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Objective: To investigate the effects of previous occupational noise exposure in older adults with hearing loss on (1) audiometric configuration and acoustic reflex (AR) thresholds and (2) self-reported hearing abilities and hearing aid (HA) effectiveness., Design: A prospective observational study., Study Sample: The study included 1176 adults (≥60 years) with bilateral sensorineural hearing loss. Pure-tone audiometry, AR thresholds, and responses to the abbreviated version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire were obtained, along with information about previous occupational noise exposure., Results: Greater occupational noise exposure was associated with a higher prevalence of steeply sloping audiograms in men and women and a 0.32 (95% CI: -0.57; -0.06) scale points lower mean SSQ12 total score among noise-exposed men. AR thresholds did not show a significant relation to noise-exposure status, but hearing thresholds at a given frequency were related to elevated AR thresholds at the same frequency., Conclusions: A noise exposure history is linked to steeper audiograms in older adults with hearing loss as well as to poorer self-reported hearing abilities in noise-exposed men. More attention to older adults with previous noise exposure is warranted in hearing rehabilitation.

Hearing loss is the cause of significant morbidity throughout the United States and the world. Because of numerous factors, such as ongoing noise exposure, poorly controlled chronic disease, and an aging population, the burden of hearing loss is expected to continue to increase. Hearing loss commonly is categorized as conductive, sensorineural, or mixed. The type of hearing loss can be determined through a combination of patient history and physical examination, and then confirmed with audiometry and tympanometry. Advanced imaging is not typically necessary, but it may be helpful in specific instances. The presentation of sudden sensorineural hearing loss should prompt urgent referral to an otolaryngologist and audiologist. Management of this condition is selective but may initially include oral corticosteroids. Management for chronic hearing loss involves the use of hearing aids, which can offer a large benefit to users but historically have been expensive and not covered by many insurance plans. Recent US legislation has made hearing aids more accessible and affordable by allowing direct-to-consumer marketing and offering over-the-counter hearing aids without a clinical evaluation., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Background: Teleaudiology can potentially improve access to hearing healthcare services. Remote hearing aid fittings offer a new mode of service delivery that removes barriers of geography and access to an audiologist. Real-ear measurements (REMs) are the gold standard for hearing aid output verification but require in-clinic appointments. This study will investigate whether remote hearing aid fittings can provide clinically equivalent outcomes when compared to current, in-clinic, best practice guidelines., Research Design: A repeated measure, double-blinded crossover design will be used. Participants will be randomly allocated to one of two groups to determine order of intervention, balanced for degree of hearing loss., Study Sample: Sixty adults with mild to moderate hearing loss and at least 1 year of experience with hearing aids will be recruited., Data Collection and Analysis: Participants will complete two hearing aid fitting protocols, one using an in-clinic fitting process and the other using a remote (at-home) fitting process. In-clinic fittings will include REMs with adjustments to standard (NAL-NL2) prescription targets. The two fitting protocols will then be randomly assigned to participants in a crossover design, so participants and researchers will be blinded to the order of the two fitting protocols. Participants will then have a 4-week period with follow-up appointments for participant-directed gain adjustment. For each fitting protocol, participants will complete objective measurements of final hearing aid output with REMs, speech-in-noise testing, subjective measurements of hearing aid performance, and quality of life measurements. They will then begin an identical period of living with, adjusting, and objective assessment with the other fitting protocol. Data will be analysed as repeated measures with statistical control for potential confounding variables., Results: Data will compare the four-frequency average real-ear aided response (4FREAR) for hearing aids programmed in-clinic and hearing aids programmed remotely, after participant-directed gain adjustments. Secondary measures will assess clinically significant differences in estimated speech intelligibility, hearing-related quality of life, hearing aid benefit, sound quality and preference, and speech-in-noise ability., Conclusions: This study will inform the development of best practice guidelines for remote hearing aid fittings. If no clinically significant differences are found between in-clinic and remote fit hearing aids, it has the potential to expand teleaudiology initiatives., Trial Registration: Australian New Zealand Clinical Trial Registry, ACTRN12623000028606p . Date of registration: 12 January 2023., (© 2024. The Author(s).)

Spectro-temporal modulation (STM) detection sensitivity has been shown to be associated with speech-in-noise reception in hearing-impaired (HI) individuals. Based on previous research, a recent study [Zaar, Simonsen, Dau, and Laugesen (2023). Hear Res 427:108650] introduced an STM test paradigm with audibility compensation, employing STM stimulus variants using noise and complex tones as carrier signals. The study demonstrated that the test was suitable for the target population of elderly individuals with moderate-to-severe hearing loss and showed promising predictions of speech-reception thresholds (SRTs) measured in a realistic set up with spatially distributed speech and noise maskers and linear audibility compensation. The present study further investigated the suggested STM test with respect to (i) test-retest variability for the most promising STM stimulus variants, (ii) its predictive power with respect to realistic speech-in-noise reception with non-linear hearing-aid amplification, (iii) its connection to effects of directionality and noise reduction (DIR+NR) hearing-aid processing, and (iv) its relation to DIR+NR preference. Thirty elderly HI participants were tested in a combined laboratory and field study, collecting STM thresholds with a complex-tone based and a noise-based STM stimulus design, SRTs with spatially distributed speech and noise maskers using hearing aids with non-linear amplification and two different levels of DIR+NR, as well as subjective reports and preference ratings obtained in two field periods with the two DIR+NR hearing-aid settings. The results indicate that the noise-carrier based STM test variant (i) showed optimal test-retest properties, (ii) yielded a highly significant correlation with SRTs (R 2 =0.61) exceeding and complementing the predictive power of the audiogram, (iii) yielded significant correlation (R 2 =0.51) with the DIR+NR-induced SRT benefit, and (iv) did not provide significant correlation with subjective preference for DIR+NR settings in the field. Overall, the suggested STM test represents a valuable tool for diagnosing speech-reception problems that remain when hearing-aid amplification has been provided and the resulting need for and benefit from DIR+NR hearing-aid processing., (Copyright © 2024. Published by Elsevier B.V.)

Early assessment of hearing aid benefit is crucial, as the extent to which hearing aids provide audible speech information predicts speech and language outcomes. A growing body of research has proposed neural envelope tracking as an objective measure of speech intelligibility, particularly for individuals unable to provide reliable behavioral feedback. However, its potential for evaluating speech intelligibility and hearing aid benefit in children with hearing loss remains unexplored. In this study, we investigated neural envelope tracking in children with permanent hearing loss through two separate experiments. EEG data were recorded while children listened to age-appropriate stories (Experiment 1) or an animated movie (Experiment 2) under aided and unaided conditions (using personal hearing aids) at multiple stimulus intensities. Neural envelope tracking was evaluated using a linear decoder reconstructing the speech envelope from the EEG in the delta band (0.5-4 Hz). Additionally, we calculated temporal response functions (TRFs) to investigate the spatio-temporal dynamics of the response. In both experiments, neural tracking increased with increasing stimulus intensity, but only in the unaided condition. In the aided condition, neural tracking remained stable across a wide range of intensities, as long as speech intelligibility was maintained. Similarly, TRF amplitudes increased with increasing stimulus intensity in the unaided condition, while in the aided condition significant differences were found in TRF latency rather than TRF amplitude. This suggests that decreasing stimulus intensity does not necessarily impact neural tracking. Furthermore, the use of personal hearing aids significantly enhanced neural envelope tracking, particularly in challenging speech conditions that would be inaudible when unaided. Finally, we found a strong correlation between neural envelope tracking and behaviorally measured speech intelligibility for both narrated stories (Experiment 1) and movie stimuli (Experiment 2). Altogether, these findings indicate that neural envelope tracking could be a valuable tool for predicting speech intelligibility benefits derived from personal hearing aids in hearing-impaired children. Incorporating narrated stories or engaging movies expands the accessibility of these methods even in clinical settings, offering new avenues for using objective speech measures to guide pediatric audiology decision-making., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Hearing loss commonly causes difficulties in understanding speech in the presence of background noise. The benefits of hearing-aids in terms of speech intelligibility in challenging listening scenarios remain limited. The present study investigated if phoneme-in-noise discrimination training improves phoneme identification and sentence intelligibility in noise in hearing-aid users., Design: Two groups of participants received either a two-week training program or a control intervention. Three phoneme categories were trained: onset consonants (C1), vowels (V) and post-vowel consonants (C2) in C1-V-C2-/i/ logatomes from the Danish nonsense word corpus (DANOK). Phoneme identification test and hearing in noise test (HINT) were administered before and after the respective interventions and, for the training group only, after three months., Study Sample: Twenty 63-to-79 years old individuals with a mild-to-moderate sensorineural hearing loss and at least one year of experience using hearing-aids., Results: The training provided an improvement in phoneme identification scores for vowels and post-vowel consonants, which was retained over three months. No significant performance improvement in HINT was found., Conclusion: The study demonstrates that the training induced a robust refinement of auditory perception at a phoneme level but provides no evidence for the generalisation to an untrained sentence intelligibility task.

