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Alter DS. The role of hearing and listening in hypnotic responsiveness. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2024:1-13. [PMID: 39073843 DOI: 10.1080/00029157.2024.2370777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The hypnosis literature emphasizes features of suggestion, induction, and communication that are described as evoking heightened responsiveness on the part of the subject or client. This article explores what is often overlooked: to have an effect, the subject must not only hear the suggestion but listen to it. The process of listening is described across multiple levels ranging from the acoustic signal to its transduction into a meaning-filled and motivationally enriched message that spurs action. That journey traverses challenging terrain, with numerous obstacles that serve to maintain past habits and response patterns, despite a client's stated desire for adaptive change. The article highlights those obstacles and then provides descriptions of five language structures that can reach the client consciously or non-consciously, but always in ways that increase the odds that the therapeutic messaging is packaged in a manner that optimizes it being "heard," absorbed, and enacted. Applications of each language structure are provided using relevant clinical case examples.
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Affiliation(s)
- David S Alter
- Partners in Healing of Minneapolis, Minnetonka, MN, USA
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2
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Borschke I, Jürgens T, Schinkel-Bielefeld N. How Individuals Shape Their Acoustic Environment: Implications for Hearing Aid Comparison in Ecological Momentary Assessment. Ear Hear 2024; 45:985-998. [PMID: 38514463 PMCID: PMC11175760 DOI: 10.1097/aud.0000000000001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/24/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES When using ecological momentary assessment (EMA) to compare different hearing aid programs, it is usually assumed that for sufficiently long study durations similar situations will be experienced in both programs. However, conscious or subconscious adaptation of situations to one's hearing ability (e.g., asking a conversation partner to speak up, increasing TV volume)-which might be different across the time spent in different hearing aid programs-may challenge this assumption. In the present study, we investigated how test participants modify their acoustic environment and if these modifications depend on the hearing program. DESIGN Twenty-nine experienced hearing aid users were provided with hearing aids containing two hearing programs differing in directionality and noise reduction (NR). The hearing programs called NR-on and NR-off changed each day automatically. Over the course of 3 weeks, participants were asked to answer a questionnaire every time they encountered an acoustic situation they modified or would have liked to modify to improve the listening situation. Objective data on sound pressure level and classification of the acoustic situation were collected from the hearing aids. At the beginning of the study participants recollected modifications of the acoustic environments they typically do when using their own hearing aids and reported on the frequency of this behavior. RESULTS During the field trial, participants reported on average 2.3 situations per day that they modified or would have liked to modify. Modifications were usually performed quickly after the onset of the situation and significantly improved the pleasantness of the listening situation. While the number of the reported situations did not differ between the programs, modifications increasing the volume of the target signal and increasing the hearing aid volume were more frequent for the NR-on hearing program. Changes in the objective data at the time of the modification were consistent with the reported modifications. Further, the usage time as well as the distribution of the acoustic situations over the entire study period differed between the two hearing programs. CONCLUSIONS The large improvement in pleasantness due to the modification might explain the generally positive ratings observed in EMA studies. Furthermore, the results found here suggest that caution is needed when comparing ratings of audiological attributes in EMA, because the different modification behavior across hearing programs may lead to an underestimation of hearing problems and reduced sensitivity when comparing two technologies.
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Affiliation(s)
- Iris Borschke
- WS Audiology, Erlangen, Germany
- Institute of Acoustics, Technische Hochschule Lübeck, Lübeck, Germany
| | - Tim Jürgens
- Institute of Acoustics, Technische Hochschule Lübeck, Lübeck, Germany
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Fletcher MD, Akis E, Verschuur CA, Perry SW. Improved tactile speech perception and noise robustness using audio-to-tactile sensory substitution with amplitude envelope expansion. Sci Rep 2024; 14:15029. [PMID: 38951556 PMCID: PMC11217272 DOI: 10.1038/s41598-024-65510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
Recent advances in haptic technology could allow haptic hearing aids, which convert audio to tactile stimulation, to become viable for supporting people with hearing loss. A tactile vocoder strategy for audio-to-tactile conversion, which exploits these advances, has recently shown significant promise. In this strategy, the amplitude envelope is extracted from several audio frequency bands and used to modulate the amplitude of a set of vibro-tactile tones. The vocoder strategy allows good consonant discrimination, but vowel discrimination is poor and the strategy is susceptible to background noise. In the current study, we assessed whether multi-band amplitude envelope expansion can effectively enhance critical vowel features, such as formants, and improve speech extraction from noise. In 32 participants with normal touch perception, tactile-only phoneme discrimination with and without envelope expansion was assessed both in quiet and in background noise. Envelope expansion improved performance in quiet by 10.3% for vowels and by 5.9% for consonants. In noise, envelope expansion improved overall phoneme discrimination by 9.6%, with no difference in benefit between consonants and vowels. The tactile vocoder with envelope expansion can be deployed in real-time on a compact device and could substantially improve clinical outcomes for a new generation of haptic hearing aids.
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Affiliation(s)
- Mark D Fletcher
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
| | - Esma Akis
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Carl A Verschuur
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Samuel W Perry
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK
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4
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Kuk F, Slugocki C, Korhonen P. Characteristics of the quick repeat-recall test (Q-RRT). Int J Audiol 2024; 63:482-490. [PMID: 37615510 DOI: 10.1080/14992027.2023.2245969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To determine the reliability and validity of the Quick Repeat-Recall Test (Q-RRT). DESIGN Within-subject repeated measures. Participants completed the Q-RRT at a speech level of 75 dB SPL in 2 noise configurations at signal-to-noise ratios of 5, 10, and 15 dB in a counterbalanced order, along with the full-RRT. The Q-RRT was repeated after 1-3 weeks to estimate within-session and between-session reliability. Participants also completed external validation measures relating speech-in-noise ability (Hearing-In-Noise Test, HINT), memory (Reading Span Test, RST; Forward Digit Span Test, DST-F), and noise acceptance (Tracking of Noise Tolerance, TNT). STUDY SAMPLE Twenty-five normal-hearing listeners (mean age = 63.9 years). RESULTS Group Repeat and Recall scores were similar between the full-RRT and the Q-RRT. However, Listening Effort and Tolerable Time ratings were significantly poorer for the full-RRT than the Q-RRT. The average repeat scores correlated with the HINT scores, while the recall scores correlated with the DST-F and RST scores. Tolerable Time ratings also correlated with the TNT scores. Within-session and between-session test-retest reliability using intraclass correlation coefficients were fair-to-excellent (0.41-0.91) depending on the outcome measures. CONCLUSIONS The Q-RRT is a reliable and valid measure of speech-in-noise ability, working memory, listening effort, and noise acceptance.
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Affiliation(s)
- Francis Kuk
- WSA Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL, USA
| | | | - Petri Korhonen
- WSA Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL, USA
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Sanchez VA, Dinh PC, Monahan PO, Althouse S, Rooker J, Sesso HD, Dolan ME, Weinzerl M, Feldman DR, Fung C, Einhorn LH, Frisina RD, Travis LB. Comprehensive Audiologic Analyses After Cisplatin-Based Chemotherapy. JAMA Oncol 2024; 10:912-922. [PMID: 38842797 PMCID: PMC11157440 DOI: 10.1001/jamaoncol.2024.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/22/2023] [Indexed: 06/07/2024]
Abstract
Importance Cisplatin is highly ototoxic but widely used. Evidence is lacking regarding cisplatin-related hearing loss (CRHL) in adult-onset cancer survivors with comprehensive audiologic assessments (eg, Words-in-Noise [WIN] tests, full-spectrum audiometry, and additional otologic measures), as well as the progression of CRHL considering comorbidities, modifiable factors associated with risk, and cumulative cisplatin dose. Objective To assess CRHL with comprehensive audiologic assessments, including the WIN, evaluate the longitudinal progression of CRHL, and identify factors associated with risk. Design, Setting, and Participants The Platinum Study is a longitudinal study of cisplatin-treated testicular cancer survivors (TCS) enrolled from 2012 to 2018 with follow-up ongoing. Longitudinal comprehensive audiologic assessments at Indiana University and Memorial Sloan Kettering Cancer Center included 100 participants without audiometrically defined profound hearing loss (HL) at baseline and at least 3.5 years from their first audiologic assessment. Data were analyzed from December 2013 to December 2022. Exposures Factors associated with risk included cumulative cisplatin dose, hypertension, hypercholesterolemia, diabetes, tobacco use, physical inactivity, body mass index, family history of HL, cognitive dysfunction, psychosocial symptoms, and tinnitus. Main Outcomes and Measures Main outcomes were audiometrically measured HL defined as combined-ears high-frequency pure-tone average (4-12 kHz) and speech-recognition in noise performance measured with WIN. Multivariable analyses evaluated factors associated with risk for WIN scores and progression of audiometrically defined HL. Results Median (range) age of 100 participants at evaluation was 48 (25-67) years; median (range) time since chemotherapy: 14 (4-31) years. At follow-up, 78 (78%) TCS had audiometrically defined HL; those self-reporting HL had 2-fold worse hearing than TCS without self-reported HL (48 vs 24 dB HL; P < .001). A total of 54 (54%) patients with self-reported HL showed clinically significant functional impairment on WIN testing. Poorer WIN performance was associated with hypercholesterolemia (β = 0.88; 95% CI, 0.08 to 1.69; P = .03), lower-education (F1 = 5.95; P = .004), and severity of audiometrically defined HL (β̂ = 0.07; 95% CI, 0.06 to 0.09; P < .001). CRHL progression was associated with hypercholesterolemia (β̂ = -4.38; 95% CI, -7.42 to -1.34; P = .01) and increasing age (β̂ = 0.33; 95% CI, 0.15 to 0.50; P < .001). Importantly, relative to age-matched male normative data, audiometrically defined CRHL progression significantly interacted with cumulative cisplatin dose (F1 = 5.98; P = .02); patients given 300 mg/m2 or less experienced significantly less progression, whereas greater temporal progression followed doses greater than 300 mg/m2. Conclusions and Relevance Follow-up of cisplatin-treated cancer survivors should include strict hypercholesterolemia control and regular audiological assessments. Risk stratification through validated instruments should include querying hearing concerns. CRHL progression relative to age-matched norms is likely associated with cumulative cisplatin dose; investigation over longer follow-up is warranted.
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Affiliation(s)
- Victoria A. Sanchez
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
| | - Paul C. Dinh
- Department of Medical Oncology, Indiana University, Indianapolis
| | - Patrick O. Monahan
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis
| | - Sandra Althouse
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis
| | | | - Howard D. Sesso
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - M. Eileen Dolan
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mandy Weinzerl
- Rehabilitation Services, Indiana University Health, Indianapolis
| | - Darren R. Feldman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chunkit Fung
- Department of Medical Oncology, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | | | - Robert D. Frisina
- Department of Medical Engineering, University of South Florida, Tampa
| | - Lois B. Travis
- Department of Medical Oncology, Indiana University, Indianapolis
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Schinkel-Bielefeld N, Burke L, Holube I, Iankilevitch M, Jenstad LM, Lelic D, Naylor G, Singh G, Smeds K, von Gablenz P, Wolters F, Wu YH. Implementing Ecological Momentary Assessment in Audiological Research: Opportunities and Challenges. Am J Audiol 2024:1-26. [PMID: 38950171 DOI: 10.1044/2024_aja-23-00249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Ecological momentary assessment (EMA) is a way to evaluate experiences in everyday life. It is a powerful research tool but can be complex and challenging for beginners. Application of EMA in audiological research brings with it opportunities and challenges that differ from other research disciplines. This tutorial discusses important considerations when conducting EMA studies in hearing care. While more research is needed to develop specific guidelines for the various potential applications of EMA in hearing research, we hope this article can alert hearing researchers new to EMA to pitfalls when using EMA and help strengthen their study design. The current article elaborates study design details, such as choice of participants, representativeness of the study period for participants' lives, and balancing participant burden with data requirements. Mobile devices and sensors to collect objective data on the acoustic situation are reviewed alongside different possibilities for EMA setups ranging from online questionnaires paired with a timer to proprietary apps that also have access to parameters of a hearing device. In addition to considerations for survey design, a list of questionnaire items from previous studies is provided. For each item, an example and a list of references are given. EMA typically provides data sets that are rich but also challenging in that they are noisy, and there is often unequal amount of data between participants. After recommendations on how to check the data for compliance, reactivity, and careless responses, methods for statistical analysis on the individual level and on the group level are discussed including special methods for direct comparison of hearing device programs.
