The acceptance of background noise in adult cochlear implant users.

PURPOSE: The purpose of this study was to determine (a) if acceptable noise levels (ANLs) are different in cochlear implant (CI) users than in listeners with normal hearing, (b) if ANLs are related to sentence reception thresholds in noise in CI users, and (c) if ANLs and subjective outcome measures are related in CI users. METHOD: ANLs and the Hearing in Noise Test (HINT; M. Nilsson, S. Soli, & J. Sullivan, 1994) were examined in 9 adult CI users and 15 adult listeners with normal hearing. In addition, the Abbreviated Profile of Hearing Aid Benefit (APHAB; R. M. Cox & G. C. Alexander, 1995) and a satisfaction questionnaire were administered to CI users only. RESULTS: Results indicated that (a) ANLs were not significantly different for CI users and listeners with normal hearing, (b) ANLs were not correlated with HINT values for either group, (c) ANL was not significantly correlated with APHAB scores, and (d) ANL was significantly correlated with overall CI benefit on the satisfaction questionnaire. CONCLUSIONS: CI users with large ANLs reported more benefit from implants than those with small ANLs. The results of this preliminary study of ANL in CI users suggest that ANL can be used as a tool for evaluating processing in noise in individual CI users.     

Acceptable noise level as a predictor of hearing aid use

Acceptable noise level (ANL) measures a listener's reaction to background noise while listening to speech. Relations among hearing aid use and ANL, speech in noise (SPIN) scores, and listener characteristics (age, gender, pure-tone average) were investigated in 191 listeners with hearing impairment. Listeners were assigned to one of three groups based on patterns of hearing aid use: full-time use (whenever hearing aids are needed), part-time use (occasional use), or nonuse. Results showed that SPIN scores and listener characteristics were not related to ANL or hearing aid use. However, ANLs were related to hearing aid use. Specifically, full-time hearing aid users accepted more background noise than part-time users or nonusers, yet part-time users and nonusers could not be differentiated. Thus, a prediction of hearing aid use was examined by comparing part-time users and nonusers (unsuccessful hearing aid users) with full-time users (successful hearing aid users). Regression analysis determined that unaided ANLs could predict a listener's success of hearing aids with 85% accuracy.     

Acceptance of noise growth patterns in hearing aid users.

PURPOSE: To examine whether the effects of speech presentation level on acceptance of noise could differentiate full-time, part-time, and nonusers of hearing aids and whether these effects could predict hearing aid use. METHOD: Participants were separated into 3 groups on the basis of hearing aid use: (a) full-time use, (b) part-time use, or (c) nonuse. Acceptable noise levels (ANLs) were measured conventionally and at 8 fixed presentation levels. The effects of presentation level on ANL were determined by calculating global ANL (ANL averaged across presentation level) and ANL growth (slope of the ANL function). RESULTS: Global ANLs were smaller for full-time users than for part-time users and nonusers; however, global ANLs were not different for part-time users and nonusers. ANL growth differentiated full-time users from nonusers only. Conventional ANL predicted hearing aid use with 68% accuracy. Compared with conventional ANL, the accuracy of the prediction for global ANL and ANL growth decreased, and the accuracy of the prediction at presentation levels of 65 to 75 dB HL was maintained. CONCLUSIONS: Global ANL differentiated the hearing aid groups in the same manner as conventional ANL. The effects of presentation level on acceptance of noise did not considerably increase the accuracy of the prediction compared with conventional ANL. Clinical applications are discussed.     

The effects of speech presentation level on acceptance of noise in listeners with normal and impaired hearing.