Purpose: The purpose of this study was to measure how parent concern about childhood hearing loss varies under different description conditions: classification-based, audibility-based, and simulation-based descriptions., Method: We randomly allocated study participants (n = 143) to complete an online survey about expected child difficulties with listening situations with hearing loss. Our participants were parents of children with typical hearing in the 0- to 12-month age range. Participants were exposed to one type of description (classification-based, audibility-based, or simulation-based) and one level of hearing loss (slight, mild, and moderate or their audibility and simulation equivalents), producing nine total groups. Participants rated the level of expected difficulty their child would experience performing age-appropriate listening tasks with the given hearing loss. They also selected what they perceived as the most appropriate intervention from a list of increasingly intense options., Results: Our findings revealed that audibility-based descriptions elicited significantly higher levels of parent concerns about hearing loss than classification-based strategies, but that simulation-based descriptions elicited the highest levels of concern. Those assigned to simulation-based and audibility-based groups also judged relatively more intense intervention options as appropriate compared to those assigned to classification-based groups., Conclusions: This study expands our knowledge base about descriptive factors that impact levels of parent concern about hearing loss after diagnosis. This has potentially cascading effects on later intervention actions such as fitting hearing technology. It also provides a foundation for developing and testing clinical applications of audibility-based counseling strategies., Competing Interests: There are no conflicts of interest, financial, or otherwise., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The present study aimed to investigate whether hearing aid use can induce improvement as acclimatization effect in unaided speech perception in patients with age-related hearing loss., Methods: Fifty ears in 41 patients (age range: 65-91 years) diagnosed as age-related hearing loss were enrolled in this study. They used hearing aids for more than 8 hours per day. Unaided speech audiometry using 67-S Japanese monosyllabic word list was performed one or two years after the commencement of hearing aid use. The changes in the unaided speech discrimination score before and after the commencement of hearing aid use were analyzed. To investigate factors for improvement, the patients' backgrounds in terms of age, sex, pure tone average, unaided maximum speech discrimination score, fitting period (one year/two years), fitting ear (bilateral/unilateral), audiogram type (flat-type/other-type), and the level of amplification were also analyzed., Results: Significant improvement in the unaided speech discrimination score after hearing aid use was seen only in the flat-type audiogram group. More than half of older patients in the flat-type audiogram group improved their unaided maximum speech discrimination score 10 % or more. The analysis of aided hearing thresholds revealed that the flat-type audiogram group had significantly lower thresholds of 3kHz and 4kHz than the other-type audiogram group. The age, sex, pure tone average, fitting period, fitting ear, functional gain were not influential factors for improvement. On the other hand, unaided maximum speech discrimination score before using hearing aid and aided hearing threshold at 4kHz had a negative correlation with improvement., Conclusion: The findings suggested that older patients with age-related hearing loss whose audiogram is a flat type can benefit from amplification as means of improving their unaided speech perception since flat-type audiogram can be more easily adjusted to sufficiently amplify speech sound at high frequencies. It should be considered that the potential for experience-dependent plasticity is retained even in older adults., Competing Interests: Disclosure statements The authors report no conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

This study investigates the effect of hearing aid use on the peripheral auditory pathways in children with sensorineural hearing loss prior to cochlear implantation, as revealed by the electrically evoked auditory brainstem response (EABR). Forty children with hearing aids were recruited. Half of them had normal inner ear structures and the other half had inner ear malformations (IEMs). The EABR was evoked by electrically stimulating the round window niche (RWN) and round window membrane (RWM) during the cochlear implantation operation. The onset age of hearing aid use was significantly correlated with the peak latencies, but not amplitudes, of the wave III (eIII) and wave V (eV). Higher EABR thresholds were found for RWN stimulation than for RWM stimulation and in the children with IEMs than in those without IEMs. Our study provides neurophysiological evidence that earlier use of hearing aids may ameliorate physiological functions of the peripheral auditory pathway in children with and without IEMs. The EABR evoked by the electrical stimulation at RWM is more sensitive compared with that at RWN for evaluating functions of the auditory conduction pathway.

Preference for noise reduction (NR) strength differs between individuals. The purpose of this study was (1) to investigate whether hearing loss influences this preference, (2) to find the number of distinct settings required to classify participants in similar groups based on their preference for NR strength, and (3) to estimate the number of paired comparisons needed to predict to which preference group a participant belongs. A paired comparison paradigm was used in which participants listened to pairs of speech-in-noise stimuli processed by NR with 10 different strength settings. Participants indicated their preferred sound sample. The 30 participants were divided into three groups according to hearing status (normal hearing, mild hearing loss, and moderate hearing loss). The results showed that (1) participants with moderate hearing loss preferred stronger NR than participants with normal hearing; (2) cluster analysis based solely on the preference for NR strength showed that the data could be described well by dividing the participants into three preference clusters; (3) the appropriate cluster membership could be found with 15 paired comparisons. We conclude that on average, a higher hearing loss is related to a preference for stronger NR, at least for our NR algorithm and our participants. The results show that it might be possible to use a limited set of pre-set NR strengths that can be chosen clinically. For our NR one might use three settings: no NR, intermediate NR, and strong NR. Paired comparisons might be used to find the optimal one of the three settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Chronic subjective tinnitus poses significant challenges in clinical practice, and it is usually associated with hearing impairment, particularly with high-frequency sensorineural hearing loss (SNHL). Patients suffering from tinnitus with SNHL experience one of the most severe sensory disabilities, and this has devastating effects on their quality of life. Nowadays, mild to moderate SNHL can be managed with a properly fitted hearing aid (HA) that provides sound amplification, and several studies suggest that HAs may also benefit those with tinnitus. However, inadequate attention has been paid by medical personnel to the impact of HA use in residual hearing protection for patients with tinnitus and coexisting SNHL, and existing evidence is still at a preliminary stage. This study aims to identify and evaluate the efficacy of the use of HAs in both sound perception and residual hearing preservation among patients with tinnitus and coexisting SNHL., Methods and Design: The present study is a prospective, single-center, outcome assessor and data analyst-blinded, randomized, controlled trial. Eligible participants will be recruited and randomly allocated into the HA intervention group and the waiting list control group at a ratio of 1:1. The primary outcome is to evaluate the severity of tinnitus using the Tinnitus Handicap Inventory as a continuous variable at 6 months from randomization. Secondary outcome measures include changes in hearing status and mental states. The trial will last 6 months, with follow-up visits at 3 months and 6 months., Discussion: This will be the first randomized, controlled trial to identify and evaluate HAs' efficacy on residual hearing preservation among tinnitus patients with coexisting high-frequency SNHL in China. We are aiming for novelty and generalizability, and strengths of this study are that it will examine the effectiveness of HA in patients with tinnitus and hearing impairment and will further explore the residual hearing protection provided by HA treatment in the tinnitus group., Trial Registration: ClinicalTrials.gov NCT05343026. Registered on April 25, 2022., (© 2022. The Author(s).)

Objective: To objectively evaluate acoustic sensitivity of the implanted microphone, and maximum stable gain of a totally implantable active middle ear implant., Design: Prospective, single centre evaluation., Study Sample: Fourteen adult patients., Results: Microphone sensitivity is approx. 10 dB lower than an externally worn conventional hearing aid, at frequencies up to 4000 Hz, and substantially lower at higher frequencies. The masking level due to microphone noise, which determines the softest test tones that can be detected, is estimated at <20 to <30 dB HL up to 1000 Hz, and <40 dB HL at higher frequencies. Maximum stable effective gain is the maximum amplification achievable without causing feedback whistling. In sensorineural hearing loss (SNHL) cases, it is 30-40 dB at frequencies up to 2000 Hz, allowing to compensate for even the maximum recommended hearing loss (60-70 dB HL). In both SNHL and mixed hearing loss (MHL) cases, maximum stable effective gain is lower (+20 to -30 dB) around 3000-6000 Hz., Conclusions: Microphone sensitivity is high enough to achieve aided thresholds of 20-40 dB HL. A strong correlation between actuator coupling efficiency and maximum stable effective gain implies that any effort to improve actuator efficiency should also increase the available gain.

