Quantification of directional benefit across different polar response patterns

The purpose of this study was to assess the relationship between the directivity of a directional microphone hearing aid and listener performance. Hearing aids were fit bilaterally to 19 subjects with sensorineural hearing loss, and five microphone conditions were assessed: omnidirectional, cardioid, hypercardioid, supercardioid, and "monofit," wherein the left hearing aid was set to omnidirectional and the right hearing aid to hypercardioid. Speech perception performance was assessed using the Hearing in Noise Test (HINT) and the Connected Speech Test (CST). Subjects also assessed eight domains of sound quality for three stimuli (speech in quiet, speech in noise, and music). A diffuse soundfield system composed of eight loudspeakers forming the corners of a cube was used to output the background noise for the speech perception tasks and the three stimuli used for sound quality judgments. Results indicated that there were no significant differences in the HINT or CST performance, or sound quality judgments, across the four directional microphone conditions when tested in a diffuse field. Of particular interest was the monofit condition: Performance on speech perception tests was the same whether one or two directional microphones were used.     

Full time directional versus user selectable microphone modes in hearing aids

OBJECTIVE: The purpose of this experiment was to systematically examine hearing aid benefit as measured by speech recognition and self-assessment methods across omnidirectional and directional hearing aid modes. These data were used to compare directional benefit as measured by speech recognition in the laboratory to hearing aid wearer's perceptions of benefit in everyday environments across full-time directional, full-time omnidirectional, and user selectable directional fittings. Identification of possible listening situations that resulted in different self reported hearing aid benefit as a function of microphone type was a secondary objective of this experiment. DESIGN: Fifteen adults with symmetrical, sloping sensorineural hearing loss were fitted bilaterally with in-the-ear (ITE) directional hearing aids. Measures of hearing aid benefit included the Profile of Hearing Aid Benefit (PHAB), the Connected Sentence Test (CST), the Hearing in Noise Test (HINT), and a daily use log. Additionally, two new subscales were developed for administration with the PHAB. These subscales were developed to specifically address situations in which directional hearing aids may provide different degrees of benefit than omnidirectional hearing aids. Participants completed these measures in three conditions: omnidirectional only (O), directional only with low-frequency gain compensation (D), and user-selectable directional/omnidirectional (DO). RESULTS: Results from the speech intelligibility in noise testing indicated significantly more hearing aid benefit in directional modes than omnidirectional. PHAB results indicated more benefit on the background noise subscale (BN) in the DO condition than in the O condition; however, this directional advantage was not present for the D condition. Although the reliability of the newly proposed subscales is as yet unknown, the data were interpreted as revealing a directional advantage in situations where the signal of interest was in front of the participant and a directional disadvantage in situations where the signal of interest was behind the listener or localization was required. CONCLUSIONS: Laboratory directional benefit is reflected in self-assessment measures that focus on listening in noise when the sound source of interest is in front of the listener. The use of a directional hearing aid mode; however, may have either a positive, a neutral, or a negative impact on hearing aid benefit measured in noisy situations, depending on the specific listening situation.     

Evaluation of an adaptive,directional-microphone hearing aid

The effectiveness of adaptive directional processing for improvement of speech recognition in comparison to non-adaptive directional and omni-directional processing was examined across four listening environments intended to simulate those found in the real world. The test environment was a single, moderately reverberant room with four loudspeaker configurations: three with fixed discrete noise source positions and one with a single panning noise source. Sentence materials from the Hearing in Noise Test (HINT) and Connected Speech Test (CST) were selected as test materials. Speech recognition across all listening conditions was evaluated for 20 listeners fitted binaurally with Phonak Claro behind-the-ear (BTE) style hearing aids. Results indicated improved speech recognition performance with adaptive and non-adaptive directional processing over that measured with the omnidirectional processing across all four listening conditions. While the magnitudes of directional benefit provided to subjects listening in adaptive and fixed directional modes were similar in some listening environments, a significant speech recognition advantage was measured for the adaptive mode in specific conditions. The advantage for adaptive over fixed directional processing was most prominent when a competing noise was presented from the listener's sides (both fixed and panning noise conditions), and was partially predictable from electroacoustically measured directional pattern data.     