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Affiliation(s)
| | - Louise Burke
- School of Medicine, University of Nottingham, United Kingdom
| | - Inga Holube
- Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
- Cluster of Excellence Hearing4All, Oldenburg, Germany
| | - Maria Iankilevitch
- Department of Psychology, University of Victoria, British Columbia, Canada
| | - Lorienne M Jenstad
- School of Audiology and Speech Sciences, The University of British Columbia, Vancouver, Canada
| | | | - Graham Naylor
- School of Medicine, University of Nottingham, United Kingdom
- National Institute for Health and Care Research, Nottingham Biomedical Research Centre, United Kingdom
| | - Gurjit Singh
- Sonova Canada, Kitchener, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Ontario, Canada
| | | | - Petra von Gablenz
- Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
- Cluster of Excellence Hearing4All, Oldenburg, Germany
| | | | - Yu-Hsiang Wu
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
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Yun D, Lentz J, Shen Y. The Noise Reduction Algorithm May Not Compensate for the Degradation in Output Signal-to-Noise Ratio Caused by Wide Dynamic Range Compression. Am J Audiol 2024:1-17. [PMID: 38875482 DOI: 10.1044/2024_aja-24-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
PURPOSE Most modern hearing aids (HAs) employ wide dynamic range compression (WDRC) and noise reduction (NR) algorithms. It is known that the nonlinear effects of WDRC and NR cause changes to the output signal-to-noise ratio (SNR) of an HA. However, the relative contributions of WDRC and NR to the nonlinear effects are not fully understood. The current study investigated (a) whether WDRC or NR dominates the nonlinear effects measured at the output of a digital HA and (b) whether the electroacoustic effectiveness of NR depends on WDRC parameters while input SNR and background noise are systematically varied. METHOD Test stimuli were Connected Speech Test sentences in multitalker babble noise (2- or 20-talker), presented at input SNRs ranging from -10 to +10 dB. The HA was programmed using multiband WDRC set according to the National Acoustic Laboratories for Nonlinear HA fitting formula 2 prescriptive fits for four standard audiograms and two compression speeds. The NR algorithm of the HA was switched on or off in separate conditions. Nonlinear electroacoustic effects from the WDRC and NR algorithms were assessed by measuring the output SNR of the HA using a phase-inversion technique. To investigate whether there are other factors that may be important besides the output SNR, the Hearing Aid Speech Intelligibility Index and the Hearing Aid Speech Quality Index were applied to the recordings to generate inferences on aided speech intelligibility and perceived speech quality. RESULTS Results showed that WDRC dominated the net nonlinear effect at low-input SNRs, and the net nonlinear effect of WDRC and NR was reduced at high-input SNRs. Results also showed that the effectiveness of NR depended on compression parameters. The effectiveness of NR was partially explained by the trend of Hearing Aid Speech Intelligibility Index and Hearing Aid Speech Quality Index scores, potentially indicating that the Hearing Aid Speech Intelligibility Index and Hearing Aid Speech Quality Index scores may capture factors that cannot be captured by the output SNR metric. CONCLUSIONS Results suggest that the individual signal-processing stages in an HA should not be considered as independent. Electroacoustic evaluation of WDRC and NR algorithms in isolation is not sufficient to capture the combined nonlinear effect of the two algorithms. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25962541.
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Affiliation(s)
- Donghyeon Yun
- Department of Speech, Language and Hearing Sciences, Indiana University Bloomington
| | - Jennifer Lentz
- Department of Speech, Language and Hearing Sciences, Indiana University Bloomington
| | - Yi Shen
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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DiNino M. Age and masking effects on acoustic cues for vowel categorizationa). JASA EXPRESS LETTERS 2024; 4:060001. [PMID: 38884558 DOI: 10.1121/10.0026371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/25/2024] [Indexed: 06/18/2024]
Abstract
Age-related changes in auditory processing may reduce physiological coding of acoustic cues, contributing to older adults' difficulty perceiving speech in background noise. This study investigated whether older adults differed from young adults in patterns of acoustic cue weighting for categorizing vowels in quiet and in noise. All participants relied primarily on spectral quality to categorize /ɛ/ and /æ/ sounds under both listening conditions. However, relative to young adults, older adults exhibited greater reliance on duration and less reliance on spectral quality. These results suggest that aging alters patterns of perceptual cue weights that may influence speech recognition abilities.
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Valderrama JT, Mejia J, Wong A, Chong-White N, Edwards B. The value of headphone accommodations in Apple Airpods Pro for managing speech-in-noise hearing difficulties of individuals with normal audiograms. Int J Audiol 2024; 63:447-457. [PMID: 37105144 DOI: 10.1080/14992027.2023.2199442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To investigate the extent to which Headphone Accommodations in Apple AirPods Pro attend to the hearing needs of individuals with normal audiograms who experience hearing difficulties in noisy environments. DESIGN Single-arm interventional study using acoustic measures, speech-in-noise laboratory testing, and real-world measures via questionnaires and ecological momentary assessment. STUDY SAMPLE Seventeen normal-hearing individuals (9 female, 21-59 years) with self-reported hearing-in-noise difficulties. RESULTS Acoustic measures showed that, relative to unaided, AirPods Pro provided a SNR advantage of +5.4 dB. Speech intelligibility performance in laboratory testing increased 11.8% with AirPods Pro, relative to unaided. On average, participants trialling AirPods Pro in real-world noisy venues reported that their overall hearing experience was a bit better than without them. Five participants (29%) reported that they would continue using AirPods Pro in the future. The most relevant barriers that would discourage their future use were limited hearing benefit, discomfort, and stigma. CONCLUSIONS Occasional use of AirPods Pro may help some individuals with normal audiograms ameliorate their speech-in-noise hearing difficulties. The identified barriers may inspire the development of new technological solutions aimed at providing an optimal management strategy for the hearing difficulties of this segment of the population.
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Affiliation(s)
- Joaquin T Valderrama
- National Acoustic Laboratories, Sydney, Australia
- Department of Linguistics, Macquarie University, Sydney, Australia
- Department of Signal Theory, Telematics and Communications, University of Granada, Granada, Spain
- Research Centre for Information and Communications Technologies (CITIC-UGR), University of Granada, Granada, Spain
| | - Jorge Mejia
- National Acoustic Laboratories, Sydney, Australia
- School of Computing, Macquarie University, Sydney, Australia
| | - Angela Wong
- National Acoustic Laboratories, Sydney, Australia
| | - Nicky Chong-White
- National Acoustic Laboratories, Sydney, Australia
- School of Computing, Macquarie University, Sydney, Australia
| | - Brent Edwards
- National Acoustic Laboratories, Sydney, Australia
- Department of Linguistics, Macquarie University, Sydney, Australia
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Zanin J, Vaisberg J, Swann S, Rance G. Evaluating benefits of remote microphone technology for adults with hearing loss using behavioural and predictive metrics. Int J Audiol 2024:1-9. [PMID: 38767343 DOI: 10.1080/14992027.2024.2354500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To investigate the benefit of remote-microphone (RM) systems for adults with sensory hearing loss. DESIGN Speech recognition in quiet and in background noise was assessed. Participants with hearing loss underwent testing in two device conditions: hearing aids (HAs) alone and HAs with a RM. Normal hearing participants completed testing in the unaided condition. Predictive speech intelligibility modelling using the Hearing-Aid Speech Perception Index (HASPI) was also performed on recordings of HA processed test material. STUDY SAMPLE Twenty adults with sensory hearing loss and 10 adults with normal hearing participated. RESULTS Speech recognition for participants with hearing loss improved significantly when using the RM compared to HAs alone fit to Phonak's proprietary prescription. Largest benefits were observed in the most challenging conditions. At the lowest signal-to-noise ratio, participants with hearing loss using a RM outperformed normal hearing listeners. Predicted intelligibility scores produced by HASPI were strongly correlated to behavioural results. CONCLUSIONS Adults using HAs who have significant difficulties understanding speech in noise will experience considerable benefits with the addition of a RM. Improvements in speech recognition were observed for all participants using RM systems, including those with relatively mild hearing loss. HASPI modelling reliably predicted the speech perception difficulties experienced.
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Affiliation(s)
- Julien Zanin
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Vaisberg
- Innovation Centre Toronto, Sonova Canda Inc., Mississauga, Ontario, Canada
| | - Sarah Swann
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Rance
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
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Dor YI, Algom D, Shakuf V, Ben-David BM. Age-related differences in processing of emotions in speech disappear with babble noise in the background. Cogn Emot 2024:1-10. [PMID: 38764186 DOI: 10.1080/02699931.2024.2351960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Abstract
Older adults process emotional speech differently than young adults, relying less on prosody (tone) relative to semantics (words). This study aimed to elucidate the mechanisms underlying these age-related differences via an emotional speech-in-noise test. A sample of 51 young and 47 older adults rated spoken sentences with emotional content on both prosody and semantics, presented on the background of wideband speech-spectrum noise (sensory interference) or on the background of multi-talker babble (sensory/cognitive interference). The presence of wideband noise eliminated age-related differences in semantics but not in prosody when processing emotional speech. Conversely, the presence of babble resulted in the elimination of age-related differences across all measures. The results suggest that both sensory and cognitive-linguistic factors contribute to age-related changes in emotional speech processing. Because real world conditions typically involve noisy background, our results highlight the importance of testing under such conditions.
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Affiliation(s)
- Yehuda I Dor
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
| | - Daniel Algom
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Communication Disorders, Achva Academic College, Arugot, Israel
| | - Vered Shakuf
- Department of Communication Disorders, Achva Academic College, Arugot, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
- KITE, Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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Maruthurkkara S. Cochlear Implant Remote Assist: Clinical and Real-World Evaluation. Int J Audiol 2024:1-11. [PMID: 38696614 DOI: 10.1080/14992027.2024.2337075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/20/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES To develop and evaluate Cochlear™ Remote Assist (RA), a smartphone-based cochlear implant (CI) teleaudiology solution. The development phase aimed to identify the minimum features needed to remotely address most issues typically experienced by CI recipients. The clinical evaluation phase assessed ease of use, call clarity, system latency, and CI recipient feedback. DESIGN The development phase involved mixed methods research with experienced CI clinicians. The clinical evaluation phase involved a prospective single-site clinical study and real-world use across 16 clinics. STUDY SAMPLE CI clinicians (N = 23), CI recipients in a clinical study (N = 15 adults) and real-world data (N = 57 CI recipients). RESULTS The minimum feature set required for remote programming in RA, combined with sending replacements by post, should enable the clinician to address 80% of the issues typically seen in CI follow-up sessions. Most recipients completed the RA primary tasks without prior training and gave positive ratings for usefulness, ease of use, effectiveness, reliability, and satisfaction on the Telehealth Usability Questionnaire. System latency was reported to be acceptable. CONCLUSION RA is designed to help clinicians address a significant proportion of issues typically encountered by CI recipients. Clinical study and real-world evaluation confirm RA's ease of use, call quality, and responsiveness.
