Polish sentence matrix test for speech intelligibility measurement in noise

Evaluation of the American English Matrix Test with Cochlear Implant Recipients

OBJECTIVE

Currently, the variety of speech recognition tests used to evaluate cochlear implant (CI) recipients makes it difficult to compare results, especially across languages. The Matrix Test limits contextual cues and is available in multiple languages, including American English. The current study investigated test format and noise type for the American English Matrix Test (AMT) and compared results to AzBio sentence scores in adult CI recipients.

DESIGN

Fifteen experienced CI recipients were administered the AMT in fixed- and adaptive-level formats and AzBio sentences in a fixed-level format. Testing in noise used the AMT-specific noise and 4-talker babble.

RESULTS

Ceiling effects were present for all AMT fixed-level conditions and AzBio sentences in quiet. Group mean AzBio scores were poorer than AMT scores. Noise type affected performance regardless of format; 4-talker babble was more challenging.

CONCLUSIONS

The limited number of word choices in each category likely aided listeners performance for the AMT compared to AzBio sentences. The use of the AMT in the designed adaptive-level format would allow effective evaluation and comparison of CI performance internationally. A test battery with the AMT may also benefit from including AzBio sentences in 4-talker babble to reflect performance during listening challenges.

Predicting Matrix Test Effectiveness for Evaluating Auditory Performance in Noise Using Pure-Tone Audiometry and Speech Recognition in Quiet in Cochlear Implant Recipients

INTRODUCTION

Auditory performance in noise of cochlear implant recipients can be assessed with the adaptive Matrix test (MT); however, when the speech-to-noise ratio (SNR) exceeds 15 dB, the background noise has any negative impact on the speech recognition. Here, we aim to evaluate the predictive power of aided pure-tone audiometry and speech recognition in quiet and establish cut-off values for both tests that indicate whether auditory performance in noise can be assessed using the Matrix sentence test in a diffuse noise environment.

METHODS

Here, we assessed the power of pure-tone audiometry and speech recognition in quiet to predict the response to the MT. Ninety-eight cochlear implant recipients were assessed using different sound processors from Advanced Bionics (n = 56) and CochlearTM (n = 42). Auditory tests were performed at least 1 year after cochlear implantation or upgrading the sound processor to ensure the best benefit of the implant. Auditory assessment of the implanted ear in free-field conditions included: pure-tone average (PTA), speech discrimination score (SDS) in quiet at 65 dB, and speech recognition threshold (SRT) in noise that is the SNR at which the patient can correctly recognize 50% of the words using the MT in a diffuse sound field.

RESULTS

The SRT in noise was determined in 60 patients (61%) and undetermined in 38 (39%) using the MT. When cut-off values for PTA <36 dB and SDS >41% were used separately, they were able to predict a positive response to the MT in 83% of recipients; using both cut-off values together, the predictive value reached 92%.

DISCUSSION

As the pure-tone audiometry is standardized universally and the speech recognition in quiet could vary depending on the language used; we propose that the MT should be performed in recipients with PTA <36 dB, and in recipients with PTA >36 dB, a list of Matrix sentences at a fixed SNR should be presented to determine the percentage of words understood. This approach should enable clinicians to obtain information about auditory performance in noise whenever possible.

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

BACKGROUND

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

METHOD

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

CONCLUSIONS

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

Development and evaluation of the Cantonese matrix sentence test

OBJECTIVE

To develop the Cantonese matrix (YUEmatrix) test according to the international standard procedure and examine possible different outcomes in another tonal language.

DESIGN

A 50-word Cantonese base-matrix was established. Word-specific speech recognition functions, speech recognition thresholds (SRT), and slopes were obtained. The speech material was homogenised in intelligibility by applying level corrections up to ± 3 dB. Subsequently, the YUEmatrix test was evaluated in five aspects: training effect, test-list equivalence, test-retest reliability, establishment of reference data for normal-hearing Cantonese-speakers, and comparison with the Cantonese-Hearing-In-Noise-Test.

STUDY SAMPLE

Overall, 64 normal-hearing native Cantonese-speaking listeners.

RESULTS

SRT measurements with adaptive procedures resulted in a reference SRT of -9.7 ± 0.7 dB SNR for open-set and -11.1 ± 1.2 dB SNR for the closed-set response format. Fixed SNR measurements suggested a test-specific speech intelligibility function slope of 15.5 ± 0.7%/dB. Seventeen 10-sentences base test lists were confirmed to be equivalent with respect to speech intelligibility. Training effect was not observed after two measurements of 20-sentences lists.

CONCLUSIONS

The YUEmatrix yields comparable results to matrix tests in other languages including Mandarin. Level adjustments to homogenise sentences appear to be less effective for tonal languages than for most other languages developed so far.

