• Quick Speech in Noise Test [ Time Frame: This outcome measure will assess changes from aided baseline to aided assessments made immediately and at six-months post treatment. ] [ Designated as safety issue: No ]
  

• Abbreviated Profile of Hearing Aid Benefit [ Time Frame: This outcome measure will assess changes from aided baseline to aided assessments made immediately and at six-months post treatment. ] [ Designated as safety issue: No ]
  
• Hearing Handicap Inventory for the Elderly [ Time Frame: This outcome measure will assess changes from aided baseline to aided assessments made immediately and at six-months post treatment. ] [ Designated as safety issue: No ]
  

This proposed study will be a multi-site, single-masked (blinded), randomized controlled, parallel group clinical trial to assess the effectiveness of an at home PC-based auditory training as a supplement to standard-of-care hearing-aid intervention in veterans treated for hearing loss, with or without previous hearing-aid experience. The participants will be assigned randomly to one of three groups, with hearing-aid use stratified within the groups: (1) Group 1, HA+AT, in which the participants will receive standard-of-care hearing-aid intervention (HA) and complete the four-week LACE auditory training program (AT); (2) Group 2, HA, with the participants receiving only standard-of-care hearing-aid intervention (HA); and (3) Group 3, HA+DL, in which the participants will receive standard-of-care hearing-aid intervention (HA) and complete four-weeks of placebo auditory training, consisting of directed listening (DL) to books-on-tape. The participants in each group will attend four test sessions. During Session 1 the informed consent process will be completed, baseline assessments will be made to ensure that the participants meet the study inclusion criteria (page 52), testing of predictor variables (page 57-58) will be completed, and all hearing aids will be assessed for correct functionality (page 53). The participants then will be assigned randomly to a study group. Session 2 will occur four weeks after Session 1. During Session 2, baseline performance on the outcome measures will be assessed (page 54-57), as will performance on the predictor variables. Following testing, the participants in Groups 1 and 3 will receive training in the use of the AT or DL programs. Session 3 will occur at the end of the 4-week experimental training period. During Session 3 all participants will be retested on the outcome measures to assess short-term intervention outcomes. During Session 4, which will occur at seven-months post-study enrollment (i.e., six-months post training completion for Groups 1 and 3), all participants will be retested on all outcome measures to examine the long-term outcomes. In Sessions 2-4, the stability of hearing-aid function will be assessed through electroacoustic measures.

Inclusion Criteria:

The participants will be recruited from the VA Medical Centers at Bay Pines, FL; Mountain Home, TN, and Portland, OR. Inclusion criteria consist of:

1. adult onset hearing loss,
2. English as the first language,
3. bilateral, symmetric, sensorineural hearing loss,
4. average audiometric thresholds for 500, 1000, and 2000 Hz less than 50-dB HL in either ear,
5. aided speech recognition in quiet of 40% binaurally,
6. appropriate cognitive skills assessed using the Mini Mental State Exam (Folstein et al., 1975) with age/education norms (Crum et al., 1993),
7. no known neurological, psychiatric disorders, or co-morbid diseases that would prevent completion of the study as determined by chart review,
8. adequate vision to participate in the study as determined with the Smith-Kettlewell Institute Low Luminance (SKILL) Card,
9. eligible for VA-issued hearing aids.

Exclusion Criteria: