The Appliced Research On WHO And ANSI Grading Standard In The Audiometric Test For The Deat And The Speech Intelligibility Tests For The Aided

ObjectivesTo analyze the clinical hearing data of the severe to profound sensorineural hearing loss patients with the methods of WHO and ANSI grading standard; in the meantime, to study the relationship between the grading standard and the evaluation of the speech ability after hearing aids from the perspective of Audiology. Discusses Of WHO and ANSI grading standards audiological classification differences, and the ability to understand speech after hearing aids pure tone audiometry with deaf children the link between the severity.Methods1. Information:Target at 17 sensorineural hearing loss candidates from Phonak(Macau) Hearing and Speech Center by the time of Nov,1986 to Jul,2010, among which 11 are males and 6 are females, with the wear ages around 15 to 44 months (the average age is among 33 months), now aged 9 to 26 years (the average age is among 17.18 years), the assessment level for all the patients are based on the WHO 1997 and ANSI 1996 Recommendatory Gradation Standard for the Hearing Impaired.1.1 Inclusive criterion:1.Binaural sensorineural hearing loss 2.Average threshold on severe or above level (61dB HL) 3.Prelinguistic deafness 4. Long-term experience of wearing hearing aids (3 years, the daily wear of not less than 8 hours) 5. Type A Tympanogram (Exclusion of the Middle Ear problems) 6.Communication skills to certain degree (simple statement can be used with normal conversation face to face) 7. Attend the same Speech Training with hearing aids at their early stage 8. Good results for the ear check (Including Auricle, External Auditory Meatus and Tympanic Membrane) 9.Body in good condition.1.2Exclusive criterion:The patients of conductive hearing loss, Acute and Chronic Otitis Media, Tympanic Membrane Perforation, Tympanic Sclerosis and Otosclerosis.Methods:2.1 Methods for inspectionAll cases regularly check the pure tone audiometry, All the cases are being conducted how Behavioral audiometry with the Pure-tone Threshold Test by the professionals at the standard soundproof chambers and the test is operated under the direction of the ASHA ascending -descending method. The test covers the patients' binaural Air-conduction Threshold with the corrective masking and the binaural Acoustic Admittance. American GSI 61 Clinical Audiometer and GSI TympStar Acoustic Admittance Middle Ear Analyzer are the test equipments in used. With the Acoustic Standard-zero Type one Audiometer for the Pure-tone Air-bone Conduction Audiometry calibrated by the ISO international standard, the candidates are under the tests of binaural Air-conduction Threshold in the standard soundproof chambers, with the frequency for Air-conduction Test and Bone-conduction Test at 250～8 KHz octave and 250 to 4KHZ respectively; binaural Acoustic Admittance is measured by the Tymp Diagnostic Middle Ear Analyzer with the frequency of 226 Hz.2.2 soundproof room standardRoom sound insulation standards in accordance with ANSI 3.6:1989 (R-1996); ISO 389-3 1994 standard. Permissible ambient noise level of (DHSS design criteria in accordance with the provisions of the average ambient noise level:<35dBA). Test range 63Hz,125Hz,250Hz,500Hz,10000Hz,2000Hz,4000Hz,8000 Hz, once the amount of measured noise levels derived from 63Hz measured 28.4dB,125Hz measured 24.7dB,250Hz measured 18.6dB,500Hz measured 11.5dB,1000Hz measured 12.2dB,2000Hz measured 16.0dB,4000Hz measured 14.3dB,8000Hz measured 13.2dB; measured level for the 34.5Dba, is in compliance with international standards.2.3 Test instrument calibrationTest equipment calibration:GSI61 clinical audiometer according to ANSI 3.6:1989 (R-1996); ISO 389-3 1994; ANSI3.43:IEC303; IEC318 standards. Annual calibration of instruments, calibration range 125Hz,250Hz,500Hz,1 OOOHz, 2000Hz,4000Hz,8000Hz,12000Hz, speech Hz, the actual output after calibration 125Hz left ear earpiece is 116.6dB SPL,250Hz is 97dB SPL,500Hz is 83.6dB SPL,750Hz is 78.2dB SPL,1000Hz is 77.6dB SPL,1500Hz is 77.2dB SPL, 2000Hz is 81.1dB SPL,3000Hz is 79.9dB SPL,4000Hz is 81.2dB SPL,6000Hz is 83.5dB SPL,8000Hz is 79.9dB SPL,12000Hz Is 80.9dB SPL, speech Hz is 90.9dB SPL, the actual output after calibration 125Hz right ear earpiece is 117.0dB SPL,250Hz is 96.5dB SPL,500Hz is 84.4dB SPL,750Hz is 78.9dB SPL, 1000Hz is 77.7dB SPL,1500Hz Is 77.3dB SPL,2000Hz is 81.0dB SPL,3000Hz is 80.0dB SPL,4000Hz is 81.1dB SPL,6000Hz is 83.1dB SPL,8000Hz is 80.2dB SPL,12000Hz is 80.2dB SPL, speech Hz is 90.8dB SPL, tolerance 125Hz is±5dB SPL,250Hz is±3dB SPL,500Hz is±3dB SPL,750Hz is±3dB SPL, 1000Hz is±3dB SPL,1500Hz is±3dB SPL,2000Hz is±3dB SPL,3000Hz is±3dB SPL,4000Hz is±3dB SPL,6000Hz is±5dB SPL,8000Hz is±5dB SPL, 12000Hz is±5dB SPL, speech Hz is±5dB SPL. Middle ear analyzer in accordance with ANSI S3.6:1987 Type 3; IEC 1027-1991 Type 3; ISO 8797 standard, calibrated test tone probe 226Hz±3%,678Hz±3%,1000Hz±3%, Multi Hz±3% are adjusted to 85±2dB SPL; calibrated nominal 0±10da pa,100±10da pa, 200±10da pa,300±10da pa,400±10da pa,500±10da pa,600±10da pa.2.4 Hearing data collectedThe pure-tone hearing data of all the patients are collected during their medical treatment in the hospital, including the