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The modern sling procedures for treating female stress urinary incontinence encompass numerous methods, materials and manufacturers. On the basis of the current S2e guidelines, the methods used most frequently in the diagnosis of and therapy for stress urinary incontinence in women are critically illustrated. An individualised procedure is necessary for the choice of the surgical method, especially in the presence of accompanying pathologies. This article is intended to help the treating physician to carry out quality-assured diagnostics and therapy for the patient and to offer the best possible urogynaecological management. In addition to the complications and chances of success of the surgical options, the legal aspects of therapy planning are also taken into consideration.

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The purpose of this investigation was to study the impact of spectral shape and content on thresholds of discomfort (TD) for listeners with normal hearing and listeners with hearing loss. Secondary to that purpose was to quantify binaural summation at high intensities across complex stimulus conditions for both groups of listeners. Forty subjects (20 with normal hearing, 20 with hearing loss) participated. Complex acoustic stimuli (multitone and continuous discourse) were filtered to have four spectral shapes: (1) flat spectrum, (2) long-term average speech spectrum, (3) reverse long-term average speech spectrum, and (4) the TD contour derived for each subject from pure-tone TD obtained with eight pure tones from 250 to 4000 Hz. The results suggest that (1) TD for complex stimuli are lower for subjects with hearing loss compared with those with normal hearing, suggesting increased loudness summation with this population; (2) binaural summation of approximately 6 dB (independent of stimulus type, filter shape, or spectral content), indicating that a correction of similar magnitude for bilateral hearing aid fittings is appropriate; and (3) TD obtained at 750, 1500, and 3000 Hz accounted for approximately 60 percent of the variance in the complex TD measures, suggesting that TD at these frequencies be used to set the output obtained from a hearing aid with a 90-dB pure-tone sweep as the input stimulus.

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OBJECTIVE: Investigators at the National Acoustic Laboratories have provided a theoretical derivation and experimental validation of a formula for setting the maximum output of hearing aids (Dillon & Storey, 1998; Storey, Dillon, Yeend, & Wigney, 1998). Given that measurement of discomfort levels for setting maximum output can be both time-consuming and of questionable reliability, the use of a prescriptive formula warrants consideration. In this article, an extensive data base was considered and issues of normal hearing, clinical protocol, age and gender were investigated in an effort to further determine optimal maximum output settings. DESIGN: Data were gathered from five previous investigations, for a total of 433 subjects (total ears = 710). Threshold of discomfort (TD) measures were obtained using one of two adaptations of the Ascending Method of Limits, one with category anchors and one without. RESULTS: Subjects with normal hearing had significantly lower TDs than subjects with hearing loss. A different regression line for measured TDs as a function of hearing level was noted for subjects whose hearing threshold levels fell between 20 and 60 dB HL and those with thresholds above 60 dB HL. When all effects (hearing level, method, age and gender) were considered in a single predictive model for the two threshold groups, only method and threshold were significant predictors of TD. However, for the subjects with thresholds between 20 and 60 dB HL, less than 4% of the variance in TD measures could be accounted for by those factors. For subjects with threshold above 60 dB HL, 22% of the variance in TD measures could be accounted for by those variables. CONCLUSIONS: For both groups of subjects (20 to 60 dB HL and above 60 dB HL) methodology and hearing thresholds are significant predictors of discomfort levels. Age and gender are not. Given the small variance accounted for by any of these factors, measures of discomfort using standardized methodologies seem warranted.

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In studies to date, the effectiveness of the directional microphone has been investigated independently of the signal processing scheme used in the hearing aid. In addition, the number and placement of the background noise speakers can create an advantage for a particular polar pattern (i.e., cardioid, supercardioid, and hypercardioid) in any laboratory design. With these considerations in mind, the purpose of this investigation was twofold: (1) to determine the effect of different amplitude-compression release times on speech perception ability in noise, measured with directional microphone hearing aids, and (2) to determine the impact of environment (classroom vs anechoic chamber) on those measures. Ten subjects with mild to moderate sensorineural hearing loss participated. Using an eight-speaker complex sound field, speech perception was assessed in an anechoic chamber and a typical classroom environment. None of the release times resulted in superior performance in either the anechoic or classroom environment.

