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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 30  |  Issue : 2  |  Page : 40-46

Turkish translation, reliability and validity of the amsterdam inventory for auditory disability and handicap


1 Department of Audiology, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
2 Gazi Physics and Therapy Education and Research Hospital, Ankara, Turkey
3 Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
4 Department of Biostatistics, Ankara University, Ankara, Turkey

Date of Web Publication27-Jun-2017

Correspondence Address:
Banu Mujdeci
Ankara Yıldırım Beyazıt University, Faculty of Health Sciences, Department of Audiology, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisha.JISHA_1_17

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  Abstract 

Introduction: We aimed to compose a Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (T-AIADH) and investigate validity and reliability of T-AIADH. Methods: A total of 240 individuals were included in the study. They were divided into two groups. Individuals with hearing disability constituted the study group (n = 120), and 120 normal-hearing individuals constituted the control group. Results: The reliability analysis of 30 items in all study population yielded a Cronbach's alpha coefficient of 0.98. All Cronbach's alpha coefficients obtained in 5 domains of T-AIADH were above 0.90. For 5-domain scores, intraclass correlation coefficients demonstrated very good test–retest reliability. There were statistically significant differences between the study and control groups in terms of the mean scores of each of the 30 items in the questionnaire (P < 0.01). The mean scores of each of the five domains of T-AIADH were statistically significantly different between the study and control groups (P < 0.01). Criterion analysis showed positive correlations between the domain scores and the average of hearing thresholds (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz) in the study group (P < 0.01). Conclusion: The T-AIADH has a high internal consistency and test–retest reliability. T-AIADH can differentiate the individuals with hearing loss from the individuals with normal hearing. T-AIADH is composed of easily understandable questions, and it may be used to analyze hearing disability for screening purposes or as an adjunctive test to audiological tests in Turkish-speaking patients.

Keywords: Auditory, disability, hearing loss, questionnaire, translation


How to cite this article:
Mujdeci B, Inal O, Turkyilmaz M D, Kose K. Turkish translation, reliability and validity of the amsterdam inventory for auditory disability and handicap. J Indian Speech Language Hearing Assoc 2016;30:40-6

How to cite this URL:
Mujdeci B, Inal O, Turkyilmaz M D, Kose K. Turkish translation, reliability and validity of the amsterdam inventory for auditory disability and handicap. J Indian Speech Language Hearing Assoc [serial online] 2016 [cited 2017 Dec 16];30:40-6. Available from: http://www.jisha.org/text.asp?2016/30/2/40/209011


  Introduction Top


Hearing loss affects communication.[1],[2] In individuals with hearing loss, recognition of words and sentences, localization of sounds, and hearing speech in noise may be negatively affected.[3] The negative effects of hearing loss are not only limited to disturbed communication but also can include social and emotional problems.[1],[2] Hearing loss causes negative psychosocial effects, social isolation, and an increased need for medical care. Independence levels of the individuals decrease due to hearing loss.[4],[5] Measuring hearing threshold is important in determining the disability due to hearing impairment.

Audiometric tests could be considered the gold standard for estimating hearing loss, but these tests have some limitations.[6] Hearing tests used to determine the presence of hearing loss [7],[8],[9] are expensive,[10] and they require special equipment and audiologists.[6],[11],[12],[13] Further, these tests are performed in structured clinical settings. Therefore, listening performance of the patients in daily life cannot be assessed, and information on hearing disability cannot be obtained. Hearing tests are insufficient to analyze the negative functional effects of hearing loss.[11],[12],[13],[14] Self-reported surveys have been effectively used to analyze hearing disability of the patients.[15],[16]

Word and sentence recognition, localization of the sound, and understanding speech in noisy environments are affected negatively in patients with hearing loss.[3] The grades of hearing impairments classified into five categories in terms of unaided hearing threshold level (average for frequencies 0.5, 1, 2, and 4 kHz) for the better ear by the World Health Organization (WHO): 26 dB HL or less (no impairment), 26–40 dB HL (slight impairment), 41–60 dB HL (moderate impairment), 61–80 dB HL (severe impairment), and 81 dB HL or greater (profound impairment).[17] The WHO defined auditory disability as the consequences of hearing impairment.[18]

