Oldenburg Inventory Research Articles

Impact of nurses’ burnout on safety culture

Literature indicates that burnout emphasizes its implication in the development of safety issues governing healthcare providers with physical and mental exhaustion associated with it. This study advocated determining burnout and its possible effect on key performance indicators on patient safety outcomes and in the eventual recommendation of preventive actions in policies governing nursing practice. Specifically, it ventured to determine the relationship between nurses’ burnout and their compliance with safety outcomes. A quantitative correlational study was designed to determine 274 purposive samples of registered nurses from participating government and non-government hospitals in Tarlac and Pampanga, Philippines towards their burnout and its relationship on key performance indicators on patient safety outcomes. Data were collected through two standardized self-administered questionnaires, Oldenburg Inventory Scale and the Key Performance Indicators on Patient Safety Outcomes Questionnaire, between February and May 2020. The study revealed that nurses, with a mean age of 27.86 (SD+4.81) years, experienced burnout due to work disengagement (18.10+2.812) and exhaustion (19.81+2.910). Safety guidelines on patient outcomes related to blood management (3.74+0.538) and fall prevention (3.15+0.468) received the highest mean scores with pressure ulcer management (2.82+0.597), the lowest. The study found several significant correlations between nurses’ disengagement, exhaustion, and total burnout with their overall safety culture (r=0.321, p=0.000; r=-0.225, p=0.003). All identified relationships showed a negative correlation suggesting that higher burnout scores are significantly related to lower safety culture scores. Nurses' ability to provide standard-based measures in upholding safety as a priority can be compromised at a considerable level. Recognizing the role of nurses' well-being in healthcare, policymakers should not only emphasize the need for evidence-based, quality, and safe interventions but also investigate the nurses' work conditions and contributory factors for burnout.

Burnout Among Basic Sciences Faculty; A Mixed Method Research

Objective: To study the burnout and its associated factors among the faculty of basic sciences in Faisalabad.
 Study Design: Mixed-method research.
 Place and Duration of Study: Basic sciences faculty of Public and Private Sector Medical Institutes of Faisalabad Pakistan, from Sep to Dec 2021.
 Methodology: Oldenburg Inventory was used to assess burnout among the faculty of basic medical sciences after taking the authors' permission. SPSS version 23:00 was used to analyze data, and those who had shown a higher level of burnout were interviewed. Recorded interviews were later own transcribed, and thematic analysis was done.
 Results: The mean exhaustion score for the whole basic sciences faculty was 2.35 ± 0.27, while for disengagement from work, it was 2.24 ± 0.24. Value was 0.62 and 0.144 for exhaustion and disengagement, respectively, showing no difference between the burnout level of faculty members in public and private sectors in both domains. Lack of acknowledgement, Lack of resources, Motivational factors and Lack of progress system were the main themes that emerged after an in-depth exploration of faculty members.
 Conclusion: The faculty from basic sciences are facing burnout, and the major causes are lack of acknowledgement and appreciation, decreased number of faculty, inadequate resources and ambiguity about future growth in basic sciences. The faculty member advocated the need to develop faculty training, mentoring and post-graduation programmes for the survival and strengthening of basic sciences.

The Mediating Role of Resilience and Life Satisfaction in the Relationship between Stress and Burnout in Medical Students during the COVID-19 Pandemic

Following the WHO’s declaration of a public health emergency due to the COVID-19 outbreak, the subsequent quarantine and confinement measures that were adopted, including distance learning measures, were shown to have caused a significant deterioration in the mental health of medical students. The goal of this study was to explore the mediating role of resilience and life satisfaction in the relationship between perceived stress and burnout among medical students in the context of COVID-19. A transversal assessment was performed using an online questionnaire, to which 462 students responded. The instruments applied were the Perceived Stress Scale-10, the Resilience Scale-25 items, the Satisfaction with Life Scale (SWLS), and the Burnout Scale (Oldenburg Inventory). A regression model was estimated for each dimension of burnout. The results revealed that resilience and life satisfaction play a mediating role in the association between stress and the dimensions of burnout. This suggests that measures of promoting mental health based on resilience and improving perceptions of life should be implemented.

