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Background Ecological momentary assessment (EMA) is a methodology involving repeated surveys to collect in-situ self-reports that describe respondents' current or recent experiences. Audiology literature comparing in-situ and retrospective self-reports is scarce.Purpose To compare the sensitivity of in-situ and retrospective self-reports in detecting the outcome difference between hearing aid technologies, and to determine the association between in-situ and retrospective self-reports.Research Design An observational study.Study Sample Thirty-nine older adults with hearing loss.Data Collection and Analysis The study was part of a larger clinical trial that compared the outcomes of a prototype hearing aid (denoted as HA1) and a commercially available device (HA2). In each trial condition, participants wore hearing aids for 4 weeks. Outcomes were measured using EMA and retrospective questionnaires. To ensure that the outcome data could be directly compared, the Glasgow Hearing Aid Benefit Profile was administered as an in-situ self-report (denoted as EMA-GHABP) and as a retrospective questionnaire (retro-GHABP). Linear mixed models were used to determine if the EMA- and retro-GHABP could detect the outcome difference between HA1 and HA2. Correlation analyses were used to examine the association between EMA- and retro-GHABP.Results For the EMA-GHABP, HA2 had significantly higher (better) scores than HA1 in the GHABP subscales of benefit, residual disability, and satisfaction (p = 0.029–0.0015). In contrast, the difference in the retro-GHABP score between HA1 and HA2 was significant only in the satisfaction subscale (p = 0.0004). The correlations between the EMA- and retro-GHABP were significant in all subscales (p = 0.0004 to Conclusion The study suggests that in-situ self-reports collected using EMA could have a higher sensitivity than retrospective questionnaires. Therefore, EMA is worth considering in clinical trials that aim to compare the outcomes of different hearing aid technologies. The weak to moderate association between in-situ and retrospective self-reports suggests that these two types of measures assess different aspects of hearing aid outcomes.

For both normal listeners and mild to moderately sensori-neurally impaired (probable etiology, presbycusis) listeners a summation of discomfort (S) occurs for complex stimuli, proportional to the logarithm of the number of components. Regression equations of S = 2.05 + 11.51 log n for normals and S = 3.95 + 12.88 log n for hearing impaired (where n equals the number of components or bandwidth in the complex) were found to be significantly different. This change in percept with increased bandwidth (or components) has not been satisfactorily explained in terms of power or amplitude peak density of the stimuli. The regression equations could be applied to future digital hearing aids so that maximum output levels (MPO) would account for this summation.

Auditory environments can influence the communication function of individuals with hearing loss and the effects of hearing aids. Therefore, a tool that can objectively characterize a patient’s real-world auditory environments is needed.To use the Language Environment Analysis (LENA) system to quantify the auditory environments of adults with hearing loss, to examine if the use of hearing aids changes a user’s auditory environment, and to determine the association between LENA variables and self-report hearing aid outcome measures.This study used a crossover design.Participants included 22 adults with mild-to-moderate hearing loss, age 64–82 yr.Participants were fitted with bilateral behind-the-ear hearing aids from a major manufacturer.The LENA system consists of a digital language processor (DLP) that is worn by an individual and records up to 16 hr of the individual’s auditory environment. The recording is then automatically categorized according to time spent in different types of auditory environments (e.g., meaningful speech and TV/electronic sound) by the LENA algorithms. The LENA system also characterizes the user’s auditory environment by providing the sound levels of different auditory categories. Participants in the present study wore a LENA DLP in an unaided condition and aided condition, which each lasted six to eight days. Participants wore bilateral hearing aids in the aided condition. Percentage of time spent in each auditory environment, as well as median levels of TV/electronic sounds and speech, were compared between subjects’ unaided and aided conditions using paired sample t tests. LENA data were also compared to self-report measures of hearing disability and hearing aid benefit using Pearson correlations.Overall, participants spent the greatest percentage of time in silence (∼40%), relative to other auditory environments. Participants spent ∼12% and 26% of their time in meaningful speech and TV/electronic sound environments, respectively. No significant differences were found between mean percentage of time spent in each auditory environment in the unaided and aided conditions. Median TV/electronic sound levels were on average 2.4 dB lower in the aided condition than in the unaided condition; speech levels were not significantly different between the two conditions. TV/electronic sound and speech levels did not significantly correlate with self-report data.The LENA system can provide rich data to characterize the everyday auditory environments of older adults with hearing loss. Although TV/electronic sound level was significantly lower in the aided than unaided condition, the use of hearing aids seemed not to substantially change users’ auditory environments. Because there is no significant association between objective LENA variables and self-report questionnaire outcomes, these two types of measures may assess different aspects of communication function. The feasibility of using LENA in clinical settings is discussed.

The existence of binaural interference, defined here as poorer speech recognition with both ears than with the better ear alone, is well documented. Studies have suggested that its prevalence may be higher in the elderly population. However, no study to date has explored binaural interference in groups of younger and older adults in conditions that favor binaural processing (i.e., in spatially separated noise). Also, the effects of hearing loss have not been studied.To examine binaural interference through speech perception tests, in groups of younger adults with normal hearing, older adults with normal hearing for their age, and older adults with hearing loss.A cross-sectional study.Thirty-three participants with symmetric thresholds were recruited from the University of Iowa community. Participants were grouped as follows: younger with normal hearing (18–28 yr, n = 12), older with normal hearing for their age (73–87 yr, n = 9), and older with hearing loss (78–94 yr, n = 12). Prior noise exposure was ruled out.The Connected Speech Test (CST) and Hearing in Noise Test (HINT) were administered to all participants bilaterally, and to each ear separately. Test materials were presented in the sound field with speech at 0° azimuth and the noise at 180°. The Dichotic Digits Test (DDT) was administered to all participants through earphones. Hearing aids were not used during testing. Group results were compared with repeated measures and one-way analysis of variances, as appropriate. Within-subject analyses using pre-established critical differences for each test were also performed.The HINT revealed no effect of condition (individual ear versus bilateral presentation) using group analysis, although within-subject analysis showed that 27% of the participants had binaural interference (18% had binaural advantage). On the CST, there was significant binaural advantage across all groups with group data analysis, as well as for 12% of the participants at each of the two signal-to-babble ratios (SBRs) tested. One participant had binaural interference at each SBR. Finally, on the DDT, a significant right-ear advantage was found with group data, and for at least some participants. Regarding age effects, more participants in the pooled elderly groups had binaural interference (33.3%) than in the younger group (16.7%), on the HINT. The presence of hearing loss yielded overall lower scores, but none of the comparisons between bilateral and unilateral performance were affected by hearing loss.Results of within-subject analyses on the HINT agree with previous findings of binaural interference in ≥17% of listeners. Across all groups, a significant right-ear advantage was also seen on the DDT. HINT results support the notion that the prevalence of binaural interference is likely higher in the elderly population. Hearing loss, however, did not affect the differences between bilateral and better unilateral scores. The possibility of binaural interference should be considered when fitting hearing aids to listeners with symmetric hearing loss. Comparing bilateral to unilateral (unaided) performance on tests such as the HINT may provide the clinician with objective data to support subjective preference for one hearing aid as opposed to two.

Purpose This study evaluated whether certain spectral ripple conditions were more informative than others in predicting ecologically relevant unaided and aided speech outcomes. Method A quasi-experimental study design was used to evaluate 67 older adult hearing aid users with bilateral, symmetrical hearing loss. Speech perception in noise was tested under conditions of unaided and aided, auditory-only and auditory–visual, and 2 types of noise. Predictors included age, audiometric thresholds, audibility, hearing aid compression, and modulation depth detection thresholds for moving (4-Hz) or static (0-Hz) 2-cycle/octave spectral ripples applied to carriers of broadband noise or 2000-Hz low- or high-pass filtered noise. Results A principal component analysis of the modulation detection data found that broadband and low-pass static and moving ripple detection thresholds loaded onto the first factor whereas high-pass static and moving ripple detection thresholds loaded onto a second factor. A linear mixed model revealed that audibility and the first factor (reflecting broadband and low-pass static and moving ripples) were significantly associated with speech perception performance. Similar results were found for unaided and aided speech scores. The interactions between speech conditions were not significant, suggesting that the relationship between ripples and speech perception was consistent regardless of visual cues or noise condition. High-pass ripple sensitivity was not correlated with speech understanding. Conclusions The results suggest that, for hearing aid users, poor speech understanding in noise and sensitivity to both static and slow-moving ripples may reflect deficits in the same underlying auditory processing mechanism. Significant factor loadings involving ripple stimuli with low-frequency content may suggest an impaired ability to use temporal fine structure information in the stimulus waveform. Support is provided for the use of spectral ripple testing to predict speech perception outcomes in clinical settings.

