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Objective: This study investigated a previously evaluated self-adjustment procedure with respect to its applicability for asymmetrical hearing loss (AHL). Self-adjusted settings were evaluated for speech recognition in noise and sound preference., Design: Participants were given the possibility to adjust the left and right hearing aid separately using a two-dimensional user interface. Two different adjustment sequences were tested. Realistic everyday sound scenes in a laboratory environment were presented. The difference between the ears regarding their speech recognition in noise was tested with two spatial conditions, unaided as well as with the prescriptive formula and the self-adjusted setting., Study Sample: Nineteen experienced hearing aid users (median age 76 years) with different degrees of AHL were invited to participate in this study., Results: Participants adjusted a higher gain slope across frequency in the worse ear than in the better one. The two adjustment sequences resulted in significantly different adjustment durations and gain settings. The difference between the ears regarding speech recognition in noise did not change with the self-adjustment. Overall, group-mean effect sizes were small compared to the parameter space., Conclusions: The adjustment procedure can be used also by hearing aid users with AHL to find a possibly preferred gain setting.

Objective: Audiological tests on smartphones require consistent microphone recordings across device types with a reasonable standard uncertainty (2-3 Decibel (dB)) of the sound pressure level at the microphone. However, the calibration of smartphone microphones by the non-expert user is still an unsolved issue. We show that whistling on standardized glass bottles permits a coarse sound level calibration with an uncertainty that is smaller than the standard uncertainty of clinical audiograms (4.9dB) and enough for mobile health (mHealth) products., Design: We define and test a calibration procedure with bottle-whistles for smartphones. The empirical sound pressure levels are used to calculate the mean and standard deviation of a single measurement., Study Sample: Two uncalibrated studies with a total of 30 participants, one calibrated study with 11 participants., Results: The mean maximal sound pressure level of 330 ml Vichy-shape bottle-whistles at 50 cm distance is 92.8 ± 1.6dB sound pressure level (SPL). The sound pressure level variation of a single measurement is 3.0dB SPL., Conclusions: In comparison to other possible ways of level calibration estimates for smartphones (e.g. level of own voice, level of common environmental sounds), the current method appears to be robust in background noise and easily reproducible with glass bottles of defined dimensions.

Falls are a significant health problem in older people, so preventing them is essential. Since falls are often a consequence of improper reaction to gait disturbances, such as slips and trips, their detection is gaining attention in research. However there are no studies to date that investigated perturbation detection, using everyday wearable devices like hearing aids or smartphones at different body positions. Sixty-six study participants were perturbed on a split-belt treadmill while recording data with hearing aids, smartphones, and professional inertial measurement units (IMUs) at various positions (left/right ear, jacket pocket, shoulder bag, pants pocket, left/right foot, left/right wrist, lumbar, sternum). The data were visually inspected and median maximum cross-correlations were calculated for whole trials and different perturbation conditions. The results show that the hearing aids and IMUs perform equally in measuring acceleration data (correlation coefficient of 0.93 for the left hearing aid and 0.99 for the right hearing aid), which emphasizes the potential of utilizing sensors in hearing aids for head acceleration measurements. Additionally, the data implicate that measurement with a single hearing aid is sufficient and a second hearing aid provides no added value. Furthermore, the acceleration patterns were similar for the ear position, the jacket pocket position, and the lumbar (correlation coefficient of about 0.8) or sternal position (correlation coefficient of about 0.9). The correlations were found to be more or less independent of the type of perturbation. Data obtained from everyday wearable devices appears to represent the movements of the human body during perturbations similar to that of professional devices. The results suggest that IMUs in hearing aids and smartphones, placed at the trunk, could be well suited for an automatic detection of gait perturbations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Feld et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest., Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions., Methods: In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis., Results: The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income., Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps., (©Giulia Angonese, Mareike Buhl, Inka Kuhlmann, Birger Kollmeier, Andrea Hildebrandt. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 12.08.2024.)

Objective: Smartphone-based self-testing could facilitate large-scale data collection and remote diagnostics. For this purpose, the matrix sentence test (MST) is an ideal candidate due to its repeatability and accuracy. In clinical practice, the MST requires professional audiological equipment and supervision, which is infeasible for smartphone-based self-testing. Therefore, it is crucial to investigate the feasibility of self-administering the MST on smartphones, including the development of an appropriate user interface for the small screen size., Design: We compared the traditional closed matrix user interface (10 × 5 matrix) to three alternative, newly-developed interfaces (slide, type, wheel) regarding SRT consistency, user preference, and completion time., Study Sample: We included 15 younger normal hearing and 14 older hearing-impaired participants in our study., Results: The slide interface is most suitable for mobile implementation, providing consistent and fast SRTs and enabling all participants to perform the tasks effectively. While the traditional matrix interface works well for most participants, some participants experienced difficulties due to its small size on the screen., Conclusions: We propose the newly-introduced slide interface as a plausible alternative for smartphone screens. This might be more attractive for elderly patients that may exhibit more challenges with dexterity and vision than our test subjects employed here.

Objective: This study investigated the adjustment behaviour of hearing aid (HA) users participating in a semi-supervised self-adjustment fine-tuning procedure for HAs. The aim was to link behaviour with the reproducibility and duration of the adjustments., Design: Participants used a two-dimensional user interface to identify their HA gain preferences while listening to realistic sound scenes presented in a laboratory environment. The interface allowed participants to adjust amplitude (vertical axis) and spectral slope (horizontal axis) simultaneously. Participants were clustered according to their interaction with the user interface, and their search directions were analysed., Study Sample: Twenty older experienced HA users were invited to participate in this study., Results: We identified four different archetypes of adjustment behaviour (curious, cautious, semi-browsing, and full-on browsing) by analysing the trace points of all measurements for each participant. Furthermore, participants used predominantly horizontal or vertical paths when searching for their preference. Neither the archetype, nor the search directions, nor the participants' technology commitment was predictive of the reproducibility or the adjustment duration., Conclusions: The findings suggest that enforcement of a specific adjustment behaviour or search direction is not necessary to obtain fast, reliable self-adjustments. Furthermore, no strict requirements with respect to technology commitment are necessary.

