Saunders Gabrielle H, Forsline Anna, Fausti Stephen A
The National Center for Rehabilitative Auditory Research, Portland, Oregon 97207, USA.
Ear Hear. 2004 Apr;25(2):117-26. doi: 10.1097/01.aud.0000120360.05510.e5.
Measurement of hearing aid outcomes is necessary for demonstration of treatment efficacy, third-party payment, and cost-benefit analysis. Outcomes are usually measured with hearing-related questionnaires and/or tests of speech recognition. However, results from these two types of test often conflict. In this paper, we provide data from a new test measure, known as the Performance-Perceptual Test (PPT), in which subjective and performance aspects of hearing in noise are measured using the same test materials and procedures. A Performance Speech Reception Threshold (SRTN) and a Perceptual SRTN are measured using the Hearing In Noise Test materials and adaptive procedure. A third variable, the discrepancy between these two SRTNs, is also computed. It measures the accuracy with which subjects assess their own hearing ability and is referred to as the Performance-Perceptual Discrepancy (PPDIS).
One hundred seven subjects between 24 and 83 yr of age took part. Thirty-three subjects had normal hearing, while the remaining seventy-four had symmetrical sensorineural hearing loss. Of the subjects with impaired hearing, 24 wore hearing aids and 50 did not. All subjects underwent routine audiological examination and completed the PPT and the Hearing Handicap Inventory for the Elderly/Adults on two occasions, between 1 and 2 wk apart. The PPT was conducted for unaided listening with the masker level set to 50, 65, and 80 dB SPL.
PPT data show that the subjects with normal hearing have significantly better Performance and Perceptual SRTNs at each test level than the subjects with impaired hearing but that PPDIS values do not differ between the groups. Test-retest reliability for the PPT is excellent (r-values > 0.93 for all conditions). Stepwise multiple regression analysis showed that the Performance SRTN, the PPDIS, and age explain 40% of the variance in reported handicap (Hearing Handicap Inventory for the Elderly/Adults scores). More specifically, poorer performance, underestimation of hearing ability and younger age result in greater reported handicap, and vice versa.
Reported handicap consists of a performance component and a (mis)perception component, as measured by the Performance SRTN and the PPDIS respectively. The PPT should thus prove to be a valuable tool for better understanding why some individuals complain of hearing difficulties but have only a mild hearing loss or conversely report few difficulties in the presence of substantial impairment. The measure would thus seem to provide both an explanation and a counseling tool for patients for whom there is a mismatch between reported and measured hearing difficulties.
测量助听器效果对于证明治疗效果、第三方支付及成本效益分析而言是必要的。通常使用与听力相关的问卷和/或言语识别测试来测量效果。然而，这两种测试的结果常常相互矛盾。在本文中，我们提供了一种新测试方法——性能-感知测试（PPT）的数据，该测试使用相同的测试材料和程序来测量噪声环境下听力的主观和性能方面。使用噪声中的听力测试材料和自适应程序来测量性能言语接受阈值（SRTN）和感知SRTN。还计算了第三个变量，即这两个SRTN之间的差异。它测量受试者评估自身听力能力的准确性，被称为性能-感知差异（PPDIS）。
107名年龄在24至83岁之间的受试者参与了研究。33名受试者听力正常，其余74名患有对称性感音神经性听力损失。在听力受损的受试者中，24名佩戴助听器，50名未佩戴。所有受试者均接受了常规听力学检查，并在相隔1至2周的时间内两次完成PPT和老年人/成年人听力障碍量表。PPT在未佩戴助听器的情况下进行，掩蔽级设置为50、65和80 dB SPL。
PPT数据显示，在每个测试级别，听力正常的受试者在性能和感知SRTN方面均显著优于听力受损的受试者，但两组之间的PPDIS值没有差异。PPT的重测信度极佳（所有条件下r值> 0.93）。逐步多元回归分析表明，性能SRTN、PPDIS和年龄解释了报告的听力障碍（老年人/成年人听力障碍量表得分）中40%的方差。更具体地说，较差的性能、对听力能力的低估和较年轻的年龄导致报告的听力障碍更大，反之亦然。
报告的听力障碍由一个性能成分和一个（错误）感知成分组成，分别由性能SRTN和PPDIS测量。因此，PPT应被证明是一个有价值的工具，有助于更好地理解为什么有些人抱怨听力困难但听力损失却很轻微，或者相反，在存在严重听力障碍的情况下却报告很少有困难。因此，该测量方法似乎为报告的和测量的听力困难不匹配的患者提供了一种解释和咨询工具。