Background: Ecological momentary assessment (EMA) is a methodology involving repeated assessments/surveys to collect data describing respondents’ current or very recent experiences and related contexts in their natural environments. The use of EMA in audiology research is growing. Purpose: This study examined the construct validity (i.e., the degree to which a measurement reflects what it is intended to measure) of EMA in terms of measuring speech understanding and related listening context. Experiment 1 investigated the extent to which individuals can accurately report their speech recognition performance and characterize the listening context in controlled environments. Experiment 2 investigated whether the data aggregated across multiple EMA surveys conducted in uncontrolled, real-world environments would reveal a valid pattern that was consistent with the established relationships between speech understanding, hearing aid use, listening context, and lifestyle. Research Design: This is an observational study. Study Sample: Twelve and twenty-seven adults with hearing impairment participated in Experiments 1 and 2, respectively. Data Collection and Analysis: In the laboratory testing of Experiment 1, participants estimated their speech recognition performance in settings wherein the signal-to-noise ratio was fixed or constantly varied across sentences. In the field testing the participants reported the listening context (e.g., noisiness level) of several semicontrolled real-world conversations. Their reports were compared to (1) the context described by normal-hearing observers and (2) the background noise level measured using a sound level meter. In Experiment 2, participants repeatedly reported the degree of speech understanding, hearing aid use, and listening context using paper-and-pencil journals in their natural environments for 1 week. They also carried noise dosimeters to measure the sound level. The associations between (1) speech understanding, hearing aid use, and listening context, (2) dosimeter sound level and self-reported noisiness level, and (3) dosimeter data and lifestyle quantified using the journals were examined. Results: For Experiment 1, the reported and measured speech recognition scores were highly correlated across all test conditions (r = 0.94 to 0.97). The field testing results revealed that most listening context properties reported by the participants were highly consistent with those described by the observers (74–95% consistency), except for noisiness rating (58%). Nevertheless, higher noisiness rating was associated with higher background noise level. For Experiment 2, the EMA results revealed several associations: better speech understanding was associated with the use of hearing aids, front-located speech, and lower dosimeter sound level; higher noisiness rating was associated with higher dosimeter sound level; listeners with more diverse lifestyles tended to have higher dosimeter sound levels. Conclusions: Adults with hearing impairment were able to report their listening experiences, such as speech understanding, and characterize listening context in controlled environments with reasonable accuracy. The pattern of the data aggregated across multiple EMA surveys conducted in a wide range of uncontrolled real-world environment was consistent with the established knowledge in audiology. The two experiments suggested that, regarding speech understanding and related listening contexts, EMA reflects what it is intended to measure, supporting its construct validity in audiology research.

Objectives: Progress has been made in recent years in the provision of amplification and early intervention for children who are hard of hearing. However, children who use hearing aids (HAs) may have inconsistent access to their auditory environment due to limitations in speech audibility through their HAs or limited HA use. The effects of variability in children’s auditory experience on parent-reported auditory skills questionnaires and on speech recognition in quiet and in noise were examined for a large group of children who were followed as part of the Outcomes of Children with Hearing Loss study. Design: Parent ratings on auditory development questionnaires and children’s speech recognition were assessed for 306 children who are hard of hearing. Children ranged in age from 12 months to 9 years. Three questionnaires involving parent ratings of auditory skill development and behavior were used, including the LittlEARS Auditory Questionnaire, Parents Evaluation of Oral/Aural Performance in Children rating scale, and an adaptation of the Speech, Spatial, and Qualities of Hearing scale. Speech recognition in quiet was assessed using the Open- and Closed-Set Test, Early Speech Perception test, Lexical Neighborhood Test, and Phonetically Balanced Kindergarten word lists. Speech recognition in noise was assessed using the Computer-Assisted Speech Perception Assessment. Children who are hard of hearing were compared with peers with normal hearing matched for age, maternal educational level, and nonverbal intelligence. The effects of aided audibility, HA use, and language ability on parent responses to auditory development questionnaires and on children’s speech recognition were also examined. Results: Children who are hard of hearing had poorer performance than peers with normal hearing on parent ratings of auditory skills and had poorer speech recognition. Significant individual variability among children who are hard of hearing was observed. Children with greater aided audibility through their HAs, more hours of HA use, and better language abilities generally had higher parent ratings of auditory skills and better speech-recognition abilities in quiet and in noise than peers with less audibility, more limited HA use, or poorer language abilities. In addition to the auditory and language factors that were predictive for speech recognition in quiet, phonological working memory was also a positive predictor for word recognition abilities in noise. Conclusions: Children who are hard of hearing continue to experience delays in auditory skill development and speech-recognition abilities compared with peers with normal hearing. However, significant improvements in these domains have occurred in comparison to similar data reported before the adoption of universal newborn hearing screening and early intervention programs for children who are hard of hearing. Increasing the audibility of speech has a direct positive effect on auditory skill development and speech-recognition abilities and also may enhance these skills by improving language abilities in children who are hard of hearing. Greater number of hours of HA use also had a significant positive impact on parent ratings of auditory skills and children’s speech recognition.

To examine the impact of visual cues, speech materials, age and listening condition on the frequency bandwidth necessary for optimizing speech recognition performance.Using a randomized repeated measures design; speech recognition performance was assessed using four speech perception tests presented in quiet and noise in 13 LP filter conditions and presented in multimodalities. Participants' performance data were fitted with a Boltzmann function to determine optimal performance (10% below performance achieved in FBW).Thirty adults (18-63 years) and thirty children (7-12 years) with normal hearing.Visual cues significantly reduced the bandwidth required for optimizing speech recognition performance for listeners. The type of speech material significantly impacted the bandwidth required for optimizing performance. Both groups required significantly less bandwidth in quiet, although children required significantly more than adults. The widest bandwidth required was for the phoneme detection task in noise where children required a bandwidth of 7399 Hz and adults 6674 Hz.Listeners require significantly less bandwidth for optimizing speech recognition performance when assessed using sentence materials with visual cues. That is, the amount of bandwidth systematically decreased as a function of increased contextual, linguistic, and visual content.

To evaluate the impact of non-adaptive matched and mismatched gain reduction schemes on localization in spatially-separated noise.Inspired by the function of commercial noise reduction algorithms, five frequency-specific gain reduction filter schemes were created, three for a modulated babble-noise and two for an unmodulated speech-shaped noise. Applying these schemes as both matched and mismatched conditions across ears, localization of five everyday sounds in noise was measured in a virtual environment using insert earphones. The performance in the reference scheme (no gain reduction in either ear) was measured as well.Twenty-four adult bilateral hearing-aid users were enrolled in this study.One of the two mismatched gain reduction schemes for the unmodulated noise had a small but negative impact on localization compared to the reference scheme. For that scheme more high-frequency reduction was noted than for the other schemes. Matching gain reduction across ears restored the deteriorated localization performance. No localization performance differences were observed in the modulated babble-noise regardless of whether the scheme was matched or mismatched across ears.The impact of noise-induced gain reduction on localization in noise was trivial in the study regardless of whether gain reduction schemes were matched or not across ears.

Background: Self-report questionnaires are a frequently used method of evaluating hearing aid outcomes. Studies have shown that personality can account for 5–20% of the variance in response to self-report measures. As a result, these influences can impact results and limit their generalizability when the purpose of the study is to examine the technological merit of hearing aids. To reduce personality influences on self-report outcome data, the Device-Oriented Subjective Outcome (DOSO) was developed. The DOSO is meant to demonstrate outcomes of the amplification device relatively independent of the individual’s personality. Still, it is unknown if the DOSO achieves its original goal. Purpose: The purpose of this study was to examine the relationship between personality and the DOSO. The relationship between personality and several widely used hearing-related questionnaires was also examined. Research Design: This is a nonexperimental study using a correlational design. Study Sample: A total of 119 adult hearing aid wearers participated in the study. Data Collection and Analysis: The NEO Five-Factor Inventory was used to measure five personality traits (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). The initial (unaided) hearing disablement, residual (aided) hearing disablement, and hearing aid benefit and satisfaction was measured using the DOSO, Hearing Handicap Inventory for the Elderly/Adult, Abbreviated Profile of Hearing Aid Benefit, and Satisfaction with Amplification in Daily Life. The relationship between personality and each questionnaire was examined using a correlation analysis. Results: All of the DOSO subscales were found to be significantly correlated to personality, regardless of whether age and better-ear hearing thresholds were controlled. Individuals who reported poorer hearing aid outcomes tended to have higher Neuroticism scores, while those who scored higher in Extraversion, Openness, and Agreeableness were more likely to report better outcomes. Across DOSO subscales, the maximum variance explained by personality traits ranged from 6% to 11%. Consistent with the literature, ˜3–18% of the variance of other hearing-related questionnaires was attributable to personality. Conclusions: The degree to which personality affects the DOSO is similar to other hearing-related questionnaires. Although the variance accounted for by personality is not large, researchers and clinicians should not assume that the results of the DOSO are independent of personality.

Purpose This study evaluated the relationship between working memory (WM) and speech recognition in noise with different noise types as well as in the presence of visual cues. Method Seventy-six adults with bilateral, mild to moderately severe sensorineural hearing loss (mean age: 69 years) participated. Using a cross-sectional design, 2 measures of WM were taken: a reading span measure, and Word Auditory Recognition and Recall Measure (Smith, Pichora-Fuller, & Alexander, 2016). Speech recognition was measured with the Multi-Modal Lexical Sentence Test for Adults (Kirk et al., 2012) in steady-state noise and 4-talker babble, with and without visual cues. Testing was under unaided conditions. Results A linear mixed model revealed visual cues and pure-tone average as the only significant predictors of Multi-Modal Lexical Sentence Test outcomes. Neither WM measure nor noise type showed a significant effect. Conclusion The contribution of WM in explaining unaided speech recognition in noise was negligible and not influenced by noise type or visual cues. We anticipate that with audibility partially restored by hearing aids, the effects of WM will increase. For clinical practice to be affected, more significant effect sizes are needed.

The aims of this study were to: 1) quantify the amount of change in signal-to-noise ratio (SNR) as a result of compression and noise reduction (NR) processing in devices from three hearing aid (HA) manufacturers and 2) use the SNR changes to predict changes in speech perception. We hypothesised that the SNR change would differ across processing type and manufacturer, and that improvements in SNR would relate to improvements in performance.SNR at the output of the HAs was quantified using a phase-inversion technique. A linear mixed model was used to determine whether changes in SNR across HA conditions were predictive of changes in aided speech perception in noise.Two groups participated: 25 participants had normal-hearing and 25 participants had mild to moderately severe sensorineural hearing loss.The HAs programmed for both groups changed the SNR by a small, but statistically significant amount. Significant interactions in SNR changes were observed between HA devices and processing types. However, the change in SNR was not predictive of changes in speech perception.Although observed significant changes in SNR resulting from compression and NR did not convert to changes in speech perception, these algorithms may serve other purposes.

OBJECTIVES:: The dual-task paradigm has been widely used to measure listening effort. The primary objectives of the study were to (1) investigate the effect of hearing aid amplification and a hearing aid directional technology on listening effort measured by a complicated, more real world dual-task paradigm and (2) compare the results obtained with this paradigm to a simpler laboratory-style dual-task paradigm. DESIGN:: The listening effort of adults with hearing impairment was measured using two dual-task paradigms, wherein participants performed a speech recognition task simultaneously with either a driving task in a simulator or a visual reaction-time task in a sound-treated booth. The speech materials and road noises for the speech recognition task were recorded in a van traveling on the highway in three hearing aid conditions: unaided, aided with omnidirectional processing (OMNI), and aided with directional processing (DIR). The change in the driving task or the visual reaction-time task performance across the conditions quantified the change in listening effort. RESULTS:: Compared to the driving-only condition, driving performance declined significantly with the addition of the speech recognition task. Although the speech recognition score was higher in the OMNI and DIR conditions than in the unaided condition, driving performance was similar across these three conditions, suggesting that listening effort was not affected by amplification and directional processing. RESULTS from the simple dual-task paradigm showed a similar trend: hearing aid technologies improved speech recognition performance, but did not affect performance in the visual reaction-time task (i.e., reduce listening effort). The correlation between listening effort measured using the driving paradigm and the visual reaction-time task paradigm was significant. The finding showing that our older (56 to 85 years old) participants' better speech recognition performance did not result in reduced listening effort was not consistent with literature that evaluated younger (approximately 20 years old), normal hearing adults. Because of this, a follow-up study was conducted. In the follow-up study, the visual reaction-time dual-task experiment using the same speech materials and road noises was repeated on younger adults with normal hearing. Contrary to findings with older participants, the results indicated that the directional technology significantly improved performance in both speech recognition and visual reaction-time tasks. CONCLUSIONS:: Adding a speech listening task to driving undermined driving performance. Hearing aid technologies significantly improved speech recognition while driving, but did not significantly reduce listening effort. Listening effort measured by dual-task experiments using a simulated real-world driving task and a conventional laboratory-style task was generally consistent. For a given listening environment, the benefit of hearing aid technologies on listening effort measured from younger adults with normal hearing may not be fully translated to older listeners with hearing impairment. Language: en

Backward-facing directional processing (Back-DIR) is an algorithm that employs an anti-cardioid directivity pattern to enhance speech arriving from behind the listener. An experiment that was originally designed to evaluate Back-DIR, together with its follow-up experiment, are reported to illustrate how hearing-aid users' voices could affect directional benefit.Speech recognition performance was measured in a speech-180°/noise-0° configuration, with aids programmed to Back-DIR enabled or omnidirectional processing. In the original experiment, the conventional hearing-in-noise test (HINT) was used, wherein listeners repeated heard sentences. In the follow-up experiment, a modified HINT was used, wherein a carrier phrase was presented before each sentence.Fifteen adults with sensorineural hearing loss participated in both experiments.Significant Back-DIR benefit (relative to omnidirectional processing) was observed in the follow-up experiment, while not in the original experiment.In the original experiment, hearing aids were affected by listeners' voices such that Back-DIR was not always activated when the target speech was presented. In the follow-up experiment, listeners' voice effects were eliminated by the carrier phrase activating Back-DIR before the sentences were presented. The results suggest that the effect of hearing-aid technologies is highly dependent on the characteristics of listening conditions.

Background: Communication while traveling in an automobile often is very difficult for hearing aid users. This is because the automobile/road noise level is usually high, and listeners/drivers often do not have access to visual cues. Since the talker of interest usually is not located in front of the listener/driver, conventional directional processing that places the directivity beam toward the listener's front may not be helpful and, in fact, could have a negative impact on speech recognition (when compared to omnidirectional processing). Recently, technologies have become available in commercial hearing aids that are designed to improve speech recognition and/or listening effort in noisy conditions where talkers are located behind or beside the listener. These technologies include (1) a directional microphone system that uses a backward-facing directivity pattern (Back-DIR processing), (2) a technology that transmits audio signals from the ear with the better signal-to-noise ratio (SNR) to the ear with the poorer SNR (Side-Transmission processing), and (3) a signal processing scheme that suppresses the noise at the ear with the poorer SNR (Side-Suppression processing). Purpose: The purpose of the current study was to determine the effect of (1) conventional directional microphones and (2) newer signal processing schemes (Back-DIR, Side-Transmission, and Side-Suppression) on listener's speech recognition performance and preference for communication in a traveling automobile. Research Design: A single-blinded, repeated-measures design was used. Study Sample: Twenty-five adults with bilateral symmetrical sensorineural hearing loss aged 44 through 84 yr participated in the study. Data Collection and Analysis: The automobile/road noise and sentences of the Connected Speech Test (CST) were recorded through hearing aids in a standard van moving at a speed of 70 mph on a paved highway. The hearing aids were programmed to omnidirectional microphone, conventional adaptive directional microphone, and the three newer schemes. CST sentences were presented from the side and back of the hearing aids, which were placed on the ears of a manikin. The recorded stimuli were presented to listeners via earphones in a sound-treated booth to assess speech recognition performance and preference with each programmed condition. Results: Compared to omnidirectional microphones, conventional adaptive directional processing had a detrimental effect on speech recognition when speech was presented from the back or side of the listener. Back-DIR and Side-Transmission processing improved speech recognition performance (relative to both omnidirectional and adaptive directional processing) when speech was from the back and side, respectively. The performance with Side-Suppression processing was better than with adaptive directional processing when speech was from the side. The participants' preferences for a given processing scheme were generally consistent with speech recognition results. Conclusions: The finding that performance with adaptive directional processing was poorer than with omnidirectional microphones demonstrates the importance of selecting the correct microphone technology for different listening situations. The results also suggest the feasibility of using hearing aid technologies to provide a better listening experience for hearing aid users in automobiles.

