Predictors of Hearing-Aid Outcomes

Impaired noise adaptation contributes to speech intelligibility problems in people with hearing loss

Understanding speech in noisy settings is harder for hearing-impaired (HI) people than for normal-hearing (NH) people, even when speech is audible. This is often attributed to hearing loss altering the neural encoding of temporal and/or spectral speech cues. Here, we investigated whether this difference may also be due to an impaired ability to adapt to background noise. For 25 adult hearing-aid users with sensorineural hearing loss, speech reception thresholds (SRTs) were measured for natural and tone-vocoded words embedded in speech-shaped noise (SSN). The stimuli were preceded or not by a 1-second adapting SSN precursor. Adaptation was calculated as the difference in SRT between the two precursor conditions. Corresponding data for 28 NH listeners were taken from a previously published study. SRTs were worse for HI listeners, confirming that hearing loss diminishes access to speech acoustic cues. Furthermore, noise adaptation was negatively correlated with the age-controlled hearing loss both for natural (rho=-0.56, N = 52, p < 0.001) and vocoded (rho=-0.45, N = 39, p = 0.002) words. Impaired adaptation contributed up to 10% of the SRT loss in HI listeners. We conclude that HI listeners suffer from poorer speech in noise recognition not only because of impaired access to speech acoustic cues but also because they are less able to adapt to background noise.

Difference in SII provided by initial fit and NAL-NL2 and its relation to self-reported hearing aid outcomes

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. .

Dual-Task Interference in the Assessment of Listening Effort: Results of Normal-Hearing Adults, Cochlear Implant Users, and Hearing Aid Users

PURPOSE

The purpose of the current study was to assess dual-task interference (i.e., changes between the dual-task and baseline condition) in a listening effort dual-task paradigm in normal-hearing (NH) adults, hearing aid (HA) users, and cochlear implant (CI) users.

METHOD

Three groups of 31 participants were included: (a) NH adults, (b) HA users, and (c) CI users. The dual-task paradigm consisted of a primary speech understanding task in a quiet condition, and a favorable and unfavorable noise condition, and a secondary visual memory task. Dual-task interference was calculated for both tasks, and participants were classified based on their patterns of interference. Descriptive analyses were established and differences between the three groups were examined.

RESULTS

The descriptive results showed varying patterns of dual-task interference between the three listening conditions. Most participants showed the pattern of visual memory interference (i.e., worse results for the secondary task in the dual-task condition and no difference for the primary task) in the quiet condition, whereas the pattern of speech understanding priority trade-off (i.e., worse results for the secondary task in the dual-task condition and better results for the primary task) was most prominent in the unfavorable noise condition. Particularly, in HA and CI users, this shift was seen. However, the patterns of dual-task interference were not statistically different between the three groups.

CONCLUSIONS

Results of this study may provide additional insight into the interpretation of dual-task paradigms for measuring listening effort in diverse participant groups. It highlights the importance of considering both the primary and secondary tasks for accurate interpretation of results.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26409088.

Reference Data for a Quick Speech-in-Noise Hearing Test in the French Language

INTRODUCTION

Difficulty in understanding speech in noise is the most common complaint of people with hearing impairment. Thus, there is a need for tests of speech-in-noise ability in clinical settings, which have to be evaluated for each language. Here, a reference dataset is presented for a quick speech-in-noise test in the French language (Vocale Rapide dans le Bruit, VRB; Leclercq, Renard, & Vincent, 2018).

METHODS

A large cohort (N = 641) was tested in a nationwide multicentric study. The cohort comprised normal-hearing individuals and individuals with a broad range of symmetrical hearing losses. Short everyday sentences embedded in babble noise were presented over a spatial array of loudspeakers. Speech level was kept constant, while noise level was progressively increased over a range of signal-to-noise ratios. The signal-to-noise ratio for which 50% of keywords could be correctly reported (speech reception threshold, SRT) was derived from psychometric functions. Other audiometric measures were collected for the cohort, such as audiograms and speech-in-quiet performance.

RESULTS

The VRB test was both sensitive and reliable, as shown by the steep slope of the psychometric functions and by the high test-retest consistency across sentence lists. Correlation analyses showed that pure tone averages derived from the audiograms explained 74% of the SRT variance over the whole cohort, but only 29% for individuals with clinically normal audiograms. SRTs were then compared to recent guidelines from the French Society of Audiology [Eur Ann Otorhinolaryngol Head Neck Dis. 2022;139(1):21-7]. Among individuals who would not have qualified for hearing aid prescription based on their audiogram or speech intelligibility in quiet, 18.4% were now eligible as they displayed SRTs in noise impaired by 3 dB or more. For individuals with borderline audiograms, between 20 dB HL and 30 dB HL, the prevalence of impaired SRTs increased to 71.4%. Finally, even though five lists are recommended for clinical use, a minute-long screening using only one VRB list detected 98.6% of impaired SRTs.

CONCLUSION

The reference data suggest that VRB testing can be used to identify individuals with speech-in-noise impairment.

Increased reliance on temporal coding when target sound is softer than the background

Everyday environments often contain multiple concurrent sound sources that fluctuate over time. Normally hearing listeners can benefit from high signal-to-noise ratios (SNRs) in energetic dips of temporally fluctuating background sound, a phenomenon called dip-listening. Specialized mechanisms of dip-listening exist across the entire auditory pathway. Both the instantaneous fluctuating and the long-term overall SNR shape dip-listening. An unresolved issue regarding cortical mechanisms of dip-listening is how target perception remains invariant to overall SNR, specifically, across different tone levels with an ongoing fluctuating masker. Equivalent target detection over both positive and negative overall SNRs (SNR invariance) is reliably achieved in highly-trained listeners. Dip-listening is correlated with the ability to resolve temporal fine structure, which involves temporally-varying spike patterns. Thus the current work tests the hypothesis that at negative SNRs, neuronal readout mechanisms need to increasingly rely on decoding strategies based on temporal spike patterns, as opposed to spike count. Recordings from chronically implanted electrode arrays in core auditory cortex of trained and awake Mongolian gerbils that are engaged in a tone detection task in 10 Hz amplitude-modulated background sound reveal that rate-based decoding is not SNR-invariant, whereas temporal coding is informative at both negative and positive SNRs.

Relationships Between Auditory Processing and Cognitive Abilities in Adults: A Systematic Review

PURPOSE

The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, "In adults, what is the relationship between central auditory processing abilities and cognitive abilities?"

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another.

RESULTS

Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated.

CONCLUSIONS

Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24855174.

A Step Toward Precision Audiology: Individual Differences and Characteristic Profiles From Auditory Perceptual and Cognitive Abilities

Older adults with normal hearing or with age-related hearing loss face challenges when listening to speech in noisy environments. To better serve individuals with communication difficulties, precision diagnostics are needed to characterize individuals' auditory perceptual and cognitive abilities beyond pure tone thresholds. These abilities can be heterogenous across individuals within the same population. The goal of the present study is to consider the suprathreshold variability and develop characteristic profiles for older adults with normal hearing (ONH) and with hearing loss (OHL). Auditory perceptual and cognitive abilities were tested on ONH (n = 20) and OHL (n = 20) on an abbreviated test battery using portable automated rapid testing. Using cluster analyses, three main profiles were revealed for each group, showing differences in auditory perceptual and cognitive abilities despite similar audiometric thresholds. Analysis of variance showed that ONH profiles differed in spatial release from masking, speech-in-babble testing, cognition, tone-in-noise, and binaural temporal processing abilities. The OHL profiles differed in spatial release from masking, speech-in-babble testing, cognition, and tolerance to background noise performance. Correlation analyses showed significant relationships between auditory and cognitive abilities in both groups. This study showed that auditory perceptual and cognitive deficits can be present to varying degrees in the presence of audiometrically normal hearing and among listeners with similar degrees of hearing loss. The results of this study inform the need for taking individual differences into consideration and developing targeted intervention options beyond pure tone thresholds and speech testing.

