Ninety four consecutive adults who had been fitted with cochlear implants for at least six months were sent open-ended questionnaires asking them to list the benefits and shortcomings they experienced as a result of their implants. Partners of the patients were asked to complete similar questionnaires. A wide range of benefits was reported, predominantly acoustical and psychosocial. Most of the shortcomings were acoustical and practical. Significant others reported fewer benefits and fewer shortcomings than the patients. However, the overall pattern of responses was similar. More acoustical and psychosocial benefits were reported by those fitted with cochlear implants than by those with hearing aids or bone-anchored hearing aids. Copyright © 2008 John Wiley & Sons, Ltd.

Cochlea implantat (CI) ordineras numera allt oftare som rehabilitativt hjälpmedel till personer med allt bättre ”resthörsel” och omkring 40 nya operationer genomförs för närvarande per år på Hörselvårdsavdelningen, SUS i Göteborg. För att förstå vad det innebär för patienter med grav hörselnedsättning/vuxendövhet att leva med CI och hur deras livskvalitet påverkas, krävs både traditionellt kvantitativa studier på slumpmässigt utvalda grupper ur populationen och mer inträngande kvalitativa studier på strategiskt utvalda grupper. Två av våra studier, en med kvalitativ och en med kvantitativ ansats, kommer kortfattat att beskrivas i denna artikel och belyser hur metodologisk mångfald bidrar till önskvärd kunskapstillväxt på ett komplicerat område. Since about 20 years cochlear implants have been available as audiological aids for adults with postlingual deafness, i.e. profound hearing impairment or deafness acquired after development of a spoken language. The studies that will be briefly presented in the present paper aim at gaining a deeper understanding of what a cochlear implant (CI) means to adults with postlingual deafness and how quality of life is affected by the CI. We also intend to identify factors that can predict psychological well-being (quality of life). In a qualitative study it was found that the meaning attributed to having a CI referred to psychological and existential dimensions rather than to audiological factors, only. Having a CI as a rehabilitative aid means according to the informants coming back to life. In a quantitative study it was found that environmental factors, such as availability of social support, attitudes from others and chronological age explained about half of the variance in psychological well-being/quality of life. In line with Malterud (2001) we argue that medical research needs methodological multiplicity. Despite that qualitative and quantitative research differ concerning ontological and epistemological starting-points, methodologically the approaches should be seen as complementary rather than as incompatible. Keywords: cochlear implant; grounded theory; environmental factors; postlingual deafness

Cochlea implantat (CI) ordineras numera allt oftare som rehabilitativt hjalpmedel till personer med allt battre ”resthorsel” och omkring 40 nya operationer genomfors for narvarande per ar pa Horsel ...

Cochlear implantation (CI) rates vary between countries, depending on identification routines and economic restrictions. The present study aimed at determining the prevalence of CIs in postlingually deafened, aged 20-69 years, in Goteborg, Sweden. Three patient databases with information on PTA, a questionnaire, medical records and consultations identified 88 subjects with sensorineural hearing loss >= 80 dB HL (PTA of 500, 1000, 3000 Hz), PB word score of <= 30% (better ear), regular use of hearing-aid, and oral language. The prevalence of CIs was 11.8 per 100000 population, and of subjects fulfilling the audiometric candidacy criteria 18.6 per 100000. The mean PTA (op. ear) of subjects awaiting operation was 97 dB HL (SD 12.3), and of already implanted subjects 106 dB HL (SD 10.2). Mean PB word score was 9% (SD 8.9) and 3% (SD 4.9) respectively. Subjects awaiting operation had significantly better residual hearing, emphasizing recent changes in candidacy criteria. Comparing with prevalence from other countries demonstrated that more patients could be candidates for cochlear implantation.

Purposes: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics. Subjects and methods: During one year consecutive patients (n = 343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5 – 1 – 2 – 4 kHz in the better ear. Results: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p < 0.01). In a multivariable model, the explained adjusted variance of activity limitation (R2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors. Conclusions: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.