One purported use of low-level laser therapy (LLLT) is to promote healing in damaged cells. The effects of LLLT on hearing loss and tinnitus have received some study, but results have been equivocal. The purpose of this study was to determine if LLLT improved hearing, speech understanding, and/or cochlear function in adults with hearing loss. Using a randomized, double-blind, placebo-controlled design, subjects were assigned to a treatment, placebo, or control group. The treatment group was given LLLT, which consisted of shining low-level lasers onto the outer ear, head, and neck. Each laser treatment lasted approximately five minutes. Three treatments were applied within the course of one week. A battery of auditory tests was administered immediately before the first treatment and immediately after the third treatment. The battery consisted of pure-tone audiometry, the Connected Speech Test, and transient-evoked otoacoustic emissions. Data were analyzed by comparing pre- and posttest results. No statistically significant differences were found between groups for any of the auditory tests. Additionally, no clinically significant differences were found in any individual subjects. This trial is registered with ClinicalTrials.gov (NCT01820416).

OBJECTIVES Amplification is a core component of early intervention for children who are hard of hearing, but hearing aids (HAs) have unique effects that may be independent from other components of the early intervention process, such as caregiver training or speech and language intervention. The specific effects of amplification are rarely described in studies of developmental outcomes. The primary purpose of this article is to quantify aided speech audibility during the early childhood years and examine the factors that influence audibility with amplification for children in the Outcomes of Children with Hearing Loss study. DESIGN Participants were 288 children with permanent hearing loss who were followed as part of the Outcomes of Children with Hearing Loss study. All of the children in this analysis had bilateral hearing loss and wore air-conduction behind-the-ear HAs. At every study visit, hearing thresholds were measured using developmentally appropriate behavioral methods. Data were obtained for a total of 1043 audiometric evaluations across all subjects for the first four study visits. In addition, the aided audibility of speech through the HA was assessed using probe microphone measures. Hearing thresholds and aided audibility were analyzed. Repeated-measures analyses of variance were conducted to determine whether patterns of thresholds and aided audibility were significantly different between ears (left versus right) or across the first four study visits. Furthermore, a cluster analysis was performed based on the aided audibility at entry into the study, aided audibility at the child's final visit, and change in aided audibility between these two intervals to determine whether there were different patterns of longitudinal aided audibility within the sample. RESULTS Eighty-four percent of children in the study had stable audiometric thresholds during the study, defined as threshold changes

Acceptable noise level (ANL) determines the maximum noise level that a listener is willing to accept while listening to speech. The objective of this study was to determine the equivalence of ANL measured using different speech stimuli for native speakers who lived in the U.S. and Taiwan.ANLs were measured using English, Mandarin, and the international speech test signal (ISTS) at each site. The same babble noise was used across speech stimuli. The ANLs were considered equivalent if the difference was unlikely to be greater than 3 dB.Thirty adults with normal hearing were recruited at each site.For each site, the equivalence test suggested that the native-language and foreign-language ANLs were equivalent. Between the two sites, ANLs measured using the listener's native language were also equivalent. Although the ISTS ANL obtained within each site was equivalent to, and highly correlated to, the native-language ANL, the data were unable to confirm the equivalence of the ISTS ANLs obtained from the two sites.The results suggested the possibility of directly comparing ANL measures carried out in different countries using different languages. However, it remains unclear if the ISTS can serve as an international ANL stimulus.

Background: The more a novel word conforms to the phonotactics of the language, the more wordlike it is and the easier it is to learn. It is unknown to what extent children with hearing loss (CHL) take advantage of phonotactic cues to support word learning. Aims: This study investigated whether CHL had similar sensitivities to wordlikeness during a word-learning task as children with normal hearing (CNH). Methods & Procedures: Sixteen CHL and 24 CNH participated in a novel word-learning task. Novel words varied by English wordlikeness. Recall was tested using a forced-choice identification task wherein foils for each trial related semantically, lexically or not at all. Receptive vocabulary and working memory were also assessed. Outcomes & Results:All children were able to identify high wordlike novel words more accurately than low wordlike novel words. The number of errors on identification of words that were moderate in wordlikeness was inversely correlated to vocabulary size (not working memory) and CHL had smaller vocabularies than CNH. When in error, CHL were more likely than CNH to select a semantically related foil. Conclusions & Implications: Although they are sensitive to extremes in wordlikeness, compared with their peers with normal hearing, CHL present with subtle differences in word learning. Clinical implications for exploiting wordlikeness in service of word learning assessment and intervention are presented.

Background: Transient noise can be disruptive for people wearing hearing aids. Ideally, the transient noise should be detected and controlled by the signal processor without disrupting speech and other intended input signals. A technology for detecting and controlling transient noises in hearing aids was evaluated in this study. Purpose: The purpose of this study was to evaluate the effectiveness of a transient noise reduction strategy on various transient noises and to determine whether the strategy has a negative impact on sound quality of intended speech inputs. Research Design: This was a quasi-experimental study. The study involved 24 hearing aid users. Each participant was asked to rate the parameters of speech clarity, transient noise loudness, and overall impression for speech stimuli under the algorithm-on and algorithm-off conditions. During the evaluation, three types of stimuli were used: transient noises, speech, and background noises. The transient noises included “knife on a ceramic board,” “mug on a tabletop,” “office door slamming,” “car door slamming,” and “pen tapping on countertop.” The speech sentences used for the test were presented by a male speaker in Mandarin. The background noises included “party noise” and “traffic noise.” All of these sounds were combined into five listening situations: (1) speech only, (2) transient noise only, (3) speech and transient noise, (4) background noise and transient noise, and (5) speech and background noise and transient noise. Results: There was no significant difference on the ratings of speech clarity between the algorithm-on and algorithm-off (t-test, p = 0.103). Further analysis revealed that speech clarity was significant better at 70 dB SLP than 55 dB SPL (p < 0.001). For transient noise loudness: under the algorithm-off condition, the percentages of subjects rating the transient noise to be somewhat soft, appropriate, somewhat loud, and too loud were 0.2, 47.1, 29.6, and 23.1%, respectively. The corresponding percentages under the algorithm-on were 3.0, 72.6, 22.9, and 1.4%, respectively. A significant difference on the ratings of the transient noise loudness was found between the algorithm-on and algorithm-off (t-test, p < 0.001). For overall impression for speech stimuli: under the algorithm-off condition, the percentage of subjects rating the algorithm to be not helpful at all, somewhat helpful, helpful, and very helpful for speech stimuli were 36.5, 20.8, 33.9, and 8.9%, respectively. Under the algorithm-on condition, the corresponding percentages were 35.0, 19.3, 30.7, and 15.0%, respectively. Statistical analysis revealed there was a significant difference on the ratings of overall impression on speech stimuli. The ratings under the algorithm-on condition were significantly more helpful for speech understanding than the ratings under algorithm-off (t-test, p < 0.001). Conclusions: The transient noise reduction strategy appropriately controlled the loudness for most of the transient noises and did not affect the sound quality, which could be beneficial to hearing aid wearers.