Potential barriers to the daily use of hearing aids in children

OBJECTIVES

To identify factors affecting hearing aid usage in children.

METHODS

This retrospective study examined 59 hearing-impaired children fitted with hearing aids for at least 6 months. Patients with moderate to profound sensorineural hearing loss with complete data-logging information stored in the hearing aid programming file from January 2020 until June 2021 were included. Children with concomitant disabilities were excluded. Data for audiological assessments included hearing assessment, aided hearing thresholds, and aided speech tests.

RESULTS

The children's age ranged from 6 months to 6 years. Average daily hearing aid usage was 5.5 hour (h) after 3 months, 7 h after 6 months; and 8.7± 4.7 h as reported by parents. Patient age was positively correlated with data logging at 3 months (r=0.414, p=0.01) and 6 months (r=0.406, p=0.01).

CONCLUSION

We found that children's age, gender, severity of hearing loss, residential location, and parents' educational level had a significant effect on daily hearing aid usage. Whereas, family size and a family history of hearing loss or use of amplification devices had no discernible influence.

Development of the hearing-related quality of life questionnaire for auditory-visual, cognitive and psychosocial functioning (hAVICOP)

INTRODUCTION

There is a need for a validated and standardized self-assessment instrument to assess the subjective effect of hearing aid (HA) use and/or cochlear implantation (CI) on different aspects of functioning in daily life. The aim of this study was to develop a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life. The new PROM is titled the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP).

METHODS

A conceptual framework was set up and test items were prepared per domain. Preliminary testing involved a semi-structured interview-based assessment in normal-hearing and hearing-impaired adults and an expert panel. For the further psychometric evaluation, a new sample of 15 adult HA users, 20 adult CI users and 20 normal-hearing adults filled in the refined version of the hAVICOP, the Speech, Spatial and Qualities of Hearing Scale, the Nijmegen Cochlear Implant Questionnaire and the TNO-AZL Questionnaire for Adult's Health-Related Quality of Life. Based on these results, a factor analysis was conducted and internal consistency, discriminant validity and concurrent construct validity were determined.

RESULTS

The final version of the hAVICOP consists of three domains for hearing-related quality of life: (1) auditory-visual functioning, (2) cognitive functioning, and (3) psychosocial functioning. A sufficient internal consistency was found, and discriminant validity and concurrent construct validity were good.

CONCLUSIONS

A new PROM to assess hearing-related quality of life was developed, named the hAVICOP. In the future the validity and reliability should be examined further.

A flexible data-driven audiological patient stratification method for deriving auditory profiles

For characterizing the complexity of hearing deficits, it is important to consider different aspects of auditory functioning in addition to the audiogram. For this purpose, extensive test batteries have been developed aiming to cover all relevant aspects as defined by experts or model assumptions. However, as the assessment time of physicians is limited, such test batteries are often not used in clinical practice. Instead, fewer measures are used, which vary across clinics. This study aimed at proposing a flexible data-driven approach for characterizing distinct patient groups (patient stratification into auditory profiles) based on one prototypical database (N = 595) containing audiogram data, loudness scaling, speech tests, and anamnesis questions. To further maintain the applicability of the auditory profiles in clinical routine, we built random forest classification models based on a reduced set of audiological measures which are often available in clinics. Different parameterizations regarding binarization strategy, cross-validation procedure, and evaluation metric were compared to determine the optimum classification model. Our data-driven approach, involving model-based clustering, resulted in a set of 13 patient groups, which serve as auditory profiles. The 13 auditory profiles separate patients within certain ranges across audiological measures and are audiologically plausible. Both a normal hearing profile and profiles with varying extents of hearing impairments are defined. Further, a random forest classification model with a combination of a one-vs.-all and one-vs.-one binarization strategy, 10-fold cross-validation, and the kappa evaluation metric was determined as the optimal model. With the selected model, patients can be classified into 12 of the 13 auditory profiles with adequate precision (mean across profiles = 0.9) and sensitivity (mean across profiles = 0.84). The proposed approach, consequently, allows generating of audiologically plausible and interpretable, data-driven clinical auditory profiles, providing an efficient way of characterizing hearing deficits, while maintaining clinical applicability. The method should by design be applicable to all audiological data sets from clinics or research, and in addition be flexible to summarize information across databases by means of profiles, as well as to expand the approach toward aided measurements, fitting parameters, and further information from databases.

Adopting Change and Incorporating Technological Advancements in Audiology Education, Research, and Clinical Practice

PURPOSE

With the rapid development of new technologies and resources, many avenues exist to adapt and grow as a profession. Embracing change can lead to growth, evolution, and new opportunities. Audiologists have the potential to harness many of these technological advancements to improve patient health care. Adoption and incorporation of these new technologies will likely benefit educational experiences, research methods, clinical practice, and clinical outcomes.

METHOD

This commentary highlights some historical perspectives and accepted practices while illustrating opportunities to embrace new ideas and technologies. We also provide examples of how such adoption may yield positive outcomes. Specifically, we address embracing technology in audiology education, how artificial intelligence may influence patient performance in realistic listening scenarios, the convergence between hearing aids and consumer electronics, and the emergence of audiology telehealth services and their inclusion in clinical practice. Models of change are also discussed and related to audiology.

CONCLUSION

This commentary aims to be a call to action for the entire profession of audiology to consider conscientiously the adoption of useful, evidence-based technological advancements in education, research, and clinical practice.

The Views and Experience of Audiologists Working in Flemish Hearing Aid Centers Concerning Cognition Within Audiological Practice

PURPOSE

This study aimed to get insight into the views and experience of audiologists, employed in Flemish hearing aid centers, concerning cognition within audiological practice.

METHOD

An online 49-item questionnaire was developed and subdivided into five categories: (a) work setting, (b) practical experience regarding hearing aid fitting linked to cognition, (c) knowledge regarding the auditory-cognitive perspective of speech understanding, (d) willingness and guidelines to implement cognitive measures within audiological practice, and (e) demographics. Respondents were surveyed during January and February 2021.

RESULTS

One hundred twenty-nine audiologists working in Flemish hearing aid centers responded to the entire questionnaire and showed a mean work experience of 8.0 years. Results revealed that cognition was taken into account, especially within the anamnesis interview and general communication strategy, whereas only a minority took cognition into account when actually fitting hearing aids. Knowledge and experience did not determine whether or not respondents took cognition into account. A willingness to implement cognitive measures in a time-efficient manner in audiological practice was observed among respondents.

CONCLUSION

Evidence-based guidelines regarding hearing aid fitting based on an individual's auditory-cognitive profile are needed to improve the quality of hearing rehabilitation.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19593388.

Online Reviews of Hearing Aid Acquisition and Use: A Qualitative Thematic Analysis

PURPOSE

Online reviews have become increasingly common for consumers to share their experiences about products and to assist potential consumers with decision making. The current study was aimed to understand the hearing aid user experience from online consumer reviews using qualitative analysis.

METHOD

The study used a qualitative thematic analysis to analyze open text responses from consumers leaving hearing aid reviews on the http://www.HearingTracker.com website. One thousand three hundred seventy-eight online consumer hearing aid reviews (open-text responses) were extracted and analyzed.

RESULTS

Three domains emerged within the data set, containing 11 themes and 136 subthemes. Domain one (Clinical Processes) contained two themes: Hearing Assessment and Hearing Aid Acquisition. Domain two (The Device) contained five themes: Function, Performance, Physical, Device Management, and Maintenance. Domain three (The Person) contained four themes: Satisfaction, Quality of Life, Personal Adjustment, and Knowledge. The themes gave an understanding that there were a contribution of factors that formed part of a consumers hearing aid user experience.

CONCLUSIONS

Hearing aid users described a range of positive, negative, and neutral descriptions online about their hearing aid user experience and gave advice to fellow hearing aid users helping clinicians improve their hearing aid fitting skills in practice. These findings have implications to future product development as well as service delivery model in terms of developing strategies for fostering patient-centered audiological practice.

Hearing Therapy Improves Tinnitus-Related Distress in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss: A Randomized-Controlled Cross-Over Design

BACKGROUND

The psychological effects of hearing aids and auditory training are underinvestigated.

OBJECTIVE

To assess the short- and long-term effects of an industry-developed auditory training on tinnitus-related distress, perceived stress, and psychological epiphenomena in patients with chronic tinnitus and mild-to-moderate hearing loss.

METHOD

One-hundred-seventy-seven gender-stratified patients were randomized to an immediate [IIG] or delayed [DIG] intervention group. Following binaural hearing aid fitting, participants completed a CD-enhanced 14-days self-study program. Applying a randomized-controlled cross-over design, psychological measures were obtained at four times: pre-treatment/wait [IIG: t₁; DIG: wait], post-treatment/pre-treatment [IIG: t₂; DIG: t₁], follow-up/post-treatment [IIG: t₃; DIG: t₂], and follow-up [DIG: t₃]. Between- and within-group analyses investigated treatment-related effects and their stability at a 70-day follow-up.

RESULTS

Overall, distress symptom severity was mild. Unlike the DIG, the IIG showed significant improvements in tinnitus-related distress. Some psychological epiphenomena, notably anxiety, slightly improved in both groups. Within-group analyses demonstrated the stability of the tinnitus-distress-related effects, alongside uncontrolled improvements of perceived stress and mood-related symptoms at follow-up.

CONCLUSIONS

The investigated hearing therapy lastingly improves tinnitus-related distress in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss. Beneficial psychological knock-on effects deserve further investigation.

Adaptation to noise in normal and impaired hearing

Many aspects of hearing function are negatively affected by background noise. Listeners, however, have some ability to adapt to background noise. For instance, the detection of pure tones and the recognition of isolated words embedded in noise can improve gradually as tones and words are delayed a few hundred milliseconds in the noise. While some evidence suggests that adaptation to noise could be mediated by the medial olivocochlear reflex, adaptation can occur for people who do not have a functional reflex. Since adaptation can facilitate hearing in noise, and hearing in noise is often harder for hearing-impaired than for normal-hearing listeners, it is conceivable that adaptation is impaired with hearing loss. It remains unclear, however, if and to what extent this is the case, or whether impaired adaptation contributes to the greater difficulties experienced by hearing-impaired listeners understanding speech in noise. Here, we review adaptation to noise, the mechanisms potentially contributing to this adaptation, and factors that might reduce the ability to adapt to background noise, including cochlear hearing loss, cochlear synaptopathy, aging, and noise exposure. The review highlights few knowns and many unknowns about adaptation to noise, and thus paves the way for further research on this topic.

Anatomical and audiological considerations in branchiootorenal syndrome: A systematic review

Objective

Establish anatomical considerations, audiological outcomes, and optimal management in patients with branchiootic/branchiootorenal syndrome (BO/BOR).

Methods

Databases reviewed: Medline, Pubmed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. Clinical or radiological studies of patients with BOR syndrome describing either the audiological profile or anatomical changes were included. Articles in which BOR syndrome was associated with other syndromes, and those that were focused only on general and genetic aspects of BOR syndrome were excluded. Articles were assessed using Oxford Centre for Evidence‐Based Medicine (OCEBM) grading system and the Brazzelli risk of bias tool for nonrandomized studies.

Results

Searches identified 379 articles. Of these, 64 studies met the inclusion criteria, reporting outcomes in 482 patients from at least 95 families. In 308 patients, hearing loss was categorized as sensorineural (29%), conductive (20%), and mixed (51%). Hearing outcomes were variable in terms of onset, pattern, and severity; ranging from mild to profound deafness. One hundred sixty‐nine patients presented with inner ear anomalies, 145 had middle, and 151 had external ear abnormalities. In 44 studies, 58 ear operations were described. Mixed outcomes were reported in patients managed with hearing aids or middle ear surgery; however, successful cochlear implantation was described in all five cases.

Conclusion

The anatomical and audiological profiles of patients with BO/BOR are variable. A range of surgical procedures were described, however lacked objective outcome measures. Given the range of anatomical variants, management decisions should be made on an individual basis including full audiological and radiological assessment.

Level of evidence

NA.

Feasibility of hearing aid gain self-adjustment using speech recognition

Personal hearing devices, such as hearing aids, may be fine-tuned by allowing the users to conduct self-adjustment. Two self-adjustment procedures were developed to collect the listener preferred gains in six octave-frequency bands from 0.25 kHz to 8 kHz. These procedures were designed to allow rapid exploration of a multi-dimensional parameter space using a simple, one-dimensional user control interface (i.e., a programmable knob). The two procedures differ in whether the user interface controls the gains in all frequency bands simultaneously (Procedure A) or only the gain in one frequency band (Procedure B) on a given trial. Monte-Carlo simulations suggested that for both procedures the gain preference identified by simulated listeners rapidly converged to the ground-truth preferred gain profile over the first 20 trials. Initial behavioral evaluations of the self-adjustment procedures, in terms of test-retest reliability, were conducted using 20 young, normal-hearing listeners. Each estimate of the preferred gain profile took less than 20 minutes. The deviation between two separate estimates of the preferred gain profile, conducted at least a week apart, was about 10 dB ~ 15 dB.

Revisiting Auditory Profiling: Can Cognitive Factors Improve the Prediction of Aided Speech-in-Noise Outcome?

Hearing aids (HA) are the most common type of rehabilitation treatment for age-related hearing loss. However, HA users often obtain limited benefit from their devices, particularly in noisy environments, and thus many HA candidates do not use them at all. A possible reason for this could be that current HA fittings are audiogram-based, that is, they neglect supra-threshold factors. In an earlier study, an auditory-profiling method was proposed as a basis for more personalized HA fittings. This method classifies HA users into four profiles that differ in terms of hearing sensitivity and supra-threshold hearing abilities. Previously, HA users belonging to these profiles showed significant differences in terms of speech recognition in noise but not subjective assessments of speech-in-noise (SIN) outcome. Moreover, large individual differences within some profiles were observed. The current study therefore explored if cognitive factors can help explain these differences and improve aided outcome prediction. Thirty-nine older HA users completed sets of auditory and SIN tests as well as two tablet-based cognitive measures (the Corsi block-tapping and trail-making tests). Principal component analyses were applied to extract the dominant sources of variance both within individual tests producing many variables and within the three types of tests. Multiple linear regression analyses performed on the extracted components showed that auditory factors were related to aided speech recognition in noise but not to subjective SIN outcome. Cognitive factors were unrelated to aided SIN outcome. Overall, these findings provide limited support for adding those two cognitive tests to the profiling of HA users.

Experienced hearing aid users' perspectives of assessment and communication within audiology: a qualitative study using digital methods

OBJECTIVE

To explore experienced hearing aid users' perspectives of audiological assessments and the patient-audiologist communication dynamic during clinical interactions.

DESIGN

A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice.

STUDY SAMPLES

Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 - 86 years; 9 males, 11 females).

RESULTS

Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology.

CONCLUSION

To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users' value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient-audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

Effects of demographic, audiologic, and hearing-aid-related variables on the outcomes of using hearing aids

PURPOSE

To examine the influence of demographic, audiologic, and hearing-aid (HA)-related variables on HA outcomes.

METHODS

In total, 235 adults with hearing loss (HL) who used HAs for at least 3 months were included in the study, and completed audiologic tests and the Chinese version of the International Outcome Inventory for Hearing Aids (IOI-HA). Spearman correlation analysis and Wilcoxon test were conducted to identify factors related to IOI-HA overall and subscales scores. Stepwise multiple linear regression analysis was subsequently performed to determine the influence of factors on HA outcomes.

RESULTS

Age, daily use time, HA price, pure tone average (PTA) threshold, word recognition score (WRS), fitting (bilateral or unilateral), and HA style were associated with IOI-HA overall and subscales scores. However, only WRS, daily HA use time, HA price, and age entered the final regression model and were factors determining HA outcomes.

CONCLUSIONS

HA outcome is a multi-dimensional construct. In this study, WRS had the greatest influence on HA outcomes and seemed to be a primary predictor. Thus, HA owners with a higher WRS before HA fitting may indicate better satisfaction. Daily use time, HA price, and patient age also made significant contributions to HA outcomes and should be considered in clinical practice to facilitate auditory rehabilitation.

Hearing Aid Consumer Reviews: A Linguistic Analysis in Relation to Benefit and Satisfaction Ratings

Purpose Online reviews have been used by hearing aid owners to share their experiences and to provide suggestions to potential hearing aid buyers, although they have not been systematically examined. The study was aimed at examining the hearing aid consumer reviews using automated linguistic analysis, and how the linguistic variables relate to self-reported hearing aid benefit and satisfaction ratings. Method The study used a cross-sectional design. One thousand three hundred seventy-eight consumer hearing aid reviews (i.e., text response to open-ended question), self-reported benefit and satisfaction ratings on hearing aids in a 5-point scale with meta-data (e.g., hearing aid brand, technology level) extracted from the Hearing Tracker website were analyzed using automated text analysis method known as the Linguistic Inquiry and Word Count. Results Self-reported hearing aid benefit and satisfaction ratings were high (i.e., mean rating of 4.04 in a 5-point scale). Examining the association between overall rating and the key linguistic variables point to two broad findings. First, the more people were personally, socially, and emotionally engaged with the hearing device experience, the higher they rated their hearing device(s). Second, a minimal occurrence of clinic-visit language dimensions points to factors that likely affect benefit and satisfaction ratings. For example, if people mention paying too much money (money), their overall ratings are generally lower. Conversely, if people write about their health or home, the ratings were higher. There was no significant difference in linguistic analysis across different hearing aid brands and technology levels. Conclusions Hearing aid consumers are generally satisfied with their hearing device(s), and their online reviews contain information about social/emotional dimensions as well as clinic-visit related aspects that have bearing toward hearing aid benefit and satisfaction ratings. These results suggest that the natural language used by consumers provide insights on their perceived benefit/satisfaction from their hearing device.

Temporal integration of monaural and dichotic frequency modulation

Frequency modulation (FM) detection at low modulation frequencies is commonly used as an index of temporal fine-structure processing. The present study evaluated the rate of improvement in monaural and dichotic FM across a range of test parameters. In experiment I, dichotic and monaural FM detection was measured as a function of duration and modulator starting phase. Dichotic FM thresholds were lower than monaural FM thresholds and the modulator starting phase had no effect on detection. Experiment II measured monaural FM detection for signals that differed in modulation rate and duration such that the improvement with duration in seconds (carrier) or cycles (modulator) was compared. Monaural FM detection improved monotonically with the number of modulation cycles, suggesting that the modulator is extracted prior to detection. Experiment III measured dichotic FM detection for shorter signal durations to test the hypothesis that dichotic FM relies primarily on the signal onset. The rate of improvement decreased as duration increased, which is consistent with the use of primarily onset cues for the detection of dichotic FM. These results establish that improvement with duration occurs as a function of the modulation cycles at a rate consistent with the independent-samples model for monaural FM, but later cycles contribute less to detection in dichotic FM.

Temporal fine structure: associations with cognition and speech-in-noise recognition in adults with normal hearing or hearing impairment

OBJECTIVES

To investigate associations between sensitivity to temporal fine structure (TFS) and performance in cognitive and speech-in-noise recognition tests.

DESIGN

A binaural test of TFS sensitivity (the TFS-LF) was used. Measures of cognition included the reading span, Raven's, and text-reception threshold tests. Measures of speech recognition included the Hearing in noise (HINT) and the Hagerman matrix sentence tests in three signal processing conditions.

STUDY SAMPLE

Analyses are based on the performance of 324/317 adults with and without hearing impairment.

RESULTS

Sensitivity to TFS was significantly correlated with both the reading span test and the recognition of speech-in-noise processed using noise reduction, the latter only when limited to participants with hearing impairment. Neither association was significant when the effects of age were partialled out.

CONCLUSIONS

The findings are consistent with previous research in finding no evidence of a link between sensitivity to TFS and working memory once the effects of age had been partialled out. The results provide some evidence of an influence of signal processing strategy on the association between TFS sensitivity and speech-in-noise recognition. However, further research is necessary to assess the generalisability of the findings before any claims can be made regarding any clinical implications of these findings.

Comparison of Behavioral and Physiological Measures of the Status of the Cochlear Nonlinearity

While an audiogram is a useful method of characterizing hearing loss, it has been suggested that including a complementary, suprathreshold measure, for example, a measure of the status of the cochlear active mechanism, could lead to improved diagnostics and improved hearing-aid fitting in individual listeners. While several behavioral and physiological methods have been proposed to measure the cochlear-nonlinearity characteristics, evidence of a good correspondence between them is lacking, at least in the case of hearing-impaired listeners. If this lack of correspondence is due to, for example, limited reliability of one of such measures, it might be a reason for limited evidence of the benefit of measuring peripheral compression. The aim of this study was to investigate the relation between measures of the peripheral-nonlinearity status estimated using two psychoacoustical methods (based on the notched-noise and temporal-masking curve methods) and otoacoustic emissions, on a large sample of hearing-impaired listeners. While the relation between the estimates from the notched-noise and the otoacoustic emissions experiments was found to be stronger than predicted by the audiogram alone, the relations between the two measures and the temporal-masking based measure did not show the same pattern, that is, the variance shared by any of the two measures with the temporal-masking curve-based measure was also shared with the audiogram.

