Advantages of a new miniature hearing aid for mild to moderate hearing loss

OBJECTIVES/HYPOTHESIS: To evaluate the performance of a new, miniature, behind-the-ear hearing aid designed for individuals with mild to moderate high-frequency hearing loss who need an aid but are reluctant to try one. The aid is essentially invisible, leaves the ear canal open, and can be fit in less than 30 minutes without an ear impression. The cost is less than $500. STUDY DESIGN: A 4-week trial of the aid in 63 ears (62 subjects) with mild to moderate bilateral hearing loss. METHODS: A questionnaire was completed at the end of the study by each subject asking them to evaluate several features of the aid (cosmesis, comfort, understanding speech, amplification, and so forth) and to compare their unaided performance in quiet and in noise with the test hearing aid. A rating scale of 1 to 10 was used, with 10 being excellent and 1 poor. RESULTS: Subjective improvement in understanding speech in both quiet (5.8-->7.3) and noise (4.6-->5.9) occurred with the aid. Cosmesis, comfort, and appearance were highly rated (mean scores, > 8). CONCLUSIONS: This aid appears to have several features (comfort, cost, performance, and cosmesis) that make it ideal as a first aid for patients with mild to moderate losses.     

Abutment-free bone-anchored hearing devices in children: Initial results and experience

Objectives

Bone-anchored implantable hearing devices are widely accepted as a surgical option for certain types of hearing loss in both adults and children. Most commercially available devices involve a percutaneous abutment to which a sound processor attaches. The rate of complications with such bone conduction systems is greater than 20%. Most complications arise from the abutment. Recently, the Sophono (Boulder, CO) Alpha 1, an abutment-free system, has been introduced.

Study design and methods

We conducted a retrospective chart review of the first five patients who underwent implantation with the Sophono abutment-free bone conduction hearing system with the Alpha 1 processor at our institution and report here on these patients’ pre- and postoperative audiometric data and clinical courses.

Results

Average improvement in pure-tone average was 32 dB hearing loss and average improvement in speech response threshold was 28 dB hearing loss. All patients were responding in the normal to mild hearing loss range in the operated ear after device activation. Average improvement across individual frequencies was between 17 and 37 dB (SD 5.5–11 dB).

Conclusion

Our audiometric results to date are promising and have been consistent with published data on other bone-anchored hearing devices.     

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.     

The relationship between speech recognition,behavioural listening effort,and subjective ratings

Objective: The purpose of this study was to evaluate the reliability and validity of four subjective questions related to listening effort. A secondary purpose of this study was to evaluate the effects of hearing aid beamforming microphone arrays on word recognition and listening effort. Design: Participants answered subjective questions immediately following testing in a dual-task paradigm with three microphone settings in a moderately reverberant laboratory environment in two noise configurations. Participants rated their: (1) mental work, (2) desire to improve the situation, (3) tiredness, and (4) desire to give up. Data were analysed using repeated measures and reliability analyses. Study sample: Eighteen adults with symmetrical sensorineural hearing loss participated. Results: Beamforming differentially affected word recognition and listening effort. Analysis revealed the same pattern of results for behavioural listening effort and subjective ratings of desire to improve the situation. Conversely, ratings of work revealed the same pattern of results as word recognition performance. Ratings of tiredness and desire to give up were unaffected by hearing aid microphone or noise configuration. Conclusions: Participant ratings of their desire to control the listening situation appear to reliable subjective indicators of listening effort that align with results from a behavioural measure of listening effort.     

Effect of preoperative residual hearing on speech perception after cochlear implantation

Objective: To assess the effect of substantial preoperative residual hearing on speech perception outcomes in adult cochlear implant recipients. Setting: Tertiary care academic referral center. Methods: Twenty‐nine patients with substantial preoperative residual hearing underwent cochlear implantation. Twenty‐one implant recipients matched for age and duration of hearing loss, but without preoperative residual hearing, served as controls. Postoperative speech perception was assessed using City University of New York sentence, consonant‐nucleus‐consonant, and hearing in noise test in quiet and in noise (+10 dB signal to noise ratio) tests at 1, 3, 6, and 12 months after fitting. Results: After implantation, there were no significant differences between groups for any of the tests administered. The mean change in speech perception abilities from baseline was significantly greater for the control patients than those with substantial preoperative residual hearing at a number of the test intervals across the various conditions. Moreover, at both 1 and 3 months, some patients in the residual hearing group had speech perception scores that were worse than their preoperative values. Ultimately, all of the patients with substantial residual hearing surpassed their preoperative performance. Discussion: Patients with substantial preoperative residual hearing can gain significant benefit from cochlear implantation. Although the degree of improvement in these individuals is somewhat more modest than for those patients without preoperative residual hearing, the outcomes are still excellent. That there were no significant differences between the patient groups suggests that having substantial residual hearing before implantation does not provide a measurable performance advantage for electrical stimulation. Patients with substantial residual hearing who are contemplating cochlear implantation should be counseled regarding a possible initial decline in speech perception performance.     

