Amplification with digital noise reduction and the perception of annoying and aversive sounds

Hearing aid users report difficulties using their hearing aids in noisy environments. Problems include understanding speech, loudness discomfort, and annoyance with background noise. Digital noise reduction algorithms have been promoted as a method to solve speech understanding and comfort in noise problems. Research has failed to find improved speech understanding in noise. Little is known about how digital noise reduction affects noise annoyance and aversiveness. The goals of this investigation were to determine how a specific digital noise reduction system affects hearing aid users' perception of noise annoyance and aversiveness and to compare their perceptions to those of normal-hearing listeners. Ratings of noise annoyance and of aversiveness were obtained from 49 participants with moderate sensorineural hearing loss before fitting and after 3 weeks of hearing aid use. Findings were compared to measures obtained from normal-hearing listeners. Perceived annoyance and aversiveness increased with amplification. Annoyance and aversiveness with the hearing aid approximated normal perception. The results of this investigation suggest the need for counseling patients about realistic expectations related to annoyance and aversiveness of sounds at the time of hearing aid fitting.     

Assessing speech recognition abilities with digits in noise in cochlear implant and hearing aid users

Objective: The primary objective of the study was to investigate the feasibility, reliability, and validity of the Dutch digits in noise (DIN) test for measuring speech recognition in hearing aid and cochlear implant users and compare results to the standard sentences-in-noise (SIN) test. Design: The relation between speech reception thresholds for DIN test and SIN test was analysed to determine the validity of the DIN test. As linguistic skills were expected to make different contributions in these tests, their influence was analysed. Study sample: Participants were 12 normal-hearing listeners, 24 hearing aid users, and 24 cochlear implant users. Results: The DIN test was feasible for more participants than the SIN test. Intraclass correlation coefficients showed high reliability. The standard error of measurement was smaller for the DIN test than for the SIN test. DIN test and SIN test were highly correlated (r = 0.95 and r = 0.56 for NH+ HA and CI users respectively). In the regression analysis no significant contribution of basic linguistic skills or personal factors was found. Conclusion: In the assessment of speech recognition in noise of aided hearing-impaired listeners with hearing aids or cochlear implants, the DIN test is a feasible, reliable and valid test.     

Provision,perception and use of trainable hearing aids in Australia: a survey of clinicians and hearing impaired adults

Objective: This study set out to obtain information on the impact of trainable hearing aids among clinicians and hearing aid users and candidates. Design: Two online adaptive surveys were developed to evaluate provision, uptake and experience or expectation of trainable hearing aids. Study sample: Responses from 259 clinicians, 81 hearing aid users and 23 candidates for hearing aids were included. Results: Over half of the clinicians surveyed activated trainable features in hearing aids. Most of these clinicians activated trainable features for selected users and reported positive findings. Most commonly trainable features were not activated because the hearing aid controls had already been disabled for management or client preference. One-third reported that they had no access to trainable aids or they were unsure about the presence or activation of trainable features. The remaining clinicians never activated trainable features. One in five users reported having used trainable aids and 93% would train again. Over 85% of the remaining hearing-impaired adults were interested in trainable aids.

Conclusions: Positive reports from most providers and users who had experience with the trainable feature support the provision of trainable aids to selected clients, pending more evidence-based data to support the clinical management of such devices.     

Sounds perceived as annoying by hearing-aid users in their daily soundscape

Abstract

Background: The noises in modern soundscapes continue to increase and are a major origin for annoyance. For a hearing-impaired person, a hearing aid is often beneficial, but noise and annoying sounds can result in non-use of the hearing aid, temporary or permanently. Objective: The purpose of this study was to identify annoying sounds in a daily soundscape for hearing-aid users. Design: A diary was used to collect data where the participants answered four questions per day about annoying sounds in the daily soundscape over a two-week period. Study sample: Sixty adult hearing-aid users. Results: Of the 60 participants 91% experienced annoying sounds daily when using hearing aids. The annoying sound mentioned by most users, was verbal human sounds, followed by other daily sound sources categorized into 17 groups such as TV/radio, vehicles, and machine tools. When the hearing-aid users were grouped in relation to age, hearing loss, gender, hearing-aid experience, and type of signal processing used in their hearing aids, small and only few significant differences were found when comparing their experience of annoying sounds. Conclusions: The results indicate that hearing-aid users often experience annoying sounds and improved clinical fitting routines may reduce the problem.     