Recent surveys of pediatric audiologists have highlighted the need for improved understanding of pediatric loudness perception and their role in the hearing device fitting process. The purpose of this article is to provide a brief overview of methods used to measure loudness perception and summarize the existing literature exploring loudness perception in children. A narrative literature review was conducted and 29 articles were reviewed to (1) provide evidence for or against developmental differences, (2) describe variability across listeners of the same age, and (3) discuss evaluations of test-retest reliability on measures of loudness discomfort levels (LDLs), loudness growth, and loudness balancing. A wide variety of methods have been used to measure loudness perception in children. Results of existing studies point to potential developmental differences in LDLs but relatively consistent growth of loudness across age. Considerable across-child variability of loudness perception suggests that estimating LDLs from hearing thresholds could introduce error into the hearing device fitting/mapping process. Additional areas in need of research include work using loudness balancing measures, improved understanding of how variations in clinical loudness scaling measures could influence measured loudness perception, and examination of the benefit of individually-measured loudness perception during pediatric hearing device fitting., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: There is a lack of consensus regarding the definition, consequences, and management of mild bilateral hearing loss in children. The objective of this study is to analyze the benefit of hearing aids in children with mild bilateral hearing loss by evaluating their functional hearing., Methods: This retrospective study included 57 children with mild bilateral hearing loss between 20 dB HL and 40 dB HL. Pure tone and speech audiometry thresholds were assessed with and without hearing aids. Two groups were subsequently formed: group E with an effective use of hearing aids (>10 h/day), and group IE whose use of hearing aids was deemed ineffective (<10 h/day)., Results: Without hearing aids, the initial median of hearing level was 35 dB HL and 36 dB HL in the right and left ears, respectively, compared to 23 dB HL and 25 dB HL with hearing aids. The Lafon test performed on 25 children at 55 dB HL and 65 dB HL showed results ranging from 0% to 100% without hearing aids and from 90% to 100% with hearing aids. Scores obtained with hearing aids were significantly higher than those without them at an average speech level. Median age at diagnosis and at prescription were found to significantly influence the daily use of hearing aids., Conclusions: Our results show that in the case of mild bilateral hearing loss, hearing aids have positive effects on the functional hearing of children and help them to no longer be disadvantaged. This study highlights the need to provide regular support to these children to ensure their optimal care in the event of hearing-related problems. Coordination between the different professionals working with these children is also necessary for their follow-up and appropriate management., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To explore and describe parental experiences related to the management of mild bilateral congenital hearing loss in children., Design: Using qualitative methods, we conducted semi-structured interviews with parents/caregivers until saturation of themes was achieved. We analysed transcripts using inductive content analysis., Study Sample: Caregivers of children under 3-years-old with mild bilateral sensorineural hearing loss., Results: We interviewed 12 parents. Parental perception of advice regarding hearing aid fitting was varied; almost all children were offered hearing aids. Perceived positives related to hearing aids: feeling empowered that action has been taken; improvements in the child's hearing perception and; facilitation of behavioural management. Perceived negatives of hearing aid use: difficulties with compliance resulting in parental frustration and guilt, damage/loss of equipment, discomfort, parental discord, altered quality of natural sound and potential bullying/stigma. Some parents were ambivalent about the effect of the hearing aids. Where hearing aids were offered and not fitted, there was significant ongoing uncertainty, and the family carried the burden of their decision., Conclusions: There was a wide variation in perceived advice regarding early hearing aid fitting in children with mild bilateral hearing loss. We identified parental perceptions of positive/negative impacts of hearing aid fitting and potential perceived harms from not fitting.

Objective: Exploring factors that predict a favourable clinical outcome in non-organic hearing loss (NOHL) in children. NOHL is defined as a subjective hearing loss without correlation in objective measures., Design: Retrospective analysis of all childrens' data with the diagnosis NOHL seen between 2005 and 2017 at a tertiary referral centre., Study Sample: Sixty-seven children (44 female, 23 male; mean age 11.26 years) were included. Statistical analyses included descriptive statistics, logistic regression, correlations, and Mann-Whitney U tests., Results: A quarter of the children (17/67) had been provided previously with hearing aids without objective sensorineural hearing loss. Having been provided with hearing aids before the first visit to our clinic lowered the chance of normal hearing at the final visit by 76%. The prescription of hearing aids was significantly more likely in girls. Children provided with hearing aids were significantly older than those without and the time span between the first occurrence of the NOHL and first presentation at our department was longer than in children not provided with hearing aids., Conclusions: In cases of NOHL, hearing aid prescription is not indicated and significantly lowers a child's chance of full recovery and, thus, should not be prescribed unless NOHL is ruled out.

Objective: To determine whether children with unilateral sensorineural hearing loss (USNHL) and unilateral conductive hearing loss (UCHL) have higher levels of fatigue than literature reported normal hearing (LRNH) children., Methods: This was a cross-sectional survey utilizing the PedsQL™ Multidimensional Fatigue Scale administered to children with unilateral hearing loss (UHL) and their parents at two tertiary care academic medical centers and a nationwide microtia/atresia conference. The PedsQL™ Multidimensional Fatigue Scale was used to compare child and parental proxy reports of fatigue among USNHL, UCHL, and LRNH children. ANOVA and post-hoc Tukey Honest Significant Difference testing were used for statistical analysis., Results: Of 69 children included in the study, 42 had UCHL (61%) and 27 (39%) had USNHL. Children with USNHL reported more total fatigue (mean 69.1, SD 19.3) than LRNH children (mean 80.5, SD 13.3; difference -11.4; 95% CI: -19.98 to -2.84) and children with UCHL (mean 78.0, SD 14.5; difference -8.95; 95% CI: -17.86 to 0.04). Children with UCHL reported similar levels of fatigue compared to LRNH children (difference -2.5; 95% CI: -9.95 to 5.03). Parents of children with USNHL reported greater levels of fatigue (mean 67.6, SD 22.6) in their children than parents of LRNH children (mean 89.6, SD 11.4; difference -22.0; 95% CI: -29.8 to -14.3) and parents of children with UCHL (mean 76.2, SD 17.3; difference -8.6; 95% CI: -17.5 to 0.21). Parents of children with UCHL also report higher levels of fatigue than parents of LRNH children (difference -13.4; 95% CI: -19.98 to -6.84)., Conclusions: Children with USNHL reported greater levels of fatigue than LRNH children and children with UCHL. Results implicate cognitive load as an important consideration in children with hearing loss. The measurement of fatigue may be a useful indicator to determine the benefit of intervention (e.g., amplification) for these children., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Sensorineural hearing loss in child has a profound impact on their neurodevelopment and on language acquisition. Thus, the diagnosis and early intervention are critical, namely in unilateral or bilateral asymmetric hearing losses, which are diagnosed later than symmetric bilateral hearing losses., Objectives: This study aims to examine the progression of asymmetric SNHL in children, and the link between hearing thresholds and the technological level of the hearing aid fitted., Material and Methods: Eighteen children with asymmetric SNHL were submitted to a pure tone audiogram at the age of 5 years (T0) and reassessed at the age of 10 years (T1). Children were divided according to the technological level of the hearing aid fitted: basic, medium, and advanced., Results: A positive correlation was established between the hearing thresholds at T0 and T1, revealing an accelerated progression of hearing thresholds in the better ear after a 5-year period., Conclusions: Hearing thresholds in the worse ear influence the progression of the SNHL. Moreover, technologically advanced hearing aids led to a slower progression of the hearing thresholds over time.

Objective: This study characterised the relationship between speech intelligibility and quality in listeners with hearing loss for a range of hearing-aid processing settings and acoustic conditions., Design: Binaural speech intelligibility scores and quality ratings were measured for sentences presented in babble noise and processed through a hearing-aid simulation. The intelligibility-quality relationship was investigated by (1) assessing the effects of experimental conditions on each task; (2) directly comparing intelligibility scores and quality ratings for each participant across the range of conditions; and (3) comparing the association between signal envelope fidelity (represented by a cepstral correlation metric) and intelligibility and quality., Study Sample: Participants were 15 adults (7 females; age range 59-81 years) with mild to moderately severe sensorineural hearing loss., Results: Intelligibility and quality showed a positive association both with each other and with changes to signal fidelity introduced by the entire acoustic and signal-processing system including the additive noise and the hearing-aid output. As signal fidelity decreased, quality ratings changed at a slower rate than intelligibility scores. Individual psychometric functions were more variable for quality compared to intelligibility., Conclusions: Variability in the intelligibility-quality relationship reinforces the importance of measuring both intelligibility and quality in clinical hearing-aid fittings.

