Listening to speech-in-noise with hearing aids: Do the self-reported outcomes reflect the behavioral speech perception task performance?

BACKGROUND

The aim of this study is to examine the relationship between behavioral speech-in-noise listening tasks and self-reported speech-in-noise outcomes of hearing aid user adult listeners.

METHOD

To measure the self-reported outcomes of hearing, the Hearing Handicap Inventory for Adults [HHI-A], Speech, Spatial and Qualities of Hearing Scale (SSQ) and Amsterdam Inventory for Auditory Disability and Handicap were employed. To screen the cognitive abilities, Montreal Cognitive Assessment (MoCA) tool was used. Turkish matrix sentence test (TMST) was used for speech-in-noise test. Eighteen adult hearing aid users (mean age of 36.6 years) were participated.

CONCLUSIONS

Results showed that some self-reported listening-in-noise outcomes are correlated with lab-based measurements of speech-in-noise test scores but not with the aided speech intelligibility thresholds. Given the present limitations of relying solely on self-report measures, it is important to complement them with objective measures to ensure a comprehensive evaluation.

The Chinese Zodiac-in-Noise Test: An Internet-Based Speech-in-Noise Test for Large-Scale Hearing Screening

OBJECTIVES

Motivated by the growing need for hearing screening in China, the present study has two objectives. First, to develop and validate a new test, called the Chinese Zodiac-in-noise (ZIN) test, for large-scale hearing screening in China. Second, to conduct a large-scale remote hearing screening in China, using the ZIN test developed.

DESIGN

The ZIN test was developed following a similar procedure as the digits-in-noise test but emphasizes the importance of consonant recognition by employing the 12 zodiac animals in traditional Chinese culture as speech materials. It measures the speech reception threshold (SRT) using triplets of Chinese zodiac animals in speech-shaped noise with an adaptive procedure.

RESULTS

Normative data of the test were obtained in a group of 140 normal-hearing listeners, and the performance of the test was validated by comparisons with pure-tone audiometry in 116 listeners with various hearing abilities. The ZIN test has a reference SRT of -11.0 ± 1.6 dB in normal-hearing listeners with a test-retest variability of 1.7 dB and can be completed in 3 minutes. The ZIN SRT is highly correlated with the better-ear pure-tone threshold ( r = 0.82). With a cutoff value of -7.7 dB, the ZIN test has a sensitivity of 0.85 and a specificity of 0.94 for detecting a hearing loss of 25 dB HL or more at the better ear.A large-scale remote hearing screening involving 30,552 participants was performed using the ZIN test. The large-scale study found a hearing loss proportion of 21.0% across the study sample, with a high proportion of 57.1% in the elderly study sample aged over 60 years. Age and gender were also observed to have associations with hearing loss, with older individuals and males being more likely to have hearing loss.

CONCLUSIONS

The Chinese ZIN test is a valid and efficient solution for large-scale hearing screening in China. Its remote applications may improve access to hearing screening and enhance public awareness of hearing health.

Multicentric study on surgical information and early safety and performance results with the Bonebridge BCI 602: an active transcutaneous bone conduction hearing implant

AIM

This European multicentric study aimed to prove safety and performance of the Bonebridge BCI 602 in children and adults suffering from either conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided sensorineural deafness (SSD).

METHODS

33 patients (13 adults and 10 children with either CHL or MHL and 10 patients with SSD) in three study groups were included. Patients were their own controls (single-subject repeated measures), comparing the unaided or pre-operative to the 3-month post-operative outcomes. Performance was evaluated by sound field thresholds (SF), word recognition scores (WRS) and/or speech reception thresholds in quiet (SRT) and in noise (SNR). Safety was demonstrated with a device-specific surgical questionnaire, adverse event reporting and stable pure-tone measurements.

RESULTS

The Bonebridge BCI 602 significantly improved SF thresholds (+ 25.5 dB CHL/MHL/SSD), speech intelligibility in WRS (+ 68.0% CHL/MHL) and SRT in quiet (- 16.5 dB C/MHL) and in noise (- 3.51 dB SNR SSD). Air conduction (AC) and bone conduction (BC) thresholds remained stable over time. All adverse events were resolved, with none unanticipated. Mean audio processor wearing times in hours [h] per day for the CHL/MHL group were ~ 13 h for adults, ~ 11 h for paediatrics and ~ 6 h for the SSD group. The average surgical length was 57 min for the CHL/MHL group and 42 min for the SSD group. The versatility of the BCI 602 (reduced drilling depth and ability to bend the transition for optimal placement) allows for treatment of normal, pre-operated and malformed anatomies. All audiological endpoints were reached.

CONCLUSIONS

The Bonebridge BCI 602 significantly improved hearing thresholds and speech understanding. Since implant placement follows the patient's anatomy instead of the shape of the device and the duration of surgery is shorter than with its predecessor, implantation is easier with the BCI 602. Performance and safety were proven for adults and children as well as for the CHL/MHL and SSD indications 3 months post-operatively.