The prevalence of hearing disability is 0.37% in Turkey,[19] and the number of valid and reliable self-reported surveys that assess hearing functions is insufficient. Several questionnaire instruments for assessing hearing disability and handicap have been developed in the world. Among these instruments are the Hearing Handicap Inventory for Adults (Newman et al., 1991),[20] the Hearing Disability and Handicap Scale,[21] the Spatial Hearing Questionnaire.[22] and the Amsterdam Inventory for Auditory Disability and Handicap (AIADH).[16] We have chosen AIADH survey due to the following causes: first, AIADH developed by Kramer et al. identified five domains within the questionnaire, namely, distinction of sounds, localization of sounds, speech intelligibility in quiet, speech intelligibility in noise, and detection of sounds. In the International Classification of Functioning, Disability and Health, the WHO defined five hearing functions for the auditory system. These auditory functions are thought to be important in assessing the functional outcome of hearing loss. These are sound detection, sound discrimination, sound localization, sound lateralization, and speech discrimination.[18] Second, the questions are easily understandable, and they have been made more understandable since each question is accompanied by a picture representing the situation being addressed. Therefore, in this study, we aimed to translate AIADH into Turkish and investigate validity and reliability of Turkish AIADH (T-AIADH).


  Methods Top


Amsterdam Inventory for Auditory Disability and Handicap

This inventory contains 30 items to assess hearing disability and five domains includes distinction of sounds (items 4, 5, 6, 17, 23, 24, 26, and 29), localization of sounds (items 3, 9, 15, 21, and 27), speech intelligibility in quiet (items 8, 11, 12, 14, and 20), speech intelligibility in noise (items 1, 7, 13, 19, and 25), and detection of sounds (items 2, 10, 16, 22, and 28). Items 18 and 30 have been excluded in the original version.

There are four answers for each question: almost never (3 points), occasionally (2 points), frequently (1 point), and almost always (0 point). The items 18 and 30 are on music, and those are reversely scored. The total score is obtained by summing the scores of all questions range from 0 to 90. The higher the score, the higher is the hearing problem.

Turkish translation of the inventory

Participants

The questionnaires (English version of AIADH) were given to three bilingual (speaking Turkish and English) individuals who were native speakers of Turkish. These individuals translated the original version of 30-item AIADH into Turkish. The inventory translated into Turkish was back-translated into English by three different bilingual (speaking Turkish and English) individuals. This translation was compared with the original version in English. The original pictures were added to the final version of the inventory. [Figure 1] shows one item of the inventory. Ten university graduates with normal hearing were asked to answer the questions. Here, we aimed to analyze understandability of the questions. The university graduates consisted of four females and six males, aged between 24 and 45 years. The questions were not changed in this step since there were no problems with their understandability. The original questions in English and their translation into Turkish are shown in Appendix 1 [Additional file 1].
Figure 1: One item of the Turkish version of the Amsterdam Inventory for Auditory Disability and Handicap

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A total of 240 individuals (aged 19 years and older) were included in the study. Exclusion criteria were history of major psychiatric illness and neurological disorder. They were divided into two groups. The individuals with hearing disability constituted the study group (n = 120; 66 women and 54 men), and normal hearing individuals (n = 120; 59 women and 61 men) constituted the control group. The mean age of the individuals with hearing disability was 40.54 (standard deviation = 11.80, minimum = 19, maximum = 66) years, and the mean age of the individuals with normal hearing was 38.67 (standard deviation = 11.31, minimum = 19, maximum = 61) years. There was no significant difference in age between the study and control groups (P > 0.05). No statistically significant differences were found between the study and control groups with respect to gender and educational status (P > 0.05).