The purpose of this study was to investigate the variables that affect psychological general well-being (quality of life) in patients with cochlear implants (CIs). The study sample consists of 96 adult patients with a Cl, aged 2486 years (Mean=61.8 yrs; SD=15.3 yrs). 48 were patients from the Sahlgrenska University Hospital in Sweden and 48 were patients from the University of Florida, USA- The Psychological General Well-being Index and the International Outcome inventory-Cochlear implants were used in collecting data. Possible independent variables were socioeconomic factors such as age, gender, nationality, living arrangement, education, and social support; as well as length of time since implantation, age when hearing loss became a problem, and subjective benefit of the Cl. A stepwise multiple regression analysis showed that 49% of the variance was explained by attitudes from others, restricted social participation, perceived social support and age.

The aim of this grounded theory study was to gain a deeper understanding of what it means to profoundly deaf adults to undergo cochlear implantation and their experience of living with it daily. The aim of grounded theory is theorizing, i.e. constructing from data an explanatory scheme that systematically integrates various concepts and their relationships. The study group consisted of 10 women and seven men (age 29-78 years; mean age 56.5 years), who had had their cochlear implant (CI) for between 1 and 12 years (mean 4.1 years). Open taped interviews were carried out and analysed. The core category, coming back to life, defines a psychological process basic to existence, elucidating the existential value of hearing, including perceived harmony in life and becoming a part of the living world as important dimensions. This core concept is related to four additional emerging categories in a temporal order. Preventing disappointment concerns the decision to undergo the operation governed by the conception of having nothing to lose combined with low expectations of successful outcomes. Waiting in silence relates to experiences during the postoperative period such as sensations from the head and uncertainty about the outcome of surgery. The 'switch-on' was experienced as a significant revelation and the emotionally loaded starting point for their coming back to life. Retraining the brain concerns the lengthy audiovisual learning process, finally resulting in 'a car sounding like a car'. Strengthening of self-worth concerns psychosocial outcomes of cochlear implantation, in terms of less dependency and increased social participation. CIs provide a substantial improvement in the quality of life, as identi- fied in the emerging generic process of coming back to life, fundamental for psychological existence.

The Speech Intelligibility Index (SII) was used along with paired-comparison judgements and speech recognition scores to compare the speech intelligibility provided by two hearing-aid frequency responses in two different background noises. The purpose was to validate an SII-based procedure. Test subjects were 26 hearing-aid users representing a wide range of hearing loss configurations. One hearing-aid setting was in close agreement with the NAL-R prescription, whereas the other setting was achieved by reducing the high-frequency gain by about 10 dB compared to NAL-R. There were good overall agreements between results of the three methods. Average speech re cognition scores were about 4 percentage points higher for the NAL-R frequency response, which also was subjectively judged as significantly better in terms of speech intelligibility. The SII based procedure was found to be suitable for comparing hearing-aid characteristics within subjects.

The purpose of this study was to describe the experiences of coping with demanding auditory situations in everyday life from the perspective of individuals with severe-profound hearing impairment. Seventeen individuals (11 women and 6 men), with post-lingual severe-profound hearing impairment participated in the study. All were patients at the Department of Audiology, Sahlgrenska University Hospital in Goteborg, Sweden. Inclusion criteria were a hearing impairment exceeding 70 dB HL at the frequency of 1 kHz in the better ear, and full-time employment. Data were assessed by in-depth interviews lasting about one hour. The interviews were transcribed verbatim and analysed line-by-in line in accordance with the grounded theory tradition. Six theoretical constructs, or categories, were grounded in the data. These categories were labelled 'coaching', 'belonging to two worlds', 'self-efficacy', 'hardiness' and 'directing coping strategies'. In a grounded theory the central phenomenon on which all the other categories are integrated is known as the 'core category'. The core category, which emerged in the present study, was labelled 'finding flow and entering a positive circle'. This was described as a condition necessary for successful coping with the demanding situation of being a profoundly hearing-impaired person working full-time. According to the core category, there is a small 'margin' within the positive circle (a space where smaller mistakes may occur). However, if mistakes are too severe, or too many, individuals will no longer find flow in the positive circle, rather they enter a negative circle. In the present study subjects' personalities were characterized by hardiness. It is suggested that coaching behaviour and the hearing-impaired individuals' personality dispositions of hardiness and self-efficacy function as resistance resources, buffering stressful events in everyday life.

Health-related quality of life (HRQL) was measured with the Nottingham Health Profile (NHP) in 311 Swedish adults suffering from severe-profound hearing impairment (sensorineural hearing loss in the better ear of ≥70 dB HL at a frequency of 1.0 kHz) for comparisons with a normal-hearing population. The subjects completed NHP and a questionnaire regarding bio-psycho-social status. Generally, subjects with profound hearing loss reported lower HRQL. Significant differences were obtained for lack of energy, emotional reactions and social isolation. Females with profound impaired hearing tended overall to have lower HRQL than the males. The persons with severe-profound hearing impairment working full-time reported higher HRQL than those with a partial or full disablement pension and were comparable with the hearing population. Severe-profound hearing impairment is associated with an impact on HRQL of the sufferers, especially their emotional and social coping and energy resources. The profound hearing-impaired persons seem to constitute a risk group for worse psychosocial adjustment and need greater attention and support.

Abstract The purpose of this study was to describe the experiences of coping with demanding auditory situations in everyday life from the perspective of individuals with severe-profound hearing impairment. Seventeen individuals (11 women and 6 men), with post-lingual severe-profound hearing impairment participated in the study. All were patients at the Department of Audiology, Sahlgrenska University Hospital in Göteborg, Sweden. Inclusion criteria were a hearing impairment exceeding 70 dB HL at the frequency of 1 kHz in the better ear, and full-time employment. Data were assessed by in-depth interviews lasting about one hour. The interviews were transcribed verbatim and analysed line-by-in line in accordance with the grounded theory tradition. Six theoretical constructs, or categories, were grounded in the data. These categories were labelled ‘coaching’, ‘belonging to two worlds’, ‘self-efficacy’, ‘hardiness’ and ‘directing coping strategies’. In a grounded theory the central phenomenon on which all the other categories are integrated is known as the ‘core category’. The core category, which emerged in the present study, was labelled ‘finding flow and entering a positive circle’. This was described as a condition necessary for successful coping with the demanding situation of being a profoundly hearing-impaired person working full-time. According to the core category, there is a small ‘margin’ within the positive circle (a space where smaller mistakes may occur). However, if mistakes are too severe, or too many, individuals will no longer find flow in the positive circle, rather they enter a negative circle. In the present study subjects' personalities were characterized by hardiness. It is suggested that coaching behaviour and the hearing-impaired individuals' personality dispositions of hardiness and self-efficacy function as resistance resources, buffering stressful events in everyday life.

The purpose of the present study was to measure health-related quality of life (HRQL), personal harmony and work-induced problems, and to identify typical personal traits among Swedish adults with a severe-profound hearing impairment who were employed full-time. In comparison with hearing people aged <65 years, the hearing-impaired individuals working full-time differed only as regards energy and social isolation. Compared to another group of hearing-impaired subjects (working either part-time or retired) the study group scored better on most dimensions. Personal harmony of the hearing-impaired group working full-time did not differ from that of average employed Swedish people. The work situation of the group was generally reported to be busy but rewarding, especially concerning contact with fellow workers and management. Among various personal traits examined, strong will-power and stress tolerance were the most significant. However, due to the small sample size, it is not possible to state that the results indicate a general situation or were just due to the study subjects constituting an elite sample of hearing-impaired individuals.

The Gothenburg Profile (GP) for measurement of experienced hearing disability and handicap was developed with content partly taken from the shortened Hearing Measurement Scale (HMS25). The GP consists of 20 items divided into two subscales. The first subscale measures Experienced Disability as to hearing speech (items 1-5) and sound localization (items 6-10). The second subscale targets the Experienced Handicap in social settings (items 11-15) and the personal reactions to the experienced handicap (items 16-20). In this study, data are presented for new hearing aid candidates (NewHA) (n=441) and for experienced hearing aid users (ExpHA) (n=476). Principal components factor analyses were conducted and a three-factor solution was obtained, supporting the two factors of the Experienced Disability subscale, but just confirming one factor in the Experienced Handicap subscale. The internal consistency reliability (coefficient alpha) was good (0.85 to 0.95) for the subscales as was the test-retest reliability. The ExpHA group expressed significantly greater disability (first subscale) as well as experienced handicap (second subscale). However, when controlling for hearing level the differences disappeared. The clinical use of the GP for assessment of rehabilitation needs is recommended.

Fourteen experienced users of bone-anchored hearing aids conducted paired comparisons of sound quality and speech intelligibility for 6 and 4 different stimuli respectively in the Classic 300 and a bone-conduction hearing aid with a steel clip. Ten paired comparisons were made for each stimulus. The patient selected the best hearing aid and rated the chosen hearing aid on a scale of 'somewhat better', ‘better’ and ‘much better’. The Classic 300 obtained a positive assessment in terms of sound quality and speech intelligibility far more frequently. All the patients chose the Classic 300 as the best hearing aid when they assessed the sound quality of the classical music stimulus.

