The aim of this PhD thesis was to investigate traffic safety and mobility for individuals with hearing loss (HL). Three studies were conducted: 1. a questionnaire survey aimed to evaluate differences in choice of transportation that might be related to HL, 2. a driving simulator study that looked into compensatory strategies and evaluated the efficiency of a tactile signal to alert the driver, and 3. a field study to evaluate these effects in real traffic and to evaluate a navigation system with a supportive tactile signal. The effects of HL discovered in this thesis add to the knowledge and understanding of the influence of HL on traffic safety and mobility. Differences found consistently point to a generally more cautious behavior. Compensatory and coping strategies associated with HL are bound to driving complexity and appear when complexity increases. These strategies include driving at lower speeds, using a more comprehensive visual search behavior and being less engaged in distracting activities. Evaluation of a tactile signal showed that by adding a tactile modality, some driver assistance systems can also be made accessible to drivers with HL. At the same time, the systems might be more effective for all users, since the driver can be more focused on the road. Based on the results in this thesis, drivers with HL cannot be considered an increased traffic safety risk, and there should be no need for adjustments of the requirements of hearing for a license to drive a car. / Syftet med den här doktorsavhandlingen var att undersöka trafiksäkerhet och mobilitet för individer med hörselnedsättning (HN). Tre studier har genomförts: 1. en enkätstudie för att undersöka skillnader i transportvanor relaterade till HN, 2. en körsimulatorstudie for att titta på kompensatoriska strategier och utvärdera effektiviteten i en taktil signal för att påkalla förarens uppmärksamhet och 3. en fältstudie för att undersöka effekterna i riktig trafik samt utvärdera ett navigationssystem med en taktil signal som stöd för navigering. Effekterna av HN som kom fram i denna avhandling bidrar till kunskapen och förståelsen för hur HN påverkar trafiksäkerhet och mobilitet. De funna skillnaderna pekar konsistent mot ett generelltmera försiktigt beteende. Kompensatoriska - och copingstrategier förknippade med HN beror på körkomplexitet och observeras när komplexiteten ökar. Dessa strategier innebär körning med lägre hastighet, mera heltäckande visuell avsökning och mindre engagemang i distraherande uppgifter. Utvärdering av en taktil signal visade att genom att lägga till en taktil modalitet kan vissa förarstödsystem bli tillgängliga även för förare med HN. Samtidigt kan systemen bli mera effektiva för alla användare eftersom föraren då kan fokusera mera på vägen. Baserat på resultaten i den här avhandlingen kan inte förare med HN betraktas som någon förhöjd risk och det bör därmed inte finnas något behov av att justera hörselkraven när det gäller körkortsinnehav.

Age-related declines in hearing abilities are common and can be attributed to changes in the peripheral and central levels of the auditory system. Although central auditory processing is enhanced in younger musicians, the influence of lifelong musicianship on age-related decline in central auditory processing has not yet been investigated. Therefore, the purpose of this dissertation was to investigate whether lifelong musicianship can mitigate age-related decline in central auditory processing. In the first experiment, age-related declines on four hearing assessments were compared between musicians and non-musicians. Speech-in-noise and gap-detection thresholds were found to decline at a slower rate in musicians, providing an increasing advantage with age. Furthermore, musicians had a lifelong advantage in detecting a mistuned harmonic, although the rate of age-related decline was similar for both musicians and non-musicians. Importantly, there was no significant effect of musicianship on pure-tone thresholds, suggesting that lifelong musicianship can mitigate age-related decline in central but not peripheral auditory processing. To test this hypothesis, a second experiment compared auditory evoked responses (AERs) between groups of older and younger musicians and non-musicians. Results indicated that exogenous neural activity was enhanced in musicians, but that age-related changes were similar between musicians and nonmusicians. Furthermore, endogenous, attention-dependent neural activity was enhanced in older adults, suggesting a compensatory cognitive strategy. Importantly, endogenous activity was preferentially enhanced in older musicians, suggesting that lifelong musicianship enhanced cognitive processes related to auditory perception. In the final experiment, the ability to segregate simultaneous sounds was tested in older and younger musicians and non-musicians by using a mistuned harmonic paradigm, where AERs to harmonic complexes were compared to AERs when one of the harmonics was mistuned. Results indicated that musical training in older adults has little effect on early automatic registration of the mistuned harmonic. In contrast, late attention-dependent activity, associated with the perception of the mistuned harmonic as a separate sound, was influenced by musical training in older adults, suggesting that lifelong musicianship preserves or enhances cognitive components of concurrent sound segregation. In summary, musical training was found to reduce age-related decline in hearing abilities due to enhanced central processing of auditory information.

