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Key words: adaptive procedure, auditory threshold, psychometric function, threshold reversal, word recognition. Abbreviations: ANOVA = analysis of variance, CVC = consonant-vowel-consonant, HL = hearing level, HD = high density (frequency of usage word from a dense neighborhood), HS = high sparce (high frequency of usage word from a sparse neighborhood), LD = low density (low frequency of usage word from a dense neighborhood), LS = low sparce (low frequency of usage word from a sparse neighborhood), NU 6 = Northwestern University Auditory Test No. This project was funded as a merit review from the Rehabilitation Research and Development Service, Department of Veterans Affairs. Current clinical procedures typically include recognition of isolated monosyllabic or spondaic words in a format that poorly represents communication in real-life situations.
The overall project involved the development and evaluation of sentence materials based on target words selected using two criteria: word-usage frequency and word confusability based on a single phoneme substitution metric [5]. The sentences, each of which had seven to nine syllables and three target words, were homogeneous with respect to psychometric slope, range, and midpoint [5,8].
Each subject participated in a 1-hour listening session per day for 5 days during a 5- to 10-day interval.
Finally, a subset of six listeners from the 40 to 60 years group and six listeners from the >65 years group participated in a sixth session that replicated the eight conditions administered in Sessions 1 and 5. Mean thresholds (dB HL) and SDs (in parentheses) for HD control and experimental conditions across five sessions for three groups of subjects. The distribution of the datum points for the <30 years group in Figure 3(a) is tightly grouped, reflecting homogeneity in recognition performance. The second research question addressed whether or not decreases in thresholds across sessions were owing to the subjects learning the test material, learning the test and listening environment, or a combination of both learning effects.
In comparison to the exposure received by the subjects to the materials in the control conditions, the practice received by the subjects to the materials in the experimental conditions was minimal.
To this point, the focus has been on the control and experimental data from Sessions 1 and 5.
Mean thresholds (dB HL) (and SDs) for the HD control conditions across the four trials in Sessions 2, 3, and 4.
The threshold data for the HD condition from six of the 40- to 60-year old listeners and six of the >65 year-old listeners who participated in Session 6 (20 to 30 days following Session 5) are depicted in Figure 4. Finally, in addition to the threshold measure obtained from each set of data, the amplitudes of the last nine excursions of the threshold tracks were evaluated. She also got tired of hearing me say “Excuse me” and “Huh?” too many times during the interview. One of the things I’m glad to see change from my days after coming home from Vietnamis the way VA handles mental health issues. After doing that for a year and a half, we returned home but couldn’t forget the great students we had there. Doug Young served two tours in Vietnam as an infantryman and is married to another Vietnam Veteran who served as a nurse there. I have been a recluse, worked, bowled with a Air Force Puke( Good Friend) and stayed out of society most of the time.
I myself have come across some of these problems, I submitted my grievances and instead of blowing up at the staff, I let myself be heard through the Ombudsman for the hospitals. We usually had to wait to get back to Pearl Harbor to get any major treatment after the Navy guys. But we never saw any records just got stores, even now they tell us we got to produce the records they are supposed to have. My advice, find a sympathetic Vietnam Veteran that works in the VA and can help you with your search for the records. Ya, I know, If I didn’t keep (some) of my records when I was in Nam and took pics, I would not have gotten my 30% on my knee. I don’t know why I never made it to Vietnam I joined the Army in 1968 knowing I would go to Vietnam, after graduation my orders were for Vietnam. Doug I agree with your words about the VA, I also waited until 2008 to get involved with the VA as all I ever heard was how they were not that good or true with our words and the things that our bodies are going through now, but they have done so much for me as I how have found out the I have PSTD which I never thought was from me, and I also had the purple heart and I am also glad that the VA has found that my legs are in bad shape from everything I put them through in Vietnam.
