A procedure for measuring auditory and audio-visual speech-reception thresholds for sentences in noise: rationale, evaluation, and recommendations for use

Recovering speech intelligibility with deep learning and multiple microphones in noisy-reverberant situations for people using cochlear implants

For cochlear implant (CI) listeners, holding a conversation in noisy and reverberant environments is often challenging. Deep-learning algorithms can potentially mitigate these difficulties by enhancing speech in everyday listening environments. This study compared several deep-learning algorithms with access to one, two unilateral, or six bilateral microphones that were trained to recover speech signals by jointly removing noise and reverberation. The noisy-reverberant speech and an ideal noise reduction algorithm served as lower and upper references, respectively. Objective signal metrics were compared with results from two listening tests, including 15 typical hearing listeners with CI simulations and 12 CI listeners. Large and statistically significant improvements in speech reception thresholds of 7.4 and 10.3 dB were found for the multi-microphone algorithms. For the single-microphone algorithm, there was an improvement of 2.3 dB but only for the CI listener group. The objective signal metrics correctly predicted the rank order of results for CI listeners, and there was an overall agreement for most effects and variances between results for CI simulations and CI listeners. These algorithms hold promise to improve speech intelligibility for CI listeners in environments with noise and reverberation and benefit from a boost in performance when using features extracted from multiple microphones.

Eye movement differences when recognising and learning moving and static faces

Seeing a face in motion can help subsequent face recognition. Several explanations have been proposed for this "motion advantage," but other factors that might play a role have received less attention. For example, facial movement might enhance recognition by attracting attention to the internal facial features, thereby facilitating identification. However, there is no direct evidence that motion increases attention to regions of the face that facilitate identification (i.e., internal features) compared with static faces. We tested this hypothesis by recording participants' eye movements while they completed the famous face recognition (Experiment 1, N = 32), and face-learning (Experiment 2, N = 60, Experiment 3, N = 68) tasks, with presentation style manipulated (moving or static). Across all three experiments, a motion advantage was found, and participants directed a higher proportion of fixations to the internal features (i.e., eyes, nose, and mouth) of moving faces versus static. Conversely, the proportion of fixations to the internal non-feature area (i.e., cheeks, forehead, chin) and external area (Experiment 3) was significantly reduced for moving compared with static faces (all ps < .05). Results suggest that during both familiar and unfamiliar face recognition, facial motion is associated with increased attention to internal facial features, but only during familiar face recognition is the magnitude of the motion advantage significantly related functionally to the proportion of fixations directed to the internal features.

Impact of Facemasks Use on Interpersonal Communication in a Clinical Setup: A Questionnaire Based Study

Precautionary measures such as physical distancing, wearing a mask, and hand hygiene to suppress virus transmission necessitated a shift in the communication paradigm.The study aimed to check the effects of wearing masks (N95, surgical, and cloth) due to the COVID-19 pandemic on interpersonal communication in audiology-speech-language pathology clinical setup from a clinician perspective. A total of 105 participants, 17 males, and 88 females, in the age range of 19 to 29 years (Mean age = 21.41 years; S.D = 1.6), participated in the study. A questionnaire consisting of 15 close-ended questions grouped into five major categories, Communication Effectiveness (3 questions), Visual Cues (5 questions), Physiological Effect (4 questions), Palliative Effect (1 question), and Environment Effect (2 questions) was framed. Procedure: Participants rated the questions using a binary forced-choice as either Yes or No adapted into a google form. Results showed that most questions in all five categories received an above-average "yes" response. A significant association between questions in communication effectiveness with visual cues and physiological effects was noticed, leading to the conclusion that wearing face masks impacted overall communication by affecting various parameters of speech, majorly, the voice. It was also seen that of all the participants, 60% used N95, 32.4% used cloth, and only 7.6% used surgical face masks. Speech-language pathologists have a significant role in facilitating oral/ verbal communication when such barriers are encountered in clients with communication disorders and fellow professionals with strategies to strengthen oral/ verbal communication.

Previous Mental Load and Incentives Influence Anticipatory Arousal as Indexed by the Baseline Pupil Diameter in a Speech-in-Noise Task

Listening effort and fatigue are common experiences when conversing in noisy environments. Much research has investigated listening effort in relation to listening demand using the speech-in-noise paradigm. Recent conceptualizations of listening effort postulate that mental fatigue should result in decreased arousal and a reluctance to invest further effort, particularly when the effort is not worthwhile. The aim of the study was to investigate the influence of fatigue on listening effort, in interaction with listening demands and motivation. To induce fatigue 30 adults with normal hearing completed a 40-minute long speech-in-noise task ("load sequence"). Pre- and post-load sequence listening effort was probed in easy and hard listening demands (individually adjusted signal-to-noise ratios); with high and low motivation (manipulated with monetary incentives). Subjective effort, estimated performance, and tendency to quit listening were collected using rating scales. Baseline pupil diameter and mean pupil dilation were recorded as indices of anticipatory arousal and objective effort. Self-reported effort and mean pupil dilation were overall larger during hard SNR as compared to easy SNR. Baseline pupil diameter declined from pre- to post-load sequence, suggesting an overall decrease in arousal. Monetary incentives had no influence on the baseline pupil diameter for the easy SNR condition, but for the hard SNR condition larger incentives led to larger baseline pupil diameter. These results suggest that anticipatory arousal may be influenced by fatigue and motivation effects. Models of listening effort should account for the independent influence of motivation and previous load on anticipatory arousal and effort in distinct parameters.

The possible role of early-stage phase-locked neural activities in speech-in-noise perception in human adults across age and hearing loss

Ageing affects auditory neural phase-locked activities which could increase the challenges experienced during speech-in-noise (SiN) perception by older adults. However, evidence for how ageing affects SiN perception through these phase-locked activities is still lacking. It is also unclear whether influences of ageing on phase-locked activities in response to different acoustic properties have similar or different mechanisms to affect SiN perception. The present study addressed these issues by measuring early-stage phase-locked encoding of speech under quiet and noisy backgrounds (speech-shaped noise (SSN) and multi-talker babbles) in adults across a wide age range (19-75 years old). Participants passively listened to a repeated vowel whilst the frequency-following response (FFR) to fundamental frequency that has primary subcortical sources and cortical phase-locked response to slowly-fluctuating acoustic envelopes were recorded. We studied how these activities are affected by age and age-related hearing loss and how they are related to SiN performances (word recognition in sentences in noise). First, we found that the effects of age and hearing loss differ for the FFR and slow-envelope phase-locking. FFR was significantly decreased with age and high-frequency (≥ 2 kHz) hearing loss but increased with low-frequency (< 2 kHz) hearing loss, whilst the slow-envelope phase-locking was significantly increased with age and hearing loss across frequencies. Second, potential relationships between the types of phase-locked activities and SiN perception performances were also different. We found that the FFR and slow-envelope phase-locking positively corresponded to SiN performance under multi-talker babbles and SSN, respectively. Finally, we investigated how age and hearing loss affected SiN perception through phase-locked activities via mediation analyses. We showed that both types of activities significantly mediated the relation between age/hearing loss and SiN perception but in distinct manners. Specifically, FFR decreased with age and high-frequency hearing loss which in turn contributed to poorer SiN performance but increased with low-frequency hearing loss which in turn contributed to better SiN performance under multi-talker babbles. Slow-envelope phase-locking increased with age and hearing loss which in turn contributed to better SiN performance under both SSN and multi-talker babbles. Taken together, the present study provided evidence for distinct neural mechanisms of early-stage auditory phase-locked encoding of different acoustic properties through which ageing affects SiN perception.

Spatial release of masking in children and adults in non-individualized virtual environments

The spatial release of masking (SRM) is often measured in virtual auditory environments created from head-related transfer functions (HRTFs) of a standardized adult head. Adults and children, however, differ in head dimensions and mismatched HRTFs are known to affect some aspects of binaural hearing. So far, there has been little research on HRTFs in children and it is unclear whether a large mismatch of spatial cues can degrade speech perception in complex environments. In two studies, the effect of non-individualized virtual environments on SRM accuracy in adults and children was examined. The SRMs were measured in virtual environments created from individual and non-individualized HRTFs and the equivalent real anechoic environment. Speech reception thresholds (SRTs) were measured for frontal target sentences and symmetrical speech maskers at 0° or ±90° azimuth. No significant difference between environments was observed for adults. In 7 to 12-year-old children, SRTs and SRMs improved with age, with SRMs approaching adult levels. SRTs differed slightly between environments and were significantly worse in a virtual environment based on HRTFs from a spherical head. Adult HRTFs seem sufficient to accurately measure SRTs in children even in complex listening conditions.