Speech Understanding in Manic and Depressive Episodes of Mood Disorders

OBJECTIVE

The aim of this study was to assess the perception of speech in adverse acoustic conditions during manic and depressive episodes of mood disorders.

METHODS

Forty-three patients with bipolar disorder (mania, N=20; depression, N=23) and 32 patients with unipolar depression were included for analyses. Thirty-five participants served as the control group. The study of speech understanding was carried out using the Polish Sentence Matrix Test, allowing for the determination of the speech reception threshold (SRT). The test was performed in the clinical groups both during an acute episode and remission; during remission, patients underwent audiometric evaluation.

RESULTS

Compared with control subjects, patients with mood disorders had worse speech understanding (higher SRT), regardless of the episode or remission. A manic episode in the course of bipolar disorder was not associated with worse speech understanding compared with remission of mania. However, an episode of depression in the course of both bipolar disorder and unipolar depression was associated with worse speech understanding compared with remission of depression. In bipolar depression, this correlated with age, duration of the disorder, number of episodes, and number of hospitalizations, as well as in remission with age and duration of illness. In unipolar depression, poor speech understanding was more severe in individuals with hearing impairment.

CONCLUSIONS

These findings revealed that patients with mood disorders had impaired speech understanding, even while in remission, and manic episodes in the course of bipolar disorder were not associated with impaired speech understanding compared with mania remission.

The Effect of Age, Type of Noise, and Cochlear Implants on Adaptive Sentence-in-Noise Task

Adaptive tests of sentences in noise mimic the challenge of daily listening situations. The aims of the present study were to validate an adaptive version of the HeBio sentence test on normal hearing (NH) adults; to evaluate the effect of age and type of noise on speech reception threshold in noise (SRTn); and to test it on prelingual adults with cochlear implants (CI). In Experiment 1, 45 NH young adults listened to two lists accompanied by four-talker babble noise (4TBN). Experiment 2 presented the sentences amidst 4TBN or speech-shaped noise (SSN) to 80 participants in four age groups. In Experiment 3, 18 CI adult users with prelingual bilateral profound hearing loss performed the test amidst SSN, along with HeBio sentences and monosyllabic words in quiet and forward digits span. The main findings were as follows: SRTn for NH participants was normally distributed and had high test–retest reliability; SRTn was lower among adolescents and young adults than middle-aged and older adults, and were better for SSN than 4TBN; SRTn for CI users was higher and more variant than for NH and correlated with speech perception tests in quiet, digits span, and age at first CI. This suggests that the adaptive HeBio can be implemented in clinical and research settings with various populations.

The Oticon Ponto System in Adults With Severe-to-Profound and Mixed Hearing Loss: Audiologic Outcomes and Patient Satisfaction

OBJECTIVE

To measure audiologic outcomes and self-assessed satisfaction with the Ponto system in a group of patients who had severe to profound and mixed hearing loss.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Sixteen patients aged 21 to 74 years with severe-to-profound and mixed hearing loss (bone conduction thresholds, ≥45 dB HL).

INTERVENTIONS

Ponto implant surgery.

MAIN OUTCOME MEASURES

Pure-tone audiometry, free-field hearing thresholds, effective gain, word recognition score in quiet, and speech reception threshold (SRT) in noise were assessed. Patient-reported outcomes were collected using the Clinical Global Impression Scale, Glasgow Benefit Inventory, and Abbreviated Profile of Hearing Aid Benefit. Information concerning any medical complications was also gathered.

RESULTS

Both word recognition score and SRT were significantly better after 12 months compared with before surgery. At normal speech level (65 dB SPL), 12 of 16 users had speech discrimination ≥70%. However, at the 12-month follow-up, the average effective gain was -6.2 dB. In general, the self-report outcomes showed good satisfaction in most patients. Postoperatively, skin complications were noted in six patients, of whom two underwent reoperation. All patients were still using the Ponto after an average observation time of 2.7 years.

CONCLUSION

Although skin complications were not uncommon, the Ponto system seems to be an effective method of improving hearing performance and provides subjective satisfaction in real-life situations in patients with severe-to-profound and mixed hearing loss. However, considering the significantly increased bone conduction thresholds and the risk of their further deterioration, long-term follow-up is still needed.

Evaluation of Remote Check: A Clinical Tool for Asynchronous Monitoring and Triage of Cochlear Implant Recipients

BACKGROUND

A new Remote Check App permits remote self-testing of hearing function for Nucleus cochlear implant (CI) recipients and enables asynchronous review by their clinician to support patient-management decisions.

OBJECTIVES

To evaluate the Remote Check App for: (1) ease of use; (2) overall acceptance of the test battery by CI recipient or their carer in the home setting; (3) test-retest reliability of audiological threshold and speech recognition measures via wireless streaming; and (4) to compare outcomes from patient-driven measures with conventional clinician-driven measurements of aided-hearing function.