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A table of available self-report inventories used throughout the world is provided with references for obtaining necessary psychometric data for research or clinical applications. Considerations for choosing an inventory (reliability, validity, and content appropriateness) are discussed and issues related to group versus single-subject applications examined. It is preferable that translation and revalidation of existing outcome measures be considered above developing new ones for international application.

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The participants in the Eriksholm Workshop on "Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids" debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self-report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health-care delivery systems. A set of seven core items is proposed for further study.

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The Speech in Noise (SIN) test consists of a series of Institute of Electrical and Electronic Engineers sentences presented in a background of four-talker babble at two presentation levels (83 and 53 dB SPL) and four signal-to-noise ratios (SNR) (15, 10, 5, and 0 dB). In this study, the nine lists were tested for equivalency and the test-retest reliability was determined. Twenty listeners with normal hearing and 20 listeners with sloping sensorineural hearing losses served as subjects. Five sentences were presented at each SNR at each level, and five key words in each sentence were scored (100 key words per presentation level). Each key word was scored as correct or incorrect, with errors of plurality scored as half-correct words. For percent-correct scores, Lists 1, 2, and 9 and Lists 3, 4, and 5 were found to be equivalent for listeners with normal hearing. For both groups of listeners, the test-retest correlations were high, and the critical differences appropriate for sentence material were 10 to 16% at a .95 level of confidence. Because of floor and ceiling effects across the different lists, many subjects with normal hearing did not score as low as the 50% level, and many subjects with hearing loss did not score as high as 50%. Suggestions are offered for alternate scoring in order to obtain a SNR for 50% performance. Future versions of this test should be designed with improved list equivalency and 50% performance capability.

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OBJECTIVE: To measure hearing aid performance using circuitry representative of the major eras of technological advancement during the 20th century. DESIGN: Twenty subjects with audiometric profiles consistent with hearing aid candidacy were fit with each of seven hearing aids. No directional microphones were used and binaural benefit was not assessed. Each hearing aid was fit to the strategy or fitting scheme of the era, or that which was intended by the presenting manufacturer. Electroacoustic and/or real ear measures of gain, output, bandwidth, and distortion were obtained. Objective outcome measures assessing speech perception in backgrounds of noise were obtained. Subjective outcome measures of sound quality and ease of listening were obtained in the laboratory and in real life settings. RESULTS: Electroacoustic and real ear measures indicate that gain and bandwidth have increased, and output and distortion have decreased with current electronic aids. Speech perception ability across the different outcome measures showed significantly poorer performance with the body and linear hearing aids when input levels were high; when input levels were low, outcome measures with hearing aids using a dynamic range compression were not negatively affected. At the most adverse signal to noise ratios, none of the hearing aids was shown to be superior. Measured bandwidth did not correlate highly with speech perception ability for any of the objective outcome measures used. For the subjective measures of sound quality done in a blinded manner, no significant differences were found across different listening situations for current hearing aids. CONCLUSIONS: The two most important factors for aided speech perception appear to be the audibility and distortion of the signal. No current compression scheme proved superior with the outcome measures used in this investigation.

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The aided performance and benefit achieved with linear and two-channel wide dynamic range compression (WDRC) in-the-canal (ITC) hearing aids were established in 55 individuals. Study participants had been wearing either linear or adaptive-frequency-response (Bass Increase at Low Levels, BILL) ITC hearing aids for approximately one year before participation in this study. Outcome measures included aided performance and objective benefit in quiet and noise at a variety of speech levels (50, 60, and 75 dB SPL), at various levels of babble background (quiet, signal-to-babble ratios of +5 and +10 dB), and for various types of test materials (monosyllabic words and sentences in connected speech). Several subjective measures of aided performance (sound-quality judgments and magnitude estimates of listening effort) and relative benefit (improvement in listening effort and the Hearing Aid Performance Inventory, HAPI) were also obtained. Finally, self-report measures of hearing-aid use were also obtained using daily logs. Participants completed all outcome measures for the linear ITC hearing aids first, following 2 months of usage, and then repeated all outcome measures for the WDRC instruments after a subsequent 2-month period of use. In general, although both types of hearing aids demonstrated significant benefit, the results indicated that the WDRC instruments were superior to the linear devices for many of the outcome measures. This tended to be the case most frequently when low speech levels were used. Many of the performance differences between devices most likely can be ascribed to differences in gain, and prescriptive approaches (DSL[i/o] vs. NAL-R), for the fixed volume control testing performed in this study.

