Objective: (1) To test the feasibility of the Rapid Assessment of Hearing Loss (RAHL) survey protocol in Malawi (Ntcheu); (2) To estimate the prevalence and probable causes of hearing loss (adults 50+). Design: Cross-sectional population-based survey. Study sample: Clusters (n = 38) were selected using probability-proportionate-to-size-sampling. Within each cluster, 30 people aged 50+ were selected using compact-segment-sampling. All participants completed smartphone-based audiometry (hearTest). Prevalence was estimated using WHO definitions (PTA of thresholds 0.5, 1, 2, 4 kHz in the better ear of >25 dB HL (any) and >40 dB HL (>= moderate)). Otoscopy and questionnaire were used to assess probable causes. Participants with hearing loss and/or ear disease were asked about care-seeking and barriers. Results: Four teams completed the survey in 24 days. 1080 of 1153 (93.7%) participants were examined. The median time to complete the protocol was 24 min/participant. Prevalence of hearing loss was 35.9% (95% CI = 31.6-40.2) (any level); and 10.0% (95% CI = 7.9-12.5) (>= moderate). The majority was classified as probable sensorineural. Nearly one third of people (30.9%) needed diagnostic audiology services and possible hearing aid fitting. Hearing aid coverage was Conclusion: The RAHL is simple, fast and provides information about the magnitude and probable causes of hearing loss to plan services.
Objectives: To develop a Mandarin version of the Hearing in Noise Test for Children (MHINT-C) and examine the maturational effects on sentence recognition. Design: Sentences suitable for evaluating children aged 6-18 years were selected from the adult MHINT to form 12 lists of 10 MHINT-C sentences (Study 1). List equivalence, inter-list reliability, response variability, and maturational effects on sentence recognition were examined using the MHINT-C (Study 2). Study sample: A total of 246 children aged 6.1-17.11 years were included. Six children participated in Study 1; the rest were included in Study 2. To compare these results with adults, 20 native Mandarin-speaking adults aged 18 or above were included in Study 2. Results: MHINT-C list equivalency, inter-list reliability, and response variability were similar to those of the adult MHINT and the Cantonese HINT for children. Sentence recognition in children reached adult-like performance around age 8 in quiet and at ages 15 and 14 in front and side noise conditions, respectively. Conclusions: The MHINT-C can reliably measure sentence recognition in quiet and noise in Mandarin-speaking children. Age-specific correction factors were established.
Objectives:To investigate a temporary threshold shift (TTS) of hearing and pain/discomfort caused by the microsuction procedure. Hearing loss induced by impacted cerumen was also investigated. Design:Impacted cerumen was removed from patients using microsuction. Hearing assessments were carried out before the procedure, immediately after and 1-week later. Hearing thresholds measured in different sessions were compared to determine the TTS caused by the microsuction procedure and hearing loss induced by impacted cerumen. A questionnaire was used to evaluate the pain/discomfort experienced by patients. Study Sample:30 patients (50 ears) were recruited from a cerumen removal clinic. Results:Significant hearing loss caused by impacted earwax was found across individual frequencies (mean 11.4 dB, maximum 38.1 dB). A TTS appeared in 43/50 (86%) ears, ranging from 0 to 16.2 dB averaged across frequencies between 0.25 and 8 kHz, with the highest TTS at 6 kHz. Pain and discomfort levels were both rated low, the mean levels were 1.2 (SD = 0.5) and 1.6 (SD = 0.5) respectively on a scale from 1 to 10. Conclusions:Microsuction appears to be a well-tolerated and preferred procedure for removing impacted cerumen. Because of the significant TTS induced by the microsuction procedure, safety concerns from a hearing perspective should be raised with the patient.