PURPOSE: To compare the effects of speech presentation level on acceptance of noise in listeners with normal and impaired hearing. METHOD: Participants were listeners with normal (n = 24) and impaired (n = 46) hearing who were matched for conventional acceptable noise level (ANL). ANL was then measured at 8 fixed speech presentation levels (40, 45, 50, 55, 60, 65, 70, and 75 dB HL) to determine if global ANL (i.e., ANL averaged across speech presentation levels) or ANL growth (i.e., the slope of the ANL function) varied between groups. RESULTS: The effects of speech presentation level on acceptance of noise were evaluated using global ANLs and ANL growth. Results showed global ANL and ANL growth were not significantly different for listeners with normal and impaired hearing, and neither ANL measure was related to pure-tone average for listeners with impaired hearing. Additionally, conventional ANLs were significantly correlated with both global ANLs and ANL growth for all listeners. CONCLUSION: These results indicate that the effects of speech presentation level on acceptance of noise are not related to hearing sensitivity. These results further indicate that a listener's conventional ANL was related to his or her global ANL and ANL growth.     

Comparison of speech perception in background noise with acceptance of background noise in aided and unaided conditions.

Background noise is a significant factor influencing hearing-aid satisfaction and is a major reason for rejection of hearing aids. Attempts have been made by previous researchers to relate the use of hearing aids to speech perception in noise (SPIN), with an expectation of improved speech perception followed by an increased acceptance of hearing aids. Unfortunately, SPIN was not related to hearing-aid use or satisfaction. A new measure of listener reaction to background noise has been proposed. The acceptable noise level (ANL), expressed in decibels, is defined as a difference between the most comfortable listening level for speech and the highest background noise level that is acceptable when listening to and following a story. The ANL measure assumes that speech understanding in noise may not be as important as is the willingness to listen in the presence of noise. It has been established that people who accept background noise have smaller ANLs and tend to be "good" users of hearing aids. Conversely, people who cannot accept background noise have larger ANLs and may only use hearing aids occasionally or reject them altogether. Because this is a new measure, it was important to determine the reliability of the ANL over time with and without hearing aids, to determine the effect of acclimatization to hearing aids, and to compare the ANL to well-established measures such as speech perception scores collected with the SPIN test. Results from 50 listeners indicate that for both good and occasional hearing aid users, the ANL is comparable in reliability to the SPIN test and that both measures do not change with acclimatization. The ANLs and SPIN scores are unrelated. Although the SPIN scores improve with amplification, the ANLs are unaffected by amplification, suggesting that the ANL is inherent to an individual and can be established prior to hearing aid fitting as a possible predictor of hearing-aid use.     

Advantages of Binaural Amplification to Acceptable Noise Level of Directional Hearing Aid Users

Objectives

The goal of the present study was to examine whether Acceptable Noise Levels (ANLs) would be lower (greater acceptance of noise) in binaural listening than in monaural listening condition and also whether meaningfulness of background speech noise would affect ANLs for directional microphone hearing aid users. In addition, any relationships between the individual binaural benefits on ANLs and the individuals'' demographic information were investigated.

Methods

Fourteen hearing aid users (mean age, 64 years) participated for experimental testing. For the ANL calculation, listeners'' most comfortable listening levels and background noise level were measured. Using Korean ANL material, ANLs of all participants were evaluated under monaural and binaural amplification with a counterbalanced order. The ANLs were also compared across five types of competing speech noises, consisting of 1- through 8-talker background speech maskers. Seven young normal-hearing listeners (mean age, 27 years) participated for the same measurements as a pilot testing.

Results

The results demonstrated that directional hearing aid users accepted more noise (lower ANLs) with binaural amplification than with monaural amplification, regardless of the type of competing speech. When the background speech noise became more meaningful, hearing-impaired listeners accepted less amount of noise (higher ANLs), revealing that ANL is dependent on the intelligibility of the competing speech. The individuals'' binaural advantages in ANLs were significantly greater for the listeners with longer experience of hearing aids, yet not related to their age or hearing thresholds.

Conclusion

Binaural directional microphone processing allowed hearing aid users to accept a greater amount of background noise, which may in turn improve listeners'' hearing aid success. Informational masking substantially influenced background noise acceptance. Given a significant association between ANLs and duration of hearing aid usage, ANL measurement can be useful for clinical counseling of binaural hearing aid candidates or unsuccessful users.     

