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Purpose: The pupil dilation response is sensitive not only to auditory task demand but also to cognitive conflict. Conflict is induced by incompatible trials in auditory Stroop tasks in which participants have to identify the presentation location (left or right ear) of the words "left" or "right." Previous studies demonstrated that the compatibility effect is reduced if the trial is preceded by another incompatible trial (conflict adaptation). Here, we investigated the influence of hearing status on cognitive conflict and conflict adaptation in an auditory Stroop task. Method: Two age-matched groups consisting of 32 normalhearing participants (M[subscript age] = 52 years, age range: 25-67 years) and 28 participants with hearing impairment (M[subscript age] = 52 years, age range: 23-64 years) performed an auditory Stroop task. We assessed the effects of hearing status and stimulus compatibility on reaction times (RTs) and pupil dilation responses. We furthermore analyzed the Pearson correlation coefficients between age, degree of hearing loss, and the compatibility effects on the RT and pupil response data across all participants. Results: As expected, the RTs were longer and pupil dilation was larger for incompatible relative to compatible trials. Furthermore, these effects were reduced for trials following incompatible (as compared to compatible) trials (conflict adaptation). No general effect of hearing status was observed, but the correlations suggested that higher age and a larger degree of hearing loss were associated with more interference of current incompatibility on RTs. Conclusions: Conflict processing and adaptation effects were observed on the RTs and pupil dilation responses in an auditory Stroop task. No general effects of hearing status were observed, but the correlations suggested that higher age and a greater degree of hearing loss were related to reduced conflict processing ability. The current study underlines the relevance of taking into account cognitive control and conflict adaptation processes.

Purpose: Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method: Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results: For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions: Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses.

Purpose: The pupil dilation response is sensitive not only to auditory task demand but also to cognitive conflict. Conflict is induced by incompatible trials in auditory Stroop tasks in which participants have to identify the presentation location (left or right ear) of the words 'left' or 'right.' Previous studies demonstrated that the compatibility effect is reduced if the trial is preceded by another incompatible trial (conflict adaptation). Here, we investigated the influence of hearing status on cognitive conflict and conflict adaptation in an auditory Stroop task. Method: Two age-matched groups consisting of 32 normal-hearing participants ([M.sub.age] = 52 years, age range: 25-67 years) and 28 participants with hearing impairment ([M.sub.age] = 52 years, age range: 23-64 years) performed an auditory Stroop task. We assessed the effects of hearing status and stimulus compatibility on reaction times (RTs) and pupil dilation responses. We furthermore analyzed the Pearson correlation coefficients between age, degree of hearing loss, and the compatibility effects on the RT and pupil response data across all participants. Results: As expected, the RTs were longer and pupil dilation was larger for incompatible relative to compatible trials. Furthermore, these effects were reduced for trials following incompatible (as compared to compatible) trials (conflict adaptation). No general effect of hearing status was observed, but the correlations suggested that higher age and a larger degree of hearing loss were associated with more interference of current incompatibility on RTs. Conclusions: Conflict processing and adaptation effects were observed on the RTs and pupil dilation responses in an auditory Stroop task. No general effects of hearing status were observed, but the correlations suggested that higher age and a greater degree of hearing loss were related to reduced conflict processing ability. The current study underlines the relevance of taking into account cognitive control and conflict adaptation processes., The measurement of the pupil dilation response is a means to gain insight into mental effort mobilization (Beatty, 1982; Kahneman & Beatty, 1966). Effort mobilization is the mobilization of energy [...]

