Scandinavian Audiology
ISSN: 0105-0397 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/iaud20
Auditory and Psychological Factors in ‘Auditory Disability with Normal Hearing’ Katie King & Dafydd Stephens To cite this article: Katie King & Dafydd Stephens (1992) Auditory and Psychological Factors in ‘Auditory Disability with Normal Hearing’, Scandinavian Audiology, 21:2, 109-114, DOI: 10.3109/01050399209045990 To link to this article: http://dx.doi.org/10.3109/01050399209045990
Published online: 12 Oct 2009.
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Citing articles: 11 View citing articles
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Date: 15 March 2016, At: 05:36
Scand Audiol 1992: 21: 109-1 14
AUDITORY AND PSYCHOLOGICAL FACTORS IN ‘AUDITORY DISABILITY WITH NORMAL HEARING’ Katie King’ and Dafydd Stephens’ From the ‘Department of Psychology, University of Wales, College of Cardia C a r d 8 and t h e 2Welsh Hearing Institute, University Hospital of Wales, Card$ Wales
Downloaded by [RMIT University Library] at 05:36 15 March 2016
ABSTRACT Auditory and psychologicalfactors in ‘Auditory disability with normal hearing’. King, K. and Stephens, D. (Department of PsYchologY, University of Wales College of Cardiff, and Welsh Hearing Institute, University Hospital of Wales, Cardiff, Wales). ScandAudiol 1992; 21: 109-1 14. Patients who have ‘Auditory Disability with Normal Hearing’ (ADN) complain of hearing difficulties even although their hearing is audiometrically ‘normal’. The auditory and psychological factors involved in ADN have been investigated by comparing 20 Patients of employment age with 20 controls (matched for age, sex and socioeconomic group) on appropriate auditory tests and questionnaires. From the results it was concluded that both auditory and psychological factors are involved in ADN. The principal finding was that as a result of their problems with discriminating speech in noise, individuals with ADN have a tendency to anxiety, depression and loneliness. In addition the otological history of a n individual was found to be important in the developrnent of ADN. Finally, it was suggested that bad coping strategies may lead to increased anxiety in those with ADN.
Key words: auditory disability, normal hearing, coping strategies.
INTRODUCTION For some time it has been acknowledged that a certain proportion of patients who present to audiological and otological clinics with self-reported auditory difficulties nevertheless have clinically ‘normal’ hearing thresholds and no other obvious cause. The greatest difficulties experienced by these patients seem to lie in the area of comprehension of speech in a noisy environment. Stephens & Rendell (1988) adopted the term ‘auditory disability’ with normal hearing (ADN) as an all embracing term, rather than the term ‘obscure auditory dysfunction’ (OAD) used by Saunders & Haggard (1987, 1989). They did this because, on the basis Of earlier clinical experience, they did not want to preclude the possibility that, in certain cases, the disability might stem from psychological, linguis-
tic or other factors. Here the two terms will be used interchangeably. Both the study by Stephens & Rendell (1 988) and that by Saunders & ~~~~~~d ( 1 989) found that ADN was a multifactorial disorder. Rendell & Stephens (1988) found that the commonest findings were a mild cochlear dysfunction associated with psychological problems. Stressful factors such as important examinations, marital breakup and death of close relatives were associated with the develoDment of the reported disability, In addition, high Scores were obtained on the anxiety and hysteria subscales of the Crown Crisp Experiential Index (Crown & Crisp, 1979). Saunders & Haggard (1989) found that although patients and controls both had ‘normal’ hearing thresholds, the patient group did have significantly worse thresholds at certain frequencies, but suggested that these differences were unlikely to contribute very much to the determination of self-rated disability. NO difference was found in frequency resolution between the patient and control group, although this had been reported previously by Pick & Evans (1983) in ADN patients exposed to a significant amount of noise. Results of a sentence completion task studied by Saunders & Haggard (1989) indicated that the ADN group had a lower linguistic ability. There was also a higher incidence of current and past otological disorder amongst the patient group. The authors suggested that this probably contributed to increase the likelihood of seeking medical advice for a given level of current symptoms. In addition the results of the Crown Crisp Experiential Index indicated that those with ADN were more anxious than controls. They
-
’
Auditory disability is defined following the WHO definition (1980) as being the hearing difficulty experienced by the individual rather than a psychophysical measure. This is discussed at length by Stephens & Hetu (1991). Scand Audiol 21
110
K. King and D. Stephens
further noted that self-rated disability was significantly correlated with anxiety level among the patient group-but not among the controls. When otological history was taken as a co-variate, the group differences in anxiety were completely removed. They explained this by suggesting that anxiety adds to enhance a patient’s awareness of their hearing. Therefore, a history of otological disorder in conjunction with an anxious personality type may partly explain the presentation of these patients at the clinic. In the present study we have endeavoured to investigate these matters further and also to examine the strategies adopted by such individuals to reduce their disability and handicap.
