Download PDF
J Am Acad Audiol 2018; 29(07): 634-647
DOI: 10.3766/jaaa.17034
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An Evaluation of the World Health Organization and American Medical Association Ratings of Hearing Impairment and Simulated Single-Sided Deafness

Andrew J. Vermiglio
*   Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
,
Stephanie Griffin
*   Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
,
Courtney Post
*   Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
,
Xiangming Fang
†   Department of Biostatistics, East Carolina University, Greenville, NC
› Author Affiliations
Further Information

Publication History

Publication Date:
29 May 2020 (online)

   Permissions and Reprints

Abstract

Background:

According to the World Health Organization (WHO), a pure-tone threshold average (PTA) ≤25 dB HL for the better ear represents “no impairment.” This implies that patients with single-sided deafness (SSD) would have “no or very slight hearing problems.” According to the American Medical Association (AMA), a patient with SSD would receive a binaural hearing impairment rating of 16.7%. The premise of the WHO and AMA methods is that PTA is related to the ability to perceive speech in everyday environments.

Purpose:

The overall goal of the study was to evaluate the WHO and AMA criteria for the rating of hearing impairment. The purpose of this study was to quantify the impact of simulated SSD on the ability to recognize speech in the presence of background noise in terms of binaural and spatial advantage measures.

Research Design:

Study participants were tested using the standard protocol for the Hearing in Noise Test (HINT) in both binaural and monaural conditions using a simulated soundfield environment under headphones. The target sentences were presented at 0°. Binaural thresholds were obtained for the Noise Front (0°), Noise Left (270°), and Noise Right (90°) listening conditions. Monaural thresholds were collected for each ear for the Noise Front condition and for the unshadowed ear for the Noise Left and Noise Right conditions. Binaural advantage was determined by subtracting the binaural from the monaural thresholds. Spatial advantage was determined by subtracting the Noise Side from the Noise Front thresholds.

Study Sample:

Twenty-five young native speakers of English with normal pure-tone thresholds (≤25 dB HL, 250–8000 Hz) participated in the study.

Data Collection and Analysis:

Pure-tone threshold data were collected using the modified Hughson–Westlake procedure. Speech recognition in noise data were collected using a Windows-based HINT software system. The binaural and spatial advantage measures were calculated from the HINT thresholds. Statistical analyses included descriptive statistics, correlation coefficients, and matched-pairs t-tests.

Results:

The average binaural advantage for the Noise Front conditions was 1.21 dB (p < 0.01) or a maximum estimated intelligibility improvement of 12.01% when the speech and noise were presented at 0°. The average binaural advantage across the Noise Side conditions was 11.25 dB (p < 0.01) or a maximum estimated intelligibility improvement of 84.09% when the noise was spatially separated from the speech. The average spatial advantage for the binaural conditions was 6.72 dB (p < 0.01) or a maximum estimated intelligibility improvement of 60.03%. The average spatial advantage for the monaural conditions was −3.32 dB or a maximum estimated decrease in intelligibility of 32.27%.

Conclusions:

The results do not support the WHO or AMA hearing impairment ratings for SSD. The WHO and AMA criteria for the determination of hearing impairment should be updated to include speech recognition in noise testing with and without the spatial separation of the speech and noise stimuli. In this way actual, as opposed to inferred perceptions of speech in noisy environments, may be determined. This will provide a much-needed improvement in the ratings of hearing impairment.

Key Words

audiology - binaural advantage - directional advantage - gold standard - pure-tone thresholds - single-sided deafness - spatial advantage - speech recognition in noise ability
 