OBJECTIVES: A number of clinical measures of directivity, including the front-to-back ratio (FBR) and front-to-side ratio (FSR), have been suggested to audiologists to monitor the functionality of hearing aids with directional microphones. These suggestions, however, are based on the assumption that directivity measured clinically changes monotonically when compared with changes measured using the directivity index (DI) and perceptual directional benefit. The objective of the present study was to empirically examine this assumption. In addition, the reliability of the clinical directivity measure was estimated to establish a referral threshold for defective directional microphone hearing aids. DESIGN: The directivity of the directional microphones of two behind-the-ear hearing aids was systematically degraded by plugging the microphone ports. The directivity was measured using four clinical measures: the FBR and FSR performed in the test chamber of a hearing aid analyzer and in sound field. Each measure was repeated four times in each directivity-degraded condition. The degraded directivity was also assessed using the DI measure in an anechoic chamber. The perceptual directional benefit in each directivity-degraded condition was obtained by testing 10 hearing-impaired adults in a sound field with diffuse noise using the Hearing in Noise Test (HINT). RESULTS: The results of the DI and HINT measures showed strong correlation between the two FSRs (test chamber and sound field), while the two FBRs showed no correlation. The directivity generated by the FBRs could remain unchanged even when the directional microphone had lost more than 50% of its directivity. The results further indicated that the measures performed in the sound field were more reliable than those performed in the test chamber. Based on the results of the reliability measures, a 30% change in directivity was suggested as the referral threshold signifying defective directional systems. CONCLUSIONS: Because the FSR predicts the DI and HINT measurements more accurately than does the FBR, it is suggested that clinicians use the FSR to monitor hearing aid directivity. By using the FSR measure and informed by the suggested referral threshold, clinicians would be able to correctly identify defective directional microphone hearing aids at an early stage, rather than at a point when the directivity has been diminished completely or even reversed.

Objective:The objective of this study was to characterize the typical hearing loss presenting at a clinical audiology center.Methods: Audiometric records for 8,032 cases were obtained from the database at Beijing Tongren Hospital, Capital Medical University. Based on this information, age distribution, audiometric configuration, type, degree and asymmetry of hearing loss were characterized. Results: Results showed that 48.4% of all cases of hearing loss occurred from 31 to 60 years of age, sloping hearing loss was the most common audiometric configuration, and sensorineural hearing loss dominated the type of hearing loss for both males and females. Mean pure-tone hearing thresholds revealed significant differences between genders, that is, thresholds for females were poorer than those for males from 250 to 1,000 Hz, whereas thresholds for males were poorer than those for females from 2,000 to 8,000 Hz. Analysis showed that 57.3% of audiograms showed some degree of asymmetry. No significant difference was found between genders for the average asymmetric thresholds. Conclusion: This study provides the characteristics of age distribution, audiometric configuration, type, degree and asymmetry of hearing loss from a representative clinical audiology center. These data are useful for public policy efforts involving hearing loss prevention and rehabilitative program development.

Objectives: The field tests performed in the current investigation examined how visual cues impact the benefit provided by directional (DIR) microphone hearing aids in the real world. Specifically, the study tested the hypotheses that (1 ) the provision of visual cues would reduce the preference for DIR processing (re: omnidirectional [OMNI] microphone) and (2) laboratory audiovisual (AV) testing would predict real-world outcomes better than auditory-only testing. Design: The same 24 hearing-impaired adults enrolled in the laboratory testing of this study compared microphone modes (DIR versus OMNI processing) in their everyday activities three times a day for 4 wk using paper and pencil journals. In each comparison, the participants were asked to identify an environment that favored DIR processing (e.g., the talker standing in front of the user and noise at his or her back), listen to speech amid noise via both the DIR and OMNI microphone modes, and then record the preferred microphone mode in the journal. To further understand what the listeners based their preference on, the participants were also asked to provide the reasons for their preferences. Microphone modes were compared when the listeners' eyes were either open or closed. Results: The field results first suggested that OMNI processing was more frequently preferred over DIR processing. Visual cues were not found to have a significant effect on preference for DIR processing. Furthermore, the analysis revealed that when listeners indicated "louder" or "less internal noise" as the reasons for their microphone preference, the likelihood of preferring the OMNI mode increased significantly, suggesting that OMNI processing was preferred for its louder output and lower internal circuit noise level. Finally, the preference score obtained by the laboratory preference judgment task under the AV condition was shown to be the best predictor of microphone preference in the real world. Conclusions: The field data did not reveal the effect of visual cues on preference for DIR processing because preference was not altered by the availability of visual cues. This negative result may be due to the unsuccessful control of visual cues during the field trial. However, the finding that AV laboratory testing predicted field outcomes more accurately than did auditory-only testing demonstrates the role of visual cues in the real world and emphasizes the necessity of using AV testing in the laboratory to evaluate DIR microphone hearing aids. Furthermore, this study demonstrates the importance of factors other than DIR benefit—such as loudness and hearing aid internal noise—in determining preference for microphone mode in the real world.

The aim of this study was to evaluate a clinical test proposed to verify the output setting of hearing aids. Across three test sites, 56 bilaterally fitted hearing aid users were recruited. They answered questions about real-life loudness discomfort experiences and then completed the output verification test. Using an ascending method, a 1,500 kHz narrowband noise and a selection of broadband environmental noises were presented in 5 dB steps from 80 to 90 dB SPL. Response options included 'acceptably loud', and 'uncomfortably loud'. A swept pure tone presented at 90 dB SPL was also administered. Some loudness discomfort was reportedly experienced in real life by 82% of the participants. Generally, the test noises produced low specificity, with the 1,500 kHz narrowband noise being the best predictor of loudness discomfort experiences in real life, while the swept pure tone showed low sensitivity. Individual reactions to specific sounds and the test equipment and environment used are argued to affect the laboratory performance. A better understanding of these factors is needed before the test can be improved. an ser mejoradas.

The purpose of this study was to determine the impact of a digital noise reduction (DNR) scheme implemented in a current commercial hearing aid. In a double-blinded design, three conditions of onset time (4, 8, 16 seconds) were randomly assigned to the 25 subjects, plus one condition wherein the noise-reduction feature was disengaged. Subsequently, a fifth trial/condition, wherein the subject had access to three memories in which the different onsets were programmed, was carried out. For each of the five conditions, the subjects had an at-home trial, prior to obtaining self-report measures. Laboratory measures of speech perception showed no effect of the DNR, with or without the provision of visual cues. Laboratory-based ratings of ease of listening showed DNR-on (all onset times) to be rated significantly better than DNR-off; for ratings of listening comfort, the 4-second onset time was rated significantly lower (poorer) than the 8-second onset or the DNR-off condition; for ratings of sound quality, DNR-on or -off had no differential effect. Self-report measures indicated significantly higher aversiveness in the DNR-off condition compared to the pre-test scores.

The directivity of an adaptive directional microphone hearing aid (DMHA) cannot be assessed by the method that calls for presenting a "probe" signal from a single loudspeaker to the DMHA that moves to different angles. This method is invalid because the probe signal itself changes the polar pattern. This paper proposes a method for assessing the adaptive DMHA using a "jammer" signal, presented from a second loudspeaker rotating with the DMHA, that simulates a noise source and freezes the polar pattern. Measurement at each angle is obtained by two sequential recordings from the DMHA, one using an input of a probe and a jammer, and the other with an input of the same probe and a phase-inverted jammer. After canceling out the jammer, the remaining response to the probe signal can be used to assess the directivity. In this paper, the new method is evaluated by comparing responses from five adaptive DMHAs to different jammer intensities and locations. This method was shown to be an accurate and reliable way to assess the directivity of the adaptive DMHA in a high-intensity-jammer condition.

New objective and accurate feedback detection method, transfer function variation criterion (TVC), has been developed for evaluating the performance of feedback cancellation techniques. The proposed method is able to classify stable, unstable, and sub-oscillatory stages of feedback in hearing aids. The sub-oscillatory stage is defined as a state where the hearing aid user may perceive distortion of sound quality without the occurrence of oscillation. This detection algorithm focuses on the transfer function variation of hearing aids and the relationship between system stability and feedback oscillation. The transfer functions are obtained using the FIR Wiener filtering algorithm off-line. An anechoic test box is used for the exact and reliable evaluation of different hearing aids. The results are listed and compared with the conventional power concentration ratio (PCR), which has been generally adopted as a feedback detection method for the performance evaluation of hearing aids. The possibility of real-time implementation is discussed in terms of a more convenient and exact performance evaluation of feedback cancellation techniques.

Objective In this investigation, a method for computing a directivity index (DI) on a manikin for directional microphones in hearing aids was proposed and evaluated comparatively to other conventional methods. Design Test devices included first- and second-order directional microphones. Signal presentation, implemented in an anechoic chamber, involved a single noise source rotated completely around the directional microphone in a hearing aid, in free field and on a manikin, at a defined radius. The area covered was equivalent to the approximate surface area of a sphere. It was anticipated that an equal angular resolution of 10 degrees (elevation and azimuth) would effectively estimate the DI of first-, second-, and higher-order directional microphone systems located in a hearing aid on a manikin. A total of 450 spatially varied presentation points were analyzed, each weighted in reference to direction of arrival on the directional microphone. Results Empiric differences between the DI derived from the 3D-DI method proposed in this investigation and the conventionally derived 2D-DI method DI on a manikin were as large as 3.8 dB in the higher frequencies, depending on the device under test. Conclusions The magnitude of these differences was dependent on the device under test microphone location. The further the microphone was placed into the ear of the manikin, the larger the empiric differences.

