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Fereczkowski M, Sanchez-Lopez RH, Christiansen S, Neher T. Amplitude Compression for Preventing Rollover at Above-Conversational Speech Levels. Trends Hear 2024; 28:23312165231224597. [PMID: 38179670 PMCID: PMC10771052 DOI: 10.1177/23312165231224597] [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: 04/26/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Hearing aids provide nonlinear amplification to improve speech audibility and loudness perception. While more audibility typically increases speech intelligibility at low levels, the same is not true for above-conversational levels, where decreases in intelligibility ("rollover") can occur. In a previous study, we found rollover in speech intelligibility measurements made in quiet for 35 out of 74 test ears with a hearing loss. Furthermore, we found rollover occurrence in quiet to be associated with poorer speech intelligibility in noise as measured with linear amplification. Here, we retested 16 participants with rollover with three amplitude-compression settings. Two were designed to prevent rollover by applying slow- or fast-acting compression with a 5:1 compression ratio around the "sweet spot," that is, the area in an individual performance-intensity function with high intelligibility and listening comfort. The third, reference setting used gains and compression ratios prescribed by the "National Acoustic Laboratories Non-Linear 1" rule. Speech intelligibility was assessed in quiet and in noise. Pairwise preference judgments were also collected. For speech levels of 70 dB SPL and above, slow-acting sweet-spot compression gave better intelligibility in quiet and noise than the reference setting. Additionally, the participants clearly preferred slow-acting sweet-spot compression over the other settings. At lower levels, the three settings gave comparable speech intelligibility, and the participants preferred the reference setting over both sweet-spot settings. Overall, these results suggest that, for listeners with rollover, slow-acting sweet-spot compression is beneficial at 70 dB SPL and above, while at lower levels clinically established gain targets are more suited.
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Affiliation(s)
- Michal Fereczkowski
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Research Unit for ORL – Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | | | - Stine Christiansen
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Research Unit for ORL – Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Tobias Neher
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Research Unit for ORL – Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
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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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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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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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Liu F, Demosthenes P. Real-world data: a brief review of the methods, applications, challenges and opportunities. BMC Med Res Methodol 2022; 22:287. [PMID: 36335315 PMCID: PMC9636688 DOI: 10.1186/s12874-022-01768-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
The increased adoption of the internet, social media, wearable devices, e-health services, and other technology-driven services in medicine and healthcare has led to the rapid generation of various types of digital data, providing a valuable data source beyond the confines of traditional clinical trials, epidemiological studies, and lab-based experiments.
Methods
We provide a brief overview on the type and sources of real-world data and the common models and approaches to utilize and analyze real-world data. We discuss the challenges and opportunities of using real-world data for evidence-based decision making This review does not aim to be comprehensive or cover all aspects of the intriguing topic on RWD (from both the research and practical perspectives) but serves as a primer and provides useful sources for readers who interested in this topic.
Results and Conclusions
Real-world hold great potential for generating real-world evidence for designing and conducting confirmatory trials and answering questions that may not be addressed otherwise. The voluminosity and complexity of real-world data also call for development of more appropriate, sophisticated, and innovative data processing and analysis techniques while maintaining scientific rigor in research findings, and attentions to data ethics to harness the power of real-world data.