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Affiliation(s)
- Saji Maruthurkkara
- Cochlear Limited, 1 University Ave Macquarie University, Sydney, Australia
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Ellis GM, Crukley J, Souza PE. The Effects of Signal to Noise Ratio, T60 , Wide-Dynamic Range Compression Speed, and Digital Noise Reduction in a Virtual Restaurant Setting. Ear Hear 2024; 45:760-774. [PMID: 38254265 PMCID: PMC11141238 DOI: 10.1097/aud.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Hearing aid processing in realistic listening environments is difficult to study effectively. Often the environment is unpredictable or unknown, such as in wearable aid trials with subjective report by the wearer. Some laboratory experiments create listening environments to exert tight experimental control, but those environments are often limited by physical space, a small number of sound sources, or room absorptive properties. Simulation techniques bridge this gap by providing greater experimental control over listening environments, effectively bringing aspects of the real-world into the laboratory. This project used simulation to study the effects of wide-dynamic range compression (WDRC) and digital noise reduction (DNR) on speech intelligibility in a reverberant environment with six spatialized competing talkers. The primary objective of this study was to determine the efficacy of WDRC and DNR in a complex listening environment using virtual auditory space techniques. DESIGN Participants of greatest interest were listeners with hearing impairment. A group of listeners with clinically normal hearing was included to assess the effects of the simulation absent the complex effects of hearing loss. Virtual auditory space techniques were used to simulate a small restaurant listening environment with two different reverberation times (0.8 and 1.8 sec) in a range of signal to noise ratios (SNRs) (-8.5 to 11.5 dB SNR). Six spatialized competing talkers were included to further enhance realism. A hearing aid simulation was used to examine the degree to which speech intelligibility was affected by slow and fast WDRC in conjunction with the presence or absence of DNR. The WDRC and DNR settings were chosen to be reasonable estimates of hearing aids currently available to consumers. RESULTS A WDRC × DNR × Hearing Status interaction was observed, such that DNR was beneficial for speech intelligibility when combined with fast WDRC speeds, but DNR was detrimental to speech intelligibility when WDRC speeds were slow. The pattern of the WDRC × DNR interaction was observed for both listener groups. Significant main effects of reverberation time and SNR were observed, indicating better performance with lower reverberation times and more positive SNR. CONCLUSIONS DNR reduced low-amplitude noise before WDRC-amplified the low-intensity portions of the signal, negating one potential downside of fast WDRC and leading to an improvement in speech intelligibility in this simulation. These data suggest that, in some real-world environments that include both reverberation and noise, older listeners with hearing impairment may find speech to be more intelligible if DNR is activated when the hearing aid has fast compression time constants. Additional research is needed to determine the appropriate DNR strength and to confirm results in wearable hearing aids and a wider range of listening environments.
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Affiliation(s)
- Gregory M Ellis
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Jeff Crukley
- Data Science and Statistics, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience, and Behavior, McMaster University, Hamilton, Ontario, Canada
| | - Pamela E Souza
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
- Knowles Hearing Center, Evanston, Illinois, USA
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Fletcher MD, Perry SW, Thoidis I, Verschuur CA, Goehring T. Improved tactile speech robustness to background noise with a dual-path recurrent neural network noise-reduction method. Sci Rep 2024; 14:7357. [PMID: 38548750 PMCID: PMC10978864 DOI: 10.1038/s41598-024-57312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
Many people with hearing loss struggle to understand speech in noisy environments, making noise robustness critical for hearing-assistive devices. Recently developed haptic hearing aids, which convert audio to vibration, can improve speech-in-noise performance for cochlear implant (CI) users and assist those unable to access hearing-assistive devices. They are typically body-worn rather than head-mounted, allowing additional space for batteries and microprocessors, and so can deploy more sophisticated noise-reduction techniques. The current study assessed whether a real-time-feasible dual-path recurrent neural network (DPRNN) can improve tactile speech-in-noise performance. Audio was converted to vibration on the wrist using a vocoder method, either with or without noise reduction. Performance was tested for speech in a multi-talker noise (recorded at a party) with a 2.5-dB signal-to-noise ratio. An objective assessment showed the DPRNN improved the scale-invariant signal-to-distortion ratio by 8.6 dB and substantially outperformed traditional noise-reduction (log-MMSE). A behavioural assessment in 16 participants showed the DPRNN improved tactile-only sentence identification in noise by 8.2%. This suggests that advanced techniques like the DPRNN could substantially improve outcomes with haptic hearing aids. Low-cost haptic devices could soon be an important supplement to hearing-assistive devices such as CIs or offer an alternative for people who cannot access CI technology.
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Affiliation(s)
- Mark D Fletcher
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
| | - Samuel W Perry
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Iordanis Thoidis
- School of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Carl A Verschuur
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Tobias Goehring
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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Mechtenberg H, Giorio C, Myers EB. Pupil Dilation Reflects Perceptual Priorities During a Receptive Speech Task. Ear Hear 2024; 45:425-440. [PMID: 37882091 PMCID: PMC10868674 DOI: 10.1097/aud.0000000000001438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/01/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES The listening demand incurred by speech perception fluctuates in normal conversation. At the acoustic-phonetic level, natural variation in pronunciation acts as speedbumps to accurate lexical selection. Any given utterance may be more or less phonetically ambiguous-a problem that must be resolved by the listener to choose the correct word. This becomes especially apparent when considering two common speech registers-clear and casual-that have characteristically different levels of phonetic ambiguity. Clear speech prioritizes intelligibility through hyperarticulation which results in less ambiguity at the phonetic level, while casual speech tends to have a more collapsed acoustic space. We hypothesized that listeners would invest greater cognitive resources while listening to casual speech to resolve the increased amount of phonetic ambiguity, as compared with clear speech. To this end, we used pupillometry as an online measure of listening effort during perception of clear and casual continuous speech in two background conditions: quiet and noise. DESIGN Forty-eight participants performed a probe detection task while listening to spoken, nonsensical sentences (masked and unmasked) while recording pupil size. Pupil size was modeled using growth curve analysis to capture the dynamics of the pupil response as the sentence unfolded. RESULTS Pupil size during listening was sensitive to the presence of noise and speech register (clear/casual). Unsurprisingly, listeners had overall larger pupil dilations during speech perception in noise, replicating earlier work. The pupil dilation pattern for clear and casual sentences was considerably more complex. Pupil dilation during clear speech trials was slightly larger than for casual speech, across quiet and noisy backgrounds. CONCLUSIONS We suggest that listener motivation could explain the larger pupil dilations to clearly spoken speech. We propose that, bounded by the context of this task, listeners devoted more resources to perceiving the speech signal with the greatest acoustic/phonetic fidelity. Further, we unexpectedly found systematic differences in pupil dilation preceding the onset of the spoken sentences. Together, these data demonstrate that the pupillary system is not merely reactive but also adaptive-sensitive to both task structure and listener motivation to maximize accurate perception in a limited resource system.
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Affiliation(s)
- Hannah Mechtenberg
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Cristal Giorio
- Department of Psychology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Emily B. Myers
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Speech, Language and Hearing Sciences, University of Connecticut, Storrs, Connecticut, USA
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Christensen JH, Whiston H, Lough M, Gil-Carvajal JC, Rumley J, Saunders GH. Evaluating Real-World Benefits of Hearing Aids With Deep Neural Network-Based Noise Reduction: An Ecological Momentary Assessment Study. Am J Audiol 2024; 33:1-12. [PMID: 38354098 DOI: 10.1044/2023_aja-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Noise reduction technologies in hearing aids provide benefits under controlled conditions. However, differences in their real-life effectiveness are not established. We propose that a deep neural network (DNN)-based noise reduction system trained on naturalistic sound environments will provide different real-life benefits compared to traditional systems. METHOD Real-life listening experiences collected with Ecological Momentary Assessments (EMAs) of participants who used two premium models of hearing aid are compared. One hearing aid model (HA1) used traditional noise reduction; the other hearing aid model (HA2) used DNN-based noise reduction. Participants reported listening experiences several times a day while ambient SPL, SNR, and hearing aid volume adjustments were recorded. Forty experienced hearing aid users completed a total of 3,614 EMAs and recorded 6,812 hr of sound data across two 14-day wear periods. RESULTS Linear mixed-effects analysis document that participants' assessments of ambient noisiness were positively associated with SPL and negatively associated with SNR but were not otherwise affected by hearing aid model. Likewise, mean satisfaction with the two models did not differ. However, individual satisfaction ratings for HA1 were dependent on ambient SNR, which was not the case for HA2. CONCLUSIONS Hearing aids with DNN-based noise reduction resulted in consistent sound satisfaction regardless of the level of background noise compared to hearing aids implementing noise reduction based on traditional statistical models. While the two hearing aid models also differed on other parameters (e.g., shape), these differences are unlikely to explain the difference in how background noise impacts sound satisfaction with the aids. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25114526.
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Affiliation(s)
| | - Helen Whiston
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, United Kingdom
| | - Melanie Lough
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, United Kingdom
| | | | | | - Gabrielle H Saunders
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, United Kingdom
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17
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Fitzgerald LP, DeDe G, Shen J. Effects of linguistic context and noise type on speech comprehension. Front Psychol 2024; 15:1345619. [PMID: 38375107 PMCID: PMC10875108 DOI: 10.3389/fpsyg.2024.1345619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Understanding speech in background noise is an effortful endeavor. When acoustic challenges arise, linguistic context may help us fill in perceptual gaps. However, more knowledge is needed regarding how different types of background noise affect our ability to construct meaning from perceptually complex speech input. Additionally, there is limited evidence regarding whether perceptual complexity (e.g., informational masking) and linguistic complexity (e.g., occurrence of contextually incongruous words) interact during processing of speech material that is longer and more complex than a single sentence. Our first research objective was to determine whether comprehension of spoken sentence pairs is impacted by the informational masking from a speech masker. Our second objective was to identify whether there is an interaction between perceptual and linguistic complexity during speech processing. Methods We used multiple measures including comprehension accuracy, reaction time, and processing effort (as indicated by task-evoked pupil response), making comparisons across three different levels of linguistic complexity in two different noise conditions. Context conditions varied by final word, with each sentence pair ending with an expected exemplar (EE), within-category violation (WV), or between-category violation (BV). Forty young adults with typical hearing performed a speech comprehension in noise task over three visits. Each participant heard sentence pairs presented in either multi-talker babble or spectrally shaped steady-state noise (SSN), with the same noise condition across all three visits. Results We observed an effect of context but not noise on accuracy. Further, we observed an interaction of noise and context in peak pupil dilation data. Specifically, the context effect was modulated by noise type: context facilitated processing only in the more perceptually complex babble noise condition. Discussion These findings suggest that when perceptual complexity arises, listeners make use of the linguistic context to facilitate comprehension of speech obscured by background noise. Our results extend existing accounts of speech processing in noise by demonstrating how perceptual and linguistic complexity affect our ability to engage in higher-level processes, such as construction of meaning from speech segments that are longer than a single sentence.
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Affiliation(s)
- Laura P. Fitzgerald
- Speech Perception and Cognition Laboratory, Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Gayle DeDe
- Speech, Language, and Brain Laboratory, Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jing Shen
- Speech Perception and Cognition Laboratory, Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA, United States
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Wesarg T, Wiebe K, Galindo Guerreros JC, Arndt S, Aschendorff A, Voß B. Speech Understanding and Subjective Listening Effort in Noise With Different OTEs and Sound Processing Technologies. Otol Neurotol 2024; 45:e91-e101. [PMID: 38206063 DOI: 10.1097/mao.0000000000004091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To determine speech reception thresholds (SRTs) in noise and subjective listening effort (LE) in cochlear implant (CI) recipients for application of three sound processing (SP) technologies with two off-the-ear (OTE) CI sound processors, a fixed moderately directional microphone (Standard), an adaptive directional microphone (Beam), and the spatial noise-reduction setting ForwardFocus, with the Kanso 2 (OTE2), and Beam with the Kanso (OTE1). STUDY DESIGN Prospective repeated measures, within-subject design. SETTING Single tertiary-referral center. PATIENTS Twenty CI recipients with bilateral severe-to-profound sensorineural hearing loss. MAIN OUTCOME MEASURES SRTs were assessed in two spatial configurations with frontal speech and noise from 90-180-270 degrees (S0N90-180-270) or from the CI side (S0NCI). SRTs were obtained for sentences of the Oldenburg sentence test presented in International Collegium of Rehabilitative Audiology (ICRA) noise ICRA5-250. LE for speech understanding in noise was evaluated in S0N90-180-270 and assessed in effort scale categorical units (ESCUs) by using Adaptive Categorical Listening Effort Scaling (ACALES). LEs at 5-dB signal-to-noise ratio (SNR) were calculated from fitted psychometric curves. RESULTS With OTE2 in S0N90-180-270, SRT with ForwardFocus (-4.28 dB SNR) was better than with Beam (-3.13 dB SNR) and Standard (0.43 dB SNR). ForwardFocus showed lower LE5dB (2.61 ESCU) compared with Beam (4.60 ESCU) and Standard (5.32 ESCU). In a comparison of both OTEs in S0N90-180-270 regarding best-performing SP technology, ForwardFocus with OTE2 yielded a better SRT and better LE5dB than Beam with OTE1 (SRT: -1.70 dB SNR; LE5dB: 4.00 ESCU). With OTE2 in S0NCI, SRT was improved with ForwardFocus (-2.78 dB SNR) compared with Beam (-1.23 dB SNR) and Standard (1.83 dB SNR). CONCLUSION With respect to SP technology and OTE, CI recipients experience best SRT and lowest LE in S0N90-180-270 when using ForwardFocus with OTE2. ACALES is feasible for assessing subjective LE in CI recipients.