Effect of face masks on speech perception in noise of individuals with hearing aids

Although several previous studies have confirmed that listeners find it difficult to perceive the speech of face-mask-wearing speakers, there has been little research into how masks affect hearing-impaired individuals using hearing aids. Therefore, the aim of this study was to compare the effects of masks on the speech perception in noise of hearing-impaired individuals and normal-hearing individuals. We also investigated the effect of masks on the gain conferred by hearing aids. The hearing-impaired group included 24 listeners (age: M = 69.5, SD = 8.6; M:F = 13:11) who had used hearing aids in everyday life for >1 month (M = 20.7, SD = 24.0) and the normal-hearing group included 26 listeners (age: M = 57.9, SD = 11.1; M:F = 13:13). Speech perception in noise was measured under no mask-auditory-only (no-mask-AO), no mask-auditory-visual (no-mask-AV), and mask-AV conditions at five signal-to-noise ratios (SNRs; -16, -12, -8, -4, 0 dB) using five lists of 25 monosyllabic Korean words. Video clips that included a female speaker's face and sound or the sound only were presented through a monitor and a loudspeaker located 1 m in front of the listener in a sound-attenuating booth. The degree of deterioration in speech perception caused by the mask (no-mask-AV minus mask-AV) was significantly greater for hearing-impaired vs. normal-hearing participants only at 0 dB SNR (Bonferroni's corrected p < 0.01). When the effects of a mask on speech perception, with and without hearing aids, were compared in the hearing-impaired group, the degree of deterioration in speech perception caused by the mask was significantly reduced by the hearing aids compared with that without hearing aids at 0 and -4 dB SNR (Bonferroni's corrected p < 0.01). The improvement conferred by hearing aids (unaided speech perception score minus aided speech perception score) was significantly greater at 0 and -4 dB SNR than at -16 dB SNR in the mask-AV group (Bonferroni's corrected p < 0.01). These results demonstrate that hearing aids still improve speech perception when the speaker is masked, and that hearing aids partly offset the effect of a mask at relatively low noise levels.

Evaluation of the Benefits of Bilateral Fitting in Bone-Anchored Hearing System Users: Spatial Resolution and Memory for Speech

OBJECTIVES

The purpose of this study was to evaluate the benefits of bilateral implantation for bone-anchored hearing system (BAHS) users in terms of spatial resolution abilities and auditory memory for speech.

DESIGN

This is a prospective, single-center, comparative, single-blinded study where the listeners served as their own control. Twenty-four experienced bone-anchored users with a bilateral conductive or mixed hearing loss participated in the study. After fitting the listeners unilaterally and bilaterally with BAHS sound processor(s) (Ponto 3 SuperPower), spatial resolution was estimated by measuring the minimum audible angle (MAA) to achieve an 80% correct response via a two-alternative-forced choice task (right-left discrimination of noise bursts) in two conditions: both sound processors active (bilateral condition) and only one sound processor active (unilateral condition). In addition, a memory recall test, the Sentence-final Word Identification and Recall (SWIR) test was performed with five lists of seven sentences for each of the two conditions (unilateral and bilateral). Self-reported performance in everyday life with the listener's own sound processors was also evaluated via a questionnaire (the abbreviated version of the Speech, Spatial and Qualities of Hearing scale).

RESULTS

The MAA to discriminate noise bursts improved significantly from 75.04° in the unilateral condition to 3.61° in the bilateral condition ( p < 0.0001). The average improvement in performance was 54.28°. The SWIR test results showed that the listeners could recall, on average, 55.03% of the last words in a list of seven sentences in the unilateral condition and 57.23% in the bilateral condition. While the main effect of condition was not significant, there was a significant interaction between condition and repetition (list), revealing a significantly higher recall performance in the bilateral condition than in the unilateral condition for the second repetition/list out of five (10.2% difference; p = 0.022). Self-reported performance with bilateral BAHS obtained via the Speech, Spatial and Qualities of Hearing scale questionnaire was, on average, 4.4 for speech, 3.7 for spatial, and 5.1 for qualities of hearing. There was no correlation between self-reported performance in everyday life and bilateral performance in the MAA test, while significant correlations were obtained between self-reported performance and recall performance in the SWIR test.

CONCLUSIONS

These results showed a large benefit in spatial resolution for users with symmetric BC thresholds when being fitted with two BAHS, although their self-reported performance with bilateral BAHS in everyday life was rather low. In addition, there was no overall benefit of bilateral fitting on memory for speech, despite observing a benefit in one out of five repetitions of the SWIR test. Performance in the SWIR test was correlated with the users' self-reported performance in everyday life, such that users with higher recall ability reported to achieve better performance in real life. These findings highlight the advantages of bilateral fitting on spatial resolution, although bilaterally fitted BAHS users continue to experience some difficulties in their daily lives, especially when locating sounds, judging distance and movement. More research is needed to support a higher penetration of bilateral BAHS treatment for bilateral conductive and mixed hearing losses.

Congruent aero-tactile stimuli bias perception of voicing continua

Multimodal integration is the formation of a coherent percept from different sensory inputs such as vision, audition, and somatosensation. Most research on multimodal integration in speech perception has focused on audio-visual integration. In recent years, audio-tactile integration has also been investigated, and it has been established that puffs of air applied to the skin and timed with listening tasks shift the perception of voicing by naive listeners. The current study has replicated and extended these findings by testing the effect of air puffs on gradations of voice onset time along a continuum rather than the voiced and voiceless endpoints of the original work. Three continua were tested: bilabial (“pa/ba”), velar (“ka/ga”), and a vowel continuum (“head/hid”) used as a control. The presence of air puffs was found to significantly increase the likelihood of choosing voiceless responses for the two VOT continua but had no effect on choices for the vowel continuum. Analysis of response times revealed that the presence of air puffs lengthened responses for intermediate (ambiguous) stimuli and shortened them for endpoint (non-ambiguous) stimuli. The slowest response times were observed for the intermediate steps for all three continua, but for the bilabial continuum this effect interacted with the presence of air puffs: responses were slower in the presence of air puffs, and faster in their absence. This suggests that during integration auditory and aero-tactile inputs are weighted differently by the perceptual system, with the latter exerting greater influence in those cases where the auditory cues for voicing are ambiguous.

The Impact of Temporally Coherent Visual Cues on Speech Perception in Complex Auditory Environments

Speech perception often takes place in noisy environments, where multiple auditory signals compete with one another. The addition of visual cues such as talkers’ faces or lip movements to an auditory signal can help improve the intelligibility of speech in those suboptimal listening environments. This is referred to as audiovisual benefits. The current study aimed to delineate the signal-to-noise ratio (SNR) conditions under which visual presentations of the acoustic amplitude envelopes have their most significant impact on speech perception. Seventeen adults with normal hearing were recruited. Participants were presented with spoken sentences in babble noise either in auditory-only or auditory-visual conditions with various SNRs at −7, −5, −3, −1, and 1 dB. The visual stimulus applied in this study was a sphere that varied in size syncing with the amplitude envelope of the target speech signals. Participants were asked to transcribe the sentences they heard. Results showed that a significant improvement in accuracy in the auditory-visual condition versus the audio-only condition was obtained at the SNRs of −3 and −1 dB, but no improvement was observed in other SNRs. These results showed that dynamic temporal visual information can benefit speech perception in noise, and the optimal facilitative effects of visual amplitude envelope can be observed under an intermediate SNR range.

Communication With Older Adults in Times of a Pandemic: Practical Suggestions for the Health Care Professionals

In order to limit the spread of the coronavirus, several protective measures have been put in place in the community, in private and public residences and in health care centers. Some measures have a negative impact on communication. They include physical distancing, the use of face masks and shields as well as the increased use of telephone and videoconferencing for distance communication. The effects of COVID-19 are particularly harsh on older adults. Consequently, older adults, especially those with hearing loss, are particularly at risk of experiencing communication breakdowns and increased social isolation. Health care professionals should learn about and be encouraged to use communication strategies to maintain good interactions with their patients. This article proposes practical suggestions to health professionals who interact with older adults, especially those who have difficulty understanding speech. The goal of this article is to inform on the prevalence of hearing loss, the hearing difficulties experienced by older adults, the manifestations of hearing problems, the effects of pandemic protection measures on communication and the strategies that can be used to optimize professional-patient communication during a pandemic.