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Pasta A, Szatmari TI, Christensen JH, Jensen KJ, Pontoppidan NH, Sun K, Larsen JE. Investigating the Provision and Context of Use of Hearing Aid Listening Programs From Real-world Data: Observational Study. J Med Internet Res 2022; 24:e36671. [PMID: 36251349 DOI: 10.2196/36671] [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: 01/21/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Listening programs enable hearing aid (HA) users to change device settings for specific listening situations and thereby personalize their listening experience. However, investigations into real-world use of such listening programs to support clinical decisions and evaluate the success of HA treatment are lacking. OBJECTIVE We aimed to investigate the provision of listening programs among a large group of in-market HA users and the context in which the programs are typically used. METHODS First, we analyzed how many and which programs were provided to 32,336 in-market HA users. Second, we explored 332,271 program selections from 1312 selected users to investigate the sound environments in which specific programs were used and whether such environments reflect the listening intent conveyed by the name of the used program. Our analysis was based on real-world longitudinal data logged by smartphone-connected HAs. RESULTS In our sample, 57.71% (18,663/32,336) of the HA users had programs for specific listening situations, which is a higher proportion than previously reported, most likely because of the inclusion criteria. On the basis of association rule mining, we identified a primary additional listening program, Speech in Noise, which is frequent among users and often provided when other additional programs are also provided. We also identified 2 secondary additional programs (Comfort and Music), which are frequent among users who get ≥3 programs and usually provided in combination with Speech in Noise. In addition, 2 programs (TV and Remote Mic) were related to the use of external accessories and not found to be associated with other programs. On average, users selected Speech in Noise, Comfort, and Music in louder, noisier, and less-modulated (all P<.01) environments compared with the environment in which they selected the default program, General. The difference from the sound environment in which they selected General was significantly larger in the minutes following program selection than in the minutes preceding it. CONCLUSIONS This study provides a deeper insight into the provision of listening programs on a large scale and demonstrates that additional listening programs are used as intended and according to the sound environment conveyed by the program name.
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Affiliation(s)
- Alessandro Pasta
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark.,Department of Applied Mathematics and Computer Science, Cognitive Systems, Demant A/S, Smørum, Denmark
| | - Tiberiu-Ioan Szatmari
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark.,Department of Applied Mathematics and Computer Science, Cognitive Systems, Demant A/S, Smørum, Denmark
| | | | - Kasper Juul Jensen
- Department of Applied Mathematics and Computer Science, Cognitive Systems, Demant A/S, Smørum, Denmark
| | | | - Kang Sun
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark.,Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
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Christensen JH, Saunders GH, Havtorn L, Pontoppidan NH. Real-World Hearing Aid Usage Patterns and Smartphone Connectivity. Front Digit Health 2021; 3:722186. [PMID: 34713187 PMCID: PMC8521994 DOI: 10.3389/fdgth.2021.722186] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Data for monitoring individual hearing aid usage has historically been limited to retrospective questionnaires or data logged intrinsically in the hearing aid cumulatively over time (e. g., days or more). This limits the investigation of longitudinal interactions between hearing aid use and environmental or behavioral factors. Recently it has become possible to analyze remotely logged hearing aid data from in-market and smartphone compatible hearing aids. This can provide access to novel insights about individual hearing aid usage patterns and their association to environmental factors. Here, we use remotely logged longitudinal data from 64 hearing aid users to establish basic norms regarding smartphone connectivity (i.e., comparing remotely logged data with cumulative true hearing aid on-time) and to assess whether such data can provide representative information about ecological usage patterns. The remotely logged data consists of minute-by-minute timestamped logs of cumulative hearing aid on-time and characteristics of the momentary acoustic environment. Using K-means clustering, we demonstrate that hourly hearing aid usage patterns (i.e., usage as minutes/hour) across participants are separated by four clusters that account for almost 50% of the day-to-day variation. The clusters indicate that hearing aids are worn either sparsely throughout the day; early morning to afternoon; from noon to late evening; or across the day from morning to late evening. Using linear mixed-effects regression modeling, we document significant associations between daily signal-to-noise, sound intensity, and sound diversity with hearing aid usage. Participants encounter louder, noisier, and more diverse sound environments the longer the hearing aids are worn. Finally, we find that remote logging via smartphones underestimates the daily hearing aid usage with a pooled median of 1.25 h, suggesting an overall connectivity of 85%. The 1.25 h difference is constant across days varying in total hearing aid on-time, and across participants varying in average daily hearing aid-on-time, and it does not depend on the identified patterns of daily hearing aid usage. In sum, remote data logging with hearing aids has high representativeness and face-validity, and can offer ecologically true information about individual usage patterns and the interaction between usage and everyday contexts.