The aim of the current study was to investigate whether task-evoked pupillary responses measured during encoding, individual working memory capacity and noise reduction in hearing aids were associated with the likelihood of subsequently recalling an item in an auditory free recall test combined with pupillometry. Participants with mild to moderately severe symmetrical sensorineural hearing loss (n = 21) were included. The Sentence-final Word Identification and Recall (SWIR) test was administered in a background noise composed of sixteen talkers with noise reduction in hearing aids activated and deactivated. The task-evoked peak pupil dilation (PPD) was measured. The Reading Span (RS) test was used as a measure of individual working memory capacity. Larger PPD at a single trial level was significantly associated with higher likelihood of subsequently recalling a word, presumably reflecting the intensity of attention devoted during encoding. There was no clear evidence of a significant relationship between working memory capacity and subsequent memory recall, which may be attributed to the SWIR test and RS test being administered in different modalities, as well as differences in task characteristics. Noise reduction did not have a significant effect on subsequent memory recall. This may be due to the background noise not having a detrimental effect on attentional processing at the favorable signal-to-noise ratio levels at which the test was conducted.

Objective: To describe hearing aid outcomes for children with bilateral sensorineural hearing loss (SNHL) at a pediatric public hospital in South Africa in terms of daily use and oral/aural performance., Materials and Methods: Retrospective review of clinical data and caregiver reported outcomes of children aged 0-13 years with bilateral SNHL at one-month and three-months post-fitting. Oral/aural performance was measured by the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) questionnaire. Multiple linear regression was used to evaluate factors associated with hearing aid use. Thematic analysis was applied for qualitative caregiver-reported outcomes., Study Sample: Sixty-eight children with confirmed bilateral SNHL who were fitted with binaural air-conduction hearing aids at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between January 2017 and December 2019., Results: Average daily hearing aid use increased significantly (p < 0.05) from one-month (5.0; 3.0 SD; range 0.3-14.0) to three-months post-fitting (5.9; 3.4 SD; range 1.1-16.8). Average PEACH scores were higher in Quiet (73.4%) than in Noise (69.6%). More than half (52.2%) of children required review based on their overall percentage PEACH scores. Higher average daily hearing aid use was significantly associated with higher overall PEACH scores (p < 0.05). Neuro-typically developing children had significantly higher hearing aid use than children with additional disabilities (p < 0.001). Qualitative caregiver feedback revealed themes pertaining to advantages and barriers to hearing aid use., Conclusion: Outcomes of children with SNHL fitted with binaural hearing aids at a pediatric public hospital in South Africa demonstrated increased average daily hearing aid use from one-month to three-months post-fitting. Aural/oral performance was typical for one in two children. Children with additional disabilities had significantly poorer hearing aid use and aural/oral performance requiring more support for this vulnerable group to realize sufficient benefit from hearing aid use., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The primary purpose of this project was to evaluate the influence of speech audibility on speech recognition with frequency composition, a frequency-lowering algorithm used in hearing aids., Design: Participants were tested to determine word and sentence recognition thresholds in background noise, with and without frequency composition. The audibility of speech was quantified using the speech intelligibility index (SII)., Study Sample: Participants included 17 children (ages 6-16) and 21 adults (ages 19 to 72) with bilateral mild-to-severe sensorineural hearing loss., Results: Word and sentence recognition thresholds did not change significantly with frequency composition. Participants with better aided speech audibility had better speech recognition in noise, regardless of processing condition, than those with poorer aided audibility. For the child participants, changes in the word recognition threshold between processing conditions were predictable from aided speech audibility. However, this relationship depended strongly on one participant with a low SII and otherwise, changes in speech recognition between frequency composition off and on were not predicable from aided speech audibility., Conclusion: While these results suggest that children who have a low-aided SII may benefit from frequency composition, further data are needed to generalise these findings to a greater number of participants and variety of stimuli.

Purpose: This project was undertaken to develop automated tests of speech recognition, including speech-recognition threshold (SRT) and word-recognition test, using forced-choice responses and computerized scoring of responses. Specific aims were (1) to develop an automated method for measuring SRT for spondaic words that produces scores that are in close agreement with average pure-tone thresholds and (2) to develop an automated test of word recognition that distinguishes listeners with normal hearing from those with sensorineural hearing loss and which informs the hearing aid evaluation process., Method: An automated SRT protocol was designed to converge on the lowest level at which the listener responds correctly to two out of two spondees presented monaurally. A word-recognition test was conducted with monosyllabic words (female speaker) presented monaurally at a fixed level. For each word, there were three rhyming foils, displayed on a touchscreen with the test word. The listeners touched the word they thought they heard. Participants were young listeners with normal hearing and listeners with sensorineural hearing loss. Words were also presented with nonrhyming foils and in an open-set paradigm. The open-set responses were scored by a graduate student research assistant., Results: The SRT results agreed closely with the pure-tone average (PTA) obtained by automated audiometry. The agreement was similar to results obtained with the conventional SRT scoring method. Word-recognition scores were highest for the closed-set, nonrhyming lists and lowest for open-set responses. For the hearing loss participants, the scores varied widely. There was a moderate correlation between word-recognition scores and pure-tone thresholds which increased as more high frequencies were brought into the PTA. Based on the findings of this study, a clinical protocol was designed that determines if a listener's performance was in the normal range and if the listener benefited from increasing the level of the stimuli., Conclusion: SRTs obtained using the automated procedure are comparable to the results obtained by the conventional clinical method that is in common use. The automated closed-set word-recognition test results show clear differentiation between scores for the normal and hearing loss groups. These procedures provide clinical test results that are not dependent on the availability of an audiologist to perform the tests., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Patients with otosclerosis can suffer from different grades of combined hearing loss. In addition to surgery (stapedectomy), conventional hearing aids can be used in the treatment of otosclerosis. In cases of severe conductive components in addition to sensorineural hearing loss, treatment with normal hearing aids can be difficult or impossible. In these patients, implantable hearing systems such as cochlear implants represent a possible alternative. The totally implantable Carina middle ear system can be used in patients with even high-grade sensorineural hearing loss. Based on two exemplary cases, the option of using the Carina system in otosclerosis patients and post-implantation results are reported., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This work presents a single-channel speech enhancement (SE) framework based on the super-Gaussian extension of the joint maximum a posteriori (SGJMAP) estimation rule. The developed SE algorithm is an open-source research smartphone-based application for hearing improvement studies. In this algorithm, the SGJMAP-based estimation for noisy speech mixture is smoothed along the frequency axis by a Mel filter-bank, resulting in a Mel-warped frequency-domain SGJMAP estimation. The impulse response of this Mel-warped estimation is obtained by applying a Mel-warped inverse discrete cosine transform (Mel-IDCT). This helps in filtering out the background noise and enhancing the speech signal. The proposed application is implemented on an iPhone (Apple, Cupertino, CA) to operate in real time and tested with normal-hearing (NH) and hearing-impaired (HI) listeners with different types of hearing aids through wireless connectivity. The objective speech quality and intelligibility test results are used to compare the performance of the proposed algorithm to existing conventional single-channel SE methods. Additionally, test results from NH and HI listeners show substantial improvement in speech recognition with the developed method in simulated real-world noisy conditions at different signal-to-noise ratio levels.

Real-time operation is critical for noise reduction in hearing technology. The essential requirement of real-time operation is causality-that an algorithm does not use future time-frame information and, instead, completes its operation by the end of the current time frame. This requirement is extended currently through the concept of "effectively causal," in which future time-frame information within the brief delay tolerance of the human speech-perception mechanism is used. Effectively causal deep learning was used to separate speech from background noise and improve intelligibility for hearing-impaired listeners. A single-microphone, gated convolutional recurrent network was used to perform complex spectral mapping. By estimating both the real and imaginary parts of the noise-free speech, both the magnitude and phase of the estimated noise-free speech were obtained. The deep neural network was trained using a large set of noises and tested using complex noises not employed during training. Significant algorithm benefit was observed in every condition, which was largest for those with the greatest hearing loss. Allowable delays across different communication settings are reviewed and assessed. The current work demonstrates that effectively causal deep learning can significantly improve intelligibility for one of the largest populations of need in challenging conditions involving untrained background noises.