The purpose of this investigation was to study the effectiveness of different "noise reduction" circuits for subjects of differing degrees, configurations, and experience with amplification. Fifty subjects with hearing impairment were randomly assigned one of four circuit types whose marketing claims suggested resultant improvement in speech recognition in noise backgrounds. Although no apparent circuit superiority was shown, the subjects indicated a high level of satisfaction with the hearing aids chosen for them. Improved measuring tools, improved fitting strategies, and overall improved hearing-aid circuitry (though probablynotthe noise reduction feature) may explain this level of satisfaction.

Objective: To provide guidelines for the development of two types of closed-set speech-perception tests that can be applied and interpreted in the same way across languages. The guidelines cover the digit triplet and the matrix sentence tests that are most commonly used to test speech recognition in noise. They were developed by a working group on Multilingual Speech Tests of the International Collegium of Rehabilitative Audiology (ICRA). Design: The recommendations are based on reviews of existing evaluations of the digit triplet and matrix tests as well as on the research experience of members of the ICRA Working Group. They represent the results of a consensus process. Results: The resulting recommendations deal with: Test design and word selection; Talker characteristics; Audio recording and stimulus preparation; Masking noise; Test administration; and Test validation. Conclusions: By following these guidelines for the development of any new test of this kind, clinicians and researchers working in any language will be able to perform tests whose results can be compared and combined in cross-language studies. Funding Agencies|HearCom; HurDig; Hearing4all; EU; DFG; NIH/NIDCD

To determine the effects of frequency compression on music perception, and the impact of previous music training and hearing status. It was hypothesized that lesser amounts of compression would be preferred, and that this pattern of preference would be more evident in the musically trained groups.A paired-comparison paradigm was used. Subjects listened to pairs of musical passages as processed by a hearing aid with different frequency-compression settings. Subjects indicated their preferred passage and the strength of their preference.Fifty-seven subjects divided in four groups, according to hearing status (normal hearing, mild-to-moderate hearing loss), and previous music experience (trained, not trained).Subjects generally preferred the conditions with the lesser amount of compression. Listeners in the group with previous music training showed stronger preference for less compression than those without training, as did listeners with normal hearing when compared to subjects with hearing loss.Although less frequency compression was in general preferred, there was more variability in the comparisons involving the default settings for a 50-dB hearing loss (i.e. start frequency 4000 Hz, compression ratio 2.5:1) and no compression, suggesting that mild amounts of compression may not be detrimental to perceived sound quality.

Objectives: Children who are hard of hearing (CHH) have restricted access to acoustic and linguistic information. Increased audibility provided by hearing aids (HAs) influences language outcomes, but the advantages of appropriately fit HAs can only be realized if children wear their devices on a consistent basis. The purpose of this article was to characterize long-term HA use in CHH, based on parent-report measures, and identify factors that influence longitudinal trends in HA use. Design: Participants were parents of 290 children with mild to severe hearing loss. At every visit, parents estimated the average amount of time the child used HAs per day during the week and on the weekends. Parent reports of daily HA use were analyzed to determine if different patterns of HA use were observed longitudinally during the study. Independent predictor variables were then related to longitudinal trends in HA use within three age groups (infant, preschool, school age). Results: On average across multiple visits, parents reported that their children wore their HAs for 10.63 hr per day (SD = 3.29). Data logging values were lower than parent-report measures (M = 8.44, SD = 4.06), suggesting that parents overestimated daily HA use. The majority of children in each age group wore HAs at least 8 hr per day from their first research testing interval to their last, based on parent-report measures. Maternal education level predicted longitudinal trends in HA use for infants and school-age CHH. Degree of hearing loss was related to trends in school-age children only. Conclusions: These results indicated that the majority of CHH increased HA use over time, but a sizable minority demonstrated a low level of use or decreased use in the time period studied. Maternal education level influenced longitudinal trends in daily HA use. Degree of hearing loss influenced trends in school-age children only. Audiologists and early intervention service providers might aid in improving HA use by providing regular hands-on training with the HAs and individualized problem-based strategies to address the challenges families experience with attaining a high level of use. Families may also benefit from practical demonstrations of the benefits of consistent HA use, such as hearing loss simulations, examples of listening in noise with and without HAs, or listening to malfunctioning HAs.

This clinical trial was undertaken to evaluate the benefit obtained from hearing aids employing second-order adaptive directional microphone technology, used in conjunction with digital noise reduction. Data were collected for 49 subjects across two sites. New and experienced hearing aid users were fit bilaterally with behind-the-ear hearing aids using the National Acoustics Laboratory—Nonlinear version 1 (NAL-NL1) prescriptive method with manufacturer default settings for various parameters of signal processing (e.g., noise reduction, compression, etc.). Laboratory results indicated that (1) for the stationary noise environment, directional microphones provided better speech perception than omnidirectional microphones, regardless of the number of microphones; and (2) for the moving noise environment, the three-microphone option (whether in adaptive or fixed mode) and the two-microphone option in its adaptive mode resulted in better performance than the two-microphone fixed mode, or the omnidirectional modes.

Objective: A primary purpose of fitting hearing aids is to improve the audibility of speech; however, hearing aid gain is typically measured by using standardized nonspeech signals, e.g., swept pure tones, speech-weighted broadband noise, or modulated noise. When compression hearing aids are tested with these nonspeech input signals, the measured gain can be substantially different than if a real speech input signal were used. The purpose of this study was to systematically evaluate the effects of release time, compression ratio, and number of compression channels, as well as interactions of these parameters, on the gain difference between several common nonspeech hearing aid test signals and speech. It was hypothesized that the difference in hearing aid gain between static nonspeech signals and speech would increase as release time, compression ratio, and number of channels increased. Design: Speech and several common nonspeech hearing aid test signals, matched at overall root-mean-square levels corresponding to average (65 dB SPL) and loud (80 dB SPL) conversational speech, were input into a master hearing aid circuit, and the gain of the circuit was measured in one-third octave bands. The hearing aid was programmed as a moderate-gain (23 dB) wide dynamic range compression instrument with a compression threshold of 50 dB SPL. The release time, compression ratio, and number of compression channels of the circuit were systematically adjusted by programming software. The one-third octave band gain differences between the nonspeech signals and speech were measured for all combinations of the compression settings. Multiple regression analysis was used to evaluate the effects of each compression parameter, and interactions of the parameters, on the gain difference between each nonspeech signal and speech. Results: One-third octave band gain differences between nonspeech and speech signals (calculated as nonspeech signal minus speech signal) ranged from −3.1 to 10.4 dB, depending on frequency, nonspeech test signal, and input signal level. In most cases, the compression parameters accounted for more than 70% of the variance in gain differences between the speech and nonspeech signals. At an input level of 65 dB, increases in the release time and compression ratio led to an increase in the gain difference between most nonspeech signals and speech at most frequencies. Increases in the number of channels caused an increase in the gain difference when the spectra of the nonspeech signals differed from the speech spectrum. The effects of release time and number of channels increased as the compression ratio increased. At an 80 dB input level, increasing the compression ratio led to a decrease in the gain difference between the nonspeech signals and speech. Release time and number of channels had little to no effect at the higher input level. Conclusions: The compression parameters of release time, compression ratio, and number of compression channels explain most of the variance in differences in hearing aid gain between nonspeech and speech signals. It may be cumbersome, however, to quantitatively define this relationship for all hearing aid circuits. It is therefore recommended that hearing aid “use” gain or output be measured with a real speech signal. If a nonspeech signal must be used, then it should have spectral and temporal properties that are similar to speech.

