Outside of major metropolitan areas, Arizona has limited options for hearing healthcare. The Arizona Affordable Hearing Aid Task Force proposed the development of a statewide program to provide low-cost hearing aids and audiologic care to low-income residents. The purpose of this review was to determine the status of the literature on the clinical outcomes of teleaudiology services for evaluations and hearing aid fittings which could be used to serve inhabitants of rural counties and address the goals of the Task Force. A literature search was performed to identify articles with original research in teleaudiology in the areas of evaluation and treatment and yielded 234 results. After exclusion criteria were applied, there were 15 articles for review; 10 articles focused on audiological evaluation and 5 articles focused on verification, validation, and counseling for hearing aid fittings. Evaluation-related articles showed that pure-tone air conduction testing was generally within the ± 5 dB acceptable range of variability, with little evidence on bone conduction or speech testing reliability. Studies reporting real-ear measurements with probe microphones were shown to yield similar results in traditional and teleaudiology fitting sessions and validation measures documented similar or better outcomes from teleaudiology fittings. Based on the literature, it is concluded that the use of teleaudiology is feasible for hearing aid fittings and counseling in rural areas, if associated barriers related to costs and limitations related to the availability of technology are overcome.

Abstract Hearing aid (HA) rehabilitation was studied in northern Finland. The costs of HA fitting were examined at two hospitals, Kainuu Central Hospital and Oulu University Hospital. The patients were visited and interviewed at their home and use of HAs was charted. The benefit of HAs was evaluated using generic and disease-specific questionnaires. The effect of follow-up counselling of HA users on HA use and on the benefit of HAs was studied. The proportion of all HA possessors that are regular users has clearly increased during the past twenty years, and the number of non-users, in particular, has decreased significantly. Only 5.3% of first fitted HAs were not in use in 2001. The costs of HA fitting in 2000 were approximately € 900. There was not much difference in the costs between Kainuu Central Hospital and Oulu University Hospital. The price of a HA accounted for somewhat less than half of the total hospital costs, and the costs of the audiology personnel made up roughly a third of the overall costs. Emotional problems of HA users were significant before HA fitting, but six months after HA fitting the number of patients who felt handicapped by their hearing problems had decreased significantly. This could be seen in the results of both the social and the emotional items of the disease-specific health-related quality-of-life (HRQOL) measure, the short version of the Hearing Handicap Inventory for the Elderly (HHIE-S). The benefit could not, however, be shown with the generic HRQOL instrument, the EuroQol questionnaire (EQ-5D), which apparently lacks sensitivity for measuring changes brought about by audiological intervention. Follow-up counselling of HA users can significantly increase HA use and decrease the number of non-users. It can also significantly increase the users' handling skills. The cost of follow-up counselling is approximately € 83 per fitted HA, which is an 8.7% increment to the calculated cost of fitting a HA.

Advances in hearing instrument technology have permitted the development of non-linear prescriptive methods to prescribe amplification characteristics for the hearing- impaired individual. The dispenser’s task in selecting the most appropriate prescriptive procedure for the young child is of utmost importance to ensure optimum hearing aid benefit for communication development. It was the aim of this study to compare and describe the effect of the two most widely used methods, DSL (i/o) and NAL-NL1, on speech recognition and loudness perception. An exploratory, descriptive research design was selected to realise this goal. Ten participants were selected using a convenient non-probability method of sampling. Articulation index calculations and a closed set speech recognition test were utilised in the evaluation of speech recognition, whereas functional gain results and loudness rating measurements provided an opportunity to describe loudness perception. The obtained results were analysed using the SAS (Statistical Analysis System). The study concluded that, although significant statistical differences existed in loudness perception, no statistical difference was observed in actual speech recognition measures. This effect may contribute to the individual amplification approaches of the two methods, which seem to reflect the uncertainties expressed by researchers as to the contribution of high frequency amplification to speech recognition in young children. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