61 Burnout in Core Surgical Trainees and Potential Use of Mindfulness

Abstract Aim Surgical trainees deal with long hours and stressful work content. We aimed to assess the burnout levels in London trainees, and trial a mindfulness intervention. Method London core surgical trainees (CST1) were asked to complete an online survey including validated burnout scoring system (Oldenburg Inventory). 54 of a possible 78 trainees responded (69%). We then asked them to take part in a 2-week mindfulness intervention (approximately 5 minutes a day using the app Headspace). We later resurveyed. Results 60% of trainees who answered the survey feel ‘somewhat’ or ‘completely’ burnt out. Oldenburg burnout inventory calculates 85% of trainees to be ‘disengaged’ and 93% ‘exhausted’. 13/54 trainees completed the mindfulness training. 10 out of 13 trainees found this to be ‘somewhat’ or ‘massively’ helpful for burnout. Conclusions A high percentage of year one surgical trainees can be categorised as burnt out. The low uptake of mindfulness may speak to lack of capacity trainees have to invest in resources that will self-resolve this. We cannot say with significance whether mindfulness helped burnout (and length of trial could be too short) but the majority who did trial report positive experience with mindfulness.

Improvement of Working Memory and Processing Speed in Patients over 70 with Bilateral Hearing Impairment Following Unilateral Cochlear Implantation.

Several studies demonstrated the association of hearing disorders with neurocognitive deficits and dementia disorders, but little is known about the effects of auditory rehabilitation on the cognitive performance of the elderly. Therefore, the research question of the present study was whether cochlear implantation, performed in 21 patients over 70 with bilateral severe hearing impairment, could influence their cognitive skills. The measuring points were before implantation and 12 months after the first cochlear implant (CI) fitting. Evaluation of the working memory (WMI) and processing speed (PSI) was performed using the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). The audiological assessment included speech perception (SP) in quiet (Freiburg monosyllabic test; FMT), noise (Oldenburg sentence test; OLSA), and self-assessment inventory (Oldenburg Inventory; OI). Twelve months after the first CI fitting, not only the auditory parameters (SP and OI), but also the WMI and PSI, improved significantly (p < 0.05) in the cohort. The presented results imply that cochlear implantation of bilaterally hearing-impaired patients over 70 positively influences their cognitive skills.

White Matter Lesions as Possible Predictors of Audiological Performance in Adults after Cochlear Implantation.

The presented prospective study investigated whether structural brain damage, measured with the Fazekas score, could predict hearing rehabilitation outcomes with cochlear implantation (CI). With a follow-up period of 24 months, this study included 49 bilaterally, postlingually hearing impaired CI candidates for unilateral CI (67.3 ± 8.7 years; 20 men, 29 women) older than 50 at the time of implantation. The differences in the predictive value between two age groups, 50–70 year-olds (mid-age; n = 26) and over 70-year-olds (elderly; n = 23), were analyzed. The patients were evaluated using speech perception (SP) measured in quiet (Freiburg monosyllabic test; FMT) and noise (Oldenburg sentence test; OLSA). The subjective hearing ability was assessed using Oldenburg inventory (OI). The Fazekas PVWM score predicted postoperative speech perception two years after CI in the mid-age population. The periventricular white matter lesions (PVWM) could explain 27.4% of the speech perception (FMT) variance. Our findings support the hypothesis about the influence of pre-existing WMLs on CI outcome. We recommend the evaluation of Fazekas score as a predictive factor for post-implantation hearing ability.

Aligning Hearing Aid and Cochlear Implant Improves Hearing Outcome in Bimodal Cochlear Implant Users.