Framework and baseline examination of the German National Cohort (NAKO)

The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19–74 years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2–3 year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4–5 year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30 years.

Remote Monitoring of Adult Cochlear Implant Recipients Using Digits-in-Noise Self-Testing

PURPOSE

The COVID-19 pandemic has accelerated the uptake and scope of telehealth. This study determined the accuracy and reliability of a smartphone digits-in-noise (DIN) test when conducted by adult cochlear implant (CI) recipients in a simulated home environment compared with a clinic setup. Perceptions of remote monitoring using speech-in-noise (SIN) testing were also explored.

METHOD

Thirty-three adult CI recipients between 18 and 78 years of age (M = 46.7, SD = ±20.4) conducted the DIN test in a simulated home environment and a clinic setup. Test-retest reliability across the two environments and comparisons between test settings were evaluated. A survey explored the perceptions of adult CI recipients regarding remote monitoring and use of the DIN self-test.

RESULTS

Mean-aided speech reception thresholds (SRTs) in the clinic and simulated home environment test conditions and clinic and simulated home environment retest conditions did not differ significantly. Mean test-retest SRTs in the clinic and simulated home environment were significantly different (p < .05). High intraclass correlation coefficient and low standard error of measurement scores reflected good and excellent reliability between test-retest measures and between clinic and simulated home environment measures. Most participants were positive about the possibility of using the DIN test at home to self-assess speech perception, although some test adjustments such as including training items and a less adverse starting signal-to-noise ratio may be required.

CONCLUSION

Adult CI recipients can use the smartphone DIN test to self-assess aided SIN performance in a home environment with accuracy and reliability relatively similar to clinic testing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20044418.

Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers

<b><i>Background:</i></b> Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population. <b><i>Summary:</i></b> A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus databases were searched. Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit. <b><i>Key Messages:</i></b> As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling.

User-Operated Audiometry Project (UAud) - Introducing an Automated User-Operated System for Audiometric Testing Into Everyday Clinic Practice

Hearing loss is the third leading cause of years lived with disability. It is estimated that 430 million people worldwide are affected, and the number of cases is expected to increase in the future. There is therefore increased pressure on hearing health systems around the world to improve efficiency and reduce costs to ensure increased access to quality hearing health care. Here, we describe the User-Operated Audiometry project, the goal of which is to introduce an automated system for user-operated audiometric testing into everyday clinic practice as a means to relieve part of this pressure. The alternative to the existing referral route is presented in which examination is executed via the user-operated system. This route is conceptualized as an interaction between the patient, the system, and the hearing care professional (HCP). Technological requirements of the system and challenges that are related to the interaction between patients, the user-operated system, and the HCPs within the specific medical setting are discussed. Lastly, a strategy for the development and implementation of user-operated audiometry is presented, which includes initial investigations, a validation study, and implementation in a real-life clinical situation.

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss

OBJECTIVES

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss.

DESIGN

We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs.

RESULTS

The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list.

CONCLUSION

The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

The possibility of cochlear synaptopathy in young people using a personal listening device

OBJECTIVE

To evaluate the association of listening to music loudly through personal listening devices with cochlear synaptopathy in young adults.

METHODS

Fifty healthy young adults selected among 109 volunteers were included in the study. Participants of high risk (n=25) and low risk (n=25) groups estimated according to ETDNL (estimated total daily noise level) were evaluated using pure tone audiometry, tympanometry, matrix test, electrocochleography (EcochG) and auditory brainstem response (ABR) to evaluate the occurrence of cochlear synaptopathy.

RESULTS

Audiometric thresholds between the groups were not significantly different (p>0.05). High risk group participants showed poorer performance than the low-risk group on the TurMatrix test, in non-adaptive noise with -5 SNR and -7.5 SNR, and at the 50% understanding SNR level with headphones (p<0.01). There was no difference in the adaptive free field in noise test at which 50% understanding was achieved (p>0.05). The AP amplitudes on EcochG and wave V amplitudes on ABR were significantly smaller in the high-risk group (p<0.05). There was no association between ETDNL and I/V ratio on ABR.

CONCLUSION

Poorer performance in TurMatrix and other electrophysiologic tests revealed the negative effect of personal listening devices on the auditory system. Our findings support the hypothesis that personal listening devices could cause cochlear synaptopathy. Long-term studies are needed to determine the effects of binaural hearing and duration of noise exposure on the auditory system.

Duration of deafness impacts auditory performance after cochlear implantation: A meta-analysis

OBJECTIVE

Hearing loss is a highly disabling condition. Cochlear implantation is an established remedy if conventional hearing aids have failed to alleviate the level of disability. Unfortunately, cochlear implant (CI) performance varies dramatically. This study aims to examine the effects of duration of deafness (DoD) prior to cochlear implantation and the postoperative duration of implant experience with resulting hearing performance in postlingually deaf patients.