All participants underwent pure tone audiometry and speech audiometry using AC 40 (Interacoustics, Assens, Denmark) and immittance evaluation using AZ 26 (Interacoustics, Assens, Denmark). The participants in control group had bilateral hearing thresholds within 25 dB HL between 0.25 kHz and 8 kHz, and normal tympanograms (Type-A peaked, with peak pressures of − 100–+50 daPa, static compliance of 0.3–2.0 cc)[23] and normal ipsilateral and contralateral acoustic reflex thresholds (80–100 dB HL)[24] were included in the control group.

The ones with hearing thresholds of 26 dB HL or higher at 0.25 kHz, 0.5 kHz, 1 kHz, and 4 kHz in at least one ear were included in the study group. Five individuals in the study group had unilateral hearing loss, and the remaining 115 individuals had bilateral hearing loss. Among those, 19 individuals had mixed and 101 had sensorineural hearing loss. The ethics committee had approved the study protocol. All participants had provided their written informed consent. The participants answered the questionnaire individually using paper and pencil. If any question remained unanswered, this question was asked to the patient by the audiologist and the answer was recorded.

Statistical analyses

Statistical analyses were performed using SPSS version 18 (SPSS; Chicago, IL, USA) software. Cronbach's alpha coefficient was calculated for each item of the survey and for each domain to test internal consistency. Fifteen individuals with hearing loss were asked to complete the survey again 3 weeks after their first completion to analyze test–retest reliability. Test–retest reliability of the five domains of T-AIADH was determined by calculating intraclass correlation coefficient (ICC) with a 95% confidence interval. An ICC ≥ 0.75 indicates excellent reliability, 0.4 ≤ ICC < 0.75 indicates fair to good reliability and ICC < 0.4 indicates poor reliability.[25]

Independent samples t-test was used to compare each item of the survey, the mean scores of the domains, and age between the study and control groups. The ability of the survey to differentiate between the normal individuals and the individuals with hearing loss was analyzed. To analyze criterion validity, Spearman's Rho correlation analysis was used in the study group to study the correlation between the scores of the domains of T-AIADH and the average of hearing thresholds (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz).


  Results Top


The reliability analysis of 30 items in all study population yielded a Cronbach's alpha coefficient of 0.98. All Cronbach's alpha coefficients obtained in 5 domains of T-AIADH were above 0.90 [Table 1].
Table 1: Cronbach's alpha coefficients for domains of Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (n=240)

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Fifteen individuals with hearing loss (mean age = 34.40 years, standard deviation = 10.84) were asked to complete the survey 3 weeks after their first completion to analyze test–retest reliability. The mean scores of each item and the mean scores of the domains were statistically significantly different between the study and the control groups (P < 0.001) [Table 2] and [Table 3]. In test–retest reliability, the resulting coefficients for the 5 domains (distinction of sounds, localization of sounds, speech intelligibility in quiet, speech intelligibility in noise, and detection of sounds) were high: ICC = 0.990, 0.930, 0.997, 0.985, and 0.997, respectively, showing excellent stability of measures over time [Table 4].
Table 2: Comparison of the mean scores of items for Turkish version of Amsterdam Inventory for Auditory Disability and Handicap of the study and control groups

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Table 3: Comparison of mean scores of the domains for Turkish version of Amsterdam Inventory for Auditory Disability and Handicap of the study and control groups

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Table 4: Statistical analysis of the test and retest mean domains scores for Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (n=15)

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Criterion analyses showed positive correlations between the domain scores and the average of hearing thresholds (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz) in the study group [Table 5]. The mean domain scores of T-AIADH (25th, 50th, and 75th percentiles) in the study and the control groups are shown in [Table 6] and [Table 7].
Table 5: Correlation analysis between the mean domain scores of Turkish version of Amsterdam Inventory for Auditory Disability and Handicap and the average of hearing thresholds (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz) for study group (n=120)