DESIGN

Single-site, prospective, repeated-measures cohort study with 32 experienced CI users (28 adults and 4 children).

METHODS

Participants completed self-testing using the Remote Check app at home and in the clinic. Measures include audiological, objective and subjective tests. Self-administered speech recognition in noise, via the digit triplets test (DTT) and aided thresholds, via the aided threshold test (ATT) were reassessed in free-field and by clinicians following conventional clinical protocols. Results of ATT and DTT were compared across test conditions. Completion time and perceived ease of self-driven assessments were documented. Insights from subsequent real-world experience with Remote Check are summarized and compared to the study findings.

RESULTS

Remote Check was rated as easy to use by the majority (87%) of subjects. Mean group test-retest score differences for self-administered testing within the clinic versus at-home environments were nonsignificant (p > 0.05): 1.4 dB (SD = 1.97) for ATT and 1.6 dB (SD = 1.54) for DTT. Mean group test-retest score difference for patient-driven DTT in streamed versus the free-field condition was 1.8 dB (SD = 2.02). Self-administered, streamed, ATT via Remote Check, resulted in significantly lower thresholds compared to clinician-driven warble-tone thresholds in the free-field by 6.7 dB (SD = 6.8) (p < 0.001). ATT thresholds via Remote Check were not significantly different from predicted thresholds based on the Threshold Sound Pressure Level of the sound processor.

CONCLUSION

Remote Check is the first CI telehealth assessment tool that uses wireless streaming to enable comprehensive, easy and reliable self-testing of hearing function by the CI recipient or their carer, in the comfort of their home. Asynchronous access to test results can assist clinicians in monitoring and triaging individuals for appropriate patient-management based on their needs. Use of remote monitoring may also help to reduce the burden of unnecessary clinic visits on clinic resources, patient travel time and associated costs. Remote Check is an important step toward addressing the current growing need for asynchronous audiological telepractice to support long-term care of CI recipients.

Evaluation of Speech Recognition Skills in Different Noises with the Turkish Matrix Sentence Test in Hearing Aid Users

Objective:

This study aimed to analyze the effectiveness of the Turkish matrix sentence test in evaluating the speech recognition performance of hearing aid users under different noise conditions.

Methods:

Speech recognition performance of 42 individuals, 20 to 65 years of age (mean 49.1±14 years) with bilateral sensorineural hearing loss was measured in noise with the Turkish matrix sentence test without a background noise and with headphones. Additionally, the participants’ speech recognition thresholds were measured with a matrix test while wearing their hearing aid under three different listening conditions in which the phases of speech and noise stimuli were changed with constant and fluctuating noise.

Results:

Speech-recognition thresholds were better in fluctuating noise than in constant noise in all listening conditions, and this difference was statistically significant (p=0.02). In both types of noise, speech-recognition thresholds of bilateral hearing aid users (n=29) were lower (better) than those of unilateral hearing aid users (n=13) under three different listening conditions, but there was no statistically significant difference (p=0.67). Speech-recognition thresholds without hearing aids were statistically higher (worse) than those obtained with hearing aids (p=0.001).

Conclusion:

Since the Turkish matrix sentence test gives useful results, this test can be used in the diagnosis, follow-up, and rehabilitation planning of hearing aid users. We observed that speech intelligibility was better, although there were differences among those with hearing loss when the speech test was conducted in fluctuating background noise with the Turkish matrix sentence test.

Implantation of the Bonebridge BCI 602 after Mastoid Obliteration with S53P4 Bioactive Glass: A Safe Method of Treating Difficult Anatomical Conditions-Preliminary Results

This study presents the preliminary results of a new otosurgical method in patients after canal wall down (CWD) surgery; it involves the implantation of the Bonebridge BCI 602 implant after obliteration of the mastoid cavity with S53P4 bioactive glass. The study involved eight adult patients who had a history of chronic otitis media with cholesteatoma in one or both ears and who had had prior radical surgery. The mean follow-up period was 12 months, with routine follow-up visits according to the schedule. The analysis had two aspects: a surgical aspect in terms of healing, development of bacterial flora, the impact on the inner ear or labyrinth, recurrence of cholesteatoma, and possible postoperative complications (firstly, after obliteration of the mastoid cavity with S53P4 bioactive glass, then after implantation). The second was an audiological aspect which assessed audiometric results and the patient’s satisfaction based on questionnaires. During the follow-up period, we did not notice any serious postoperative complications. Studies demonstrated significantly improved hearing thresholds and speech recognition in quiet and noise using the Bonebridge BCI 602. Data collected after six months of use showed improved audiological thresholds and patient satisfaction. Based on the preliminary results, we believe that the proposed two-stage surgical method using bioactive glass S53P4 is a safe and effective way of implanting the Bonebridge BCI 602 in difficult anatomical conditions. This makes it possible to treat a larger group of patients with the device.