Introduction: The Joint Committee of Infant Hearing (JCIH) recommended hearing screening by one month of age, diagnosis of hearing loss by three months of age, and intervention initiated by six months of age. In Malaysia however, the age of diagnosis of hearing loss in children is relatively late. This study aimed to identify the challenges faced by parents in seeking a diagnosis of hearing loss for their children., Method: The study utilized a semi-structured interview with open-ended questions to obtain information about parents' experiences during the diagnosis period and their challenges when going through that process. In this study, a total of 16 parents of children who were diagnosed with moderate to profound sensorineural hearing loss and received intervention within three years at the time of the study participated. Ten of the children were cochlear implant users, and six were hearing aid users., Results: Thematic analysis was used to analyse themes generated from the data according to the study objective. Four main themes and 17 subthemes were identified from this study. The four main themes were 1) Parents' emotion; 2) Parental knowledge; 3) Others; 4) Profesional services. Challenges that parents faced often include emotional behaviours such as feeling guilty and devastated during the diagnosis, lack of information-sharing from healthcare givers, lack of knowledge on childhood hearing loss among parents, support from families, seek for a second opinion, worry about others' acceptance, longer time for diagnosis to confirm, late referral to other related profesionals and no priority for the appointment., Conclusion: Emotion is identified as the biggest challenge faced by parents in the process of diagnosis for their children with hearing loss. Hence, management of parental emotion needs to be emphasized by health profesionals as it influences the acceptance of parents towards their child's diagnosis., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Tinnitus is a condition which is often seen coexisting with hearing loss. In many persons with tinnitus, the use of amplification devices has been reported to show improvement in difficulties due to tinnitus. Though the underlying physiological mechanism is not clearly understood, hearing aids have proven beneficial. The aim of the study is to evaluate the benefit of the hearing aid in management of tinnitus. This study was conducted to assess whether such claims are true and, if so, what is the quantum of such benefit. In order to ascertain this, we studied the effects of three commonly used newer designs of digital programmable hearing aids namely, (i) Hearing aids with Basic programming, D-Basic (ii) those with tinnitus specific programming, DTS and (iii) those with in-built masking facility, DIM. In this study 108 subjects (65 males and 43 females), in the age range of 18 to 81 years were included. Each subject was fitted with one of the above mentioned three types of hearing aids, by qualified audiologists, purely on clinical grounds. All the subjects showed improvement in their hearing. The efficacy of the hearing aids, in mitigating the tinnitus, was assessed by employing the Tinnitus Handicap Inventory - THI. The THI has been developed by Newman et al in 1996 to study the effects of tinnitus, comprehensively under three domains viz. functional, emotional and catastrophic domains. A reduction in the THI scores indicates improvement. This tool is very popular and is acclaimed worldwide. It had been translated into several languages. In this study, the translated Telugu language version (THIT) of THI was used. The use of the local language (Telugu) afforded easy comprehension and better reliability. In each subject, we documented the THIT scores, before fitting of hearing aid and after two months of proper usage of the hearing aids. In the entire sample population of 108 subjects, across all the three different designtypes of hearing aids, we found a mean reduction of 42.6 points in the THIT scores. When the design of hearing aid was taken into reckoning, the mean post-fitting reduction of THIT scores in the subjects fitted with D-Basic, DTS, DIM hearing aids were 32.2, 43.5 and 51.9 respectively. In all the three designs, several subjects, those who were in a worse grade of tinnitus severity category of tinnitus severity before fitting, improved to a better grade after fitting. Further, we studied relief in the domain sub scales of the THIT viz. functional, emotional and the catastrophic domains. While all the three designs gave over-all relief of tinnitus, we found differences in the domain sub scales. However, designs with the In built maskers and tinnitus specific programming fared better. The conclusion drawn from our study is that, apart from the amplification benefit, all the three types of digital programmable hearing aids provided appreciable mitigation of tinnitus. Among the three design-types, hearing aids with inbuilt masker (DIM) were found to give the best benefit. Hearing aids with tinnitus specific programming (DTS) were the second best.

Background: To evaluate the effect of frequency-shifting techniques recently used in hearing aids for speech discrimination scores and hearing thresholds., Methods: Thirty individuals (16 men and 14 women) with sensorineural hearing loss who used normal fitting monaural hearing aids and frequency-shifting feature for at least 2 months and whose 4000-8000 Hz hearing threshold was over 70 dB participated. The average age was 69.73 ± 10 (range: 65-80 years). We detected the types and degree of each participant's hearing loss. Measurements with and without hearing aids were made in a free field. For speech discrimination scores, 6 listings consisting of 25 monosyllables have been used. It has been avoided to learn words thanks to presentation of words in different listings to subjects., Results: Pure-tone averages of the participants were measured using a supra-aural headphone, normal fitting hearing aid, and frequency-shifting feature. The results were 55.93 ± 6.89, 40.47 ± 5.48, and 36.73 ± 5.72 dB, respectively (p˂0.05). Speech discrimination scores for hearing aids worn on the right ear were measured as 67.73 ± 12.42%, 77.33 ± 10.33%, and 82.13 ± 10.46% with supra-aural headphones, normal fitting hearing aids, and frequency-shifting feature, respectively. Scores for hearing aids worn on the left ear were 68 ± 7.56%, 76.80 ± 6.96%, and 82.13 ± 6.67% with supra-aural headphone, normal fitting hearing aid, and frequency-shifting feature, respectively (p˂0.05)., Conclusion: Elderly individuals using hearing aids had low speech discrimination scores. The frequency-shifting feature recently used in hearing aids significantly increased the scores, making a significant contribution to the solution of speech reception and communication problems in cases of high-frequency hearing loss caused by presbyacusis in elderly individuals..

Direct drive hearing devices, which deliver a signal directly to the middle ear by vibrating the tympanic membrane via a lens placed in contact with the umbo, are designed to provide an extension of audible bandwidth, but there are few studies of the effects of these devices on preference, speech intelligibility, and loudness. The current study is the first to compare aided speech understanding between narrow and extended bandwidth conditions for listeners with hearing loss while fitted with a direct drive hearing aid system. The study also explored the effect of bandwidth on loudness perception and investigated subjective preference for bandwidth. Fifteen adult hearing aid users with symmetrical sensorineural hearing loss participated in a prospective, within-subjects, randomized single-blind repeated-measures study. Participants wore the direct drive hearing aids for 4 to 15 weeks (average 6 weeks) prior to outcome measurement. Outcome measures were completed in various bandwidth conditions achieved by reducing the gain of the device above 5000 Hz or by filtering the stimuli. Aided detection thresholds provided evidence of amplification to 10000 Hz. A significant improvement was found in high-frequency consonant detection and recognition, as well as for speech in noise performance in the full versus narrow bandwidth conditions. Subjective loudness ratings increased with provision of the full bandwidth available; however, real-world trials showed most participants were able to wear the full bandwidth hearing aids with only small adjustments to the prescription method. The majority of participants had either no preference or a preference for the full bandwidth setting.

The Aim of the Study: To assess speech recognition in users of mono- and binaural hearing aids (HA) with dynamic environment control system (DECS)., Material and Methods: 25 HA users with symmetrical bilateral moderate to severe sensorineural hearing loss and 10 individuals with normal hearing underwent speech audiometry in a free sound field by listening to an adaptive Russian matrix sentence test with a background noise. The testing was conducted for hearing impaired patients with one and two HA. The Speech Recognition Thresholds in noise (SRT N ) using HA with DESC and using HA without DESC were compared. The dichotic digits test and the rapidly alternating speech perception test were performed to evaluate the central auditory system function., Results: The SRT N in normal hearing listeners was -16.4±1.9 dB SNR. In the case of monaural using HA without DESC the SRT N was -2.5±4.4 dB SNR, using HA with DESC it was -5.8±4.0 dB SNR; in the case of using binaural HAs it was -6.3±3.8 dB SNR and -9.9±3.1 dB SNR accordingly., Conclusions: HAs with Dynamic Environment Control System are highly effective for speech perception in noisy environments. Binaural HA use is more effective than monaural HA use regardless of HA model. Speech recognition in noisy environments in cases of binaural HA use correlates significantly with results of tests assessing the central auditory system function.