Influence of Three Auditory Profiles on Aided Speech Perception in Different Noise Scenarios

Hearing aid (HA) users differ greatly in their speech-in-noise (SIN) outcomes. This could be because the degree to which current HA fittings can address individual listening needs differs across users and listening situations. In two earlier studies, an auditory test battery and a data-driven method were developed for classifying HA candidates into four distinct auditory profiles differing in audiometric hearing loss and suprathreshold hearing abilities. This study explored aided SIN outcome for three of these profiles in different noise scenarios. Thirty-one older habitual HA users and six young normal-hearing listeners participated. Two SIN tasks were administered: a speech recognition task and a “just follow conversation” task requiring the participants to self-adjust the target-speech level. Three noise conditions were tested: stationary speech-shaped noise, speech-shaped babble noise, and speech-shaped babble noise with competing dialogues. Each HA user was fitted with three HAs from different manufacturers using their recommended procedures. Real-ear measurements were performed to document the final gain settings. The results showed that HA users with mild hearing deficits performed better than HA users with pronounced hearing deficits on the speech recognition task but not the just follow conversation task. Moreover, participants with pronounced hearing deficits obtained different SIN outcomes with the tested HAs, which appeared to be related to differences in HA gain. Overall, these findings imply that current proprietary fitting strategies are limited in their ability to ensure good SIN outcomes, especially for users with pronounced hearing deficits, for whom the choice of device seems most consequential.

Trends in COSI responses associated with age and degree of hearing loss

OBJECTIVE

To investigate the relationships between age, gender, hearing loss and hearing asymmetry with reported hearing difficulties and perceived benefit from hearing aids.

DESIGN

A retrospective service evaluation of patients' COSI responses.

STUDY SAMPLE

A non-sampled population (n = 995) attending audiology over two months.

RESULTS

Clear trends were observed between hearing difficulties, age and hearing loss. A direct logistic regression model suggested that increasing age was the predominant cause of the most common hearing problems. Gender and hearing asymmetry had no significant effect on the difficulties reported. Hearing aids were effective for the most commonly reported problems. There were no significant associations between hearing aid benefit and age or degree of hearing loss. Patients with a mild hearing loss perceived at least equal benefit from hearing aids compared to those with greater degrees of loss.

CONCLUSIONS

The study demonstrated an effect of age on reported hearing problems over and above that expected due to peripheral hearing impairment, which may be a sign of wider auditory system decline. Elderly patients form the majority of the audiology patient population and their treatment requires more complex consideration than is suggested solely by the audiogram, irrespective of degree of hearing loss.

Hearing aid acquisition and ownership: what can we learn from online consumer reviews?

OBJECTIVE

To explore the publicised opinions of consumers actively participating in online hearing aid reviews.

DESIGN

A retrospective design examining data generated from an online consumer review website (www.HearingTracker.com). Qualitative data (open text responses) were analysed using the open source automated topic modelling software IRaMuTeQ (http://www.iramuteq.org/) to identify themes. Outputs were compared with quantitative data from the consumer reviews (short response questions exploring hearing aid performance and benefit, and some meta-data such as hearing aid brand and years of hearing aid ownership).

STUDY SAMPLE

1378 online consumer hearing aid reviews.

RESULTS

Six clusters within two domains were identified. The domain Device Acquisition included three clusters: Finding the right provider, device and price-point; Selecting a hearing aid to suit the hearing loss; Attaining physical fit and device management skills. The domain Device Use included three clusters: Smartphone streaming to hearing aids; Hearing aid adjustment using smartphone; and Hearing in noise.

CONCLUSIONS

Although online hearing aid consumers indicate positive performance on multiple-choice questions relating to hearing aid performance and benefit, their online reviews describe a number of barriers limiting their success. Hearing healthcare clinicians must employ a personalised approach to audiological rehabilitation to ensure individual clients' needs are met.

Inference of the distortion component of hearing impairment from speech recognition by predicting the effect of the attenuation component

OBJECTIVE

A model-based determination of the average supra-threshold ("distortion") component of hearing impairment which limits the benefit of hearing aid amplification.

DESIGN

Published speech recognition thresholds (SRTs) were predicted with the framework for auditory discrimination experiments (FADE), which simulates recognition processes, the speech intelligibility index (SII), which exploits frequency-dependent signal-to-noise ratios (SNR), and a modified SII with a hearing-loss-dependent band importance function (PAV). Their attenuation-component-based prediction errors were interpreted as estimates of the distortion component.

STUDY SAMPLE

Unaided SRTs of 315 hearing-impaired ears measured with the German matrix sentence test in stationary noise.

RESULTS

Overall, the models showed root-mean-square errors (RMSEs) of 7 dB, but for steeply sloping hearing loss FADE and PAV were more accurate (RMSE = 9 dB) than the SII (RMSE = 23 dB). Prediction errors of FADE and PAV increased linearly with the average hearing loss. The consideration of the distortion component estimate significantly improved the accuracy of FADE's and PAV's predictions.

CONCLUSIONS

The supra-threshold distortion component-estimated by prediction errors of FADE and PAV-seems to increase with the average hearing loss. Accounting for a distortion component improves the model predictions and implies a need for effective compensation strategies for supra-threshold processing deficits with increasing audibility loss.

The Effect of Cognition on the Aided Benefit in Terms of Speech Understanding and Listening Effort Obtained With Digital Hearing Aids: A Systematic Review

Purpose Hearing aids are the primary rehabilitation devices used to compensate for presbycusis, though large intersubject variability in hearing aid benefit has been reported. This systematic review aimed to investigate how intersubject differences in cognition could influence the aided benefit for speech understanding and listening effort with bilateral digital hearing aids. Method Articles were selected through systematic searches in MEDLINE, Embase, Central, and reference lists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results The initial search resulted in 1,092 unique hits, of which 16 were included. The effect of cognition on the aided benefit in terms of speech understanding and listening effort was examined in 12 and four studies, respectively. The aided speech and listening effort benefit obtained from hearing aid use in general or from a specific digital feature (i.e., microphone directionality, noise reduction, amplitude compression, and frequency compression) was associated with four cognitive functions (i.e., working memory, processing speed, selective attention, and executive functions). Conclusions Hearing aid users with poorer cognitive functioning derived more aided benefit in terms of speech understanding from hearing aid settings facilitating the matching process between the incoming auditory signal and representations stored in long-term memory. However, since the number of included studies was limited, this trend should be interpreted with caution. Supplemental Material https://doi.org/10.23641/asha.13626509.