Downloaded by [RMIT University Library] at 05:36 15 March 2016
MATERIALS AND METHODS Su bjecis
Twenty patients of employment age were compared with 20 controls (matched for age, sex and socio-economic group) on a number of appropriate measures. Twelve were matched on a paired basis, 8 as closely as possible. The ADN patients were selected from the total on file at the Welsh Hearing Institute. The controls were volunteers from other hospital departments. Approximately one-third were staff members solicited by notices placed in the hospital. Two-thirds were patients contacted in the general out-patient departments of the hospital, but excluding ENT patients. All subjects were selected on the basis of having audiometrically ‘normal’ hearing, defined as c 2 0 dB in both ears averaged over 250-800 Hz with no hearing at any frequency exceeding 30 dB HTL. All subjects were unsophisticated with respect t o psychoacoustical and personality tests. The mean age of the ADN patients was 30.3 years (S.D. 10.7) while the controls had a mean range of 27.9 (S.D. 9.1). Their ages ranged between 16 and 59 years. In the ADN patient group there were 7 males and 13 females, compared with 5 males and I 5 females in the control group. The distribution of socio-economic groups was comparable in the ADN patient and control groups. None of the differences between the two groups was significant at the 5 Yo probability level.
Audiometric investigations Pure-tone audiometry Absolute thresholds were determined for both ears at frequencies from 250 Hz to 8 kHz, using a calibrated Kamplex AC4 audiometer with TDH-39P headphones in a soundtreated chamber. High-J-equency audiometry Absolute thresholds were also determined at 10, 12, 14 and 16 kHz usinga Farnell sinekquare oscillator LEPl 10 Hz-1 MHZ in conjunction with a 32 mHz counter-time type 401T attached to a Kamplex AC4 audiometer. High-frequency headphones (Pioneer SE30D) wcrc used in a sound-attenuated booth. This was carried out to detect subclinical hearing loss in the patient group. Scand Audio1 21
Notched noise (Frequency Resolution) This test was used t o give a measure of frequency resolution which had been said to be related to speech discrimination (Moore, 1985). The difference between a pulsed 2 kHz sinusoidal tone in white noise at 85 dB SPL and the same pulsed tone in white noise with a notch around 2 kHz was measured using the audiometer, oscillator and counter-timer already mentioned, with standard headphones in a sound-attenuated chamber. A measure of the difference in thresholds between notch and no-notch noises gives a measure of frequency resolution.
Questionnaire Questionnaire one (Appendix 1 ) The questions comprising this questionnaire probed the otological history, the disabilities in hearing encountered by all subjects, the level of loneliness experienced (revised UCLA loneliness scale-Hayes & Dimatteo, 1987) and the types of coping strategy used. From the responses made to part b of questions 1 1 t o 17 and questions 18 and 19, the types of coping strategy used by each patient with ADN were determined (after Hetu et al. 1987).
Questionnaire two The Crown Crisp Experiential Index (Crown & Crisp, 1979) was used t o evaluate the emotional status of all subjects scores for free-floating anxiety, phobic anxiety, obsessionality, somatic anxiety, depression and hysteria.