The effectiveness of an adaptive directional microphone design, as implemented in the Phonak Claro behind-the-ear hearing aid, is evaluated. Participants were fit bilaterally and tested in 2 environments, an anechoic chamber and a moderately reverberant classroom, with the microphones in the fixed (cardioid) setting and the adaptive setting. Five speakers were placed between 110° and 250° azimuth around the listener. Speech-weighted noise was presented from those speakers at an overall level (OAL) of 65 dB (A). Noise was increased by 8 dB from 1 speaker at a time, using 2-s modulation and random assignment, while the output from the other speakers was reduced to maintain the constant OAL. Results of 2 speech perception tasks used as outcome measures indicated that the adaptive system was not able to follow the dominant noise source in the presence of lower level noise sources. Selfreport measures obtained after blinded home trials were consistent with laboratory findings that the participants did not perceive this adaptive microphone design to be more effective than the default fixed-microphone option.

In this study, the performance of 48 listeners with normal hearing was compared to the performance of 46 listeners with documented hearing loss. Various conditions of directional and omnidirectional hearing aid use were studied. The results indicated that when the noise around a listener was stationary, a first- or second-order directional microphone allowed a group of hearing-impaired listeners with mild-to-moderate, bilateral, sensorineural hearing loss to perform similarly to normal hearing listeners on a speech-in-noise task (i.e., they required the same signal-to-noise ratio to achieve 50% understanding). When the noise source was moving around the listener, only the second-order (three-microphone) system set to an adaptive directional response (where the polar pattern changes due to the change in noise location) allowed a group of hearing-impaired individuals with mild-to-moderate sensorineural hearing loss to perform similarly to young, normal-hearing individuals.

The purpose of this study was to explain differences in threshold of discomfort (TD) across complex stimuli using acoustic and sound-quality variables as predictors. Two 4-tone complexes and 10 environmental sounds were used as stimuli. The environmental sounds consisted of a baby crying, hairdryer blowing, glass breaking, jet engine propelling, person laughing, motorcycle accelerating, orchestra tuning, telephone ringing, siren blowing, and toilet flushing. One-third octave band (1/3 OB) spectra were obtained for the 12 stimuli, with overall rms amplitude held constant across the stimuli. Nine acoustic quantities describing the high- and low-frequency content, peakiness, and bandwidth of each 1/3 OB spectrum were defined. Twenty adult subjects, 6 men and 14 women, with normal hearing sensitivity participated in the study. TDs were obtained from each subject for all of the stimuli. In addition, subjects rated each of the stimuli for annoyance, harshness, loudness, noisiness, and tinniness on a 10-point scale. These ratings were completed at a level 10 dB below each subject's TD for that stimulus. A hierarchical multiple regression analysis was used to estimate the amount of variance in TDs accounted for by subject differences, defined acoustic properties, and sound-quality ratings. Results indicated that, after controlling for intersubject differences, acoustic and sound-quality factors significantly influenced TD ratings. Increases in high-frequency cutoff and low-frequency cutoff, as well as higher ratings of loudness and annoyance, were associated with higher TDs. Associated with lower TDs were an increase in the frequency of the primary spectral peak, an increase in the number of spectral peaks, an increase in the center frequency, an increase in the area under the frequency response curve 30 dB down from the peak amplitude, an increase in the calculated loudness level re ANSI S3.4-1980, and higher ratings of tinniness.

Objectives The research questions of this study were: (1) Are children using nonlinear frequency compression (NLFC) in their hearing aids getting better access to the speech signal than children using conventional processing schemes? The authors hypothesized that children whose hearing aids provided wider input bandwidth would have more access to the speech signal, as measured by an adaptation of the Speech Intelligibility Index, and (2) are speech and language skills different for children who have been fit with the two different technologies; if so, in what areas? The authors hypothesized that if the children were getting increased access to the speech signal as a result of their NLFC hearing aids (question 1), it would be possible to see improved performance in areas of speech production, morphosyntax, and speech perception compared with the group with conventional processing. Design Participants included 66 children with hearing loss recruited as part of a larger multisite National Institutes of Health-funded study, Outcomes for Children with Hearing Loss, designed to explore the developmental outcomes of children with mild to severe hearing loss. For the larger study, data on communication, academic and psychosocial skills were gathered in an accelerated longitudinal design, with entry into the study between 6 months and 7 years of age. Subjects in this report consisted of 3-, 4-, and 5-year-old children recruited at the North Carolina test site. All had at least at least 6 months of current hearing aid usage with their NLFC or conventional amplification. Demographic characteristics were compared at the three age levels as well as audibility and speech/language outcomes; speech-perception scores were compared for the 5-year-old groups. Results Results indicate that the audibility provided did not differ between the technology options. As a result, there was no difference between groups on speech or language outcome measures at 4 or 5 years of age, and no impact on speech perception (measured at 5 years of age). The difference in Comprehensive Assessment of Spoken Language and mean length of utterance scores for the 3-year-old group favoring the group with conventional amplification may be a consequence of confounding factors such as increased incidence of prematurity in the group using NLFC. Conclusions Children fit with NLFC had similar audibility, as measured by a modified Speech Intelligibility Index, compared with a matched group of children using conventional technology. In turn, there were no differences in their speech and language abilities.

In studies to date, the effectiveness of the directional microphone has been investigated independently of the signal processing scheme used in the hearing aid. In addition, the number and placement of the background noise speakers can create an advantage for a particular polar pattern (i.e., cardioid, supercardioid, and hypercardioid) in any laboratory design. With these considerations in mind, the purpose of this investigation was twofold: (1) to determine the effect of different amplitude-compression release times on speech perception ability in noise, measured with directional microphone hearing aids, and (2) to determine the impact of environment (classroom vs anechoic chamber) on those measures. Ten subjects with mild to moderate sensorineural hearing loss participated. Using an eight-speaker complex sound field, speech perception was assessed in an anechoic chamber and a typical classroom environment. None of the release times resulted in superior performance in either the anechoic or classroom environment. Abbreviations: ANOVA = analysis of variance, BTE = behind the ear, HINT = Hearing in Noise Test, ITE = in the ear, KEMAR = Knowles Electronics Mannikin for Acoustic Research, RBCF = randomized blocks completely factorial, RT = reverberation time, SNR = signal-to-noise ratio, SPIN = Speech Perception in Noise (test), TR = release time

The purpose of this investigation was to study the impact of spectral shape and content on thresholds of discomfort (TD) for listeners with normal hearing and listeners with hearing loss. Secondary to that purpose was to quantify binaural summation at high intensities across complex stimulus conditions for both groups of listeners. Forty subjects (20 with normal hearing, 20 with hearing loss) participated. Complex acoustic stimuli (multitone and continuous discourse) were filtered to have four spectral shapes: (1) flat spectrum, (2) long-term average speech spectrum, (3) reverse long-term average speech spectrum, and (4) theTD contour derived for each subject from pure-tone TD obtained with eight pure tones from 250 to 4000 Hz. The results suggest that (1) TD for complex stimuli are lower for subjects with hearing loss compared with those with normal hearing, suggesting increased loudness summation with this population; (2) binaural summation of approximately 6 dB (independent of stimulus type, filter shape, or spectral content), indicating that a correction of similar magnitude for bilateral hearing aid fittings is appropriate; and (3) TD obtained at 750, 1500, and 3000 Hz accounted for approximately 60 percent of the variance in the complex TD measures, suggesting that TD at these frequencies be used to set the output obtained from a hearing aid with a 90–dB pure-tone sweep as the input stimulus. Abbreviations: ANOVA = analysis of variance, FIR = finite-impulse response, FS = flat spectrum, LTASS = long-term average speech spectrum, OSPL90 = output obtained from a hearing aid with a 90–dB pure-tone sweep as the input stimulus, R-LTASS = reverse long-term average speech spectrum, TD = threshold(s) of discomfort, TD contour = spectrum derived from TDs obtained with eight pure tones from 250 to 4000 Hz

The Speech in Noise (SIN) test consists of a series of Institute of Electrical and Electronic Engineers sentences presented in a background of four-talker babble at two presentation levels (83 and 53 dB SPL) and four signal-to-noise ratios (SNR) (15, 10, 5, and 0 dB). In this study, the nine lists were tested for equivalency and the test-retest reliability was determined. Twenty listeners with normal hearing and 20 listeners with sloping sensorineural hearing losses served as subjects. Five sentences were presented at each SNR at each level, and five key words in each sentence were scored (100 key words per presentation level). Each key word was scored as correct or incorrect, with errors of plurality scored as half-correct words. for percent-correct scores, Lists 1, 2, and 9 and Lists 3, 4, and 5 were found to be equivalent for listeners with normal hearing. For both groups of listeners, the test-retest correlations were high, and the critical differences appropriate for sentence material were 10 to16% at a .95 level of confidence. Because of floor and ceiling effects across the different lists, many subjects with normal hearing did not score as low as the 50% level, and many subjects with hearing loss did not score as high as 50%. Suggestions are offered for alternate scoring in order to obtain a SNR for 50% performance. Future versions of this test should be designed with improved list equivalency and 50% performance capability.