双侧先天性外中耳畸形患者骨锚式助听器效果分析

目的 评估双侧先天性外中耳畸形患者应用骨锚式助听器(bone-anchored hearing aid,BAHA)后的听力效果及满意度.方法 双侧先天性耳廓畸形合并外耳道闭锁患者7例,单侧耳廓畸形伴双侧中耳畸形3例,佩戴软带BAHA后单侧植入BAHA钛植入体.分别测试患者在声场中裸耳与应用软带BAHA、植入式BAHA后的平均听阈、言语识别率及言语识别阈.以BAHA应用情况调查问卷和儿童格拉斯格受益列表(Glasgow children's benefit inventory,GCBI)分析患者应用BAHA后的生活质量提高程度和满意度.结果 患者裸耳平均听阈为(64.8 ±5.9)dBHL,佩戴软带BAHA后平均听阈降至(30.2±3.7) dBHL,佩戴植入式BAHA后平均听阈为(20.3±3.9) dBHL,三者两两比较,差异均具有统计学意义(P值均＜0.05).佩戴软带BAHA后患者听阈较裸耳平均下降(36.1±8.0)dB;植入式BAHA听阈较软带BAHA平均下降(12.2 ±3.4)dB.在45dBHL和65dBHL给声强度下,裸耳言语识别率分别为(3.00±1.07)％和(57.55 ±10.30)％,植入BAHA后言语识别率提高至(89.39±5.83)％和(91.19 ±4.16)％,二者差异具有统计学意义(P值均＜0.05).裸耳平均言语识别阈为(63.1±5.9) dBHL,佩戴植入式BAHA后为(24.7±3.5) dBHL,二者差异具有统计学意义(P＜0.05).BAHA应用情况调查问卷显示患者应用软带BAHA和植入式BAHA均获得满意效果,GCBI平均受益分数为(35.59 ±14.35)分.结论 对于双侧先天性外中耳畸形患者,应用BAHA可显著改善其听力及生活质量,患者满意度较高.     

Contribution of hearing aids to music perception by cochlear implant users

Abstract

Objectives

Modern cochlear implant (CI) encoding strategies represent the temporal envelope of sounds well but provide limited spectral information. This deficit in spectral information has been implicated as a contributing factor to difficulty with speech perception in noisy conditions, discriminating between talkers and melody recognition. One way to supplement spectral information for CI users is by fitting a hearing aid (HA) to the non-implanted ear.

Methods

In this study 14 postlingually deaf adults (half with a unilateral CI and the other half with a CI and an HA (CI + HA)) were tested on measures of music perception and familiar melody recognition.

Results

CI + HA listeners performed significantly better than CI-only listeners on all pitch-based music perception tasks. The CI + HA group did not perform significantly better than the CI-only group in the two tasks that relied on duration cues. Recognition of familiar melodies was significantly enhanced for the group wearing an HA in addition to their CI. This advantage in melody recognition was increased when melodic sequences were presented with the addition of harmony.

Conclusion

These results show that, for CI recipients with aidable hearing in the non-implanted ear, using a HA in addition to their implant improves perception of musical pitch and recognition of real-world melodies.     

Wireless binaural hearing aid technology for telephone use and listening in wind noise

Objective: To assess the speech perception benefits of binaural streaming technology for bilateral hearing aid users in two difficult listening conditions.

Design: Two studies were conducted to compare hearing aid processing features relating to telephone use and wind noise. Speech perception testing was conducted in four different experimental conditions in each study.

Study sample: Ten bilaterally-aided children in each study.

Results: Significant improvements in speech perception were obtained with a wireless feature for telephone use. Significant speech perception benefits were also obtained with wireless hearing aid features when listening to speech in simulated wind noise.

Conclusions: Binaural signal processing algorithms can significantly improve speech perception for bilateral hearing aid users in challenging listening situations.     