Single microphone noise reduction (NR) in hearing aids can provide a subjective benefit even when there is no objective improvement in speech intelligibility. A possible explanation lies in a reduction of listening effort. Previously, we showed that response times (a proxy for listening effort) to an auditory-only dual-task were reduced by NR in normal-hearing (NH) listeners. In this study, we investigate if the results from NH listeners extend to the hearing-impaired (HI), the target group for hearing aids. In addition, we assess the relevance of the outcome measure for studying and understanding listening effort. Twelve HI subjects were asked to sum two digits of a digit triplet in noise. We measured response times to this task, as well as subjective listening effort and speech intelligibility. Stimuli were presented at three signal-to-noise ratios (SNR; -5, 0, +5 dB) and in quiet. Stimuli were processed with ideal or nonideal NR, or unprocessed. The effect of NR on response times in HI listeners was significant only in conditions where speech intelligibility was also affected (-5 dB SNR). This is in contrast to the previous results with NH listeners. There was a significant effect of SNR on response times for HI listeners. The response time measure was reasonably correlated ( R 142  = 0.54) to subjective listening effort and showed a sufficient test-retest reliability. This study thus presents an objective, valid, and reliable measure for evaluating an aspect of listening effort of HI listeners.

Objective: To study the effectiveness of auditory training using virtual reality technologies in people with chronic sensorineural hearing loss in dynamics., Material and Methods: The study included 68 patients aged from 24 to 97 years (mean age 57.63±15.87 years) with latent hearing loss (hearing loss at high frequencies), I degree of hearing loss and its variations. Auditory training was carried out on the basis of the Diagnostic and Rehabilitation System for spatial and speech hearing based on virtual reality using various audiovisual scenarios ReviAudio and control of speech perception, spatial hearing and hearing quality using the SSQRus questionnaire., Results: A comparative analysis of the training results using the ReviAudio software revealed positive trends in the patient's response time and the patient's accuracy in determining the direction of the target signal, regardless of the symmetry and asymmetry of hearing loss. Patients with asymmetric hearing impairment observe an improvement in spatial hearing parameters, patients with symmetric hearing loss - speech perception and hearing quality, patients with latent hearing loss report an improvement in the quality of hearing. The auditory training is effective in individuals with mild chronic sensorineural hearing loss and in individuals with latent hearing loss as an adjunctive treatment.

The aim of this study was to evaluate the efficacy of dual compression for Mandarin-speaking hearing aid users. Dual compression combines fast and slow compressors operating simultaneously across all frequency channels. The study participants were 31 hearing aid users with symmetrical moderate-to-severe hearing loss, with a mean age of 67 years. A new pair of 20-channel behind-the-ear hearing aids (i.e., Phonak Bolero B90-P) was used during the testing. The results revealed a significant improvement in speech reception thresholds in noise when switching from fast-acting compression to dual compression. The sound quality ratings revealed that most listeners preferred dual compression to fast-acting compression for listening effort, listening comfort, speech clarity, and overall sound quality at +4 dB signal-to-noise ratio. These results are consistent with predictions based on the theoretical understanding of dual and fast-acting compression. However, whether these results can be generalized to other languages or other dual compression systems should be verified by future studies.

For hearing aid users to experience everyday benefit from their hearing aids, research, development, and fitting of hearing aids must be performed using evaluation methods that are indicative of everyday performance. These evaluations can take place both in peoples' ordinary lives and in laboratory settings. For the results of laboratory testing to be ecologically valid, the selected test scenarios must capture the essence of everyday listening. The present article discusses the selection of these laboratory test scenarios in three parts. Part 1 reviews prior research on the selection of everyday listening situations for laboratory testing and discusses realistic test scenarios as important research tools. Part 2 presents findings from an ecological momentary assessments study in which 19 experienced hearing aid users reported real-time auditory reality data, including their current listening activity and their current sound environment. Participants categorized their listening situations according to the common sound scenarios framework and rated how often each situation occurred, how important it was to hear well, and how difficult it was to hear in the situation. These ratings made it possible to filter the data according to three criteria (occurrence, importance, and difficulty). The filtered data could potentially be used for selecting laboratory test scenarios. Part 3 uses the data from Part 2 and data from the studies reviewed in Part 1 to broadly explore the test scenarios that various selection criteria lead to. Further, implementation of test scenarios in the laboratory, and the strengths and limitations of data collection methods for investigating auditory reality are briefly discussed. The article concludes with a summary of the collected study.

Objective: In the present study, we investigated whether varying the task difficulty of the Sentence-Final Word Identification and Recall (SWIR) Test has an effect on the benefit of noise reduction, as well as whether task difficulty predictability affects recall. The relationship between working memory and recall was examined., Design: Task difficulty was manipulated by varying the list length with noise reduction on and off in competing speech and speech-shaped noise. Half of the participants were informed about list length in advance. Working memory capacity was measured using the Reading Span., Study Sample: Thirty-two experienced hearing aid users with moderate sensorineural hearing loss., Results: Task difficulty did not affect the noise reduction benefit and task difficulty predictability did not affect recall. Participants may have employed a different recall strategy when task difficulty was unpredictable and noise reduction off. Reading Span scores positively correlated with the SWIR test. Noise reduction improved recall in competing speech., Conclusions: The SWIR test with varying list length is suitable for detecting the benefit of noise reduction. The correlation with working memory suggests that the SWIR test could be modified to be adaptive to individual cognitive capacity. The results on noise and noise reduction replicate previous findings.

Importance: Cochlear implants are a treatment option for individuals with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss (SNHL) who receive little or no benefit from hearing aids; however, cochlear implantation in adults is still not routine., Objective: To develop consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral SNHL., Design, Setting, and Participants: This study was a modified Delphi consensus process that was informed by a systematic review of the literature and clinical expertise. Searches were conducted in the following databases: (1) MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE, (2) Embase, and (3) the Cochrane Library. Consensus statements on cochlear implantation were developed using the evidence identified. This consensus process was relevant for the use of unilateral cochlear implantation in adults with severe, profound, or moderate sloping to profound bilateral SNHL. The literature searches were conducted on July 18, 2018, and the 3-step Delphi consensus method took place over the subsequent 9-month period up to March 30, 2019., Main Outcomes and Measures: A Delphi consensus panel of 30 international specialists voted on consensus statements about cochlear implantation, informed by an SR of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience. A modified 3-step Delphi consensus method was used to vote on and refine the consensus statements. This method consisted of 2 rounds of email questionnaires and a face-to-face meeting of panel members at the final round. All consensus statements were reviewed, discussed, and finalized at the face-to-face meeting., Results: In total, 6492 articles were identified in the searches of the electronic databases. After removal of duplicate articles, 74 articles fulfilled all of the inclusion criteria and were used to create the 20 evidence-based consensus statements. These 20 consensus statements on the use of unilateral cochlear implantation in adults with SNHL were relevant to the following 7 key areas of interest: level of awareness of cochlear implantation (1 consensus statement); best practice clinical pathway from diagnosis to surgery (3 consensus statements); best practice guidelines for surgery (2 consensus statements); clinical effectiveness of cochlear implantation (4 consensus statements); factors associated with postimplantation outcomes (4 consensus statements); association between hearing loss and depression, cognition, and dementia (5 consensus statements); and cost implications of cochlear implantation (1 consensus statement)., Conclusions and Relevance: These consensus statements represent the first step toward the development of international guidelines on best practices for cochlear implantation in adults with SNHL. Further research to develop consensus statements for unilateral cochlear implantation in children, bilateral cochlear implantation, combined electric-acoustic stimulation, unilateral cochlear implantation for single-sided deafness, and asymmetrical hearing loss in children and adults may be beneficial for optimizing hearing and quality of life for these patients.

Objective: In contrast to the past, some current hearing aids can provide gain for frequencies above 4-5 kHz. This study assessed the effect of wider bandwidth on outcome measures using hearing aids fitted with the DSL v5.0 prescription. Design: There were two conditions: an extended bandwidth condition, for which the maximum available bandwidth was provided, and a restricted bandwidth condition, in which gain was reduced for frequencies above 4.5 kHz. Outcome measures were assessed in both conditions. Study sample: Twenty-four participants with mild-to-moderately-severe sensorineural high-frequency sloping hearing loss. Results: Providing extended bandwidth resulted in maximum audible output frequency values of 7.5 kHz on average for an input level of 65 dB SPL. An improvement in consonant discrimination scores (4.1%), attributable to better perception of /s/, /z/, and /t/ phonemes, was found in the extended bandwidth condition, but no significant change in loudness perception or preferred listening levels was found. Most listeners (79%) had either no preference (33%) or some preference for the extended bandwidth condition (46%). Conclusions: The results suggest that providing the maximum bandwidth available with modern hearing aids fitted with DSL v5.0, using targets from 0.25 to 8 kHz, can be beneficial for the tested population.