Acceptable noise level (ANL) and real-world hearing-aid success in Taiwanese listeners

Abstract

Objective: The objective of this prospective study was to investigate the relationship between acceptable noise level (ANL), which was measured using Taiwanese and the international speech test signal (ISTS), and real-world hearing-aid success for listeners who were representative of the population commonly seen in clinics. Design: Unaided ANLs were measured pre-hearing-aid fitting. Hearing-aid success was assessed three months post-fitting using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Study sample: Eighty adults with hearing impairment completed the study. Results: Both Taiwanese and ISTS ANLs were significantly associated with hearing-aid success, with higher ANLs suggesting poorer outcomes. However, the ANL's prediction accuracy for the probability of hearing-aid success was either much lower than that suggested by some literature, or was not much different from that of simply predicting all listeners as successful users. Conclusions: The current study suggested the possibility of using ANL to predict hearing-aid success. However, the usefulness of ANL as a clinical tool is unlikely to be as great as indicated by the literature.     

Audiometric correlates of the unaided APHAB

The Abbreviated Profile of Hearing Aid Benefit (APHAB) is a self-report questionnaire that is used to quantify the impact of a hearing problem on an individual's daily life. In this investigation, the relationships were explored between typical clinical audiometric data and the four subscale scores of the APHAB administered in the unaided (without-amplification) condition. Sixty subjects provided APHAB scores, audiograms, and speech recognition data. Analyses revealed significant relationships between audiometric data and each of the three APHAB subscales that reflect speech communication (EC, RV, and BN). None of these subscales was significantly more strongly related to any specific audiological variable. However, the pattern of associations between audiometric variables and subscale scores was consistent with predictions based on item content for subscales EC and RV, but not for BN. As predicted, no relationship was found between audiometric data and scores for the Aversiveness subscale (AV). Even for the subscales with the strongest associations, differences in audiometric data could be used to explain half or less of the variance in self-report data.     

Measuring hearing aid benefit using a willingness-to-pay approach

The value associated with self-perceived hearing aid benefit was assessed using a "willingness-to-pay" (WTP) approach. Abbreviated Profile of Hearing Aid Benefit (APHAB) data were obtained from 79 veterans who also indicated how much they were willing to pay for each hearing aid. The results of a multiple regression analysis revealed that veterans were willing to pay $22.06 more for a hearing aid for each 1-point increase in APHAB global benefit. A second multiple regression analysis revealed that the APHAB subscale scores for Ease of Communication (EC) benefit and understanding speech in Background Noise (BN) benefit, as well as income level, were all significant predictors of WTP. In addition, each 1-point increase in EC, BN, and Reverberation benefit increased the value associated with amplification by $16.32, $16.88, and $13.78, respectively. Each 1-point increase in the Aversiveness of Sounds subscale decreased the value associated with amplification by $7.63. The mean WTP across all income groups was $981.71 per hearing aid. These data are interpreted to support the use of WTP as a valid measure of hearing aid benefit.     

Acceptance of background noise levels in bilingual (Korean-English) listeners

The acceptable noise level (ANL) is the maximum amount of background noise that listeners are willing to accept while listening to speech. ANL has not been studied in listeners who use languages other than English. The purpose of this study was to explore whether ANLs obtained from Korean listeners in both English and Korean were comparable to ANLs obtained from monolingual English listeners. The results showed that ANLs obtained in English (ANL-E) did not differ significantly for the bilingual and monolingual listeners. Additionally, a cross-language comparison, within bilinguals, showed that ANLs obtained using Korean (ANL-K) speech stimuli were not significantly different from ANL-E. Finally, speech perception in noise did not correlate with ANLs in English or Korean for the bilingual listeners. Results suggest that the ANL measure is language independent within bilinguals and may be of potential clinical use in minority language groups.     

