Listening to Music Through Hearing Aids: Potential Lessons for Cochlear Implants

Some of the problems experienced by users of hearing aids (HAs) when listening to music are relevant to cochlear implants (CIs). One problem is related to the high peak levels (up to 120 dB SPL) that occur in live music. Some HAs and CIs overload at such levels, because of the limited dynamic range of the microphones and analogue-to-digital converters (ADCs), leading to perceived distortion. Potential solutions are to use 24-bit ADCs or to include an adjustable gain between the microphones and the ADCs. A related problem is how to squeeze the wide dynamic range of music into the limited dynamic range of the user, which can be only 6-20 dB for CI users. In HAs, this is usually done via multi-channel amplitude compression (automatic gain control, AGC). In CIs, a single-channel front-end AGC is applied to the broadband input signal or a control signal derived from a running average of the broadband signal level is used to control the mapping of the channel envelope magnitude to an electrical signal. This introduces several problems: (1) an intense narrowband signal (e.g. a strong bass sound) reduces the level for all frequency components, making some parts of the music harder to hear; (2) the AGC introduces cross-modulation effects that can make a steady sound (e.g. sustained strings or a sung note) appear to fluctuate in level. Potential solutions are to use several frequency channels to create slowly varying gain-control signals and to use slow-acting (or dual time-constant) AGC rather than fast-acting AGC.

Self-Reported Tinnitus Severity Prior to and During the COVID-19 Lockdown in the United Kingdom

BACKGROUND AND PURPOSE

 The aim of this study was to assess whether the severity of tinnitus, as measured using ratings of tinnitus loudness, annoyance, and effect on life, was influenced by the lockdown related to the coronavirus disease 2019 (COVID-19) pandemic.

RESEARCH DESIGN

 This was a retrospective study.

STUDY SAMPLE

 The data for 105 consecutive patients who were seen at a tinnitus clinic in an audiology department in the United Kingdom during the COVID-19 lockdown between April and June 2020 and 123 patients seen in the same period of the previous year, prior to the COVID-19 pandemic were included.

DATA COLLECTION

 Demographic data for the patients, results of their pure-tone audiometry, and their score on visual analog scale (VAS) of tinnitus loudness, annoyance, and effect on life were imported from their records held at the audiology department. This was a retrospective survey comparing ratings on the VAS of tinnitus loudness, annoyance, and effect on life for consecutive patients seen during the COVID-19 lockdown and consecutive patients seen in the same period of the previous year, prior to the COVID-19 pandemic. Patients seen prior to lockdown used a pen and paper version of the VAS, while the patients who were assessed during the COVID-19 lockdown used an adapted version of the VAS, via telephone. All patients were seeking help for their tinnitus for the first time.

RESULTS

 The mean scores for tinnitus loudness, annoyance, and effect on life did not differ significantly for the groups seen prior to and during lockdown.

CONCLUSION

 Any changes in psychological well-being or stress produced by the lockdown did not significantly affect ratings of the severity of tinnitus.

Does Exposure to Noise During Military Service Affect the Progression of Hearing Loss with Increasing Age?

It is traditionally believed that the effects of exposure to noise cease once the exposure itself has ceased. If this is the case, exposure to noise relatively early in life, for example during military service, should not affect the subsequent progression of hearing loss. However, recent data from studies using animals suggest that noise exposure can accelerate the subsequent progression of hearing loss. This paper presents new longitudinal data obtained from 29 former male military personnel. Audiograms obtained at the end of military service were compared with those obtained at least five years later. Rates of change of hearing threshold level (HTL) in dB/year were compared with those expected from ISO7029 (2017) for men at the 50^th percentile. The results are consistent with the hypothesis that noise exposure during military service accelerates the progression of hearing loss for frequencies where the hearing loss is absent or mild at the end of military service, by about 1.7 dB/year on average for frequencies from 3 to 8 kHz, but has no effect on or slows the progression of hearing loss for frequencies where the hearing loss exceeds about 50 dB. Acceleration appears to occur over a wide frequency range, including 1 kHz. There remains a need for further longitudinal studies using larger sample sizes. Longitudinal studies are also needed to establish whether exposure to other types of sounds, for example at rock concerts or from work in heavy industries, affects the subsequent progression of hearing loss.