The effect of increased channel interaction on speech perception with cochlear implants

Cochlear implants (CIs) are neuroprostheses that partially restore hearing for people with severe-to-profound hearing loss. While CIs can provide good speech perception in quiet listening situations for many, they fail to do so in environments with interfering sounds for most listeners. Previous research suggests that this is due to detrimental interaction effects between CI electrode channels, limiting their function to convey frequency-specific information, but evidence is still scarce. In this study, an experimental manipulation called spectral blurring was used to increase channel interaction in CI listeners using Advanced Bionics devices with HiFocus 1J and MS electrode arrays to directly investigate its causal effect on speech perception. Instead of using a single electrode per channel as in standard CI processing, spectral blurring used up to 6 electrodes per channel simultaneously to increase the overlap between adjacent frequency channels as would occur in cases with severe channel interaction. Results demonstrated that this manipulation significantly degraded CI speech perception in quiet by 15% and speech reception thresholds in babble noise by 5 dB when all channels were blurred by a factor of 6. Importantly, when channel interaction was increased just on a subset of electrodes, speech scores were mostly unaffected and were only significantly degraded when the 5 most apical channels were blurred. These apical channels convey information up to 1 kHz at the apical end of the electrode array and are typically located at angular insertion depths of about 250 up to 500°. These results confirm and extend earlier findings indicating that CI speech perception may not benefit from deactivating individual channels along the array and that efforts should instead be directed towards reducing channel interaction per se and in particular for the most-apical electrodes. Hereby, causal methods such as spectral blurring could be used in future research to control channel interaction effects within listeners for evaluating compensation strategies.

The Benefit of Remote and On-Ear Directional Microphone Technology Persists in the Presence of Visual Information

BACKGROUND

 Both the Roger remote microphone and on-ear, adaptive beamforming technologies (e.g., Phonak UltraZoom) have been shown to improve speech understanding in noise for cochlear implant (CI) listeners when tested in audio-only (A-only) test environments.

PURPOSE

 Our aim was to determine if adult and pediatric CI recipients benefited from these technologies in a more common environment-one in which both audio and visual cues were available and when overall performance was high.

STUDY SAMPLE

 Ten adult CI listeners (Experiment 1) and seven pediatric CI listeners (Experiment 2) were tested.

DESIGN

 Adults were tested in quiet and in two levels of noise (level 1 and level 2) in A-only and audio-visual (AV) environments. There were four device conditions: (1) an ear canal-level, omnidirectional microphone (T-mic) in quiet, (2) the T-mic in noise, (3) an adaptive directional mic (UltraZoom) in noise, and (4) a wireless, remote mic (Roger Pen) in noise. Pediatric listeners were tested in quiet and in level 1 noise in A-only and AV environments. The test conditions were: (1) a behind-the-ear level omnidirectional mic (processor mic) in quiet, (2) the processor mic in noise, (3) the T-mic in noise, and (4) the Roger Pen in noise.

DATA COLLECTION AND ANALYSES

 In each test condition, sentence understanding was assessed (percent correct) and ease of listening ratings were obtained. The sentence understanding data were entered into repeated-measures analyses of variance.

RESULTS

 For both adult and pediatric listeners in the AV test conditions in level 1 noise, performance with the Roger Pen was significantly higher than with the T-mic. For both populations, performance in level 1 noise with the Roger Pen approached the level of baseline performance in quiet. Ease of listening in noise was rated higher in the Roger Pen conditions than in the T-mic or processor mic conditions in both A-only and AV test conditions.

CONCLUSION

 The Roger remote mic and on-ear directional mic technologies benefit both speech understanding and ease of listening in a realistic laboratory test environment and are likely do the same in real-world listening environments.

Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report

Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthesia (GA), precluding patients who have higher risk associated with GA. Recent literature describes the safety and efficacy of performing unilateral CI surgery under local anaesthesia (LA). We report the first simultaneous bilateral CI under LA in the UK in an adult patient with profound sensorineural deafness and visual impairment.Case study: A 46-year-old gentleman, registered blind, presented with a 20-year history of bilateral progressive hearing loss. He was assessed as unfit for surgery under GA due to significant cardiac comorbidities. We performed simultaneous bilateral CI surgery under LA on the patient; he was discharged home the following day. Postoperative free field audiometry showed a significant improvement; speech discrimination using Bamford, Kowal and Bench sentences presented in quiet, increased from 0% pre-operatively to 100% four months post-operatively.Conclusion: Simultaneous bilateral CI surgery under LA is a safe and feasible procedure for eligible patients who may otherwise have been denied surgery due to their GA risk.

Impacts of face coverings on communication: an indirect impact of COVID-19

OBJECTIVE

To understand the impact of face coverings on hearing and communication.

DESIGN

An online survey consisting of closed-set and open-ended questions distributed within the UK to gain insights into experiences of interactions involving face coverings, and of the impact of face coverings on communication.

SAMPLE

Four hundred and sixty members of the general public were recruited via snowball sampling. People with hearing loss were intentionally oversampled to more thoroughly assess the effect of face coverings in this group.

RESULTS

With few exceptions, participants reported that face coverings negatively impacted hearing, understanding, engagement, and feelings of connection with the speaker. Impacts were greatest when communicating in medical situations. People with hearing loss were significantly more impacted than those without hearing loss. Face coverings impacted communication content, interpersonal connectedness, and willingness to engage in conversation; they increased anxiety and stress, and made communication fatiguing, frustrating and embarrassing - both as a speaker wearing a face covering, and when listening to someone else who is wearing one.

CONCLUSIONS

Face coverings have far-reaching impacts on communication for everyone, but especially for people with hearing loss. These findings illustrate the need for communication-friendly face-coverings, and emphasise the need to be communication-aware when wearing a face covering.

Using Spectral Blurring to Assess Effects of Channel Interaction on Speech-in-Noise Perception with Cochlear Implants

Cochlear implant (CI) listeners struggle to understand speech in background noise. Interactions between electrode channels due to current spread increase the masking of speech by noise and lead to difficulties with speech perception. Strategies that reduce channel interaction therefore have the potential to improve speech-in-noise perception by CI listeners, but previous results have been mixed. We investigated the effects of channel interaction on speech-in-noise perception and its association with spectro-temporal acuity in a listening study with 12 experienced CI users. Instead of attempting to reduce channel interaction, we introduced spectral blurring to simulate some of the effects of channel interaction by adjusting the overlap between electrode channels at the input level of the analysis filters or at the output by using several simultaneously stimulated electrodes per channel. We measured speech reception thresholds in noise as a function of the amount of blurring applied to either all 15 electrode channels or to 5 evenly spaced channels. Performance remained roughly constant as the amount of blurring applied to all channels increased up to some knee point, above which it deteriorated. This knee point differed across listeners in a way that correlated with performance on a non-speech spectro-temporal task, and is proposed here as an individual measure of channel interaction. Surprisingly, even extreme amounts of blurring applied to 5 channels did not affect performance. The effects on speech perception in noise were similar for blurring at the input and at the output of the CI. The results are in line with the assumption that experienced CI users can make use of a limited number of effective channels of information and tolerate some deviations from their everyday settings when identifying speech in the presence of a masker. Furthermore, these findings may explain the mixed results by strategies that optimized or deactivated a small number of electrodes evenly distributed along the array by showing that blurring or deactivating one-third of the electrodes did not harm speech-in-noise performance.

Bilateral Cochlear Implants Allow Listeners to Benefit from Visual Information When Talker Location is Varied

BACKGROUND

Previous research has found that when the location of a talker was varied and an auditory prompt indicated the location of the talker, the addition of visual information produced a significant and large improvement in speech understanding for listeners with bilateral cochlear implants (CIs) but not with a unilateral CI. Presumably, the sound-source localization ability of the bilateral CI listeners allowed them to orient to the auditory prompt and benefit from visual information for the subsequent target sentence.

PURPOSE

The goal of this project was to assess the robustness of previous research by using a different test environment, a different CI, different test material, and a different response measure.