METHODS

A systematic literature review and two meta-analyses were conducted using the search terms cochlear implant AND duration deafness. Included studies evaluate the correlation between the DoD and auditory performance after cochlear implantation using monosyllabic and sentence tests. Correlation coefficients were determined using Pearson's correlation and Spearman rho.

RESULTS

A total of 36 studies were identified and included data on cochlear implantations following postlingual deafness and postoperative speech testing of hearing outcomes for 1802 patients. The mean age ranged from 44 to 68 years with a DoD of 0.1 to 77 years. Cochlear implant use varied from 3 months to 14 years of age. Speech perception, which was assessed by sentence and monosyllabic word perception, was negatively correlated with DoD. Subgroup analyses revealed worse outcomes for longer DoD and shorter postoperative follow-up.

CONCLUSION

DoD is one of the most important factors to predict speech perception after cochlear implantation in postlingually deaf patients. The meta-analyses revealed a negative correlation between length of auditory deprivation and postoperative sentence and monosyllabic speech perception. Longer DoD seems to lead to worse CI performance, whereas more experience with CI mitigates the effect.

The simplified French Matrix. A tool for evaluation of speech intelligibility in noise

INTRODUCTION

In audiology, the usual tests of speech perception in silence are non-predictive of intelligibility in noise. The French Matrix was developed to assess intelligibility in noise in adults with normal cognitive capacity. A simplified adaptive version, FRA-SIMAT, was derived for use with children and elderly persons with diminished memory span. The aim of the present study was to apply this adaptive procedure to determine signal-to-noise ratio (SNR) according to percentage intelligibility.

METHODS

Twenty normal-hearing adults and 60 normal-hearing children aged 5-6 years (G1), 7-8 years (G2) and 9-10 years (G3) were included. FRA-SIMAT uses groups of 3 words, to limit memory demand.

RESULTS

In adults, SNR for 50% (SNR-50) and 80% intelligibility (SNR-80) was respectively -7.1±1.4dB and -3.7±1.6dB. In children, SNR-50 was -4.2±1.3dB in G1, -4.6±1.2dB in G2, and -5.5±1.5dB in G3.

CONCLUSION

The FRA-SIMAT test of speech perception in noise was validated in adults and children of different ages, and can be implemented as a diagnostic and rehabilitation tool in clinical practice.

Understanding ethnic inequalities in hearing health in the UK: a cross-sectional study of the link between language proficiency and performance on the Digit Triplet Test

INTRODUCTION

Research using the UK Biobank data has shown ethnic inequalities in hearing health; however, the hearing test used may exhibit a disadvantage for non-native language speakers.

OBJECTIVES

To validate the results of the UK Biobank hearing test (Digit Triplet Test, DTT) against self-reported measures of hearing in the dataset and create classifications of hearing health. To observe if language proficiency and migration age have the same effect on hearing health classification as on the DTT in isolation. Our hypothesis is that language proficiency acts differently on the DTT, demonstrating that the DTT is biased for non-native speakers of English.

DESIGN

Latent classes representing profiles of hearing health were identified from the available hearing measures. Factors associated with class membership were tested using multinomial logistic regression models. Ethnicity was defined as (1) White, native English-speaking, (2) ethnic minority, arrived in the UK aged <12 or (3) ethnic minority, arrived aged >12.

PARTICIPANTS

The UK Biobank participants with valid hearing test results and associated covariates (N=151 268).

OUTCOME MEASURES

DTT score, self-reported hearing difficulty, self-reported hearing difficulty in noise and hearing aid use.

RESULTS

Three classes of hearing health were found: 'normal', 'generally poor' and 'only subjectively poor'. In a model adjusting for known confounders of hearing loss, a poor or insufficient hearing test result was less likely for those with better language (OR 0.69, 95% CI 0.65 to 0.74) or numerical ability (OR 0.71, 95% CI 0.67 to 0.75) but more likely for those having migrated aged >12 (OR 3.85, 95% CI 3.64 to 4.07).

CONCLUSIONS

The DTT showed evidence of bias, having greater dependence on language ability and migration age than other hearing indicators. Designers of future surveys and hearing screening applications may wish to consider the limitations of speech-in-noise tests in evaluating hearing acuity for populations that include non-native speakers.

Speech Audiometry at Home: Automated Listening Tests via Smart Speakers With Normal-Hearing and Hearing-Impaired Listeners