Guidelines for Diagnosing and Quantifying Noise-Induced Hearing Loss

This paper makes recommendations for the diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context. A distinction is made between NIHL produced by: steady broadband noise, as occurs in some factories; more impulsive factory sounds, such as hammering; noise exposure during military service, which can involve very high peak sound levels; and exposure to very intense tones. It is argued that existing diagnostic methods, which were primarily developed to deal with NIHL produced by steady broadband noise, are not adequate for the diagnosis of NIHL produced by different types of exposures. Furthermore, some existing diagnostic methods are based on now-obsolete standards, and make unrealistic assumptions. Diagnostic methods are proposed for each of the types of noise exposure considered. It is recommended that quantification of NIHL for all types of exposures is based on comparison of the measured hearing threshold levels with the age-associated hearing levels (AAHLs) for a non-noise exposed population, as specified in ISO 7029 (2017), usually using the 50^th percentile, but using another percentile if there are good reasons for doing so. When audiograms are available both soon after the end of military service and some time afterwards, the most recent audiogram should be used for diagnosis and quantification, since this reflects any effect of the noise exposure on the subsequent progression of hearing loss. It is recommended that the overall NIHL for each ear be quantified as the average NIHL across the frequencies 1, 2, and 4 kHz.

Modification of a Method for Diagnosing Noise-Induced Hearing Loss Sustained During Military Service

Moore (2020) proposed a method for diagnosing noise-induced hearing loss (NIHL) sustained during military service, based on an analysis of the shapes of the audiograms of military personnel. The method, denoted M-NIHL, was estimated to have high sensitivity but low-to-moderate specificity. Here, a revised version of the method, denoted rM-NIHL, was developed that gave a better balance between sensitivity and specificity. A database of 285 audiograms of military noise-exposed men was created by merging two previously used databases with a new database, randomly shuffling, and then splitting into two, one for development of the revised method and one for evaluation. Two comparable databases of audiograms of 185 non-exposed men were also created, again one for development and one for evaluation. Based on the evaluation databases, the rM-NIHL method has slightly lower sensitivity than the M-NIHL method, but the specificity is markedly higher. The two methods have similar overall diagnostic performance. If an individual is classified as having NIHL based on a positive diagnosis for either ear, the rM-NIHL method has a sensitivity of 0.98 and a specificity of 0.63. Based on a positive diagnosis for both ears, the rM-NIHL method has a sensitivity of 0.76 and a specificity of 0.95.

Development of binaural temporal fine structure sensitivity in children

The highest frequency for which the temporal fine structure (TFS) of a sinewave can be compared across ears varies between listeners with an upper limit of about 1400 Hz for young normal-hearing adults (YNHA). In this study, binaural TFS sensitivity was investigated for 63 typically developing children, aged 5 years, 6 months to 9 years, 4 months using the temporal fine structure-adaptive frequency (TFS-AF) test of Füllgrabe, Harland, Sęk, and Moore [Int. J. Audiol. 56, 926-935 (2017)]. The test assesses the highest frequency at which an interaural phase difference (IPD) of ϕ° can be distinguished from an IPD of 0°. The values of ϕ were 30° and 180°. The starting frequency was 200 Hz. The thresholds for the children were significantly lower (worse) than the thresholds reported by Füllgrabe, Harland, Sęk, and Moore [Int. J. Audiol. 56, 926-935 (2017)] for YNHA. For both values of ϕ, the median age at which children performed above chance level was significantly higher (p < 0.001) than for those who performed at chance. For the subgroup of 40 children who performed above chance for ϕ = 180°, the linear regression analyses showed that the thresholds for ϕ = 180° increased (improved) significantly with increasing age (p < 0.001) with adult-like thresholds predicted to be reached at 10 years, 2 months of age. The implications for spatial release from masking are discussed.