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In a recent tutorial for the journal, Palmer et al. [J. Acoust. Soc. Am. 103, 1705-1721 (1998)] reviewed the literature on the potential for increases in hearing aid benefit over time (acclimatization). Their review might leave some readers with the impression that acclimatization has implications for the fitting and selection of hearing aids today. We (Turner and Bentler), along with two other researchers in the field (Humes and Cox), conducted a similar review of the literature a few years earlier [Turner et al., Ear and Hearing 17, 14S-28S (1996)] and found little evidence of a robust effect. The bulk of the existing evidence, including the most recent studies on this topic, support earlier conclusions, i.e., that there is no evidence for the existence of a strong acclimatization effect in current hearing aid use.

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OBJECTIVE: The objective of this investigation was to compare real and perceived benefit for two currently marketed digital hearing aids, the Oticon DigiFocus and the Widex Senso. The hearing aids have different philosophies of design and fitting strategies; as a result, it was hypothesized that there would be performance differences. DESIGN: Twenty subjects with documented sensorineural hearing losses were fit with each of the two digital hearing aids. After 4 wk of use with each hearing aid, a battery of objective and subjective tests was completed to assess hearing aid benefit. RESULTS: No significant differences were found between the hearing aids as revealed by the objective testing of speech recognition and self-report inventories of hearing aid benefit. The DigiFocus was shown by real ear measurements to provide more high-frequency gain than the Senso. The Widex Senso was preferred by 13 of the 20 subjects (seven of 10 of the new hearing aid users). This may be explained, in part, by the increased high-frequency gain provided by the Oticon DigiFocus, which was perceived as having greater "harshness." CONCLUSIONS: Based on the results of this investigation, neither hearing aid processor was shown to be superior to the other. In addition, the least amount of objective benefit was shown in the presence of background noise.

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Hearing aid benefit refers to a relative change in performance on a particular measure between aided and unaided listening conditions. A number of studies in recent years have investigated the hypothesis that hearing aid benefit increases over time after the initial fitting of the aid. Both objective (speech recognition) and subjective (questionnaire) measures have been used to measure hearing aid benefit. Some studies have reported a positive increase over time in group mean benefit, and some have reported no change in benefit, whereas none have reported a group mean negative change in benefit. However, individual subjects in these studies can show changes in benefit in either a positive or negative direction. The variability across subjects in each study has been large in comparison with the observed amount of benefit increase. In this review of the literature, it is argued that the studies present essentially similar results and the range of values across subjects in the various studies shows considerable overlap. Although there does appear to be a tendency for hearing aid benefit to increase over time, there are other, much stronger, factors influencing changes in hearing aid benefit that make it impossible at present to predict which patients will show a reliable increase (or decrease) in hearing aid benefit over time.

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The terminology used in studies documenting changes in auditory performance following fitting of hearing aids has been diverse. Definitions for the auditory deprivation effect and auditory acclimatization are offered as a first step in rationalization. Two statements summarize current knowledge concerning auditory deprivation effects and auditory acclimatization, as well as considering the potential implications for research, field trial and clinical practice applications. Potential areas for future research are identified.

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Recently several methods for obtaining clinical measures of loudness growth through the use of categorical scaling (CS) have been proposed for the selection of hearing aids. These methods use differing test signals or suggest frequency-specific level corrections in an attempt to reflect the loudness perception of hearing aid-processed speech. While some decisions regarding the stimuli utilized for loudness perception procedures are based on measured relationships to speech signals, the effect on loudness perception of changing signal type and bandwidth (as measured by CS) remains unclear. The relationships between the CS loudness growth of signals of differing type, (pure tones, noise bands, filtered/temporally inverted/passband speech) and bandwidth were examined for subjects with both normal and impaired hearing. Results suggest that when the bandwidth is similar (e.g., pure tone and 1/3 oct), signal type does not have significant bearing on loudness perception. As expected, increasing the bandwidth beyond the critical band affected loudness growth, as wideband speech stimuli were judged to be significantly louder than narrow-band speech at equivalent overall sound levels. In this investigation, similar loudness growth patterns were noted across category ratings for all test signal bandwidths. In contrast, loudness growth data obtained using an intelligible speech signal [Cox et al., The American Academy of Audiology (1994a)], revealed loudness growth patterns for speech were fundamentally different than those obtained for tones. Implications for hearing aid fitting strategies are discussed.

