ABSTRACT
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hearing aid users
Tatiana Manfrini GARCIA, Regina Tangerino de Souza JACOB, Maria Fernanda Capoani Garcia MONDELLI
Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Fonoaudiologia, Bauru, SP, Brasil.
Corresponding address: Maria Fernanda Capoani Garcia Mondelli - Departamento de Fonoaudiologia da Faculdade de Odontologia de Bauru - Universidade de São Paulo - Al. Octávio Pinheiro Brisolla, 9-75 - Bauru - São Paulo - Brazil - 17012-901 - Phone: 014-3235-8332 - e-mail: mfernandamondelli@hotmail.com
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bj ect ive: To relat e t he perform ance of individuals w it h hearing loss at high frequencies LQVSHHFKSHUFHSWLRQZLWKWKHTXDOLW\RIOLIHEHIRUHDQGDIWHUWKH¿WWLQJRIDQRSHQ¿W KHDULQJDLG+$0HWKRGV7KH:+242/%5()KDGEHHQXVHGEHIRUHWKH¿WWLQJDQG days aft er t he use of HA. The Hearing in Noise Test ( HI NT) had been conduct ed in t w o SKDVHVDWWKHWLPHRI¿WWLQJZLWKRXWDQ+$VLWXDWLRQ$DQGZLWKDQ+$VLWXDWLRQ %ZLWKDQ+$GD\VDIWHU¿WWLQJVLWXDWLRQ&6WXG\6DPSOH7KLUW\VXEMHFWVZLWK sensorineural hearing loss at high frequencies. Result s: By using an analysis of variance and t he Tukey’s t est com paring t he t hree HI NT sit uat ions in quiet and noisy environm ent s, DQLPSURYHPHQWKDVEHHQREVHUYHGDIWHUWKH+$¿WWLQJ7KHUHVXOWVRIWKH:+242/%5() KDYHVKRZHGDQLPSURYHPHQWLQWKHTXDOLW\RIOLIHDIWHUWKH+$¿WWLQJSDLUHGWWHVW7KH UHODWLRQVKLSEHWZHHQVSHHFKSHUFHSWLRQDQGTXDOLW\RIOLIHEHIRUHWKH+$¿WWLQJLQGLFDWHGD VLJQL¿FDQWUHODWLRQVKLSEHWZHHQVSHHFKUHFRJQLWLRQLQQRLV\HQYLURQPHQWVDQGLQWKHGRPDLQ RIVRFLDOUHODWLRQVDIWHUWKH+$¿WWLQJ3HDUVRQ¶VFRUUHODWLRQFRHI¿FLHQW&RQFOXVLRQV7KH audit ory st im ulat ion has im proved speech percept ion and t he qualit y of life of individuals.Ke yw or ds: Hearing aids. Hearing loss. Qualit y of life. Speech percept ion.
I N TROD UCTI ON
+HDULQJDLGXVHUVVKRZGLI¿FXOW\LQSHUFHLYLQJ sp e e ch w h e n i n t h e p r e se n ce o f co m p e t i n g back gr ound noise, w hich m ay affect t heir social i n t er a ct i o n . Th e a u d i t o r y d ep r i v a t i o n ca u ses consequences in t he indiv idual’s life and affect s t h e a b i l i t y t o p r o p e r l y u n d e r st a n d a co u st i c inform at ion, as well as in t he way t hey relat e t o t heir environm ent , which can cause a decisive im pact on t heir qualit y of life ( QoL) .