Purpose: The purpose of this study is to determine which demographic, health-related, mood, personality, or social factors predict discrepancies between older adults' functional speech-in-noise test result and their self-reported hearing problems. Method: Data of 1,061 respondents from the Longitudinal Aging Study Amsterdam were used (ages ranged from 57 to 95 years). Functional hearing problems were measured using a digit triplet speech-in-noise test. Five questions were used to assess self-reported hearing problems. Scores of both hearing measures were dichotomized. Two discrepancy outcomes were created: (a) being unaware: those with functional but without self-reported problems (reference is "aware": those with functional and self-reported problems); (b) reporting false complaints: those without functional but with self-reported problems (reference is "well": those without functional and self-reported hearing problems). Two multivariable prediction models (logistic regression) were built with 19 candidate predictors. The speech reception threshold in noise was kept (forced) as a predictor in both models. Results: Persons with higher self-efficacy (to initiate behavior) and higher self-esteem had a higher odds to being unaware than persons with lower self-efficacy scores (odds ratio [OR] = 1.13 and 1.11, respectively). Women had a higher odds than men (OR = 1.47). Persons with more chronic diseases and persons with worse (i.e., higher) speech-in-noise reception thresholds in noise had a lower odds to being unaware (OR = 0.85 and 0.91, respectively) than persons with less diseases and better thresholds, respectively. A higher odds to reporting false complaints was predicted by more depressive symptoms (OR = 1.06), more chronic diseases (OR = 1.21), and a larger social network (OR = 1.02). Persons with higher self-efficacy (to complete behavior) had a lower odds (OR = 0.86), whereas persons with higher self-esteem had a higher odds to report false complaints (OR = 1.21). The explained variance of both prediction models was small (Nagelkerke R[superscript 2] = 0.11 for the "unaware" model, and 0.10 for the "false complaints" model). Conclusions: The findings suggest that a small proportion of the discrepancies between older individuals' results on a speech-in-noise screening test and their self-reports of hearing problems can be explained by the unique context of these individuals. The likelihood of discrepancies partly depends on a person's health (chronic diseases), demographics (gender), personality (self-efficacy to initiate behavior and to persist in adversity, self-esteem), mood (depressive symptoms), and social situation (social network size). Implications are discussed.

Purpose: Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method: Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results: For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions: Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses., Hearing loss and cognitive decline are both known to be strongly related to aging (e.g., Gates & Mills 2005; Schneider, Pichora-Fuller, & Daneman, 2010). In 1994, the cross-sectional structural equation [...]

Purpose: We reevaluated the psychometric properties of the Amsterdam Inventory for Auditory Disability and Handicap (AIADH; Kramer, Kapteyn, Festen, & Tobi, 1995) using item response theory. Item response theory describes item functioning along an ability continuum. Method: Cross-sectional data from 2,352 adults with and without hearing impairment, ages 18-70 years, were analyzed. They completed the AIADH in the web-based prospective cohort study "Netherlands Longitudinal Study on Hearing." A graded response model was fitted to the AIADH data. Category response curves, item information curves, and the standard error as a function of self-reported hearing ability were plotted. Results: The graded response model showed a good fit. Item information curves were most reliable for adults who reported having hearing disability and less reliable for adults with normal hearing. The standard error plot showed that self-reported hearing ability is most reliably measured for adults reporting mild up to moderate hearing disability. Conclusions: This is one of the few item response theory studies on audiological self-reports. All AIADH items could be hierarchically placed on the self-reported hearing ability continuum, meaning they measure the same construct. This provides a promising basis for developing a clinically useful computerized adaptive test, where item selection adapts to the hearing ability of individuals, resulting in efficient assessment of hearing disability.