Audiometric assessment of hearing loss sustained during military service

An analysis is presented of the audiograms, obtained using Telephonics TDH39 headphones (Huntington, NY), of 80 men claiming compensation for noise-induced hearing loss (NIHL) sustained during military service. A comparison with an independent database of audiograms collected using other headphones suggested that no adjustment was needed to the hearing threshold levels (HTLs) at 6 kHz to allow for the use of TDH39 headphones. The method of Moore [(2020). J. Acoust. Soc. Am. 148, 884-894] for diagnosing military noise-induced hearing loss (M-NIHL) gave a positive diagnosis for 92.5% of right ears and 97.5% of left ears. The mean HTLs were maximal and similar at 4, 6, and 8 kHz but with considerable individual variability. A comparison with age-expected HTLs showed that M-NIHL was typically greatest at 3, 4, 6, or 8 kHz but with considerable individual variability. M-NIHL values were positive from 0.5 to 8 kHz. The HTLs were significantly higher for the left than for the right ears, but the asymmetry varied across individuals and could usually be ascribed to specific features of the noise exposure. The asymmetry existed over the range from 0.5 to 8 kHz, supporting the idea that M-NIHL occurs over a wide frequency range. Tinnitus was reported by 76 of the 80 men.

Factors Affecting Auditory Estimates of Virtual Room Size: Effects of Stimulus, Level, and Reverberation

When vision is unavailable, auditory level and reverberation cues provide important spatial information regarding the environment, such as the size of a room. We investigated how room-size estimates were affected by stimulus type, level, and reverberation. In Experiment 1, 15 blindfolded participants estimated room size after performing a distance bisection task in virtual rooms that were either anechoic (with level cues only) or reverberant (with level and reverberation cues) with a relatively short reverberation time of T₆₀ = 400 milliseconds. Speech, noise, or clicks were presented at distances between 1.9 and 7.1 m. The reverberant room was judged to be significantly larger than the anechoic room (p < .05) for all stimuli. In Experiment 2, only the reverberant room was used and the overall level of all sounds was equalized, so only reverberation cues were available. Ten blindfolded participants took part. Room-size estimates were significantly larger for speech than for clicks or noise. The results show that when level and reverberation cues are present, reverberation increases judged room size. Even relatively weak reverberation cues provide room-size information, which could potentially be used by blind or visually impaired individuals encountering novel rooms.

Frequency selectivity in the modulation domain estimated using forward masking: Effects of masker modulation depth and masker-signal delay

The threshold for detecting amplitude modulation (AM) of a sinusoidal or noise carrier is elevated when the signal AM is preceded by masker AM applied to the same carrier. This effect, called AM forward masking, shows selectivity in the AM domain, consistent with the existence of a modulation filter bank (MFB). In this paper we explore the effect of two factors that can influence AM forward masking, using an 8-kHz sinusoidal carrier and a range of masker AM frequencies, f_m, both below and above the signal AM frequency, f_s, of 40 Hz. The first factor was the time delay, t_d, between the end of the masker AM and the start of the signal AM. The second was the AM depth, m, of the masker, which was either 1 or 0.25. The AM forward masking patterns in all conditions showed tuning in the AM domain; signal thresholds were highest when f_m was close to f_s. The amount of AM forward masking decreased with increasing t_d in a similar way for all f_m, so the shapes of the masking patterns did not change markedly with t_d. Remarkably, the amount of AM forward masking decreased by only about 3 dB (a non-significant effect) when the masker m was decreased from 1 to 0.25. This result appears to be inconsistent with an explanation of AM forward masking in terms of adaptation in a MFB or in terms of a sliding temporal integrator.

A framework to account for the effects of visual loss on human auditory abilities

Until recently, a commonly held view was that blindness resulted in enhanced auditory abilities, underpinned by the beneficial effects of cross-modal neuroplasticity. This viewpoint has been challenged by studies showing that blindness results in poorer performance for some auditory spatial tasks. It is now clear that visual loss does not result in a general increase or decrease in all auditory abilities. Although several hypotheses have been proposed to explain why certain auditory abilities are enhanced while others are degraded, these are often limited to a specific subset of tasks. A comprehensive explanation encompassing auditory abilities assessed in fully blind and partially sighted populations and spanning spatial and non-spatial cognition has not so far been proposed. The current article proposes a framework comprising a set of nine principles that can be used to predict whether auditory abilities are enhanced or degraded. The validity of these principles is assessed by comparing their predictions with a wide range of empirical evidence concerning the effects of visual loss on spatial and non-spatial auditory abilities. Developmental findings and the effects of early- versus late-onset visual loss are discussed. Ways of improving auditory abilities for individuals with visual loss and reducing auditory spatial deficits are summarized. A new Perceptual Restructuring Hypothesis is proposed within the framework, positing that the auditory system is restructured to provide the most accurate information possible given the loss of the visual signal and utilizing available cortical resources, resulting in different auditory abilities getting better or worse according to the nine principles. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of Exposure to Noise during Military Service on the Subsequent Progression of Hearing Loss

This paper reviews and re-analyses data from published studies on the effects of noise exposure on the progression of hearing loss once noise exposure has ceased, focusing particularly on noise exposure during military service. The data are consistent with the idea that such exposure accelerates the progression of hearing loss at frequencies where the hearing loss is absent or mild at the end of military service (hearing threshold levels (HTLs) up to approximately 50 dB HL), but has no effect on or slows the progression of hearing loss at frequencies where the hearing loss exceeds approximately 50 dB. Acceleration appears to occur over a wide frequency range, including 1 kHz. However, each of the studies reviewed has limitations. There is a need for further longitudinal studies of changes in HTLs over a wide range of frequencies and including individuals with a range of HTLs and ages at the end of military service. Longitudinal studies are also needed to establish whether the progression of hearing loss following the end of exposure to high-level sounds depends on the type of noise exposure (steady broadband factory noises versus impulsive sounds).

Forward masking of amplitude modulation across ears and its tuning in the modulation domain

Frequency selectivity in the amplitude modulation (AM) domain has been demonstrated using both simultaneous AM masking and forward AM masking. This has been explained using the concept of a modulation filter bank (MFB). Here, we assessed whether the MFB occurs before or after the point of binaural interaction in the auditory pathway by using forward masking in the AM domain in an ipsilateral condition (masker AM and signal AM applied to the left ear with an unmodulated carrier in the right ear) and a contralateral condition (masker AM applied to the right ear and signal AM applied to the left ear). The carrier frequency was 8 kHz, the signal AM frequency, f_s, was 40 or 80 Hz, and the masker AM frequency ranged from 0.25 to 4 times f_s. Contralateral forward AM masking did occur, but it was smaller than ipsilateral AM masking. Tuning in the AM domain was slightly sharper for ipsilateral than for contralateral masking, perhaps reflecting confusion of the signal and masker AM in the ipsilateral condition when their AM frequencies were the same. The results suggest that there might be an MFB both before and after the point in the auditory pathway where binaural interaction occurs.

Transient Noise Reduction Using a Deep Recurrent Neural Network: Effects on Subjective Speech Intelligibility and Listening Comfort

A deep recurrent neural network (RNN) for reducing transient sounds was developed and its effects on subjective speech intelligibility and listening comfort were investigated. The RNN was trained using sentences spoken with different accents and corrupted by transient sounds, using the clean speech as the target. It was tested using sentences spoken by unseen talkers and corrupted by unseen transient sounds. A paired-comparison procedure was used to compare all possible combinations of three conditions for subjective speech intelligibility and listening comfort for two relative levels of the transients. The conditions were: no processing (NP); processing using the RNN; and processing using a multi-channel transient reduction method (MCTR). Ten participants with normal hearing and ten with mild-to-moderate hearing loss participated. For the latter, frequency-dependent linear amplification was applied to all stimuli to compensate for individual audibility losses. For the normal-hearing participants, processing using the RNN was significantly preferred over that for NP for subjective intelligibility and comfort, processing using the RNN was significantly preferred over that for MCTR for subjective intelligibility, and processing using the MCTR was significantly preferred over that for NP for comfort for the higher transient level only. For the hearing-impaired participants, processing using the RNN was significantly preferred over that for NP for both subjective intelligibility and comfort, processing using the RNN was significantly preferred over that for MCTR for comfort, and processing using the MCTR was significantly preferred over that for NP for comfort.