Multicenter Clinical Investigation of a New Active Osseointegrated Steady-State Implant System

Objective:

A new active transcutaneous bone conduction hearing implant system that uses piezoelectric technology has been developed: an active osseointegrated steady-state implant system (OSI). This was the first clinical investigation undertaken to demonstrate clinical performance, safety, and benefit of the new implant system.

Study Design and Setting:

A multicenter prospective within-subject clinical investigation was conducted.

Patients:

Fifty-one adult subjects with mixed and conductive hearing loss (MHL/CHL, n = 37) and single-sided sensorineural deafness (SSD, n = 14) were included.

Main Outcome Measure:

Audiological evaluations included audiometric thresholds, speech recognition in noise, and quiet. Hearing and health-related patient-reported outcomes (PROs; health utilities index [HUI], abbreviated profile of hearing aid benefit [APHAB], and speech, spatial of qualities of hearing scale [SSQ]), daily use, surgical and safety parameters were collected.

Results:

Intra- and postoperative complications were few. One implant was removed before activation due to post-surgical infection. Compared with the preoperative softband tests, a significant improvement in speech recognition-in-noise was observed in the MHL/CHL group (–7.3 dB, p ≤ 0.0001) and the SSD group (–8.1 dB, p = 0.0008). In quiet, word recognition improved in the MHL/CHL group, most markedly at lower intensity input of 50 dB SPL (26.7%, p ≤ 0.0001). The results of all PROs showed a significant improvement with the new device compared with preoperative softband in the MHL/CHL group. In the SSD group significant improvements were observed in the APHAB and SSQ questionnaires.

Discussion:

The results confirmed the clinical safety, performance, and benefit of this new treatment modality for subjects with CHL, MHL, and SSD.

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

A Comparative Study of a Novel Adhesive Bone Conduction Device and Conventional Treatment Options for Conductive Hearing Loss

Objective:

To compare the audiological performance with the novel adhesive bone conduction hearing device (ADHEAR) to that with a passive bone conduction (BC) implant and to that with a bone conduction device (BCD) on a softband.

Study Design:

Prospective study in an acute setting, single-subject repeated measure in three situations: unaided, with conventional BCDs (passive implant or on softband), and with the ADHEAR.

Setting:

Tertiary referral center.

Patients:

Ten subjects with conductive hearing loss were evaluated with the ADHEAR. Five of these were users of a passive BC implant (Baha Attract with Baha4); five received a BCD (Baha4) on a softband for test purposes.

Intervention:

Use of non-invasive adhesive bone conduction system for the treatment of conductive hearing loss.

Main Outcome Measures:

Air and bone conduction thresholds, sound field thresholds, word recognition scores in quiet, and speech recognition thresholds in quiet and noise were assessed.

Results:

Users of the passive BC implant received comparable hearing benefit with the ADHEAR. The mean aided thresholds in sound field measurements and speech understanding in quiet and noise were similar, when subjects were evaluated either with the ADHEAR or the passive BC implant. The audiological outcomes for the non-implanted group were also comparable between the ADHEAR and the BCD on softband.

Conclusions:

Based on our initial data, the ADHEAR seems to be a suitable alternative for patients who need a hearing solution for conductive hearing loss but for medical reasons cannot or do not want to undergo surgery for a passive BC implant.

The long-term learning effect related to the repeated use of the Finnish matrix sentence test and the Finnish digit triplet test

Objectives: To assess are there learning-related improvements in the speech reception thresholds (SRTs) for the Finnish matrix sentence test (FMST) and the Finnish digit triplet test (FDTT) in repeated use over 12 months.Design: Test sessions were scheduled at 0, 1, 3, 6 and 12 months, and each session included five FMST measurements and four FDTT measurements. The within-session and inter-session improvements in SRTs were analysed with a linear mixed model.Study sample: Fifteen young normal-hearing participants.Results: Statistically significant mean improvements of 2.0 dB SNR and 1.2 dB SNR were detected for the FMST and the FDTT, respectively, over the 12-month follow-up period. For the FMST, majority of the improvement occurred during the first two test sessions. For the FDTT, statistically significant differences were detected only in comparison to the first test session and to the first test measurement of every session over the 12-month follow-up.Conclusions: Repeated use of the FMST led to significant learning-related improvements, but the improvements appeared to plateau by the third test session. For the FDTT, the overall improvements were smaller, but a significant within-session difference between the first and consecutive FDTT measurements persisted throughout the test sessions.

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.

Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: Six-month results from a multicentre study

OBJECTIVES

To compare the hearing performance of patients with conductive and mild mixed hearing loss and single-sided sensorineural deafness provided with a new transcutaneous bone conduction hearing implant (the Baha Attract System) with unaided hearing as well as aided with a sound processor on a softband. Furthermore, to evaluate safety and subjective benefit before and after implantation of the test device.

PARTICIPANTS

Fifty-four adult patients in five participating centres were enrolled in this prospective study. Baseline data were collected during a pre-operative visit, and after a softband trial, all patients were implanted unilaterally. Follow-up visits were scheduled at 10 days, 4, 6, 12 weeks and 6 months.

MAIN OUTCOME MEASURES

Free-field hearing thresholds pure-tone average (PTA4 in dB HL; mean threshold at 500, 1000, 2000, 4000 Hz; primary outcome measure). Individual free-field hearing thresholds, speech recognition in quiet and in noise, soft tissue status during follow-up and subjective benefit as measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB), Speech, Spatial and Qualities of Hearing Scale (SSQ) and Health Utilities Index (HUI) questionnaires.

RESULTS

Implantation of the Baha Attract System resulted in favourable audiological outcomes compared to unaided conditions. On the primary outcome parameter, a statistically significant improvement was observed compared to unaided hearing for the patients with conductive/mixed hearing loss (mean PTA4 difference -20.8 dB HL, SD 9.8; P < 0.0001) and for the patients with single-sided sensorineural deafness (SSD) (mean PTA4 difference -21.6 dB HL, SD 12.2; P < 0.0001). During all audiology tests, the non-test ear was blocked. Statistically significant improvements were also recorded in speech tests in quiet and noise compared to unaided hearing for the conductive/mixed hearing loss group and for speech in quiet in the SSD group. Compared to the pre-operative measurement with softband, no significant differences were recorded in the PTA4 free-field hearing threshold or the other audiological outcomes in either of the groups (P > 0.05). Soft tissue-related issues observed during follow-up included numbness, pain/discomfort at the implant site and to a lesser extent pressure-related skin complications. A declining trend was noted in the rate of these complications during follow-up. Approximately 20% of patients reported some degree of numbness and 38% (slight) pain/discomfort at final follow-up of 6 months. Good results on the subjective benefit questionnaires were observed, with statistically significant improvements on APHAB and SSQ questionnaires, and on the hearing attribute of HUI3.

CONCLUSIONS

The Baha Attract System provided a significant improvement in hearing performance and subjective benefit compared to the pre-operative unaided condition (with the non-test ear blocked). Hearing performance of the Baha Attract was similar to a test situation with the same sound processor on a softband. A proportion of the patients reported numbness and pain/discomfort at the implant site during follow-up, especially during the first post-operative weeks. Based on the results of the current multicentre study, the Baha Attract can be considered as a treatment option for patients with the aforementioned hearing losses. Especially in the SSD patients, a careful selection procedure is warranted. Therefore, a pre-operative trial should be part of the decision-making process before fitting a patient with the Baha Attract System.

The Effects of Intensive Speech Treatment on Conversational Intelligibility in Spanish Speakers With Parkinson's Disease

PURPOSE

The purpose of this study was to examine the effects of intensive speech treatment on the conversational intelligibility of Castilian Spanish speakers with Parkinson's disease (PD), as well as on the speakers' self-perceptions of disability.

METHOD

Fifteen speakers with a medical diagnosis of PD participated in this study. Speech recordings were completed twice before treatment, immediately posttreatment, and at a 1-month follow-up session. Conversational intelligibility was assessed in 2 ways-transcription accuracy scores and intelligibility ratings on a 9-point Likert scale. The Voice Handicap Index (Núñez-Batalla et al., 2007) was administered as a measure of self-perceived disability.

RESULTS

Group data revealed that transcription accuracy and median ease-of-understanding ratings increased significantly immediately posttreatment, with gains maintained at the 1-month follow-up. The functional subscale of the Voice Handicap Index decreased significantly posttreatment, suggesting a decrease in perceived communication disability after speech treatment.

CONCLUSION

These findings support the implementation of intensive voice treatment to improve conversational intelligibility in Spanish speakers with PD with dysarthria as well as to improve the speakers' perception of their daily communicative capabilities. Clinical and theoretical considerations are discussed.