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This report is the first of two detailing a longitudinal follow-up of hearing aid users. Sixty-five subjects were followed for 12 months post-hearing aid fitting. Objective tests included insertion gain, the Speech Perception in Noise (SPIN) test (Kalikow, Stevens & Elliot, 1977; Bilger, Neutzel, Rabinowitz, & Rzeczkowski, 1984) and the Nonsense Syllable Test (NST) (Levitt & Resnick, 1978) presented in quiet and noise backgrounds. Initially each subject's hearing aid was fit to the revised National Acoustic Laboratories prescriptive formula (NAL-R) (Byrne & Dillon, 1986) using insertion gain measures. Use gain, measured at 6 and 12 months post-fitting, indicated that subjects generally used those prescribed values, except for subjects in the steeply sloping configuration subgroup. The NST and SPIN tests were administered at the fitting and at 1, 3, 6, and 12 months post-fitting. No change in performance, or training effect, was found for the group or for factors of experience, degree of hearing loss, configuration of hearing loss, use time, or circuit type. Failure to demonstrate a training effect may be attributed, in part, to the fact that initial speech recognition testing was done with the hearing aid volume set at the prescribed values. None of the circuits used showed performance superiority, except when comparing scores for the NST obtained in a quiet background to those obtained in a background of speech-weighted noise. In that comparison, the users of adaptive filter circuits exhibited less deterioration of performance in a noise background.

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This report is the second of two detailing a longitudinal follow-up of hearing aid users. The experimental group (N = 65) was followed closely for a 12-month period after obtaining amplification. Factors of degree of hearing loss, configuration of hearing loss, previous experience with hearing aids, daily use time, and circuit type were defined. Subjective tests included the "Understanding Speech" subsection of the Hearing Performance Inventory (HPI) (Giolas, Owens, Lamb, & Schubert, 1979; Lamb, Owens, & Schubert, 1983), an expectations checklist, a qualitative judgment task, and a satisfaction questionnaire that included items of use time, battery life, and main reason for satisfaction rating. Only those items of the HPI describing fairly quiet backgrounds showed significant change (improvement) over the year. The expectation checklist showed a mean reduction in score indicative of performance exceeding expectations. The qualitative judgment task did not significantly differentiate among the circuits used, although the linear circuit was judged as having better sound quality than those circuits considered to be noise-reduction. Correlations with the objective tests reported previously in Part I suggest a weak relationship between speech recognition performance and self-assessment of communication performance. Questions of the validity of subjective measures, the best time frame for obtaining outcome measures, and the usefulness of group data are addressed.

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The purpose of this investigation was to study the effectiveness of different "noise reduction" circuits for subjects of differing degrees, configurations, and experience with amplification. Fifty subjects with hearing impairment were randomly assigned one of four circuit types whose marketing claims suggested resultant improvement in speech recognition in noise backgrounds. Although no apparent circuit superiority was shown, the subjects indicated a high level of satisfaction with the hearing aids chosen for them. Improved measuring tools, improved fitting strategies, and overall improved hearing-aid circuitry (though probably not the noise reduction feature) may explain this level of satisfaction.

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In an earlier publication, various transformations used in hearing aid research and its application were summarized. As a result of continued interest and requests, additional transfer functions are provided in this addendum.

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The purpose of this project was to compare the Widex Quattro and the Ensoniq Sound Selector hearing instruments as to benefits (real and perceived) and overall convenience. It is the premise of the Ensoniq designers that a high fidelity (wide band) hearing aid is adequate for all listening conditions due to its exact reproduction of sound. Conversely, it is the premise of the Quattro designers that a hearing aid user needs access to multiple frequency responses (memories) for optimal benefit in different communicative situations. Subjective measures showed little differentiation between the two instruments, except for the Ease of Communication subtest of the Profile of Hearing Aid Performance (PHAP). New users rated the Quattro as performing better, while experienced users rated the Ensoniq significantly better. Objective measures indicated some differences in the performance of the two instruments, although these results may be related to the fitting strategies employed.

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