Prediction of the use of conventional hearing aids in Korean adults with unilateral hearing impairment

Objective: To determine the use of a hearing aid at six months post-fitting and to evaluate the predictors of its ongoing use in Korean adults with unilateral hearing impairment (HI). Design: Retrospective study at a secondary referral hospital over a 15-year period. Study sample: This study analysed 119 adults with unilateral HI who had been recommended for hearing amplification (55 men and 64 women, mean age, 58.0 ± 11.7 years). Six months after the fitting, all of the participants were surveyed regarding subsequent decisions and actions about obtaining hearing aids. Results: General uptake rate for a hearing aid was 68.1% (58.0% of participants surveyed were successful users, and 10.1% were intermittent users). The most significant parameter associated with hearing-aid use was social and/or work activities (R² = 0.457), and the significant predictors for successful hearing-aid use were social and/or work activities and method of signal processing (discriminatory power = 56.3%). Conclusions: Six months post-fitting, 68.1% of Korean adults with unilateral HI who had agreed to try a hearing aid continued to use it regularly. The predictors for hearing-aid use six months post-fitting included social and/or work activities and digital signal processing.     

False air-bone gaps at 4 kHz in listeners with normal hearing and sensorineural hearing loss

Abstract

Objective: This report presents data from four studies to examine standard bone-conduction reference equivalent threshold force levels (RETFL), especially at 4 kHz where anomalous air-bone gaps are common. Design: Data were mined from studies that obtained air- and bone-conduction thresholds from normal-hearing and sensorineural hearing loss (SNHL) participants, using commercial audiometers and standard audiometric transducers. Study sample: There were 249 normal-hearing and 188 SNHL participants. Results: (1) Normal-hearing participants had small air-bone gaps at 0.5, 1.0, and 2.0 kHz (‐1.7 to 0.3 dB) and larger air-bone gaps at 4 kHz (10.6 dB). (2) SNHL participants had small air-bone gaps at 0.5, 1.0, and 2.0 kHz (‐0.7 to 1.7 dB) and a larger air-bone gap at 4 kHz (14.1 dB). (3) The 4-kHz air-bone gap grew with air-conduction threshold from 10.1 dB when the air-conduction threshold was 5–10 dB HL to 21.1 dB when the air-conduction threshold was greater than 60 dB. (4) With the 4-kHz RETFL corrected by the average SNHL air-bone gap, the relationship between RETFL and frequency is linear with a slope of ? 12 dB per octave. Conclusions: The 4-kHz air-bone gaps for listeners with SNHL could be avoided by adjusting the 4-kHz RETFL by ? 14.1 dB.     

Acoustic stimulation effect on temporal processing skills in elderly subjects before and after hearing aid fitting

Aging can alter, temporal processing and affect speech perception.Aim: To compare temporal processing auditory processing in elderly subject to and new hearing aid users.Materials and Methods: The study included 60 elderly patients with bilateral sensorineural hearing loss. The procedures selected were the Duration Pattern Tests (DPT) and gaps in noise (GIN) test were used to analyze the responses of correct identification, and the temporal acuity threshold before and after the fitting of hearing aids. Study design: clinical and experimental research with non-probability sample of convenience.Results: There was no statistically significant difference between the responses from GI and GII individuals. The elderly users of hearing aids had a lower gap detection threshold, greater recognition of gaps and of discrimination of the duration pattern in relation to when they were only potential users.Conclusion: There was a deterioration in temporal processing skills, regardless of hearing loss degrees. Thus, the effect of acoustic stimulation by the use of a hearing aid improved resolution and temporal ordering.     

Preferred overall loudness. II: Listening through hearing aids in field and laboratory tests

In a laboratory study, we found that normal-hearing and hearing-impaired listeners preferred less than normal overall calculated loudness (according to a loudness model of Moore & Glasberg, ). The current study verified those results using a research hearing aid. Fifteen hearing-impaired and eight normal-hearing participants used the hearing aid in the field and adjusted a volume control to give preferred in median loudness. The hearing aid logged the preferred volume control setting and the calculated loudness at that setting. The hearing-impaired participants preferred loudness levels of ?14 phon re normal for input levels from 50 to 89?dB?SPL. The normal-hearing participants preferred close to normal overall loudness. In subsequent laboratory tests, using the same hearing aid, both hearing-impaired and normal-hearing listeners preferred less than normal overall calculated loudness, and larger reductions for higher input levels. In summary, the hearing-impaired listeners preferred less than normal overall calculated loudness, whereas the results for the normal-hearing listeners were inconclusive.

Sumario

En un estudio de laboratorio encontramos que normoacúsicos o hipoacúsicos prefieren una intensidad subjetiva global menor que la calculada (de acuerdo con el modelo de intensidad subjetiva de Moore & Glasberg, ). Este estudio verificó esos resultados usando un auxiliar auditivo de investigación. Quince hipoacúsicos y ocho normoacúsicos usaron el auxiliar auditivo en campo libre y ajustaron el control de volumen hasta el nivel de intensidad subjetiva preferido. El auxiliar auditivo conservó el nivel de control de volumen preferido y el nivel de intensidad subjetiva calculado para esa posición. Los hipoacúsicos prefirieron niveles de intensidad subjetiva de ?14 phon re normal, para niveles de presentación de 50 a 89?dB SPL. Los normoacúsicos prefirieron niveles de intensidad subjetiva globales cerca de lo normal. En unas pruebas de laboratorio subsecuentes, usando el mismo auxiliar auditivo tanto los hipoacúsicos como los normoacúsicos prefirieron una intensidad subjetiva global menor que la calculada como normal así como amplias reducciones para los niveles de presentación mayores. En resumen, los hipoacúsicos prefieren intensidades subjetivas globales menores que las calculadas como normales, mientras que los resultados para los normoacúsicos no fueron concluyentes.     

The interaction of hearing loss and level-dependent hearing protection on speech recognition in noise

Abstract

Objectives: To determine the effects of different control settings of level-dependent hearing protectors on speech recognition performance in interaction with hearing loss. Design: Controlled laboratory experiment with two level-dependent devices (Peltor^® PowerCom Plus? and Nacre QuietPro^®) in two military noises. Study sample: Word recognition scores were collected in protected and unprotected conditions for 45 participants grouped into four hearing profile categories ranging from within normal limits to moderate-to-severe hearing loss. Results: When the level-dependent mode was switched off to simulate conventional hearing protection, there were large differences across hearing profile categories regarding the effects of wearing the devices on speech recognition in noise; participants with normal hearing showed little effect while participants in the most hearing-impaired category showed large decrements in scores compared to unprotected listening. Activating the level-dependent mode of the devices produced large speech recognition benefits over the passive mode at both low and high gain pass-through settings. The category of participants with the most impaired hearing benefitted the most from the level-dependent mode. Conclusions: The findings indicate that level-dependent hearing protection circuitry can provide substantial benefits in speech recognition performance in noise, compared to conventional passive protection, for individuals covering a wide range of hearing losses.     