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Table 6: Mean domains scores of Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (25th, 50th, 75th percentile) for study group (n=120)

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Table 7: Mean domains scores of Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (25th, 50th, 75th percentile) for control group (n=120)

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  Discussion Top


In this study, we aimed to adapt AIADH developed by Kramer et al.[16] into Turkish and investigate its validity and reliability. The study group consists of 120 individuals and control group includes 120 normal-hearing subjects. No statistically significant differences were found between the study and control groups with respect to gender and educational status (P > 0.05). The Cronbach's alpha coefficients of all 30 items in T-AIADH were found to be above 0.90. In fact, 0.70 is an acceptable consistency coefficient.[26] We found a good internal consistency for T-AIADH. Similarly, the Cronbach's alpha coefficients were >0.90 for each domain (distinction of sounds, localization of sounds, speech intelligibility in quiet, speech intelligibility in noise, and detection of sounds). Similar to the original survey [16] and its adaptation into Spanish,[27] Turkish version of the survey may be used to investigate five hearing functions defined by the WHO [18] (sound detection, sound discrimination, sound localization, sound lateralization, and speech discrimination). Therefore, T-AIADH may be used for screening hearing functions when audiometric equipment is not available.

In our study, we asked patients to complete the survey for a second time 3 weeks after the first completion to abolish the learning effect. For 5-domain scores (distinction of sounds, localization of sounds, speech intelligibility in quiet, speech intelligibility in noise, and detection of sounds), ICC demonstrated very good test–retest reliability (ICC ≥0.90 for all domains). ICCs above 0.90 are indicating excellent reliability.[25] It was shown that T-AIADH had high test–retest reliability.

Comparison of the mean scores of items and mean scores of the domains yielded significantly different scores between the individuals with hearing loss and the individuals with normal hearing (P < 0.001). Turkish version of the survey can discriminate the individuals with hearing loss from the ones with normal hearing. This result is in accordance with the results of Fuente et al.[27] and Kramer et al.,[16] who found a significant difference between the scores obtained from the individuals with hearing loss and the ones with normal hearing. This questionnaire may be used as a first screening tool for patients with suspected hearing loss.

Korsten-Meijer et al.[28] used AIADH in addition to audiological tests in patients who had tympanoplasty. The authors reported that the survey could be used to analyze improvement of hearing functions after cochlear implantation. AIADH may also be used in patients with auditory neuropathy spectrum disorders, to analyze hearing disability in daily life-hearing situations.[27] Since T-AIADH is a Turkish translation of the original AIADH, it might also be useful in evaluating outcomes of cochlear implantation and analyzing hearing disability in auditory neuropathy spectrum disorders. However, this is only a corollary and can be proven after utilization of this work in these populations.

In our study, we found positive correlations between pure tone average hearing thresholds (0.5, 1, 2, and 4 kHz) and mean domain scores of the survey in the individuals with hearing loss. In this group of individuals, total scores of all domains increased as the hearing loss increased. These results are in agreement with the results of Fuente et al.[27] who adapted the survey into Spanish. The authors determined that deterioration in hearing thresholds was correlated with hearing function, as assessed by the survey.[27] Van Toor et al.[29] used AIADH and auditory processing tests in patients with whiplash injury, and they compared the results with the individuals with normal hearing. The authors found that noise intolerance and intelligibility in noise scores of AIADH were lower in the study group compared to the control group. In another study, Fuente et al.[30] found significant correlations of AIADH scores with hearing thresholds and central processing test performance (Random Gap Detection) in individuals with solvent exposure.


  Conclusion Top


The T-AIADH has a high internal consistency and test–retest reliability. T-AIADH can differentiate the individuals with hearing loss from the individuals with normal hearing. Criterion validity showed significant correlations between the domain scores of the survey and the hearing thresholds in individuals with hearing loss. T-AIADH is composed of easily understandable questions, and it may be used to analyze hearing disability for screening purposes or as an adjunctive test to audiological tests in Turkish-speaking patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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