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Affiliation(s)
- Thomas Wesarg
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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19
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Sabin AT, McElhone D, Gauger D, Rabinowitz B. Modeling the Intelligibility Benefit of Active Noise Cancelation in Hearing Devices That Improve Signal-to-Noise Ratio. Trends Hear 2024; 28:23312165241260029. [PMID: 38831646 PMCID: PMC11149449 DOI: 10.1177/23312165241260029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
The extent to which active noise cancelation (ANC), when combined with hearing assistance, can improve speech intelligibility in noise is not well understood. One possible source of benefit is ANC's ability to reduce the sound level of the direct (i.e., vent-transmitted) path. This reduction lowers the "floor" imposed by the direct path, thereby allowing any increases to the signal-to-noise ratio (SNR) created in the amplified path to be "realized" at the eardrum. Here we used a modeling approach to estimate this benefit. We compared pairs of simulated hearing aids that differ only in terms of their ability to provide ANC and computed intelligibility metrics on their outputs. The difference in metric scores between simulated devices is termed the "ANC Benefit." These simulations show that ANC Benefit increases as (1) the environmental sound level increases, (2) the ability of the hearing aid to improve SNR increases, (3) the strength of the ANC increases, and (4) the hearing loss severity decreases. The predicted size of the ANC Benefit can be substantial. For a moderate hearing loss, the model predicts improvement in intelligibility metrics of >30% when environments are moderately loud (>70 dB SPL) and devices are moderately capable of increasing SNR (by >4 dB). It appears that ANC can be a critical ingredient in hearing devices that attempt to improve SNR in loud environments. ANC will become more and more important as advanced SNR-improving algorithms (e.g., artificial intelligence speech enhancement) are included in hearing devices.
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20
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Slugocki C, Kuk F, Korhonen P. Alpha-Band Dynamics of Hearing Aid Wearers Performing the Repeat-Recall Test (RRT). Trends Hear 2024; 28:23312165231222098. [PMID: 38549287 PMCID: PMC10981257 DOI: 10.1177/23312165231222098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 04/01/2024] Open
Abstract
This study measured electroencephalographic activity in the alpha band, often associated with task difficulty, to physiologically validate self-reported effort ratings from older hearing-impaired listeners performing the Repeat-Recall Test (RRT)-an integrative multipart assessment of speech-in-noise performance, context use, and auditory working memory. Following a single-blind within-subjects design, 16 older listeners (mean age = 71 years, SD = 13, 9 female) with a moderate-to-severe degree of bilateral sensorineural hearing loss performed the RRT while wearing hearing aids at four fixed signal-to-noise ratios (SNRs) of -5, 0, 5, and 10 dB. Performance and subjective ratings of listening effort were assessed for complementary versions of the RRT materials with high/low availability of semantic context. Listeners were also tested with a version of the RRT that omitted the memory (i.e., recall) component. As expected, results showed alpha power to decrease significantly with increasing SNR from 0 through 10 dB. When tested with high context sentences, alpha was significantly higher in conditions where listeners had to recall the sentence materials compared to conditions where the recall requirement was omitted. When tested with low context sentences, alpha power was relatively high irrespective of the memory component. Within-subjects, alpha power was related to listening effort ratings collected across the different RRT conditions. Overall, these results suggest that the multipart demands of the RRT modulate both neural and behavioral measures of listening effort in directions consistent with the expected/designed difficulty of the RRT conditions.
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Affiliation(s)
- Christopher Slugocki
- Office of Research in Clinical Amplification (ORCA-USA), WS Audiology, Lisle, IL, USA
| | - Francis Kuk
- Office of Research in Clinical Amplification (ORCA-USA), WS Audiology, Lisle, IL, USA
| | - Petri Korhonen
- Office of Research in Clinical Amplification (ORCA-USA), WS Audiology, Lisle, IL, USA
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21
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Narayanan SK, Rye P, Houmøller SS, Wolff A, Hougaard DD, Gaihede M, Schmidt JH, Hammershøi D. Difference in SII provided by initial fit and NAL-NL2 and its relation to self-reported hearing aid outcomes. Int J Audiol 2023:1-8. [PMID: 38112025 DOI: 10.1080/14992027.2023.2291633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The speech intelligibility index (SII) is used to quantify the audibility of the speech. This study examined the relationship between self-reported hearing aid (HA) outcomes and the difference in aided SII (SIIA) calculated from the initial fit (IF) gain and that prescribed as per the second generation of National Acoustic Laboratory Non-Linear (NAL-NL2). DESIGN A prospective observational study. STUDY SAMPLE The study included 718 first-time and 253 experienced HA users. All users had a valid real-ear measurement (REM) at three input levels (55, 65 and 80 dB SPL). RESULTS The gain provided by IF was lower than NAL-NL2 at 55 and 65 dB SPL. IF gain exhibited reduced compression than NAL-NL2 as input levels increased from 55 to 80 dB SPL. On average, the SIIA provided by IF was significantly lower than that for NAL-NL2 at all input levels. The difference in SIIA between IF and NAL-NL2 at 80 dB SPL input level with 0 dB signal-to-noise ratio (SNR) turned out to be a predictor for self-reported outcome for first-time HA users. CONCLUSION The study suggests that an SIIA close to that provided by NAL-NL2 at high input levels would be preferred to obtain a better self-reported outcome. .
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Affiliation(s)
- Sreeram K Narayanan
- Department of Electronic Systems, Section for AI and Sound, Aalborg University, Aalborg, Denmark
| | - Palle Rye
- Department of Electronic Systems, Section for AI and Sound, Aalborg University, Aalborg, Denmark
| | - Sabina Storbjerg Houmøller
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Anne Wolff
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Gaihede
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Hvass Schmidt
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Dorte Hammershøi
- Department of Electronic Systems, Section for AI and Sound, Aalborg University, Aalborg, Denmark
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Jorgensen E, Wu YH. Effects of entropy in real-world noise on speech perception in listeners with normal hearing and hearing lossa). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:3627-3643. [PMID: 38051522 PMCID: PMC10699887 DOI: 10.1121/10.0022577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
Hearing aids show more benefit in traditional laboratory speech-in-noise tests than in real-world noisy environments. Real-world noise comprises a large range of acoustic properties that vary randomly and rapidly between and within environments, making quantifying real-world noise and using it in experiments and clinical tests challenging. One approach is to use acoustic features and statistics to quantify acoustic properties of real-world noise and control for them or measure their relationship to listening performance. In this study, the complexity of real-world noise from different environments was quantified using entropy in both the time- and frequency-domains. A distribution of noise segments from low to high entropy were extracted. Using a trial-by-trial design, listeners with normal hearing and hearing loss (in aided and unaided conditions) repeated back sentences embedded in these noise segments. Entropy significantly affected speech perception, with a larger effect of entropy in the time-domain than the frequency-domain, a larger effect for listeners with normal hearing than for listeners with hearing loss, and a larger effect for listeners with hearing loss in the aided than unaided condition. Speech perception also differed between most environment types. Combining entropy with the environment type improved predictions of speech perception above the environment type alone.
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Affiliation(s)
- Erik Jorgensen
- Department of Communication Sciences and Disorders University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Yu-Hsiang Wu
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa 52242, USA
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Venkitakrishnan S, Urbanski D, Wu YH. Efficacy and Effectiveness of Evidence-Based Non-Self-Fitting Presets Compared to Prescription Hearing Aid Fittings and a Personal Sound Amplification Product. Am J Audiol 2023; 33:1-24. [PMID: 37956699 PMCID: PMC11001427 DOI: 10.1044/2023_aja-23-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE In this study, we compare the efficacy and effectiveness of gain-frequency responses of evidence-based presets developed by our lab for over-the-counter hearing aids to conventional National Acoustic Laboratories' nonlinear fitting procedure, version 2 (NAL-NL2) gain-frequency response and to gain-frequency response of a personal sound amplification product (PSAP). We hypothesized that the hearing aids with our presets would perform better than a PSAP with poor frequency response and comparably to the hearing aid with NAL-NL2 frequency response. METHOD We used a single-blinded, randomized cross-over design to compare audibility, speech recognition, sound quality, listening effort, and subjective preferences in 37 participants in laboratory settings and following field trials. RESULTS The presets developed in our lab showed comparable outcomes to the hearing aids with NAL-NL2 gain-frequency response in most measured domains. Performance with the presets was better than the PSAP gain-frequency response in the domains of listening effort and sound quality in laboratory testing and speech recognition in our real-world measures. We also found that most participants (54.05%) preferred our presets over the PSAPs and were willing to pay significantly more to purchase the hearing aids with our presets. CONCLUSION Our evidence-based presets have better outcomes than a PSAP with a single, poorly suited frequency response while performing comparably to the clinical best-practice National Acoustic Laboratories condition.
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Affiliation(s)
- Soumya Venkitakrishnan
- Department of Communication Sciences and Disorders, California State University, Sacramento
| | - Dana Urbanski
- Department of Communication Sciences and Disorders, University of Minnesota Duluth
| | - Yu-Hsiang Wu
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
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Wang B, Xu X, Niu Y, Wu C, Wu X, Chen J. EEG-based auditory attention decoding with audiovisual speech for hearing-impaired listeners. Cereb Cortex 2023; 33:10972-10983. [PMID: 37750333 DOI: 10.1093/cercor/bhad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023] Open
Abstract
Auditory attention decoding (AAD) was used to determine the attended speaker during an auditory selective attention task. However, the auditory factors modulating AAD remained unclear for hearing-impaired (HI) listeners. In this study, scalp electroencephalogram (EEG) was recorded with an auditory selective attention paradigm, in which HI listeners were instructed to attend one of the two simultaneous speech streams with or without congruent visual input (articulation movements), and at a high or low target-to-masker ratio (TMR). Meanwhile, behavioral hearing tests (i.e. audiogram, speech reception threshold, temporal modulation transfer function) were used to assess listeners' individual auditory abilities. The results showed that both visual input and increasing TMR could significantly enhance the cortical tracking of the attended speech and AAD accuracy. Further analysis revealed that the audiovisual (AV) gain in attended speech cortical tracking was significantly correlated with listeners' auditory amplitude modulation (AM) sensitivity, and the TMR gain in attended speech cortical tracking was significantly correlated with listeners' hearing thresholds. Temporal response function analysis revealed that subjects with higher AM sensitivity demonstrated more AV gain over the right occipitotemporal and bilateral frontocentral scalp electrodes.
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Affiliation(s)
- Bo Wang
- Speech and Hearing Research Center, Key Laboratory of Machine Perception (Ministry of Education), School of Intelligence Science and Technology, Peking University, Beijing 100871, China
| | - Xiran Xu
- Speech and Hearing Research Center, Key Laboratory of Machine Perception (Ministry of Education), School of Intelligence Science and Technology, Peking University, Beijing 100871, China
| | - Yadong Niu
- Speech and Hearing Research Center, Key Laboratory of Machine Perception (Ministry of Education), School of Intelligence Science and Technology, Peking University, Beijing 100871, China
| | - Chao Wu
- School of Nursing, Peking University, Beijing 100191, China
| | - Xihong Wu
- Speech and Hearing Research Center, Key Laboratory of Machine Perception (Ministry of Education), School of Intelligence Science and Technology, Peking University, Beijing 100871, China
- National Biomedical Imaging Center, College of Future Technology, Beijing 100871, China
| | - Jing Chen
- Speech and Hearing Research Center, Key Laboratory of Machine Perception (Ministry of Education), School of Intelligence Science and Technology, Peking University, Beijing 100871, China
- National Biomedical Imaging Center, College of Future Technology, Beijing 100871, China
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Sun K, Szatmari TI, Pasta A, Bramsløw L, Wendt D, Christensen JH, Pontoppidan NH. Daily sound exposure of hearing aids users during COVID-19 pandemic in Europe. Front Public Health 2023; 11:1091706. [PMID: 37905241 PMCID: PMC10613490 DOI: 10.3389/fpubh.2023.1091706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/15/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction This study aimed to investigate the daily sound exposure of hearing aid (HA) users during the COVID-19 pandemic, with a specific focus on the impact of different governance intervention levels. Methods Modern HA technology was employed to measure and compare the sound exposure of HA users in three distinct periods: pre-pandemic, and two 14-day periods during the pandemic, corresponding to varying levels of governance interventions. The study sample comprised a total of 386 HA users in Europe during the pandemic, with daily sound exposure data collected as part of the main dataset. Results The results revealed that, during the pandemic, the equivalent continuous sound pressure level (SPL) experienced by HA users decreased, while the signal-to-noise ratio (SNR) increased compared to the pre-pandemic period. Notably, this impact was found to be more pronounced (p < 0.05) when individuals were subjected to stronger governance intervention levels, characterized by lower SPL and higher SNR. Discussion This study highlights the changes in daily sound exposure experienced by HA users during the COVID-19 pandemic, particularly influenced by the extent of governance interventions that restricted social activities. These findings emphasize the importance of considering the effects of pandemic-related governance measures on the sound environments of HA users and have implications for audiological interventions and support strategies during similar crises.
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Affiliation(s)
- Kang Sun
- Eriksholm Research Centre, Snekkersten, Denmark
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Tiberiu-Ioan Szatmari
- Eriksholm Research Centre, Snekkersten, Denmark
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Alessandro Pasta
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
- Demant A/S, Smørum, Denmark
| | | | - Dorothea Wendt
- Eriksholm Research Centre, Snekkersten, Denmark
- Hearing Systems, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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Aliakbaryhosseinabadi S, Keidser G, May T, Dau T, Wendt D, Rotger-Griful S. The Effects of Noise and Simulated Conductive Hearing Loss on Physiological Response Measures During Interactive Conversations. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4009-4024. [PMID: 37625145 DOI: 10.1044/2023_jslhr-23-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
PURPOSE The purpose of this work was to study the effects of background noise and hearing attenuation associated with earplugs on three physiological measures, assumed to be markers of effort investment and arousal, during interactive communication. METHOD Twelve pairs of older people (average age of 63.2 years) with age-adjusted normal hearing took part in a face-to-face communication to solve a Diapix task. Communication was held in different levels of babble noise (0, 60, and 70 dBA) and with two levels of hearing attenuation (0 and 25 dB) in quiet. The physiological measures obtained included pupil size, heart rate variability, and skin conductance. In addition, subjective ratings of perceived communication success, frustration, and effort were obtained. RESULTS Ratings of perceived success, frustration, and effort confirmed that communication was more difficult in noise and with approximately 25-dB hearing attenuation and suggested that the implemented levels of noise and hearing attenuation resulted in comparable communication difficulties. Background noise at 70 dBA and hearing attenuation both led to an initial increase in pupil size (associated with effort), but only the effect of the background noise was sustained throughout the conversation. The 25-dB hearing attenuation led to a significant decrease of the high-frequency power of heart rate variability and a significant increase of skin conductance level, measured as the average z value of the electrodermal activity amplitude. CONCLUSION This study demonstrated that several physiological measures appear to be viable indicators of changing communication conditions, with pupillometry and cardiovascular as well as electrodermal measures potentially being markers of communication difficulty.
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Affiliation(s)
- Susan Aliakbaryhosseinabadi
- Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark
- Hearing System Section, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Gitte Keidser
- Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark
- Department of Behavioral Sciences and Learning, Linnaeus Center HEAD, Linköping University, Sweden
| | - Tobias May
- Hearing System Section, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Torsten Dau
- Hearing System Section, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Dorothea Wendt
- Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark
- Hearing System Section, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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Simantiraki O, Wagner AE, Cooke M. The impact of speech type on listening effort and intelligibility for native and non-native listeners. Front Neurosci 2023; 17:1235911. [PMID: 37841688 PMCID: PMC10568627 DOI: 10.3389/fnins.2023.1235911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Listeners are routinely exposed to many different types of speech, including artificially-enhanced and synthetic speech, styles which deviate to a greater or lesser extent from naturally-spoken exemplars. While the impact of differing speech types on intelligibility is well-studied, it is less clear how such types affect cognitive processing demands, and in particular whether those speech forms with the greatest intelligibility in noise have a commensurately lower listening effort. The current study measured intelligibility, self-reported listening effort, and a pupillometry-based measure of cognitive load for four distinct types of speech: (i) plain i.e. natural unmodified speech; (ii) Lombard speech, a naturally-enhanced form which occurs when speaking in the presence of noise; (iii) artificially-enhanced speech which involves spectral shaping and dynamic range compression; and (iv) speech synthesized from text. In the first experiment a cohort of 26 native listeners responded to the four speech types in three levels of speech-shaped noise. In a second experiment, 31 non-native listeners underwent the same procedure at more favorable signal-to-noise ratios, chosen since second language listening in noise has a more detrimental effect on intelligibility than listening in a first language. For both native and non-native listeners, artificially-enhanced speech was the most intelligible and led to the lowest subjective effort ratings, while the reverse was true for synthetic speech. However, pupil data suggested that Lombard speech elicited the lowest processing demands overall. These outcomes indicate that the relationship between intelligibility and cognitive processing demands is not a simple inverse, but is mediated by speech type. The findings of the current study motivate the search for speech modification algorithms that are optimized for both intelligibility and listening effort.
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Affiliation(s)
- Olympia Simantiraki
- Institute of Applied and Computational Mathematics, Foundation for Research & Technology-Hellas, Heraklion, Greece
| | - Anita E. Wagner
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Martin Cooke
- Ikerbasque (Basque Science Foundation), Vitoria-Gasteiz, Spain
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Schinkel-Bielefeld N, Ritslev J, Lelic D. Reasons for ceiling ratings in real-life evaluations of hearing aids: the relationship between SNR and hearing aid ratings. Front Digit Health 2023; 5:1134490. [PMID: 37600480 PMCID: PMC10436089 DOI: 10.3389/fdgth.2023.1134490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction In past Ecological Momentary Assessment (EMA) studies, hearing aid outcome ratings have often been close to ceiling. Methods To analyze the underlying reasons for the very positive ratings, we conducted a study with 17 experienced hearing aid wearers who were fitted with study hearing aids. The acceptable noise level and the noise level where participants were unable to follow speech were measured. The participants then rated hearing aid satisfaction, speech understanding and listening effort for pre-defined SNRs between -10 and +20 dB SPL in the laboratory. These ratings were compared to ratings of a two-week EMA trial. Additionally, estimates of SNRs were collected from hearing aids during the EMA trial and we assessed whether the participants experienced those SNRs rated poorly in the laboratory in real life. Results The results showed that for hearing aid satisfaction and speech understanding, the full rating scale was used in the laboratory, while the ratings in real life were strongly skewed towards the positive end of the scale. In the laboratory, SNRs where participants indicated they could not follow the narrator ("unable to follow" noise level) were rated clearly better than the lowest possible ratings. This indicates that very negative ratings may not be applicable in real-life testing. The lower part of the distribution of real-life SNR estimates was related to participants' individual "unable to follow" noise levels and the SNRs which were rated poorly in the laboratory made up less than 10% of the speech situations experienced in real life. Discussion This indicates that people do not seem to frequently experience listening situations at SNRs where they are dissatisfied with their hearing aids and this could be the reason for the overly positive hearing aid outcome ratings in EMA studies. It remains unclear to what extent the scarcity of such situations is due lack of encounters or intentional avoidance.
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Affiliation(s)
| | - Jana Ritslev
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
- R&D PSA SA DE ERL, WS Audiology, Lynge, Denmark
| | - Dina Lelic
- R&D PSA SA DE ERL, WS Audiology, Lynge, Denmark
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Benítez-Barrera CR, Ramirez-Esparza N, García-Sierra A, Skoe E. Cultural differences in auditory ecology. JASA EXPRESS LETTERS 2023; 3:083601. [PMID: 37589565 DOI: 10.1121/10.0020608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Demographic differences in acoustic environments are usually studied using geographic area monitoring. This approach, however, may miss valuable information differentiating cultures. This motivated the current study, which used wearable sound recorders to measure noise levels and speech-to-noise ratios (SNRs) in the immediate acoustic environment of Latinx and European-American college students. Latinx experienced higher noise levels (64.8 dBC) and lower SNRs (3.7 dB) compared to European-Americans (noise levels, 63 dB; SNRs, 5.4 dB). This work provides a framework for a larger study on the impact of culture on auditory ecology.
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Affiliation(s)
- Carlos R Benítez-Barrera
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Nairán Ramirez-Esparza
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut 06269, USA
| | - Adrián García-Sierra
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut 06269, , , ,
| | - Erika Skoe
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut 06269, , , ,
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Herbert N, Keller M, Derleth P, Kühnel V, Strelcyk O. Optimised adaptive procedures and analysis methods for conducting speech-in-noise tests. Int J Audiol 2023; 62:776-786. [PMID: 35791080 DOI: 10.1080/14992027.2022.2087112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Speech-in-noise testing is a valuable part of audiological test batteries. Test standardisation using precise methods is desirable for ease of administration. This study investigated the accuracy and reliability of different Bayesian and non-Bayesian adaptive procedures and analysis methods for conducting speech-in-noise testing. DESIGN Matrix sentence tests using different numbers of sentences (10, 20, 30 and 50) and target intelligibilities (50 and 75%) were simulated for modelled listeners with various characteristics. The accuracy and reliability of seven different measurement procedures and three different data analysis methods were assessed. RESULTS The estimation of 50% intelligibility was accurate and showed excellent reliability across the majority of methods tested, even with relatively few stimuli. Estimating 75% intelligibility resulted in decreased accuracy. For this target, more stimuli were required for sufficient accuracy and selected Bayesian procedures surpassed the performance of others. Some Bayesian procedures were also superior in the estimation of psychometric function width. CONCLUSIONS A single standardised procedure could improve the consistency of the matrix sentence test across a range of target intelligibilities. Candidate adaptive procedures and analysis methods are discussed. These could also be applicable for other speech materials. Further testing with human participants is required.