Purpose: The purpose of this study is to determine which demographic, health-related, mood, personality, or social factors predict discrepancies between older adults' functional speech-in-noise test result and their self-reported hearing problems. Method: Data of 1,061 respondents from the Longitudinal Aging Study Amsterdam were used (ages ranged from 57 to 95 years). Functional hearing problems were measured using a digit triplet speech-in-noise test. Five questions were used to assess self-reported hearing problems. Scores of both hearing measures were dichotomized. Two discrepancy outcomes were created: (a) being unaware: those with functional but without self-reported problems (reference is aware: those with functional and self-reported problems); (b) reporting false complaints: those without functional but with self-reported problems (reference is well: those without functional and self-reported hearing problems). Two multivariable prediction models (logistic regression) were built with 19 candidate predictors. The speech reception threshold in noise was kept (forced) as a predictor in both models. Results: Persons with higher self-efficacy (to initiate behavior) and higher self-esteem had a higher odds to being unaware than persons with lower self-efficacy scores (odds ratio [OR] = 1.13 and 1.11, respectively). Women had a higher odds than men (OR = 1.47). Persons with more chronic diseases and persons with worse (i.e., higher) speech-in-noise reception thresholds in noise had a lower odds to being unaware (OR = 0.85 and 0.91, respectively) than persons with less diseases and better thresholds, respectively. A higher odds to reporting false complaints was predicted by more depressive symptoms (OR = 1.06), more chronic diseases (OR = 1.21), and a larger social network (OR = 1.02). Persons with higher self-efficacy (to complete behavior) had a lower odds (OR = 0.86), whereas persons with higher self-esteem had a higher odds to report false complaints (OR = 1.21). The explained variance of both prediction models was small (Nagelkerke [R.sup.2] = .11 for the unaware model, and .10 for the false complaints model). Conclusions: The findings suggest that a small proportion of the discrepancies between older individuals' results on a speech-in-noise screening test and their self-reports of hearing problems can be explained by the unique context of these individuals. The likelihood of discrepancies partly depends on a person's health (chronic diseases), demographics (gender), personality (self-efficacy to initiate behavior and to persist in adversity, self-esteem), mood (depressive symptoms), and social situation (social network size). Implications are discussed., It is often observed that measures of self-reported hearing problems correlate to a limited degree with objective, functional measures of hearing disability, such as pure-tone audiometry or speech-in-noise test (SNT) [...]

Purpose: We reevaluated the psychometric properties of the Amsterdam Inventory for Auditory Disability and Handicap (AIADH; Kramer, Kapteyn, Festen, &Tobi, 1995) using item response theory. Item response theory describes item functioning along an ability continuum. Method: Cross-sectional data from 2,352 adults with and without hearing impairment, ages 18-70 years, were analyzed. They completed the AIADH in the web-based prospective cohort study 'Netherlands Longitudinal Study on Hearing.' A graded response model was fitted to the AIADH data. Category response curves, item information curves, and the standard error as a function of self-reported hearing ability were plotted. Results: The graded response model showed a good fit. Item information curves were most reliable for adults who reported having hearing disability and less reliable for adults with normal hearing. The standard error plot showed that self-reported hearing ability is most reliably measured for adults reporting mild up to moderate hearing disability. Conclusions: This is one of the few item response theory studies on audiological self-reports. All AIADH items could be hierarchically placed on the self-reported hearing ability continuum, meaning they measure the same construct. This provides a promising basis for developing a clinically useful computerized adaptive test, where item selection adapts to the hearing ability of individuals, resulting in efficient assessment of hearing disability., Hearing impairment is a chronic condition that may lead to limitations in daily communication and emotional and social loneliness (Granberg et al., 2014; Pronk et al., 2011). The degree of [...]

Purpose: In this research, the authors aimed to increase the analogy between Text Reception Threshold (TRT; Zekveld, George, Kramer, Goverts, & Houtgast, 2007) and Speech Reception Threshold (SRT; Plomp & Mimpen, 1979) and to examine the TRT's value in estimating cognitive abilities that are important for speech comprehension in noise. Method: The authors administered 5 TRT versions, SRT tests in stationary (SRT[subscript STAT]) and modulated (SRT[subscript MOD]) noise, and 2 cognitive tests: a reading span (RSpan) test for working memory capacity and a letter-digit substitution test for information-processing speed. Fifty-five adults with normal hearing (18-78 years, M = 44 years) participated. The authors examined mutual associations of the tests and their predictive value for the SRTs with correlation and linear regression analyses. Results: SRTs and TRTs were well associated, also when controlling for age. Correlations for the SRT[subscript STAT] were generally lower than for the SRT[subscript MOD]. The cognitive tests were correlated to the SRTs only when age was not controlled for. Age and the TRTs were the only significant predictors of SRT[subscript MOD]. SRT[subscript STAT] was predicted by level of education and some of the TRT versions. Conclusions: TRTs and SRTs are robustly associated, nearly independent of age. The association between SRTs and RSpan is largely age dependent. The TRT test and the RSpan test measure different nonauditory components of linguistic processing relevant for speech perception in noise.

