Search

About 5% of those presenting at an ENT clinic with ear or hearing complaints are found to have normal pure-tone thresholds. Many of this group complain specifically of difficulties understanding speech in background noise. We have termed this complaint 'Obscure Auditory Dysfunction' (OAD). Previous research on OAD (Saunders and Haggard, 1992) on a sample of 50 patients and 50 matched controls showed that 83% of the deviance (binary variance) in membership of group (OAD/control) could be explained by four variables, with three underlying factors. These four variables are performance threshold in noise for speech; discrepancy between this and a self-adjusted signal-to-noise ratio value (i.e. a measure of auditory confidence); dichotic listening performance; and performance on a psychoacoustic test, the threshold for detecting a tone in a spectrally notched noise. This paper reports a study on a further 59 new OAD patients and 64 unmatched controls, using the tests in the form present in the test package, plus certain others. For routine practice, slightly differing implementations of the auditory test techniques were used. Compared to the earlier sample, the new sample had poorer measures of speech reception threshold in noise and they considered themselves more handicapped by their OAD state; however there was no significant difference between the two samples on the other performance variables. Overall, the results demonstrate the robustness of the conclusions reached from the previous study, as the test-variable determinants of OAD status (i.e. case-control differences) were similar. The items on the OAD interview questionnaire which had shown significant differences between OADs and controls were also similar for the two OAD samples, giving a consistent picture of patient profile. These were: difficulties learning to read or write as a child (which relates to dichotic listening scores); adult ear problems; and tinnitus (which relate to the psychoacoustic scores). This necessary replication confirms the validity of the three-factor model of OAD status and the utility of the clinical test package based upon it.

Just under one in 10 of a nationally representative sample of UK television viewers said that they experienced difficulty with their hearing. These hard-of-hearing viewers were found to report much greater difficulty watching programmes (mean difficulty rating = 32%) than elderly viewers with no reported hearing difficulty (mean difficulty rating = 10%), or those viewers generally who said they had no hearing problems (mean difficulty rating = 3%). Using a similarly constructed rating for reported enjoyment of different television programmes, hard-of-hearing viewers were found to exhibit a small reduction in enjoyment across the majority of programmes types. While it might have been anticipated that a greater proportion of those with impaired hearing owned a teletext television set giving them access to subtitling, this was not found to be the case. Across the sample as a whole, teletext ownership was shown to be 45%, but was lower than this (38.5%) amongst the hard-of-hearing. The findings corroborate what has been shown in another study, namely that teletext ownership is lower among older viewers. Hearing impairment, if it is not congenital or of early childhood origin, is a condition associated with increasing age. Thus, those whose viewing and appreciation of programmes might be enhanced by subtitles, in the main, do not have access to them. Among hard-of-hearing viewers who did have access to the teletext subtitle service, two thirds of those aged 51 years and over felt that subtitles assisted their understanding of television programmes. As one might expect, of those owning teletext, hard-of-hearing viewers reported greatest use of subtitles. Thirteen per cent of those with hearing difficulty and aged over 51 years said they used subtitles for all programmes watched and a further 26% of the over fifties with hearing difficulty reported regularly using subtitles for selected programmes. These data advocate that there are many hard-of-hearing viewers whose viewing could be enhanced by subtitling. Effort should be made to promote public and professional awareness of the availability of teletext subtitling and additional resources will be needed to combat the technophobia which may hinder older people from initially purchasing a teletext television set, or making effective use of one they already own.

Depressed auditory thresholds without evidence of organic hearing loss are observed in a small percentage of children and young adults. Several studies suggest that non-organic hearing loss (NOHL) is a manifestation of, or reaction to stress. Proposed treatments range from ignoring the apparent hearing loss through the use of psychotherapy and/or counselling to confronting the individual with evidence to prove that there is no real loss of function. Few studies report on long-term outcome. Thirty-eight subjects who had been diagnosed more than six and up to twenty-seven years ago as having NOHL were identified from records. Efforts were made to determine if there was any evidence of longer term effects. Nine were untraceable. Of those reviewed one was established as a malingerer; five had concurrent speech problems; one was possibly dyslexic; five were or had been under psychiatric care. These findings suggest that NOHL may, in some individuals, indicate underlying problems that merit detailed investigation and treatment.

Obscure auditory dysfunction (OAD) is defined as convincing self-report of auditory disability accompanied by normal pure-tone thresholds. This has been increasingly recognized as a clinical problem, but until now there has not been a standard clinical procedure for dealing with such patients. This paper summarizes a demographic and clinical characterization of a sample of 50 OAD patients, reports new norms on the tests in the version issued, and describes a test package developed from a case-control research study that can be routinely used with OAD patients. The package enables clinicians: (i) to confirm, or otherwise, OAD as the appropriate classification for individuals presenting with OAD-like symptoms; (ii) to elucidate the underlying basis of OAD in such individuals and hence in most cases to provide explanations that are justified by test findings; and (iii) to counsel cases in a fashion appropriate for each individual. The package consists of four performance tests, a specialized clinical interview and a brief questionnaire to determine the severity of OAD. The assessment takes approximately 37 min and can be run using a two-channel audiometer and a cassette recorder.