Sensitivity and specificity of a method for diagnosis of military noise-induced hearing loss

Moore [(2020). J. Acoust. Soc. Am. 148, 884-894] proposed a method for the diagnosis of hearing loss produced by noise exposure during military service (denoted M-NIHL) based on the audiogram. This letter characterizes the sensitivity and specificity of the method, based on 116 ears of men claiming compensation for M-NIHL and 244 ears of an age-matched non-noise-exposed control group of men screened to match the noise-exposed group in age, absence of conductive hearing loss, no history of ear diseases, and asymmetry across ears ≤10 dB. The sensitivity was 0.97 and the specificity was 0.67, giving a discriminability index d' of 2.3.

Preliminary Examination of the Incidence of and Factors Related to Hearing Tinnitus in Dreams

BACKGROUND AND PURPOSE

 The aim of this study was to assess the incidence of the perception of tinnitus in dreams among patients seeking help for tinnitus and/or hyperacusis and to assess whether this is related to the severity of tinnitus and/or hyperacusis.

RESEARCH DESIGN

 This was a retrospective study.

STUDY SAMPLE

 The data for 148 consecutive adult patients who attended a tinnitus/hyperacusis clinic in the United Kingdom were included. The average age of the patients was 56 years (standard deviation [SD] = 15 years).

DATA COLLECTION

 Data were collected retrospectively from their records held at the audiology department. Audiological measures were pure-tone audiometry and uncomfortable loudness levels. Questionnaires administered were: Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire, Insomnia Severity Index, Visual Analogue Scale (VAS) of tinnitus loudness, annoyance, and effect on life, Generalized Anxiety Disorder, and Patient Health Questionnaire. Patients were also asked "If you dream have you ever perceived tinnitus in your dreams?"

RESULTS

 Five percent of patients (7/148) reported hearing tinnitus in their dreams. There was a nonsignificant trend for patients who reported hearing tinnitus in their dreams to be younger (mean age = 46 years, SD = 15 years) than those who did not (mean age = 57 years, SD = 15 years). The mean scores for the THI and VAS for effect of tinnitus on life were significantly higher (worse) for patients who reported hearing tinnitus in their dreams than for those who did not.

CONCLUSION

 A small proportion of patients reported hearing tinnitus in their dreams and this was associated with higher tinnitus handicap as measured via the THI and more effect of tinnitus on life as measured via the VAS. These preliminary results may indicate that those who are greatly affected by their tinnitus are more likely to hear it in their dreams or to be woken by it. Future studies should use methods that can be used to reliably assess if and when tinnitus is perceived during the sleep cycle, using more physiological measures and testing a wider population.

Development of a Deep Neural Network for Speeding Up a Model of Loudness for Time-Varying Sounds

The “time-varying loudness” (TVL) model of Glasberg and Moore calculates “instantaneous loudness” every 1 ms, and this is used to generate predictions of short-term loudness, the loudness of a short segment of sound, such as a word in a sentence, and of long-term loudness, the loudness of a longer segment of sound, such as a whole sentence. The calculation of instantaneous loudness is computationally intensive and real-time implementation of the TVL model is difficult. To speed up the computation, a deep neural network (DNN) was trained to predict instantaneous loudness using a large database of speech sounds and artificial sounds (tones alone and tones in white or pink noise), with the predictions of the TVL model as a reference (providing the “correct” answer, specifically the loudness level in phons). A multilayer perceptron with three hidden layers was found to be sufficient, with more complex DNN architecture not yielding higher accuracy. After training, the deviations between the predictions of the TVL model and the predictions of the DNN were typically less than 0.5 phons, even for types of sounds that were not used for training (music, rain, animal sounds, and washing machine). The DNN calculates instantaneous loudness over 100 times more quickly than the TVL model. Possible applications of the DNN are discussed.