Speech audiometry in noise based on sentence tests is an important diagnostic tool to assess listeners’ speech recognition threshold (SRT), i.e., the signal-to-noise ratio corresponding to 50% intelligibility. The clinical standard measurement procedure requires a professional experimenter to record and evaluate the response (expert-conducted speech audiometry). The use of automatic speech recognition enables self-conducted measurements with an easy-to-use speech-based interface. This article compares self-conducted SRT measurements using smart speakers with expert-conducted laboratory measurements. With smart speakers, there is no control over the absolute presentation level, potential errors from the automated response logging, and room acoustics. We investigate the differences between highly controlled measurements in the laboratory and smart speaker-based tests for young normal-hearing (NH) listeners as well as for elderly NH, mildly and moderately hearing-impaired listeners in low, medium, and highly reverberant room acoustics. For the smart speaker setup, we observe an overall bias in the SRT result that depends on the hearing loss. The bias ranges from +0.7 dB for elderly moderately hearing-impaired listeners to +2.2 dB for young NH listeners. The intrasubject standard deviation is close to the clinical standard deviation (0.57/0.69 dB for the young/elderly NH compared with 0.5 dB observed for clinical tests and 0.93/1.09 dB for the mild/moderate hearing-impaired listeners compared with 0.9 dB). For detecting a clinically elevated SRT, the speech-based test achieves an area under the curve value of 0.95 and therefore seems promising for complementing clinical measurements.

Language-Independent Hearing Screening Based on Masked Recognition of Ecological Sounds

A language-independent automated self-test on tablet based on masked recognition of ecological sounds, the Sound Ear Check (SEC), was developed. In this test, 24 trials of eight different sounds are randomly presented in a noise that was spectrally shaped according to the average frequency spectra of the stimulus sounds, using a 1-up 2-down adaptive procedure. The test was evaluated in adults with normal hearing and hearing loss, and its feasibility was investigated in young children, who are the target population of this test. Following equalization of perceptual difficulty across sounds by applying level adjustments to the individual tokens, a reference curve with a steep slope of 18%/dB was obtained, resulting in a test with a high test–retest reliability of 1 dB. The SEC sound reception threshold was significantly associated with the averaged pure tone threshold (r = .70), as well as with the speech reception threshold for the Digit Triplet Test (r = .79), indicating that the SEC is susceptible to both audibility and signal-to-noise ratio loss. Sensitivity and specificity values on the order of magnitude of ∼70% and ∼80% to detect individuals with mild and moderate hearing loss, respectively, and ∼80% to detect individuals with slight speech-in-noise recognition difficulties were obtained. Homogeneity among sounds was verified in children. Psychometric functions fitted to the data indicated a steep slope of 16%/dB, and test–retest reliability of sound reception threshold estimates was 1.3 dB. A reference value of −9 dB signal-to-noise ratio was obtained. Test duration was around 6 minutes, including training and acclimatization.

Neural Evidence for Speech Processing Deficits During a Cocktail Party Scenario in Minimally and Low Verbal Adolescents and Young Adults with Autism

As demonstrated by the Cocktail Party Effect, a person's attention is grabbed when they hear their name in a multispeaker setting. However, individuals with autism (ASD) are commonly challenged in multispeaker settings and often do not respond to salient speech, including one's own name (OON). It is unknown whether neural responses during this Cocktail Party scenario differ in those with ASD and whether such differences are associated with expressive language or auditory filtering abilities. We measured neural responses to hearing OON in quiet and multispeaker settings using electroencephalography in 20 minimally or low verbal ASD (ASD-MLV), 27 verbally fluent ASD (ASD-V), and 27 neurotypical (TD) participants, ages 13-22. First, we determined whether TD's neural responses to OON relative to other names could be quantified with early frontal mismatch responses (MMRs) and late, slow shift parietal and frontal responses (LPPs/FNs). Second, we compared the strength of MMRs and LPPs/FNs across the three groups. Third, we tested whether participants with poorer auditory filtering abilities exhibited particularly weak neural responses to OON heard in a multispeaker setting. Our primary finding was that TDs and ASD-Vs, but not ASD-MLVs, had significant MMRs to OON in a multispeaker setting, and strength of LPPs positively correlated with auditory filtering abilities in those with ASD. These findings reveal electrophysiological correlates of auditory filtering disruption within a clinical population that has severe language and communication impairments and offer a novel neuroimaging approach to studying the Cocktail Party effect in neurotypical and clinical populations. Autism Res 2020, 13: 1828-1842. © 2020 International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: We found that minimally and low verbal adolescents and young adults with autism exhibit decreased neural responses to one's own name when heard in a multispeaker setting. In addition, decreased strength of neural responses in those with autism correlated with decreased auditory filtering abilities. We propose that these neural deficits may reflect the ineffective processing of salient speech in noisy settings and contribute to language and communication deficits observed in autism.

Development and validation of a digits-in-noise hearing test in Persian

OBJECTIVE

The prevalence of unrecognised and late-diagnosed hearing loss is higher in low- and middle-income than in high-income countries, due in part to lack of access to hearing services. Because hearing screening is important for early identification of hearing loss, development of an accessible, self-screening test that can detect hearing loss reliably and quickly would provide significant benefits, especially for underserved populations. This study aimed to develop and validate a new version of the digits-in-noise (DIN) test for Persian speaking countries.

DESIGN

Recordings of Persian digits 0-9 were binaurally presented in broadband speech-shaped noise. Using fitted speech intelligibility functions, digits were homogenised to achieve equal perceptual difficulty across stimuli. The evaluation was established by reference to existing English DIN tests.