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Bakgrund: Personer i åldersspannet 65 till 85 år utgör en stor del av alla hörselskadade iSverige idag. Dessa utgör därmed en stor patientgrupp inom hörselvården. Således är detrelevant att inventera deras förväntningar på hörapparater eftersom förväntningar hos denblivande hörapparatanvändaren kan påverka resultatet vid hörapparatutprovningen. Patientermed höga förväntningar blir oftare nöjdare med sina hörapparater. Genom att ha ett brabemötande och vara lyhörd för patientens förväntningar och önskemål, samt ge patientenadekvat information, kan audionomen hjälpa patienten att uppnå en mer lyckadhörselrehabilitering.Syfte: Syftet med studien var att undersöka vilka förväntningar äldre blivandehörapparatanvändare i åldrarna 65 till 85 år har på hörapparater och hörapparatutprovningen.Metod: Elva blivande hörapparatanvändare intervjuades i en kvalitativ intervjustudie medsemistrukturerade frågor. Insamlade data analyserades sedan med en kvalitativinnehållsanalys.Resultat: Analysen av förväntningarna resulterade i fyra olika teman: förväntade effekter påhörandet, förväntningar på hörapparater, förväntade effekter på livssituationen ochförväntningar på hörapparatutprovningen.Slutsats: De uttryckta förväntningarna på hörapparater och hörapparatutprovningen vargenerellt positiva. Kärnan i förväntningarna handlar om förbättrad kommunikation och ökadlivskvalitet. Det finns också en medvetenhet om hörapparaters begränsningar. Audionomenförväntas kunna ge ett bra bemötande och sprida sina kunskaper till patienterna. För att göradetta behöver audionomen få verktyg för att identifiera och träna på att bemöta patientersförväntningar och på så sätt säkerställa nöjda hörapparatanvändare. / Background: Patients aged between 65-85 years is a large group of patients in the hearinghealth care. Hence, it is important to learn what their expectations may be comprised ofbecause expectations in potential hearing aid users may affect the result of the hearing aidfitting. Patients with high expectations are often more satisfied with their hearing aids. Theaudiologist can, by being responsive to patient's expectations and wishes, and give patientsadequate information, help patients to reach a more successful hearing rehabilitation.Purpose: The purpose of the study was to investigate expectations on hearing aids andhearing aid fitting in elderly (65-85 years) potential hearing aid users.Study design: Eleven participants were individually interviewed in a qualitative interviewstudywith semi-structured questions. Collected data were analysed with a qualitative contentanalysis.Result: The analysis of the expectations resulted in four different themes: expected effects onhearing, expectations on hearing aids, expectations on the life situation and expectations onhearing aid fitting.Conclusion: The expressed expectations on hearing aids and hearing aid fitting weregenerally positive. The core of the expectations contains improved communication andimproved quality of life. There is an awareness of hearing aid limitations. Audiologists areexpected to have a good reception and spread their knowledge to their patients. To do this, theaudiologist need to get tools to identify and practice meeting patients' expectations and thusensure satisfied hearing aid users.