The effects of changes in head angle on auditory and visual input for omnidirectional and directional microphone hearing aids

Improving the signal-to-noise ratio (SNR) for individuals with hearing loss who are listening to speech in noise provides an obvious benefit. Although binaural hearing provides the greatest advantage over monaural hearing in noise, some individuals with symmetrical hearing loss choose to wear only one hearing aid. The present study tested the hypothesis that individuals with symmetrical hearing loss fit with one hearing aid would demonstrate improved speech recognition in background noise with increases in head turn. Fourteen individuals were fit monaurally with a Starkey Gemini in-the-ear (ITE) hearing aid with directional and omnidirectional microphone modes. Speech recognition performance in noise was tested using the audiovisual version of the Connected Speech Test (CST v.3). The test was administered in auditory-only conditions as well as with the addition of visual cues for each of three head angles: 0 degrees, 20 degrees, and 40 degrees. Results indicated improvement in speech recognition performance with changes in head angle for the auditory-only presentation mode at the 20 degrees and 40 degrees head angles when compared to 0 degrees. Improvement in speech recognition performance for the auditory + visual mode was noted for the 20 degrees head angle when compared to 0 degrees. Additionally, a decrement in speech recognition performance for the auditory + visual mode was noted for the 40 degrees head angle when compared to 0 degrees. These results support a speech recognition advantage for listeners fit with one ITE hearing aid listening in a close listener-to-speaker distance when they turn their head slightly in order to increase signal intensity.     

Comparison of benefits provided by different hearing aid technologies

The performance of 40 hearing-impaired adults with the GN ReSound digital BZ5 hearing instrument was compared with performance with linear hearing aids with input compression limiting (AGC-I) or two-channel analog wide dynamic range compression (WDRC) instruments. The BZ5 was evaluated with an omnidirectional microphone, dual-microphone directionality, and a noise reduction circuit in combination with dual-microphone directionality. Participants were experienced hearing aid users who were wearing linear AGC-I or analog WDRC instruments at the time of enrolment. Performance was assessed using the Connected Speech Test (CST) presented at several presentation levels and under various conditions of signal degradation and by the Profile of Hearing Aid Benefit (PHAB). Subjective ratings of speech understanding, listening comfort, and sound quality/naturalness were also obtained using 11-point interval scales. Small performance advantages were observed for WDRC over linear AGC-I, although WDRC did not have to be implemented digitally for these performance advantages to be realized. Substantial performance advantages for the dual microphones over the omnidirectional microphone were observed in the CST results in noise, but participants generally did not perceive these large advantages in everyday listening. The noise reduction circuit provided improved listening comfort but little change in speech understanding.     

Comparison of performance across three directional hearing aids

This study compared the speech recognition performance of 12 hearing-impaired listeners fit with three commercially available behind-the-ear hearing aids in both directional and omnidirectional modes. One digitally programmable analog and two "true digital" hearing aids were selected as test instruments. Testing was completed in both "living room" and anechoic room environments. Speech recognition was examined using modified forms of the Hearing in Noise Test and the Nonsense Syllable Test. The single competing stimuli of these tests were replaced with five uncorrelated competing sources. Results revealed a significant speech recognition in noise advantage for all directional hearing aids in comparison to their omnidirectional counterparts. Maximum performance of the directional hearing aids did not significantly vary across circuit type, suggesting that processing differences did not affect maximum directional hearing aid performance. In addition, the results suggest that performance in one reverberant environment cannot be used to accurately predict performance in an environment with differing reverberation.     