I ndividuals who exhibit hearing loss rest rict ed t o h ig h f r eq u en cies ( ab ov e 1 k Hz) in ad v er se condit ions, such as w hen speech is dist ort ed, or in WKHSUHVHQFHRIQRLVHPD\IDFHVHYHUDOGLI¿FXOWLHV in speech in t elligibilit y becau se t h e n u m ber of au d it or y cu es d r op s con sid er ab ly. Th e sp eech int elligibilit y depends on t he consonant sounds t hat present sound spect rum w it h frequencies above 2 kHz. The fact t hat t he consonant s are low int ensit y sounds in r elat ion t o vow els m akes t hem m or e
GLI¿FXOW WR GHWHFW HVSHFLDOO\ IRU LQGLYLGXDOV ZLWK
slope hearing loss97KHSXUSRVHRIDPSOL¿FDWLRQ
LQ LQGLYLGXDOV ZLWK WKLV DXGLRORJLFDO SUR¿OH LV WR provide an em phasis on high frequencies sounds, p r ov i d i n g au d i b i l i t y o f sp eech si g n al w i t h o u t generat ing acoust ic feedback or dist or t ion, and av oidin g au t oph on ia f r om t h e occlu sion of t h e ext ernal audit ory canal ( EAC) by t he earm old. The t ot al or part ial occlusion of t he EAC wit h an earm old causes t he loss of nat ural resonance of t he EAC, ZKLFKPDNHVLWGLI¿FXOWWRREWDLQJDLQVLQWKHUHJLRQ of 3–4 kHz. Therefore, som e st rat egies should be considered during t he hearing aids ( HAs) select ion
VXFKDVWKHRSHQ¿W2)+$V8.
2QHZD\WRPHDVXUHVXFFHVVLQWKH+$V¿WWLQJLV t o assess t he im provem ent in speech recognit ion, par t icular ly in noisy env ir onm ent s, w hich could possibly lead t o an im provem ent in t he individual QoL.
Over t he years, m any t est s of speech percept ion in noise have been developed in an at t em pt t o bet t er evaluat e t he individual’s perform ance in noisy environm ent s, seeking t o m axim ize t he approach in sit uat ions of daily life such as CTS - Connect ed Speech Test , SI N - Speech in Noise Test , QuickSI N-QuickSpeech- in- Noise Test , BKB- SI N - Bam for d-Kowal- Bench Speech- in- Noise Test , SPI N - Speech Percept ion I n Noise, and HI NT – Hearing in Noise Test . There are differences bet ween t he t est s in t he VSHHFKPDWHULDOVWKDWLQÀXHQFHWKHDVVHVVPHQWRI speech int elligibilit y in noisy environm ent s15. Test s
t h at con t ain sen t en ces in n oisy env ir on m en t s, such as HI NT, represent everyday speech and are PRUHHIIHFWLYHLQWKHPHDVXUHPHQWRIGLI¿FXOWLHVLQ underst anding speech by exposing t he individual t o different variat ions in t he signal- t o- noise rat io ( SNR) in each environm ent13. The HI NT is w idely
XVHG WR REMHFWLYHO\ GHPRQVWUDWH WKH EHQH¿W RI HAs, ev alu at e an d v er if y HAs algor it h m s su ch as d i r ect i on al m i cr op h on es, ex p an si on , n oi se r educt ion, w ir eless and var ious ot her m odels of HAs5,7,11,14,18- 21.
Li t er at u r e sh o w s t h at t h e v er i f i cat i o n an d YDOLGDWLRQLQWKH¿WWLQJRI+$VGHFUHDVHGWKHQXPEHU of ret urns and increased t he pat ient ’s sat isfact ion w it h HAs. Thus, t he aut hor suggest ed percept ion of speech in noise t est s for validat ion6.
Several st udies point t o a negat ive assessm ent of QoL in indiv iduals w it h hear ing loss, but few VWXGLHVKDYHXVHGVSHFL¿FLQVWUXPHQWVWRPHDVXUH
t he QoL, such as t he WHOQOL- Breef, relat ed t o
h ear in g loss. Th ese su r v ey s ar e scar ce in t h e lit erat ure, which m akes t his t opic a necessary st udy subj ect in t he audiology area2.
