Standardization of Audiological tests in NATASHA
Hans Verschuure
Audiological Center of Erasmus Medical Center Rotterdam
Dr. Molewaterplein 40
NL-3015 GD Rotterdam, the Netherlands
Tel: +31 10 463 4586
fax: +31 10 463 3102
e-mail: verschuure@kno.fgg.eur.nl
1. Summary
In the field of Audiology there is a strong need to develop new tests in order to make full benefit of new possibilities of new and digital hearing aids. These tests involve speech tests. It would be a waste of resources to do so separately for each country or language area. Furthermore there is a need for standardization of all available tests with the increasing exchange of people over national boundaries. NATASHA aims at standardizing tests and testing procedure. They can be developed in countries with more available resources (scientific, financial). If the design of the tests and the characteristics of the recordings are explicitly stated, the tests can be translated into other languages without great effort due to the availability of good phonetic and language descriptors from earlier European research. The program aims at analyzing existing audiological tests for design and content, describing explicitly the goal of a test and linking the goal to its functional use in modern Audiology. The inventory will be made extensively in France, Germany, the Netherlands, the United Kingdom and Sweden and in as many other languages as there are institutions that will cooperate. The requirements and the available tests and procedures will then be translated in a specification for the design of international or multi-language tests.
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2. Introduction
There are very few tests in Audiology that are the same in the various countries. This has to do for tonal tests of auditory functioning with differences in view of what is to be tested and for speech tests with different languages and differences between languages and with the established tradition in the countries. On the other hand we see that there are a number of test that are similar over the borders and speech tests that are similar in the various languages but there always seems to be a difference in content and aim.
New and powerful hearing aids are being marketed and will certainly be further marketed in the near future. These hearing aids are complex in their handling and require complex fitting procedures. These procedures should at least partly be based on speech test. Now we can either develop these procedures separately for each country using available material (not available in every country in Europe) or develop more consistent testing procedures and material to use in a general and internationally verified fitting strategy.
With an opening European market people move from country to country. Audiological testing is, however, strongly based on traditionally developed tests which are different for the various countries; sometimes the tests seem similar but are different in goal and design, sometimes the tests seem very different but result in similar outcomes. In order to improve the exchangeability of the data we need standardization of tests and procedures. Only with standardization the interpretation of test results can be done across borders. This will promote to mobility of people with hearing impairments who make up about 10% of the population.
NATASHA aims at making an inventory of tests used in the various countries both for research and for use in clinics, analyzing these tests for aim, design and content and establishing a consensus on what is useful and what will be useful given future trends. A functional specification should be made of tests to be used all over Europe.
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3. Method
Five European countries participate directly in the project. In these countries cooperation is established with a leading clinic and a leading research institution in the field of Audiology and phonetics. These institutions will start the inventory in their particular country, discuss the tests in the country and come up with proposals for future tests and procedures, all with explicitly stated aims, design and content. Differences between countries will be discussed at meetings of the consortium.
Through the European Federation of Audiology Societies (EFAS) other countries will be approached to participate in this accompanying measure program. EFAS has now over 30 member societies all over Europe. We hope to include in this way all EU member states, the majority of the EFTA states and a significant number of the eastern European states.
The participating countries are France, Germany, the Netherlands, United Kingdom and Sweden. They represent four languages from the same group of Germanic languages; this should enable us to show that we can cover various languages within a language group. French is representing another language group, the Roman languages; this should enable us to show that also differences over group boundaries can be dealt with.
The process of standardization will be a three-stage set-up.
- We start with an inventory of available tests in the countries. The tests will be analyzed and goal, design and content will be made explicit. This will involve both tonal and speech tests. A comparison will be made of what is available in the different countries and how these relate on goal, design and content. The results will be discussed at the first meeting on standardization to be held about six months after the signing of the contract which most probably will take place in May or June 1998. After the meeting the presented papers and the consensus on tests and procedures will be published in printed form and on the Internet.