Air-conduction Test range of 250Hz, 500Hz, 1000Hz,2000Hz,4000Hz,8000Hz and the Bone-conduction Test at the frequency of 250Hz,500Hz, 1000Hz,2000Hz and 4000 Hz; limitation for the air conduction 250Hz is 105dB,500Hz air conduction limit 120 dB, 1000Hz air conduction limit 120dB,2000Hz air conduction limit 120dB,4000Hz air conduction limit 120dB,8000Hz air conduction limit 105dB, the data beyond the limitation and by the absence of determination is positioned as missing values; 250Hz,500 Hz is considered as low frequency,500Hz, 1000Hz,2000 Hz as speech frequency and 4000Hz,8000 Hzas high frequency.2.5 Speech Intelligibility Tests data collectedSpeech Audiometry is conducted by the standard sound field and soundproof chambers according to the GB/T 16538-2008 acoustic measurement. With the Closed-set Test, the speech ability of the patients is measured by a quiet environment, which is 2.27m far from the testers, using 60 dBSPL real-men Cantonese Pronunciation and the tests of sentence comprehension, phonemic awareness and word cognition that derive from the Hearing Screening Reports in Phonak (Macau) Hearing and Speech Center (This test has been employed in Hong Kong and Macau for more than 20 years, The tests mentioned above have included Ling's 6 Phonemes, ANSI and other international testing standards). The final results are concluded with the reference to the maximum speech recognition of the "Action for Hearing Reconstruction and Rehabilitation" that <=70% of the operational subscale.2.6 Audiology GradeAccording to the WHO 1997 Recommendatory Gradation Standard for theHearing Impaired, the gradation standard is based on the Pure-Tone Average at the frequency of 500,1000,2000 and 4000 Hz of the normal ear with 26～40 dB HL as mild hearing loss,41～60 dB HL as moderate hearing loss,61～80 dB HL as severe hearing loss and>81 dB HL as profound hearing loss. In other words, there are 5 people as sever hearing loss and the other 12 as profound hearing loss among the 17candidates; while for the ANSI 1996 Recommendatory Gradation Standard for the Hearing Impaired, the gradation standard is also based on the Pure-Tone Average at the frequency of 500,1000,2000 and 4000 Hz of the normal ear, but for 26～40 dB HL as mild hearing loss,41～55 dB HL as moderate hearing loss,56～70 dB HL as moderately severe hearing loss,71～90dB HL as severe hearing loss and>91 dB HL as profound hearing loss. Thus, there are 2 people as moderately severe hearing loss,8 people as sever hearing loss and the other 7 as profound hearing loss among the 17 candidates.2.7 Statistical analysisAll data are used for statistical software SPSS13.0 on WHO and ANSI grading standards the both relevance of the results, WHO grading standards and wear hearing aids speech understanding the relevance of the test results, ANSI grading standards and wear hearing aids Speech understanding the relevance of test results by matching tables from the kappa analysis was used for statistical analysis.Results:The comparisons of the final results with the analyzing of the related information:1. According to the results of pure tone audiometry were graded by WHO and the ANSI standards for both deaf children of hearing all the severity of the classification: the classification criteria used to evaluate the WHO,17 cases of severe in 6 cases,11 cases were extremely Severe. With the ANSI standard to evaluate the classification, 17 cases in 11 patients with severe,6 cases of very severe.Using statistical techniques, WHO grading standards grading standards, and ANSI, consistency is poor, so the use of the same patient more than 2 kinds of methods to assess, large errors may occur.2. According to the results of pure tone audiometry were graded by WHO and the ANSI standards for both the frequencies used, and then dividing by 81 dB:the WHO classification criteria evaluation:17 cases,5 cases <81dB HL,12 cases≥81dB HL. Grading standards to ANSI assessment:17 cases,7 cases<81dB HL,10 cases≥81dB HL.3. Speech Intelligibility Tests:17 cases of verbal comprehension in 10 cases≤70%,7 cases> 70%.4. WHO grading standards and wearing hearing aids for deaf children do not necessarily reflect the level of language comprehension.5. ANSI grading standards and wearing hearing aids and speech comprehension after test results. Using statistical techniques, indicating the severity of ANSI classification hearing wear hearing aids and speech comprehension are in good agreement. Simply using ANSI grading standards are good predictors of speech after hearing aids comprehension conclusion.6. WHO grading standards between the 81～90dBHL 5 deaf children, including 3 cases wearing hearing aids speech comprehension> 70%,2 cases <70%. ANSI grading standards between the 81～90dBHL 4 cases deaf children, language comprehension 3 cases> 70%,1 cases<70%. Severe hearing loss that this part of the (81～90dBHL) of cases, even after wearing the device may help to achieve good speech comprehension.Conclusion:ANSI and WHO grading standards applied to both audiological this more than 17 cases of deaf children with severe hearing severity classification, the comparative analysis suggests a strong practical ANSI grading standards, may be deaf children wearing hearing aids speech comprehension Has a certain predictability.