Objective:The purpose of the present study was to examine the effects of NLFC fitting in hearing aids and auditory acclimatisation on speech perception and sound-quality rating in hearing-impaired, native Mandarin-speaking adult listeners. Design:Mandarin consonant, vowel and tone recognition were tested in quiet and sentence recognition in noise (speech-shaped noise at a +5 dB signal-to-noise ratio) with NLFC-on and NLFC-off. Sound-quality ratings were collected on a 0-10 scale at each test session. A generalised linear model and correlational analyses were performed. Study sample:Thirty native Mandarin-speaking adults with moderate-to-severe sensorineural hearing loss were recruited. Results:The hearing-impaired listeners showed significantly higher accuracy with NLFC-on than with NLFC-off for consonant and sentence recognition and the recognition performance improved with both NLFC-on and off as a function of increased length of use. The satisfaction score of sound-quality ratings for different types of sounds significantly increased with NLFC-on than with NLFC-off. The speech recognition results showed moderate to strong correlation with the unaided hearing thresholds. Conclusion:For native Mandarin-speaking listeners with hearing loss, the NLFC technology provided modest but significant improvement in Mandarin fricative and sentence recognition. Subjectively, the naturalness and overall preference of sound-quality satisfaction judgement also improved with NLFC.
Objective:Available data on dichotic listening using tonal Chinese words have been limited, and conflicting results on a right-ear advantage (REA) have been reported. The current study developed a set of Mandarin CV-words based on the Bergen dichotic listening paradigm. Design:The test materials consisted of two sets of stimuli. The English set, derived from the iDichotic application, consisted of six nonsense syllables with plosives conjugated to /a/. The Mandarin set had these 6 CV-syllables spoken as real words according to the Mandarin phonology. Study sample:Forty young, native Mandarin speakers were tested dichotically with both sets of test materials. Twenty participants were right-handed, and the other twenty were left-handed. Fourteen participants were randomly selected to repeat the test with the Mandarin set. Results:The mean difference of correct recognition responses between two ears indicated a REA with both sets of stimuli for the right-handers, but not for left-handers. For the right-handers, performance with the Mandarin set was significantly better than performance with the English set. Dichotic listening with the Mandarin set had strong correlation between two time points,r = 0.8. Conclusions:Performance using the Mandarin set is reliable in dichotic listening; a REA is observed for the right-handers.
Objective:To assess the recognition of lexical tones in Mandarin-speaking bimodal cochlear implant (CI) subjects. Design:Lexical tone recognition in quiet and noise (SNR= +5 dB) was measured with electric stimulation (CI alone) or bimodal stimulation (CI + hearing aid (HA)). The recognition and confusion rates of the four tones (T1, T2, T3 and T4) were analysed. Spearman correlation analysis was performed to examine the relationship between hearing levels in the contralateral ear and bimodal benefits. Study sample:Twenty native Mandarin-speaking bimodal CI users, with ages ranging from 16-49 years. Results:Relative to the CI alone, mean tone recognition with the CI + HA improved significantly from 84.1-92.1% correct in quiet (+8 points) and from 57.9-73.1% correct in noise (+15.2 points). Tone confusions between T2 and T3 were the most prominent in all test conditions, and T4 tended to be labelled as T3 in noise. There was no significant correlation between the bimodal benefits for tone recognition and the unaided or HA-aided pure-tone thresholds at 0.25 kHz. Conclusion:Listeners with CI + HA exhibited significantly better tone recognition than with CI alone. The bimodal advantage for tone recognition was greater in noise than in quiet, perhaps due to a ceiling effect in quiet.
Objective: To compare speech perception obtained with different time compression rates in teenagers that do or do not use personal listening devices (PLDs). Design: Teenagers in a high school were recruited to complete questionnaires reporting their recreational noise exposure using PLDs. The dose of individual recreational noise exposure was calculated. The individuals with the most and least doses of recreational noise were selected and grouped into PLD users and non-PLD users. Normal rate and time-compressed (60% and 70%) speech recognition in quiet and noisy conditions was measured. Study sample: PLD user and non-PLD user group each included 20 participants. Results: ANOVA analysis showed that the effect of group, background, compression rate, and interactions between any two factors are significant. Post hoc analysis showed that the speech recognition scores with normal rate in quiet and noise and those obtained from time-compressed speech in the quiet condition were not significantly different between PLD users and non-PLD users. However, differences in the time-compressed speech recognition scores (60% and 70%) in noisy conditions between the two groups were statistically significant. Conclusions: The fast-speed speech recognition in noise decreased significantly in PLD users compared with that in non-PLD users selected by extreme entertainment exposure.