- The next stage will be a further inventory of tests that are considered desirable or required for certain tasks and goals in audiology. This inventory will be partly based on the earlier inventory but will be wider in concept or goals and may cover far more patient groups. There should be a good description of goals and design with attention to internationalization or construction in other languages. This inventory goes beyond existing tests and procedures and will involve expectation on future trends in audiology. A discussion of these recommendations for design of new tests shall be discussed extensively, first between the leading clinics and leading institutions, next in meetings of the scientific societies in the various countries. The participating partners should be the presenters of these proposals in those meetings and there should be a back up of these presentations by the audiological societies. It will result in detailed functional specifications of the tests and procedures, making explicit what the goal of the test is, how it should be used, how it can be designed and what the content should be. These specifications will involve both threshold and supra-threshold tests to measure the functionality of the auditory system (impairment) for (near-) normal hearing and cochlear implant patients and all groups in between. It will also involve speech tests and inquiry forms for the measurement of the disability and handicap. The goal, design and content of these tests, procedures and forms shall be formulated explicitly and the specifications will contain procedures for the translation from one language into another using available information from other European studies on the differences between the languages. The inventory and formulations will be presented at the second meeting of the consortium and participants from other countries after consultation with the national societies of audiology. A consensus should be reached. The proposals, the discussion of these proposals and the consensus will be published again in hard copy and on the Internet.
- Further discussion of the consensus proposals in meetings of national societies of Audiology and within the EFAS will take place. An inventory of the available tests and procedures will be done related to the consensus on the functional specifications drafted at the second meeting. All available tests in the participating countries will be screened and useful testing material will be collected. The inventory will further describe the specifications of the material as it should be recorded or programmed. Furthermore the implementation strategy, both for the recording and design of the tests and procedures and for the implementation of the tests and procedures for research and in the clinic will be specified. The proposals will be drafted again, discussed at a consensus meeting and a consensus should be reached. The proposals, the discussion of the proposals and the consensus will be published, again in hard copy and on the Internet.
The publications will be freely available to all and should stimulate discussions in the national societies of Audiology and in EFAS. Discussion groups on the Internet can be formed. It should stimulate a detailed discussion in research institutions, in clinics and in companies (hearing-aid manufacturers and manufacturers of audiological equipment) that could develop new tests or develop procedures for the fitting of new hearing aids. It should in itself be instrumental to start standardization of new tests and perhaps to adaptation of existing tests. It should also stimulate the drafting of proposals for implementation of these tests all over Europe. It can be used in nations without a tradition in Audiology to develop up-to-date tests and testing procedures.
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Resulting publications
Every meeting of the discussants of this accompanying measure program will result in draft proposals, a discussion paper of these draft proposals and a consensus. The publications will be distributed as freely as possible in as many countries as show an interest. This can be realized by a couple of measures:
- All publications will be available on the internet
- There will be discussion groups of the proposals
- The participants will stimulate discussion of inventories, drafts and consensus proposals in their countries and in other countries where they can do so.
- The participants and EFAS will approach national societies of audiology in order to start a formal discussion of standardization procedures in all countries. This may involve the setting up of standardization committees in which the participants in the consortium meetings play a major role.
- EFAS will endorse the standardization proposals within their own committees and will approach all national societies with a firm recommendation to follow the developed guidelines and functional specifications.
- EFAS will give full support to all initiatives to use the functional specifications and to translate these specifications into real tests and testing procedures.
The publications should be seen as a starting point for further developments with clearly described functional specifications of tests and procedures. The end of the accompanying measure should be the starting point of further initiatives to implement the results of this program.
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Conclusion
NATASHA is an accompanying measure aiming at the standardization of tests and procedures in audiology. The major points are the standardization of existing tests and the drafting of functional specifications for future tests. The tests should be specified on goal, design and content and speech tests should be designed in such a way that tests in the different countries should give similar information interpretable by users over language borders.
The results of NATASHA should be used for developing standardized fitting procedures for new and existing hearing aids. The procedures should be internationalized excluding the need of validation procedures for each and every country. Furthermore it will enable the definition of standardized benefit measures of hearing aids. This should enable decision-makers to judge the additional value of newly developed hearing aids.
The results of NATASHA should also make it possible to design new measures of hearing disability and handicap based on these standardized testing procedures. This will also enable standardized social legislation in the member countries.
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