传导性或混合性耳聋患者佩戴骨锚式助听器软带的预期效果

目的 研究分析传导性或混合性耳聋患者进行佩戴骨锚式助听器(BAHA)软带后的听力改善情况。方法 参与研究者62例, 在声场进行BAHA软带佩戴前后纯音听力测试及问卷调查, 了解患者佩戴BAHA后的听力情况及主观感受。结果 62例佩戴BAHA后0.25～4 kHz气导听力均得到了不同程度提高, 对声音的方向感及噪声下言语交流能力提高。结论 BAHA能改善传导性聋或混合性聋患者的听力。     

Evaluation of a wireless remote microphone in bimodal cochlear implant recipients

Objective: To evaluate the benefit of a wireless remote microphone (MM) for speech recognition in noise in bimodal adult cochlear implant (CI) users both in a test setting and in daily life. Design: This prospective study measured speech reception thresholds in noise in a repeated measures design with factors including bimodal hearing and MM use. The participants also had a 3-week trial period at home with the MM. Study sample: Thirteen post-lingually deafened adult bimodal CI users. Results: A significant improvement in SRT of 5.4?dB was found between the use of the CI with the MM and the use of the CI without the MM. By also pairing the MM to the hearing aid (HA) another improvement in SRT of 2.2?dB was found compared to the situation with the MM paired to the CI alone. In daily life, participants reported better speech perception for various challenging listening situations, when using the MM in the bimodal condition. Conclusion: There is a clear advantage of bimodal listening (CI and HA) compared to CI alone when applying advanced wireless remote microphone techniques to improve speech understanding in adult bimodal CI users.     

Comparison of two different bone anchored hearing instruments: Baha-5 vs Ponto-plus

Background: To our knowledge, there is no study comparing Ponto Plus^® (Oticon Medical AB, Askim, Sweden) and Baha^® 5 (Cochlear Bone Anchored Solutions AG, Mölnlycke, Sweden) available in the literature.

Aims/objectives: The primary aim was to compare the performance of the Baha 5 with the Ponto Plus device in terms of speech understanding in quiet and in noise. In addition, to determine statistically whether or not the difference between the abutment systems created any variation in terms of skin reaction.

Materials and methods: Twenty bone-anchored hearing instrument users, ten in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios using the Turkish Matrix Test in a two-speaker setup. The Holger classifications were also reviewed to determine adverse skin reactions.

Results: It was revealed that the hearing results of both devices were similar and, when the skin reactions were compared, there was no statistically significant difference between the two-implant systems.

Conclusions and significance: Because of the similar results of the groups, it can be interpreted as the key different device features such as the size, weight, colour alternatives, and the ease of use of the devices might be important in terms of device preference.     

The BAHA HC200/300 in comparison with conventional bone conduction hearing aids

A retrospective study was performed on 89 patients from a consecutive series who received a BAHA HC200/300 after having previously used conventional bone conduction hearing aids. The patients’ performance with the BAHA HC 200/300 was compared to their performance with conventional bone conduction hearing aids. The patients were divided into two groups, depending on the time of implantation (before or after May 1992). The patients in group 1 (long-term users) were asked to fill in a questionnaire, the same one as they had filled in at the initial BAHA fitting more than 5 years previously. The answers were compared to their original opinions and difference scores were calculated. The long-term clinical results from group 1 are also presented. Although they are encouraging, the patients’ opinion about the BAHA deteriorated somewhat over time. The audiometric results of group 2 were highly comparable with those of group 1. This confirms the positive results with the BAHA found in previous studies.     

Changing characteristics of first-time hearing aid applicants in The Netherlands in the past decade

This study assessed changes in the characteristics of firsttime hearing aid applicants in the past decade. Age, gender, date, type and ear of first hearing aid and audiometry were determined for a sample of 705 firsttime hearing aid applicants. Thirteen cohorts resulted, according to the year of first visit to the dispenser. Differences in age, hearing loss, gender and type and ear of first hearing aid between cohorts were analysed. The mean age of first-time hearing aid users increased from 59.52 years in 1987 to 71.84 years in 1999. The mean pure-tone average hearing loss in the better ear (1, 2 and 4 kHz) decreased from 69.06 dB in 1987 to 51.86 dB in 1999. Relatively more males than females were fitted with hearing aids. Our conclusions are that people are being fitted with hearing aids at older ages and with smaller degrees of hearing loss.     

Effectiveness of low-cut modified amplification strategy and channel-free hearing aid in individuals with auditory neuropathy spectrum disorder

Objective: The present study attempted to compare the aided benefit using low-cut modified amplification and channel-free hearing aids in individuals with auditory neuropathy spectrum disorder (ANSD). It was also attempted to determine these effects in good and poor performers with ANSD. Design: Cross-sectional within group pretest, post-test design. Study sample: Twenty-five individuals with acquired ANSD were selected for the study. The study sample included 11 males and 14 females between the age ranges of 17–40 years (mean age of 24.6 years). Results: The results of the repeated measures analysis of variance (ANOVA) showed that aided benefit was significantly higher with the channel-free hearing aid. Mixed ANOVA results showed that the improvement was more in good performers than poor performers with ANSD. Multiple regression analyses showed that speech identification scores are a strong predictor of aided benefit. Conclusions: The results of the present study suggest that channel-free hearing aids and low-cut modified amplification can be used as an efficient alternative technique during hearing aid fitting for individuals with ANSD. However, further evidence-based studies on a larger group are essential to validate the results.     