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Affiliation(s)
| | - Gabrielle H Saunders
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Lena Havtorn
- Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark
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Investigating Real-World Benefits of High-Frequency Gain in Bone-Anchored Users with Ecological Momentary Assessment and Real-Time Data Logging. J Clin Med 2021; 10:jcm10173923. [PMID: 34501371 PMCID: PMC8432250 DOI: 10.3390/jcm10173923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: To compare listening ability (speech reception thresholds) and real-life listening experience in users with a percutaneous bone conduction device (BCD) with two listening programs differing only in high-frequency gain. In situ real-life experiences were recorded with ecological momentary assessment (EMA) techniques combined with real-time acoustical data logging and standard retrospective questionnaires. Methods: Nineteen experienced BCD users participated in this study. They all used a Ponto 4 BCD from Oticon Medical during a 4-week trial period. Environmental data and device parameters (i.e., device usage and volume control) were logged in real-time on an iPhone via a custom iOS research app. At the end of the trial period, subjects filled in APHAB, SSQ, and preference questionnaires. Listening abilities with the two programs were evaluated with speech reception threshold tests. Results: The APHAB and SSQ questionnaires did not reveal any differences between the two listening programs. The EMAs revealed group-level effects, indicating that in speech and noisy listening environments, subjects preferred the default listening program, and found the program with additional high-frequency gain too loud. This finding was corroborated by the volume log—subjects avoided the higher volume control setting and reacted more to changes in environmental sound pressure levels when using the high-frequency gain program. Finally, day-to-day changes in EMAs revealed acclimatization effects in the listening experience for ratings of “sound quality” and “program suitability” of the BCD, but not for ratings of “loudness perception” and “speech understanding”. The acclimatization effect did not differ among the listening programs. Conclusion: Adding custom high-frequency amplification to the BCD target-gain prescription improves speech reception in laboratory tests under quiet conditions, but results in poorer real-life listening experiences due to loudness.
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Saunders GH, Vercammen C, Timmer BHB, Singh G, Pelosi A, Meis M, Launer S, Kramer SE, Gagné JP, Bott A. Changing the narrative for hearing health in the broader context of healthy living: a call to action. Int J Audiol 2021; 60:86-91. [PMID: 33794720 DOI: 10.1080/14992027.2021.1905892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To discuss the steps necessary to facilitate hearing health care in the context of well-being and healthy living. DESIGN Common themes among the articles in this special supplement of the International Journal of Audiology were used to identify issues that must be addressed if audiology is to move from being hearing-focussed to taking a holistic perspective of hearing care in the context of healthy aging. These are discussed within the context of other published literature. RESULTS AND CONCLUSIONS Three needs were identified: (i) Increased interdisciplinary education to raise awareness of the interplay between hearing and health. (ii) Increased emphasis on counselling education in audiology programs so that audiologists are equipped with the knowledge, competence and confidence to provide counselling and emotional support to their patients, beyond care. (iii) Redefinition of therapeutic goal setting and hearing outcomes to include aspects of well-being, so that audiologists can capture and patients realise that that good hearing outcomes can have a direct positive impact on a person's quality of life that extends beyond their improved ability to hear. It was emphasised that each of these needs to be considered within the context of the audiologists' scope of practice and audiologists' well-being.
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Affiliation(s)
- Gabrielle H Saunders
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
| | | | - Barbra H B Timmer
- Sonova AG, Stafa, Switzerland.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Gurjit Singh
- Phonak Canada, Mississauga, Canada.,Ryerson University, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | - Marcus Meis
- Hörzentrum Oldenburg gGmbH, Oldenburg, Germany.,Cluster of excellence Hearing4all, University of Oldenburg, Germany
| | - Stefan Launer
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK.,Sonova AG, Stafa, Switzerland.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Sophia E Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Oldenburg, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jean-Pierre Gagné
- École d'orthophonie et d'audiologie, Université de Montréal, Montréal, Canada.,Fondation Caroline Durand en audition et vieillissement de l'Universtié de Montréal, Montréal, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Canada
| | - Anthea Bott
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,GN Hearing A/S, Ballerup, Denmark
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