  • REFERENCES

  • AAO-ACO 1979; Guide for the evaluation of hearing handicap. JAMA 241 (19) 2055-2059
    CrossrefPubMedGoogle Scholar
  • AMA (2008). Guides to the Evaluation of Permanent Impairment. Rondinelli RD, ed. 6th ed. Chicago, IL: American Medical Association;
    Google Scholar
  • Arsenault MD, Punch JL. 1999; Nonsense-syllable recognition in noise using monaural and binaural listening strategies. J Acoust Soc Am 105 (03) 1821-1830
    CrossrefPubMedGoogle Scholar
  • ASHA 2015 2014 Audiology Survey report: Clinical focus patterns. Retrieved from www.asha.org . Accessed June 8, 2017
    PubMed
  • Blackwell KL, Oyler RF, Seyfried DN. 1991; A clinical comparison of Grason Stadler insert earphones and TDH-50P standard earphones. Ear Hear 12 (05) 361-362
    PubMedGoogle Scholar
  • Byun H, Moon IJ, Woo SY, Jin SH, Park H, Chung WH, Hong SH, Cho YS. 2015; Objective and subjective improvement of hearing in noise after surgical correction of unilateral congenital aural atresia in pediatric patients: a prospective study using the hearing in noise test, the sound-spatial-quality questionnaire, and the glasgow benefit inventory. Ear Hear 36 (04) e183-e189
    CrossrefPubMedGoogle Scholar
  • Carhart R. 1965; Monaural and binaural discrimination against competing sentences. International Audiology 4: 5-10
    Google Scholar
  • Council on Physical Medicine and Rehabilitation (CPMR) 1955; PRINCIPLES for evaluating hearing loss. J Am Med Assoc 157 (16) 1408-1409
    Google Scholar
  • Danermark B, Granberg S, Kramer SE, Selb M, Möller C. 2013; The creation of a comprehensive and a brief core set for hearing loss using the international classification of functioning, disability and health. Am J Audiol 22 (02) 323-328
    CrossrefPubMedGoogle Scholar
  • Dickson ED, Simpson JF, Fry DB, Swindell GE, Brown REC. 1946; A new method of testing the hearing efficiency of aviation candidates. J Laryngol Otol 61 (03) 139-203
    CrossrefPubMedGoogle Scholar
  • Douglas SA, Yeung P, Daudia A, Gatehouse S, O’Donoghue GM. 2007; Spatial hearing disability after acoustic neuroma removal. Laryngoscope 117 (09) 1648-1651
    CrossrefPubMedGoogle Scholar
  • Dubno JR, Ahlstrom JB, Horwitz AR. 2008; Binaural advantage for younger and older adults with normal hearing. J Speech Lang Hear Res 51 (02) 539-556
    CrossrefPubMedGoogle Scholar
  • Dwyer NY, Firszt JB, Reeder RM. 2014; Effects of unilateral input and mode of hearing in the better ear: self-reported performance using the speech, spatial and qualities of hearing scale. Ear Hear 35 (01) 126-136
    CrossrefPubMedGoogle Scholar
  • Fabry D, Clark J. 2017; Global Action for Hearing Loss, Interview with Shelly Chadha. Audiology Today 29 (02) 14-22
    Google Scholar
  • Fletcher H. 1929. Speech and Hearing. New York: D. Van Nostrand Company, Inc.;
    Google Scholar
  • Fry DB. 1942; A suggestion for a new method of testing hearing in aviation candidates. J Laryngol Otol 57 (01) 11-13
    CrossrefGoogle Scholar
  • Gatehouse S, Akeroyd M. 2006; Two-eared listening in dynamic situations. Int J Audiol 45 (Suppl. 1) S120-S124
    CrossrefPubMedGoogle Scholar
  • Gatehouse S, Noble W. 2004; The speech, spatial and qualities of hearing scale (SSQ). Int J Audiol 43 (02) 85-99
    CrossrefPubMedGoogle Scholar
  • Goodman A. 1965; Reference zero levels for pure-tone audiometer. ASHA 7: 262-263
    Google Scholar
  • Gray L, Kesser B, Cole E. 2009; Understanding speech in noise after correction of congenital unilateral aural atresia: effects of age in the emergence of binaural squelch but not in use of head-shadow. Int J Pediatr Otorhinolaryngol 73 (09) 1281-1287
    CrossrefPubMedGoogle Scholar
  • Haskins HL, Hardy WG. 1960; Clinical studies in stereophonic hearing. Laryngoscope 70 (10) 1427-1432