Introduction: The clinical implications of single-sided deafness (SSD) in children has historically been underappreciated by patients and providers alike, despite a large body of literature on the wide-ranging neurocognitive, language, scholastic, and functional impairments that occur. Conventional amplification options are marked by variable results and frequent loss of follow-up., Methods: Retrospective case series for pediatric SSD from 2008 to 2018., Results: 88 children with congenital SSD were identified. Seventeen (N = 17/88, 23.9%) passed their newborn hearing screen. Median age at first otolaryngology evaluation was 0.65 years (range 0.1-16.9 years). Most common etiologies included cochlear nerve deficiency (N = 39, CND, 44.3%), unknown (N = 30, 35.2%), inner ear malformation (N = 7, 8.0%), and congenital cytomegalovirus (N = 6, 6.8%). 32.5% of patients elected for continued observation only, followed by bone conduction hearing aid (27.7%), contralateral routing of sound aid (20.5%), conventional hearing aid (13.3%), or cochlear implant (6%). Lack of follow-up at ≥1 year was common (39.8%). Of those with device use data (N = 39), 84.7% reported either discontinued or <6 h of daily use., Conclusions: Despite early diagnosis and evaluation, the pediatric SSD cohort is characterized by high rates of loss of follow-up and amplification discontinuation. Cochlear nerve deficiency is commonly seen in congenital SSD. Early specialist referral is critical for habilitation evaluation. Patients and caregivers should be educated on the significant implications of unilateral hearing loss., Competing Interests: Declaration of competing interest No relevant conflict of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The use of a large number of amplitude-compression channels in hearing aids has potential advantages, such as the ability to compensate for variations in loudness recruitment across frequency and provide appropriate frequency-response shaping. However, sound quality and speech intelligibility could be adversely affected due to reduction of spectro-temporal contrast and distortion, especially when fast-acting compression is used. This study assessed the effect of the number of channels and compression speed on speech recognition when the multichannel processing was used solely to implement amplitude compression, and not for frequency-response shaping. Computer-simulated hearing aids were used. The frequency-dependent insertion gains for speech with a level of 65 dB sound pressure level were applied using a single filter before the signal was filtered into compression channels. Fast-acting (attack, 10 ms; release, 100 ms) or slow-acting (attack, 50 ms; release, 3000 ms) compression using 3, 6, 12, and 22 channels was applied subsequently. Using a sentence recognition task with speech in two- and eight-talker babble at three different signal-to-babble ratios (SBRs), 20 adults with sensorineural hearing loss were tested. The number of channels and compression speed had no significant effect on speech recognition, regardless of babble type or SBR.

Purpose: To establish the relationship between the performance on word recognition tasks, using words with and without sense and degree, and the configuration of hearing loss, by using Speech Inteligibility Index (SII) values as indicators, in children with hearing loss., Methods: SII were established for 55 and 65 Decibel of Sound Pressure Level (dB SPL) input sounds of ten children presenting bilateral sensorineural hearing loss (SNHL), adapted with bilateral hearing aids, and who have oral language as the main mode of communication. The children were submitted to a word and nonsense-word repetition task of two or three intensity degrees. Their productions were analyzed according to the Word Association for Syllable Perception (WASP) Protocol. In the data analysis, the values of SII were compared with the results obtained in each analysis criterion., Results: Pertaining to the words, there was statistically significant difference between the two types of stimuli in 55 dBSPL. As for the performance of consonants and point of articulation, there was a statistically significant difference between stimuli types in 65 and 55 dB SPL, and between intensities 65 and 55 dB SPL in nonsense words., Conclusion: Overall, there was no regularity in the relationship between hearing ability and performance in speech perception tasks. The results suggest that performance in the nonsense words recognition tasks was more related to intelligibility index than to words with meaning, possibly because it limits semantic closure strategies by the subject.

In common practice, hearing aids are fitted by a clinician who measures an audiogram and uses it to generate prescriptive gain and output targets. This report describes an alternative method where users select their own signal processing parameters using an interface consisting of two wheels that optimally map to simultaneous control of gain and compression in each frequency band. The real-world performance of this approach was evaluated via a take-home field trial. Participants with hearing loss were fitted using clinical best practices (audiogram, fit to target, real-ear verification, and subsequent fine tuning). Then, in their everyday lives over the course of a month, participants either selected their own parameters using this new interface (Self group; n = 38) or used the parameters selected by the clinician with limited control (Audiologist Best Practices Group; n = 37). On average, the gain selected by the Self group was within 1.8 dB overall and 5.6 dB per band of that selected by the audiologist. Participants in the Self group reported better sound quality than did those in the Audiologist Best Practices group. In blind sound quality comparisons conducted in the field, participants in the Self group slightly preferred the parameters they selected over those selected by the clinician. Finally, there were no differences between groups in terms of standard clinical measures of hearing aid benefit or speech perception in noise. Overall, the results indicate that it is possible for users to select effective amplification parameters by themselves using a simple interface that maps to key hearing aid signal processing parameters.

Objective: To assess quality of life (QOL) in pediatric patients with sensorineural hearing loss (SNHL) with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) and the Hearing Environments and Reflection on Quality of Life 26 (HEAR-QL-26) and HEAR-QL-28 surveys., Study Design: Prospective longitudinal study., Setting: Tertiary care center., Subjects and Methods: Surveys were administered to patients with SNHL (ages 2-18 years) from July 2016 to December 2018 at a multidisciplinary hearing loss clinic. Patients aged >7 years completed the HEAR-QL-26, HEAR-QL-28, and PedsQL 4.0 self-report tool, while parents completed the PedsQL 4.0 parent proxy report for children aged ≤7 years. Previously published data from children with normal hearing were used for controls. The independent t test was used for analysis., Results: In our cohort of 100 patients, the mean age was 7.7 years (SD, 4.5): 62 participants had bilateral SNHL; 63 had mild to moderate SNHL; and 37 had severe to profound SNHL. Sixty-eight patients used a hearing device. Mean (SD) total survey scores for the PedsQL 4.0 (ages 2-7 and 8-18 years), HEAR-QL-26 (ages 7-12 years), and HEAR-QL-28 (ages 13-18 years) were 83.9 (14.0), 79.2 (11.1), 81.2 (9.8), and 77.5 (11.3), respectively. Mean QOL scores for patients with SNHL were significantly lower than those for controls on the basis of previously published normative data ( P < .0001). There was no significant difference in QOL between children with unilateral and bilateral SNHL or between children with SNHL who did and did not require a hearing device. Low statistical power due to small subgroup sizes limited our analysis., Conclusion: It is feasible to collect QOL data from children with SNHL in a hearing loss clinic. Children with SNHL had significantly lower scores on validated QOL instruments when compared with peers with normal hearing.

Trainable hearing aids let users fine-tune their hearing aid settings in their own listening environment: Based on consistent user-adjustments and information about the acoustic environment, the trainable aids will change environment-specific settings to the user's preference. A requirement for effective fine-tuning is consistency of preference for similar settings in similar environments. The aim of this study was to evaluate consistency of preference for settings differing in intensity, gain-frequency slope, and directionality when listening in simulated real-world environments and to determine if participants with more consistent preferences could be identified based on profile measures. A total of 52 adults (63-88 years) with hearing varying from normal to a moderate sensorineural hearing loss selected their preferred setting from pairs differing in intensity (3 or 6 dB), gain-frequency slope (±1.3 or ± 2.7 dB/octave), or directionality (omnidirectional vs. cardioid) in four simulated real-world environments: traffic noise, a monologue in traffic noise at 5 dB signal-to-noise ratio, and a dialogue in café noise at 5 and at 0 dB signal-to-noise ratio. Forced-choice comparisons were made 10 times for each combination of pairs of settings and environment. Participants also completed nine psychoacoustic, cognitive, and personality measures. Consistency of preference, defined by a setting preferred at least 9 out of 10 times, varied across participants. More participants obtained consistent preferences for larger differences between settings and less difficult environments. The profile measures did not predict consistency of preference. Trainable aid users could benefit from counselling to ensure realistic expectations for particular adjustments and listening situations.

Effective hearing aid (HA) rehabilitation requires personalization of the HA fitting parameters, but in current clinical practice only the gain prescription is typically individualized. To optimize the fitting process, advanced HA settings such as noise reduction and microphone directionality can also be tailored to individual hearing deficits. In two earlier studies, an auditory test battery and a data-driven approach that allow classifying hearing-impaired listeners into four auditory profiles were developed. Because these profiles were found to be characterized by markedly different hearing abilities, it was hypothesized that more tailored HA fittings would lead to better outcomes for such listeners. Here, we explored potential interactions between the four auditory profiles and HA outcome as assessed with three different measures (speech recognition, overall quality, and noise annoyance) and six HA processing strategies with various noise reduction, directionality, and compression settings. Using virtual acoustics, a realistic speech-in-noise environment was simulated. The stimuli were generated using a HA simulator and presented to 49 habitual HA users who had previously been profiled. The four auditory profiles differed clearly in terms of their mean aided speech reception thresholds, thereby implying different needs in terms of signal-to-noise ratio improvement. However, no clear interactions with the tested HA processing strategies were found. Overall, these findings suggest that the auditory profiles can capture some of the individual differences in HA processing needs and that further research is required to identify suitable HA solutions for them.