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Affiliation(s)
| | | | - Peter Derleth
- Research & Development, Sonova AG, Stäfa, Switzerland
| | - Volker Kühnel
- Research & Development, Sonova AG, Stäfa, Switzerland
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Perea Pérez F, Hartley DEH, Kitterick PT, Zekveld AA, Naylor G, Wiggins IM. Listening efficiency in adult cochlear-implant users compared with normally-hearing controls at ecologically relevant signal-to-noise ratios. Front Hum Neurosci 2023; 17:1214485. [PMID: 37520928 PMCID: PMC10379644 DOI: 10.3389/fnhum.2023.1214485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Due to having to work with an impoverished auditory signal, cochlear-implant (CI) users may experience reduced speech intelligibility and/or increased listening effort in real-world listening situations, compared to their normally-hearing (NH) peers. These two challenges to perception may be usefully integrated in a measure of listening efficiency: conceptually, the amount of accuracy achieved for a certain amount of effort expended. Methods We describe a novel approach to quantifying listening efficiency based on the rate of evidence accumulation toward a correct response in a linear ballistic accumulator (LBA) model of choice decision-making. Estimation of this objective measure within a hierarchical Bayesian framework confers further benefits, including full quantification of uncertainty in parameter estimates. We applied this approach to examine the speech-in-noise performance of a group of 24 CI users (M age: 60.3, range: 20-84 years) and a group of 25 approximately age-matched NH controls (M age: 55.8, range: 20-79 years). In a laboratory experiment, participants listened to reverberant target sentences in cafeteria noise at ecologically relevant signal-to-noise ratios (SNRs) of +20, +10, and +4 dB SNR. Individual differences in cognition and self-reported listening experiences were also characterised by means of cognitive tests and hearing questionnaires. Results At the group level, the CI group showed much lower listening efficiency than the NH group, even in favourable acoustic conditions. At the individual level, within the CI group (but not the NH group), higher listening efficiency was associated with better cognition (i.e., working-memory and linguistic-closure) and with more positive self-reported listening experiences, both in the laboratory and in daily life. Discussion We argue that listening efficiency, measured using the approach described here, is: (i) conceptually well-motivated, in that it is theoretically impervious to differences in how individuals approach the speed-accuracy trade-off that is inherent to all perceptual decision making; and (ii) of practical utility, in that it is sensitive to differences in task demand, and to differences between groups, even when speech intelligibility remains at or near ceiling level. Further research is needed to explore the sensitivity and practical utility of this metric across diverse listening situations.
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Affiliation(s)
- Francisca Perea Pérez
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Douglas E. H. Hartley
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Pádraig T. Kitterick
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Acoustic Laboratories, Sydney, NSW, Australia
| | - Adriana A. Zekveld
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Graham Naylor
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ian M. Wiggins
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Jorgensen E, Xu J, Chipara O, Oleson J, Galster J, Wu YH. Auditory Environments and Hearing Aid Feature Activation Among Younger and Older Listeners in an Urban and Rural Area. Ear Hear 2023; 44:603-618. [PMID: 36534639 PMCID: PMC10101872 DOI: 10.1097/aud.0000000000001308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate differences in auditory environments and hearing aid feature activation between younger listeners with normal hearing and older listeners with hearing loss in an urban and rural location. We hypothesized that (1) urban dwellers and younger listeners would encounter more diverse and demanding auditory environments than rural dwellers and older listeners, respectively; (2) the advanced hearing aid features (noise reduction and directional microphone) of urban dwellers and younger listeners would be activated more frequently than rural dwellers and older listeners, respectively. DESIGN The design of this study was cross-sectional with repeated measures. A total of 12 older adults with hearing loss (OHL-U) and 11 younger adults with normal hearing (YNH-U) were recruited from an urban area (Berkeley, California) and 13 older adults with hearing loss (OHL-R) and 10 YNH-U were recruited from a rural area (Iowa City, Iowa). Participants wore hearing aids that recorded data about their listening environments and completed ecological momentary assessments for 1 week. RESULTS The YNH-U group experienced higher sound pressure levels and hearing aid features were activated more frequently than in the OHL groups. The OHL-R group experienced significantly less diverse sound pressure levels than the YNH-U group. The YNH-R group had sound levels between the YNH-U group and the OHL groups but without significant differences from any other group. The YNH groups showed a greater likelihood of hearing aid feature activation than the OHL-R group. CONCLUSIONS Demographics affect auditory environments and the activation of hearing aid features. Younger urban dwellers have the most diverse or demanding auditory environments and hearing aid feature activation, and older, rural dwellers with hearing loss have the least diverse or demanding auditory environments and hearing aid feature activation. Future studies of real-world auditory environments and audiology intervention effectiveness should consider location in recruitment and interpretation of results.
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Affiliation(s)
- Erik Jorgensen
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Octav Chipara
- Department of Computer Science, University of Iowa, Iowa City, Iowa, USA
| | - Jacob Oleson
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | | | - Yu-Hsiang Wu
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
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Diehl PU, Singer Y, Zilly H, Schönfeld U, Meyer-Rachner P, Berry M, Sprekeler H, Sprengel E, Pudszuhn A, Hofmann VM. Restoring speech intelligibility for hearing aid users with deep learning. Sci Rep 2023; 13:2719. [PMID: 36792797 PMCID: PMC9932078 DOI: 10.1038/s41598-023-29871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Almost half a billion people world-wide suffer from disabling hearing loss. While hearing aids can partially compensate for this, a large proportion of users struggle to understand speech in situations with background noise. Here, we present a deep learning-based algorithm that selectively suppresses noise while maintaining speech signals. The algorithm restores speech intelligibility for hearing aid users to the level of control subjects with normal hearing. It consists of a deep network that is trained on a large custom database of noisy speech signals and is further optimized by a neural architecture search, using a novel deep learning-based metric for speech intelligibility. The network achieves state-of-the-art denoising on a range of human-graded assessments, generalizes across different noise categories and-in contrast to classic beamforming approaches-operates on a single microphone. The system runs in real time on a laptop, suggesting that large-scale deployment on hearing aid chips could be achieved within a few years. Deep learning-based denoising therefore holds the potential to improve the quality of life of millions of hearing impaired people soon.
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Affiliation(s)
- Peter Udo Diehl
- Audatic, Berlin, Friedrichstr. 210, 10117, Berlin, Germany. .,Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.
| | - Yosef Singer
- Audatic, Berlin, Friedrichstr. 210, 10117 Berlin, Germany
| | - Hannes Zilly
- Audatic, Berlin, Friedrichstr. 210, 10117 Berlin, Germany
| | - Uwe Schönfeld
- grid.6363.00000 0001 2218 4662Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | | | - Mark Berry
- Audatic, Berlin, Friedrichstr. 210, 10117 Berlin, Germany
| | - Henning Sprekeler
- grid.6734.60000 0001 2292 8254Department for Electrical Engineering and Computer Science, Technische Universität Berlin, Berlin, Germany ,grid.455089.50000 0004 0456 0961Bernstein Center for Computational Neuroscience Berlin, Philippstr. 13, 10115 Berlin, Germany ,grid.6734.60000 0001 2292 8254Exzellenzcluster Science of Intelligence, Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany
| | - Elias Sprengel
- Audatic, Berlin, Friedrichstr. 210, 10117 Berlin, Germany
| | - Annett Pudszuhn
- grid.6363.00000 0001 2218 4662Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Veit M. Hofmann
- grid.6363.00000 0001 2218 4662Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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Houben R, Reinten I, Dreschler WA, Mathijssen R, Dijkstra TMH. Preferred Strength of Noise Reduction for Normally Hearing and Hearing-Impaired Listeners. Trends Hear 2023; 27:23312165231211437. [PMID: 37990543 PMCID: PMC10666719 DOI: 10.1177/23312165231211437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/23/2023] Open
Abstract
Preference for noise reduction (NR) strength differs between individuals. The purpose of this study was (1) to investigate whether hearing loss influences this preference, (2) to find the number of distinct settings required to classify participants in similar groups based on their preference for NR strength, and (3) to estimate the number of paired comparisons needed to predict to which preference group a participant belongs. A paired comparison paradigm was used in which participants listened to pairs of speech-in-noise stimuli processed by NR with 10 different strength settings. Participants indicated their preferred sound sample. The 30 participants were divided into three groups according to hearing status (normal hearing, mild hearing loss, and moderate hearing loss). The results showed that (1) participants with moderate hearing loss preferred stronger NR than participants with normal hearing; (2) cluster analysis based solely on the preference for NR strength showed that the data could be described well by dividing the participants into three preference clusters; (3) the appropriate cluster membership could be found with 15 paired comparisons. We conclude that on average, a higher hearing loss is related to a preference for stronger NR, at least for our NR algorithm and our participants. The results show that it might be possible to use a limited set of pre-set NR strengths that can be chosen clinically. For our NR one might use three settings: no NR, intermediate NR, and strong NR. Paired comparisons might be used to find the optimal one of the three settings.
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Affiliation(s)
- Rolph Houben
- Pento Audiological Centre, Amersfoort, The Netherlands
| | - Ilja Reinten
- Clinical and Experimental Audiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Wouter A. Dreschler
- Clinical and Experimental Audiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | | | - Tjeerd M. H. Dijkstra
- Institute for Computing and Information Sciences, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department of Women’s Health, University Clinic Tübingen, Tübingen, Germany
- Institute for Translational Bioinformatics, University Clinic Tübingen, Tübingen, Germany
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Maillard E, Joyal M, Murray MM, Tremblay P. Are musical activities associated with enhanced speech perception in noise in adults? A systematic review and meta-analysis. CURRENT RESEARCH IN NEUROBIOLOGY 2023. [DOI: 10.1016/j.crneur.2023.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Kuk F, Slugocki C, Davis-Ruperto N, Korhonen P. Measuring the effect of adaptive directionality and split processing on noise acceptance at multiple input levels. Int J Audiol 2023; 62:21-29. [PMID: 35015970 DOI: 10.1080/14992027.2021.2022789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study used the multi-level Tracking of Noise Tolerance (TNT) test to compare Augmented Focus (AF) or split processing over non-AF processing with adaptive directionality (non-AF-dirm) and with an omnidirectional microphone (non-AF-omni). DESIGN This was a single-blind, within-subject repeated measures design. STUDY SAMPLE Nineteen listeners with a mild-to-moderate hearing loss. The listeners' task was to determine their tolerable noise level (TNL) in the sound-field at four fixed speech levels (i.e. 62, 68, 75, and 85 dB SPL) in the unaided condition and the different aided conditions. The speech passages were presented from 0° while a continuous speech-shaped noise was presented from 180°. Each condition was tested twice, each in a different counterbalanced order. RESULTS AF improved TNL by an average of 2.9 dB over non-AF-dirm. Adaptive directionality improved the aided TNL by 4.7 dB over the non-AF-omni condition. The unaided TNL was similar to the aided non-AF-omni TNL. Whereas a stable TNL was reached in 20-30 s for non-AF-dirm, it took AF < 15 s to reach a stable TNL at all input levels. CONCLUSIONS This study shows that AF allowed 2.9 dB of signal-to-noise ratio (SNR) improvement over that of non-AF-dirm and 7.6 dB over the aided non-AF-omni condition.
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Affiliation(s)
- Francis Kuk
- WS Audiology, Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL, USA
| | - Christopher Slugocki
- WS Audiology, Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL, USA
| | - Neal Davis-Ruperto
- WS Audiology, Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL, USA
| | - Petri Korhonen
- WS Audiology, Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL, USA
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Schmid C, Wimmer W, Kompis M. BPACE: A Bayesian, Patient-Centered Procedure for Matrix Speech Tests in Noise. Trends Hear 2023; 27:23312165231191382. [PMID: 37501653 PMCID: PMC10388612 DOI: 10.1177/23312165231191382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Matrix sentence tests in noise can be challenging to the listener and time-consuming. A trade-off should be found between testing time, listener's comfort and the precision of the results. Here, a novel test procedure based on an updated maximum likelihood method was developed and implemented in a German matrix sentence test. It determines the parameters of the psychometric function (threshold, slope, and lapse-rate) without constantly challenging the listener at the intelligibility threshold. A so-called "credible interval" was used as a mid-run estimate of reliability and can be used as a termination criterion for the test. The procedure was evaluated and compared to a STAIRCASE procedure in a study with 20 cochlear implant patients and 20 normal hearing participants. The proposed procedure offers comparable accuracy and reliability to the reference method, but with a lower listening effort, as rated by the listeners (- 1.8 points on a 10-point scale). Test duration can be reduced by 1.3 min on average when a credible interval of 2 dB is used as the termination criterion instead of testing 30 sentences. Particularly, normal hearing listeners and well performing, cochlear implant users can benefit from shorter test duration. Although the novel procedure was developed for a German test, it can easily be applied to tests in any other language.