Purpose: Researchers have used the distortion-sensitivity approach in the psychoacoustical domain to investigate the role of auditory processing abilities in speech perception in noise (van Schijndel, Houtgast, & Festen, 2001; Goverts & Houtgast, 2010). In this study, the authors examined the potential applicability of the distortion-sensitivity approach for investigating the role of linguistic abilities in speech understanding in noise. Method: The authors applied the distortion-sensitivity approach by measuring the processing of visually presented masked text in a condition with manipulated syntactic, lexical, and semantic cues and while using the Text Reception Threshold (George et al., 2007; Kramer, Zekveld, & Houtgast, 2009; Zekveld, George, Kramer, Goverts, & Houtgast, 2007) method. Two groups that differed in linguistic abilities were studied: 13 native and 10 non-native speakers of Dutch, all typically hearing university students. Results: As expected, the non-native subjects showed substantially reduced performance. The results of the distortion-sensitivity approach yielded differentiated results on the use of specific linguistic cues in the 2 groups. Conclusion: The results show the potential value of the distortion-sensitivity approach in studying the role of linguistic abilities in speech understanding in noise of individuals with hearing impairment.

Purpose: Seven scales of the Communication Profile for the Hearing Impaired (CPHI; M. E. Demorest & S. A. Erdman, 1987) were translated into Dutch: Maladaptive Behavior, Verbal Strategies, and Nonverbal Strategies (within the area of Communication Strategies) and Self-Acceptance, Acceptance of Loss, Stress, and Withdrawal (within the area of Personal Adjustment). Method: This cross-sectional study evaluated the factor structure, internal consistency, test-retest reliability, and measurement error of the Dutch CPHI scales. In all, 399 adults with impaired hearing participated, and data on a subgroup of 40 patients were included in the test-retest analyses. The participants completed the questionnaire before routine clinical care or at home. Demographic data and data on pure-tone hearing thresholds were also collected. Results: Based on item factor analyses, we omitted 5 items, moved 3 items to different scales, and combined the Stress and Withdrawal scales. The resulting 6 scales, containing 52 items, showed good internal consistency (alphas between 0.81 and 0.94), good test-retest reliability (intraclass correlation coefficients between 0.78 and 0.86), and small standard error of measurement (between 0.28 and 0.46). Conclusions: The suggested revisions of the Dutch CPHI scales will increase their interpretability. Further research is needed to evaluate their usefulness for monitoring patients and in longitudinal studies by determining their responsiveness and minimal important change values.

Purpose: The goal of this study was to find factors for refining candidacy criteria for bilateral hearing aid fittings. Clinical files of 1,000 consecutive hearing aid fittings were analyzed. Method: Case history, audiometric, and rehabilitation data were collected from clinical files, and an extensive questionnaire on long-term outcome measures was conducted. After at least 2 years of hearing aid use, 505 questionnaires were returned. In order to compare differences in benefits between unilateral and bilateral fittings, two subgroups were composed in which most relevant variables (age, degree of hearing loss, and audiometric asymmetry) were matched for unilateral fittings (n = 212) and bilateral fittings (n = 477). Results: The bilateral group had significantly higher benefit scores than the unilateral group for detection, speech intelligibility in reverberation, and localization, but poorer scores for comfort of loud sounds. The benefit of bilateral hearing aids was not significantly related to the level of technology of the hearing aids. Conclusion: The analysis of the relation between objective parameters and the subjective outcome measures showed that candidacy for a successful bilateral fitting could not be predicted from age, maximum speech intelligibility, employment, exposure to background noise, or social activities.

Purpose: In this study, the authors aimed to develop a visual analogue of the widely used Speech Reception Threshold (SRT; R. Plomp & A. M. Mimpen, 1979b) test. The Text Reception Threshold (TRT) test, in which visually presented sentences are masked by a bar pattern, enables the quantification of modality-aspecific variance in speech-in-noise comprehension to obtain more insight into interindividual differences in this ability. Method: Using an adaptive procedure similar to the SRT test, the TRT test determines the percentage of unmasked text needed to read 50% of sentences correctly. SRTs in stationary noise (SRT[subscript STAT]), modulated noise (SRT[subscript MOD]), and TRTs were determined for 34 participants with normal hearing, aged 19 to 78 years. Results: The results indicate that about 30% of the variance in SRT[subscript STAT] and SRT[subscript MOD] is shared with variance in TRT, which reflects the shared involvement of a modality-aspecific cognitive or linguistic ability in forming meaningful wholes of fragments of sentences. Conclusion: The TRT test, a visual analogue of the SRT test, has been developed to measure the variance in speech-in-noise comprehension associated with modality-aspecific cognitive skills. In future research, normative data of the TRT test should be developed. It would also be interesting to measure TRTs of individuals experiencing difficulties understanding speech.

