Publication: Sensorinöral işitme kayıplılarda şiddet algısı (Loudness perception) ve klinik olarak ölçülen şiddet algısının optimal amplifikasyon için kullanımı
Abstract
Gelişen teknolojiyle beraber nonlineer işitme cihazlarinin ortaya çikmasi, lineer cihazlar için geliştirilmiş formüllerin yetersiz kalmasina neden olmuş ve çeşitli nonlineer işitme cihazi formülleri geliştirilmiştir. Bu çalışmada hafif/ orta derecede bilateral sensorinöral işitme kayıplı toplam 40 yetişkin hasta yeralmıştır. Çalışma üç aşama halinde yapılmıştır. İlk aşamada, Contour Şiddet Algısı Testi (10) uygulanmış ve Contour verileri VIOLA (11) programına girilip hedef kazanç hesaplanarak Resound BT2-ES işitme cihazı programlanmıştır. Contour Testi ve VIOLA IHAFF (64) protokolünün integral parçalarıdır. İkinci aşamada, Viennatone Newtone işitme cihazı NAL-NL1 (17) prosedürüne uygun olarak hesaplanan hedef kazanca göre programlanmıştır. Üçüncü aşamada ise, her iki cihazı ayrı ayrı dörder hafta kullandıktan sonra hastaların memnuniyet dereceleri İşitme Cihazı Kullanıcıları İçin Değerlendirme Formu (HAUQ) (18) ile değerlendirilmiştir. Hastaların aile ortamındaki ve ufak bir grup içindeki memnuniyetlerinde VIOLA formülüyle programlanan Resound BT2-ES ve NAL-NL1 formülüyle programlanan Viennatone Newtone işitme cihazları arasında istatistiksel olarak anlamlı bir fark bulunmamıştır. Toplantı ortamında, sosyal aktivitelerde, televizyon seyrederken, radyo dinlerken ve telefonda konuşurken NAL-NL1 formülü ile programlanan Viennatone Newtone işitme cihazından memnuniyet daha fazla bulunmuştur. Bu çalışmada, yaş ve işitme eğrisinin şekli memnuniyet sonuçlarını etkilememiştir. Şiddet algisi normalizasyonunun nonlineer işitme cihazlar ile amplifikasyon saglamada faydali oldugu düşünülmektedir. Bu çalışmanın sonuçları, şiddet algısını işitme kaybının derecesine göre normal ya da normalin altında tutarak frekans spesifik normalizasyon yapan NAL-NL1 prosedürünün, VIOLA formülüne göre özellikle gürültülü ortamlarda konuşmayı ayırdetmede daha başarılı olduğunu göstermiştir. Ancak, optimal amplifikasyon için bir altın formül olmadığı görüşündeyiz. Her işitme kayıplı hasta ayrı bir birey olarak değerlendirilmeli ve genellemelere dayalı uygulamalardan kaçınılmalıdır.
After the advent of nonlinear hearing aids, the formulas for linear devices has become inappropriate and this has led to the development of numerous prescriptive procedures for nonlinear hearing aids. In this study, 40 adult patients with bilateral mild-to-moderate sensori-neural hearing loss were assessed. This study was performed in three steps. At the initial step the Contour Loudness Test (10) was administered and the Contour data were entered into the VIOLA (11) program which prescribes target values for Resound BT2-ES hearing aid. The Contour Test and VIOLA are the components of the IHAFF (64) protocol. At the second step the patients were fitted with Viennatone Newtone hearing aid by using NAL-NL1 (17) procedure which prescribes the target gain. Finally, after using each hearing aid for four weeks the patient satisfaction was assessed with Hearing Aid User's Questionnaire (HAUQ) (18). There was no statistically significant difference between Resound BT2-ES (VIOLA) and Viennatone Newtone (NAL-NL1) for patient satisfaction in family environment and in small group conversation. On the other hand, the patient satisfaction for speech understanding in noisy environments, while talking on the phone, while watching TV and listenning to the radio was significantly better with Viennatone Newtone (NAL-NL1). In this study, age and hearing configuration did not influence the satisfaction scores. It is believed that loudness normalization is useful for amplification with nonlinear hearing aids. The results of this study show that NAL-NL1 procedure which requires a different specific loudness pattern at each frequency is better for maximizing speech intelligibility, especially in noisy environments. However, there is no gold standard for optimal amplification. It should be kept in mind that individual needs of every patient with sensori-neural hearing loss should be considered in hearing aid fitting.
After the advent of nonlinear hearing aids, the formulas for linear devices has become inappropriate and this has led to the development of numerous prescriptive procedures for nonlinear hearing aids. In this study, 40 adult patients with bilateral mild-to-moderate sensori-neural hearing loss were assessed. This study was performed in three steps. At the initial step the Contour Loudness Test (10) was administered and the Contour data were entered into the VIOLA (11) program which prescribes target values for Resound BT2-ES hearing aid. The Contour Test and VIOLA are the components of the IHAFF (64) protocol. At the second step the patients were fitted with Viennatone Newtone hearing aid by using NAL-NL1 (17) procedure which prescribes the target gain. Finally, after using each hearing aid for four weeks the patient satisfaction was assessed with Hearing Aid User's Questionnaire (HAUQ) (18). There was no statistically significant difference between Resound BT2-ES (VIOLA) and Viennatone Newtone (NAL-NL1) for patient satisfaction in family environment and in small group conversation. On the other hand, the patient satisfaction for speech understanding in noisy environments, while talking on the phone, while watching TV and listenning to the radio was significantly better with Viennatone Newtone (NAL-NL1). In this study, age and hearing configuration did not influence the satisfaction scores. It is believed that loudness normalization is useful for amplification with nonlinear hearing aids. The results of this study show that NAL-NL1 procedure which requires a different specific loudness pattern at each frequency is better for maximizing speech intelligibility, especially in noisy environments. However, there is no gold standard for optimal amplification. It should be kept in mind that individual needs of every patient with sensori-neural hearing loss should be considered in hearing aid fitting.