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Affiliation(s)
- Christoph Schmid
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, Inselspital, Bern, Switzerland
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, Inselspital, Bern, Switzerland
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Diehl PU, Thorbergsson L, Singer Y, Skripniuk V, Pudszuhn A, Hofmann VM, Sprengel E, Meyer-Rachner P. Non-intrusive deep learning-based computational speech metrics with high-accuracy across a wide range of acoustic scenes. PLoS One 2022; 17:e0278170. [PMID: 36441711 PMCID: PMC9704549 DOI: 10.1371/journal.pone.0278170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
Speech with high sound quality and little noise is central to many of our communication tools, including calls, video conferencing and hearing aids. While human ratings provide the best measure of sound quality, they are costly and time-intensive to gather, thus computational metrics are typically used instead. Here we present a non-intrusive, deep learning-based metric that takes only a sound sample as an input and returns ratings in three categories: overall quality, noise, and sound quality. This metric is available via a web API and is composed of a deep neural network ensemble with 5 networks that use either ResNet-26 architectures with STFT inputs or fully-connected networks with wav2vec features as inputs. The networks are trained and tested on over 1 million crowd-sourced human sound ratings across the three categories. Correlations of our metric with human ratings exceed or match other state-of-the-art metrics on 51 out of 56 benchmark scenes, while not requiring clean speech reference samples as opposed to metrics that are performing well on the other 5 scenes. The benchmark scenes represent a wide variety of acoustic environments and a large selection of post-processing methods that include classical methods (e.g. Wiener-filtering) and newer deep-learning methods.
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Affiliation(s)
- Peter Udo Diehl
- Audatic, Berlin, Germany
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Otorhinolaryngology, Head and Neck Surgery, Campus Benjamin Franklin, Berlin, Germany
- * E-mail:
| | | | | | | | - Annett Pudszuhn
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Otorhinolaryngology, Head and Neck Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Veit M. Hofmann
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Otorhinolaryngology, Head and Neck Surgery, Campus Benjamin Franklin, Berlin, Germany
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Krueger M, Schulte M, Brand T. Assessing and Modeling Spatial Release From Listening Effort in Listeners With Normal Hearing: Reference Ranges and Effects of Noise Direction and Age. Trends Hear 2022; 26:23312165221129407. [PMID: 36285532 PMCID: PMC9618758 DOI: 10.1177/23312165221129407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Listening to speech in noisy environments is challenging and effortful. Factors like the signal-to-noise ratio (SNR), the spatial separation between target speech and noise interferer(s), and possibly also the listener's age might influence perceived listening effort (LE). This study measured and modeled the effect of the spatial separation of target speech and interfering stationary speech-shaped noise on the perceived LE and its relation to the age of the listeners. Reference ranges for the relationship between subjectively perceived LE and SNR for different noise azimuths were established. For this purpose, 70 listeners with normal hearing and from three age groups rated the perceived LE using the Adaptive Categorical Listening Effort Scaling method (ACALES, Krueger et al., 2017a) with speech from the front and noise from 0°, 90°, 135°, or 180° azimuth. Based on these data, the spatial release from listening effort (SRLE) was calculated. The noise azimuth had a strong effect on SRLE, with the highest release for 135°. The binaural speech intelligibility model (BSIM2020, Hauth et al., 2020) predicted SRLE very well at negative SNRs, but overestimated for positive SNRs. No significant effect of age was found on the respective subjective ratings. Therefore, the reference ranges were determined independently of age. These reference ranges can be used for the classification of LE measurements. However, when the increase of the perceived LE with SNR was analyzed, a significant age difference was found between the listeners of the youngest and oldest group when considering the upper range of the LE function.
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Affiliation(s)
- Melanie Krueger
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany,Melanie Krueger, Hörzentrum Oldenburg gGmbH, Marie-Curie-Straße 2, D-26129 Oldenburg, Germany.
| | | | - Thomas Brand
- Medizinische Physik, Department für Medizinische Physik und Akustik, Fakultät VI, Carl-von-Ossietzky Universität Oldenburg, Oldenburg, Germany
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Rallapalli V, Schauer J, Souza P. Preference for Combinations of Hearing Aid Signal Processing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3100-3116. [PMID: 35881878 DOI: 10.1044/2022_jslhr-22-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to determine how multiple types of signal processing activated together influence listeners' preferences. METHOD Participants were adults with mild to moderately severe sensorineural hearing loss. Stimuli were spatialized low-context sentences mixed with six-talker babble at 3 and 8 dB signal-to-noise ratios (SNRs). Stimuli were processed with three common hearing aid processing algorithms: wide dynamic range compression (WDRC), frequency compression (FC), and digital noise reduction (DNR). A full-factorial design with two levels for each algorithm (WDRC & DNR: mild versus strong; FC: ON versus OFF; clinically relevant ranges) was evaluated. Preference was measured using a paired-comparison task within a choice-based conjoint analysis framework. Remote data collection methods were used. A signal fidelity metric quantified the acoustic effects across conditions. RESULTS At 3 dB SNR, participants preferred a combination of Slow WDRC and Mild DNR, although the mean preference was small (odds ratio close to 1). At both SNRs when Strong DNR was used, Fast WDRC was preferred over Slow WDRC. This may be related to signal fidelity, which was lower for the combination of Fast WDRC and Mild DNR and higher for the combination of Slow WDRC and either Mild DNR or Strong DNR. There was no effect of FC on preference or signal fidelity. CONCLUSIONS WDRC and DNR together influenced both listeners' preferences and signal fidelity in the investigated listening conditions. On average, the small effect sizes suggest that minor fine-tuning adjustments to hearing aid algorithms may not result in a substantial change in clinical outcomes.
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Affiliation(s)
- Varsha Rallapalli
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jacob Schauer
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pamela Souza
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Knowles Hearing Center, Northwestern University, Evanston, IL
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Rallapalli V, Souza P. Feasibility of Tablet-Based Remote Data Collection Method for Measuring Hearing Aid Preference. Am J Audiol 2022; 31:746-756. [PMID: 35914021 DOI: 10.1044/2022_aja-21-00273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the feasibility of a tablet-based remote data collection method for measuring preference for hearing aid signal processing features. METHOD Participants were nine individuals with bilateral mild to moderately severe sensorineural hearing loss. Stimuli were spatialized low-context sentences mixed with six-talker babble at two realistic signal-to-noise ratios (3 and 8 dB) and processed through a hearing aid simulator. Preference for full factorial combinations of three common hearing aid processing features (two levels each) was elicited using a paired-comparison task. Participants completed two versions of the experiment: The lab version was completed in a sound-treated booth using a custom MATLAB application on a desktop computer; the remote version was completed in a quiet room in the participant's home, using a custom MATLAB executable application on a tablet. Both versions used the same calibrated headphones. Strict infection control protocols were followed. RESULTS McNemar's test showed no association between preference and data collection method for the majority of the conditions. Percentage agreement and kappa scores were moderate/fair across most conditions. The results indicated that the remote versus lab versions did not have a systematic effect on preference. However, the relatively low agreement and kappa scores suggested within-subject variability in the outcome (preference). CONCLUSION The tablet-based version of remote experimentation was comparable to the lab-based version for eliciting preference for hearing aid signal processing features.
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Affiliation(s)
- Varsha Rallapalli
- Roxelyn and Richard Pepper Department of Communication Sciences & Disorders, Northwestern University, Evanston, IL
| | - Pamela Souza
- Roxelyn and Richard Pepper Department of Communication Sciences & Disorders, Northwestern University, Evanston, IL.,Knowles Hearing Center, Northwestern University, Evanston, IL
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Picou EM, Roberts RA, Angley G, Ricketts TA. Applying the Hearing Aid Fitting Standard to Selection for Adults. Semin Hear 2022; 43:66-78. [PMID: 35903077 PMCID: PMC9325089 DOI: 10.1055/s-0042-1748874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus on the selection of unilateral/bilateral hearing aids, hearing aid style, and coupling, in addition to feature selection. The standard emphasizes that decisions around these three aspects should be recommended for a patient in an individualized manner, based on their needs assessment. For these decisions, the needs assessment might include measures of speech-in-noise ability, social network size, patient preference, and a trial period. Additional elements could include assessments of manual dexterity, binaural interference, and attitude toward hearing aids. However, there are a multitude of ways to practice clinically and still meet the items outlined in the standard. As long as the selection decisions consider individualized patient factors and are capable of meeting validated prescriptive targets, a clinician would be meeting the adult hearing aid fitting minimum standard guidance. In addition, despite the large number of past studies supporting these standards, additional, high-quality research including randomized, controlled, clinical trials are still needed to further support appropriate minimum standard recommendations.
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Affiliation(s)
- Erin M. Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee,Address for correspondence Erin M. Picou, Au.D., Ph.D. 1215 21st Avenue South, Room 8310, Nashville, TN 37232
| | - Richard A. Roberts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gina Angley
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd A. Ricketts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Zhang Y, Chen J, Zhang Y, Sun B, Liu Y. Using Auditory Characteristics to Select Hearing Aid Compression Speeds for Presbycusic Patients. Front Aging Neurosci 2022; 14:869338. [PMID: 35847672 PMCID: PMC9285002 DOI: 10.3389/fnagi.2022.869338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to select the optimal hearing aid compression speeds (fast-acting and slow-acting) for presbycusic patients by using auditory characteristics including temporal modulation and speech-in-noise performance. Methods In total, 24 patients with unilateral or bilateral moderate sensorineural hearing loss who scored higher than 21 on the Montreal Cognitive Assessment (MoCA) test participated in this study. The electrocochleogram (ECochG) results, including summating potentials (SP) and action potentials (AP), were recorded. Subjects' temporal modulation thresholds and speech recognition at 4 individualized signal-to-noise ratios were measured under three conditions, namely, unaided, aided with fast-acting compression (FAC), and aided with slow-acting compression (SAC). Results The results of this study showed that modulation discrimination thresholds in the unaided (−8.14 dB) and aided SAC (−8.19 dB) conditions were better than the modulation thresholds in the FAC (−4.67 dB) conditions. The speech recognition threshold (SRT75%) for FAC (5.21 dB) did not differ significantly from SAC (3.39 dB) (p = 0.12). A decision tree analysis showed that the inclusion of the AP, unaided modulation thresholds, and unaided SRT75% may correctly identify the optimal compression speeds (FAC vs. SAC) for individual presbycusic patients with up to 90% accuracy. Conclusion Both modes of compression speeds improved a presbycusic patient's speech recognition ability in noise. The SAC hearing aids may better preserve the modulation thresholds than the FAC hearing aids. The measurement of AP, along with the unaided modulation thresholds and unaided SRT75%, may help guide the selection of optimal compression speeds for individual presbycusic patients.
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Affiliation(s)
- Yi Zhang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Chen
- School of Electronics Engineering and Computer Science, Peking University, Beijing, China
| | - Yanmei Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Baoxuan Sun
- Widex Hearing Aid (Shanghai) Co., Ltd., Shanghai, China
| | - Yuhe Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yuhe Liu
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Brumer N, Elkins E, Hillyer J, Hazlewood C, Parbery-Clark A. Relationships Between Health-Related Quality of Life and Speech Perception in Bimodal and Bilateral Cochlear Implant Users. Front Psychol 2022; 13:859722. [PMID: 35572246 PMCID: PMC9096554 DOI: 10.3389/fpsyg.2022.859722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Previous studies examining the relationship between health-related quality of life (HRQoL) and speech perception ability in cochlear implant (CI) users have yielded variable results, due to a range of factors, such as a variety of different HRQoL questionnaires and CI speech testing materials in addition to CI configuration. In order to decrease inherent variability and better understand the relationship between these measures in CI users, we administered a commonly used clinical CI speech testing battery as well as two popular HRQoL questionnaires in bimodal and bilateral CI users. Methods The Glasgow Benefit Inventory (GBI), a modified five-factor version of the GBI (GBI-5F), and the Nijmegen Cochlear Implant Questionnaire (NCIQ) were administered to 25 CI users (17 bimodal and 8 bilateral). Speech perception abilities were measured with the AzBio sentence test in several conditions (e.g., quiet and noise, binaural, and first-ear CI only). Results Higher performance scores on the GBI general subscore were related to greater binaural speech perception ability in noise. There were no other relationships between the GBI or NCIQ and speech perception ability under any condition. Scores on many of the GBI-5F factors were substantially skewed and asymmetrical; therefore, correlational analyses could not be applied. Across all participants, binaural speech perception scores were greater than first-ear CI only scores. Conclusion The GBI general subscore was related to binaural speech perception, which is considered the everyday listening condition of bimodal and bilateral CI users, in noise; while the more CI-specific NCIQ did not relate to speech perception ability in any listening condition. Future research exploring the relationships between the GBI, GBI-5F, and NCIQ considering bimodal and bilateral CI configurations separately is warranted.