Yes VA is big allot for them to do i remember being sick and in between jobs no insurance and a wwII vet took me to VA they treated me sent me off with some medicine thanku. Your comments and continue to speak to as many Vets you come across, is a way to give back. You would be surprised at to how many Vets do not go to VA to check in once they get out of the military.
It’s great that Ed and Ronald get excellent care from the VA, but, not all Vietnam vets are treated the same. I agree 100% with what Norm says about us Vietnam vets that had significant exposure to agent orange. Besides being a Vietnam vet (1st Recon Bn, 1st MarDiv 66-67), I am a retired Master Chief Hospital Corpsman. Charles, have you tried bringing this to the attention of the hospital patient advocate or your social worker? I was told that maybe I should go to the VA Regional hospital in Lexington instead of the one here in Louisville that even that mileage difference would help, but, to make sure that I would get better health care they suggested the 125 mile drive to Nashville VA. For the past 20 years, Mary Lou Lauricella has worked through VA Connecticut to facilitate a PTSD drama therapy group called the Veterans’ Homefront Theater Group. Three target words, based on word-usage frequency and word confusability, were embedded within the seven to nine syllable sentences. The senior author is a senior research career scientist supported by the Rehabilitation Research and Development Service. The validity of these tests depends on the assumption that the paradigms represent everyday speech. The aspect of the project reported here examined the learning effects associated with repeated presentations of word-recognition materials with the use of sentence materials and an adaptive psychophysical procedure. The three groups were included to determine if practice on the listening task had different effects on listeners of various age groups and degrees of hearing loss.
Left ears were used on the odd number subjects and right ears were used on the even number subjects. Session 6 was included to determine the extent of the carryover associated with the learning effects that were observed in the first five sessions.

This second finding, which answers the first research question, indicates that for each of the three subject groups, the thresholds improved significantly between the first and fifth session. In contrast to the <30 years group, the datum points for the other two subject groups progressively become less homogeneous as age and degree of hearing loss increase.
From Figure 2 and Table 1, comparison of the thresholds for the experimental and control conditions obtained in Session 1 indicates essentially no difference between the two sets of data.
The thresholds for the control and experimental conditions were lowered by the same amount between Sessions 1 and 5 (Table 1, right column). Sessions 2, 3, and 4 were used as control conditions in which eight thresholds (four HD and four HS) were obtained from each subject in each session. For comparison, the mean data from the respective subsets of subjects obtained in Sessions 1 through 5 are shown.
The mean track excursion sizes (in decibel) are depicted in Figure 5 for the various HD listening conditions, listening sessions, and subject groups. The first thing she did after the paperwork was complete was arrange to have my hearing checked. For years, I struggled with hearing ordinary conversations, especially in crowded places and with people with high voices.
During a recent visit to my doctor, I was talking to a VA nurse and said something about being in a bad mood and that I got angry easily. I’m a little unusual in that I’m married to a Vietnam Vet. My wife was a nurse over there, and we met at her hospital in 1969. They worked so hard and were so appreciative to be able to learn English from a native speaker. Cindy and I stayed in touch with some of them by email. Hell no – it took a very long time for the audiologist who fitted me with my hearing aids to be paid and she almost dropped VA.
Doug is retired and lives in South Texas where he helps support young Vietnamese students in their studies in the United States. My wife of 26 Years has been my best friend and we have 6 Children, 10 Grandchildren and Two Great Grand Children, One little girl, who just came into this world , Saturday 22 March 2014. I am almost completely deaf in my right ear and without the Hearing Aids provided to me from the VA.