Procedure Subjects were tested individually, the whole procedure taking about 40 min. All instructions were given by K. K. and queries addressed t o her. The auditory testing was carried out by an audiological technician. Relevant statistical analyses were carried out on the data, using t-tests, ,yz-tests, Mann Whitney’s U-test and Pearson’s correlation as appropriate.
RESULTS ADN status of the patient group
All patients met the definition of ADN. No subject included in the study had hearing worse than 20 dB in either ear, averaged over 250 to 8 000 Hz. Whereas all ADN patients reported having a hearing problem on questionnaire one, no controls indicated having any degree of hearing disability from part A of questions 11-1 7. The results indicated that the ADN group had the greatest degree of difficulty when trying to follow group conversation (Q12a) and in trying to understand what was being said in background noise (Q16a, Q17a). This supports both Saunders & Haggard (1989) and Stephens & Rendell’s (1988) work, which found the greatest disability to be comprehension of speech in a noisy environment.
Factors in ADN Table I. Frequencies showing significantly different thresholds between the ADN and Control Group X
X
ADN (dB HL)
Control (dB HL)
t
P
Worse 1 000 2 000 6 000 8 000
1.7 6.5 18.2 11.0
3.2 2.2 12.0 5.7
2.66 2.32 2.18 2.29
0.01 0.03 0.04 0.03
Better 1 000 2 000 3 000 6 000
4.0 3.5 8.5 18.0
0.7 0.0 2.7 12.5
2.60 2.10 2.82 2.21
0.01 0.04 0.01 0.03
Downloaded by [RMIT University Library] at 05:36 15 March 2016
Ear frequency (Hz)
A udiometry From pure-tone and high-frequency audiometry it was observed that the ADN group had worse average thresholds at all frequencies. This difference was significant for mean thresholds in both ears averaged over 250 to 8 000 Hz and for a number of individual frequencies. These are shown in Table I. The only significant difference found at high frequencies was at 16 kHz in the right ear (t=2.61, df=33, p
ISSN: 0105-0397 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/iaud20
Auditory and Psychological Factors in ‘Auditory Disability with Normal Hearing’ Katie King & Dafydd Stephens To cite this article: Katie King & Dafydd Stephens (1992) Auditory and Psychological Factors in ‘Auditory Disability with Normal Hearing’, Scandinavian Audiology, 21:2, 109-114, DOI: 10.3109/01050399209045990 To link to this article: http://dx.doi.org/10.3109/01050399209045990
Published online: 12 Oct 2009.
Submit your article to this journal
Article views: 47
View related articles
Citing articles: 11 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iaud20 Download by: [RMIT University Library]
Date: 15 March 2016, At: 05:36
Scand Audiol 1992: 21: 109-1 14
AUDITORY AND PSYCHOLOGICAL FACTORS IN ‘AUDITORY DISABILITY WITH NORMAL HEARING’ Katie King’ and Dafydd Stephens’ From the ‘Department of Psychology, University of Wales, College of Cardia C a r d 8 and t h e 2Welsh Hearing Institute, University Hospital of Wales, Card$ Wales
Downloaded by [RMIT University Library] at 05:36 15 March 2016
ABSTRACT Auditory and psychologicalfactors in ‘Auditory disability with normal hearing’. King, K. and Stephens, D. (Department of PsYchologY, University of Wales College of Cardiff, and Welsh Hearing Institute, University Hospital of Wales, Cardiff, Wales). ScandAudiol 1992; 21: 109-1 14. Patients who have ‘Auditory Disability with Normal Hearing’ (ADN) complain of hearing difficulties even although their hearing is audiometrically ‘normal’. The auditory and psychological factors involved in ADN have been investigated by comparing 20 Patients of employment age with 20 controls (matched for age, sex and socioeconomic group) on appropriate auditory tests and questionnaires. From the results it was concluded that both auditory and psychological factors are involved in ADN. The principal finding was that as a result of their problems with discriminating speech in noise, individuals with ADN have a tendency to anxiety, depression and loneliness. In addition the otological history of a n individual was found to be important in the developrnent of ADN. Finally, it was suggested that bad coping strategies may lead to increased anxiety in those with ADN.