Objective: To investigate whether acoustic neuroma is associated with noise. Design: PubMed, Cochrane, Embase and CINAHL databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) using quality-effect models. Study sample: A total of eight studies with moderate or high quality involving 75,571 participants met the inclusion criteria. Results: There was no significant relationship between overall noise exposure and acoustic neuroma (OR:1.02, 95% CI: 0.64-1.63). However, further subgroup analysis showed that leisure noise exposure (OR: 1.73, 95% CI: 1.10-2.73), above five years' exposure (OR: 1.81, 95% CI: 1.14-2.85) and continuous exposure (OR:2.77, 95% CI: 1.70-4.49) were associated with an increased risk of acoustic neuroma. Conclusions: These results suggest an elevated risk of acoustic neuroma among individuals who have been exposed to occupational noise when some subgroup analysis are conducted. Leisure noise in particular seems to play a significant role in the development of acoustic neuroma. However, due to the heterogeneity among the included studies, this conclusion should be interpreted with cautions, even though the continuous long-term consequences should not be ignored.
Objectives: To gain insight into the hearing protection practice of Chinese workers and the value of hearing protection fit testing.Design: The Field Attenuation Estimation System (FAES) was used to measure the personal attenuation ratings (PARs) of one foam earplug used at the work sites in China. Intervention was provided to workers who needed it. Follow-up fit testing was conducted approximately six months later. Paired t-tests were conducted to compare the baseline, post-intervention and follow-up visit PARs.Study sample: Fit testing was conducted on 335 workers in four factories with 269 workers intervened. Follow-up visit was conducted on 97 intervened workers in three factories.Results: The mean PAR baseline was 10 dB. Significant improvement was shown on post-intervention PARs (p < 0.05) as well as follow-up visit PARs (p < 0.05). Comparing follow-up visit PARs to post-intervention PARs, good sustainability was shown in two factories (p > 0.05), while a significant decline (p < 0.05) was observed in another.Conclusions: Hearing protection fit testing demonstrated value for verifying sufficiency of attenuation. The training along with fit testing contributed to improve PARs and maintaining effectiveness over time. Employer's attention and follow-up actions are important in sustaining the training effectiveness.
Objective: This study investigated hearing screening tests by using a custom-designed compensated hybrid active noise cancellation (ANC) earphone and compared it with TDH39 and Audiocups audiometric earphones under conditions of quiet, 45 dB HL masking narrowband, wideband speech-shaped, and white noise. Design: The hearing screening tests were conducted to characterise the shifts of screening results under noisy conditions, and real-ear attenuations at thresholds were assessed to quantify real-ear noise reduction performance. Study sample: Twenty-four normal-hearing adults, aged 20-25 years, participated in this study. Results: The ANC earphone exhibited significantly lower/better mean screening results than those of the TDH39 earphone at 250 and 500 Hz and those of the Audiocups earphone at 250 Hz under conditions of narrowband, speech-shaped, and white noise. Compared with the TDH39 earphone at 250 and 500 Hz, applying a hybrid ANC earphone reduced the shifts in screening results by 14.2 and 12.3 dB, respectively, under the narrowband noise condition. Conclusion: This study demonstrated that the compensated hybrid ANC earphone provided lower shifts of screening results than the TDH39 and Audiocups earphones and that it was capable of screening at 250 and 500 Hz from 20 dB HL under 45 dB HL masking narrowband and wideband noise.
Objective: Data with regard to the Mandarin dichotic digits test (DDT) are limited, with conflicting results reported between the Mandarin and English DDTs. The current study examined factors that might affect the performance in the Mandarin DDT. Design: The digits were arranged in 3 sets of 20 dichotic pairs; each set comprised 2, 3 or 4 digits in a pair. Study sample: Forty-one young, native Mandarin speakers with normal hearing were tested; 30 of them were right-handed and 11 left-handed. Six participants repeated the test. Results: The prevalence of ceiling effect in recognition score decreased systematically as the digit-pair length increased. At digit sets of 3-pair and 4-pair, the right-handed group showed a significant higher recognition score at right ear than left ear, while the left-handed group reversed the performance. The score difference between ears is significantly different between the right- and left-handed groups. The retest of the Mandarin DDT was reliable. Conclusions: For the right-handed group, a right-ear advantage can exist in the Mandarin DDT at a longer digit-pair length, similar to what was reported in the English DDT. Moreover, for the left-handed group, the attended right hemisphere in processing the tonal digits can result in a left-ear advantage.