We did not have doctors and nurses, but they Navy was supposed to take care of us when we were hurt. The VA does have the right Doctors and employees that care about all veterans and I wish that all vets would also trust them because the VA is very good for us. Now other vets tell me i should get my VA card i called once they said my name is in the system and the Marines sent me to rehab i have 28yrs. Every veteran’s service should have the same respect but through personal experience I have found that those who served in Iraq or Afghanistan get much more respect and proper treatment than some of us Vietnam veterans that served and especially have to endure the effects of Agent Orange. I have an ex-navy friend in upstate NY who gets excellent care, a Marine in central Ohio that gets crappy treatment like I do here in KY. Hell, if I could make trips like that myself, I wouldn’t need them for half the crap they are supposed to be helping me with. Thresholds were obtained for the control lists in Sessions 1 to 5 and for the experimental lists in Sessions 1 and 5. Although syllable and word tests may give insights into certain perceptual problems, syllable and word tests do not reasonably approximate everyday listening conditions. Egan reported that with multiple trials of listening to words in an ambient noise [6], recognition performance improved from about 60 percent correct to about 80 percent correct over 5 successive practice days. Briefly, the sentences were grouped into one of the following four categories based on the word category of the three target words: (1) HD (high density)-high frequency of usage from a dense neighborhood, (2) HS (high sparce)-high frequency of usage from a sparse neighborhood, (3) LD (low density)-low frequency of usage from a dense neighborhood, and (4) LS (low sparce)-low frequency of usage from a sparse neighborhood. The control lists were materials that were administered in each of the five sessions that served as practice items with multiple thresholds being established in each session. During Sessions 1 and 5, thresholds for four experimental conditions (HD, HS, LD, and LS) were obtained, as were thresholds for four control conditions (two randomizations of HD and HS). This is an expected finding when the variability associated with the hearing sensitivity between groups and within groups reflected in the pure-tone audiometric findings is considered (see Figure 1).
The practice received on the control conditions improved the word-recognition performance by the subjects on the control materials. These control conditions provided the subjects with practice on the listening task and materials. A general characteristic of both the control data (open symbols with solid lines) and the experimental data (filled symbols with dashed lines) is that the excursion size decreased as the number of sessions increased.
Development of a test of speech intelligibility in noise using sentence materials with controlled word predictability. Speech recognition in noise at higher than normal levels: Decreases in scores and increases in masking.
I’d heard the horror stories from other Vets and wondered if VA was just another government bureaucracy, but when the clerk (herself a Veteran) sat down with me, it was painless.
I remember being processed out of the Army in 1970 in Oakland and being given a hearing exam. Within 30 minutes, I was in a conversation with a psychiatrist, talking about anger issues. In 2002, we decided – with a lot of nervousness and hesitation – to return to Vietnam as a part of a medical team working in the slums of Danang. I volunteered twice after that to go to Vietnam but was not sent, I got out of the Army in 1971 after a couple years I joined the US Marine Corps. Clean and sober i was not in any wars or campains but i am definitely indebt to them they helped me.
In general, Vietnam veterans have always been treated the same as the days we returned by being spat upon and called baby killers; like we were some kind of crazy monsters from hell. Egan did not attribute the improved performance to any particular aspect of the listening-response task.
The categorization of low versus high frequency of word usage was based on the entire set of familiar monosyllabic consonant-vowel-consonant (CVC) words in the pocket lexicon, which was described by a 7-point rating scale [9].
For a given subject, then, the control lists were used throughout the five sessions to provide practice on the listening and response task, whereas the experimental sentence lists were used only during Sessions 1 and 5.

During Sessions 2, 3, and 4, thresholds for eight control conditions were established (two conditions-HD and HS, by two randomizations, by two replications). Likewise, the recognition performance of the subjects improved on the experimental materials on which no practice was received during Sessions 2, 3, and 4.
The mean thresholds for the HD condition (and SDs) for the four trials within each of Sessions 2, 3, and 4 are listed in Table 2 for each of the subject groups. These results indicate that over the 20- to 30-day interval, the listeners retained a portion of the listening sophistication that had been acquired during the initial five test sessions. I was amazed to find out that as the holder of a Purple Heart, all of my medical needs would be covered.
After a few sessions, I realized I was just having a “bad hair day” and was fine, but I was struck by how well VA was reacting to Veteran suicides and violence. As it turned out, we fell in love with Vietnam and its people. For them, the war is truly over and forgotten. I try to keep in mind that the VA is a huge organization, with all the problems any big organization has.