Contributions of Age-Related and Audibility-Related Deficits to Aided Consonant Identification in Presbycusis: A Causal-Inference Analysis

The decline of speech intelligibility in presbycusis can be regarded as resulting from the combined contribution of two main groups of factors: (1) audibility-related factors and (2) age-related factors. In particular, there is now an abundant scientific literature on the crucial role of suprathreshold auditory abilities and cognitive functions, which have been found to decline with age even in the absence of audiometric hearing loss. However, researchers investigating the direct effect of aging in presbycusis have to deal with the methodological issue that age and peripheral hearing loss covary to a large extent. In the present study, we analyzed a dataset of consonant-identification scores measured in quiet and in noise for a large cohort (n = 459, age = 42-92) of hearing-impaired (HI) and normal-hearing (NH) listeners. HI listeners were provided with a frequency-dependent amplification adjusted to their audiometric profile. Their scores in the two conditions were predicted from their pure-tone average (PTA) and age, as well as from their Extended Speech Intelligibility Index (ESII), a measure of the impact of audibility loss on speech intelligibility. We relied on a causal-inference approach combined with Bayesian modeling to disentangle the direct causal effects of age and audibility on intelligibility from the indirect effect of age on hearing loss. The analysis revealed that the direct effect of PTA on HI intelligibility scores was 5 times higher than the effect of age. This overwhelming effect of PTA was not due to a residual audibility loss despite amplification, as confirmed by a ESII-based model. More plausibly, the marginal role of age could be a consequence of the relatively little cognitively-demanding task used in this study. Furthermore, the amount of variance in intelligibility scores was smaller for NH than HI listeners, even after accounting for age and audibility, reflecting the presence of additional suprathreshold deficits in the latter group. Although the non-sense-syllable materials and the particular amplification settings used in this study potentially restrict the generalization of the findings, we think that these promising results call for a wider use of causal-inference analysis in audiology, e.g., as a way to disentangle the influence of the various cognitive factors and suprathreshold deficits associated to presbycusis.

Evaluation of the efficacy of hearing aids in older adults: a multiparametric longitudinal study protocol

Background

Prevalence of hearing loss increases with age. Its estimated prevalence is 40–50 % in people over 75 years of age. Recent studies agree that declinein hearing threshold contribute to deterioration in sociality, sensitivity, cognition, and quality of life for elderly subjects.

The aim of the study presented in this paper is to verify whether or not rehabilitation using first time applied Hearing Aids (HA) in a cohort of old people with hearing impairment improves both speech perception in a noisy environment over time and the overall health-related quality of life.

Methods

The monocentric, prospective, repeated measurements, single-subject, clinical observational study is to recruit 100 older adults, first-time HA recipients (≥ 65 years).The evaluation protocol is designed to analyze changes in specific measurement tools a year after the first HA usage in comparison with the evaluation before HA fitting.

Evaluations will consist of multiparametric details collected through self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in speech perception in noise to be used is the Italian version of Oldenburg Satz (OLSA) test whereas the indicator of changes in overall quality of life will be the Assessment of Quality of Life (AQoL) and Hearing Handicap Inventory for the Elderly (HHIE) questionnaires. The Montreal Cognitive Assessment (MoCA) will help in screening the cognitive state of the subjects.

Discussion

The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare the effects of HA rehabilitation in the older adults immediately before first HA usage (Pre) and after 1 year of experience (Post). This broad approach will lead to a greater understanding of how useful hearing influences the quality of life in older individuals, and therefore improves potentials for healthy aging. The data is to be analyzed by using an intrasubject endpoint comparison. Outcomes will be described and analyzed in detail.

Trial registration

This research was retrospectively registered underno. NCT04333043at ClinicalTrials.gov (http://www.clinicaltrials.gov/) on the 26 March 2020. This research has been registered with the Ethics Committee of the Area Vasta Emilia Nord under number 104, date of approval 17/07/2017.

Investigating the Effects of Four Auditory Profiles on Speech Recognition, Overall Quality, and Noise Annoyance With Simulated Hearing-Aid Processing Strategies

Effective hearing aid (HA) rehabilitation requires personalization of the HA fitting parameters, but in current clinical practice only the gain prescription is typically individualized. To optimize the fitting process, advanced HA settings such as noise reduction and microphone directionality can also be tailored to individual hearing deficits. In two earlier studies, an auditory test battery and a data-driven approach that allow classifying hearing-impaired listeners into four auditory profiles were developed. Because these profiles were found to be characterized by markedly different hearing abilities, it was hypothesized that more tailored HA fittings would lead to better outcomes for such listeners. Here, we explored potential interactions between the four auditory profiles and HA outcome as assessed with three different measures (speech recognition, overall quality, and noise annoyance) and six HA processing strategies with various noise reduction, directionality, and compression settings. Using virtual acoustics, a realistic speech-in-noise environment was simulated. The stimuli were generated using a HA simulator and presented to 49 habitual HA users who had previously been profiled. The four auditory profiles differed clearly in terms of their mean aided speech reception thresholds, thereby implying different needs in terms of signal-to-noise ratio improvement. However, no clear interactions with the tested HA processing strategies were found. Overall, these findings suggest that the auditory profiles can capture some of the individual differences in HA processing needs and that further research is required to identify suitable HA solutions for them.

The role of cochlear place coding in the perception of frequency modulation

Natural sounds convey information via frequency and amplitude modulations (FM and AM). Humans are acutely sensitive to the slow rates of FM that are crucial for speech and music. This sensitivity has long been thought to rely on precise stimulus-driven auditory-nerve spike timing (time code), whereas a coarser code, based on variations in the cochlear place of stimulation (place code), represents faster FM rates. We tested this theory in listeners with normal and impaired hearing, spanning a wide range of place-coding fidelity. Contrary to predictions, sensitivity to both slow and fast FM correlated with place-coding fidelity. We also used incoherent AM on two carriers to simulate place coding of FM and observed poorer sensitivity at high carrier frequencies and fast rates, two properties of FM detection previously ascribed to the limits of time coding. The results suggest a unitary place-based neural code for FM across all rates and carrier frequencies.

Analysis of data from the International Outcome Inventory for Hearing Aids (IOI-HA) using Bayesian Item Response Theory

OBJECTIVE

IOI-HA response data are conventionally analysed assuming that the ordinal responses have interval-scale properties. This study critically considers this assumption and compares the conventional approach with a method using Item Response Theory (IRT).

DESIGN

A Bayesian IRT analysis model was implemented and applied to several IOI-HA data sets.

STUDY SAMPLE

Anonymised IOI-HA responses from 13273 adult users of one or two hearing aids in 11 data sets using the Australian English, Dutch, German and Swedish versions of the IOI-HA.

RESULTS

The raw ordinal responses to IOI-HA items do not represent values on interval scales. Using the conventional rating sum as an overall score introduces a scale error corresponding to about 10 - 15% of the true standard deviation in the population. Some interesting and statistically credible differences were demonstrated among the included data sets.

CONCLUSIONS

It is questionable to apply conventional statistical measures like mean, variance, t-tests, etc., on the raw IOI-HA ratings. It is recommended to apply only nonparametric statistical test methods for comparisons of IOI-HA results between groups. The scale error can sometimes cause incorrect conclusions when individual results are compared. The IRT approach is recommended for analysis of individual results.

The effects of task difficulty, background noise and noise reduction on recall

OBJECTIVE

In the present study, we investigated whether varying the task difficulty of the Sentence-Final Word Identification and Recall (SWIR) Test has an effect on the benefit of noise reduction, as well as whether task difficulty predictability affects recall. The relationship between working memory and recall was examined.

DESIGN

Task difficulty was manipulated by varying the list length with noise reduction on and off in competing speech and speech-shaped noise. Half of the participants were informed about list length in advance. Working memory capacity was measured using the Reading Span.

STUDY SAMPLE

Thirty-two experienced hearing aid users with moderate sensorineural hearing loss.

RESULTS

Task difficulty did not affect the noise reduction benefit and task difficulty predictability did not affect recall. Participants may have employed a different recall strategy when task difficulty was unpredictable and noise reduction off. Reading Span scores positively correlated with the SWIR test. Noise reduction improved recall in competing speech.

CONCLUSIONS

The SWIR test with varying list length is suitable for detecting the benefit of noise reduction. The correlation with working memory suggests that the SWIR test could be modified to be adaptive to individual cognitive capacity. The results on noise and noise reduction replicate previous findings.