Patients with unilateral deafness and residual hearing on the contralateral ear can benefit from a cochlear implant (CI) on one side and a hearing aid (HA) on the other. However, hearing improvement among these patients is heterogenous. Interindividual differences in bimodal benefit may be caused by a mismatch of CI and HA. The aim of this study was to clinically apply a HA fitting strategy and to evaluate hearing outcome with and without a dedicated bimodal fitting formula. Prospective non-randomized study. Tertiary referral center. Twelve patients using a CI processor and a conventional HA were enrolled. Before and after the new HA had been adjusted to the patient and linked to the CI, pure-tone audiometry and localization tests were performed. Speech perception was determined in quiet and noise. Tests were repeated after 6 and 12 weeks. To evaluate the subjective listening comfort two questionnaires (Oldenburg Inventory and HISQUI19) were assessed. Therapeutic. Word recognition in quiet, sentence recognition in noise. Speech perception in noise improved significantly: directed suppression of noise helped to segregate the target speech signal from a mixture of sounds or competing speakers. Evaluation of the questionnaires revealed a positive subjective hearing experience compared with patients' initial settings of the devices. By linking CI and HA hearing and speech perception can be improved. However, good counselling at the outset is essential to obtain enhanced outcome.

Improvement in tinnitus distress, health-related quality of life and psychological comorbidities by cochlear implantation in single-sided deaf patients.

Patients with single-sided deafness (SSD) lack the ability localize sound sources and have difficulty with speech-in-noise hearing. In addition, there is ahigh prevalence of tinnitus distress. These problems may result in reduced health-related quality of life (HRQoL) and psychological comorbidities. This study aimed to investigate the influence of treatment with a cochlear implant (CI) on HRQoL, tinnitus distress, psychological comorbidities, and audiological parameters in SSD patients. This retrospective study included 20patients with postlingually acquired SSD (13women, 7men, mean age 57.0years). Data on HRQoL were collected with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and the Medical Outcome Study Short Form36 Survey (SF-36). Tinnitus distress was assessed with the Tinnitus Questionnaire (TQ), psychological comorbidities were evaluated with validated questionnaires, and speech perception and hearing ability were measured with validated speech tests. Postoperatively, the mean total NCIQ score (p < 0.0001) and four subscores improved significantly, as did tinnitus distress (p < 0.05). Anxiety symptoms (Generalized Anxiety Disorder questionnaire, GAD-7) decreased significantly after CI. Speech perception improved significantly, particularly "hearing with background noise" (p < 0.05, Oldenburg Inventory, OI) and "localization" (p < 0.001, OI), as well as the Oldenburg Sentence Test (OlSa) scores for with vs. without CI when speech was presented from the SSD side and noise was presented from the normal hearing side (SSSDNNH; p < 0.005). CI in SSD patients is apowerful procedure to improve HRQoL, reduce tinnitus distress, and improve psychological comorbidities. Additionally, it is beneficial for hearing improvement, particularly in noise and for directional hearing.

Multifactorial positive influence of cochlear implantation on patients with single-sided deafness.

Single-sided deafness (SSD) is an extreme case with profound unilateral hearing loss in the poorer ear and regular hearing in the other ear. The aim of this study is to investigate the impairment in the daily life of SSD patients and the influence of cochlear implants (CI) on their health-related quality of life (HRQoL), the impact on existing tinnitus distress and psychological comorbidities, and audiometric parameters. In total, 21 patients (8 male and 13 female) were included, and the Charité Test Battery was applied for all patients. Data on HRQoL were collected with the Nijmegen Cochlear Implant Questionnaire and the Medical Outcome Study Short Form 36 (SF-36) Survey. Tinnitus distress was assessed with the Tinnitus Questionnaire (TQ). Data with regard to psychological comorbidities were collected using four validated questionnaires. Speech perception was assessed with the Freiburg Monosyllable Test (FMS), the Oldenburg Sentence Test (OLSA), and the Oldenburg Inventory (OI). HRQoL improved in the subdomain social interactions. Tinnitus distress dropped significantly 6 months postoperatively. SSD patients preoperatively showed elevated levels of stress, depressive symptoms, and anxiety. Postoperatively, these psychological symptoms improved with regard to stress, tension, and demands. The audiometry tools revealed a significant improvement in directional hearing (OI), speech perception in silence, and in the speech intelligibility threshold (OLSA). There was an improvement in HRQoL and a reduction of tinnitus and cognitive distress. The preoperatively elevated stress level decreased significantly, and psychological comorbidities such as depressive symptoms and anxiety all improved postimplantation. II-2 Laryngoscope, 130:500-506, 2020.