Objective: To identify clinical variables associated with the decision to surgically discontinue bone-anchored hearing device function., Study Design: Retrospective chart review., Setting: Tertiary neurotology referral center., Subjects and Methods: This study examines surgical interventions performed on existing bone-anchored hearing devices at a single institution from 2008 to 2018. Patient characteristics, indications for implantation, and complications prompting surgical intervention were assessed., Results: Seventy-seven cases were included in this study. Among patients in the younger cohort (<37 years old), 100% (13 of 13) of those discontinuing their device had a contralateral normal-hearing ear. Conversely, 0% (0 of 14) of the younger patients with bilateral hearing loss surgically discontinued their devices. Within the older cohort (≥37 years old), female patients ( P = .002) and those with an increased body mass index ( P = .035) were more likely to surgically discontinue their devices. Multivariate analysis revealed that a contralateral normal-hearing ear ( P = .001) and infection without soft tissue overgrowth of the abutment ( P = .026) were the strongest predictors of device discontinuation, after adjusting for potential confounders., Conclusion: Surgical discontinuation is associated with several clinical variables. Targeted interventions that are viable alternatives to removal, such as device relocation, should be presented to younger patients with a contralateral normal-hearing ear who experience persistent complications. Patients with persistent infection in the absence of soft tissue overgrowth would especially benefit from enhanced counseling on proper hygiene.

While listening to recorded sentences with a sound-field level of 65 dB SPL, 24 adults with hearing-aid experience used the "Goldilocks" explore-and-select procedure to adjust level and spectrum of amplified speech to preference. All participants started adjustment from the same generic response. Amplification was provided by a custom-built Master Hearing Aid with online processing of microphone input. Primary goals were to assess the effects of including a formal speech-perception test between repeated self-adjustments and of adding multitalker babble (signal-to-noise ratio +6 dB) during self-adjustment. The speech test did not affect group-mean self-adjusted output, which was close to the National Acoustics Laboratories' prescription for Non-Linear hearing aids. Individuals, however, showed a wide range of deviations from this prescription. Extreme deviations at the first self-adjustment fell by a small but significant amount at the second. The multitalker babble had negligible effect on group-mean self-selected output but did have predictable effects on word recognition in sentences and on participants' opinion regarding the most important subjective criterion guiding self-adjustment. Phoneme recognition in monosyllabic words was better with the generic starting response than without amplification and improved further after self-adjustment. The findings continue to support the efficacy of hearing aid self-fitting, at least for level and spectrum. They do not support the need for inclusion of a formal speech-perception test, but they do support the value of completing more than one self-adjustment. Group-mean data did not indicate a need for threshold-based prescription as a starting point for self-adjustment.

Studies of the recent years are devoted to using the auditory steady-state responses (ASSR) as an evaluation method of amplification outcomes. In this case stimulation is performed in the sound field via loudspeaker with a hearing aid (HA) in patient's ear., Goal: Estimation the optimal stimulation parameters of ASSR in free field, which provide maximum correlation with behavioral thresholds., Materials and Methods: 26 subjects were included in the study: 10 with normal hearing (4 adults and 6 children) and 16 children (1-16 years old) with sensorineural hearing loss (SNHL). Aided and unaided ASSR thresholds were compared with corresponding behavioral thresholds (BT). All recordings were conducted in free sound field. We used mono-frequency stimulation method at 500-4000 Hz career frequencies. Modulation frequency was set as 40 Hz. Types of stimuli modulation: AM/FM modulation, exponential modulation (AM 2 ), three carrier frequencies and modulated Chirp-tone (Chirp)., Results: In normal hearing subjects the difference between ASSR and BT varied from 0 dB to 35 dB, and the significant correlation between them was observed ( p <0.05). The maximum difference between ASSR and BT in children with SNHL was at 500 Hz (15.6±4.3 dB), minimum - at 2 and 4 kHz (8±2.9 dB and 7±3 dB respectively). In aided condition maximum difference was detected at 500 Hz (10.2±3.8 dB), minimum - at 1 and 2 kHz (7.8±2.8 and 7.3±3.1 dB respectively). We got significantly less difference between ASSR and BT in all test conditions using following types of stimuli: at 500 Hz and 1000 Hz - AM 2 ( p <0.01); at 2 and 4 kHz - Chirp ( p <0.05 and p <0.01 respectively). Thereby, free field ASSR might be used as an objective method of evaluation the amplification outcomes in children with SNHL.

Introduction: Hearing loss is a common chronic problem which can be effectively managed with hearing devices. At present, only a limited number of people with hearing loss use hearing aids (HAs) and cochlear implants (CIs) to improve hearing and sound quality and enhance quality of life. Clinical equipoise, by which we mean healthcare professional uncertainty about which treatment options are the most efficacious due to the lack of evidence-based information, can lead to inconsistent and poorly informed referral processes for hearing devices.A randomised controlled trial (RCT) that offers high-quality, generalisable information is needed to clarify which hearing device (HA or CI) is more suitable for different degrees of hearing loss and for which kinds of patients. Qualitative research can improve this RCT, by gathering the information on patient and provider perspectives, attitudes and values, which can inform design, conduct and information dissemination, either during preparatory stages of an intervention, or as a fully integrated methodology. The Comparison of Outcomes with hearing Aids and Cochlear implants in adults with moderately severe-to-profound bilateral sensorineural Hearing loss (COACH) study is being planned as an RCT with a qualitative arm (the qualitative COACH study, q-COACH), acting as a pretrial intervention examining views of HAs, CIs, equipoise and the impetus for an RCT of this nature., Methods and Analysis: The q-COACH study involves semistructured interviews and a demographic questionnaire which will be collected from four participant cohorts: General Practitioners (GPs) and Ear, Nose and Throat Surgeons (ENTs); audiologists; adult HA users and their support networks. Data will be analysed thematically and through descriptive statistics., Ethics and Dissemination: Macquarie University Human Research Ethics Committee, Australia, granted ethical approval (no. 5201833514848). Peer-reviewed journal articles, research conferences and a final report will present study findings., Competing Interests: Competing interests: CW is an employee of Cochlear Ltd and will, therefore, not be involved in the data collection, data analysis and reporting of the study findings. Would like to assure readers that no bias has taken place within this study and all employees of Cochlear Ltd were excluded from the data collection, analysis or reporting of results. In his capacity as Clinical Studies Research Manager at Cochlear Ltd, CW contributed to the research design to ensure that its general purpose would support the development of the COACH study and that research questions (which were not proposed by Cochlear) were consistent and appropriate for the COACH RCT. Given CW’s valuable contributions to this aspect of oversight it would be unethical for the team to exclude CW as an author. As experienced qualitative researchers, FR and EA ensured that the design of this qualitative study was not driven by an industry agenda in any way. For example, both FR and EA drafted the interview questions and ensured that the final interview schedule was not leading or contained assumptions pertaining to industry. Also, during the interviews, EA made it clear to all participants that she was not an employee of Cochlear Ltd and was only concerned with understanding participants’ genuine responses to hearing loss, hearing services and the proposed COACH study. Moreover, any attempts to influence participants towards a favourable perspective of Cochlear Implants or the proposed design would be counterproductive to the purpose of the research. That is, we are not seeking complete validation of the proposed COACH study, rather we are interested in the genuine response of a variety of stakeholders to the proposed COACH study in order to determine which aspects of the study are acceptable to stakeholders and why, as well whether the proposed study will need to be altered or improved on., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To assess the speech perception benefits of binaural streaming technology for bilateral hearing aid users in two difficult listening conditions., Design: Two studies were conducted to compare hearing aid processing features relating to telephone use and wind noise. Speech perception testing was conducted in four different experimental conditions in each study., Study Sample: Ten bilaterally-aided children in each study., Results: Significant improvements in speech perception were obtained with a wireless feature for telephone use. Significant speech perception benefits were also obtained with wireless hearing aid features when listening to speech in simulated wind noise., Conclusions: Binaural signal processing algorithms can significantly improve speech perception for bilateral hearing aid users in challenging listening situations.