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL)

Objective: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting. Design: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique. Study sample: A total of 132 adults with hearing impairment. Results: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (～18 dB) than first-time hearing-aid users (～10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs. Conclusions: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.     

Acceptable noise level: reliability measures and comparison to preference for background sounds

The present study (1) assessed the reliability of the acceptable noise level (ANL) measure using speech-spectrum and speech-babble noises as the competing stimuli, and (2) investigated the relationship between ANL and preference for background sounds in 30 young adults with normal hearing sensitivity. Listeners were evaluated during three test sessions approximately one week apart. Results demonstrated that ANLs are highly reliable over short periods of time, independent of the background noise distraction. Mean ANLs, however, were affected by type of background noise distraction, indicating ANLs obtained using different competing stimuli should not be compared directly. Results further demonstrated that participants' ratings of preference for background sound were consistent over time; however, listeners' preference for background sound was not related to their acceptance of background noise (i.e., ANL). This may indicate listeners cannot accurately assess their ability to accept background sounds, at least with the questionnaire used in the present study.     

Acceptable noise level (ANL) with Danish and non-semantic speech materials in adult hearing-aid users

Abstract Objective: The acceptable noise level (ANL) test is used for quantification of the amount of background noise subjects accept when listening to speech. This study investigates Danish hearing-aid users' ANL performance using Danish and non-semantic speech signals, the repeatability of ANL, and the association between ANL and outcome of the international outcome inventory for hearing aids (IOI-HA). Design: ANL was measured in three conditions in both ears at two test sessions. Subjects completed the IOI-HA and the ANL questionnaire. Study sample: Sixty-three Danish hearing-aid users; fifty-seven subjects were full time users and 6 were part time/non users of hearing aids according to the ANL questionnaire. Results: ANLs were similar to results with American English speech material. The coefficient of repeatability (CR) was 6.5-8.8 dB. IOI-HA scores were not associated to ANL. Conclusions: Danish and non-semantic ANL versions yield results similar to the American English version. The magnitude of the CR indicates that ANL with Danish and non-semantic speech materials is not suitable for prediction of individual patterns of future hearing-aid use or evaluation of individual benefit from hearing-aid features. The ANL with Danish and non-semantic speech materials is not related to IOI-HA outcome.     

APHAB-Scores zur individuellen Beurteilung des Nutzens von Hörgeräteversorgungen

Objective

The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire measures subjective hearing impairment on four different subscales pertaining to different listening situations. Using a very large patient cohort, this study aims to show how answers are distributed within the four subscales before and after hearing aid fitting, and what benefit the patients experience. The results are discussed on the basis of the available literature.

Patients and methods

Between April 2013 and March 2016, 35,000 APHAB questionnaires from nine German statutory health insurance providers were evaluated. The average values before and after hearing aid fitting, as well as the benefit, were determined for all four APHAB subscales and analyzed graphically.

Results

The results of the subjective evaluation of hearing impairment before and after hearing aid fitting and the resultant benefit were plotted by percentile distribution graphs and boxplots. The data were analyzed statistically. There was no overlap of the interquartile ranges before and after hearing aid fitting in any of the APHAB subscales. In three scales (EC, BN and RV), the median improvement after hearing aid fitting was nearly 30 percentage points. In the AV subscale, this value was slightly negative.

Discussion

The percentile distribution graphs used in this study allow individual evaluation of subjective hearing impairment before and after hearing aid fitting, as well as of the resultant benefit, on the background of a huge database. Additionally, it is demonstrated why presentation as boxplots and the average benefit values calculated from these is problematic.