6ORSHKHDULQJORVVFRQ¿JXUDWLRQVDUHSUHYDOHQW in au diological clin ics. Su bj ect s w it h t h e slope KHDULQJORVVGRQRWRIWHQIHHOKHDULQJGLI¿FXOWLHV in t he silence, t hus t hey do not present hearing com plaint s, since t hey have norm al hearing up t o 1 kHz and m oderat e loss t o high t ones, w hich causes GLI¿FXOW\RQO\LQQRLV\HQYLURQPHQWV7KHLQGLFDWLRQ of HA for t his populat ion should be based on t he GLI¿FXOW\SUHVHQWHGLQQRLVH7KHVSHHFKSHUFHSWLRQ t est is an im p or t an t t ool t h at can ob j ect iv ely show t he im provem ent for t he pat ient s, t herefore im proving t heir qualit y of life.
St udies on t he QoL and t he speech percept ion of individuals w it h hearing loss at high frequencies m ay f u n d am en t al l y con t r i b u t e t o t h e f i el d of DXGLRORJ\DLGLQJDQGRUFRQ¿UPLQJWKHGHFLVLRQ m aking process regarding t he prescript ion of HAs and providing m ore support for t he counseling and JXLGDQFHSURFHVVHVLQWKHXVHRI2)¿WWLQJ
Th e ai m o f t h i s st u d y w as t o an al y ze t h e relat ionship bet w een speech percept ion and QoL in adult s and elder ly w it h hear ing loss at high frequencies, before and aft er t he adapt at ion of OF HAs.
M ETH OD S
This prospective cohort study has been conducted aft er approval by t he Et hics Com m it t ee for Research in Hum ans ( 607.178) and aft er t he agreem ent and inform ed consent of t he subj ect s.
The st udy included 30 individuals who have m et t he follow ing inclusion crit eria:
Aged m ore t han 30 years;
Diagnosed w it h sensorineural hearing loss w it h a slope hearing loss, rest rict ed at high frequencies ( above 1 kHz) , com pat ible w it h a convent ional OF +$5HFHLYHULQWKHDGYLFH5,7$¿WWLQJDQGZLWK digit al t echnology;
No prior experience w it h t he use of HAs; Absen ce of ot h er pat h ology associat ed w it h hearing loss;
Ab i l i t y t o u n d e r st a n d t h e W H OQOL- BREF TXHVWLRQQDLUH ,I VXEMHFWV KDG DQ\ GLI¿FXOWLHV LQ answ ering t he quest ions, t hey w ould be excluded from t he sam ple.
Pa r t icipa n t s
The sam ple consist ed of 11 fem ale and 19 m ale aging from 34 t o 78 years ( m ean: 61, 41 sd: 9, 67) . The audiom et ric t hreshold averages are in Figure 1.
Pr oce du r e s
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I n order t o select t he t ype and m odel of HA, t he audiological feat ures and com m unicat ive needs of t he part icipant s have been analyzed. According t o t his analysis, t he OF HAs w ere select ed. The HAs select ed was t he m iniat ure digit al BTE t ype, wit h four channels, a dir ect ional m icr ophone syst em , digit al noise reduct ion, and feedback cancellat ion by reversed phase t echnology. All HAs w ere t he sam e m anufact urer and m odel.
The HAs have been program m ed via HI - Pro and WKHSDUWLFLSDQW¶VLGHQWL¿FDWLRQGDWDVXFKDVQDPH dat e of birt h, gender, and audiom et ric t hresholds, have been input int o t he NOAH plat form version
3.0 ( HI MSA - Copenhagen, Denm ark) .
When pr ogram m ing t he ent er pr ise soft w ar e, WKH OHYHO RI XVHU H[SHULHQFH KDV EHHQ GH¿QHG as “ ex per ienced”, w it h t he aim t o r each t ar get . I nform at ion relat ed t o t he acoust ic charact erist ics of t he t hin t ube and pr obes hav e been added. The NAL- NL1 prescript ive m et hod has been used b a sed o n t h e p r ev i o u sl y en t er ed t h r esh o l d s. Th e algor it h m s f or digit al n oise r edu ct ion an d dir ect ional m icr ophones have been act ivat ed for all part icipant s.
