The human auditory system is a sound information processing system. For examination of patients with hearing loss, analytic evaluation of each part of the auditory system and an integrated understanding of the influence of possible pathologies of each component on the entire auditory system are important. This paper outlines the underlying mechanisms of hearing impairment associated with representative pathologies of the auditory system. Threshold elevation accompanying the recruitment phenomenon (i.e., classical “inner ear disorder”) results from outer hair cell damage. Both auditory neuropathy (AN) and hidden hearing loss (HHL) are caused by synaptic pathology between the inner hair cells and cochlear nerve endings. However, the pathologies of AN and HHL differ: while dys-synchrony of cochlear nerve spike information (qualitative disorder) appears to the main pathology in AN, that in HLL is a quantitative reduction of neurons with a high threshold. Functional impairment of the auditory scene analysis mechanism is a possible causal factor of auditory processing disorders.

Objective: To examine the feasibility of fitting hearing aids and their effects in elderly persons with hearing loss requiring nursing care.

Subjects: Twenty-four persons admitted to a single long-term care facility (mean± standard deviation: age, 84± 8 years; hearing threshold, 47± 13 dB; Mini Mental State Examination (MMSE) score, 16± 8).

Methods: The total trial period was 4 months. Speech-language-hearing therapists of Kitasato University Hospital conducted the hearing-aid fitting and carried out the following, with the aid of speech-language-hearing therapists of the facility helping the subjects wear the hearing aids everyday, changing the batteries every week, and writing observation records.

Results: There was no case of loss or need for repair of the hearing aids. The subjects were divided into 3 groups according to their pattern of use of the hearing aids: “the consistently wearing group” (n=5; wore the hearing aid all day for over 80% of days during the trial period), “the rejecting group” (n=5; rejected using hearing aids), and “the intermediate group” (n=14; others). Excluding the “rejecting group” there was a significant correlation between a percentage of whole day wearing days and MMSE score. Significantly more waking hours during the day time were observed in the “consistently wearing group” compared to in the “intermediate group”.

Conclusion: Cognitive function and length of waking hours seemed to influence the wearing time. Encouraging care staff to provide support to patients for wearing hearing aids does not seem easy, although it is necessary.

Purpose: To identify factors in fluencing the use of hearing aids (HAs) in elderly persons requiring nursing care.

Subjects: The subjects were 14 elderly persons admitted to a long-term care facility who showed various patterns of use of the HAs during the trial period of 4 months (median age, 81.5 years ; hearing threshold, 47dB; MMSE score, 14).

Methods: The total trial period of four months was divided into four time periods of one month each. Then, the percentage of days per month on which the subjects wore HAs the entire day was calculated for each month.

Results: The subjects were classified into the following 4 groups, depending on their pattern of use of the HAs: “elongating group” (n=5), “fluctuation group” (n=3), “stagnation group” (n=3), and “interrupted group” (n=3). The “elongating group” underwent three phases. In the first phase, they did not understand what HAs were and reject using them. In the second phase, they did not reject wearing them but often took them off, and in the third phase, they noticed effects of wearing HAs on hearing and wore them the whole day.

Discussion: Decline in physical health, progression of behavioral and psychological symptoms of dementia and symptoms of higher brain dysfunction seemed to interfere with the wearing of HAs. Regularly scheduled daily intervention and provision of continued support for the use of HAs seemed to be useful for encouraging elderly persons, even with dementia, to recognize the usefulness of HAs.

　 While TRT (Tinnitus Retraining Therapy) is the first line of treatment for tinnitus, it is often difficult to conduct sound therapy for patients with hyperacusis. At our department, patients are assessed by both the HQ (Hyperacusis Questionnaire), which is used to assess the severity of auditory hyperacusis, and UCL (Uncomfortable level) measurement before the start of treatment, to evaluate the possible presence of hyperacusis associated with tinnitus. In the present paper, the relationships among the HQ score, UCL and scores on the conventional questionnaires administered to tinnitus patients (THI: Tinnitus Handicap Inventory, HADS: Hospital Anxiety Depression Scale) were retrospectively examined in 131 patients who visited our department from January 2015 to December 2016. There were strongly positive correlations among the THI, HQ and HADS A scores (HQ vs. HADS (A score), r=0.626, p<0.05; THI vs. HQ, r=0.649, p<0.05; HADS (A score) vs. HQ, r=0.506, p<0.05), and a somewhat weaker positive correlation between the HQ and HADS D scores (r=0.322, p<0.05). However, there were no significant correlations among THI and HQ scores, and the UCL. The present results seem to indicate that it would be difficult to use UCL to estimate the subjective severity of tinnitus and/or auditory hyperacusis, and also suggest the possible existence of a correlation between the development of tinnitus and hyperacusis.