The development and validation of the Closed-set Mandarin Sentence (CMS) test

Matrix-styled sentence tests offer a closed-set paradigm that may be useful when evaluating speech intelligibility. Ideally, sentence test materials should reflect the distribution of phonemes within the target language. We developed and validated the Closed-set Mandarin Sentence (CMS) test to assess Mandarin speech intelligibility in noise. CMS test materials were selected to be familiar words and to represent the natural distribution of vowels, consonants, and lexical tones found in Mandarin Chinese. Ten key words in each of five categories (Name, Verb, Number, Color, and Fruit) were produced by a native Mandarin talker, resulting in a total of 50 words that could be combined to produce 100,000 unique sentences. Normative data were collected in 10 normal-hearing, adult Mandarin-speaking Chinese listeners using a closed-set test paradigm. Two test runs were conducted for each subject, and 20 sentences per run were randomly generated while ensuring that each word was presented only twice in each run. First, the level of the words in each category were adjusted to produce equal intelligibility in noise. Test-retest reliability for word-in-sentence recognition was excellent according to Cronbach's alpha (0.952). After the category level adjustments, speech reception thresholds (SRTs) for sentences in noise, defined as the signal-to-noise ratio (SNR) that produced 50% correct whole sentence recognition, were adaptively measured by adjusting the SNR according to the correctness of response. The mean SRT was -7.9 (SE=0.41) and -8.1 (SE=0.34) dB for runs 1 and 2, respectively. The mean standard deviation across runs was 0.93 dB, and paired t-tests showed no significant difference between runs 1 and 2 (p=0.74) despite random sentences being generated for each run and each subject. The results suggest that the CMS provides large stimulus set with which to repeatedly and reliably measure Mandarin-speaking listeners' speech understanding in noise using a closed-set paradigm.

[The Russian-language version of the matrix test (RUMatrix) in free field in patients after cochlear implantation in the long term]

The deterioration of speech intelligibility in the patients using cochlear implantation (CI) systems is especially well apparent in the noisy environment. It explains why phrasal speech tests, such as a Matrix sentence test, have become increasingly more popular in the speech audiometry during rehabilitation after CI. The Matrix test allows to estimate speech perception by the patients in a real life situation. The objective of this study was to assess the effectiveness of audiological rehabilitation of CI patients using the Russian-language version of the matrix test (RUMatrix) in free field in the noisy environment. 33 patients aged from 5 to 40 years with a more than 3 year experience of using cochlear implants inserted at the National Research Center for Audiology and Hearing Rehabilitation were included in our study. Five of these patients were implanted bilaterally. The results of our study showed a statistically significant improvement of speech intelligibility in the noisy environment after the speech processor adjustment; dynamics of the signal-to-noise ratio changes was -1.7 dB (p<0.001).

CONCLUSION

The RUMatrix test is a highly efficient method for the estimation of speech intelligibility in the patients undergoing clinical investigations in the noisy environment. The high degree of comparability of the RUMatrix test with the Matrix tests in other languages makes possible its application in international multicenter studies.

Simulated Critical Differences for Speech Reception Thresholds

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Normal and Time-Compressed Speech

Short-term and long-term learning effects were investigated for the German Oldenburg sentence test (OLSA) using original and time-compressed fast speech in noise. Normal-hearing and hearing-impaired participants completed six lists of the OLSA in five sessions. Two groups of normal-hearing listeners (24 and 12 listeners) and two groups of hearing-impaired listeners (9 listeners each) performed the test with original or time-compressed speech. In general, original speech resulted in better speech recognition thresholds than time-compressed speech. Thresholds decreased with repetition for both speech materials. Confirming earlier results, the largest improvements were observed within the first measurements of the first session, indicating a rapid initial adaptation phase. The improvements were larger for time-compressed than for original speech. The novel results on long-term learning effects when using the OLSA indicate a longer phase of ongoing learning, especially for time-compressed speech, which seems to be limited by a floor effect. In addition, for normal-hearing participants, no complete transfer of learning benefits from time-compressed to original speech was observed. These effects should be borne in mind when inviting listeners repeatedly, for example, in research settings.

Development and evaluation of the Turkish matrix sentence test

OBJECTIVES

The Turkish matrix sentence test, TURMatrix, was developed for precise, internationally comparable speech intelligibility testing.

DESIGN

The TURMatrix comprises a base matrix of ten well-known Turkish names, numbers, adjectives, objects, verbs, from which syntactically fixed sentences were randomly composed. Test conduction may be in an open-set (standard), or closed-set response format. Homogeneity in intelligibility of the test material was optimized by applying level adaptations (maximal ± 3 dB) based on word-specific speech reception thresholds (SRTs). Test list equivalence was verified and reference values were determined.

STUDY SAMPLE

Thirty-eight native listeners of Turkish with normal hearing.

RESULTS

After training, mean SRT and slope of the final test lists were -8.3 ± 0.2 dB SNR and 14.1 ± 1.0%/dB, respectively (fixed SNR measurements; inter-list variability). For adaptive measurements, average across listeners was -7.2 ± 0.7 dB SNR in the open-set and -7.9 ± 0.7 dB SNR in the closed-set response format. Mean SRT for adaptive measurements in the open-set response format in quiet was 20.3 ± 4.1 dB. Individual SRTs in quiet correlated more closely with audiograms than with SRTs in noise.

