The AMA Method of Estimation of Hearing Disability: A Validation Study
The AMA Method of Estimation of Hearing Disability: A Validation Study
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DOI：
10.1097/aud.0b013e31822228be
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发表时间：
2011-11-01
期刊：
影响因子：
3.7
通讯作者：
Dobie, Robert A.
中科院分区：
文献类型：
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作者：
Dobie, Robert A.
目的：检验1979年美国医学会听力障碍评估方法的假设。设计：对5个地区听力学中心的1,001名患者进行常规测听测试和听力障碍者通讯模式测试。根据听障人士沟通能力量表计算的沟通能力(CP)分数是自我评估听力障碍的金标准。结果：几种不同的耳部纯音平均(PTA)与自评CP有较好的相关性，没有一个优于目前AMA方法中使用的0.5、1、2和3 kHz纯音平均(PTA)。从3：1到9：1的好耳朵到坏耳朵的重量表现相似，但没有一个比AMA好耳朵重量5：1更好。AMA方法假设残疾在25dBHL以下，残疾在这个“低栅栏”以上呈线性增长；这项研究显示，PTA和自我评估听力残疾之间存在类似的关系。有严重和严重的语音频率损失的受试者太少，不能验证AMA的92dBHL的“高围栏”。结合纯音听阈值和WRSS，对听力障碍的预测改善很小。结论：本研究支持继续使用1979年的AMA方法。不支持将通常在临床上测量的WRSS合并到评估听力障碍的方法中，因为在准确性方面的改进微乎其微，并且无法控制医疗法律环境中的语音测试的夸张。
Objective: To test the assumptions of the 1979 American Medical Association (AMA) method for estimation of hearing disability.Design: One thousand and one patients attending five regional audiology centers competed conventional audiometric testing and the Communication Profile for the Hearing Impaired. A Communication Performance (CP) score calculated from scales of the Communication Profile for the Hearing Impaired served as the gold standard for self-assessed hearing disability. Pure-tone thresholds and word recognition scores (WRSs), and combinations thereof, were compared with the CP scores using correlation and multiple regression analysis.Results: Several different better-ear pure-tone averages (PTAs) correlated reasonably well with self-assessed CP; none were significantly better than the 0.5, 1, 2, and 3 kHz PTA used in the current AMA method. Better-ear to worse-ear weights ranging from 3: 1 to 9: 1 performed similarly, but none were better than the AMA better-ear weight of 5:1. The AMA method assumes no disability below 25 dB HL and linear growth of disability above this "low fence"; this study showed a similar relationship between PTA and self-assessed hearing disability. There were too few subjects with severe and profound speech-frequency losses to permit validation of the AMA "high fence" of 92 dB HL. Combining pure-tone thresholds and WRSs improved prediction of hearing disability only very slightly.Conclusions: This study supports the continued use of the 1979 AMA method. Incorporation of WRSs, as typically measured clinically, into methods of estimating hearing disability is not supported because of negligible improvement in accuracy and inability to control exaggeration for speech tests in medical-legal settings.