A table of available self-report inventories used throughout the world is provided with references for obtaining necessary psychometric data for research or clinical applications. Considerations for choosing an inventory (reliability, validity, and content appropriateness) are discussed and issues related to group versus single-subject applications examined. It is preferable that translation and revalidation of existing outcome measures be considered above developing new ones for international application.

Once the frequency/gain and output characteristics have been determined, the verification stage begins. As discussed in the ASHA (Adult) Guidelines (ASHA, 1998), verification refers to outcome measures taken to ensure that the hearing aids meet the intended fitting goals. Those fitting goals include electroacoustic characteristics, appropriateness of physical fit, and real ear performance. In the context of this chapter, real ear refers to any verification of gain or output obtained while the hearing aids are being worn by the child.

The purpose of this study was to determine whether different release times, as implemented in a commercial two-channel AGC hearing aid, would result in differing speech intelligibility performance, user preference, or use time. In experiment one, 14 subjects were fitted with a two-channel multi-memory AGC hearing aid. Four memories were programmed to have identical frequency responses and output limitation characteristics. Only the release times were varied, with the low channel/high channel set as follows (in ms): 20/35, 20/150, 100/35, 500/7. Results obtained from the NST (+5 S/N), magnitude estimations of intelligibility, and data-logging of use time did not show any release-time pair to be superior to any other. In experiment two, 10 subjects participated in a forced-choice, paired-comparison procedure using the same release-time pairs from experiment one. Auditory stimuli consisted of three input levels, consisting of speech, speech in noise, and music. Results indicated no release-time pair to be superior in any listening condition. Results may be explained, in part, by the use of a curvilinear compression circuit and the milder hearing loss exhibited by the subjects. Future investigation of the effect of release-time variation should be carried out on circuits with adjustable compression parameters (and fixed compression ratios) with listeners exhibiting different degrees of hearing loss.

Objectives Hearing aids (HAs) provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported HA fitting outcomes for a large group of children. The present study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided HAs for the children in the present study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. In addition, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and greater audibility than cohorts fitted without these measures. Design HA fitting data from 195 children with mild to severe hearing losses were analyzed as part of a multicenter study evaluating outcomes in children with hearing loss. Proximity of fitting to prescriptive targets was quantified by calculating the average root-mean-square (RMS) error of the fitting compared with Desired Sensation Level prescriptive targets for 500, 1000, 2000, and 4000 Hz. Aided audibility was quantified using the Speech Intelligibility Index. Survey data from the pediatric audiologists who fit amplification for children in the present study were collected to evaluate trends in fitting practices and relate those patterns to proximity of the fitting to prescriptive targets and aided audibility. Results More than half (55%) of the children in the study had at least 1 ear that deviated from prescriptive targets by more than 5 dB RMS on average. Deviation from prescriptive target was not predicted by pure-tone average, assessment method, or reliability of assessment. Study location was a significant predictor of proximity to prescriptive target with locations that recruited participants who were fit at multiple clinical locations (University of Iowa and Boys Town National Research Hospital) having larger deviations from target than the location where the participants were recruited primarily from a single, large pediatric audiology clinic (University of North Carolina). Fittings based on average real-ear to coupler differences resulted in larger deviations from prescriptive targets than fittings based on individually measured real-ear to coupler differences. Approximately 26% of the children in the study has aided audibility less than 0.65 on the Speech Intelligibility Index (SII). Aided audibility was significantly predicted by the proximity to prescriptive targets and pure-tone average, but not age in months. Conclusions Children in the study had a wide range of fitting outcomes in terms of proximity to prescriptive targets (RMS error) and aided speech audibility (SII). Even when recommended HA verification strategies were reported, fittings often exceeded the criteria for both proximity to the prescriptive target and aided audibility. The implications for optimizing amplification for children are also discussed.

The more a novel word conforms to the phonotactics of the language, the more wordlike it is and the easier it is to learn. It is unknown to what extent children with hearing loss (CHL) take advantage of phonotactic cues to support word learning.This study investigated whether CHL had similar sensitivities to wordlikeness during a word-learning task as children with normal hearing (CNH).Sixteen CHL and 24 CNH participated in a novel word-learning task. Novel words varied by English wordlikeness. Recall was tested using a forced-choice identification task wherein foils for each trial related semantically, lexically or not at all. Receptive vocabulary and working memory were also assessed.All children were able to identify high wordlike novel words more accurately than low wordlike novel words. The number of errors on identification of words that were moderate in wordlikeness was inversely correlated to vocabulary size (not working memory) and CHL had smaller vocabularies than CNH. When in error, CHL were more likely than CNH to select a semantically related foil.Although they are sensitive to extremes in wordlikeness, compared with their peers with normal hearing, CHL present with subtle differences in word learning. Clinical implications for exploiting wordlikeness in service of word learning assessment and intervention are presented.

Background: Frequency-lowering signal processing in hearing aids has re-emerged as an option toimprove audibility of the high frequencies by expanding the input bandwidth. Few studies have inves-tigated the usefulness of the scheme as an option for bimodal users (i.e., combined use of a cochlearimplant and a contralateral hearing aid). In this study, that question was posed.Purpose: The purposes of this study were (1) to determine if frequency compression was a better bimo-dal option than conventional amplification and (2) to determine the impact of a frequency-compressionhearing aid on speech recognition abilities.ResearchDesign: Thereweretwoseparateexperimentsinthisstudy.Thefirstexperimentinvestigatedthe contribution of a frequency-compression hearing aid to contralateral cochlear implant (CI) perform-ance for localization and speech perception in noise. The second experiment assessed monaural con-sonant and vowel perception in quiet using the frequency-compression and conventional hearing aidwithout the use of a contralateral CI or hearing aid.StudySample:Tensubjectsfittedwithacochlearimplantandhearingaidparticipatedinthefirstexperi-ment.Seventeenadultsubjectswithacochlearimplantandhearingaidortwohearingaidsparticipatedinthe second experiment. To be included, subjects had to have a history of postlingual deafness, a mod-erate or moderate-to-severe hearing loss, and have not worn this type of frequency-lowering hearing aidpreviously.Data Collection and Analysis: In the first experiment, performance using the frequency-compressionandconventionalhearingaidswasassessedontestsofsoundlocalization,speechperceptioninaback-ground of noise, and two self-report questionnaires. In the second experiment, consonant and vowelperception in quiet was assessed monaurally for the two conditions. In both experiments, subjects alter-nateddailybetweenafrequency-compression and conventionalhearingaidfor 2mo. Theparametersoffrequency compression were set individually for each subject, and audibility was measured for the fre-quency compression and conventional hearing aid programs by comparing estimations of the SpeechIntelligibilityIndex(SII)usingamodifiedalgorithm(Bentleretal,2011).Inbothexperiments,theoutcomemeasureswereadministeredfollowingthehearingaidfittingtoassessperformanceatbaselineandafter2 mo of use.Results:Forthisgroupofsubjects,theresultsrevealednosignificantdifferencebetweenthefrequency-compression and conventional hearing aid on tests of localization and consonant recognition. Spondee-in-noiseand vowelperceptionscoresweresignificantlyhigher withthe conventionalhearingaidcomparedto the frequency-compression hearing aid after 2 mo of use.Conclusions: These results suggest that, for the subjects in this study, frequency compression is not abetter bimodal option than conventional amplification. In addition, speech perception may be negatively*DepartmentofCommunicationSciencesandDisorders,AugustanaCollege;†DepartmentofCommunicationSciencesandDisorders,Universityof Iowa; ‡Department of Otolaryngology—Head and Neck Surgery, University of IowaAnn E. Perreau, 639 38th Street, Rock Island, IL 61201; Phone: 309-794-8935; Fax: 309-794-3497; E-mail: annperreau@augustana.eduPhonakAGprovideddevicesforthisstudy.TheGraduateCollegeandtheDepartmentofCommunicationSciencesandDisordersattheUniversityof Iowa contributed financially.J Am Acad Audiol 24:105–120 (2013)