Long-term Benefit of Unilateral Cochlear Implantation on Quality of Life and Speech Perception in Bilaterally Deafened Patients.

Cochlear implantation (CI) is a common treatment modality for unilaterally and bilaterally deafened patients as well as patients with severe to profound hearing loss. The aim of our study is the complex evaluation of the improvement and influence of health related quality of life (HRQoL) and auditory performance in cochlear implant patients during a long-term follow-up. Sixty-one bilaterally, postlingually deafened patients with unilateral CI were included in this prospective study. Assessment tools for auditory performance and HRQoL included the Freiburg Monosyllabic Speech test, Oldenburg Inventory (OI) questionnaire, Nijmegen Cochlear Implant Questionnaire (NCIQ) and 36-item Short Form Survey (SF-36). Data were collected before CI, at 6, 12, and 24 months postoperatively. The assessment tools for speech perception yielded a statistically significant improvement in the Freiburg Monosyllabic Speech test scores and of all subdomain scores of the OI during the 6-month follow-up period. The subdomain scores of the NCIQ and the psychological score of the SF-36 also improved significantly during this follow-up period. All results remained stable thereafter during the 12- and 24-month follow-up. There was a statistically significant correlation between subjective speech perception and HRQoL after CI. This is the first prospective study to show results in regard to speech perception and HRQoL and their correlation during a 2-year follow-up after unilateral CI in bilaterally deafened patients. Our results for speech perception and HRQoL showed a significant improvement during the 6-month follow-up that remained stable thereafter during a 24-month follow-up, even after finishing the hearing rehabilitation program.

Age-Dependent Psychological Factors Influencing the Outcome of Cochlear Implantation in Elderly Patients.

Increasing number of older adults undergo cochlear implantation (CI). Accumulating evidence implicates that the outcome of implantation may not only depend on physical and psychological health status of patients but also on their age. In the present work, we analyzed the elderly (70-80) and very old (80+) patients who underwent CI regarding their hearing abilities, health-related quality of life (HRQoL), and psychological comorbidities. Eighty-six patients were included in this prospective study. The patients were split into two groups: 70-80 years-old (n = 62) and ≥ 80 years-old (n = 24). Hearing performance was assessed with Freiburg monosyllabic test and Oldenburg inventory (OI); the health-related quality of life was measured with Nijmegen Cochlear Implantation Questionnaire (NCIQ); depressive symptoms with General Depression Scale (ADS-L); stress with Perceived Stress Questionnaire (PSQ) and anxiety with General Anxiety Disorder-7 (GAD-7). Prior to CI, the hearing performance (Ol) impacted positively the HRQoL of both groups whereas the perceived stress (PSQ) had a negative impact. Six months after implantation, the HRQoL of 70-80 group was still positively influenced by the hearing performance (Ol) whereas HRQoL of 80+ group was influenced by stress perception (negative impact) and anxiety (positive impact). Twelve months later, anxiety and depressive symptoms correlated negatively with HRQoL of both age groups. Hearing performance had the positive and anxiety the negative impact on HRQoL in both groups but in addition, the 80+ group seemed to benefit from an increased level of anxious symptoms. In elderly patients, the outcome of CI depends on their psychological status. Differences found between the age groups imply a need for an age-group targeted psychological counselling, which might further improve outcome of CI.

Asymmetric hearing loss and the benefit of cochlear implantation regarding speech perception, tinnitus burden and psychological comorbidities: a prospective follow-up study.