I to couldn’t hear any conversations, and because I only heard bits and pieces of a conversation. But, we are no different than any other vet that has served this country and we should all be treated the same, but, unfortunately that does NOT hold true. The mean thresholds (1) for the three subject groups were significantly different, (2) for the experimental conditions and the control conditions were not significantly different, and (3) for Session 5 were significantly lower than in Session 1. Sparse and dense refer to similarity neighborhoods in an assumed representation of the mental lexicon. Because of the limited number of LD and LS sentences, the LD and LS lists were always used as experimental lists. The task of the subject was to repeat the sentence, with scoring based on the three target words in each sentence. This finding was expected as the subjects were selected from specific age-related categories that reflect different degrees of hearing loss. Egan noted a 20 percent (4 dB to 5 dB) improvement in the recognition of the PB-50 words presented in noise on 5 successive days. We loved it so much that we actually quit our jobs in the US and went to live in Vietnam, where we taught English at the University of Hue.
My VA benefits went a long way towards being able to support these two young ladies, who have become the daughters Cindy and I never had.
The first question addressed whether or not thresholds measured with sentence materials changed with repeated measures.
Four experimental lists (HD, HS, LD, and LS) and two control lists (HD and HS) were selected for each listener.
If two or three of the target words were recognized, then the level of the subsequent sentence was decreased 2 dB; if fewer than two of the target words were recognized, then the level of the subsequent sentence was increased 2 dB. Second, as indicated earlier, the thresholds obtained in Session 5 were significantly lower than the thresholds obtained in Session 1. First, as was reported earlier, as the session number increased, the thresholds decreased, a relation that is true for each subject group.
Although these differences are small, the findings indicate that as practice on the listening task increased, the subjects became more proficient at the listening-response task. The threshold track was terminated after 12 reversals with the first 3 reversals discarded and the last 9 reversals used to compute threshold, which was defined as the midpoint of the excursion. Second, the thresholds for a given condition changed little, if any, across trials of a given session.
I felt like a fool and even today, I am very unsure about having any kind of conversation, in a crowed , much less a one on one!
Words from each lexical category were used three at time to form the sentences in a format similar to that used by Plomp and Mimpen or Bench and Bamford [4,10].
In addition to the threshold metric, the amplitudes of the excursions of the threshold tracks were evaluated. Although the thresholds for the three groups of listeners are displaced from one another in Figure 2, the functions for the three groups across the five sessions are essentially parallel.
Neither study, however, was designed to examine the learning components that contributed to the improved performances that were observed. Because the sizes of the track excursions of the control and experimental conditions changed by similar amounts between Sessions 1 and 5, one can conclude, as with the threshold measures, that the equivalent changes in performance on the control and experimental conditions were owing to practice or exposure on the test procedure and test environment and not to learning the target stimulus words and sentences. This finding indicates that the improvements noted in recognition performances across the sessions were the same for all groups.
The decrease in threshold must be attributable to improvement that the subjects experienced with repeated practice in Sessions 2, 3, and 4 with the task. Thus, the thresholds across trials within a session remain remarkably stable, which is in contrast to the systematic decrease in thresholds that was observed across sessions. I was even accused of coming in off the streets and demanding narcotic’s ( which was a lie ) even though I had an appointment with my primary care doctor ( changed doctors over ayear ago ) at the time . Despite some physician shortages and long lead times for appointments at the outlying clinics, the VA is trying to do right by the vets. Thus, age differences and degree of hearing loss did not influence the degree of improvement in performance noted between Sessions 1 and 5. Because substantially more words met selection criteria in the HD and HS categories than in the LD and LS categories, the HD and HS categories had two lists each, whereas the LD and LS categories had one list each. The data from the experimental conditions, however, provide insight that differentiates the two types of learning effects. VA Health Benefits is not like health insurance, you can’t just go anywhere for anything and expect them to pay for it, although it does meet the Affordable Care Act requirement.

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