     

Acceptable noise level (ANL) with Danish and non-semantic speech materials in adult hearing-aid users

Abstract

Objective: The acceptable noise level (ANL) test is used for quantification of the amount of background noise subjects accept when listening to speech. This study investigates Danish hearing-aid users’ ANL performance using Danish and non-semantic speech signals, the repeatability of ANL, and the association between ANL and outcome of the international outcome inventory for hearing aids (IOI-HA). Design: ANL was measured in three conditions in both ears at two test sessions. Subjects completed the IOI-HA and the ANL questionnaire. Study sample: Sixty-three Danish hearing-aid users; fifty-seven subjects were full time users and 6 were part time/non users of hearing aids according to the ANL questionnaire. Results: ANLs were similar to results with American English speech material. The coefficient of repeatability (CR) was 6.5–8.8 dB. IOI-HA scores were not associated to ANL. Conclusions: Danish and non-semantic ANL versions yield results similar to the American English version. The magnitude of the CR indicates that ANL with Danish and non-semantic speech materials is not suitable for prediction of individual patterns of future hearing-aid use or evaluation of individual benefit from hearing-aid features. The ANL with Danish and non-semantic speech materials is not related to IOI-HA outcome.     

Development and evaluation of the Mandarin speech signal content on the acceptable noise level test in listeners with normal hearing in mainland China

Abstract

Objective: To develop and evaluate the Mandarin speech signal content on the acceptable noise level (ANL) test in listeners with normal hearing in mainland China. Design: The Mandarin ANL tests were conducted using three different sets of Mandarin running speech materials which were chosen from textbooks for primary school, secondary school, and high school, respectively. For each discourse, two ANL measurements were obtained and averaged for each experimental condition using ANL test procedures. Study sample: Thirty-one normal-hearing listeners participated in this study. Results: There were significant differences for ANLs among the normal-hearing listeners, but no differences were found for MCLs and ANLs for the three sets of test materials. The Pearson correlations suggested significant correlations between MCL and ANL among the three test materials; also the results showed that the correlation coefficient between MCL-ANL of the primary material was much better than other two materials. Conclusions: (1) The contents of different Mandarin running speeches may not affect the acceptable noise level in Mandarin normal-hearing listeners; (2) The running speech selected from the primary school ought to be used as the Mandarin acceptable noise level test material to evaluate the outcomes of hearing aid fitting.

Sumario

Objetivo: Desarrollar y evaluar el contenido de la señal de lenguaje en mandarín con la Prueba de Nivel de Ruido Aceptable (ANL), en sujetos con audición normal de China continental. Diseño: Las pruebas de ANL en mandarín fueron conducidas usando tres diferentes tipos de contenidos provenientes de materiales de lenguaje en mandarín escogidos de libros de texto para la escuela primaria, secundaria y preparatoria, respectivamente. Para cada discurso, se obtuvieron dos mediciones de ANL y se promediaron para cada condición experimental, usando los procedimientos de la prueba de ANL. Muestra del Estudio: Participaron en el estudio treinta y un sujetos con audición normal. Resultados: Existieron diferencias significativas de ANL entre los sujetos con audición normal, pero no se encontraron diferencias en el MCL y ANL de los tres materiales. Las correlaciones de Pearson sugirieron correlaciones significativas entre el MCL y ANL de los tres materiales; también los resultados mostraron que el coeficiente de correlación entre MCL-ANL del material de primaria fue mucho mejor que con los otros dos materiales. Conclusiones: (1) el contenido de los diferentes discursos en mandarín puede no afectar el nivel aceptable de ruido en oyentes de mandarín con audición normal; (2) el discurso seleccionado de la escuela primaria debería ser utilizado como el material de prueba en mandarín con un nivel aceptable de ruido, para evaluar los resultados de la adaptación de auxiliares auditivos.     

Acceptance of noise with monaural and binaural amplification

The present study investigated the effects of monaural and binaural amplification on speech understanding in noise and acceptance of noise for 39 listeners with hearing impairment. Results demonstrated that speech understanding in noise improved with binaural amplification; however, acceptance of noise was not dependent on monaural or binaural amplification for most listeners. These results suggest that although two hearing aids maximize speech understanding ability in noise, most individuals' acceptance of noise, which is directly related to hearing aid use, may not be affected by the use of binaural amplification. It should be noted that monaural amplification resulted in greater acceptance of noise for some listeners, indicating that binaural amplification may negatively affect some individuals' willingness to wear hearing aids. It should also be noted that interaural differences in acceptance of noise might exist for some listeners; therefore, if only one hearing aid is fitted, monaural ANLs should be measured.     