Af t er p r og r am m in g t h e HAs, a v er if icat ion p r oced u r e u sin g m easu r em en t s f r om a p r ob e m icrophone has been perform ed. This procedure h as been per f or m ed in an acou st ically t r eat ed URRPXVLQJ$I¿QLW\HTXLSPHQW,QWHUDFRXVWLFV± Middelfart , Denm ark) . The following m easurem ent s h av e t h en b een p er f or m ed : r eal - ear u n ai d ed UHVSRQVH 5(85 RSHQ¿W FDOLEUDWLRQ UHDOHDU occluded response ( REOR) always equal t o t he real-ear unaided response ( REUR) , and real- real-ear aided response ( REAR) .
The values of t he REAR at frequencies from 0.25 t o 6 kHz for input levels of 50, 65, and 80 dB SPL have been respect ively com pared wit h t he NAL- NL1 t ar get s. Respon ses w er e con sider ed equ ivalen t w hen t he difference bet w een t he t arget and t he
REAR value did not exceed 10 dB3. The responses
have reached t arget s for all subj ect s.
Eva lu a t ion of spe e ch pe r ce pt ion
The assessm ent of speech percept ion has been per for m ed using t he HI NT adapt ed t o Brazilian Port uguese1 under t w o condit ions:
Sent ences pr esent ed in a quiet env ir onm ent ( quiet ) ;
Sent ences present ed in com pet it ive noise; t he t ype used was m asking com posit e noise, w it h only t he front al posit ion noise being used ( noise front ) ;
I n bot h condit ions t he sent ences hav e been SUHVHQWHG¿UVWXQDLGHGDQGWKHQDLGHG
The HI NT t est have been perform ed in t hree sit uat ions and divided int o t w o phases as follow s:
3KDVHDWWKHWLPHRI+$¿WWLQJLQVLWXDWLRQV unaided ( sit uat ion A) and aided ( sit uat ion B) .
3KDVH DLGHG GD\V DIWHU WKH +$ ¿WWLQJ ( sit uat ion C) .
The t est has been conduct ed in an acoust ically WUHDWHG URRP XVLQJ IUHH¿HOG VHQWHQFHV ,Q DOO evaluat ion condit ions, t he signal ( speech and noise) was present ed from a single speaker at 0° azim ut h, 1 m from t he list ener at a height of t he head. The syst em calibrat ion has been perform ed by placing a m icrophone at t he reference corresponding t o t he part icipant ’s head cent er locat ion and 1 m away from t he speaker.
A list of 2 0 sen t en ces h as b een r an d om ly pr esen t ed by t h e HI NT PRO sof t w ar e f or each condit ion. Part icipant s have been inst ruct ed orally as t o t he guidelines cont ained in t he HI NT m anual.
The sent ence w as consider ed cor r ect by t he m easurer w hen all essent ial w ords w ere repeat ed correct ly. I n t his case, t he exam iner pressed t he “ yes” but t on on t he soft ware screen, and t he next sent ence was present ed at 2 dB below t he int ensit y of t he previous sent ence.
Fo r t h e se n t e n ce s i n q u i e t co n d i t i o n , t h e pr esent at ion level was init ially set at 45 dB( A) . The present at ion level was increased in st eps of 2 dB unt il t he part icipant correct ly repeat ed t he sent ence. The score for t his t est was expressed as dB( A) level, at w hich t he part icipant correct ly repeat ed 50% of t he sent ences.
7KHOHYHORIQRLVHZDV¿[HGDWG%$IRUWKH sent ences and t he present at ion level was init ially set at 65 dB( A) . The level of present at ion of t he sent ences varied in t he sam e m anner as described for t he sent ences in quiet condit ion. The scor e was expressed in dB as being t he SNR aft er t he present at ion of a list of 20 sent ences. Therefore, t he low er t he SNR is, t he bet t er t he speech percept ion for t he part icipant under t his condit ion.
Asse ssm e n t of QoL
Organizat ion and validat ed in Brazil by Fleck, et al.4 ( 2000) .
The WHOQOL- BREF consist s of 26 quest ions wit h t w o pert aining t o general QoL issues and t he ot her 24 quest ions represent ing each of t he 24 facet s t hat com pose t he original inst rum ent ( WHOQOL- 100) . Th u s, t h e 2 4 q u e st i o n s co v e r f o u r d o m a i n s ( physical, psychological, social relat ionships, and environm ent ) and each facet is represent ed by a
quest ion5. The WHOQOL- BREF dom ains are:
1. Phy sical dom ain: cor r esponding t o issues r el a t ed t o p a i n , d i sco m f o r t , en er g y, f a t i g u e, sleep, r est ing, m obilit y, act ivit ies of daily living, dependence on m edicat ion or t reat m ent , and t he abilit y t o work.
2 . Psy ch olog ical d om ain : cor r esp on d in g t o q u e st i o n s a b o u t p o si t i v e f e e l i n g s, t h i n k i n g , learning, m em ory and concent rat ion, self- est eem , body im age and appearance, negat ive feelings, spirit ualit y, religion, and personal beliefs.
3 . En v i r o n m en t d o m ai n : co r r esp o n d i n g t o quest ions about phy sical safet y and pr ot ect ion, KRPH HQYLURQPHQW ¿QDQFHV KHDOWK FDUH VRFLDO care, accessibilit y and qualit y of opport unit ies t o acquire inform at ion and skills, opport unit ies and part icipat ion in recreat ion and leisure, t he physical HQYLURQPHQWSROOXWLRQQRLVHWUDI¿FFOLPDWHDQG t ransport at ion.
4. Social r elat ions dom ain: cor r esponding t o q u est ion s ab ou t p er son al r elat ion sh ip s, social support , and sexual act ivit y.
Th e WHOQOL- BREF i n cl u d es f o u r t y p es o f response scales: int ensit y ( ranging from not hing t o int ense) ; capacit y ( ranging from none t o full) ; fr equency ( ranging fr om never t o alw ay s) ; and HYDOXDWLRQUDQJLQJIURPYHU\GLVVDWLV¿HGWRYHU\ VDWLV¿HG DQG YHU\ EDG WR YHU\ JRRG DOO EHLQJ JUDGHGLQ¿YHOHYHOV7KHTXHVWLRQVDUHVFRUHGIURP 1 t o 5, and t he scores are reversed for quest ions 3, 4, and 26, in such a way t hat 1= 5; 2= 4; 3= 3; 4= 2; and 5= 1.
Aft er t he quest ionnair e had been com plet ed, g en er al an d d om ai n ( p h y si cal , p sy ch ol og i cal , environm ent al, and social relat ions) values w ere cal cu l at ed , al l o w i n g f o r an ev al u at i o n o f t h e
individual QoL. This analysis has been perform ed according t o t he synt ax described by t he t ranslat ors using t he St at ist ical Pack age for Social Science ( SPSS) 10.0 for Window s.
The par t icipant s com plet ed t he quest ionnair e EHIRUHWKH¿WWLQJRIWKH+$VDQGDIWHUGD\VRI WKH¿WWLQJ
St a t ist ica l a n a lysis
The result s have been analyzed using descript ive an d in du ct iv e st at ist ical an aly sis. All st at ist ical procedures have been perform ed on STATI STI CA soft ware version 5.1 ( St at Soft , I nc., Tulsa, USA) . 7KHOHYHORIVLJQL¿FDQFHKDGEHHQVHWDWLQDOO cases.
I n t he com parison of speech percept ion ( HI NT) DWWKHWLPHRI¿WWLQJLQVLWXDWLRQVZLWKRXWDQ+$ ZLWK +$V DQG ZLWK DQ +$ SRVW ¿WWLQJ DQDO\VLV of variance and Tukey’s t est have been applied. Com parisons of t he result s of t he WHOQOL- BREF unaided and aided hav e been per for m ed using paired t - t est s. The Pearson’s correlat ion t est has been applied t o det erm ine w het her t here has been a correlat ion bet w een speech percept ion and QoL scores in t he different dom ains of t he WHOQOL-BREF.