With the introduction of universal newborn hearing screening (UNHS) the need for quality early hearing intervention (EHI) services became critical. Screening is but the avenue to EHI services. Without appropriate intervention infants with hearing loss are at risk for language delay which might subsequently adversely influence academic success and vocational choices later on in life. The numerous socio-economic, cultural and healthcare barriers associated with developing countries such as South Africa, do not negate or diminish the need for optimal outcomes for infants with hearing loss through quality EHI services. The principle of quality EHI services, aligned with international standards, is endorsed by the HPCSA (2003: 2). In order to assure quality in EHI, service evaluation is critical. The necessary first step when evaluating service provision is to measure current service delivery. The main aim of this study was to determine whether South African audiologists provide EHI and support services aligned with international professional best practice to infants following the diagnosis of hearing loss. The first part of this study reviews the evidence available in EHI. The guidelines derived from the international evidence were stated as benchmarks against which South African EHI services were measured. These benchmarks were categorised using the so-called six M variation categories. These categories are: Man, machine (equipment), method (systemaric procedures), measurements, material (amplification devices) and Mother Nature. During the empirical research a descriptive design was followed comprising of questionnaire surveys to audiologists in different working sectors rendering EHI services to infants with hearing loss. The questionnaire survey explored the nature and scope of the EHI services offered to infants with hearing loss with regard to all the components (categorised in the six M categories) of the EHI programme of 40 South African audiologists. The results of this study indicate that respondents often do not use evidence-based measurements or methods during EHI services. Results suggest that undergraduate training in areas regarding the selection and fitting of amplification to infants with hearing loss is often inadequate (>20 respondents indicated that they are not trained). Evidence-based measurements are not typically performed when fitting amplification to infants (29 respondents do not perform probe-microphone or elctroacoustic measurements). Many respondents indicated that they do not have the necessary equipment to do these measurements. EHI services often (50% of respondents) do not provide A/R directly, but refer to other team members. From the results there seems to be significant delays in the rendering of EHI services to infants with hearing loss. Financial constraints of the family of the infants, accessibility problems, as well as a lack of infant support from their families often influence the EHI programmes of respondents. The implications of this study were discussed. Recommendations include the development of South African guidelines, aligned with international guidelines but taking into account the challenges posed by the unique South African context. Other recommendations include: Centres of excellence, relevant continuing education programmes and the evaluation of undergraduate training programmes. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted

Bakgrund: Finjusteringar av hörapparatens förstärkning görs för att validera förstärkningen. Patientens förmåga att kategorisera ljudbilden ligger till grund för de justeringar som görs. Syfte: Att utvärdera en praktiknära metod för finjustering av hörapparater. Metod: Deltagarna (N = 18) fick lyssna på och bedöma ljudbilden för ett talmaterial med slumpade nivåmodifieringar i oktavbandet 4 kHz. Försöksledaren korrigerade ljudbilden utifrån deltagarnas nivåbedömning, till dess att deltagarna upplevde att ljudbilden var naturlig. Deltagarna fick efter halva undersökningen, som intervention, lyssna på en genomgång som förklarade och jämförde de olika ljudbilderna. Resultat: Deltagarnas nivåbedömningar ledde till korrigeringar i oktavbandet som var statistiskt signifikanta, men en normalisering av oktavbandet uppnåddes inte. Efter genomgången kunde fler nivåmodifikationer korrigeras med en statistiskt signifikant skillnad. Nivåmodifikationer som kan kategoriseras som metalliska/skarpa ledde oftare till en statistiskt signifikant korrigering, än nivåmodifikationer som kan kategoriseras som otydliga/dova. Slutsatser: Om finjusteringar av hörapparaterna görs, bör audionomen ha klart för sig att det kan behövas större nivåförändringar i större frekvensband, för att patienten ska ha möjlighet att uppleva en skillnad i ljudbilden i en klinisk miljö. / Background: Fine-tuning of the hearing aid amplification is done to validate the amplification. The patient's ability to describe the sound quality lays as a foundation for the fine-tuning. Aim: To evaluate a practice-oriented method for fine-tuning hearing aids. Methods: The participants (N = 18) listened to and evaluated the sound quality for a speech-material with randomized level modifications in the octave band 4 kHz. The sound quality was adjusted according to the participants' evaluation, until a normalized sound quality was perceived by the participants. Halfway through the examination the participants, as an intervention, listened to a briefing which explained and compared differences in the different sound qualities. Results: The participants level evaluation led to adjustment in the octave band that was statistically significant, but a normalization of the octave band could not be achieved. After the briefing a larger number of level modifications were adjusted with a statistical significance. Level modifications which were categorized as metallic/sharp more often led to a statistically significant adjustment compared to level modifications categorized as unclear/dull. Conclusions: If fine-tuning of hearing aids is done, the audiologist should be aware that bigger level adjustment in broad bands might be needed, for the patient to be able to notice a difference in sound quality in a clinical setting.