RESEARCH DESIGN

Nine listeners fit with bilateral CIs were tested in a simulation of a crowded restaurant. Auditory-visual (AV) sentence material was presented from loudspeakers and video monitors at 0, +90, and -90 degrees. Each trial started with the presentation of an auditory alerting phrase from one of the three target loudspeakers followed by an AV target sentence from that loudspeaker/monitor. On each trial, the two nontarget monitors showed the speaker mouthing a different sentence. Sentences were presented in noise in four test conditions: one CI, one CI plus vision, bilateral CIs, and bilateral CIs plus vision.

RESULTS

Mean percent words correct for the four test conditions were: one CI, 43%; bilateral CI, 60%; one CI plus vision, 52%; and bilateral CI plus vision, 84%. Visual information did not significantly improve performance in the single CI conditions but did improve performance in the bilateral CI conditions. The magnitude of improvement for two CIs versus one CI in the AV condition was approximately twice that for two CIs versus one CI in the auditory condition.

CONCLUSIONS

Our results are consistent with previous data showing the large value of bilateral implants in a complex AV listening environment. The results indicate that the value of bilateral CIs for speech understanding is significantly underestimated in standard, auditory-only, single-speaker, test environments.

Cortical Neuroplasticity and Cognitive Function in Early-Stage, Mild-Moderate Hearing Loss: Evidence of Neurocognitive Benefit From Hearing Aid Use

Age-related hearing loss (ARHL) is associated with cognitive decline as well as structural and functional brain changes. However, the mechanisms underlying neurocognitive deficits in ARHL are poorly understood and it is unclear whether clinical treatment with hearing aids may modify neurocognitive outcomes. To address these topics, cortical visual evoked potentials (CVEPs), cognitive function, and speech perception abilities were measured in 28 adults with untreated, mild-moderate ARHL and 13 age-matched normal hearing (NH) controls. The group of adults with ARHL were then fit with bilateral hearing aids and re-evaluated after 6 months of amplification use. At baseline, the ARHL group exhibited more extensive recruitment of auditory, frontal, and pre-frontal cortices during a visual motion processing task, providing evidence of cross-modal re-organization and compensatory cortical neuroplasticity. Further, more extensive cross-modal recruitment of the right auditory cortex was associated with greater degree of hearing loss, poorer speech perception in noise, and worse cognitive function. Following clinical treatment with hearing aids, a reversal in cross-modal re-organization of auditory cortex by vision was observed in the ARHL group, coinciding with gains in speech perception and cognitive performance. Thus, beyond the known benefits of hearing aid use on communication, outcomes from this study provide evidence that clinical intervention with well-fit amplification may promote more typical cortical organization and functioning and provide cognitive benefit.

Measuring access to high-modulation-rate envelope speech cues in clinically fitted auditory prostheses

The signal processing used to increase intelligibility within the hearing-impaired listener introduces distortions in the modulation patterns of a signal. Trade-offs have to be made between improved audibility and the loss of fidelity. Acoustic hearing impairment can cause reduced access to temporal fine structure (TFS), while cochlear implant processing, used to treat profound hearing impairment, has reduced ability to convey TFS, hence forcing greater reliance on modulation cues. Target speech mixed with a competing talker was split into 8-22 frequency channels. From each channel, separate low-rate (EmodL, <16 Hz) and high-rate (EmodH, <300 Hz) versions of the envelope modulation were extracted, which resulted in low or high intelligibility, respectively. The EModL modulations were preserved in channel valleys and cross-faded to EModH in channel peaks. The cross-faded signal modulated a tone carrier in each channel. The modulated carriers were summed across channels and presented to hearing aid (HA) and cochlear implant users. Their ability to access high-rate modulation cues and the dynamic range of this access was assessed. Clinically fitted hearing aids resulted in 10% lower intelligibility than simulated high-quality aids. Encouragingly, cochlear implantees were able to extract high-rate information over a dynamic range similar to that for the HA users.

Speech-in-Noise Perception in Children With Cochlear Implants, Hearing Aids, Developmental Language Disorder and Typical Development: The Effects of Linguistic and Cognitive Abilities

Children with hearing loss, and those with language disorders, can have excellent speech recognition in quiet, but still experience unique challenges when listening to speech in noisy environments. However, little is known about how speech-in-noise (SiN) perception relates to individual differences in cognitive and linguistic abilities in these children. The present study used the Norwegian version of the Hearing in Noise Test (HINT) to investigate SiN perception in 175 children aged 5.5–12.9 years, including children with cochlear implants (CI, n = 64), hearing aids (HA, n = 37), developmental language disorder (DLD, n = 16) and typical development (TD, n = 58). Further, the study examined whether general language ability, verbal memory span, non-verbal IQ and speech perception of monosyllables and sentences in quiet were predictors of performance on the HINT. To allow comparisons across ages, scores derived from age-based norms were used for the HINT and the tests of language and cognition. There were significant differences in SiN perception between all the groups except between the HA and DLD groups, with the CI group requiring the highest signal-to-noise ratios (i.e., poorest performance) and the TD group requiring the lowest signal-to-noise ratios. For the full sample, language ability explained significant variance in HINT performance beyond speech perception in quiet. Follow-up analyses for the separate groups revealed that language ability was a significant predictor of HINT performance for children with CI, HA, and DLD, but not for children with TD. Memory span and IQ did not predict variance in SiN perception when language ability and speech perception in quiet were taken into account. The finding of a robust relation between SiN perception and general language skills in all three clinical groups call for further investigation into the mechanisms that underlie this association.

The Principle of Inverse Effectiveness in Audiovisual Speech Perception

We assessed how synchronous speech listening and lipreading affects speech recognition in acoustic noise. In simple audiovisual perceptual tasks, inverse effectiveness is often observed, which holds that the weaker the unimodal stimuli, or the poorer their signal-to-noise ratio, the stronger the audiovisual benefit. So far, however, inverse effectiveness has not been demonstrated for complex audiovisual speech stimuli. Here we assess whether this multisensory integration effect can also be observed for the recognizability of spoken words. To that end, we presented audiovisual sentences to 18 native-Dutch normal-hearing participants, who had to identify the spoken words from a finite list. Speech-recognition performance was determined for auditory-only, visual-only (lipreading), and auditory-visual conditions. To modulate acoustic task difficulty, we systematically varied the auditory signal-to-noise ratio. In line with a commonly observed multisensory enhancement on speech recognition, audiovisual words were more easily recognized than auditory-only words (recognition thresholds of -15 and -12 dB, respectively). We here show that the difficulty of recognizing a particular word, either acoustically or visually, determines the occurrence of inverse effectiveness in audiovisual word integration. Thus, words that are better heard or recognized through lipreading, benefit less from bimodal presentation. Audiovisual performance at the lowest acoustic signal-to-noise ratios (45%) fell below the visual recognition rates (60%), reflecting an actual deterioration of lipreading in the presence of excessive acoustic noise. This suggests that the brain may adopt a strategy in which attention has to be divided between listening and lipreading.

Subclinical Auditory Neural Deficits in Patients With Type 1 Diabetes Mellitus

Supplemental Digital Content is available in the text.

Objectives:

Diabetes mellitus (DM) is associated with a variety of sensory complications. Very little attention has been given to auditory neuropathic complications in DM. The aim of this study was to determine whether type 1 DM (T1DM) affects neural coding of the rapid temporal fluctuations of sounds, and how any deficits may impact on behavioral performance.

Design:

Participants were 30 young normal-hearing T1DM patients, and 30 age-, sex-, and audiogram-matched healthy controls. Measurements included electrophysiological measures of auditory nerve and brainstem function using the click-evoked auditory brainstem response, and of brainstem neural temporal coding using the sustained frequency-following response (FFR); behavioral tests of temporal coding (interaural phase difference discrimination and the frequency difference limen); tests of speech perception in noise; and self-report measures of auditory disability using the Speech, Spatial and Qualities of Hearing Scale.

Results:

There were no significant differences between T1DM patients and controls in the auditory brainstem response. However, the T1DM group showed significantly reduced FFRs to both temporal envelope and temporal fine structure. The T1DM group also showed significantly higher interaural phase difference and frequency difference limen thresholds, worse speech-in-noise performance, as well as lower overall Speech, Spatial and Qualities scores than the control group.

Conclusions:

These findings suggest that T1DM is associated with degraded neural temporal coding in the brainstem in the absence of an elevation in audiometric threshold, and that the FFR may provide an early indicator of neural damage in T1DM, before any abnormalities can be identified using standard clinical tests. However, the relation between the neural deficits and the behavioral deficits is uncertain.