Semantic context improves speech intelligibility and reduces listening effort for listeners with hearing impairment

Objective: We investigated whether speech intelligibility and listening effort for hearing-aid users is affected by semantic context and hearing-aid setting. Design: Participants heard target sentences spoken in a reverberant background of cafeteria noise and competing speech. Participants reported each sentence verbally. Eight participants also rated listening effort after each sentence. Sentence topic was either the same as, or different from, the previous target sentence. Study sample: Twenty participants with sensorineural hearing loss were fit binaurally with Signia receiver-in-the-canal hearing aids. Participants performed the task twice: once using the hearing aid’s omnidirectional setting and once using the “Reverberant Room” setting, designed to aid listening in reverberant environments. Results: Participants achieved better speech intelligibility for same-topic than different-topic sentences, and when they used the “Reverberant Room” than the omnidirectional hearing-aid setting. Participants who rated effort showed a reliable reduction in listening effort for same-topic sentences and for the “Reverberant Room” hearing-aid setting. The improvement in speech intelligibility from semantic context (i.e. same-topic compared to different-topic sentences) was greater than the improvement gained from changing hearing-aid setting. Conclusions: These findings highlight the enormous potential of cognitive (specifically, semantic) factors for improving speech intelligibility and reducing perceived listening effort in noise for hearing-aid users.     

The robustness of hearing aid microphone preferences in everyday listening environments

Automatic directionality algorithms currently implemented in hearing aids assume that hearing-impaired persons with similar hearing losses will prefer the same microphone processing mode in a specific everyday listening environment. The purpose of this study was to evaluate the robustness of microphone preferences in everyday listening. Two hearing-impaired persons made microphone preference judgments (omnidirectional preferred, directional preferred, no preference) in a variety of everyday listening situations. Simultaneously, these acoustic environments were recorded through the omnidirectional and directional microphone processing modes. The acoustic recordings were later presented in a laboratory setting for microphone preferences to the original two listeners and other listeners who differed in hearing ability and experience with directional microphone processing. The original two listeners were able to replicate their live microphone preferences in the laboratory with a high degree of accuracy. This suggests that the basis of the original live microphone preferences were largely represented in the acoustic recordings. Other hearing-impaired and normal-hearing participants who listened to the environmental recordings also accurately replicated the original live omnidirectional preferences; however, directional preferences were not as robust across the listeners. When the laboratory rating did not replicate the live directional microphone preference, listeners almost always expressed no preference for either microphone mode. Hence, a preference for omnidirectional processing was rarely expressed by any of the participants to recorded sites where directional processing had been preferred as a live judgment and vice versa. These results are interpreted to provide little basis for customizing automatic directionality algorithms for individual patients. The implications of these findings for hearing aid design are discussed.     

Unilateral hearing loss: benefits and satisfaction from the use of hearing aids

Aunilateral hearing loss is characterized by reduced hearing in one ear. The problems caused by sensory deprivation can be minimized with the use of hearing aids (HA).AimTo analyze the correlation between the prescribed grain and the insertion gain difference and with the results obtained regarding the benefit and satisfaction with the use of hearing aids in unilateral hearing impaired patients.Materials and MethodsProspective study with 15 subjects, mean age of 41.6 years, of both genders, users of hearing aids effectively. We used the International Questionnaire Results for hearing aids (International Outcome Inventory for Hearing Aids - IOI-HA), measured with a probe microphone.ResultsThe mean values in the analyses of the IOI-HA per item were positive and higher than four points. In relation to the objective measures, the frequencies in which we obtained the gain values which were closer to the target were: 1K Hz, 2K Hz and 500 Hz, respectively.ConclusionThe satisfaction of individuals using hearing aid unilaterally is not completely correlated to the prescribed gain, because even if the target is not being reached in some frequencies, the individuals were pleased as to the use of their hearing aids.     