Directivity and noise reduction in hearing aids: speech perception and benefit

Hearing aid.AimTo compare the performance, benefit and satisfaction of users of ITE, CIC and BTE digital hearing aid with noise reduction and omnidirectional and directional microphones.Method34 users of hearing aid were evaluated by means of speech perception in noise tests and APHAB and IOI self assessment questionnaires. Prospective study.ResultsBetter results were obtained by users of ITE, CIC and directional hearing aids, however, no statistical significance was found between the groups.ConclusionDirectivity improved speech perception in noise and benefit in daily life situations.     

Effects of noise source configuration on directional benefit using symmetric and asymmetric directional hearing aid fittings

OBJECTIVE: The benefits of directional processing in hearing aids are well documented in laboratory settings. Likewise, substantial research has shown that speech understanding is optimized in many settings when listening binaurally. Although these findings suggest that speech understanding would be optimized by using bilateral directional technology (e.g., a symmetric directional fitting), recent research suggests similar performance with an asymmetrical fitting (directional in one ear and omnidirectional in the other). The purpose of this study was to explore the benefits of using bilateral directional processing, as opposed to an asymmetric fitting, in environments where the primary speech and noise sources come from different directions. DESIGN: Sixteen older adults with mild-to-severe sensorineural hearing loss (SNHL) were recruited for the study. Aided sentence recognition using the Hearing in Noise Test (HINT) was assessed in a moderately reverberant room, in three different speech and noise conditions in which the locations of the speech and noise sources were varied. In each speech and noise condition, speech understanding was assessed in four different microphone modes (bilateral omnidirectional mode; bilateral directional mode; directional mode left and omnidirectional mode right; omnidirectional mode left and directional mode right). The benefits and limitations of bilateral directional processing were assessed by comparing HINT thresholds across the various symmetric and asymmetric microphone processing conditions. RESULTS: Study results revealed directional benefit varied based on microphone mode symmetry (i.e., symmetric versus asymmetric directional processing) and the specific speech and noise configuration. In noise configurations in which the speech was located in the front of the listener and the noise was located to the side or surrounded the listener, maximum directional benefit (approximately 3.3 dB) was observed with the symmetric directional fitting. HINT thresholds obtained when using bilateral directional processing were approximately 1.4 dB better than when an asymmetric fitting (directional processing in only one ear) was used. When speech was located on the side of the listener, the use of directional processing on the ear near the speech significantly reduced speech understanding. CONCLUSIONS: Although directional benefit is present in asymmetric fittings, the use of bilateral directional processing optimizes speech understanding in noise conditions in which the speech comes from in front of the listener and the noise sources are located to the side of or surround the listener. In situations in which the speech is located to the side of the listener, the use of directional processing on the ear adjacent to the speaker is likely to reduce speech audibility and thus degrade speech understanding.     

Predicting directional hearing aid benefit for individual listeners

The fitting of directional microphone hearing aids is becoming increasingly more routine, and this fitting option has proven to be a successful method to improve speech intelligibility in many noisy listening environments. Data suggest, however, that some hearing-impaired listeners receive significantly more directional benefit than others. It is of interest, therefore, to determine if directional benefit is predictable from identifiable audiologic factors. In this report, we examined whether the slope of audiometric configuration, amount of high-frequency hearing loss, and/or the aided omnidirectional performance for a speech-in-noise intelligibility task could be used to predict the magnitude of directional hearing aid benefit. Overall results obtained from three separate investigations revealed no significant correlation between the slope of audiometric configuration or amount of high-frequency hearing loss and the benefit obtained from directional microphone hearing instruments. Although there was a significant, negative relationship between aided omnidirectional performance and the directional benefit obtained in one study, there was considerable variability among individual participants, and nearly all of the listeners with the best omnidirectional hearing aid performance still received significant additional benefit from directional amplification. These results suggest that audiologists should consider the use of directional amplification for patients regardless of audiogram slope, high-frequency hearing loss, or omnidirectional speech intelligibility score.     

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.     