Application of Bayesian Active Learning to the Estimation of Auditory Filter Shapes Using the Notched-Noise Method

Time-efficient hearing tests are important in both clinical practice and research studies. This particularly applies to notched-noise tests, which are rarely done in clinical practice because of the time required. Auditory-filter shapes derived from notched-noise data may be useful for diagnosis of the cause of hearing loss and for fitting of hearing aids, especially if measured over a wide range of center frequencies. To reduce the testing time, we applied Bayesian active learning (BAL) to the notched-noise test, picking the most informative stimulus parameters for each trial based on nine Gaussian Processes. A total of 11 hearing-impaired subjects were tested. In 20 to 30 min, the test provided estimates of signal threshold as a continuous function of frequency from 500 to 4000 Hz for nine notch widths and for notches placed both symmetrically and asymmetrically around the signal frequency. The thresholds were found to be consistent with those obtained using a 2-up/1-down forced-choice procedure at a single center frequency. In particular, differences in threshold between the methods did not vary with notch width. An independent second run of the BAL test for one notch width showed that it is reliable. The data derived from the BAL test were used to estimate auditory-filter width and asymmetry and detection efficiency for center frequencies from 500 to 4000 Hz. The results agreed with expectations for cochlear hearing losses that were derived from the audiogram and a hearing model.

No Influence of Musicianship on the Effect of Contralateral Stimulation on Frequency Selectivity

The efferent system may control the gain of the cochlea and thereby influence frequency selectivity. This effect can be assessed using contralateral stimulation (CS) applied to the ear opposite to that used to assess frequency selectivity. The effect of CS may be stronger for musicians than for nonmusicians. To assess whether this was the case, psychophysical tuning curves (PTCs) were compared for 12 musicians and 12 nonmusicians. The PTCs were measured with and without a 60-dB sound pressure level (SPL) pink-noise CS, using signal frequencies of 2 and 4 kHz. The sharpness of the PTCs was quantified using the measure Q10, the signal frequency divided by the PTC bandwidth measured 10 dB above the level at the tip. Q10 values were lower in the presence of the CS, but this effect did not differ significantly for musicians and nonmusicians. The main effect of group (musicians vs. nonmusicians) on the Q10 values was not significant. Overall, these results do not support the idea that musicianship enhances contralateral efferent gain control as measured using the effect of CS on PTCs.

Molecular Aspects of Melatonin Treatment in Tinnitus: A Review

Tinnitus is a hearing disorder characterized by the perception of sound without external acoustic stimuli, which is caused by damage to the auditory system in response to excessive levels of noise, ototoxic agents and aging. Neural plasticity, oxidative/nitrosative stress and apoptosis play important roles in the pathogenesis of tinnitus. The expression of neural plasticity related to excessive glutamatergic neurotransmission leads to generation of abnormal sound in one's ears or head. Furthermore, hyperactivation and over-expression of NMDA receptors in response to excessive release of glutamate contribute to the calcium overload in the primary auditory neurons and subsequent cytotoxicity. Reactive oxygen/nitrogen species are endogenously produced by different type of cochlear cells under pathological conditions, which cause direct damage to the intracellular components and apoptotic cell death. Cochlear hair-cell death contributes to the progressive deafferentation of auditory neurons, which consequently leads to the aberrant activity in several parts of the auditory pathway. Therefore, targeting neural plasticity, oxidative/nitrosative stress, apoptosis and autophagy may ameliorate tinnitus. Melatonin is an endogenously produced indoleamine synchronizing circadian and circannual rhythms. Based on laboratory studies indicating the protective effect of melatonin against cochlear damage induced by acoustic trauma and ototoxic agents, and also clinical studies reporting the ability of melatonin to minimize the severity of tinnitus, melatonin is suggested to be a treatment option for the patient with tinnitus. Herein, we describe the ameliorative effect of melatonin on tinnitus, focusing on neural plasticity, oxidative/nitrosative stress, apoptotsis and autophagy.