Relations between psychophysical measures of spatial hearing and self-reported spatial-hearing abilities

Objective: The aim of the present study was to investigate how well the virtual psychophysical measures of spatial hearing from the preliminary auditory profile predict self-reported spatial-hearing abilities. Design: Virtual spatial-hearings tests (conducted unaided, via headphones) and a questionnaire were administered in five centres in Germany, the Netherlands, Sweden, and the UK. Correlations and stepwise linear regression models were calculated among a group of hearing-impaired listeners. Study sample: Thirty normal-hearing listeners aged 19–39 years, and 72 hearing-impaired listeners aged 22–91 years with a broad range of hearing losses, including asymmetrical and mixed hearing losses. Results: Several significant correlations (between 0.24 and 0.54) were found between results of virtual psychophysical spatial-hearing tests and self-reported localization abilities. Stepwise linear regression analyses showed that the minimum audible angle (MAA) test was a significant predictor for self-reported localization abilities (5% extra explained variance), and the spatial speech reception threshold (SRT) benefit test for self-reported listening to speech in spatial situations (6% extra explained variance). Conclusions: The MAA test and spatial SRT benefit test are indicative measures of everyday binaural functioning. The binaural SRT benefit test was not found to predict self-reported spatial-hearing abilities.     

Evaluation of the NAL Dynamic Conversations Test in older listeners with hearing loss

Objective: The National Acoustic Laboratories Dynamic Conversations Test (NAL-DCT) is a new test of speech comprehension that incorporates a realistic environment and dynamic speech materials that capture certain features of everyday conversations. The goal of this study was to assess the suitability of the test for studying the consequences of hearing loss and amplification in older listeners. Design: Unaided and aided comprehension scores were measured for single-, two- and three-talker passages, along with unaided and aided sentence recall. To characterise the relevant cognitive abilities of the group, measures of short-term working memory, verbal information-processing speed and reading comprehension speed were collected. Study sample: Participants were 41 older listeners with varying degrees of hearing loss. Results: Performance on both the NAL-DCT and the sentence test was strongly driven by hearing loss, but performance on the NAL-DCT was additionally related to a composite cognitive deficit score. Benefits of amplification were measurable but influenced by individual test SNRs. Conclusions: The NAL-DCT is sensitive to the same factors as a traditional sentence recall test, but in addition is sensitive to the cognitive factors required for speech processing. The test shows promise as a tool for research concerned with real-world listening.     

Use of technological aids and interpretation services among children and adults with hearing loss

Objectives: The technological development of communication aids for people with hearing loss has progressed rapidly over the last decades. Quality has improved and the number of different types of aids has increased. However, few studies have examined the prevalence of technology use and interpreting services use among people with hearing loss as they relate to demographic characteristics of this population. Design: This study reports from national surveys of children and adults with hearing loss. Use of hearing aids, cochlear implants, other aids and interpreting services were analysed with regard to gender, age, degree of hearing loss, mode of communication, having an additional disability, level of educational achievement among adults, and whether or not children lived together with both of their parents. Study sample: 269 children (0–15 years of age) and 839 adults (16–65 years of age). Results: Differences in technology and service use were associated with age, degree of hearing loss, and mode of communication among children and adults, and gender and level of educational achievement among adults. Conclusion: Individual and social factors have an impact on technological hearing aid and interpreter use. More research about individual differences and clinical implications of support services is needed.     

An evaluation of the performance of two binaural beamformers in complex and dynamic multitalker environments

Objective: Binaural beamformers are super-directional hearing aids created by combining microphone outputs from each side of the head. While they offer substantial improvements in SNR over conventional directional hearing aids, the benefits (and possible limitations) of these devices in realistic, complex listening situations have not yet been fully explored. In this study we evaluated the performance of two experimental binaural beamformers. Design: Testing was carried out using a horizontal loudspeaker array. Background noise was created using recorded conversations. Performance measures included speech intelligibility, localization in noise, acceptable noise level, subjective ratings, and a novel dynamic speech intelligibility measure. Study sample: Participants were 27 listeners with bilateral hearing loss, fitted with BTE prototypes that could be switched between conventional directional or binaural beamformer microphone modes. Results: Relative to the conventional directional microphones, both binaural beamformer modes were generally superior for tasks involving fixed frontal targets, but not always for situations involving dynamic target locations. Conclusions: Binaural beamformers show promise for enhancing listening in complex situations when the location of the source of interest is predictable.     