Electro-haptic enhancement of speech-in-noise performance in cochlear implant users

Cochlear implant (CI) users receive only limited sound information through their implant, which means that they struggle to understand speech in noisy environments. Recent work has suggested that combining the electrical signal from the CI with a haptic signal that provides crucial missing sound information (“electro-haptic stimulation”; EHS) could improve speech-in-noise performance. The aim of the current study was to test whether EHS could enhance speech-in-noise performance in CI users using: (1) a tactile signal derived using an algorithm that could be applied in real time, (2) a stimulation site appropriate for a real-world application, and (3) a tactile signal that could readily be produced by a compact, portable device. We measured speech intelligibility in multi-talker noise with and without vibro-tactile stimulation of the wrist in CI users, before and after a short training regime. No effect of EHS was found before training, but after training EHS was found to improve the number of words correctly identified by an average of 8.3%-points, with some users improving by more than 20%-points. Our approach could offer an inexpensive and non-invasive means of improving speech-in-noise performance in CI users.

Using recurrent neural networks to improve the perception of speech in non-stationary noise by people with cochlear implants

Speech-in-noise perception is a major problem for users of cochlear implants (CIs), especially with non-stationary background noise. Noise-reduction algorithms have produced benefits but relied on a priori information about the target speaker and/or background noise. A recurrent neural network (RNN) algorithm was developed for enhancing speech in non-stationary noise and its benefits were evaluated for speech perception, using both objective measures and experiments with CI simulations and CI users. The RNN was trained using speech from many talkers mixed with multi-talker or traffic noise recordings. Its performance was evaluated using speech from an unseen talker mixed with different noise recordings of the same class, either babble or traffic noise. Objective measures indicated benefits of using a recurrent over a feed-forward architecture, and predicted better speech intelligibility with than without the processing. The experimental results showed significantly improved intelligibility of speech in babble noise but not in traffic noise. CI subjects rated the processed stimuli as significantly better in terms of speech distortions, noise intrusiveness, and overall quality than unprocessed stimuli for both babble and traffic noise. These results extend previous findings for CI users to mostly unseen acoustic conditions with non-stationary noise.

A Site-Selection Strategy Based on Polarity Sensitivity for Cochlear Implants: Effects on Spectro-Temporal Resolution and Speech Perception

Thresholds of asymmetric pulses presented to cochlear implant (CI) listeners depend on polarity in a way that differs across subjects and electrodes. It has been suggested that lower thresholds for cathodic-dominant compared to anodic-dominant pulses reflect good local neural health. We evaluated the hypothesis that this polarity effect (PE) can be used in a site-selection strategy to improve speech perception and spectro-temporal resolution. Detection thresholds were measured in eight users of Advanced Bionics CIs for 80-pps, triphasic, monopolar pulse trains where the central high-amplitude phase was either anodic or cathodic. Two experimental MAPs were then generated for each subject by deactivating the five electrodes with either the highest or the lowest PE magnitudes (cathodic minus anodic threshold). Performance with the two experimental MAPs was evaluated using two spectro-temporal tests (Spectro-Temporal Ripple for Investigating Processor EffectivenesS (STRIPES; Archer-Boyd et al. in J Acoust Soc Am 144:2983–2997, 2018) and Spectral-Temporally Modulated Ripple Test (SMRT; Aronoff and Landsberger in J Acoust Soc Am 134:EL217–EL222, 2013)) and with speech recognition in quiet and in noise. Performance was also measured with an experimental MAP that used all electrodes, similar to the subjects’ clinical MAP. The PE varied strongly across subjects and electrodes, with substantial magnitudes relative to the electrical dynamic range. There were no significant differences in performance between the three MAPs at group level, but there were significant effects at subject level—not all of which were in the hypothesized direction—consistent with previous reports of a large variability in CI users’ performance and in the potential benefit of site-selection strategies. The STRIPES but not the SMRT test successfully predicted which strategy produced the best speech-in-noise performance on a subject-by-subject basis. The average PE across electrodes correlated significantly with subject age, duration of deafness, and speech perception scores, consistent with a relationship between PE and neural health. These findings motivate further investigations into site-specific measures of neural health and their application to CI processing strategies.

Same or Different: The Overlap Between Children With Auditory Processing Disorders and Children With Other Developmental Disorders: A Systematic Review

Supplemental Digital Content is available in the text.

Objectives:

Children diagnosed with auditory processing disorders (APD) experience difficulties in auditory functioning and with memory, attention, language, and reading tasks. However, it is not clear whether the behavioral characteristics of these children are distinctive from the behavioral characteristics of children diagnosed with a different developmental disorder, such as specific language impairment (SLI), dyslexia, attention-deficit hyperactivity disorder (ADHD), learning disorder (LD), or autism spectrum disorder. This study describes the performance of children diagnosed with APD, SLI, dyslexia, ADHD, and LD to different outcome measurements. The aim of this study was to determine (1) which characteristics of APD overlap with the characteristics of children with SLI, dyslexia, ADHD, LD, or autism spectrum disorder; and (2) if there are characteristics that distinguish children diagnosed with APD from children diagnosed with other developmental disorders.

Design:

A systematic review. Six electronic databases (Pubmed, CINAHL, Eric, PsychINFO, Communication & Mass Media Complete, and EMBASE) were searched to find peer-reviewed studies from 1954 to May 2015. The authors included studies reporting behaviors and performance of children with (suspected) APD and children diagnosed with a different developmental disorder (SLI, Dyslexia, ADHD, and LD). Two researchers identified and screened the studies independently. Methodological quality of the included studies was assessed with the American Speech-Language-Hearing Association’s levels-of-evidence scheme.

Results:

In total, 13 studies of which the methodological quality was moderate were included in this systematic review. In five studies, the performance of children diagnosed with APD was compared with the performance of children diagnosed with SLI: in two with children diagnosed with dyslexia, one with children diagnosed with ADHD, and in another one with children diagnosed with LD. Ten of the studies included children who met the criteria for more than one diagnosis. In four studies, there was a comparison made between the performances of children with comorbid disorders. There were no studies found in which the performance of children diagnosed with APD was compared with the performance of children diagnosed with autism spectrum disorder. Children diagnosed with APD broadly share the same characteristics as children diagnosed with other developmental disorders, with only minor differences between them. Differences were determined with the auditory and visual Duration Pattern Test, the Children’s Auditory Processing Performance Scale questionnaire, and the subtests of the Listening in Spatialized Noise-Sentences test, in which noise is spatially separated from target sentences. However, these differences are not consistent between studies and are not found in comparison to all groups of children with other developmental disorders.

Conclusions:

Children diagnosed with APD perform equally to children diagnosed with SLI, dyslexia, ADHD, and LD on tests of intelligence, memory or attention, and language tests. Only small differences between groups were found for sensory and perceptual functioning tasks (auditory and visual). In addition, children diagnosed with dyslexia performed poorer in reading tasks compared with children diagnosed with APD. The result is possibly confounded by poor quality of the research studies and the low quality of the used outcome measures. More research with higher scientific rigor is required to better understand the differences and similarities in children with various neurodevelopmental disorders.

Time-Compressed Speech Identification Is Predicted by Auditory Neural Processing, Perceptuomotor Speed, and Executive Functioning in Younger and Older Listeners

Older adults typically have difficulty identifying speech that is temporally distorted, such as reverberant, accented, time-compressed, or interrupted speech. These difficulties occur even when hearing thresholds fall within a normal range. Auditory neural processing speed, which we have previously found to predict auditory temporal processing (auditory gap detection), may interfere with the ability to recognize phonetic features as they rapidly unfold over time in spoken speech. Further, declines in perceptuomotor processing speed and executive functioning may interfere with the ability to track, access, and process information. The current investigation examined the extent to which age-related differences in time-compressed speech identification were predicted by auditory neural processing speed, perceptuomotor processing speed, and executive functioning. Groups of normal-hearing (up to 3000 Hz) younger and older adults identified 40, 50, and 60 % time-compressed sentences. Auditory neural processing speed was defined as the P1 and N1 latencies of click-induced auditory-evoked potentials. Perceptuomotor processing speed and executive functioning were measured behaviorally using the Connections Test. Compared to younger adults, older adults exhibited poorer time-compressed speech identification and slower perceptuomotor processing. Executive functioning, P1 latency, and N1 latency did not differ between age groups. Time-compressed speech identification was independently predicted by P1 latency, perceptuomotor processing speed, and executive functioning in younger and older listeners. Results of model testing suggested that declines in perceptuomotor processing speed mediated age-group differences in time-compressed speech identification. The current investigation joins a growing body of literature suggesting that the processing of temporally distorted speech is impacted by lower-level auditory neural processing and higher-level perceptuomotor and executive processes.