Purpose: In this explorative study, the authors investigated the relationship between auditory and cognitive abilities and self-reported hearing disability. Method: Thirty-two adults with mild to moderate hearing loss completed the Amsterdam Inventory for Auditory Disability and Handicap (AIADH; Kramer, Kapteyn, Festen, &Tobi, 1996) and performed the Text Reception Threshold (TRT; Zekveld, George, Kramer, Goverts, & Houtgast, 2007) test as well as tests of spatial working memory (SWM) and visual sustained attention. Regression analyses examined the predictive value of age, hearing thresholds (pure-tone averages [PTAs]), speech perception in noise (speech reception thresholds in noise [SRTNs]), and the cognitive tests for the 5 AIADH factors. Results: Besides the variance explained by age, PTA, and SRTN, cognitive abilities were related to each hearing factor. The reported difficulties with sound detection and speech perception in quiet were less severe for participants with higher age, lower PTAs, and better TRTs. Fewer sound localization and speech perception in noise problems were reported by participants with better SRTNs and smaller SWM. Fewer sound discrimination difficulties were reported by subjects with better SRTNs and TRTs and smaller SWM. Conclusions: The results suggest a general role of the ability to read partly masked text in subjective hearing. Large working memory was associated with more reported hearing difficulties. This study shows that besides auditory variables and age, cognitive abilities are related to self-reported hearing disability. KeyWords: cognition, hearing loss, speech recognition, speech perception, Listeners with hearing impairment vary widely in their speech reception performance in challenging conditions (George et al., 2007). In the last several decades, researchers have repeatedly acknowledged the relevance of [...]

Purpose: In this research, the authors aimed to increase the analogy between Text Reception Threshold (TRT; Zekveld, George, Kramer, Goverts, & Houtgast, 2007) and Speech Reception Threshold (SRT; Plomp &Mimpen, 1979) and to examine the TRT's value in estimating cognitive abilities that are important for speech comprehension in noise. Method: The authors administered 5 TRT versions, SRT tests in stationary ([SRT.sub.STAT]) and modulated ([SRT.sub.MOD]) noise, and 2 cognitive tests: a reading span (RSpan) test for working memory capacity and a letter-digit substitution test for information-processing speed. Fifty-five adults with normal hearing (18-78 years, M = 44 years) participated. The authors examined mutual associations of the tests and their predictive value for the SRTs with correlation and linear regression analyses. Results: SRTs and TRTs were well associated, also when controlling for age. Correlations for the [SRT.sub.STAT] were generally lower than for the [SRT.sub.MOD]. The cognitive tests were correlated to the SRTs only when age was not controlled for. Age and the TRTs were the only significant predictors of [SRT.sub.MOD]. [SRT.sub.STAT] was predicted by level of education and some of the TRT versions. Conclusions: TRTs and SRTs are robustly associated, nearly independent of age. The association between SRTs and RSpan is largely age dependent. The TRT test and the RSpan test measure different nonauditory components of linguistic processing relevant for speech perception in noise. Key Words: masked text recognition, speech perception, cognitive abilities, age, working memory, A key component of human communication is the exchange of spoken information. Distortion of conversational interaction by factors such as hearing loss can have serious implications for the affected person's [...]