Factors associated with success with hearing aids in older adults

Abstract

Objective: To examine associations between audiological and non-audiological factors and successful hearing aid use in older adults. Design: In a retrospective study, audiological factors, attitudinal beliefs (as derived from the health belief model), client demographics, psychological factors, and age-related factors were evaluated. Study sample: Participants included 160 individuals, 60 years or older, with unilateral or bilateral hearing impairment (HI), fitted with hearing aids for the first time in the previous two years. Participants were assigned to either an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85) based on their self-reported hearing aid use and benefit. Results: A multivariate, binomial logistic regression model indicated five factors associated with group membership: participants who had greater support from significant others; more difficulties with hearing and communication in everyday life before getting hearing aids; more positive attitudes to hearing aids; coupled with greater perceived self-efficacy for advanced handling of hearing aids; or who were receiving more gain from their devices; were more likely to be successful hearing aid owners. Conclusions: These findings highlight the importance of addressing non-audiological factors in order to assist older adults achieve success with hearing aids.     

Evaluation of the effects of nonlinear frequency compression on speech recognition and sound quality for adults with mild to moderate hearing loss

Objective: While potentially improving audibility for listeners with considerable high frequency hearing loss, the effects of implementing nonlinear frequency compression (NFC) for listeners with moderate high frequency hearing loss are unclear. The purpose of this study was to investigate the effects of activating NFC for listeners who are not traditionally considered candidates for this technology. Design: Participants wore study hearing aids with NFC activated for a 3–4 week trial period. After the trial period, they were tested with NFC and with conventional processing on measures of consonant discrimination threshold in quiet, consonant recognition in quiet, sentence recognition in noise, and acceptableness of sound quality of speech and music. Study sample: Seventeen adult listeners with symmetrical, mild to moderate sensorineural hearing loss participated. Better ear, high frequency pure-tone averages (4, 6, and 8 kHz) were 60 dB HL or better. Results: Activating NFC resulted in lower (better) thresholds for discrimination of /s/, whose spectral center was 9 kHz. There were no other significant effects of NFC compared to conventional processing. Conclusion: These data suggest that the benefits, and detriments, of activating NFC may be limited for this population.     

Effects of Noise Reduction on AM Perception for Hearing-Impaired Listeners

Noise reduction (NR) systems are commonplace in modern digital hearing aids. Though not improving speech intelligibility, NR helps the hearing-aid user in terms of lowering noise annoyance, reducing cognitive load and improving ease of listening. Previous psychophysical work has shown that NR does in fact improve the ability of normal-hearing (NH) listeners to discriminate the slow amplitude-modulation (AM) cues representative of those found in speech. The goal of this study was to assess whether this improvement of AM discrimination with NR can also be observed for hearing-impaired (HI) listeners. AM discrimination was measured at two audio frequencies of 500 Hz and 2 kHz in a background noise with a signal-to-noise ratio of 12 dB. Discrimination was measured for ten HI and ten NH listeners with and without NR processing. The HI listeners had a moderate sensorineural hearing loss of about 50 dB HL at 2 kHz and normal hearing (≤20 dB HL) at 500 Hz. The results showed that most of the HI listeners tended to benefit from NR at 500 Hz but not at 2 kHz. However, statistical analyses showed that HI listeners did not benefit significantly from NR at any frequency region. In comparison, the NH listeners showed a significant benefit from NR at both frequencies. For each condition, the fidelity of AM transmission was quantified by a computational model of early auditory processing. The parameters of the model were adjusted separately for the two groups (NH and HI) of listeners. The AM discrimination performance of the HI group (with and without NR) was best captured by a model simulating the loss of the fast-acting amplitude compression applied by the normal cochlea. This suggests that the lack of benefit from NR for HI listeners results from loudness recruitment.