Key words: auditory disability, normal hearing, coping strategies.
INTRODUCTION For some time it has been acknowledged that a certain proportion of patients who present to audiological and otological clinics with self-reported auditory difficulties nevertheless have clinically ‘normal’ hearing thresholds and no other obvious cause. The greatest difficulties experienced by these patients seem to lie in the area of comprehension of speech in a noisy environment. Stephens & Rendell (1988) adopted the term ‘auditory disability’ with normal hearing (ADN) as an all embracing term, rather than the term ‘obscure auditory dysfunction’ (OAD) used by Saunders & Haggard (1987, 1989). They did this because, on the basis Of earlier clinical experience, they did not want to preclude the possibility that, in certain cases, the disability might stem from psychological, linguis-
tic or other factors. Here the two terms will be used interchangeably. Both the study by Stephens & Rendell (1 988) and that by Saunders & ~~~~~~d ( 1 989) found that ADN was a multifactorial disorder. Rendell & Stephens (1988) found that the commonest findings were a mild cochlear dysfunction associated with psychological problems. Stressful factors such as important examinations, marital breakup and death of close relatives were associated with the develoDment of the reported disability, In addition, high Scores were obtained on the anxiety and hysteria subscales of the Crown Crisp Experiential Index (Crown & Crisp, 1979). Saunders & Haggard (1989) found that although patients and controls both had ‘normal’ hearing thresholds, the patient group did have significantly worse thresholds at certain frequencies, but suggested that these differences were unlikely to contribute very much to the determination of self-rated disability. NO difference was found in frequency resolution between the patient and control group, although this had been reported previously by Pick & Evans (1983) in ADN patients exposed to a significant amount of noise. Results of a sentence completion task studied by Saunders & Haggard (1989) indicated that the ADN group had a lower linguistic ability. There was also a higher incidence of current and past otological disorder amongst the patient group. The authors suggested that this probably contributed to increase the likelihood of seeking medical advice for a given level of current symptoms. In addition the results of the Crown Crisp Experiential Index indicated that those with ADN were more anxious than controls. They
-
’
Auditory disability is defined following the WHO definition (1980) as being the hearing difficulty experienced by the individual rather than a psychophysical measure. This is discussed at length by Stephens & Hetu (1991). Scand Audiol 21
110
K. King and D. Stephens
further noted that self-rated disability was significantly correlated with anxiety level among the patient group-but not among the controls. When otological history was taken as a co-variate, the group differences in anxiety were completely removed. They explained this by suggesting that anxiety adds to enhance a patient’s awareness of their hearing. Therefore, a history of otological disorder in conjunction with an anxious personality type may partly explain the presentation of these patients at the clinic. In the present study we have endeavoured to investigate these matters further and also to examine the strategies adopted by such individuals to reduce their disability and handicap.
Downloaded by [RMIT University Library] at 05:36 15 March 2016
MATERIALS AND METHODS Su bjecis
Twenty patients of employment age were compared with 20 controls (matched for age, sex and socio-economic group) on a number of appropriate measures. Twelve were matched on a paired basis, 8 as closely as possible. The ADN patients were selected from the total on file at the Welsh Hearing Institute. The controls were volunteers from other hospital departments. Approximately one-third were staff members solicited by notices placed in the hospital. Two-thirds were patients contacted in the general out-patient departments of the hospital, but excluding ENT patients. All subjects were selected on the basis of having audiometrically ‘normal’ hearing, defined as c 2 0 dB in both ears averaged over 250-800 Hz with no hearing at any frequency exceeding 30 dB HTL. All subjects were unsophisticated with respect t o psychoacoustical and personality tests. The mean age of the ADN patients was 30.3 years (S.D. 10.7) while the controls had a mean range of 27.9 (S.D. 9.1). Their ages ranged between 16 and 59 years. In the ADN patient group there were 7 males and 13 females, compared with 5 males and I 5 females in the control group. The distribution of socio-economic groups was comparable in the ADN patient and control groups. None of the differences between the two groups was significant at the 5 Yo probability level.