Der Hörsturz, seine Pathoätiogenese und Therapie werden nach wie vor kontrovers diskutiert. Basierend auf der Annahme, dass dem Hörsturz eine reduzierte kochleäre Perfusion durch eine erhöhte Plasmaviskosität zugrunde liegt, therapierten wir 85 Patienten im Zeitraum von März 2007 bis Oktober 2009 an der Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde der Universität Leipzig mit der HELP-Apherese. Die HELP-Apherese ist ein Verfahren, um selektiv Fibrinogen, LDL-Cholesterin und Lipoprotein(a) im Blut zu reduzieren, wodurch die Plasmaviskosität gesenkt werden kann. Verglichen haben wir die Wirksamkeit der HELP- Apherese mit einer historischen Kontrollgruppe (n=89), die im Zeitraum von September 2005 bis Oktober 2009 an der Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde der Universität Leipzig die Standardinfusionstherapie mit Glukokortikoiden nach dem Stennert - Schema erhalten hatte. Im Gesamtkollektiv zeigte sich hinsichtlich der Hörverbesserungen kein signifikanter Unterschied zwischen beiden Therapien, es fanden sich jedoch Hinweise für das besondere Profitieren der Apherese in bestimmten Subgruppen (Alter >60 Jahre, hochgradige Hörverluste). Außerdem wies die HELP -Gruppe trotz gleicher mittlerer Hörverbesserung signifikant mehr Vollremissionen auf als die Standardgruppe. Des Weiteren konnten wir als bedeutenden Risikofaktor für das Auftreten des akuten Hörsturzes einen hohen Fibrinogenspiegel im Blut identifizieren. Darüber hinaus erlangten wir Kenntnisse über prognosebeeinflussende Faktoren. So stellten wir fest, dass der Schweregrad des Hörverlustes, das Alter der Patienten und die Art des Hörverlustes einen Einfluss auf das therapeutische Outcome hatten. Demnach konnten wir bestätigen, was vorherige Studien bereits gezeigt hatten. Die HELP-Apherese ist eine effektive Therapiealternative zur Standardtherapie und kann höchst wahrscheinlich für besondere Subgruppen sogar bessere Ergebnisse erzielen. Vor allem, da sie hinsichtlich Lebensqualität und Nebenwirkungsprofil überlegen ist, stellt sie eine bedeutende Therapieoption dar. Auf die Frage nach der Ätiologie des Hörsturzes konnten wir Fibrinogen eine bedeutende Rolle nachweisen. Weitere multizentrische prospektive klinische Studien sind erforderlich, um die Hinweise unserer Arbeit zu belegen und eine individuelle Therapie im klinischen Alltag zu gewährleisten.

Being given the diagnosis of a disability generally affects an individual's emotional state, however, this has not previously been investigated with respect to audiology and the diagnosis of hearing loss. The first aim of this study was to describe some of the common initial reactions to the diagnosis of hearing loss (HL). An awareness of these emotional reactions will aid audiologists in counselling their patients. Counselling occurs at the time of the diagnosis and throughout the aural rehabilitation process. However, counselling tuition is currently not provided for audiology students at New Zealand universities and there are few professional development courses for practicing audiologists. The second aim of this study was to evaluate current audiological counselling services and ascertain the impact on patients' decisions to get hearing aids (HAs). To accomplish these aims, 27 adults who had been newly-diagnosed with a HL completed an initial reaction questionnaire, partook in an interview which followed up on the questionnaire, and subsequently completed a second questionnaire at least three weeks later. There were two versions of the second questionnaire, depending on whether they had chosen to have HA(s) fitted. The results found that the common emotions reported were a sense of loss, sadness and resignation, as well as relief. Furthermore, an individual's level of optimism tended to decrease in response to the hearing test result. The ratings of the audiological counselling services were positive and seemed not to significantly influence the individual with respect to their decision to purchase HAs. The two areas of audiological counselling which could be improved related to how the audiologist explained the HL, particularly in relation to the individual's life, and also the provision of information to patients prior to the fitting of the HA. In addition to the data that was collected in relation to these aims, information was collected with respect to patients' perceptions of their HL prior to the hearing test, their interpretation of the hearing test results, and also how the patient's significant other responded to the diagnosis. The information from this study will be useful for equipping audiologists, both new graduates and those with more experience, to provide optimal audiological care for their patients.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. Linköping : Universitetet, 2005.

Thesis (M.A. (Communication Disorders))--Mahidol University, 1984.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 101-112).