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      Hearing aid fitting for visual and hearing impaired patients with Usher syndrome type IIa

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          Abstract

          Objectives

          Usher syndrome is the leading cause of hereditary deaf‐blindness. Most patients with Usher syndrome type IIa start using hearing aids from a young age. A serious complaint refers to interference between sound localisation abilities and adaptive sound processing (compression), as present in today's hearing aids. The aim of this study was to investigate the effect of advanced signal processing on binaural hearing, including sound localisation.

          Design and participants

          In this prospective study, patients were fitted with hearing aids with a nonlinear (compression) and linear amplification programs. Data logging was used to objectively evaluate the use of either program. Performance was evaluated with a speech‐in‐noise test, a sound localisation test and two questionnaires focussing on self‐reported benefit.

          Results

          Data logging confirmed that the reported use of hearing aids was high. The linear program was used significantly more often (average use: 77%) than the nonlinear program (average use: 17%). The results for speech intelligibility in noise and sound localisation did not show a significant difference between type of amplification. However, the self‐reported outcomes showed higher scores on ‘ease of communication’ and overall benefit, and significant lower scores on disability for the new hearing aids when compared to their previous hearing aids with compression amplification.

          Conclusions

          Patients with Usher syndrome type IIa prefer a linear amplification over nonlinear amplification when fitted with novel hearing aids. Apart from a significantly higher logged use, no difference in speech in noise and sound localisation was observed between linear and nonlinear amplification with the currently used tests. Further research is needed to evaluate the reasons behind the preference for the linear settings.

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          Most cited references26

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          The abbreviated profile of hearing aid benefit.

          To develop and evaluate a shortened version of the Profile of Hearing Aid Benefit, to be called the Abbreviated Profile of Hearing Aid Benefit, or APHAB. The Profile of Hearing Aid Benefit (PHAB) is a 66-item self-assessment, disability-based inventory that can be used to document the outcome of a hearing aid fitting, to compare several fittings, or to evaluate the same fitting over time. Data from 128 completed PHABs were used to select items for the Abbreviated PHAB. All subjects were elderly hearing-impaired who wore conventional analog hearing aids. Statistics of score distributions and psychometric properties of each of the APHAB subscales were determined. Data from 27 similar subjects were used to examine the test-retest properties of the instrument. Finally, equal-percentile profiles were generated for unaided, aided and benefit scores obtained from successful wearers of linear hearing aids. The APHAB uses a subset of 24 of the 66 items from the PHAB, scored in four 6-item subscales. Three of the subscales, Ease of Communication, Reverberation, and Background Noise address speech understanding in various everyday environments. The fourth subscale, Aversiveness of Sounds, quantifies negative reactions to environmental sounds. The APHAB typically requires 10 minutes or less to complete, and it produces scores for unaided and aided performance as well as hearing aid benefit. Test-retest correlation coefficients were found to be moderate to high and similar to those reported in the literature for other scales of similar content and length. Critical differences for each subscale taken individually were judged to be fairly large, however, smaller differences between two tests from the same individual can be significant if the three speech communication subscales are considered jointly. The APHAB is a potentially valuable clinical instrument. It can be useful for quantifying the disability associated with a hearing loss and the reduction of disability that is achieved with a hearing aid.
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            Efficient adaptive procedures for threshold and concurrent slope estimates for psychophysics and speech intelligibility tests.

            The minimum standard deviations achievable for concurrent estimates of thresholds and psychometric function slopes as well as the optimal target values for adaptive procedures are calculated as functions of stimulus level and track length on the basis of the binomial theory. The optimum pair of targets for a concurrent estimate is found at the correct response probabilities p1 = 0.19 and p2 = 0.81 for the logistic psychometric function. An adaptive procedure that converges at these optimal targets is introduced and tested with Monte Carlo simulations. The efficiency increases rapidly when each subject's response consists of more than one statistically independent Bernoulli trial. Sentence intelligibility tests provide more than one Bernoulli trial per sentence when each word is scored separately. The number of within-sentence trials can be quantified by the j factor [Boothroyd and Nittrouer, J. Acoust. Soc. Am. 84, 101-114 (1988)]. The adaptive procedure was evaluated with 10 normal-hearing and 11 hearing-impaired listeners using two German sentence tests that differ in j factors. The expected advantage of the sentence test with the higher j factor was not observed, possibly due to training effects. Hence, the number of sentences required for a reliable speech reception threshold (approximately 1 dB standard deviation) concurrently with a slope estimate (approximately 20%-30% relative standard deviation) is at least N = 30 if word scoring for short, meaningful sentences (j approximately 2) is performed.
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              Development and analysis of an International Speech Test Signal (ISTS).

              For analysing the processing of speech by a hearing instrument, a standard test signal is necessary which allows for reproducible measurement conditions, and which features as many of the most relevant properties of natural speech as possible, e.g. the average speech spectrum, the modulation spectrum, the variation of the fundamental frequency together with its appropriate harmonics, and the comodulation in different frequency bands. Existing artificial signals do not adequately fulfill these requirements. Moreover, recordings from natural speakers represent only one language and are therefore not internationally acceptable. For this reason, an International Speech Test Signal (ISTS) was developed. It is based on natural recordings but is largely non-intelligible because of segmentation and remixing. When using the signal for hearing aid measurements, the gain of a device can be described at different percentiles of the speech level distribution. The primary intention is to include this test signal with a new measurement method for a new hearing aid standard (IEC 60118-15).
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                Author and article information

                Contributors
                bas.hartel@radboudumc.nl
                Journal
                Clin Otolaryngol
                Clin Otolaryngol
                10.1111/(ISSN)1749-4486
                COA
                Clinical Otolaryngology
                John Wiley and Sons Inc. (Hoboken )
                1749-4478
                1749-4486
                06 November 2016
                August 2017
                : 42
                : 4 ( doiID: 10.1111/coa.2017.42.issue-4 )
                : 805-814
                Affiliations
                [ 1 ] Department of Otorhinolaryngology Radboud University Medical Center Nijmegen The Netherlands
                [ 2 ] Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen The Netherlands
                [ 3 ] Department of Biophysics Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen Nijmegen The Netherlands
                [ 4 ] Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen Nijmegen The Netherlands
                Author notes
                [*] [* ] Correspondence: B.P. Hartel, Department of Otolaryngology, Radboud University Medical Center, Philips van Leydenlaan 15, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands.

                Tel.: +31 (0)24 3617203; fax: +31 (0)24 3540251; e‐mail: bas.hartel@ 123456radboudumc.nl

                [†]

                Shared last authors.

                Article
                COA12775
                10.1111/coa.12775
                5516239
                27759911
                e8cfcbed-7f1e-406b-bb84-bb89157239b6
                © 2016 The Authors. Clinical Otolaryngology Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 16 October 2016
                Page count
                Figures: 6, Tables: 3, Pages: 10, Words: 6245
                Funding
                Funded by: Innovatiefonds
                Award ID: B13‐200‐2677
                Funded by: Fonds Nuts‐Ohra
                Award ID: 1303‐009
                Funded by: Heinsius Houbolt Fonds
                Funded by: Netherlands Organisation for Health Research and Development
                Funded by: ZonMW Klinisch Fellowship
                Award ID: 90700388
                Funded by: FP7‐PEOPLE‐2013‐ITN Marie Curie Initial Training Network iCage
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                coa12775
                August 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.4 mode:remove_FC converted:19.07.2017

                Otolaryngology
                Otolaryngology

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