STUDY SAMPLE

Thirty Persian speaking young adults with normal hearing thresholds (≤20 dB HL, 0.25-8 kHz).

RESULTS

Speech intelligibility functions produced a mean speech reception threshold (SRT) of -7.7 dB, corresponding closely to previously developed DIN tests. There was no significant difference between test and retest SRTs, indicating high reliability of the test. Our findings suggest that language-specific factors need to be considered for cross-language comparison of DIN-SRTs.

CONCLUSION

This study introduces a convenient tool for future hearing screening in Persian speaking countries with limited access to audiology services.

Clinical validation of the Russian Matrix test - effect of hearing loss, age, and noise level

OBJECTIVE

To validate the Russian matrix sentence test (RUMatrix) for the assessment of speech recognition in quiet and in noise in clinical praxis. The effect of hearing impairment, age, and masking-noise level on speech recognition was examined.

DESIGN

All participants underwent pure tone audiometry, a monosyllabic speech test in quiet, and speech recognition measurements with RUMatrix in quiet (SRT_Q) and in noise (SRT_N).

STUDY SAMPLE

One hundred and forty-two listeners divided into four groups: 1. Young normal-hearing listeners, 2. Older normal-hearing listeners, 3. Young hearing-impaired listeners, and 4. Older hearing-impaired listeners.

RESULTS

Significant differences between groups of listeners were found in the SRT_Q and SRT_N. A strong correlation between hearing threshold and SRT_Q (R²=0.88, p < 0.001) indicates a strong link between speech recognition in quiet and audibility. The pure-tone average explained less variance in SRT_N (R²=0.67, p < 0.001), pointing out an additional influence of suprathreshold distortion. A high test sensitivity of 0.99 was found for SRT_N and SRT_Q. The monosyllabic test had a low sensitivity (0.21), indicating that the test is not suitable for separating normal-hearing and hearing-impaired listeners.

CONCLUSIONS

RuMatrix is a reliable speech recognition assessment tool with a high sensitivity and validity for the main aspects of hearing impairment.

Development of the Canadian Digit Triplet Test in English and French

The Canadian Digit Triplet Test was developed in English and French, the official languages of Canada. Four versions were developed on a common software platform using recordings produced by two fluent bilinguals, one male and one female, following procedures recommended by international guidelines. Phase I of test development focused on homogenizing digit recognition across tokens and positions within the triplets for young adults with normal hearing (n = 48). In phase II, normative data were collected for young adults with normal hearing (n = 64). Statistical properties were found to be uniform across test versions and comparable to digit triplet tests in other languages.

Enhancing Screening Systems to Facilitate Hearing-Healthcare Access: A Qualitative Study

BACKGROUND

Although hearing loss is a common health issue, hearing healthcare (HHC) is poorly accessed. Screening to identify hearing loss is an important part of HHC access, specifically for those who screen positive for hearing loss and would benefit from seeing a HHC provider. New technologies can be automated to provide information and recommendations that are tailored to the needs of individual users, potentially enhancing rates of HHC access after positive screens. A greater understanding of the facilitators of postscreening HHC access that could be leveraged in such systems is needed.

PURPOSE

The purpose of this project was to identify facilitators of postscreening HHC access that can be used in automated screening systems.

RESEARCH DESIGN

This qualitative study used focus groups (FGs) to understand perceived barriers, perceived benefits, and potential cues to action, as informed by the Health Belief Model, for accessing HHC after use of automated hearing screening systems.

STUDY SAMPLE

Fifty individuals participated in one of seven FGs. FGs were conducted separately with three types of stakeholders: four FGs included adults who reported some degree of perceived hearing loss and had recently completed a hearing screening; two FGs included adults who had recently sought HHC for the first time because of hearing loss; and one FG involved significant others/family members of individuals with hearing loss.

DATA COLLECTION AND ANALYSIS

FGs were 60-90 minutes in length and were led by a trained facilitator following a discussion guide. A research audiologist was present at each FG and served as a notetaker. FGs were recorded and transcribed by research team members, and transcripts were then coded in an iterative process by multiple team members. Qualitative content analysis was used to reduce data and to identify salient themes and subthemes, following an inductive approach. We focused on identifying themes that were related to facilitators of HHC access after positive screens for hearing loss and, separately, potential enhancements to automated hearing screening systems that would leverage these facilitators to improve HHC access.

RESULTS

We identified five key themes related to HHC access after a positive screen for hearing loss, along with ideas for enhancing automated hearing screening systems based on these themes. The themes included knowledge, trust, access, quality of life, and interpersonal influence.

CONCLUSIONS

The results of our work help inform the development of innovative hearing screening systems that can be automated to leverage individual facilitators of HHC access.

[Characteristics, advantages, and limits of matrix tests]

BACKGROUND

Deterioration of communication abilities due to hearing problems is particularly relevant in listening situations with noise. Therefore, speech intelligibility tests in noise are required for audiological diagnostics and evaluation of hearing rehabilitation.