Purpose: Researchers have used the distortion-sensitivity approach in the psychoacoustical domain to investigate the role of auditory processing abilities in speech perception in noise (van Schijndel, Houtgast, & Festen, 2001; Goverts & Houtgast, 2010). In this study, the authors examined the potential applicability of the distortion-sensitivity approach for investigating the role of linguistic abilities in speech understanding in noise. Method: The authors applied the distortion-sensitivity approach by measuring the processing of visually presented masked text in a condition with manipulated syntactic, lexical, and semantic cues and while using the Text Reception Threshold (George et al., 2007; Kramer, Zekveld, & Houtgast, 2009; Zekveld, George, Kramer, Goverts, & Houtgast, 2007) method. Two groups that differed in linguistic abilities were studied: 13 native and 10 non-native speakers of Dutch, all typically hearing university students. Results: As expected, the non-native subjects showed substantially reduced performance. The results of the distortion-sensitivity approach yielded differentiated results on the use of specific linguistic cues in the 2 groups. Conclusion: The results show the potential value of the distortion-sensitivity approach in studying the role of linguistic abilities in speech understanding in noise of individuals with hearing impairment. Key Words: linguistic abilities, speech in noise, distortion sensitivity, Reduced speech understanding in noise is a major complaint of individuals with hearing loss (e.g., Kramer, Kapteyn, & Festen, 1998). The main reason for this disability is reduced hearing capacity [...]

Purpose: The aim of this study was to improve the quality and applicability of the 6 Dutch scales of the Communication Profile for the Hearing Impaired (CPHI; Demorest & Erdman, 1986, 1987, 1988) using item response theory (IRT). IRT modeling can produce precise, valid, and relatively brief instruments, resulting in minimal response burden (Edelen & Reeve, 2007). Method: We investigated (a) whether items fit to the graded response model (GRM; Samejima, 1969) using Stone and Zhang's (2003) procedure to test goodness of fit and (b) whether items showed differential item functioning (DIF) with the IRT log-likelihood ratio approach for 5 group variables: gender, age, living arrangement, use of hearing aids, and degree of hearing impairment. We investigated the magnitude of DIF by calculating the maximum difference between expected item scores for subgroups of the group variables of items showing DIF. Results: In a cross-sectional study, 408 consecutive individuals with hearing impairment completed the Dutch CPHI scales. Twelve items were deleted because of misfit to GRMs, 14 items showed uniform DIF, and 2 showed nonuniform DIF. Five items showing DIF were deleted due to large magnitude of DIF. The short form of the Dutch CPHI scales contains 35 items. Conclusions: DIF analyses showed that the short form was relatively free of DIF with respect to the 5 group variables. Hence, there is no need to make adjustments for the calculation of subgroup scores. KEY WORDS: Communication Profile for the Hearing Impaired (CPHI), coping, hearing impairment, item fit, differential item functioning, item response theory (IRT), There is some evidence showing that coping behavior is a more relevant indicator or predictor of psychosocial problems in people with hearing impairment than the degree and nature of the [...]

Purpose: Seven scales of the Communication Profile for the Hearing Impaired (CPHI; M. E. Demorest & S. A. Erdman, 1987) were translated into Dutch: Maladaptive Behavior, Verbal Strategies, and Nonverbal Strategies (within the area of Communication Strategies) and Self-Acceptance, Acceptance of Loss, Stress, and Withdrawal (within the area of Personal Adjustment). Method: This cross-sectional study evaluated the factor structure, internal consistency, test--retest reliability, and measurement error of the Dutch CPHI scales. In all, 399 adults with impaired hearing participated, and data on a subgroup of 40 patients were included in the test--retest analyses. The participants completed the questionnaire before routine clinical care or at home. Demographic data and data on pure-tone hearing thresholds were also collected. Results: Based on item factor analyses, we omitted 5 items, moved 3 items to different scales, and combined the Stress and Withdrawal scales. The resulting 6 scales, containing 52 items, showed good internal consistency (alphas between 0.81 and 0.94), good test--retest reliability (intraclass correlation coefficients between 0.78 and 0.86), and small standard error of measurement (between 0.28 and 0.46). Conclusions: The suggested revisions of the Dutch CPHI scales will increase their interpretability. Further research is needed to evaluate their usefulness for monitoring patients and in longitudinal studies by determining their responsiveness and minimal important change values. KEY WORDS: Communication Profile for the Hearing Impaired (CPHI), factor analysis, reliability, internal consistency, measurement error, Instead of developing new outcome measures for use in audiological rehabilitation, the exploitation of existing measurement instruments is strongly advocated (Hyde, 2000; Streiner & Norman, 2003). The use of the [...]