    PubMedGoogle Scholar
  • HEI 2007. HINT Pro User’s and Service Manual. Mundelein, Illinois. Los Angeles, CA: House Ear Institute;
    Google Scholar
  • Jerger J, Jerger S. 1980. Measurement of hearing in adults. In: Paperella MM, Shumrick DA. Otolayrngology. 2nd ed. Philadelphia, PA: W. B. Saunders;
    Google Scholar
  • Knudsen VO. 1939; An ear to the future. J Acoust Soc Am 11 (01) 29-36
    CrossrefGoogle Scholar
  • Koenig W. 1950; Subjective effects in binaural hearing. J Acoust Soc Am 22 (01) 61-62
    Google Scholar
  • Kryter KD, Williams C, Green DM. 1962; Auditory acuity and the perception of speech. J Acoust Soc Am 34 (09) 1217-1223
    CrossrefGoogle Scholar
  • Mathers C, Smith A, Concha M. 2000; Global burden of hearing loss in the year 2000. Global Burden of Disease 18: 1-30
    Google Scholar
  • Moon SK, Hee Kim S, Ah Mun H, Jung HK, Lee JH, Choung YH, Park K. 2008; The Korean hearing in noise test. Int J Audiol 47 (06) 375-376
    CrossrefPubMedGoogle Scholar
  • Nilsson M, Soli SD, Sullivan JA. 1994; Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise. J Acoust Soc Am 95 (02) 1085-1099
    CrossrefPubMedGoogle Scholar
  • Olusanya BO, Neumann KJ, Saunders JE. 2014; The global burden of disabling hearing impairment: a call to action. Bull World Health Organ 92 (05) 367-373
    CrossrefPubMedGoogle Scholar
  • Persson P, Harder H, Arlinger S, Magnuson B. 2001; Speech recognition in background noise: monaural versus binaural listening conditions in normal-hearing patients. Otol Neurotol 22 (05) 625-630
    CrossrefPubMedGoogle Scholar
  • Resnick SB, Dubno JR, Hoffnung S, Levitt H. 1975; Phoneme errors on a nonsense syllable test. J Acoust Soc Am 58 (S1) S114
    Google Scholar
  • Ruscetta MN, Arjmand EM, Pratt SR. 2005; Speech recognition abilities in noise for children with severe-to-profound unilateral hearing impairment. Int J Pediatr Otorhinolaryngol 69 (06) 771-779
    CrossrefPubMedGoogle Scholar
  • Shargorodsky J, Curhan SG, Curhan GC, Eavey R. 2010; Change in prevalence of hearing loss in US adolescents. JAMA 304 (07) 772-778
    CrossrefPubMedGoogle Scholar
  • Sindhusake D, Mitchell P, Smith W, Golding M, Newall P, Hartley D, Rubin G. 2001; Validation of self-reported hearing loss. The blue mountains hearing study. Int J Epidemiol 30 (06) 1371-1378
    CrossrefPubMedGoogle Scholar
  • Steinberg JC, Montgomery HC, Gardner MB. 1940; Results of the world’s fair hearing tests. J Acoust Soc Am 12: 533-562
    Google Scholar
  • Tschopp K, Züst H. 1994; Performance of normally hearing and hearing-impaired listeners using a German version of the SPIN test. Scand Audiol 23 (04) 241-247
    CrossrefPubMedGoogle Scholar
  • Vermiglio AJ. 2007. Speech Recognition in Noise. (AuD Doctoral Project). Mount Pleasant, MI: Central Michigan University;
    Google Scholar
  • Vermiglio AJ. 2008; The American english hearing in noise test. Int J Audiol 47 (06) 386-387
    CrossrefPubMedGoogle Scholar
  • Vermiglio AJ, Soli SD, Freed DJ, Fisher LM. 2012; The relationship between high-frequency pure-tone hearing loss, hearing in noise test (HINT) thresholds, and the articulation index. J Am Acad Audiol 23 (10) 779-788
    Article in Thieme ConnectPubMedGoogle Scholar
  • WHO 2010 Measuring Health and Disability Manual for the World Health Organization Disability Assessment Schedule 2.0. Retrieved from Geneva: http://apps.who.int/iris/bitstream/10665/43974/1/9789241547598_eng.pdf . Accessed July 29, 2016.
    PubMedGoogle Scholar
  • Wilson RH, McArdle RA, Smith SL. 2007; An evaluation of the BKB-SIN, HINT, QuickSIN, and WIN materials on listeners with normal hearing and listeners with hearing loss. J Speech Lang Hear Res 50 (04) 844-856
    CrossrefPubMedGoogle Scholar