Unaided and aided performance with a directional open-fit hearing aid

Differences in performance between unaided and aided performance (omnidirectional and directional) were measured using an open-fit behind-the-ear (BTE) hearing aid. Twenty-six subjects without prior experience with amplification were fitted bilaterally using the manufacturer's recommended procedure. After wearing the hearing aids for one week, the fitting parameters were fine-tuned, based on subjective comments. Four weeks later, differences in performance between unaided and aided (omnidirectional and directional) were assessed by measuring reception thresholds for sentences (RTS in dB), using HINT sentences presented at 0 degrees with R-Space restaurant noise held constant at 65dBA and presented via eight loudspeakers set 45 degrees apart. In addition, the APHAB was administered to assess subjective impressions of the experimental aid. Results revealed that significant differences in RTS (in dB) were present between directional and omnidirectional performance, as well as directional and unaided performance. Aided omnidirectional performance, however, was not significantly different from unaided performance. These findings suggest for the hearing aids and experimental condition used in this study, a patient would require directional microphones in order to perform significantly better than unaided or aided with omnidirectional microphones, and that performance with an omnidirectional microphone would not be significantly better than unaided. Finally, the APHAB-aided scores were significantly better than unaided scores for the EC, BN, RV, and AV subscales indicating the subjects, on average, perceived the experimental aid to provide significantly better performance than unaided, and that aided performance was more aversive than unaided.     

Unaided and aided performance with a directional open-fit hearing aid

Differences in performance between unaided and aided performance (omnidirectional and directional) were measured using an open-fit behind-the-ear (BTE) hearing aid. Twenty-six subjects without prior experience with amplification were fitted bilaterally using the manufacturer's recommended procedure. After wearing the hearing aids for one week, the fitting parameters were fine-tuned, based on subjective comments. Four weeks later, differences in performance between unaided and aided (omnidirectional and directional) were assessed by measuring reception thresholds for sentences (RTS in dB), using HINT sentences presented at 0° with R-Space^TM restaurant noise held constant at 65dBA and presented via eight loudspeakers set 45° apart. In addition, the APHAB was administered to assess subjective impressions of the experimental aid.

Results revealed that significant differences in RTS (in dB) were present between directional and omnidirectional performance, as well as directional and unaided performance. Aided omnidirectional performance, however, was not significantly different from unaided performance. These findings suggest for the hearing aids and experimental condition used in this study, a patient would require directional microphones in order to perform significantly better than unaided or aided with omnidirectional microphones, and that performance with an omnidirectional microphone would not be significantly better than unaided. Finally, the APHAB-aided scores were significantly better than unaided scores for the EC, BN, RV, and AV subscales indicating the subjects, on average, perceived the experimental aid to provide significantly better performance than unaided, and that aided performance was more aversive than unaided.     

The effect of speech presentation level on acceptance of background noise in listeners with normal hearing

A method has been established to measure the maximum acceptable background noise level (BNL) for a listener, while listening to speech at the most comfortable listening level (MCL). The acceptable noise level (ANL) is the difference between BNL and MCL. In the present study, the ANL procedure was used to measure acceptance of noise, first, in the presence of speech at MCL and, then, for speech presented at much lower and higher levels in listeners with normal hearing. This study used the term ANL to describe the results obtained at MCL and also at other speech presentation levels. The mean ANL at MCL was 15.5 dB, which is comparable to results obtained by previous investigators. ANL increases systematically with speech presentation level. Mean ANLs ranged from 10.6 dB when speech was presented at 20 dB HL to 24.6 dB when speech was presented at 76 dB HL. The results indicated that the acceptance of noise depends significantly on speech presentation level.