OBJECTIVE

This study analyzed the characteristics of matrix tests assessing the 50 % speech recognition threshold in noise. What are their advantages and limitations?

METHODS

Matrix tests are based on a matrix of 50 words (10 five-word sentences with same grammatical structure). In the standard setting, 20 sentences are presented using an adaptive procedure estimating the individual 50 % speech recognition threshold in noise. At present, matrix tests in 17 different languages are available.

RESULTS

A high international comparability of matrix tests exists. The German language matrix test (OLSA, male speaker) has a reference 50 % speech recognition threshold of -7.1 (± 1.1) dB SNR.

CONCLUSION

Before using a matrix test for the first time, the test person has to become familiar with the basic speech material using two training lists. Hereafter, matrix tests produce constant results even if repeated many times. Matrix tests are suitable for users of hearing aids and cochlear implants, particularly for assessment of benefit during the fitting process. Matrix tests can be performed in closed form and consequently with non-native listeners, even if the experimenter does not speak the test person's native language. Short versions of matrix tests are available for listeners with a shorter memory span, e.g., children.

Diagnosing and Screening in a Minority Language: A Validation Study

PURPOSE

The Turkish Digit Triplet Test for hearing self-screening purposes and the Turkish Matrix Test (TURMatrix) for follow-up hearing diagnostics offer an automated closed-set response format where patients respond by choosing from response alternatives. Their applicability for testing Turkish-speaking patients in their native language by German audiologists with different Turkish language skills was investigated.

METHOD

Tests were composed of spoken numbers (Turkish Digit Triplet Test) or sentences (TURMatrix). For 49 participants differing in hearing ability, speech reception thresholds (SRTs) in noise and quiet were obtained, for the TURMatrix with either the open- or closed-set response format, by audiologists with and without Turkish language skills, respectively.

RESULTS

SRTs of both tests correlate closely with each other as well as with hearing ability, but not as closely as individual SRTs in quiet with hearing ability. SRTs in noise of listeners with normal hearing were about 0.7 dB lower for the closed-set than for the open-set response format.

CONCLUSIONS

The 2 tests yield comparable results and are applicable to professionals without suitable language skills. For the closed-set response format of the TURMatrix, literacy is crucial and supplemental (visual) cues improve performance. Speech audiometry in noise should assess suprathreshold processing deficits independently from language proficiency in the majority language.

Simulated Critical Differences for Speech Reception Thresholds

PURPOSE

Critical differences state by how much 2 test results have to differ in order to be significantly different. Critical differences for discrimination scores have been available for several decades, but they do not exist for speech reception thresholds (SRTs). This study presents and discusses how critical differences for SRTs can be estimated by Monte Carlo simulations. As an application of this method, critical differences are proposed for a 5-word sentences test (a matrix test) using 2 widely implemented adaptive test procedures.

METHOD

For each procedure, simulations were performed for different parameters: the number of test sentences, the j factor, the distribution of the subjects' true SRTs, and the slope of the discrimination function. For 1 procedure and 1 parameter setting, simulation data are compared with results found by listening tests (experimental data).

RESULTS

The critical differences were found to depend on the parameters tested, including interactive effects. The critical differences found by simulation agree with data found experimentally.

CONCLUSIONS

As the critical differences for SRTs rely on multiple parameters, they must be determined for each parameter setting individually. However, with knowledge of the test setup, rules of thumb can be derived.

[The speech audiometry using the matrix sentence test]

The matrix sentence test in which the five-word semantically unpredictable sentences presented under the background noise conditions are used as the speech material was designed and validated for many languages. The objective of the present study was to evaluate the Russian version of the matrix sentence test (RuMatrix test) in the listeners of different ages with normal hearing. At the first stage of the study, 35 listeners at the age from 18 to 33 year were examined. The results of the estimation of the training effect dictated the necessity of conducting two training tracks before carrying out the RuMatrix test proper. The signal-to-noise ratio at which 50% speech recognition (SRT50) was obtained was found to be -8.8±0.8 dB SNR. A significant effect of exposure to the background noise was demonstrated: the noise level of 80 and 75 Db SPL led to a considerably lower intelligibility than the noise levels in the range from 45 to 70 dB SPL; in the subsequent studies, the noise level of 65 dB SPL was used. The high test-retest reliability of the RuMatrix test was proved. At the second stage of the study, 20 young (20-40 year old) listeners and 20 aged (62-74 year old) ones were examined. The mean SRT50 in the aged patients was found to be -6.9±1.1 dB SNR which was much worse than the mean STR50 in the young subjects (-8.7±0.9 dB SNR). It is concluded that, bearing in mind the excellent comparability of the results of the RUMat rix test across different languages, it can be used as a universal tool in international research projects.

Characteristics and international comparability of the Finnish matrix sentence test in cochlear implant recipients

OBJECTIVES

The first Finnish sentence-based speech test in noise--the Finnish matrix sentence test--was recently developed. The aim of this study was to determine the characteristics of the new test with respect to test-retest reliability, speech recognition curve, and international comparability in Finnish cochlear implant (CI) recipients.