中老年听力障碍者助听器验配特点

目的通过123例50岁以上听力障碍患者的纯音听阈测试及助听器验配情况,了解其听力特点及助听器选配的特点。方法感音神经性聋患者123例,以每10岁为一年龄组,统计他们125～8000Hz的纯音听阈,根据听力情况验配西门子数字式助听器,记录最终验配情况并了解未验配的原因。结果各年龄段就诊的中老年聋者总体听力水平大致相仿,均为中重度感音神经性聋,纯音听阈测试表现为下降型听阈曲线。就诊者以70～岁年龄段者最多,最终接受助听器者以70岁以下年龄段者为多。70岁以上者多因戴上助听器后效果不理想或经济原因拒绝验配,70岁以下拒绝验配者则主要担心社会影响。结论中老年感音神经性聋患者的纯音听阈曲线主要为下降型,早诊查、早干预有助于提高生活质量。     

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.     

Frequency-compression outcomes in listeners with steeply sloping audiograms

Previous investigation of an experimental, wearable frequency-compression hearing aid revealed improvements in speech perception for a group of listeners with moderately sloping audiograms (Simpson et al, 2005). In the frequency-compression hearing aid, high frequencies (above 1600 Hz) were amplified in addition to being lowered in frequency. Lower frequencies were amplified without frequency shifting. In the present study, an identical frequency-compression scheme was evaluated in a group of seven subjects, all of whom had steeply sloping hearing losses. No significant differences in group mean scores were found between the frequency-compression device and a conventional hearing instrument for understanding speech in quiet. Testing in noise showed improvements for the frequency-compression scheme for only one of the five subjects tested. Subjectively, all but one of the subjects preferred the sound quality of the conventional hearing instruments. In conclusion, the experimental frequency-compression scheme provided only limited benefit to these listeners with steeply sloping hearing losses.

Sumario

Las investigaciones previas sobre un auxiliar auditivo experimental con compresión de frecuencia revelaron una mejor percepción del lenguaje en un grupo de oyentes con audiogramas de pendiente moderada (Simpson y col., 2005). En el auxiliar auditivo con compresión de frecuencia, las frecuencias agudas (por encima de 1600Hz) se amplificaron además de ser reducidas en frecuencia. Las frecuencias más graves fueron amplificadas sin cambio en la frecuencia. En el presente estudio, un esquema similar de compresión de frecuencia fue evaluado en un grupo de 7 sujetos, todos los cuales tenían hipoacusia con pendientes abruptas. No se encontraron diferencias significativas en los puntajes medios de grupo para entender el lenguaje en silencio entre el dispositivo con compresión de frecuencia y el instrumento convencional. La evaluación en ruido mostró mejoría para el esquema de compresión de la frecuencia en sólo uno de los cinco sujetos evaluados. Subjetivamente, todos menos uno de los sujetos, prefirieron la calidad del sonido de los instrumentos auditivos convencionales. En conclusión, el esquema experimental de compresión de frecuencia aportó sólo un beneficio limitado para los oyentes con hipoacusias de pendiente abrupta.     

Bimodal benefit for cochlear implant listeners with different grades of hearing loss in the opposite ear

Objective: To determine speech perception in quiet and noise of adult cochlear implant listeners retaining a hearing aid contralaterally. Second, to investigate the influence of contralateral hearing thresholds and speech perception on bimodal hearing.

Patients and methods: Sentence recognition with hearing aid alone, cochlear implant alone and bimodally at 6 months after cochlear implantation were assessed in 148 postlingually deafened adults. Data were analyzed for bimodal summation using measures of speech perception in quiet and in noise.

Results: Most of the subjects showed improved sentence recognition in quiet and in noise in the bimodal condition compared to the hearing aid-only or cochlear implant-only mode. The large variability of bimodal benefit in quiet can be partially explained by the degree of pure tone loss. Also, subjects with better hearing on the acoustic side experience significant benefit from the additional electrical input.

Conclusions: Bimodal summation shows different characteristics in quiet and noise. Bimodal benefit in quiet depends on hearing thresholds at higher frequencies as well as in the lower- and middle-frequency ranges. For the bimodal benefit in noise, no correlation with hearing threshold in any frequency range was found.