Advancements in cochlear implants (CIs) have led to a significant increase in bilateral CI users, especially among children. Yet, most bilateral CI users do not fully achieve the intended binaural benefit due to potential limitations in signal processing and/or surgical implant positioning. One crucial auditory cue that normal hearing (NH) listeners can benefit from is the interaural time difference (ITD), i.e ., the time difference between the arrival of a sound at two ears. The ITD sensitivity is thought to be heavily relying on the effective utilization of temporal fine structure (very rapid oscillations in sound). Unfortunately, most current CIs do not transmit such true fine structure. Nevertheless, bilateral CI users have demonstrated sensitivity to ITD cues delivered through envelope or interaural pulse time differences, i.e ., the time gap between the pulses delivered to the two implants. However, their ITD sensitivity is significantly poorer compared to NH individuals, and it further degrades at higher CI stimulation rates, especially when the rate exceeds 300 pulse per second. The overall purpose of this research thread is to improve spatial hearing abilities in bilateral CI users. This study aims to develop electroencephalography (EEG) paradigms that can be used with clinical settings to assess and optimize the delivery of ITD cues, which are crucial for spatial hearing in everyday life. The research objective of this article was to determine the effect of CI stimulation pulse rate on the ITD sensitivity, and to characterize the rate-dependent degradation in ITD perception using EEG measures. To develop protocols for bilateral CI studies, EEG responses were obtained from NH listeners using sinusoidal-amplitude-modulated (SAM) tones and filtered clicks with changes in either fine structure ITD (ITD FS ) or envelope ITD (ITD ENV ). Multiple EEG responses were analyzed, which included the subcortical auditory steady-state responses (ASSRs) and cortical auditory evoked potentials (CAEPs) elicited by stimuli onset, offset, and changes. Results indicated that acoustic change complex (ACC) responses elicited by ITD ENV changes were significantly smaller or absent compared to those elicited by ITD FS changes. The ACC morphologies evoked by ITD FS changes were similar to onset and offset CAEPs, although the peak latencies were longest for ACC responses and shortest for offset CAEPs. The high-frequency stimuli clearly elicited subcortical ASSRs, but smaller than those evoked by lower carrier frequency SAM tones. The 40-Hz ASSRs decreased with increasing carrier frequencies. Filtered clicks elicited larger ASSRs compared to high-frequency SAM tones, with the order being 40 > 160 > 80> 320 Hz ASSR for both stimulus types. Wavelet analysis revealed a clear interaction between detectable transient CAEPs and 40-Hz ASSRs in the time-frequency domain for SAM tones with a low carrier frequency., Competing Interests: The authors declare that they have no competing interests., (© 2024 Hu et al.)

Inattention plays a critical role in the accuracy of threshold measurements, e.g., when using mobile devices. To describe the influence of distraction, long- and short-term inattention models based on either a stationary or a non-stationary psychometric function were developed and used to generate three simulated listeners: fully-, moderately-, and non-concentrated listeners. Six established adaptive procedures were assessed via Monte-Carlo simulations in combination with the inattention models and compared with a newly proposed method: the graded response bracketing procedure (GRaBr). Robustness was examined by bias and root mean square error between the "true" and estimated thresholds while efficiency was evaluated using rates of convergence and a normalized efficiency index. The findings show that inattention has a detrimental impact on adaptive procedure performance-especially for the short-term inattentive listener-and that several model-based procedures relying on a consistent response behavior of the listener are prone to errors owing to inattention. The model-free procedure GRaBr, on the other hand, is considerably robust and efficient in spite of the (assumed) inattention. As a result, adaptive techniques with desired properties (i.e., high robustness and efficiency) as revealed in our simulations-such as GRaBr-appear to be advantageous for mobile devices or in laboratory tests with untrained subjects., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To develop the Cantonese matrix (YUEmatrix) test according to the international standard procedure and examine possible different outcomes in another tonal language., Design: A 50-word Cantonese base-matrix was established. Word-specific speech recognition functions, speech recognition thresholds (SRT), and slopes were obtained. The speech material was homogenised in intelligibility by applying level corrections up to ± 3 dB. Subsequently, the YUEmatrix test was evaluated in five aspects: training effect, test-list equivalence, test-retest reliability, establishment of reference data for normal-hearing Cantonese-speakers, and comparison with the Cantonese-Hearing-In-Noise-Test., Study Sample: Overall, 64 normal-hearing native Cantonese-speaking listeners., Results: SRT measurements with adaptive procedures resulted in a reference SRT of -9.7 ± 0.7 dB SNR for open-set and -11.1 ± 1.2 dB SNR for the closed-set response format. Fixed SNR measurements suggested a test-specific speech intelligibility function slope of 15.5 ± 0.7%/dB. Seventeen 10-sentences base test lists were confirmed to be equivalent with respect to speech intelligibility. Training effect was not observed after two measurements of 20-sentences lists., Conclusions: The YUEmatrix yields comparable results to matrix tests in other languages including Mandarin. Level adjustments to homogenise sentences appear to be less effective for tonal languages than for most other languages developed so far.