DESIGN

The speech reception thresholds (SRT) were measured by means of an adaptive test procedure and compared with the results of the traditional Finnish word test. Additional measurements for concurrent slope and SRT estimation were conducted to determine the speech recognition curve and to check the test-retest reliability.

STUDY SAMPLE

The measurements were performed on 78 Finnish CI recipients. In a subset of 25 patients, additional measurements for test-retest reliability and slope determination were performed.

RESULTS

The mean SRT was -3.5 ± 1.7 dB SNR, with only a weak correlation with the Finnish word test. Test-retest reliability was within ± 1 dB and the mean slope of the speech recognition curve was 14.6 ± 3.6 %/dB. The rehabilitation results were similar to the results published for the German matrix test.

CONCLUSIONS

The Finnish matrix test was found to be suitable and efficient in CI recipients with similar characteristics as the German matrix test.

Optimization of the Dutch matrix test by random selection of sentences from a preselected subset

Matrix tests are available for speech recognition testing in many languages. For an accurate measurement, a steep psychometric function of the speech materials is required. For existing tests, it would be beneficial if it were possible to further optimize the available materials by increasing the function's steepness. The objective is to show if the steepness of the psychometric function of an existing matrix test can be increased by selecting a homogeneous subset of recordings with the steepest sentence-based psychometric functions. We took data from a previous multicenter evaluation of the Dutch matrix test (45 normal-hearing listeners). Based on half of the data set, first the sentences (140 out of 311) with a similar speech reception threshold and with the steepest psychometric function (≥9.7%/dB) were selected. Subsequently, the steepness of the psychometric function for this selection was calculated from the remaining (unused) second half of the data set. The calculation showed that the slope increased from 10.2%/dB to 13.7%/dB. The resulting subset did not allow the construction of enough balanced test lists. Therefore, the measurement procedure was changed to randomly select the sentences during testing. Random selection may interfere with a representative occurrence of phonemes. However, in our material, the median phonemic occurrence remained close to that of the original test. This finding indicates that phonemic occurrence is not a critical factor. The work highlights the possibility that existing speech tests might be improved by selecting sentences with a steep psychometric function.

Speech perception with interaction-compensated simultaneous stimulation and long pulse durations in cochlear implant users

Early multi-channel designs in the history of cochlear implant development were based on a vocoder-type processing of frequency channels and presented bands of compressed analog stimulus waveforms simultaneously on multiple tonotopically arranged electrodes. The realization that the direct summation of electrical fields as a result of simultaneous electrode stimulation exacerbates interactions among the stimulation channels and limits cochlear implant outcome led to the breakthrough in the development of cochlear implants, the continuous interleaved (CIS) sampling coding strategy. By interleaving stimulation pulses across electrodes, CIS activates only a single electrode at each point in time, preventing a direct summation of electrical fields and hence the primary component of channel interactions. In this paper we show that a previously presented approach of simultaneous stimulation with channel interaction compensation (CIC) may also ameliorate the deleterious effects of simultaneous channel interaction on speech perception. In an acute study conducted in eleven experienced MED-EL implant users, configurations involving simultaneous stimulation with CIC and doubled pulse phase durations have been investigated. As pairs of electrodes were activated simultaneously and pulse durations were doubled, carrier rates remained the same. Comparison conditions involved both CIS and fine structure (FS) strategies, either with strictly sequential or paired-simultaneous stimulation. Results showed no statistical difference in the perception of sentences in noise and monosyllables for sequential and paired-simultaneous stimulation with doubled phase durations. This suggests that CIC can largely compensate for the effects of simultaneous channel interaction, for both CIS and FS coding strategies. A simultaneous stimulation paradigm has a number of potential advantages over a traditional sequential interleaved design. The flexibility gained when dropping the requirement of interleaving pulses across electrodes may be instrumental in designing coding strategies for a more accurate transmission of stimulus features such as temporal fine structure or interaural time delays to the auditory nerve. Also, longer pulse phase durations may be implemented while maintaining relatively high stimulation pulse rates. Utilizing longer pulse durations may relax requirements on implant compliance and facilitate the design of more energy-efficient implant receivers for a longer battery lifetime or a reduction in implant size. This article is part of a Special Issue entitled <Lasker Award>.

Development of a German reading span test with dual task design for application in cognitive hearing research

OBJECTIVE

To report the development of a standardized German version of a reading span test (RST) with a dual task design. Special attention was paid to psycholinguistic control of the test items and time-sensitive scoring. We aim to establish our RST version to use for determining an individual's working memory in the framework of hearing research in German contexts.

DESIGN

RST stimuli were controlled and pretested for psycholinguistic factors. The RST task was to read sentences, quickly determine their plausibility, and later recall certain words to determine a listener's individual reading span. RST results were correlated with outcomes of additional sentence-in-noise tests measured in an aided and an unaided listening condition, each at two reception thresholds.