Purpose: The goal of this study was to find factors for refining candidacy criteria for bilateral hearing aid fittings. Clinical files of 1,000 consecutive hearing aid fittings were analyzed. Method: Case history, audiometric, and rehabilitation data were collected from clinical files, and an extensive questionnaire on long-term outcome measures was conducted. After at least 2 years of hearing aid use, 505 questionnaires were returned. in order to compare differences in benefits between unilateral and bilateral fittings, two subgroups were composed in which most relevant variables (age, degree of hearing loss, and audiometric asymmetry) were matched for unilateral fittings (n = 212) and bilateral fittings (n = 477). Results: The bilateral group had significantly higher benefit scores than the unilateral group for detection, speech intelligibility in reverberation, and localization, but poorer scores for comfort of loud sounds. The benefit of bilateral hearing aids was not significantly related to the level of technology of the hearing aids. Conclusion: The analysis of the relation between objective parameters and the subjective outcome measures showed that candidacy for a successful bilateral fitting could not be predicted from age, maximum speech intelligibility, employment, exposure to background noise, or social activities. KEY WORDS: hearing loss, hearing aids, bilateral, speech intelligibility, In the literature, many advantages have been described as benefits of a second hearing aid, but these advantages are not always consistently found in all studies. Also, the experimental designs [...]

Purpose: In this study, the authors aimed to develop a visual analogue of the widely used Speech Reception Threshold (SRT; R. Plomp & A. M. Mimpen, 1979b) test. The Text Reception Threshold (TRT) test, in which visually presented sentences are masked by a bar pattern, enables the quantification of modality-aspecific variance in speech-in-noise comprehension to obtain more insight into interindividual differences in this ability. Method: Using an adaptive procedure similar to the SRT test, the TRT test determines the percentage of unmasked text needed to read 50% of sentences correctly. SRTs in stationary noise ([SRT.sub.STAT]), modulated noise ([SRT.sub.MOD]), and TRTs were determined for 34 participants with normal hearing, aged 19 to 78 years. Results: The results indicate that about 30% of the variance in [SRT.sub.STAT] and [SRT.sub.MOD] is shared with variance in TRT, which reflects the shared involvement of a modality-aspecific cognitive or linguistic ability in forming meaningful wholes of fragments of sentences. Conclusion: The TRT test, a visual analogue of the SRT test, has been developed to measure the variance in speech-in-noise comprehension associated with modality-aspecific cognitive skills. In future research, normative data of the TRT test should be developed. It would also be interesting to measure TRTs of individuals experiencing difficulties understanding speech. KEY WORDS: speech perception in noise, SRT test, ability to read masked text, TRT test, modality-aspecific cognitive functions, For several decades, it has been known that although the ability to comprehend speech in noise is related to peripheral hearing loss and to the ability to comprehend speech in [...]

Purpose: This study investigated the relationship between hearing loss and memory and attention when nonverbal, visually presented cognitive tests are used. Method: Hearing loss (pure-tone audiometry) and IQ were measured in 30 participants with mild to severe hearing loss. Participants performed cognitive tests of pattern recognition memory, sustained visual attention, and spatial working memory. All cognitive tests were selected from the Cambridge Neuropsychological Test Automated Battery (CANTAB expedio; Cambridge Cognition Ltd., 2002). Regression analyses were performed to examine the relationship between hearing loss and these cognitive measures of memory and attention when controlling for age and IQ. Results: The data indicate that hearing loss was not associated with decreased performance on the memory and attention tests. In contrast, participants with more severe hearing loss made more use of an efficient strategy during performance on the spatial working memory subtest. This result might reflect the more extensive use of working memory in daily life to compensate for the loss of speech information. Conclusions: The authors conclude that the use of nonverbal tests is essential when testing cognitive functions of individuals with hearing loss. KEY WORDS: cognitive functions and disorders, hearing loss, memory, attention, In several studies, auditory measures like pure-tone audiometry and speech perception in noise have been associated with performance on various tests of cognitive functioning (e.g. Hallgren, Larsby, Lyxell, & Arlinger, [...]