Visual Inhibition Measures Predict Speech-in-Noise Perception Only in People With Low Levels of Education

Inhibition-the ability to suppress goal-irrelevant information-is thought to be an important cognitive skill in many situations, including speech-in-noise (SiN) listening. Both inhibition and SiN perception are thought to worsen with age, but attempts to connect age-related declines in these two abilities have produced mixed results even though a clear positive relationship has generally been hypothesized. We suggest that these inconsistencies may occur because listener-based demographic variables such as educational attainment modulate the relationship between inhibition and SiN perception. We tested this hypothesis with a group of 50 older adults (61-86 years, mean: 69.5) with mild-to-moderate age-related hearing loss (8-53 average dB HL, mean: 25.3 dB HL). Participants performed a visual Stroop task and two SiN tasks. In a Stroop task one stimulus dimension is named while a second, more prepotent dimension is ignored. Results show a clear influence of educational attainment on the relationship of visual Stroop scores to SiN performance, but only for those with lower levels of education. These findings highlight for the first time the importance of considering potentially heterogeneous demographic listener variables when analyzing cognitive tasks and their relationship to SiN perception.

The MAndarin spoken word-Picture IDentification test in noise-Adaptive (MAPID-A) measures subtle speech-recognition-in-noise changes and spatial release from masking in very young children

Background

Spatial release of masking (SRM) is a measure of an individual’s ability to perform speech-noise segregation, which is usually quantified by the extent of improvement of the individual’s speech recognition performance when the noise is switched from a spatially co-located position (e.g., speech and noise both presented from the front) to a spatially separated position (e.g., speech presented from the front and noise presented from the right side) with reference to the target speech. SRM is a combined measure of head shadow and binaural unmasking benefits. SRM has only been investigated in young children at group level but not at individual participant level in the international literature due to the lack of reliable speech recognition test materials able to detect subtle statistically significant within-participant changes in speech-recognition-in-noise thresholds.

Method

The performance to signal-to-noise ratio (P-SNR) functions of twenty-four disyllabic words were obtained from 40 native Mandarin-speaking children aged 3.6–6.2 years with reported normal speech, language and hearing. The test items’ difficulty levels were homogenized by adjusting the speech intensity level of each item so that the adjusted signal-to-noise ratio for 50% correct score (SNR-50%) point of each item would overlap at the mean SNR-50% point of all test items. In the MAPID-A, the homogenized test items were randomly presented in an adaptive testing procedure at a fixed noise intensity level, but the speech intensity level of the upcoming test item varied in 2-dB SNR steps depending on the recognition result of the previous test item. The SNR reversal point is marked by a change from a decrease to an increase in the SNR or vice versa. Two successive SNR reversal points marked the boundaries of an excursion. The mid-points from 12 excursions (in dB SNR) were averaged to produce the adaptive SNR-50% measure (aSNR-50%).

Results

The aSNR-50% results were obtained from another 12 children aged 4.8–5.3 years with reported normal speech, language and hearing. The average 99% confidence interval (CI) of all participants’ mean aSNR-50% values was ±1.61 dB SNR; therefore, 3.22 dB SNR was the average critical difference required to confirm a significant difference in the scores obtained from the same participant between two test conditions. Statistically significant within-participant SRM was identified in 95% of the participants; in other words, aSNR-50% obtained from the spatially separated condition outperformed aSNR-50% obtained from the spatially co-located condition. The adaptive testing procedure was highly reliable, with an within-participant test-retest reliability of 90.6%. and significantly limited testing time to an average of 4.2 min. This research study has fulfilled its aim on detecting subtle within-participant SRM in very young children starting from 4 years of age with a reliable statistical procedure. MAPID-A offers a reliable and efficient clinical tool to investigate speech-recognition-in-noise and SRM performances in young Mandarin-speaking children.

Conclusions

The narrow CIs, high test-retest reliability, and short testing time has proven that the MAPID-A is a promising sensitive, reliable and time-efficient clinical tool to detect subtle within-participant speech-recognition-in-noise changes in children as young as 4–5 years. The MAPID-A offers a clinical tool to behaviorally track young children’s development in speech-recognition-in-noise and SRM, and to potentially review the development of the auditory neural pathway and the cerebral dominance for speech-recognition-in-noise in young children.

Conversational speech levels and signal-to-noise ratios in realistic acoustic conditions

Estimating the basic acoustic parameters of conversational speech in noisy real-world conditions has been an elusive task in hearing research. Nevertheless, these data are essential ingredients for speech intelligibility tests and fitting rules for hearing aids. Previous surveys did not provide clear methodology for their acoustic measurements and setups, were opaque about their samples, or did not control for distance between the talker and listener, even though people are known to adapt their distance in noisy conversations. In the present study, conversations were elicited between pairs of people by asking them to play a collaborative game that required them to communicate. While performing this task, the subjects listened to binaural recordings of different everyday scenes, which were presented to them at their original sound pressure level (SPL) via highly open headphones. Their voices were recorded separately using calibrated headset microphones. The subjects were seated inside an anechoic chamber at 1 and 0.5 m distances. Precise estimates of realistic speech levels and signal-to-noise ratios (SNRs) were obtained for the different acoustic scenes, at broadband and third octave levels. It is shown that with acoustic background noise at above approximately 69 dB SPL at 1 m distance, or 75 dB SPL at 0.5 m, the average SNR can become negative. It is shown through interpolation of the two conditions that if the conversation partners would have been allowed to optimize their positions by moving closer to each other, then positive SNRs should be only observed above 75 dB SPL. The implications of the results on speech tests and hearing aid fitting rules are discussed.

Individually tailored spectral-change enhancement for the hearing impaired

An algorithm for enhancing spectral changes over time was previously shown to improve the intelligibility of speech in steady speech-spectrum noise (SSN) for hearing-impaired subjects but tended to impair intelligibility for speech in a background of two-talker speech. Large individual differences were found and the application of a genetic algorithm for selecting the "best" parameter values for each listener was found to be beneficial. In the present study, the spectral-change enhancement (SCE) processing was modified by individually tailoring the degree of SCE based on the frequency-dependent hearing loss of the subjects, and by using finer frequency resolution. The effect of the modified SCE processing on the intelligibility and quality of speech in SSN and babble noise (BBN) was evaluated. Ten subjects with mild to moderate hearing loss were tested twice for all tests. The SCE processing led to small but significant improvements in the intelligibility of speech in both SSN and BBN, while the effect of the SCE processing on speech quality was small.

A Randomized Control Trial: Supplementing Hearing Aid Use with Listening and Communication Enhancement (LACE) Auditory Training

OBJECTIVE

To examine the effectiveness of the Listening and Communication Enhancement (LACE) program as a supplement to standard-of-care hearing aid intervention in a Veteran population.

DESIGN

A multisite randomized controlled trial was conducted to compare outcomes following standard-of-care hearing aid intervention supplemented with (1) LACE training using the 10-session DVD format, (2) LACE training using the 20-session computer-based format, (3) placebo auditory training (AT) consisting of actively listening to 10 hr of digitized books on a computer, and (4) educational counseling-the control group. The study involved 3 VA sites and enrolled 279 veterans. Both new and experienced hearing aid users participated to determine if outcomes differed as a function of hearing aid user status. Data for five behavioral and two self-report measures were collected during three research visits: baseline, immediately following the intervention period, and at 6 months postintervention. The five behavioral measures were selected to determine whether the perceptual and cognitive skills targeted in LACE training generalized to untrained tasks that required similar underlying skills. The two self-report measures were completed to determine whether the training resulted in a lessening of activity limitations and participation restrictions. Outcomes were obtained from 263 participants immediately following the intervention period and from 243 participants 6 months postintervention. Analyses of covariance comparing performance on each outcome measure separately were conducted using intervention and hearing aid user status as between-subject factors, visit as a within-subject factor, and baseline performance as a covariate.

RESULTS

No statistically significant main effects or interactions were found for the use of LACE on any outcome measure.