Objective: This study was to investigate whether there is impairment of auditory function in chronic rhinosinusitis (CRS). Study sample: A total of 85 patients were allocated into either the CRS group (n = 65) or a simple deviated nasal septum group (n = 20). Both groups without other risk factors for sensorineural hearing loss exhibited normal thresholds at standard audiometric frequencies. Another group (n = 30) of healthy subjects without CRS or a deviated nasal septum were gender and age matched. Design: Analyse the results of audiology test including pure tone audiometry, an acoustic impedance test, distortion product otoacoustic emissions (DPOAE) and the auditory brainstem response (ABR) for each subject analyse the test results of for each object. Results: The group differences were statistically significant for each high-frequency pure tone (p < 0.05). The ABR showed a difference between groups in amplitude. The DPOAE pass rate of the CRS group was lower than that of the control group. Conclusions: This study showed a significant correlation between CRS and auditory impairment. CRS might impair cochlear functions by damaging inner ear hair cells and/or, outer hair cells (OHCs), consequently altering the activity of the entire auditory pathway originating in the ventral cochlear nucleus (VCN) to the inferior colliculus.
Objective: The present study aimed to establish the test-retest reliability and validity of a tablet-based automated pure-tone screening test and a word-in-noise test as hearing screening tools for older Hong Kong Cantonese-speaking adults. Design and study sample: It was a cross-sectional within-subject study. One hundred and thirty-two older adults participated in this study, and 112 of them completed the automated pure-tone screening test, word-in-noise test, and conventional pure-tone audiometry. Pure-tone threshold of 40 dB HL at each of the tested frequencies including 500, 1000, 2000 and 4000 Hz, obtained with conventional pure-tone audiometry was set as the pass/refer criterion, for the calculation of sensitivity and specificity of the tablet-based screening tools. Results: The tablet-based automated pure-tone screening test yielded a sensitivity of 0.93 and specificity of 0.82, while the word-in-noise test yielded a sensitivity of 0.81 and specificity of 0.70 with the cut-off chosen as a speech reception threshold of -3.5 dB signal-to-noise ratio. Both tests require around 3 minutes to be completed on both ears. Conclusions: The tablet-based pure-tone test and word-in-noise test are reliable and valid to be used as screening tools for hearing loss in the Hong Kong Cantonese-speaking elderly.
Objectives: To establish the reliability, validity and responsiveness of the Chinese version of the Tinnitus Functional Index (TFI-CH) in measuring tinnitus severity in Hong Kong Chinese population. Design: This is a cross-sectional psychometric validation study. Study sample: Subjects were 124 adult Chinese who attended the audiology clinics in a hospital setting for tinnitus treatment. Results: The TFI-CH showed good internal consistency reliability (alpha=0.94) and test-retest reliability (ICC=0.84). Confirmatory factor analysis revealed that the TFI-CH has eight factors which are exactly the same as the original version. The TFI-CH has good convergent and divergent validity as supported by the strong correlation of the overall scale with other tinnitus-related distress measures (r=0.86, p<0.01) and weaker correlation with the general health status measures. Moderate to strong effect sizes obtained 3 months after initial visit indicated that the TFI-CH is responsive in detecting change in tinnitus suffering. Conclusions: The results of this study demonstrate that the TFI-CH is a reliable and valid measure which should be useful in both clinical and research settings for intake assessment and for measuring treatment-related changes in tinnitus.
Objective: This study aims to investigate the prevalence of hearing loss, and to analyse the major demographics and risk factors that influence the prevalence in older adults of China. Design: Cross-sectional investigation. Study sample: Probability proportionate to size sampling (PPS) was adopted for this survey. Among 45,052 individuals, 6984 older adults (>= 60 years) were selected as subjects for this study. Results: The prevalence of hearing loss defined as a speech frequency pure tone average of more than 25 dB HL in the better ear was 58.85%. Age and gender were the factors most strongly associated with hearing loss after multivariate adjustment. Ear disease, diabetes, hypertension, atherosclerosis, noise exposure, and ototoxic drugs were significantly correlated with hearing loss. The largest effects were found for ear disease and noise exposure (OR = 2.83 [95% CI: 2.43-3.29]; OR = 2.59 [95% CI: 1.80-3.72]). Conclusions: Hearing loss is prevalent in nearly two thirds of adults aged 60 years and older in China population. Chronic diseases, ear disease, and noise are important factors in adults aged 60 years and older.