Diagnosis and quantification of military noise-induced hearing loss

The diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context are usually based on the pattern of hearing loss that is typically associated with long-term exposure to steady broadband noises, such as occur in noisy factories. Evidence is reviewed showing that this pattern is not typical for hearing loss produced by intense impulsive sounds of the type that military personnel are exposed to. The audiometric characteristics of noise-exposed military personnel are reviewed. A set of audiograms from a sample of 58 hearing-impaired noise-exposed military veterans was analyzed and used to develop methods for the diagnosis and quantification of military NIHL. Three requirements are specified for diagnosing military NIHL. Quantification of any loss is done by comparison with audiometric thresholds for non-noise exposed individuals, as specified in ISO7029 [International Organization for Standardization, 2017].

Audiological Rehabilitation for Facilitating Hearing Aid Use: A Review

This article reviews and critically analyzes the design of studies on the effect of audiological rehabilitation (AR) programs on hearing aid (HA) outcomes, in order to guide future research.

The design of this study was a narrative review. Studies were included in the review if they were randomized controlled trials that investigated the effects of AR on HA use and outcome between 2000 and 2016.

Seven articles that met the inclusion criteria were included in the review. Most used educational rather than counseling approaches. Although educational AR programs seem to be useful in enhancing the use of communication strategies, there is limited evidence for their effect on HA use and self-perceived hearing handicap.

More research is needed in this field. Future studies should (1) investigate the efficacy of AR interventions based on counseling and empathetic listening as opposed to or in addition to educational interventions, (2) use stricter criteria to include only a subpopulation of patients who do not get on well with their HAs, (3) measure the amount of HA use via data-logging and self-report questionnaires, and (4) use a matching comparison intervention for patients in the control group.

No evidence for a link between noise exposure and auditory temporal processing for young adults with normal audiograms

The link between lifetime noise exposure and temporal processing abilities was investigated for 45 normal-hearing participants, recruited from a population of undergraduate students, aged 18 to 23 years. A self-report instrument was employed to assess the amount of neuropathic noise (here defined as sounds with levels exceeding approximately 80 dBA) each participant had been exposed to and sensitivity to temporal-fine-structure and temporal-envelope information was determined using frequency discrimination and envelope irregularity detection tasks, respectively. Despite sizable individual variability in all measures, correlations between noise exposure and the ability to process temporal cues were small and non-significant.

Prevalence and Characteristics of Patients with Severe Hyperacusis among Patients Seen in a Tinnitus and Hyperacusis Clinic

The purpose was to assess the proportion of patients seeking help for tinnitus and/or hyperacusis who have severe hyperacusis and to examine factors associated with severe hyperacusis.

This was a retrospective cross-sectional study based on 362 consecutive patients who attended a National Health Service audiology clinic for tinnitus and/or hyperacusis rehabilitation and for whom uncomfortable loudness levels (ULLs) had been measured. The criterion for severe hyperacusis was taken as a ULL of 30 dB HL or less for at least one of the measured frequencies for at least one ear.

Thirteen patients had severe hyperacusis, and eight of those had normal hearing. The lowest average ULL across frequencies was 28 dB HL. The difference in average ULLs between ears was 5 dB or less for nine patients. The range of ULLs across frequencies was between 5 and 60 dB, ULLs often being lowest at 8 kHz. Eleven patients had tinnitus, eight had otological abnormalities, twelve had mental health problems, and six were taking antidepressants.

Severe hyperacusis is characterized by low ULLs for specific frequencies and no or mild hearing loss. Given the high incidence of tinnitus, otological abnormalities, and mental health problems, the management of patients with severe hyperacusis should involve otologists and psychiatrists in addition to audiologists.