RESULTS
7KHUHVXOWVRIWKH+,17DWWKHWLPHRI¿WWLQJLQ sit uat ions unaided ( sit uat ion A) , aided ( sit uat ion %DQGDLGHGGD\VDIWHU+$¿WWLQJVLWXDWLRQ& are show n in Table 1.
Th e an al y si s o f v ar i an ce an d Tu k ey ’s t est com paring t he t hree HI NT sit uat ions under quiet an d n oisy con d it ion s h av e sh ow ed sig n if ican t im provem ent s com paring sit uat ion A t o B ( 0.00012) an d A t o C ( 0 . 0 0 0 7 6 ) , bu t t h er e h as been n o difference bet w een sit uat ions B and C ( 0.17659) .
The result s of t he WHOQOL- BREF unaided and aided are described in Table 2.
Com par isons of t he r esult s of t he WHOQOL-%5()LQVLWXDWLRQV$DQG&KDYHVKRZHGVLJQL¿FDQW im pr ov em en t s in all dom ain s by pair ed t - t est s ( p> 0.005) , w it h t he largest difference in t he social
QUIET NOISY
HINT A HINT B HINT C HINT A HINT B HINT C
Mean 43.36 38.05 39.72 1.01 -0.51 -1.1
Mediam 41.35 37.6 38.4 0.55 -0.2 -1.8
Minimum 33.5 30.6 30.8 -3 -4 -4.1
Maximum 57.8 50 57.5 10.6 3 4
SD 7.15 5.46 5.78 2.91 1.74 2.07
$ XQDLGHG% DLGHG& DLGHGGD\VDIWHUWKH+$¿WWLQJ
relat ions dom ain, follow ed by t he self- assessm ent of QoL dom ain.
The relat ionship bet ween speech percept ion and QoL in sit uat ions A and C has been perform ed using 3HDUVRQ¶VFRUUHODWLRQFRHI¿FLHQWDQGWKHYDOXHVRI p and r are described in Table 3.
D I SCUSSI ON
Th e HI NT h a s b e e n u se d a s a n o u t co m e m easur em ent for HAs. The m ean t hr eshold for sp eech r eco g n i t i o n i n q u i et co n d i t i o n s a i d ed ( sit u at ion B) w as 5 . 3 1 dB low er t h an u n aided ( sit u at ion A) . Com p ar in g t h e r esu lt s af t er 9 0 d ay s o f f i t t i n g t o t h e r esu l t s w i t h o u t a n HA ( sit uat ion C and A) , t he difference was 3.74 dB. Th ese d if f er en ces w er e st at ist ically sig n if ican t ( p= 0.00012; p= 0.00076) and dem onst rat ed t hat
DPSOL¿FDWLRQSURYLGHVEHWWHUVSHHFKSHUFHSWLRQLQ quiet11.
I n r e l a t i o n t o t h e p e r f o r m a n ce i n sp e e ch per cept ion in noise, t he SNR scor es com par ing ¿UVW VLWXDWLRQV $ DQG % WKHQ VLWXDWLRQV $ DQG & w ere respect ively 0.5 dB and 2.11 dB low er. These d if f er en ces w er e also sig n if ican t ( p = 0 . 0 0 0 1 8 ; p= 0.00012) . I t is im por t ant t o not e t hat at t he t im e of t his evaluat ion, t he algorit hm of direct ional m i cr o p h o n e s w a s e n a b l e d , w h i ch m a y h a v e con t r ibu t ed t o an im pr ov ed speech per cept ion i n n o i s y e n v i r o n m e n t s , s i n c e s o m e st u d i e s h av e i n d i ca t ed t h e a d v a n t a g es o f u si n g t h i s algorit hm s for im proved speech percept ion in noisy environm ent s5,18.
