vaikai, turintys klausos sutrikimų, yra nežymiai geriau pasirengę mokyklai nei girdinčių tėvų vaikai, turintys klausos sutrikimų. Gerai gestų kalba kalbantys vaikai pasižymi aukštesniu intelektiniu, matematiniu ir fiziniu brandumu, dėmesingumu ir geresniais... [toliau žr. visą tekstą] / The aim of the study was to assess school readiness of hearing impaired children, its relationship with socio-demographic factors and coherence with successful learning in the first grade. In this research participated 16 children from about 24 who are studying in 5 deaf and hard of hearing educational centres: 10 was preschoolers and 6 first grade students. Age average: 7.5 years. In this group was: 11 deaf and 5 hard of hearing pupils, 11 children whose parents were hearing impaired and 5 whose parents hearing, 11 children who are good sign language users and 5 who poorly can speak it. All of pupils attended kindergartens. Children participated in two individual assessments of readiness for school in intellectual maturity (intellectual level according to Raven's Coloured Progressive Matrices test, attentiveness, verbal and visual short-term memory, mathematical comprehension), physical readiness and social-emotional maturity according to teachers' Strengths and Difficulties Questionnaire. The results of the study showed that hearing impaired children' increased intellectual maturity is coherent with better results in all other readiness for school areas, especially verbal memory, attentiveness, physical and social-emotional maturity. Children whose parents are hearing impaired are a bit better at readiness for school than children whose parents are hearing. Children who are good at sign language achieved better results in intellectual maturity, mathematical comprehension... [to full text]

I denna studie är syftet att undersöka hur och varför pedagoger tillämpar ett inkluderande arbetssätt av förskolebarn med hörselnedsättning. Detta görs utifrån ett sociokulturellt perspektiv där språk och interaktion anses grundläggande för lärande. För att kunna svara på forskningsfrågorna har observationer samt intervjuer utförts. Utifrån resultatet kan vi se att ett frekvent användande av tecken och förstärkning är av stor vikt för att kunna inkludera barn med hörselnedsättning och ge dem samma förutsättningar att ta del av sammanhanget som övriga barn. I resultatet går att utläsa miljöns påverkan och hur den utnyttjas i utformningen av verksamheten för att anpassas till de enskilda individernas förutsättningar. Genom sex punkter sammanställs studiens slutsatser vilka listar vad vi anser vara viktigt att tänka på kring arbetet med barn med hörselnedsättning. Grundläggande för en god inkludering är enligt oss att anpassa verksamheten utan att överbetona eller negligera hörselnedsättningen. / The purpose of this study is to examine how pedagogues apply an inclusive method of teaching preschool children with hearing impairment. This process will be examined from a sociocultural perspective, where language and interaction is considered a basic foundation for teaching. Interviews and field observations have been conducted in order to effectively address our outlined research questions. The results indicate that frequent use of signs and body language is crucial in providing children with hearing impairment with the same opportunity to engage in contextual learning. Our findings illustrate the importance of environmental factors, as well as how they are utilized when adapting school curriculums to individual circumstances. This study is summarized into six points, which lists important things to consider while working with children with hearing impairment. Our findings conclude that the foundation for an inclusive learning environment is to adapt the school curriculum without emphasizing or neglecting the hearing impairment.

Monogenic disorders offer a possibility for studies of genetic disturbances in hearing impairment—a knowledge which could be essential for development of future treatment options. In this thesis, the underlying genetic disturbances in neurofibromatosis 2 (NF2) and familial Meniere’s disease (FMD) were evaluated, and familial X-linked hearing impairment was described from a clinical point of view. In paper I, constitutional DNA from 116 individuals with NF2 of variable severity was studied using the array-CGH method focusing on a 7.6-Mb area surrounding the NF2 gene on chromosome 22q. Deletions were found in 20.7% of samples. In mild NF2, the deletions were small, but variable sizes of deletions were found in cases that were moderately or severely affected. Disease phenotype could not be predicted from the size of the deletions. In papers II and III, a single five-generation family with autosomal dominant FMD was described. Anticipation concerning age of onset was observed. Genome scan revealed five candidate gene regions with a LOD score of > 1. Two additional families with autosomal dominant MD were analyzed for linkage to these five regions. A cumulative Zmax of 3.46 was obtained for a single 463-kb region on chromosome 12p12.3, containing only one known gene: PIK3C2G. This encodes a protein with a proposed role in hair cell regeneration in mammalian ears. No mutations were found in protein-coding sequences or exon-intron borders. In two of the three families, a shared haplotype, suggested common ancestry, was found to extend over 1.7 Mb, which could be a genomic region of importance for FMD. In paper IV, a family in which five males displayed progressive low- and mid-frequency hearing impairment from the first or second decade was described. Female carriers were affected by a high-frequency hearing impairment from the fourth decade. The family could represent a novel X-linked dominant audiophenotype.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.