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.

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.

Approximately 80% of the adult and elderly population ≥65 years have not been assessed or treated for a hearing loss, despite the effect a hearing loss has on communication and quality of life (World Health Organization [WHO], 2013a). In South Africa, many challenges to the health care system exist of which access to ear and hearing health care is one of the major problems. This study aimed to develop and validate a smartphone-based digits-in-noise hearing test for South African English towards improved access to hearing screening. The study also considered the effect of hearing loss and English speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers. Lastly, the study evaluated the digits-in-noise test’s applicability as part of the diagnostic audiometric test battery as a clinical test to measure speech recognition ability in noise. During the development and validation phase of this study the sample size consisted of 40 normal-hearing subjects with thresholds ≤15 dB across the frequency spectrum (250 – 8000 Hertz [Hz]) and 186 subjects with normal-hearing in both ears, or normal-hearing in the better ear. Single digits (0 – 9) were recorded and spoken by a N English female speaker. Level corrections were applied to create a set of homogeneous digits with steep speech recognition functions. A smartphone application (app) was created to utilize 120 digit-triplets in noise as test material. An adaptive test procedure determined the speech reception threshold (SRT). Experiments were performed to determine headphones effects on the SRT and to establish normative data. The results showed steep speech recognition functions with a slope of 20%/dB for digit-triplets presented in noise using the smartphone app. The results of five headphone types indicate that the smartphone-based hearing test is reliable and can be conducted using standard Android smartphone headphones or clinical headphones. A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone air conduction thresholds to the SRT recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners’ self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 – 90 years), of which 337 listeners had a best ear 4 frequency pure-tone average (4FPTA; 0.5, 1, 2 and 4 kHz) of ≤25 dB hearing level (HL). A linear regression model identified three predictors of the digits-in-noise SRT namely 4FPTA, age and self-reported English speaking competence. The NN group with poor self-reported English speaking competence (≤5/10) performed significantly (p<0.01) poorer than the N & NN (≥6/10) group on the digits-in-noise test. Screening characteristics of the test improved with separate cut-off values depending on self-reported English speaking competence for the N & NN (≥6/10) group and NN (≤5/10) group. Logistic regression models, that include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operator characteristic curve [AUROC] .962 and .903 respectively). A descriptive study evaluated 109 adult subjects (43 male, 66 female) with and without sensorineural hearing loss by comparing pure-tone air conduction thresholds, speech recognition monaural performance score intensity (SRS dB) and the digits-in-noise SRT. An additional nine adult hearing aid users (4 male, 5 female) was utilized in a subset to determine aided and unaided digits-in-noise SRTs. The digits-in-noise SRT was strongly associated with the best ear 4FPTA (r=0.81) and maximum SRS dB (r=0.72). The digits-in-noise test had high sensitivity and specificity to identify abnormal pure-tone (0.88 and 0.88 respectively) and SRS dB (0.76 and 0.88 respectively) results. There was a mean signal-to-noise ratio (SNR) improvement in the aided condition that demonstrated an overall benefit of 0.84 dB SNR. A significant individual variability between subjects in the aided condition (-3.2 to -9.4 dB SNR) and unaided condition (-2 to -9.4 dB SNR) was indicated. This study demonstrated that a smartphone app provides the opportunity to use the English digits-in-noise hearing test as a national test for South Africans. The smartphone app can accommodate NN listeners by adjusting reference scores based on a self-reported English speaking competence. The inclusion of age when determining the screening test result increases the accuracy of the screening test in normal-hearing listeners. Providing these adjustments can ensure adequate test performance across N English and NN English listeners. Furthermore, the digits-in-noise SRT is strongly associated with the best ear 4FPTA and maximum SRS dB and could therefore provide complementary information on speech recognition impairment in noise in a clinical audiometric setting. The digits-in-noise SRT can also demonstrate benefit for hearing aid fittings. The test is quick to administer and provides information on the SNR loss. The digits-in-noise SRT could therefore serve as a valuable tool in counselling and management of expectations for persons with hearing loss who receives amplification. / Thesis (PhD)--University of Pretoria, 2017. / National Research Foundation (NRF) / Speech-Language Pathology and Audiology / PhD / Unrestricted

Background: Several European countries have demonstrated successful use of telephone screening tests for auditory function. The screening test consists of spoken three-digit sequences presented in a noise background. The speech-to-noise ratios of the stimuli are determined by an adaptive tracking method that converges on the level required to achieve 50% correct recognition.Purpose: A version of the three-digit telephone screening protocol for the United States was developed: the US National Hearing Test (NHT). The objective of the current study was to determine the sensitivity and specificity as well as the feasibility of the NHT for use within the Department of Veterans Affairs (VA).Research Design and Study Sample: Using a multisite study design with convenience sampling, we used the NHT to collect data from 693 participants (1379 ears) from three geographical areas of the United States (Florida, Tennessee, and California).Data Collection and Analysis: The NHT procedures were as follows: the participants (1) called a tollfree telephone number, (2) entered their assigned ear-specific identification code, (3) listened to 40-sets of digit triplets presented in speech-spectrum background noise, and (4) entered in the numbers that they heard on the telephone key pad. The NHT was performed on each ear, either at home or in a VA clinic. In addition to collecting data from the experimental task, we gathered demographic data and the data from other standard-of-care tests (i.e., audiometric thresholds and speech recognition tests in quiet and in noise).Results: A total of 505 participants completed the NHT at a VA clinic, whereas 188 completed the test at home. Although the ear-specific NHT and mean pure-tone threshold all correlated significantly (p < 0.001), there were more modest correlations in the low- and high-frequency ranges with the highest correlation seen with the 2000 Hz mean pure-tone threshold. When the NHT 50% point or threshold was compared with the three-frequency PTA at 500, 1000, and 2000 Hz, the sensitivity was 0.87 and specificity was 0.54. When comparing the NHT with the four-frequency PTA at 500, 1000, 2000, and 4000 Hz, the sensitivity was 0.81 and specificity increased to 0.65. The NHT also correlated strongly with other speech-in-noise measures.Conclusions: The NHT was found to correlate with other audiometric measures, including pure-tone thresholds and speech recognition tests in noise, at sufficiently high correlation values to support its use as a screening test of auditory function.