Coping strategies are presumed to be modifying factors between a hearing impairment and the perceived handicap. The focus of this investigation was to explore audiological and psychological factors affecting the perceived handicap in hearing-impaired middle-aged subjects. The Hearing Measurement Scale, supplemented by a subjective estimation of the perceived handicap, was used as the dependent variable in a study of 62 subjects, heterogeneous as to type and severity of hearing loss and to hearing aid use. In a stepwise regression analysis, maladaptive communication strategies as well as active and constructive coping behaviours were found to increase the self-perception of hearing handicap. Other significant variables were severity of hearing loss and years of education. Tinnitus symptoms did not contribute to the explained variance in the perceived handicap, which was an unexpected finding. A conclusion that may be drawn from the present study is that active coping strategies tend to focus attention on disability and thereby increase perceived handicap.

The aim of this study was to gain a deeper understanding of what hearing-impaired people are doing to deal with demanding auditory situations in everyday life. Twelve middle-aged subjects with clinical hearing impairments were interviewed monthly during 5 months. The interviews focused on the subjects' own descriptions of demanding auditory situations and what they did, thought and felt in these situations. Verbatim transcribed protocols were content-analysed according to Grounded Theory. Fourteen categories were grounded in the data, forming a model for dealing with demanding auditory situations, including two qualitatively different management patterns: 'to control the social scene' and 'to avoid the social scene'. The emerging core variable was socio-psychological: the hearing-impaired individuals strive to maintain the normal identity and to prevent their definition as deviant in interactions with hearing people. The result of the inductive study was verified in a deductive study of 50 hearing-impaired subjects.

Rehabilitation of the majority of hearing handicapped in Sweden consists of hearing aid fitting, provision of technical devices and information during about four visits to a Hearing Centre. Generally there is no structured guidance of the hearing handicapped on how to proceed with the hearing aid at home between appointments. A programme of active fitting (AF) of hearing aids, with a task-oriented diary, 'Try Your Hearing Aid' as a basic part, was therefore developed. We conducted a series of studies from 1985 to 1988 with the aim of investigating the benefit and applicability of the programme. A total of 128 new hearing aid candidates participated in three studies at the Sahlgrens hospital and at four other hearing centres in smaller Swedish towns. In a controlled study the AF group was more positive to their hearing aids and to the fitting period after 10 months. They used their hearing aids more frequently and felt psychologically more secure with them. It was established that the AF programme could well be applied in the clinical routine for a majority of new hearing aid patients. Old age per se was not found to be a relevant exclusion criterion. The positive outcome of the AF programme has stimulated the Swedish Institute of the Handicapped to print 'Try Your Hearing Aid' with a manual, and to introduce it to all hearing centres in Sweden.

Social and audiometric characteristics of the hearing-impaired elderly without aids have been analysed and some understanding developed of the factors which lead people to seek rehabilitation. The two major single determinants of seeking help were found to be severity of impairment and onset of deafness before reaching retirement age. There were strong indications that negative attitudes of both the elderly themselves and their general practitioners towards deafness and ageing played a crucial part in perpetuating the neglect of the disorder.

The roles of an open-ended problems questionnaire are described. The results are presented for the first 500 consecutive responses obtained with such a questionnaire. These emphasise the qualitative importance of difficulties in conversation and the commonest of problems with hearing the radio or television.

This report, which outlines the official policy of the British Society of Audiology on the aural rehabilitation of hearing impaired adults, (a) estimates the prevalence of hearing impairment in adults in the United Kingdom; (b) identifies the main problems associated with hearing impairment in adults; (c) outlines the main aural rehabilitative procedures and (d) puts forward recommendations for future developments in this area.

Much recent research emphasises the importance of pre-verbal communicative behaviour in the language development of children. A child normally becomes a competent user of spoken language through communicative interaction with caregivers in the course of everyday activities and play. When acquisition of spoken language is problematic due to hearing loss, the need to restore and/or maintain the integrity of the caregiver-child interactions is acute. However, relatively few attempts have been made to organise our knowledge of pre-verbal behaviour so that it can be used in developing spoken language in hearing-impaired children. This paper presents a clinical procedure for analysing caregiver-child interactive behaviours, which was derived from language acquisition research and literature. The procedure is intended for use by teachers/clinicians with hearing-impaired children prior to the use of conventional words in connected sentences. A videotape analysis is developed to meet two clinical aims. The first aim is to identify systematically those elements of the interaction which promote the child's communicative development, as well as those which are counterproductive to it. The second aim is to use this information to facilitate communication between caregiver and hearing-impaired child. Illustrative examples from analyses of caregiver-child dyads are provided to demonstrate the clinically useful information which results.