We determined the audiological outcome, the subjective and objective hearing quality in patients suffering from asymmetric hearing loss (AHL). Furthermore, we evaluated psychological comorbidities and tinnitus burden before and after cochlear implantation. Prospective cohort study. 44 AHL patients were unilaterally implanted with a multichannel cochlear implant between 2011 and 2016. Speech discrimination (Freiburg Monosyllable Word Test, Oldenburg Sentence Test) was measured before, 6 and 12 months after implantation. Subjective hearing quality, health-related quality of life (HRQoL), tinnitus burden, anxiety, depressiveness, perceived stress level and coping abilities were evaluated before implantation, 6 and 12 months postoperative using specific validated questionnaires (Oldenburg Inventory, Nijmegen Cochlear Implantation Questionnaire, Tinnitus Questionnaire, General Anxiety Disorder-7, Depression Scale, Perceived Stress Questionnaire and Cope Inventory). Subjective and objective hearing quality, speech discrimination and health-related quality of life were significantly increased in AHL patients. Tinnitus burden significantly decreased over the 12 postoperative months. No significant alteration was observed for anxiety, depressiveness, coping abilities and stress level. This study demonstrates that cochlear implantation achieves hearing rehabilitation, increases HRQoL and decreases tinnitus burden in patients suffering from AHL. Subjective hearing quality increased, while tinnitus burden significantly decreased 6 and 12 months after implantation. HRQoL in AHL patients is an important factor to focus on and is significantly increased postoperatively. In contrast, general anxiety, depressiveness, coping abilities and perceived stress level remained unaffected.

In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation.

Cochlear implantation (CI) is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS) speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus-related distress was measured with the German version of Tinnitus Questionnaire (TQ). We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI) was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the degree of psychological burden decreased significantly post-CI. The implants benefitted patients in a number of psychosocial areas, improving the symptoms of depression and anxiety, tinnitus, and their quality of life and coping strategies. The prevalence of mental disorders in patients who are candidates for CI suggests the need for a comprehensive psychological and psychosomatic management of their treatment.

Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress.

Tinnitus is a common symptom of hearing impairment. Patients who are bilaterally hard of hearing are often affected by tinnitus. However, they cannot undergo any of the standard tinnitus therapies, since they rely on hearing. Cochlear implantation (CI) used to treat severe hearing disabilities, such as bilateral hearing loss, was also shown to reduce tinnitus. Our goal was to determine if CI induces sustained reduction of tinnitus. We performed prospective, longitudinal analyses of tinnitus-related distress in a uniform group of bilaterally deafened patients after CI. The homogenous sample consisted of 41 patients who met the inclusion criteria and were consecutively included in this study. The impact of unilateral CI on tinnitus-related distress, health-related quality of life (HRQoL), and hearing abilities was studied with validated instruments. The follow-up appointments were scheduled at 6, 12, and 24 months after CI surgery. During the appointments, hearing abilities were estimated with monosyllabic Freiburg test, whereas the tinnitus-related distress, the HRQoL, and the subjective hearing were measured with standard questionnaires [Tinnitus Questionnaire (TQ), Nijmegen Cochlear Implantation Questionnaire, and Oldenburg Inventory, respectively]. Tinnitus-related distress decreased significantly from the mean TQ score of 35.0 (SD = 19.6) prior to surgery to the mean TQ = 27.54 (SD = 20.0) 6 months after surgery and remained sustained low until the end of follow-up period. In addition, CI significantly improved the hearing abilities and the HRQoL of all patients. The results from our prospective study suggest that in a homogenous sample of bilaterally deafened, implanted patients who report having tinnitus prior to surgery, CI alone not only improves the hearing abilities but also significantly reduces the tinnitus-related distress and improves the HRQoL in a sustained way.

Rapid Positive Influence of Cochlear Implantation on the Quality of Life in Adults 70 Years and Older

The deteriorating ability to communicate has a negative impact on quality of life in the aging population. Cochlear implantation is increasingly used to treat hearing impairment and to restore the ability to communicate. Here, in a sample of 79 adults (70 years and older), we explored the effect of cochlear implantation on the health-related quality of life via the Nijmegen Cochlear Implant Questionnaire, auditory performance for speech recognition comparing scores on the Freiburg Monosyllabic Test and Oldenburg Inventory and tinnitus-related distress using the German version of the Tinnitus Questionnaire. We observed that the health-related quality of life and auditory performance increased significantly after cochlear implantation for the study cohort. After implantation, tinnitus-related distress declined significantly for the group. Our results support the concept of cochlear implantation treatment positively influencing the quality of life, restoring the auditory performance in older adults and reducing stress related to tinnitus. Importantly, positive effects were seen as early as 6 months after cochlear implantation, corroborating the rationale for cochlear implantation in adults 70 years and older.