Th e se f i n d i n g s a r e e x t r e m e l y si g n i f i ca n t , especially w hen com paring t he perform ance of OF HAs w it h direct ional m icrophones and OF HAs t o
Domains Mean SD CV Minimum Maximum
Unaided
P 14.27 2.98 20.92 5.71 18.86
Ps 14.82 2.23 15.02 9.33 18.67
SR 14.44 3.32 23.01 4 20
E 13.8 2.59 18.73 6.5 19
SR/QL 14.87 2.66 17.9 8 20
Total 14.32 2.16 15.08 8.77 18.46
Aided
P 15.45 2.52 16.3 10.86 20
Ps 16.49 1.66 10.07 13.33 20
SR 16.67 2.34 14.05 10.67 20
E 15.55 1.83 11.77 12 19.5
SR/QL 16.93 2.27 13.42 12 20
Total 15.97 1.62 10.13 13.38 19.38
3 SK\VLFDO3V SV\FKRORJLFDO65 VRFLDOUHODWLRQVKLSV( HQYLURQPHQW654/ VHOIDVVHVVPHQWTXDOLW\RIOLIH
Table 2- Values obtained when applying the World Health Organization Quality of Life (WHOQOL-bref) instrument unaided and aided
WHOQOL-bref domains
P Ps SR E SR/QL Total
Unaided
HINT Q U U U U U U
S S S S S S
HINT NF U U U U U U
S S S S S S
Aided
HINT Q U U U U U U
S S S S S S
HINT NF U U U U U U
S S S S S S
3 SK\VLFDO3V SV\FKRORJLFDO65 VRFLDOUHODWLRQVKLSV( HQYLURQPHQW654/ VHOIDVVHVVPHQWTXDOLW\RIOLIH4 TXLHW 1) QRLVHIURQW
om nidirect ional m icrophones. The lit erat ure show s t h at sp eech r ecog n it ion p er f or m an ce in n oisy environm ent s using OF devices wit h om nidirect ional m icrophones resem bles t he perform ance unaided. I n or der t o en su r e t h at t h is var ian t of t h e HA KDV D EHQH¿W LW LV HVVHQWLDO WR XVH D GLUHFWLRQDO m icrophone18.
Differences bet w een HI NT scores unaided and aided have been clear ( com paring sit uat ions A t o B and A t o C) , but t he result s im m ediat ely aft er t he ¿WWLQJDQGWKRVHREWDLQHGDIWHUGD\VVLWXDWLRQ% t o C) were very sim ilar for silence. These differences w ere 1.67 dB and 0.59 dB of noise. Considering t he st andard deviat ion for t he Port uguese HI NT1
of 1.7 dB for silence and 1.2 dB for noise, it is not possible t o say t hat t here has been an im provem ent or w orsening in t he result s.
7KH HYDOXDWLRQ RI 4R/ KDV VKRZQ VLJQL¿FDQW LPSURYHPHQWVLQDOOGRPDLQVDIWHU+$¿WWLQJ$Q im pr ov em en t in social r elat ion s w as ex pect ed, since individuals w ho are able t o list en bet t er are consequent ly bet t er socializers, part icipat e m ore act ively in groups, and avoid social isolat ion caused by hearing loss12,16.
Som e r esear ches dem onst rat ed im pr ovem ent RQO\ LQ WKH SV\FKRORJLFDO GRPDLQ 7KHVH ¿QGLQJV could be explained as a result of t he short durat ion of use of HAs, since t he re- evaluat ion quest ionnaire h a s b e e n co n d u ct e d j u st 1 m o n t h a f t e r t h e ¿WWLQJDQGWKHLQGLYLGXDOPLJKWKDYHEHHQLQWKH acclim at izat ion process during t his period16.