　We investigated the differences in sentence recognition during natural fast speech among subjects with cochlear implants (CIs), users of hearing aids (HAs) and subjects with normal hearing (NH). Additionally, we tested the effect of context on the hearing performance at various speeds of speech.

　Our subjects comprised 15 subjects with CIs and 16 users of HAS, with 10 subjects with NH serving as controls. For the experimental stimuli, the sentence test materials were natural fast speech at the normal speed, and 1.5 times and 2 times the normal speed. Two different types of speech materials were tested, contextual and non-contextual.

　The results revealed that contextual and non-contextual speech perception scores decreased as the rate of speech increased in the subjects with CIs and users of HAs. Furthermore, the subjects with CIs and users of HAs showed impaired non-contextual speech perception scores as compared to the contextual speech perception scores in response to speech at the normal speed and at 1.5 times the normal speed. On the other hand, we did not recognize any difference between the contextual and non-contextual speech perception scores during speech at 2 times the normal speed.

　The results suggested that the predictive capability for sentence meaning exerted a significant influence on the understanding of speech at the normal speed and at 1.5 times the normal speed, whereas in very fast speech, such as 2 times faster than the normal speed, there was no effect of the predictive capability for sentence meanings.

　Many patients consult health care providers to improve the effectiveness of unsatisfactory hearing aids purchased elsewhere. We conducted this study to elucidate the clinical features of these patients and identify management approaches. Of 233 patients who visited our institution from 2010 to 2016 with complaints about the effectiveness of their hearing aids, 232 (99.6%) had ill-fitting devices. The causes for a poor fit included incorrect device selection in 129 cases (55%), inappropriate adjustment in 85 (37%), and malfunction in 18 (8%) cases. We resolved the problem in 204 (88%) of these cases by changing the hearing aid to a more appropriate model, adjusting or repairing the device, or taking other measures. In 28 cases, the patients chose to continue using their ill-fitting hearing aids. We found from this study that refitting of hearing aids purchased elsewhere requires resources, such as testing equipment, fitting software, and speech-language-hearing therapists.

　“UD talk” is a software program aimed at supporting communication between people with and without hearing disability, using automatic speech recognition. However, its speech recognition accuracy is still not perfect. We performed a Japanese hearing test battery for cochlear implant recipients (CI2004 test) using the “UD talk” software program. The “UD talk” word recognition scores in quiet and noisy environments were 76% and 38.5%, respectively, and the sentence recognition scores in quiet and noisy environments were 97.3% and 75.6%, respectively. These scores corresponded to those of adult unilateral cochlear implant recipients with relatively high performance in Japan. Our results suggest that “UD talk” can be used to objectively evaluate the hearing-friendliness of a given environment for hearing-impaired people.

　The LENA (Language ENvironment Analysis) system measures the quantity of spoken language in a child's environment by means of a small wearable digital recorder and processing software. The purpose of the present study was to evaluate the performance of the LENA system for the Japanese language environment. Our study focused on three groups of participants: (1) 5 children with normal hearing (1 male and 4 females, 10-40 months old); (2) 2 children with congenital profound hearing loss who had undergone cochlear implantation (CI) (2 males, CI at 2 years 9 months old and 3 years 4 months old); (3) elderly adults with hearing impairment (3 males, 4 females; 75-88 years old). Recording and analysis using the LENA system was possible for all participants. The auditory environment of the children with normal hearing children and those with hearing loss were similar, while TV time was much longer in elderly adults with hearing loss as compared to either group of children. The quantities of spoken language, such as adult word counts, child vocalizations and conversational turns in the Japanese environment could also be evaluated. Further investigation of the normal Japanese environment versus the English environment using the LENA system is necessary.