Hearing abilities measured with the Hearing in Noise Test (HINT)

101 Pages·2017·4.11 MB·English

Hearing abilities measured with the Hearing in Noise Test (HINT)
Studies on normal hearing and cochlear implant users

Marte Myhrum
8/31/2016

Department of Otorhinolaryngology,
Oslo University Hospital
© Marte Myhrum, 2017

Series of dissertations submitted to the
Faculty of Medicine, University of Oslo

ISBN 978-82-8333-369-5

All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, without permission.

Cover: Hanne Baadsgaard Utigard.
Print production: Reprosentralen, University of Oslo.
Contents
Acknowledgements ...................................................................................................... 3
Abbreviations ............................................................................................................... 4
List of publications ....................................................................................................... 5
Preface .......................................................................................................................... 6
1 Background ........................................................................................................... 8
1.1 Introduction ................................................................................................... 8
1.2 Auditory pathways ........................................................................................ 9
1.3 The auditory system and auditory processing ............................................. 16
1.4 Binaural hearing .......................................................................................... 24
1.5 Development of the auditory system ........................................................... 26
1.6 Cochlear implants (CIs) ............................................................................... 28
1.7 Speech perception tests ............................................................................... 32
1.8 Speech, Spatial and Qualities of Hearing scale (SSQ) ................................ 35
2 Thesis aims ......................................................................................................... 37
2.1 Motivation ................................................................................................... 37
2.2 Aims of the thesis ........................................................................................ 38
2.3 Summary of objectives ................................................................................ 39
2.4 Thesis outline .............................................................................................. 40
3 Materials and methods ........................................................................................ 41
3.1 Overview ..................................................................................................... 41
3.2 Terms used .................................................................................................. 42
3.3 Summary of material and methods in each paper ....................................... 43
4 Results ................................................................................................................. 47
4.1 Norwegian Hearing in Noise test (Papers I+II) ........................................... 47
4.2 Pediatric CI participants with sequential CI (Paper III) ............................. 49
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4.3 Adult CI participants (Paper IV) ................................................................. 51
4.4 HINT results across study groups (Papers II, III, IV) ................................. 52
5 Discussion ........................................................................................................... 53
5.1 Norwegian Hearing in Noise test (Papers I+II) ........................................... 53
5.2 Pediatric CI participants with sequential CI (Paper III) ............................. 54
2
5.3 Adult CI participants (Paper IV) ................................................................. 55
5.4 Methodological considerations .................................................................... 56
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5.5 General discussion ....................................................................................... 58
6 Conclusions ......................................................................................................... 64
6.1 Norwegian Hearing in Noise test (Papers I+II) ........................................... 64
6.2 Pediatric CI participants with sequential CI (Paper III) ............................. 64
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6.3 Adult CI participants (Paper IV) ................................................................. 65
6.4 HINT in clinical practice ............................................................................. 66
7 Future perspectives ............................................................................................. 66
8 Appendix ............................................................................................................. 77
8.1 SSQ questionnaire in Norwegian ................................................................ 77
8.2 SSQ questionnaire for children in Norwegian............................................. 89
9 Errata ................................................................................................................... 98
10 Papers I - IV ........................................................................................................ 99

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Acknowledgements
I would like to express my thanks to my main supervisor, Greg Jablonski, for
his help and support. Greg is a great otosurgeon, and he is a person who never
says “no” if you ask him for a favor. I also express my thanks to my co-
supervisors, Inger Moen, Ole Tvete, and Mariann Gjervik Heldahl for
insightful comments and suggestions during this research. Ole has invaluable
knowledge of and experience in audiology and in the field of cochlear
implants, and he has lots of ideas. Mariann is young and structured and is a
very effective supervisor. They are all caring persons with great sense of
humor.
My special thanks and words in memory are due to Inger Moen, who sadly
passed away last year, on Nov 28th, at 75 years old. I remember Inger Moen
with much pleasure as an elegant, cultured person with great professional
skills and personality. Thank you.
I am also grateful to Sig Soli, formerly of the House Ear Institute. Though not
a formal supervisor, he has provided supervision. He helped and supported the
development of the Norwegian Hearing in Noise test (HINT), and made it
possible. Big thanks to Dan Freed and Andy Vermiglio, of House Ear Institute,
who assisted in the technical part of the HINT development.
Many thanks to Dr. William Noble at the MRC Institute of Hearing Research
for checking the back-translated version of the Norwegian Speech Spatial and
Qualities of hearing scale (SSQ). The Norwegian SSQ was modified
according to his feedback.
I would like to thank all my wonderful colleagues and friends at the Cochlea
Implant team and Hørselsentralen at Oslo University Hospital, Oslo, Norway.
Colleagues contributed substantially in the clinical studies data acquisition,
and their contribution was essential. Not least, thanks for laughs and so much
fun at work, and for all your support.
Thanks to the Master degree students Eli Anne Eiesland and Elisabeth Finsen
at the Department of Linguistics and Scandinavian Studies, the Bachelor
degree students Kristoffer Mosti, Eilen Holloway, Kristina Daland, Monica
Normann, Kari Lien, Thea Catrine Hjetland, Thor Kristian Melhuus Hojem,
and Heidi Maudal at the Faculty of Health Education and Social Work at the
Sør-Trøndelag University College who participated in the data collection in
Paper II.
Finally, my warmest thanks to my family: Mamma and Pappa for everything.
Oddleif, Eline, Dina and Torkel, for laughs, love, and everyday happiness.
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Abbreviations