Hearing aids are still beneficial to patients, even if they have a low speech discrimination

PURPOSE

A speech discrimination score (SDS) is a predictor for the successful use of hearing aids (HAs). This study is to evaluate the efficacy of HAs in patients with a low or poor SDS.

METHODS

We enrolled 186 ears using HAs, with an unaided SDS ≤ 64%. They were categorized into four groups by their unaided SDS: 0-16% for Group 1, 20-32% for Group 2, 36-48% for Group 3, and 52-64% for Group 4. Aided SDS was measured 1, 3, 6, and 12 months after the use. The Hearing In Noise Test (HINT), the Hearing Handicap Inventory for the Elderly (HHIE), and the International Outcome Inventory for Hearing Aids (IOI-HA) were assessed.

RESULTS

The SDS increased by 27.4% (12.0 to 39.4%) in Group 1, 26.4% (26.9 to 53.3%) in Group 2, 24.6% (42.2 to 66.8%) in Group 3, and 10.5% (59.5% to 70.0%) in Group 4. HINT composite scores significantly decreased from 22.5 to 15.1 in Group 1, 9.4 to 7.0 in Group 2, and 4.4 to 2.4 in Group 4. Total HHIE score changed from 48.2 to 24.2 in Group 1, 64.0 to 32.8 in Group 2, 37.1 to 16.6 in Group 3, and 55.8 to 40.1 in Group 4 (P < 0.05 in Groups 2, 3, and 4).

CONCLUSION

In patients with a low SDS, a significant increase in SDS was achieved after the use of HAs, and subjective satisfaction was also acceptable. Low SDS might not be a contraindication for HAs.

Bottom-up and top-down neural signatures of disordered multi-talker speech perception in adults with normal hearing

In social settings, speech waveforms from nearby speakers mix together in our ear canals. Normally, the brain unmixes the attended speech stream from the chorus of background speakers using a combination of fast temporal processing and cognitive active listening mechanisms. Of >100,000 patient records,~10% of adults visited our clinic because of reduced hearing, only to learn that their hearing was clinically normal and should not cause communication difficulties. We found that multi-talker speech intelligibility thresholds varied widely in normal hearing adults, but could be predicted from neural phase-locking to frequency modulation (FM) cues measured with ear canal EEG recordings. Combining neural temporal fine structure processing, pupil-indexed listening effort, and behavioral FM thresholds accounted for 78% of the variability in multi-talker speech intelligibility. The disordered bottom-up and top-down markers of poor multi-talker speech perception identified here could inform the design of next-generation clinical tests for hidden hearing disorders.

Predicting Speech Perception in Older Listeners with Sensorineural Hearing Loss Using Automatic Speech Recognition

The objective of this study was to provide proof of concept that the speech intelligibility in quiet of unaided older hearing-impaired (OHI) listeners can be predicted by automatic speech recognition (ASR). Twenty-four OHI listeners completed three speech-identification tasks using speech materials of varying linguistic complexity and predictability (i.e., logatoms, words, and sentences). An ASR system was first trained on different speech materials and then used to recognize the same speech stimuli presented to the listeners but processed to mimic some of the perceptual consequences of age-related hearing loss experienced by each of the listeners: the elevation of hearing thresholds (by linear filtering), the loss of frequency selectivity (by spectrally smearing), and loudness recruitment (by raising the amplitude envelope to a power). Independently of the size of the lexicon used in the ASR system, strong to very strong correlations were observed between human and machine intelligibility scores. However, large root-mean-square errors (RMSEs) were observed for all conditions. The simulation of frequency selectivity loss had a negative impact on the strength of the correlation and the RMSE. Highest correlations and smallest RMSEs were found for logatoms, suggesting that the prediction system reflects mostly the functioning of the peripheral part of the auditory system. In the case of sentences, the prediction of human intelligibility was significantly improved by taking into account cognitive performance. This study demonstrates for the first time that ASR, even when trained on intact independent speech material, can be used to estimate trends in speech intelligibility of OHI listeners.

Challenges and Strengths of Multidisciplinary Research in Audiology: The EVOTION Example

Purpose The EU-funded research project EVOTION has brought together clinical, technical, and public health experts with the aim to offer a solution for the holistic management of hearing loss. This report presents the challenges, strengths, and key take-home messages of working in this multidisciplinary consortium. Method Fifteen consortium members completed an online survey with 6 open-ended questions. Responses were analyzed using a thematic approach. Results Analysis identified 4 main themes: (a) communication, that is, cross-disciplinary communication difficulties but also range of expertise; (b) opportunities, that is, innovation, learning, and collaborations; (c) technology, that is, technical requirements and data collection and management issues; and (d) local constraints, that is, institutional limitations, resources, and planning. Conclusions Although the challenges reported differed by country and specialty, there was consensus about the value, expertise, and opportunities of the project. It is recommended that in future similar multidisciplinary projects in audiology, researchers establish a common language and assess technical requirements and local constraints prior to initiating research activities.

Retracted Article: Temporal fine structure: relations to cognition and aided speech recognition

Retraction statementWe, the Editor and Publisher of the International Journal of Audiology, have retracted the following article.Rachel J. Ellis, and Jerker Rönnberg. 2019. "Temporal fine structure: relations to cognition and aided speech recognition." International Journal of Audiology. doi:10.1080/14992027.2019.1672899.The authors of the above-mentioned article published in the International Journal of Audiology have identified errors in the reported analysis (relating to the inclusion of data that should have been excluded) which impact the validity of the findings. The authors have, therefore, requested that the article be retracted.We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as "Retracted".

Speech predictability can hinder communication in difficult listening conditions

In difficult listening situations, such as in noisy environments, one would expect speech intelligibility to improve over time thanks to noise adaptation and/or to speech predictability facilitating the recognition of upcoming words. We tested this possibility by presenting normal-hearing human listeners (N = 100; 70 women) with sentences and measuring word recognition as a function of word position in a sentence. Sentences were presented in quiet and in competition with various masker sounds at individualized levels where listeners had 50% probability of recognizing a full sentence. Contrary to expectations, recognition was best for the first word and gradually deteriorated with increasing word position along the sentence. The worsening in recognition was unlikely due to differences in word audibility or word type and was uncorrelated with age or working memory capacity. Using a probabilistic model of word recognition, we show that the worsening effect probably occurs because misunderstandings generate inaccurate predictions that outweigh the benefits from accurate predictions. Analyses also revealed that predictions overruled the potential benefits from noise adaptation. We conclude that although speech predictability can facilitate sentence recognition, it can also result in declines in word recognition as the sentence unfolds because of inaccuracies in prediction.