Predictability of speech-in-noise performance from real ear measures of directional hearing AIDS

OBJECTIVE: Inability to understand speech in noise has been cited repeatedly as the principal complaint of hearing aid users. While data exist documenting the benefit provided by hearing aids with directional microphones when listening to speech in noise, little work has been done to develop a standard clinical protocol for fitting these hearing aids. Our goal was to evaluate a clinical measure of the acoustic directivity of a directional hearing aid, including its association with a test of speech perception in noise. DESIGN: The performance of two commercially available directional behind-the-ear (BTE) hearing aids was evaluated using the Hearing in Noise Test (HINT) and the Real Ear Aided Response (REAR) on 24 adult participants with symmetric, mild to moderately severe, sensorineural hearing loss. The HINT was conducted with the speech signal presented from 0 degrees and the noise from 180 degrees and either 135 degrees or 225 degrees, depending on the ear tested. REAR was measured at the above three angles using swept pure tones, and these measures were used to compute in situ directivity for each subject and hearing aid. CONCLUSIONS: Directional benefit for the HINT was greatest when noise was presented from the azimuth of the published polar diagram null of a given hearing aid in its directional mode (180 or 135/225 degrees). The only significant correlation between HINT and REAR results, however, was found when the noise source was at 180 degrees. These results confirm the validity of using real ear measures as a way to assess directionality in situ, but also indicate the complexity of predicting perceptual benefit from them. These data suggest that factors beyond acoustic directionality may contribute to improvement in speech perception in noise when such improvements are found.     

Speech recognition with in-the-ear and behind-the-ear dual-microphone hearing instruments

The primary purpose of this study was to compare the overall listening benefit in diffuse noise provided by dual-microphone technology in an in-the-ear (ITE) hearing instrument to that provided by dual-microphone technology in a behind-the-ear (BTE) hearing instrument. Further, the study was designed to determine whether the use of the dual-microphone + the manufacturer's party response algorithm in the ITE and BTE hearing instruments provided listening benefit in diffuse noise over their respective omnidirectional microphone modes. Twenty-four adults with mild to moderately severe sensorineural hearing loss were evaluated while wearing binaural BTE and ITE hearing instruments. The results indicated that the dual-microphone + party response mode did provide significant benefit in diffuse noise for both the ITE (3.27 dB signal-to-noise ratio [SNR] improvement) and BTE (5.77 dB SNR improvement) hearing instruments relative to their respective conventional omnidirectional microphones. No significant difference in performance was found between the ITE and BTE hearing instruments when each device was in the dual-microphone + party response mode. It is concluded that the use of dual-microphone technology in both ITE and BTE hearing instruments can improve speech recognition in diffuse noise.     

Objective and subjective hearing aid assessment outcomes

PURPOSE: To determine whether specific sentence recognition assessments were sensitive enough to serve as objective outcome measurements that document subjective improvements in speech understanding with hearing aids. METHOD: The Revised Speech Perception in Noise test (R-SPIN; R. C. Bilger, J. M. Nuetzel, W. M. Rabinowitz, & C. Rzeczkowski, 1984), the Hearing in Noise Test (HINT; M. Nilsson, S. D. Soli, & J. A. Sullivan, 1994), and the Quick Speech-in-Noise test (QuickSIN; Etymotic Research, 2001; M. C. Killion, P. A. Niquette, G. I. Gudmundsen, L. J. Revit, & S. Banerjee, 2004) were administered to 21 hearing aid users to determine whether the tests could adequately document improvements in speech understanding with hearing aids compared with the research participants' self-assessments of their own performance. Comparisons were made between unaided and aided performance on these sentence tests and on the Hearing Aid Performance Inventory (HAPI; B. E. Walden, M. Demorest, & E. Hepler, 1984). RESULTS: The R-SPIN, the HINT Quiet threshold, and the QuickSIN signal-to-noise ratio (SNR) loss were the most sensitive of the sentence recognition tests to objectively assess improvements in speech perception performance with hearing aids. Comparisons among the subjective and objective outcome measures documented that HAPI ratings improved as performance on the R-SPIN, the HINT Quiet threshold, and the QuickSIN SNR loss improved. CONCLUSIONS: Objective documentation of subjective impressions is essential for determining the efficacy of treatment outcomes in hearing aid fitting. The findings reported here more clearly define the relationship between objective and subjective outcome measures in an attempt to better define true hearing aid benefit.     