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Affiliation(s)
- Nadav Brumer
- Auditory Research Laboratory, Swedish Neuroscience Institute, Seattle, WA, United States
| | - Elizabeth Elkins
- Auditory Research Laboratory, Swedish Neuroscience Institute, Seattle, WA, United States
| | - Jake Hillyer
- College of Medicine, University of Arizona, Phoenix, AZ, United States
| | - Chantel Hazlewood
- Auditory Research Laboratory, Swedish Neuroscience Institute, Seattle, WA, United States
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do Carmo DM, Borsoi RA, Costa MH. Robust parameter strategy for Wiener-based binaural noise reduction methods in hearing aids. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Arehart KH, Chon SH, Lundberg EMH, Harvey LO, Kates JM, Anderson MC, Rallapalli VH, Souza PE. A comparison of speech intelligibility and subjective quality with hearing-aid processing in older adults with hearing loss. Int J Audiol 2022; 61:46-58. [PMID: 33913795 PMCID: PMC11108258 DOI: 10.1080/14992027.2021.1900609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/18/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study characterised the relationship between speech intelligibility and quality in listeners with hearing loss for a range of hearing-aid processing settings and acoustic conditions. DESIGN Binaural speech intelligibility scores and quality ratings were measured for sentences presented in babble noise and processed through a hearing-aid simulation. The intelligibility-quality relationship was investigated by (1) assessing the effects of experimental conditions on each task; (2) directly comparing intelligibility scores and quality ratings for each participant across the range of conditions; and (3) comparing the association between signal envelope fidelity (represented by a cepstral correlation metric) and intelligibility and quality. STUDY SAMPLE Participants were 15 adults (7 females; age range 59-81 years) with mild to moderately severe sensorineural hearing loss. RESULTS Intelligibility and quality showed a positive association both with each other and with changes to signal fidelity introduced by the entire acoustic and signal-processing system including the additive noise and the hearing-aid output. As signal fidelity decreased, quality ratings changed at a slower rate than intelligibility scores. Individual psychometric functions were more variable for quality compared to intelligibility. CONCLUSIONS Variability in the intelligibility-quality relationship reinforces the importance of measuring both intelligibility and quality in clinical hearing-aid fittings.
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Affiliation(s)
| | - Song Hui Chon
- Audio Engineering Technology, Belmont University, Nashville, TN, USA
| | | | - Lewis O. Harvey
- Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - James M. Kates
- SLHS Department, University of Colorado Boulder, Boulder, CO, USA
| | | | - Varsha H. Rallapalli
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Pamela E. Souza
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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Predictive Sentence Context Reduces Listening Effort in Older Adults With and Without Hearing Loss and With High and Low Working Memory Capacity. Ear Hear 2022; 43:1164-1177. [PMID: 34983897 PMCID: PMC9232842 DOI: 10.1097/aud.0000000000001192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Listening effort is needed to understand speech that is degraded by hearing loss, a noisy environment, or both. This in turn reduces cognitive spare capacity, the amount of cognitive resources available for allocation to concurrent tasks. Predictive sentence context enables older listeners to perceive speech more accurately, but how does contextual information affect older adults' listening effort? The current study examines the impacts of sentence context and cognitive (memory) load on sequential dual-task behavioral performance in older adults. To assess whether effects of context and memory load differ as a function of older listeners' hearing status, baseline working memory capacity, or both, effects were compared across separate groups of participants with and without hearing loss and with high and low working memory capacity. DESIGN Participants were older adults (age 60-84 years; n = 63) who passed a screen for cognitive impairment. A median split classified participants into groups with high and low working memory capacity. On each trial, participants listened to spoken sentences in noise and reported sentence-final words that were either predictable or unpredictable based on sentence context, and also recalled short (low-load) or long (high-load) sequences of digits that were presented visually before each spoken sentence. Speech intelligibility was quantified as word identification accuracy, and measures of listening effort included digit recall accuracy, and response time to words and digits. Correlations of context benefit in each dependent measure with working memory and vocabulary were also examined. RESULTS Across all participant groups, accuracy and response time for both word identification and digit recall were facilitated by predictive context, indicating that in addition to an improvement in intelligibility, listening effort was also reduced when sentence-final words were predictable. Effects of predictability on all listening effort measures were observed whether or not trials with an incorrect word identification response were excluded, indicating that the effects of predictability on listening effort did not depend on speech intelligibility. In addition, although cognitive load did not affect word identification accuracy, response time for word identification and digit recall, as well as accuracy for digit recall, were impaired under the high-load condition, indicating that cognitive load reduced the amount of cognitive resources available for speech processing. Context benefit in speech intelligibility was positively correlated with vocabulary. However, context benefit was not related to working memory capacity. CONCLUSIONS Predictive sentence context reduces listening effort in cognitively healthy older adults resulting in greater cognitive spare capacity available for other mental tasks, irrespective of the presence or absence of hearing loss and baseline working memory capacity.
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Heeren J, Nuesse T, Latzel M, Holube I, Hohmann V, Wagener KC, Schulte M. The Concurrent OLSA Test: A Method for Speech Recognition in Multi-talker Situations at Fixed SNR. Trends Hear 2022; 26:23312165221108257. [PMID: 35702051 PMCID: PMC9208053 DOI: 10.1177/23312165221108257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A multi-talker paradigm is introduced that uses different attentional processes to adjust speech-recognition scores with the goal of conducting measurements at high signal-to-noise ratios (SNR). The basic idea is to simulate a group conversation with three talkers. Talkers alternately speak sentences of the German matrix test OLSA. Each time a sentence begins with the name “Kerstin” (call sign), the participant is addressed and instructed to repeat the last words of all sentences from that talker, until another talker begins a sentence with “Kerstin”. The alternation of the talkers is implemented with an adjustable overlap time that causes an overlap between the call sign “Kerstin” and the target words to be repeated. Thus, the two tasks of detecting “Kerstin” and repeating target words are to be done at the same time. The paradigm was tested with 22 young normal-hearing participants (YNH) for three overlap times (0.6 s, 0.8 s, 1.0 s). Results for these overlap times show significant differences, with median target word recognition scores of 88%, 82%, and 77%, respectively (including call-sign and dual-task effects). A comparison of the dual task with the corresponding single tasks suggests that the observed effects reflect an increased cognitive load.
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Affiliation(s)
- Jan Heeren
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany.,Cluster of Excellence Hearing4All, Oldenburg, Germany
| | - Theresa Nuesse
- Cluster of Excellence Hearing4All, Oldenburg, Germany.,Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
| | | | - Inga Holube
- Cluster of Excellence Hearing4All, Oldenburg, Germany.,Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
| | - Volker Hohmann
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany.,Cluster of Excellence Hearing4All, Oldenburg, Germany.,Auditory Signal Processing, Department of Medical Physics and Acoustics, University of Oldenburg, Oldenburg, Germany
| | - Kirsten C Wagener
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany.,Cluster of Excellence Hearing4All, Oldenburg, Germany
| | - Michael Schulte
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany.,Cluster of Excellence Hearing4All, Oldenburg, Germany
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Smeds K, Larsson J, Dahlquist M, Wolters F, Herrlin P. Live Evaluation of Auditory Preference, a Laboratory Test for Evaluating Auditory Preference. J Am Acad Audiol 2021; 32:487-500. [PMID: 34965595 DOI: 10.1055/s-0041-1735213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many laboratory tests are performed under unrealistic conditions. Tasks, such as repeating words or sentences, are performed in simple loudspeaker setups. Currently, many research groups focus on realistic audiovisual laboratory setups. Fewer groups focus on the tasks performed during testing. PURPOSE A semicontrolled laboratory test method focusing on the tasks performed, the Live Evaluation of Auditory Preference (LEAP) was evaluated. LEAP is developed to evaluate hearing-instrument performance in test scenarios that represent everyday listening situations. RESEARCH DESIGN LEAP was evaluated in a feasibility study. The method comprises conversations between a test participant and one or two test leaders, enabling evaluation of the test participant's own voice. The method allows for visual cues (when relevant) and introduce social pressure to participate in the conversation. In addition, other everyday listening tasks, such as watching television (TV) and listening to radio, are included. In this study, LEAP was used to assess preference for two hearing aid settings using paired comparisons. STUDY SAMPLE Nineteen experienced hearing aid users (13 females and 6 males; mean age 74 years), participated in the study. DATA COLLECTION AND ANALYSIS LEAP was performed at three visits to the laboratory. In addition, participants conducted a field trial where the two hearing aid programs were compared using Ecological Momentary Assessments (EMA). During LEAP testing, six mandatory test cases were used, representing commonly occurring everyday listening situations. Individual test cases were also included, selected from individually experienced listening situations during the field trial. Within- and between-session reliability of the LEAP test was investigated. Validity was investigated by comparing the LEAP and the EMA results. RESULTS For the current signal-processing evaluation, the test was judged to have acceptable reliability and validity. The inclusion of individually selected test cases increased the representativeness of the LEAP test, but it did not substantially alter the results in the current study. CONCLUSION LEAP in its current implementation seems suitable for investigating signal-processing preference in the laboratory in a way that is indicative of everyday preference. The LEAP method represents one step forward in bringing the real world into the laboratory.
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Ecological Momentary Assessment: A Field Evaluation of Subjective Ratings of Speech in Noise. Ear Hear 2021; 42:1770-1781. [PMID: 34010249 DOI: 10.1097/aud.0000000000001071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE As hearing rehabilitation research evolves to include both retrospective and momentary assessment outcome measures, it is important to understand how in-the-moment contextual factors influence subjective ratings. We aimed to determine, over a 4-week period of participants responding to ecological momentary assessments (EMAs) in their own environments, whether: (1) participants will complete surveys in speech-in-noise listening situations; (2) ratings of speech in noise change in a predictable manner as the acoustic conditions change; and (3) EMAs provide patient insights beyond those provided from retrospective ratings. DESIGN Fourteen adults aged 26 to 86 years with at least 6 months of hearing aid experience were recruited for an 8-week crossover field trial (4 weeks wearing hearing aids with no EMA; 4 weeks wearing hearing aids with EMA). Participants were fitted with hearing aids and provided with a streamer and a smartphone with an app that analyzed the acoustic signal from the hearing aids and alerted the participant to respond to a survey when predetermined acoustic conditions were detected. Participants were prompted to complete brief surveys up to 9 times/day that contained establishing questions, quality ratings, and items assessing perceived benefit, residual activity limitation, and satisfaction. Participants also completed retrospective questionnaires at intake and after each 4-week field trial. RESULTS Participants completed an average of 4.4 surveys per day. The quality ratings changed as the acoustics changed: Ratings of intelligibility were lower for 10 dB signal-to-noise ratio (SNR) than 20 dB SNR (p = 0.006); ratings of noisiness were higher for 10 dB SNR than 20 dB SNR (p = 0.001) and higher for 65 dB SPL than 50 dB SPL (p < 0.001); ratings of effort were higher for 65 dB SPL than 50 dB SPL (p = 0.004); ratings of loudness were higher for 65 dB SPL than 50 dB SPL (p = 0.001). Descriptive analysis of satisfaction, benefit, and residual activity limitation responses showed that the momentary surveys provided more detail about individual variability across acoustic conditions than the retrospective questions. CONCLUSIONS Participants completed more than 99% of the triggered surveys, demonstrating high compliance. Because the quality ratings generally changed in the hypothesized direction, it is concluded that the participants provided valid responses. The greater variability in responses with EMA than retrospective questionnaires demonstrates its potential utility as a clinical tool for exploring hearing aid outcomes in real-world environments.
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