Submitted by Marlene Aparecida de Souza Cardozo (mcardozo@pucsp.br) on 2016-08-27T15:05:09Z No. of bitstreams: 1 Mary Ellen dos Santos.pdf: 862232 bytes, checksum: 49c986c29cce37665eec385fa318b02b (MD5) / Made available in DSpace on 2016-08-27T15:05:09Z (GMT). No. of bitstreams: 1 Mary Ellen dos Santos.pdf: 862232 bytes, checksum: 49c986c29cce37665eec385fa318b02b (MD5) Previous issue date: 2016-05-10 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introduction: The Wideband Tympanometry (WBT), with acoustic absorbance measures, is a recently introduced procedure in audiology, and its diagnostic comprehensiveness is still little explored. This is a technique that provides dynamic measurements of acoustic absorbance of the middle ear (ME), which increases the possibilities of studying anatomical and functional variables of this structure in children. It also measures all tympanograms from 226 Hz to 8000 Hz and identifies the resonance frequency of ME in an only and fast stimulus, using the same classical tympanometry procedure. Objective: To evaluate the Wideband Tympanometry with acoustic absorbance measures associated with the hearing status in children up to 3 years of age. Method: This is a descriptive, observational, retrospective and quantitative approach, accomplished through the use of WBT, with acoustic absorbance measurements and chirp stimuli in children up to 3 years old. We studied 81 medical records of patients of both sexes, of which only twenty-four completed the diagnosis, with normal tests, slight conductive alterations, or conductive hearing loss. Results: The results show important statistics differences of the broaband absorbance between the ears of same hearing status groups. Statistical analysis showed that the group with normal hearing tends to have higher means and medians of acoustic resonance and absorbance than the groups with slight conductive alterations and conductive hearing loss. However, it was observed that at frequencies below 0.5 kHz was not practically significant difference in the average absorbance between the acoustic group with normal hearing and the other groups aged ≥ 7 months. The group's results with normal hearing showed further that the means and medians absorbance changed systematically till the frequency of 6168.84 Hz. Conclusions: This study demonstrated, in general, the values of absorbance of broadband energy group with normal hearing were higher than the group with mild conductive hearing disorders and hearing loss, regardless of age. However, for it’s clinical practice becomes effective, it is recommended to establish normality patterns / Introdução: A Timpanometria de Banda Larga (TBL) com medidas de absorvância acústica é um procedimento introduzido recentemente na clínica audiológica, tendo sua abrangência diagnóstica ainda pouco explorada. Trata-se de uma técnica que oferece medidas dinâmicas de absorvância acústica da orelha média (OM), o que aumenta as possibilidades de estudo das variáveis anatômicas e funcionais dessa estrutura no público infantil. Além disso, também mensura todos os timpanogramas de 226 Hz a 8000 Hz e identifica a frequência de ressonância da OM em um único e rápido estímulo, utilizando o mesmo procedimento da timpanometria clássica. Objetivo: Estudar a Timpanometria de Banda Larga com medidas de absorvância acústica em crianças de até 3 anos de idade. Método: Trata-se de um estudo descritivo, observacional, retrospectivo e de caráter quantitativo, realizado por meio da utilização da TBL, com medidas de absorvância acústica e estímulos chirp, em crianças até 3 anos de idade. Foram estudados 81 prontuários de pacientes de ambos os sexos, dos quais apenas vinte e quatro concluíram o diagnóstico, apresentando exames normais, alterações condutivas leves, ou perda auditiva condutiva. Resultados: Os resultados evidenciaram diferenças estatísticas importantes da absorvância de banda larga entre as orelhas dos grupos de mesmo status auditivo. A análise estatística apontou que o grupo com audição normal tende a apresentar maiores médias e medianas de ressonância e absorvância acústica do que os grupos com alterações condutivas leves e perda auditiva condutiva. Porém, dessa comparação, observou-se que nas frequências abaixo de 0,5 kHz não houve, praticamente, diferença significativa na média da absorvância acústica entre o grupo com audição normal e os demais grupos na faixa etária ≥ 7 meses. Os resultados do grupo com audição normal demonstraram, ainda, que as médias e medianas de absorvância mudaram de forma sistemática até a frequência de 6168,84 Hz. Conclusões: Este estudo demonstrou, de forma geral, que os valores da absorvância da energia de banda larga dos grupos com audição normal foram mais altos do que os dos grupos com alterações condutivas leves e perda auditiva condutiva, independentemente da faixa etária. No entanto, para que sua prática clínica se torne efetiva, recomenda-se o estabelecimento de padrões de normalidades