CONCLUSIONS

The TURMatrix was developed according to European standards and provides reliable speech intelligibility measurements in noise and quiet.

Relationship Between Speech Intelligibility and Speech Comprehension in Babble Noise

PURPOSE

The authors investigated the relationship between the intelligibility and comprehension of speech presented in babble noise.

METHOD

Forty participants listened to French imperative sentences (commands for moving objects) in a multitalker babble background for which intensity was experimentally controlled. Participants were instructed to transcribe what they heard and obey the commands in an interactive environment set up for this purpose. The former test provided intelligibility scores and the latter provided comprehension scores.

RESULTS

Collected data revealed a globally weak correlation between intelligibility and comprehension scores (r = .35, p < .001). The discrepancy tended to grow as noise level increased. An analysis of standard deviations showed that variability in comprehension scores increased linearly with noise level, whereas higher variability in intelligibility scores was found for moderate noise level conditions.

CONCLUSION

These results support the hypothesis that intelligibility scores are poor predictors of listeners' comprehension in real communication situations. Intelligibility and comprehension scores appear to provide different insights, the first measure being centered on speech signal transfer and the second on communicative performance. Both theoretical and practical implications for the use of speech intelligibility tests as indicators of speakers' performances are discussed.

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

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

Audiovisual integration in children listening to spectrally degraded speech

PURPOSE

The study explored whether visual information improves speech identification in typically developing children with normal hearing when the auditory signal is spectrally degraded.

METHOD

Children (n=69) and adults (n=15) were presented with noise-vocoded sentences from the Children's Co-ordinate Response Measure (Rosen, 2011) in auditory-only or audiovisual conditions. The number of bands was adaptively varied to modulate the degradation of the auditory signal, with the number of bands required for approximately 79% correct identification calculated as the threshold.

RESULTS

The youngest children (4- to 5-year-olds) did not benefit from accompanying visual information, in comparison to 6- to 11-year-old children and adults. Audiovisual gain also increased with age in the child sample.

CONCLUSIONS

The current data suggest that children younger than 6 years of age do not fully utilize visual speech cues to enhance speech perception when the auditory signal is degraded. This evidence not only has implications for understanding the development of speech perception skills in children with normal hearing but may also inform the development of new treatment and intervention strategies that aim to remediate speech perception difficulties in pediatric cochlear implant users.

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

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

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

Variations in the slope of the psychometric functions for speech intelligibility: a systematic survey

Although many studies have looked at the effects of different listening conditions on the intelligibility of speech, their analyses have often concentrated on changes to a single value on the psychometric function, namely, the threshold. Far less commonly has the slope of the psychometric function, that is, the rate at which intelligibility changes with level, been considered. The slope of the function is crucial because it is the slope, rather than the threshold, that determines the improvement in intelligibility caused by any given improvement in signal-to-noise ratio by, for instance, a hearing aid. The aim of the current study was to systematically survey and reanalyze the psychometric function data available in the literature in an attempt to quantify the range of slope changes across studies and to identify listening conditions that affect the slope of the psychometric function. The data for 885 individual psychometric functions, taken from 139 different studies, were fitted with a common logistic equation from which the slope was calculated. Large variations in slope across studies were found, with slope values ranging from as shallow as 1% per dB to as steep as 44% per dB (median = 6.6% per dB), suggesting that the perceptual benefit offered by an improvement in signal-to-noise ratio depends greatly on listening environment. The type and number of maskers used were found to be major factors on the value of the slope of the psychometric function while other minor effects of target predictability, target corpus, and target/masker similarity were also found.

Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments

OBJECTIVE

The aim of this study was to assess the benefit of having preserved acoustic hearing in the implanted ear for speech recognition in complex listening environments.

DESIGN

The present study included a within-subjects, repeated-measures design including 21 English-speaking and 17 Polish-speaking cochlear implant (CI) recipients with preserved acoustic hearing in the implanted ear. The patients were implanted with electrodes that varied in insertion depth from 10 to 31 mm. Mean preoperative low-frequency thresholds (average of 125, 250, and 500 Hz) in the implanted ear were 39.3 and 23.4 dB HL for the English- and Polish-speaking participants, respectively. In one condition, speech perception was assessed in an eight-loudspeaker environment in which the speech signals were presented from one loudspeaker and restaurant noise was presented from all loudspeakers. In another condition, the signals were presented in a simulation of a reverberant environment with a reverberation time of 0.6 sec. The response measures included speech reception thresholds (SRTs) and percent correct sentence understanding for two test conditions: CI plus low-frequency hearing in the contralateral ear (bimodal condition) and CI plus low-frequency hearing in both ears (best-aided condition). A subset of six English-speaking listeners were also assessed on measures of interaural time difference thresholds for a 250-Hz signal.