Dat a f r om t h is st u d y d em on st r at e t h at t h e VPDOOHVW FKDQJH DIWHU +$ ¿WWLQJ RFFXUUHG LQ WKH p h y sical d om ain . Th is can b e j u st if ied b y t h e m ean age of t he subj ect s evaluat ed ( 61.96 years) involving issues relat ed t o pain, discom fort , energy, fat igue, sleep, rest ing, m obilit y, act ivit ies of daily life, dependence on m edicat ion or t reat m ent , and abilit y t o work10.
I n t h e lit er at u r e, f ew p ap er s h av e r elat ed QoL w it h hear ing loss using t he WHOQOL- BREF. Som e st udies have invest igat ed t he r elat ionship am ong QoL, age, sex, and t he presence of hearing im pairm ent , and found t hat t hese fact ors w ere not associat ed w it h hearing im pairm ent10,17.
When w e com par ed t he r esult s bet w een t he HI NT and WHOQOL- BREF in sit uat ion A, t here was QR VLJQL¿FDQW UHODWLRQVKLS 7KLV FDQ EH MXVWL¿HG by t he fact t hat t he individuals select ed for t his st udy show ed a slope hear ing loss w it h hear ing preserved t o 1 kHz, and in m ost cases, individuals ZLWK WKLV DXGLRPHWULF FRQ¿JXUDWLRQ GHPRQVWUDWH g ood sp eech r ecog n it ion p er f or m an ce in q u iet sit uat ions9. I n addit ion, t he individuals evaluat ed
had m oderat e losses at high frequencies, w it h an average t hreshold at 8 kHz of around 60 dBNA, w hich cont ribut es t o bet t er speech recognit ion.
Co m p a r i n g t h e r e su l t s b e t w e e n t h e HI NT
DQG :+242/%5() LQ VLWXDWLRQ & D VLJQL¿FDQW r elat ionship, only bet w een HI NT noise and t he dom ain of social relat ions, has been observed. These UHVXOWV DUH VLJQL¿FDQW EHFDXVH WKH\ GHPRQVWUDWH t hat individuals w it h bet t er speech percept ion in noisy environm ent s have a bet t er QoL regarding VRFLDOUHODWLRQVDIWHU+$¿WWLQJ
Th is is im p or t an t in t h is p op u lat ion , sin ce i n d i v i d u a l s w i t h h ea r i n g l o ss l i m i t ed t o h i g h IUHTXHQFLHVPHQWLRQOLWWOHGLI¿FXOW\LQXQGHUVWDQGLQJ speech in quiet env ir onm ent s, w hile in adver se condit ions, such as w hen speech is dist or t ed or in t he pr esence of noise, t he per son m ay have PDQ\ GLI¿FXOWLHV LQ VSHHFK LQWHOOLJLELOLW\ EHFDXVH t he num ber of audit ory cues drops considerably8.
There are no st udies in t he lit erat ure relat ing speech per cept ion w it h QoL. The r esult s of t his VWXG\ DOORZ WKH FRQFOXVLRQ WKDW DQ RSHQ¿W +$ im prove t he speech percept ion of individuals w it h hear ing loss at high fr equencies, bot h in quiet sit uat ions and in com pet it ive noise.
7KH+$¿WWLQJLPSURYHVWKH4R/RILQGLYLGXDOV i n a l l a r ea s a ssessed b y t h e W HOQOL- BREF. I ndividuals w it h bet t er speech recognit ion in noisy environm ent s w ho use HAs have a bet t er QoL.
$FFRUGLQJ WR WKHVH ¿QGLQJV WKLV UHVHDUFK dem onst rat es t he im port ance of conduct ing st udies WR LQYHVWLJDWH WKH EHQH¿WV WKDW DPSOL¿FDWLRQ FDQ provide for individuals wit h slope hearing loss, t hus im proving t he decision- m aking process regarding t he prescript ion of HAs.
CON CLUSI ON S
Th e acou st ic st im u lat ion in h ear in g loss in high frequencies t hrough t he use of OF HA favors t he speech recognit ion and im proves t he QoL of individuals especially in t he social relat ions dom ain.
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