STUDY SAMPLE

Item plausibility was pre-determined by 28 native German participants. An additional 62 listeners (45-86 years, M = 69.8) with mild-to-moderate hearing loss were tested for speech intelligibility and reading span in a multicenter study.

RESULTS

The reading span test significantly correlated with speech intelligibility at both speech reception thresholds in the aided listening condition.

CONCLUSION

Our German RST is standardized with respect to psycholinguistic construction principles of the stimuli, and is a cognitive correlate of intelligibility in a German matrix speech-in-noise test.

The effects of dosage and duration of auditory training for older adults with hearing impairment

This study explored a range of training dosages and durations for a word-based auditory-training procedure for older adults with hearing impairment. Three groups received a different "dose": 2x/week; 3x/week; no training. Fifteen training sessions comprised a "cycle" which was repeated three times for each dosage. Groups that completed training performed significantly better than controls for speech-in-noise materials included in the training regimen, with no significant difference observed between the 2x or 3x/week training groups. Based on these results, as well as prior literature on learning theory, training 2x or 3x/week for 5-15 weeks appears to be sufficient to yield training benefits with this training regimen.

The development and evaluation of the Finnish Matrix Sentence Test for speech intelligibility assessment

CONCLUSION

The Finnish Matrix Test is the first sentence test in noise for the Finnish language. It was developed according to the HearCom standards and provides reliable speech intelligibility measurements with highly comparable results with the other international matrix tests.

OBJECTIVES

The aim of the study was to develop an accurate speech intelligibility test in noise for the Finnish language that is comparable across different languages.

METHODS

We chose a matrix sentence test, which comprises a base matrix of 10 names, verbs, numerals, adjectives and nouns. Test lists were formed from this matrix quasi randomly, providing test sentences of the same syntactical structure. The speech material corresponds to everyday spoken language and the phoneme distribution is representative of the Finnish language. The test was optimized by determining the speech recognition thresholds of the individual words and subsequently by applying level corrections of up to ±3 dB. Evaluation measurements were performed to check the equivalence of the different test lists with respect to speech intelligibility and to provide reference values for further clinical applications.

RESULTS

After training, the mean speech recognition threshold (SRT) and the slope of the final test lists were -10.1 ± 0.1 dB signal-to-noise-ratio (SNR)and 16.7 ± 1.2%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and the slope of the test subjects were -10.1 ± 0.7 dB SNR and 17.5 ± 2.2%/dB (measurements at constant level; inter-subject variability). The expected SRT range for normal-hearing young adults for adaptive measurements is -9.7 ± 0.7 dB SNR.

Investigation into the applicability and optimization of the Dutch matrix sentence test for use with cochlear implant users

OBJECTIVE

Matrix sentence tests use words from a fixed word matrix to compose syntactically equivalent, but semantically unpredictable sentences. These tests are suitable for monitoring performance of cochlear implant (CI) users by repeated speech intelligibility testing. This study evaluates the Dutch matrix sentence test in CI users in quiet and in noise. It then investigates the possibility to improve the test-retest reliability for CI users by selecting subsets of sentences.

DESIGN

Repeated speech intelligibility testing was performed in quiet and in noise. The effect of sentence selection on the test-retest reliability was predicted by computer simulations and experimentally evaluated using a cross-over design.

STUDY SAMPLE

Fifteen post-lingually deafened CI users, of which eleven participated in the cross-over study.

RESULTS

The test-retest reliability equaled 2.3 dB in quiet and 1.3 dB in noise. The simulations predicted an improvement in test-retest reliability, especially in quiet. The cross-over study did not confirm the predictions.

CONCLUSIONS

The results of the study suggest that the homogeneity of the sentences is not the prime component underlying the test-retest reliability. The Dutch matrix speech material and the selected subsets of sentences were equally suitable for speech intelligibility testing in CI users.

An eye-tracking paradigm for analyzing the processing time of sentences with different linguistic complexities

An eye-tracking paradigm was developed for use in audiology in order to enable online analysis of the speech comprehension process. This paradigm should be useful in assessing impediments in speech processing. In this paradigm, two scenes, a target picture and a competitor picture, were presented simultaneously with an aurally presented sentence that corresponded to the target picture. At the same time, eye fixations were recorded using an eye-tracking device. The effect of linguistic complexity on language processing time was assessed from eye fixation information by systematically varying linguistic complexity. This was achieved with a sentence corpus containing seven German sentence structures. A novel data analysis method computed the average tendency to fixate the target picture as a function of time during sentence processing. This allowed identification of the point in time at which the participant understood the sentence, referred to as the decision moment. Systematic differences in processing time were observed as a function of linguistic complexity. These differences in processing time may be used to assess the efficiency of cognitive processes involved in resolving linguistic complexity. Thus, the proposed method enables a temporal analysis of the speech comprehension process and has potential applications in speech audiology and psychoacoustics.