RESULTS

Small, but significant, improvements in performance (1.7-2.1 dB and 6-10 percentage points) were found for the best-aided condition versus the bimodal condition. Postoperative thresholds in the implanted ear were correlated with the degree of electric and acoustic stimulation (EAS) benefit for speech recognition in diffuse noise. There was no reliable relationship among measures of audiometric threshold in the implanted ear nor elevation in threshold after surgery and improvement in speech understanding in reverberation. There was a significant correlation between interaural time difference threshold at 250 Hz and EAS-related benefit for the adaptive speech reception threshold.

CONCLUSIONS

The findings of this study suggest that (1) preserved low-frequency hearing improves speech understanding for CI recipients, (2) testing in complex listening environments, in which binaural timing cues differ for signal and noise, may best demonstrate the value of having two ears with low-frequency acoustic hearing, and (3) preservation of binaural timing cues, although poorer than observed for individuals with normal hearing, is possible after unilateral cochlear implantation with hearing preservation and is associated with EAS benefit. The results of this study demonstrate significant communicative benefit for hearing preservation in the implanted ear and provide support for the expansion of CI criteria to include individuals with low-frequency thresholds in even the normal to near-normal range.

An algorithm that administers adaptive speech-in-noise testing to a specified reliability at selectable points on the psychometric function

OBJECTIVE

To introduce and verify an algorithm designed to administer adaptive speech-in- noise testing to a specified reliability at selectable points on the psychometric function.

DESIGN

Speech-in-noise performances were measured using BKB sentences presented in diffuse babble-noise, using morphemic scoring. Target of the algorithm was a test-retest standard deviation of 1.13 dB within the presentation of 32 sentences. Normal-hearing participants completed repeated measures using manual administration targeting 50% correct, and the automated procedure targeting 25%, 50%, and 75% correct. Aided hearing-impaired participants completed testing with the automated procedure targeting 25%, 50%, and 75% correct, repeating measurements at the 50% point three times.

STUDY SAMPLE

Twelve normal-hearing and 63 hearing-impaired people who had English as first language.

RESULTS

Relative to the manual procedure, the algorithm produced the same speech reception threshold in noise (p = 0.96) and lower test-retest reliability on normal-hearing listeners. Both groups obtained significantly different results at the three target points (p < 0.04) with observed reliability close to expected. Target accuracy was not reached within 32 sentences for 18% of measurements on hearing-impaired participants.

CONCLUSIONS

The reliability of the algorithm was verified. A second test is recommended if the target variability is not reached during the first measurement.

Speech-in-Noise Tests for Multilingual Hearing Screening and Diagnostics1

Purpose

New complementary multilingual speech-in-noise tests in Russian, Turkish, and Spanish for hearing self-screening purposes and follow-up hearing diagnostics are compared to the speech tests of the European project, HearCom (Hearing in the Communication Society).

Method

The tests consist of spoken numbers (Digit Triplet Test; Smits, Kapteyn, & Houtgast, 2004) or sentences (Matrix Test; e.g., Hagerman, 1982) presented in a background noise and estimate the speech reception threshold, which is the signal-to-noise ratio that yields 50% speech intelligibility. All tests were developed according to the HearCom minimum quality standards for speech intelligibility tests. This report presents a cross-language comparison of reference speech intelligibility functions for monaural headphone measurements with normal-hearing listeners. The same model function was employed to describe the speech intelligibility functions for all of the tests.

Results

Reference speech intelligibility functions of the new versions of the Digit Triplet Test and Matrix Test show high comparability to the HearCom tests. In order to achieve the highest possible comparability across languages, language- and speaker-dependent factors in speech intelligibility should be compensated for.

Conclusion

To date, several complementary tests for screening and diagnostics have been developed in several languages. Adhering to the HearCom standards, the tests are highly comparable across languages. For the Matrix Test, equal syntax and linguistic complexity were maintained across languages due to common methodological standards.

Methods of improving speech intelligibility for listeners with hearing resolution deficit

Methods developed for real-time time scale modification (TSM) of speech signal are presented. They are based on the non-uniform, speech rate depended SOLA algorithm (Synchronous Overlap and Add). Influence of the proposed method on the intelligibility of speech was investigated for two separate groups of listeners, i.e. hearing impaired children and elderly listeners. It was shown that for the speech with average rate equal to or higher than 6.48 vowels/s, all of the proposed methods have statistically significant impact on the improvement of speech intelligibility for hearing impaired children with reduced hearing resolution and one of the proposed methods significantly improves comprehension of speech in the group of elderly listeners with reduced hearing resolution.

VIRTUAL SLIDES

http://www.diagnosticpathology.diagnomx.eu/vs/2065486371761991.