A Comparison of Behavioral Methods for Indexing the Auditory Processing of Temporal Fine Structure Cues

Purpose Growing evidence supports the inclusion of perceptual tests that quantify the processing of temporal fine structure (TFS) in clinical hearing assessment. Many tasks have been used to evaluate TFS in the laboratory that vary greatly in the stimuli used and whether the judgments require monaural or binaural comparisons of TFS. The purpose of this study was to compare laboratory measures of TFS for inclusion in a battery of suprathreshold auditory tests. A subset of available TFS tasks were selected on the basis of potential clinical utility and were evaluated using metrics that focus on characteristics important for clinical use. Method TFS measures were implemented in replication of studies that demonstrated clinical utility. Monaural, diotic, and dichotic measures were evaluated in 11 young listeners with normal hearing. Measures included frequency modulation (FM) tasks, harmonic frequency shift detection, interaural phase difference (TFS-low frequency), interaural time difference (ITD), monaural gap duration discrimination, and tone detection in noise with and without a difference in interaural phase (N0S0, N0Sπ). Data were compared with published results and evaluated with metrics of consistency and efficiency. Results Thresholds obtained were consistent with published data. There was no evidence of predictive relationships among the measures consistent with a homogenous group. The most stable tasks across repeated testing were TFS-low frequency, diotic and dichotic FM, and N0Sπ. Monaural and diotic FM had the lowest normalized variance and were the most efficient accounting for differences in total test duration, followed by ITD. Conclusions Despite a long stimulus duration, FM tasks dominated comparisons of consistency and efficiency. Small differences separated the dichotic tasks FM, ITD, and N0Sπ. Future comparisons following procedural optimization of the tasks will evaluate clinical efficiency in populations with impairment.

Benefit of hearing aid use in the elderly: the impact of age, cognition and hearing impairment

This study describes the benefits of hearing aid (HA) use in a sample of elderly experienced HA users (n = 102, mean age 81.1 years), investigating the role of the age, hearing impairment and cognitive function. The benefit was assessed in aided condition by measuring audiometric outcomes (aided thresholds and speech reception in quiet and in noise) and self-assessed outcomes addressing the disability and the handicap domains of auditory dysfunction. Several cognitive abilities were assessed, including short-term memory, working memory and executive functions. To discover potential latent factors and assess which factors significantly influenced the benefit of HA use, age, hearing impairment, cognitive function, audiometric and self-assessed outcomes were examined with multivariate analysis, followed by correlation and regression analysis. The analysis revealed a significant improvement in aided audiometric outcomes and a decrease in the perceived disability and handicap in the sample population. Multivariate, correlation and regression analyses showed that better aided audiometric outcomes were significantly associated with hearing impairment of lower degree and higher cognitive abilities. Moreover, self-assessed outcomes were significantly associated with audiometric outcomes and hearing impairment: subjects with better audiometric outcomes and lower hearing impairment tend to perceive more benefit in using their HAs. Cognition was only indirectly associated with self-assessed outcomes through its direct correlation with aided audiometric outcomes, meaning that the perceived subjective benefit with HA was not directly associated with better cognitive abilities.

The Association Between the Processing of Binaural Temporal-Fine-Structure Information and Audiometric Threshold and Age: A Meta-Analysis

The ability to process binaural temporal fine structure (TFS) information, which influences the perception of speech in spatially distributed soundscapes, declines with increasing hearing loss and age. Because of the relatively small sample sizes used in previous studies, and the population-unrepresentative distribution of hearing loss and ages within study samples, it has been difficult to determine the relative and combined contributions of hearing loss and age. The aim of this study was to survey published and unpublished studies that assessed binaural TFS sensitivity using the TFS-low frequency (LF) test. Results from 19 studies were collated, yielding sample sizes of 147 to 648, depending on the test frequency. At least for the test frequency of 500 Hz, there were at least 67 listeners in each of four adult age groups and the distribution of audiometric thresholds at the test frequency within each group was similar to that for the population as a whole. Binaural TFS sensitivity declined with increasing age across the adult lifespan and with increasing hearing loss in old adulthood. For all test frequencies, both audiometric threshold and age were significantly negatively correlated with TFS-LF sensitivity (r ranging from −0.19 to −0.64) but the correlation was always significantly higher for age than for audiometric threshold. Regression analyses showed that the standardized regression coefficient was greater for age than for audiometric threshold, and that there was a significant interaction; the effect of increasing age among older listeners was greater when the hearing loss was ≥30 dB than when it was < 30 dB.

Age-Related Differences in the Effects of Masker Cuing on Releasing Chinese Speech From Informational Masking

The aims of the present study were to examine whether familiarity with a masker improves word recognition in speech masking situations and whether there are age-related differences in the effects of masker cuing. Thirty-two older listeners (range = 59–74; mean age = 66.41 years) with high-frequency hearing loss and 32 younger normal-hearing listeners (range = 21–28; mean age = 23.73) participated in this study, all of whom spoke Chinese as their first language. Two experiments were conducted and 16 younger and 16 older listeners were used in each experiment. The masking speech with different content from target speech with syntactically correct but semantically meaningless was a continuous recording of meaningless Chinese sentences spoken by two talkers. The masker level was adjusted to produce signal-to-masker ratios of -12, -8, -4, and 0 dB for the younger participants and -8, -4, 0, and 4 dB for the older participants. Under masker-priming conditions, a priming sentence, spoken by the masker talkers, was presented in quiet three times before a target sentence was presented together with a masker sentence 4 s later. In Experiment 1, using same-sentence masker-priming (identical to the masker sentence), the masker-priming improved the identification of the target sentence for both age groups compared to when no priming was provided. However, the amount of masking release was less in the older adults than in the younger adults. In Experiment 2, two kinds of primes were considered: same-sentence masker-priming, and different-sentence masker-priming (different from the masker sentence in content for each keyword). The results of Experiment 2 showed that both kinds of primes improved the identification of the targets for both age groups. However, the release from speech masking in both priming conditions was less in the older adults than in the younger adults, and the release from speech masking in both age groups was greater with same-sentence masker-priming than with different-sentence masker-priming. These results suggest that both the voice and content cues of a masker could be used to release target speech from maskers in noisy listening conditions. Furthermore, there was an age-related decline in masker-priming-induced release from speech masking.

Adaptation to Noise in Human Speech Recognition Unrelated to the Medial Olivocochlear Reflex

Sensory systems constantly adapt their responses to the current environment. In hearing, adaptation may facilitate communication in noisy settings, a benefit frequently (but controversially) attributed to the medial olivocochlear reflex (MOCR) enhancing the neural representation of speech. Here, we show that human listeners (N = 14; five male) recognize more words presented monaurally in ipsilateral, contralateral, and bilateral noise when they are given some time to adapt to the noise. This finding challenges models and theories that claim that speech intelligibility in noise is invariant over time. In addition, we show that this adaptation to the noise occurs also for words processed to maintain the slow-amplitude modulations in speech (the envelope) disregarding the faster fluctuations (the temporal fine structure). This demonstrates that noise adaptation reflects an enhancement of amplitude modulation speech cues and is unaffected by temporal fine structure cues. Last, we show that cochlear implant users (N = 7; four male) show normal monaural adaptation to ipsilateral noise. Because the electrical stimulation delivered by cochlear implants is independent from the MOCR, this demonstrates that noise adaptation does not require the MOCR. We argue that noise adaptation probably reflects adaptation of the dynamic range of auditory neurons to the noise level statistics.SIGNIFICANCE STATEMENT People find it easier to understand speech in noisy environments when they are given some time to adapt to the noise. This benefit is frequently but controversially attributed to the medial olivocochlear efferent reflex enhancing the representation of speech cues in the auditory nerve. Here, we show that the adaptation to noise reflects an enhancement of the slow fluctuations in amplitude over time that are present in speech. In addition, we show that adaptation to noise for cochlear implant users is not statistically different from that for listeners with normal hearing. Because the electrical stimulation delivered by cochlear implants is independent from the medial olivocochlear efferent reflex, this demonstrates that adaptation to noise does not require this reflex.