The bone-anchored hearing aid is connected, by means of a skin-penetrating bayonet coupling, to an implanted titanium fixture. Hence, direct bone conduction (dbc) excitation is used. Since no international standard of audiometric zero for dbc force threshold exists, it is of general interest to determine the dbc force threshold for normal hearing subjects. Two different methods have previously been applied to estimate the relation between bone conduction (bc) and dbc thresholds. One preliminary problem was to make a measurement of the output-force level of dbc transducers, which is equivalent to the situation in situ. A skull simulator, TU-1000, has been designed for measuring the output-force level of dbc transducers. The skull simulator does, in an adequate way, reflect the mechanical point impedance of the human skull. This opportunity to determine equivalent dbc force thresholds has motivated the present study in which a linear relation between the dbc force threshold and the bc force threshold was estimated. The estimate found in the present study conforms fairly well with the two previously found estimates. It is suggested that the estimate found in the present study be used as the reference equivalent threshold force level for dbc.

Eighteen patients judged the sound quality of the new Classic 300 and the existing HC 100 or HC 200 on 4 five-stage sound quality scales. Two of the scales relate to the perceptual dimensions softness and clarity, one relates to interference or noise and one relates to the overall impression. The evaluations were made, based on a questionnaire, in the patients' own homes and comprised the listening situations: TV news, music, conversation with two to three people in a noisy environment and one optional choice. The patients also stated which hearing aid was best in each situation and made a confidence rating for their selection. The patients were accustomed to wearing the HC 100 or HC 200. In these comparisons of the different bone-anchored hearing aid models, the Classic 300 received the best ratings overall. Seventeen patients changed their previously fitted hearing aid to a Classic 300 and satisfactory sound quality was undoubtedly one of the principal reasons. When it came to the confidence rating for their selections, some two-thirds of the patients stated that it was without hesitation or with little hesitation. Our overall conclusion is that the sound quality of bone-anchored hearing aids is satisfactory when it comes to clarity and overall impression. However, it may be expected that these patients with conductive losses get a better sound quality than other patients with sensorineural losses if the same type of aid is used.

The main argument for purchasing a programmable hearing instrument with multiple programs is the assumption that different program settings can be used in acoustically different listening environments. The presumed advantages of the 3M Model 8200 programmable hearing instrument have been investigated in three clinical trials. This paper is a summary of the results. The evaluations were based on protocols and diary booklets where the patients indicated the selected listening situation versus program number. The Datalogging feature of the instrument, measuring the total on-time and the on-time per program, provided a unique support of the evaluation. The results indicated that most patients use 2–5 different programs, and have 2–4 programs fitted for their specific listening environments (“spotlight-listening”). It will, however, be difficult to develop general prescriptive formulas, as the listening pattern and environments differ across subjects.

Hearing aid users with longstanding and severe dermatitis in the ear canal were examined by a dermatologist and patch tested. In 6 of 22 (27%) patients, contact allergy to the earmold material was found. Four of the six had a positive test reaction to methyl methacrylate and two also to triethyleneglycol dimethacrylate and urethane dimethacrylate. Positive patch test reactions to substances used for topical treatment were found as well. Routines including liberal patch testing for this group of patients are suggested.

Four different prescriptions of hearing aid insertion gain versus frequency were validated with a group of 26 moderately hearing-impaired, elderly hearing aid users. Three prescriptions were based on calculating the loudness and articulation index (AI) for aided speech, and ranged from a frequency response with moderate high-frequency emphasis, restoring normal loudness for speech peaks, to a response with the greatest high-frequency emphasis, maximizing the AI. The fourth prescription was a well-established formula of the half-gain type. The frequency responses were evaluated by paired comparison ratings of the pleasantness and intelligibility of speech in noise, and by speech identification tests in noise. The subjects rated the flattest response as significantly more pleasant than the other responses, and significantly more intelligible than the prescription with maximal high-frequency emphasis. There were no detectable differences in signal/noise ratios required for 50% speech identification. These results indicate that a prescription that restores normal loudness for speech peaks in each critical band is probably more easily accepted than either a procedure which is intended to make all speech bands equally loud, or a prescription which maximizes the AI.