Audiometric investigations Pure-tone audiometry Absolute thresholds were determined for both ears at frequencies from 250 Hz to 8 kHz, using a calibrated Kamplex AC4 audiometer with TDH-39P headphones in a soundtreated chamber. High-J-equency audiometry Absolute thresholds were also determined at 10, 12, 14 and 16 kHz usinga Farnell sinekquare oscillator LEPl 10 Hz-1 MHZ in conjunction with a 32 mHz counter-time type 401T attached to a Kamplex AC4 audiometer. High-frequency headphones (Pioneer SE30D) wcrc used in a sound-attenuated booth. This was carried out to detect subclinical hearing loss in the patient group. Scand Audio1 21
Notched noise (Frequency Resolution) This test was used t o give a measure of frequency resolution which had been said to be related to speech discrimination (Moore, 1985). The difference between a pulsed 2 kHz sinusoidal tone in white noise at 85 dB SPL and the same pulsed tone in white noise with a notch around 2 kHz was measured using the audiometer, oscillator and counter-timer already mentioned, with standard headphones in a sound-attenuated chamber. A measure of the difference in thresholds between notch and no-notch noises gives a measure of frequency resolution.
Questionnaire Questionnaire one (Appendix 1 ) The questions comprising this questionnaire probed the otological history, the disabilities in hearing encountered by all subjects, the level of loneliness experienced (revised UCLA loneliness scale-Hayes & Dimatteo, 1987) and the types of coping strategy used. From the responses made to part b of questions 1 1 t o 17 and questions 18 and 19, the types of coping strategy used by each patient with ADN were determined (after Hetu et al. 1987).
Questionnaire two The Crown Crisp Experiential Index (Crown & Crisp, 1979) was used t o evaluate the emotional status of all subjects scores for free-floating anxiety, phobic anxiety, obsessionality, somatic anxiety, depression and hysteria.
Procedure Subjects were tested individually, the whole procedure taking about 40 min. All instructions were given by K. K. and queries addressed t o her. The auditory testing was carried out by an audiological technician. Relevant statistical analyses were carried out on the data, using t-tests, ,yz-tests, Mann Whitney’s U-test and Pearson’s correlation as appropriate.
RESULTS ADN status of the patient group
All patients met the definition of ADN. No subject included in the study had hearing worse than 20 dB in either ear, averaged over 250 to 8 000 Hz. Whereas all ADN patients reported having a hearing problem on questionnaire one, no controls indicated having any degree of hearing disability from part A of questions 11-1 7. The results indicated that the ADN group had the greatest degree of difficulty when trying to follow group conversation (Q12a) and in trying to understand what was being said in background noise (Q16a, Q17a). This supports both Saunders & Haggard (1989) and Stephens & Rendell’s (1988) work, which found the greatest disability to be comprehension of speech in a noisy environment.
Factors in ADN Table I. Frequencies showing significantly different thresholds between the ADN and Control Group X
X
ADN (dB HL)
Control (dB HL)
t
P
Worse 1 000 2 000 6 000 8 000
1.7 6.5 18.2 11.0
3.2 2.2 12.0 5.7
2.66 2.32 2.18 2.29
0.01 0.03 0.04 0.03
Better 1 000 2 000 3 000 6 000
4.0 3.5 8.5 18.0
0.7 0.0 2.7 12.5
2.60 2.10 2.82 2.21
0.01 0.04 0.01 0.03
Downloaded by [RMIT University Library] at 05:36 15 March 2016
Ear frequency (Hz)
A udiometry From pure-tone and high-frequency audiometry it was observed that the ADN group had worse average thresholds at all frequencies. This difference was significant for mean thresholds in both ears averaged over 250 to 8 000 Hz and for a number of individual frequencies. These are shown in Table I. The only significant difference found at high frequencies was at 16 kHz in the right ear (t=2.61, df=33, p