A new hearing aid variant. Preliminary evaluation

An attempt was made to combine the advantages of a behind-the-ear (BTE) hearing aid (trouble-free use, powerful amplification, room for high-quality components, space for large energy source, use of extra equipment), with the advantages of the in-the-ear (ITE) hearing aid (improved intelligibility, improved directional hearing, improved signal/noise ratio). A BTE hearing aid was equipped with filters and provided with an external microphone. A first experiment, carried out in an anechoic chamber on KEMAR (Knowles Electronic Manikin for Acoustical Research), showed that directional variation of the frequency response of the hearing aid microphone was better in the new hearing aid than in the original BTE. A second experiment was carried out with a group of 6 normal-hearing persons concerning the frequency characteristic of sound transmission from twelve angles in the horizontal plane without a hearing aid, with a normal BTE aid, with the 'new aid', and with an ITE aid. The new instrument gave significantly better directional hearing than the original BTE aid. A clinical study will be started to verify and extend the experimental results obtained.     

Advantages of directional hearing aid microphones related to room acoustics.

In this study, two types of hearing aids were used. Both aids had the same frequency characteristics for frontal sound, but one employed an omnidirectional microphone and the other a directional microphone. The frequency characteristics of both hearing aids were measured for five azimuths on KEMAR and in situ in 12 normal-hearing subjects. For these subjects we also determined the speech reception threshold (SRT) with background noise in two rooms with different reverberation times. The direction of the speech stimuli was always frontal; the direction of the noise was varied. Additionally, directional hearing was measured with short noise bursts from eight loudspeakers surrounding the subject. In the less reverberant room, sounds coming from behind were less amplified by the hearing aid with the directional microphone than by the one with the omnidirectional microphone. In this room the monaural SRT values were largely determined by the level of the background noise. For the directional hearing aids there was an extra binaural advantage which depended on the direction of the background noise. Only for low-frequency noise bursts was directional hearing better with directional hearing aids. In the more reverberant room, no distinct differences between the frequency characteristics of the two hearing aid types were measured. However, a systematic difference between monaural SRT values measured through the two hearing aids was found. This difference was independent of noise azimuth. In conclusion, hearing aid(s) with a directional microphone showed no disadvantages and clear advantages under specific conditions.     

Speech understanding and directional hearing for hearing-impaired subjects with in-the-ear and behind-the-ear hearing aids

With respect to acoustical properties, in-the-ear (ITE) aids should give better understanding and directional hearing than behind-the-ear (BTE) aids. Also hearing-impaired subjects often prefer ITEs. A study was performed to assess objectively the improvement in speech understanding and directional hearing afforded by ITE aids versus BTEs. In 28 hearing-impaired subjects, who visited our Centre for a check-up of their ITEs, the following parameters were measured: (a) thresholds for third-octave bandpass noises between 0.25 and 4 kHz, (b) speech reception thresholds for short Dutch sentences in quiet and with background noise, (c) directional hearing. All three experiments were done binaurally with the subjects wearing their ITEs, BTEs, and no hearing aid. With the 2-cc coupler, the gain used by the subject was measured. The SRT values for the ITE were significantly lower than those for BTE. More gain at 2 and 4 kHz in the ITE proved to be a responsible factor for this improvement. Directional hearing was not improved by wearing an ITE. Large interindividual differences were found between functional gain and the 2-cc coupler measurements. The mean functional gain at 4 kHz for an ITE is higher than the gain measured in a 2-cc coupler. For a BTE, the functional gain at 2 and 4 kHz is lower than the 2-cc coupler gain.