ASA Auditory scene analysis
AVCN Anteroventral cochlear nucleus
dB SPL Decibel (dB) sound pressure level
CF Characteristic frequency
CI Cochlear implant
CI First side cochlear implant
1
CI Second side cochlear implant
2
CI Bilateral cochlear implants
BI
CN Cochlear nucleus
DCN Dorsal cochlear nucleus
ESP / ESP-N Early Speech Perception test / ESP test in Norwegian
HA Hearing aid
HINT Hearing in Noise test
ILD Interaural level difference
ITD Interaural time difference
JND Just-noticable differences
LSO Lateral superior olive
MGB Medial geniculate body
MLD Masking level difference
MSO Medial superior olive
NF Noise Front
NL Noise Left
NR Noise Right
OUS Oslo University Hospital
PI Performance intensity
PVCN Posteroventral cochlear nucleus
RMS Root mean square
SD Standard deviation
SNR Signal-to-noise ratio
SRM Spatial release from masking
SRT Speech Reception Threshold
SSQ Speech Spatial and Qualities of Hearing scale

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List of publications
Paper I
Myhrum, M., Moen, I. (2008). The Norwegian hearing in noise test. Int J
Audiol, 47, 377-378 (Myhrum et al. 2008)
Paper II
Myhrum, M., Tvete, O., Heldahl, M. G., et al. (2016). The Norwegian Hearing
in Noise Test for Children. Ear Hear, 37, 80-92 (Myhrum et al. 2016)
Paper III
Myhrum, M., Strøm-Roum, H., Heldahl, M.G., Rødvik, A.K., Eksveen, B.,
Landsvik, B., Rasmussen, K., Tvete, O.E. Sequential bilateral cochlear
implantation in children – outcome of the second CI and long-term use.
(Accepted with minor changes 2nd August 2016, Ear Hear)
Paper IV
Myhrum, M., Heldahl, M.G., Jablonski, G.E., Tvete, O.E. Self-Assessed
Speech, Spatial, and Qualities of Hearing Scores (SSQ) and Speech Perception
in Adult Cochlear Implant Recipients (Journal of Speech, Language, and
Hearing Research, Submitted in July 2016)
The papers will be referred to by their Roman numerals.
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Preface
The overall purpose of the thesis was to develop a Hearing in Noise test
(HINT) in Norwegian, and apply the test via headphones to normal-hearing
adults. The subsequent purpose was to develop a pediatric version of the test
and apply adult and pediatric versions of the test from speakers in free-field, to
normal hearing adults and children. Speaker presentation is necessary when
the test is to be used with hearing aid (HA) and cochlear implant (CI) users.
Earlier studies have shown effects of maturation, therefore children aged from
6 to 13 years old were included.
The test was then used in two different CI population studies. The first CI
study used the Hearing in Noise test (HINT) to investigate the advantage of
two CIs in a subgroup of a pediatric CI population who had received
sequential CIs. This study also investigated the use and benefit of a second CI
in the total cohort.
The other CI study used the HINT to describe the hearing ability of an adult
CI study group. A questionnaire for self-assessment of hearing abilities was
translated from English into Norwegian and was used in the latter study to
describe a self-assessed, subjective measure of hearing abilities. The
relationship between HINT results (objective measure) and questionnaire
results (subjective measure) was investigated.
The HINT is a validated English test using sentences in background noise. It
has been used in several CI studies, and has been implemented in several
languages and with pediatric versions, and was the basis for the Norwegian
version used in the studies here. The Speech, Spatial and Qualities of Hearing
scale (SSQ) is a validated English hearing ability self-assessment
questionnaire and was selected for use in these studies. The SSQ was
originally developed in English, translated into other languages and validated,
and used to study hearing abilities in the hearing impaired. It is used in an
increasing number of CI studies.
The studies in the thesis were prospective, except for the pediatric CI study
which was a combination of a retrospective longitudinal cohort study and a
prospective study of a subgroup of the cohort. The number of participants in
the normal-hearing studies was based on the inclusion number in similar
studies in other languages, in addition to our own sample power calculations.
The normal-hearing studies were necessary, to obtain Norwegian norms and to
compare results with other languages. The investigation of maturation effects
on speech in noise was a supplement to earlier research in other languages, but
testing of speech in noise in an anechoic chamber with speech and noise
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spatially separated gained new insight in the field. The CI studies included a
large number of participants (160 in the pediatric and 152 in the adult study).
The retrospective, longitudinal, pediatric CI cohort study is unique since the
population is from a country’s only pediatric CI center, and includes all
children who underwent sequential CI in the study period. There was also a
long follow-up after implantation, longitudinally followed for at least 5 years
after second CI surgery. In the adult CI study, a large number of CI users
assessed themselves using the SSQ, and a disability profile could be calculated
and compared to SSQ profiles in other CI studies using the SSQ in other
languages, though the other studies included fewer participants. The adult CI
study provided new insights by combining subjective and objective measures
in a large study group.
Another important overall purpose was to integrate the HINT in the array of
tests used to assess speech perception in CI users. This had a clinical purpose,
but also meant that data could be used in future studies. Systematic collection
according to test protocol and database storage of clinical test results will
make it easy to retrieve data in subsequent studies.

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