Influence of hearing aids on monosyllabic test score and subjective everyday hearing

Pure tone and speech audiometry are essential methods for examining the indication for hearing aids, as well as for hearing aid evaluation. Additionally, the subjective benefit of hearing aids has to be evaluated with appropriate questionnaires. The aim of the present study was to investigate the correlation between speech audiometry data and the results of asimple and user-friendly questionnaire, as well as to provide normative data for subjective benefit. Data from 136hearing aid users with bilateral sensorineural hearing loss were analyzed retrospectively. Pure tone thresholds and Freiburg monosyllabic speech perception in the binaural situation were measured at 65dB in quiet and in noise (signal-to-noise ratio, SNR= +5dB), with and without hearing aids. Additionally, subjective hearing in everyday life was recorded using the 12-item Oldenburg Inventory. Improvement of speech perception with hearing aids for the Freiburg monosyllabic test in quiet was 32.0percentage points on average; in noise, there was an average improvement of 16.4percentage points. There was astrong correlation between the results of pure tone and speech audiometry. With hearing aids, patients scored their everyday hearing using the Oldenburg Inventory on average 1.4scale points better than without hearing aids. Results of the Oldenburg Inventory correlate with both pure tone and speech audiometry. Hearing aid evaluation should include both speech audiometry and systematic measurement of the subjective benefit using asuitable questionnaire. In combination, the Freiburg monosyllabic test and the Oldenburg Inventory allow for quick and comprehensive evaluation.

Extra Benefit of a Second Cochlear Implant With Respect to Health-Related Quality of Life and Tinnitus

To evaluate whether the second cochlear implant (CI) provides any extra benefit with respect to health-related quality of life, tinnitus, and auditory abilities. The data were evaluated using validated questionnaires before and after the first and second CI supply. Preimplantation data were collected retrospectively. Forty postlingually deafened adults, 11 male and 29 female subjects were included in this study. All patients were sequentially bilaterally implanted with a multi-channel CI for at least 6 months. The health-related quality of life assessed with the Nijmegen Cochlear Implant Questionnaire further increased after the second CI. In patients with initially higher level of tinnitus annoyance measured with the Tinnitus Questionnaire, the scores decreased after the first CI and remained steady after the second CI. Patients with initially lower level of tinnitus annoyance had a further decrease of the Tinnitus Questionnaire score after the second CI. Additionally, the second CI induced further improvement of auditory abilities, as assessed by the Oldenburg Inventory and the Freiburg monosyllable test in quiet and the HSM and Oldenburg sentence tests in noise. The quality of life scores correlated with the auditory abilities, especially after the second CI. The present study provides evidence that the second CI leads to further increase in quality of life and reduction of tinnitus annoyance in addition to improvement of auditory abilities as compared with the first CI. Patients with bilateral CIs benefit from additional positive effects in all these fields.

Multi-microphone technology for severe-to-profound hearing loss.

In this study the potential benefit of hearing instruments with multi-microphone technology was investigated in laboratory and in field tests for users with severe-to-profound hearing loss. Twenty-one experienced hearing aid users were fitted with high-power multi-microphone hearing instruments (Phonak PowerZoom P4 AZ). The following evaluations were performed: (i) adaptive speech test (SRT for HSM sentence test) in quiet and in noise with their own instrument and the test instrument in the omnidirectional (basic program) and directional mode (party noise profound+zoom algorithm). (ii) Paired comparisons of loudness, sound quality and speech intelligibility for both the omni and zoom program. (iii) Questionnaires on satisfaction and self-assessment of communication in different listening conditions (Oldenburg Inventory). Only 10 subjects achieved 50% correct (SRT) on the sentence test in noise (speech 0 degrees/noise 180 degrees) with both their own instrument and the test instrument in the omnidirectional mode. However, 15 subjects succeeded in the SRT measurement in the directional mode. The average SRT improvement of the directional over the omnidirectional mode was 13.7 dB. Loudness was judged 'medium loud' for both listening programs. Sound quality and intelligibility were rated significantly better for the zoom program. Compared to their own instrument users' satisfaction with the test instrument was significantly higher, especially in noisy listening situations.