CONCLUSIONS

Findings from this randomized controlled trial show that LACE training does not result in improved outcomes over standard-of-care hearing aid intervention alone. Potential benefits of AT may be different than those assessed by the performance and self-report measures utilized here. Individual differences not assessed in this study should be examined to evaluate whether AT with LACE has any benefits for particular individuals. Clinically, these findings suggest that audiologists may want to temper the expectations of their patients who embark on LACE training.

Effects of Binaural Spatialization in Wireless Microphone Systems for Hearing Aids on Normal-Hearing and Hearing-Impaired Listeners

Little is known about the perception of artificial spatial hearing by hearing-impaired subjects. The purpose of this study was to investigate how listeners with hearing disorders perceived the effect of a spatialization feature designed for wireless microphone systems. Forty listeners took part in the experiments. They were arranged in four groups: normal-hearing, moderate, severe, and profound hearing loss. Their performance in terms of speech understanding and speaker localization was assessed with diotic and binaural stimuli. The results of the speech intelligibility experiment revealed that the subjects presenting a moderate or severe hearing impairment better understood speech with the spatialization feature. Thus, it was demonstrated that the conventional diotic binaural summation operated by current wireless systems can be transformed to reproduce the spatial cues required to localize the speaker, without any loss of intelligibility. The speaker localization experiment showed that a majority of the hearing-impaired listeners had similar performance with natural and artificial spatial hearing, contrary to the normal-hearing listeners. This suggests that certain subjects with hearing impairment preserve their localization abilities with approximated generic head-related transfer functions in the frontal horizontal plane.

Shifts in Maximum Audiovisual Integration with Age

Listeners attempting to understand speech in noisy environments rely on visual and auditory processes, typically referred to as audiovisual processing. Noise corrupts the auditory speech signal and listeners naturally leverage visual cues from the talker’s face in an attempt to interpret the degraded auditory signal. Studies of speech intelligibility in noise show that the maximum improvement in speech recognition performance (i.e., maximum visual enhancement or VEmax), derived from seeing an interlocutor’s face, is invariant with age. Several studies have reported that VEmaxis typically associated with a signal-to-noise (SNR) of −12 dB; however, few studies have systematically investigated whether the SNR associated with VEmaxchanges with age. We investigated if VEmaxchanges as a function of age, whether the SNR at VEmaxchanges as a function of age, and what perceptual/cognitive abilities account for or mediate such relationships. We measured VEmaxon a nongeriatric adult sample () ranging in age from 20 to 59 years old. We found that VEmaxwas age-invariant, replicating earlier studies. No perceptual/cognitive measures predicted VEmax, most likely due to limited variance in VEmaxscores. Importantly, we found that the SNR at VEmaxshifts toward higher (quieter) SNR levels with increasing age; however, this relationship is partially mediated by working memory capacity, where those with larger working memory capacities (WMCs) can identify speech under lower (louder) SNR levels than their age equivalents with smaller WMCs. The current study is the first to report that individual differences in WMC partially mediate the age-related shift in SNR at VEmax.

Forty Years After Hearing Lips and Seeing Voices: the McGurk Effect Revisited

Since its discovery 40 years ago, the McGurk illusion has been usually cited as a prototypical paradigmatic case of multisensory binding in humans, and has been extensively used in speech perception studies as a proxy measure for audiovisual integration mechanisms. Despite the well-established practice of using the McGurk illusion as a tool for studying the mechanisms underlying audiovisual speech integration, the magnitude of the illusion varies enormously across studies. Furthermore, the processing of McGurk stimuli differs from congruent audiovisual processing at both phenomenological and neural levels. This questions the suitability of this illusion as a tool to quantify the necessary and sufficient conditions under which audiovisual integration occurs in natural conditions. In this paper, we review some of the practical and theoretical issues related to the use of the McGurk illusion as an experimental paradigm. We believe that, without a richer understanding of the mechanisms involved in the processing of the McGurk effect, experimenters should be really cautious when generalizing data generated by McGurk stimuli to matching audiovisual speech events.

The minimum monitoring signal-to-noise ratio for off-axis signals and its implications for directional hearing aids

The signal-to-noise ratio (SNR) benefit of hearing aid directional microphones is dependent on the angle of the listener relative to the target, something that can change drastically and dynamically in a typical group conversation. When a new target signal is significantly off-axis, directional microphones lead to slower target orientation, more complex movements, and more reversals. This raises the question of whether there is an optimal design for directional microphones. In principle an ideal microphone would provide the user with sufficient directionality to help with speech understanding, but not attenuate off-axis signals so strongly that orienting to new signals was difficult or impossible. We investigated the latter part of this question. In order to measure the minimal monitoring SNR for reliable orientation to off-axis signals, we measured head-orienting behaviour towards targets of varying SNRs and locations for listeners with mild to moderate bilateral symmetrical hearing loss. Listeners were required to turn and face a female talker in background noise and movements were tracked using a head-mounted crown and infrared system that recorded yaw in a ring of loudspeakers. The target appeared randomly at ± 45, 90 or 135° from the start point. The results showed that as the target SNR decreased from 0 dB to −18 dB, first movement duration and initial misorientation count increased, then fixation error, and finally reversals increased. Increasing the target angle increased movement duration at all SNRs, decreased reversals (above −12 dB target SNR), and had little to no effect on initial misorientations. These results suggest that listeners experience some difficulty orienting towards sources as the target SNR drops below −6 dB, and that if one intends to make a directional microphone that is usable in a moving conversation, then off-axis attenuation should be no more than 12 dB.

•

Investigated the minimum signal-to-noise ratio (SNR) required to localize a target.

•

Head movement to targets at varying SNRs and locations was measured.

•

Orienting towards a new off-axis target became difficult below −6 dB SNR.

•

An ideal directional microphone should not attenuate off-axis sources by > 12 dB.

Development of equally intelligible Telugu sentence-lists to test speech recognition in noise

OBJECTIVE

To develop sentence lists in the Telugu language for the assessment of speech recognition threshold (SRT) in the presence of background noise through identification of the mean signal-to-noise ratio required to attain a 50% sentence recognition score (SRTn).

DESIGN

This study was conducted in three phases. The first phase involved the selection and recording of Telugu sentences. In the second phase, 20 lists, each consisting of 10 sentences with equal intelligibility, were formulated using a numerical optimisation procedure. In the third phase, the SRTn of the developed lists was estimated using adaptive procedures on individuals with normal hearing.

STUDY SAMPLE

A total of 68 native Telugu speakers with normal hearing participated in the study. Of these, 18 (including the speakers) performed on various subjective measures in first phase, 20 performed on sentence/word recognition in noise for second phase and 30 participated in the list equivalency procedures in third phase.

RESULTS

In all, 15 lists of comparable difficulty were formulated as test material. The mean SRTn across these lists corresponded to -2.74 (SD = 0.21).

CONCLUSIONS

The developed sentence lists provided a valid and reliable tool to measure SRTn in Telugu native speakers.

Different Measures of Auditory and Visual Stroop Interference and Their Relationship to Speech Intelligibility in Noise

Inhibition-the ability to suppress goal-irrelevant information-is thought to be an important cognitive skill in many situations, including speech-in-noise (SiN) perception. One way to measure inhibition is by means of Stroop tasks, in which one stimulus dimension must be named while a second, more prepotent dimension is ignored. The to-be-ignored dimension may be relevant or irrelevant to the target dimension, and the inhibition measure-Stroop interference (SI)-is calculated as the reaction time difference between the relevant and irrelevant conditions. Both SiN perception and inhibition are suggested to worsen with age, yet attempts to connect age-related declines in these two abilities have produced mixed results. We suggest that the inconsistencies between studies may be due to methodological issues surrounding the use of Stroop tasks. First, the relationship between SI and SiN perception may differ depending on the modality of the Stroop task; second, the traditional SI measure may not account for generalized slowing or sensory declines, and thus may not provide a pure interference measure. We investigated both claims in a group of 50 older adults, who performed two Stroop tasks (visual and auditory) and two SiN perception tasks. For each Stroop task, we calculated interference scores using both the traditional difference measure and methods designed to address its various problems, and compared the ability of these different scoring methods to predict SiN performance, alone and in combination with hearing sensitivity. Results from the two Stroop tasks were uncorrelated and had different relationships to SiN perception. Changing the scoring method altered the nature of the predictive relationship between Stroop scores and SiN perception, which was additionally influenced by hearing sensitivity. These findings raise questions about the extent to which different Stroop tasks and/or scoring methods measure the same aspect of cognition. They also highlight the importance of considering additional variables such as hearing ability when analyzing cognitive variables.

Evaluation of a Frequency-Lowering Algorithm for Adults With High-Frequency Hearing Loss

The objective was to determine the effects of a frequency-lowering algorithm (frequency composition, Fcomp) on consonant identification, word-final /s, z/ detection, the intelligibility of sentences in noise, and subjective benefit, for people with high-frequency hearing loss, including people with dead regions (DRs) in the cochlea. A single-blind randomized crossover design was used. Performance with Bernafon Acriva 9 hearing aids was compared with Fcomp off and Fcomp on. Participants wore the hearing aids in each condition in a counterbalanced order. Data were collected after at least 8 weeks of experience with a condition. Outcome measures were audibility, scores from the speech perception tests, and scores from a questionnaire comparing self-perceived hearing ability with Fcomp off and Fcomp on. Ten adults with mild to severe high-frequency hearing loss (seven with extensive DRs, one with patchy or restricted DRs, and two with no DR) were tested. Fcomp improved the audibility of high-frequency sounds for 6 out of 10 participants. There was no overall effect of Fcomp on consonant identification, but the pattern of consonant confusions varied across conditions and participants. For word-final /s, z/ detection, performance was significantly better with Fcomp on than with Fcomp off. Questionnaire scores showed no differences between conditions. In summary, Fcomp improved word-final /s, z/ detection. No benefit was found for the other measures.

Experiments on Auditory-Visual Perception of Sentences by Users of Unilateral, Bimodal, and Bilateral Cochlear Implants

PURPOSE

Five experiments probed auditory-visual (AV) understanding of sentences by users of cochlear implants (CIs).

METHOD

Sentence material was presented in auditory (A), visual (V), and AV test conditions to listeners with normal hearing and CI users.

RESULTS

(a) Most CI users report that most of the time, they have access to both A and V information when listening to speech. (b) CI users did not achieve better scores on a task of speechreading than did listeners with normal hearing. (c) Sentences that are easy to speechread provided 12 percentage points more gain to speech understanding than did sentences that were difficult. (d) Ease of speechreading for sentences is related to phrase familiarity. (e) Users of bimodal CIs benefit from low-frequency acoustic hearing even when V cues are available, and a second CI adds to the benefit of a single CI when V cues are available. (f) V information facilitates lexical segmentation by improving the recognition of the number of syllables produced and the relative strength of these syllables.

CONCLUSIONS

Our data are consistent with the view that V information improves CI users' ability to identify syllables in the acoustic stream and to recognize their relative juxtaposed strengths. Enhanced syllable resolution allows better identification of word onsets, which, when combined with place-of-articulation information from visible consonants, improves lexical access.

Evaluation of a method for enhancing interaural level differences at low frequencies

A method (called binaural enhancement) for enhancing interaural level differences at low frequencies, based on estimates of interaural time differences, was developed and evaluated. Five conditions were compared, all using simulated hearing-aid processing: (1) Linear amplification with frequency-response shaping; (2) binaural enhancement combined with linear amplification and frequency-response shaping; (3) slow-acting four-channel amplitude compression with independent compression at the two ears (AGC4CH); (4) binaural enhancement combined with four-channel compression (BE-AGC4CH); and (5) four-channel compression but with the compression gains synchronized across ears. Ten hearing-impaired listeners were tested, and gains and compression ratios for each listener were set to match targets prescribed by the CAM2 fitting method. Stimuli were presented via headphones, using virtualization methods to simulate listening in a moderately reverberant room. The intelligibility of speech at ±60° azimuth in the presence of competing speech on the opposite side of the head at ±60° azimuth was not affected by the binaural enhancement processing. Sound localization was significantly better for condition BE-AGC4CH than for condition AGC4CH for a sentence, but not for broadband noise, lowpass noise, or lowpass amplitude-modulated noise. The results suggest that the binaural enhancement processing can improve localization for sounds with distinct envelope fluctuations.

On The (Un)importance of Working Memory in Speech-in-Noise Processing for Listeners with Normal Hearing Thresholds

With the advent of cognitive hearing science, increased attention has been given to individual differences in cognitive functioning and their explanatory power in accounting for inter-listener variability in the processing of speech in noise (SiN). The psychological construct that has received much interest in recent years is working memory. Empirical evidence indeed confirms the association between WM capacity (WMC) and SiN identification in older hearing-impaired listeners. However, some theoretical models propose that variations in WMC are an important predictor for variations in speech processing abilities in adverse perceptual conditions for all listeners, and this notion has become widely accepted within the field. To assess whether WMC also plays a role when listeners without hearing loss process speech in adverse listening conditions, we surveyed published and unpublished studies in which the Reading-Span test (a widely used measure of WMC) was administered in conjunction with a measure of SiN identification, using sentence material routinely used in audiological and hearing research. A meta-analysis revealed that, for young listeners with audiometrically normal hearing, individual variations in WMC are estimated to account for, on average, less than 2% of the variance in SiN identification scores. This result cautions against the (intuitively appealing) assumption that individual variations in WMC are predictive of SiN identification independently of the age and hearing status of the listener.

Spatial Frequency Requirements and Gaze Strategy in Visual-Only and Audiovisual Speech Perception

PURPOSE

The aim of this article is to examine the effects of visual image degradation on performance and gaze behavior in audiovisual and visual-only speech perception tasks.

METHOD

We presented vowel-consonant-vowel utterances visually filtered at a range of frequencies in visual-only, audiovisual congruent, and audiovisual incongruent conditions (Experiment 1; N = 66). In Experiment 2 (N = 20), participants performed a visual-only speech perception task and in Experiment 3 (N = 20) an audiovisual task while having their gaze behavior monitored using eye-tracking equipment.

RESULTS

In the visual-only condition, increasing image resolution led to monotonic increases in performance, and proficient speechreaders were more affected by the removal of high spatial information than were poor speechreaders. The McGurk effect also increased with increasing visual resolution, although it was less affected by the removal of high-frequency information. Observers tended to fixate on the mouth more in visual-only perception, but gaze toward the mouth did not correlate with accuracy of silent speechreading or the magnitude of the McGurk effect.

CONCLUSIONS

The results suggest that individual differences in silent speechreading and the McGurk effect are not related. This conclusion is supported by differential influences of high-resolution visual information on the 2 tasks and differences in the pattern of gaze.

Distinct neural systems recruited when speech production is modulated by different masking sounds

When talkers speak in masking sounds, their speech undergoes a variety of acoustic and phonetic changes. These changes are known collectively as the Lombard effect. Most behavioural research and neuroimaging research in this area has concentrated on the effect of energetic maskers such as white noise on Lombard speech. Previous fMRI studies have argued that neural responses to speaking in noise are driven by the quality of auditory feedback-that is, the audibility of the speaker's voice over the masker. However, we also frequently produce speech in the presence of informational maskers such as another talker. Here, speakers read sentences over a range of maskers varying in their informational and energetic content: speech, rotated speech, speech modulated noise, and white noise. Subjects also spoke in quiet and listened to the maskers without speaking. When subjects spoke in masking sounds, their vocal intensity increased in line with the energetic content of the masker. However, the opposite pattern was found neurally. In the superior temporal gyrus, activation was most strongly associated with increases in informational, rather than energetic, masking. This suggests that the neural activations associated with speaking in noise are more complex than a simple feedback response.

Multisensory signalling enhances pupil dilation

Detecting and integrating information across the senses is an advantageous mechanism to efficiently respond to the environment. In this study, a simple auditory-visual detection task was employed to test whether pupil dilation, generally associated with successful target detection, could be used as a reliable measure for studying multisensory integration processing in humans. We recorded reaction times and pupil dilation in response to a series of visual and auditory stimuli, which were presented either alone or in combination. The results indicated faster reaction times and larger pupil diameter to the presentation of combined auditory and visual stimuli than the same stimuli when presented in isolation. Moreover, the responses to the multisensory condition exceeded the linear summation of the responses obtained in each unimodal condition. Importantly, faster reaction times corresponded to larger pupil dilation, suggesting that also the latter can be a reliable measure of multisensory processes. This study will serve as a foundation for the investigation of auditory-visual integration in populations where simple reaction times cannot be collected, such as developmental and clinical populations.