Most comfortable listening for the loudness and intelligibility of speech.

The effect of instructional set upon most comfortable listening (MCL) was investigated among normal listeners. MCL level and range were determined (method of limits) in relation to listening for comfortable speech loudness versus comfortable speech intelligibility. The results indicate that instructional set does influence listener performance. the mean MCL level for comfortable speech intelligibility was significantly higher (4.96 dB) than the mean level for comfortable speech loudness; the mean MCL range for comfortable speech intelligibility was higher by 7.33 dB and wider by 7.10 dB than the mean range for speech loudness. Ascending stimulus presentation obtained comparable MCL levels for both listening conditions, whereas descending presentation obtained a mean MCL level almost 10 dB higher for comfortable speech intelligibility than for comfortable speech loudness. Males achieved slightly higher MCL levels than did females for both loudness (4.32 dB) and intelligibility (4.96 dB) criteria. It was concluded that the nature of the instructional set be taken into account when interpreting comfortable listening measures.     

Comparison of the NAL(R) and Cambridge formulae for the fitting of linear hearing aids

This paper describes a laboratory-based comparison of the effectiveness of two formulae for fitting linear hearing aids, the NAL(R) formula and the Cambridge formula. The formulae prescribe the desired insertion gain as a function of frequency, based on the audiometric threshold. The two formulae have a similar rationale; both are based on the goal that, for speech with a moderate level, all frequency bands should be equally loud (equal loudness per critical band) over the frequency range important for speech (400-5000 Hz), and the overall loudness should be comfortable. However, the formulae differ; generally the Cambridge formula leads to slightly more high-frequency gain (above 2 kHz) and slightly less mid-frequency gain (between 500 Hz and 2000 Hz) than the NAL(R) formula. The two formulae were implemented using an experimental digital hearing aid whose frequency-gain characteristic could be controlled very precisely. A loudness model (Moore and Glasberg, 1997) was used to adjust the overall gains for each subject and each formula so that a speech-shaped noise with an overall level of 65 dB SPL would give the same loudness as for a normally hearing person (according to the model). The adjustments were, on average, smaller for the Cambridge than for the NAL(R) formula. A condition was also used with all insertion gains set to zero, simulating unaided listening. Evaluation was based on: (1) subjective ratings of the loudness, intelligibility and quality of continuous discourse presented in quiet at levels of 45, 55, 65 and 75 dB SPL and in babble at an 0-dB speech-to-babble ratio, using speech levels of 55, 65 and 75 dB SPL; (2) measures of the speech reception threshold (SRT) in background noise for two noise levels (65 and 75 dB SPL) and four types of background noise. Neither the subjective ratings nor the measures of the SRTs revealed any consistent difference between the results obtained using the two formulae, although both formulae led to lower (better) SRTs than for simulated unaided listening. It is concluded that the differences between the NAL(R) formula and the Cambridge formula are too small to have measurable effects, at least in a laboratory setting.     

Use of a loudness model for hearing aid fitting: II. Hearing aids with multi-channel compression.

A model for predicting loudness for people with cochlear hearing loss was applied to the problem of the initial fitting of a multi-channel compression hearing aid. The fitting was based on two constraints: (1) The specific loudness pattern evoked by speech of a moderate level (65 dB SPL) should be reasonably flat (equal loudness per critical band), and the overall loudness should be similar to that evoked in a normal listener by 65-dB speech (about 23 sones for binaural listening); (2) Speech with an overall level of 45 dB SPL should just be audible in all frequency bands from 500 Hz up to about 4 kHz, provided that this does not require compression ratios exceeding about 3. These two constraints were used to determine initial values for the gain, compression ratio and compression threshold in each channel of a multi-channel compression system. This initial fitting was based entirely on audiometric thresholds; it does not require suprathreshold loudness measures. The fitting method was evaluated using an experimental fast-acting four-channel compression system. The initial fitting was followed by an adaptive procedure to 'fine tune' the fitting, and the aids were then used in everyday life. Performance was evaluated by use of questionnaires and by measures of speech intelligibility. Although the fine tuning resulted in modest changes in the fitting parameters for some subjects, on average the frequency response shapes and compression ratios were similar before and after the fine tuning. The fittings led to satisfactory loudness impressions in everyday life and to high speech intelligibility over a wide range of levels. It was concluded that the initial fitting method gives reasonable starting values for the fine tuning.     

Binaural loudness summation in the hearing impaired

Binaural loudness summation was measured using three different paradigms with 10 normally hearing and 20 bilaterally symmetrical high-frequency sensorineural hearing loss subjects. An adaptive paradigm and a loudness matching procedure measured summation at the lower and upper level of comfortable loudness and the loudness discomfort level (LDL). Monaural and binaural LDLs also were obtained with a clinical procedure designed to select maximum output of hearing aids. Stimuli for all three tasks consisted of 500- and 4000-Hz pure tones and a speech spectrum noise. Binaural summation increased with presentation level using the loudness matching procedure, with values in the 6-10 dB range. Summation decreased with level using the adaptive paradigm, and no summation was present with the clinical LDL task. The hearing-impaired subjects demonstrated binaural summation that was not significantly different from the normally hearing subjects. The results suggest that a bilaterally symmetrical sensorineural hearing loss does not affect binaural loudness summation. The monaural and binaural dynamic range widths were similar, and the LDL results suggest that binaural loudness summation may not be an important factor in selecting maximum output of hearing aids.     

Use of a loudness model for hearing aid fitting: III. A general method for deriving initial fittings for hearing aids with multi-channel compression.

A model for predicting loudness for people with cochlear hearing loss is applied to the problem of the initial fitting of multi-channel fast-acting compression hearing aids. The fitting is based entirely on the pure tone audiogram, and does not require measures of loudness growth. One constraint is always applied: the specific loudness pattern evoked by speech of a moderate level (65 dB SPL) should be reasonably flat (equal loudness per critical band), and the overall loudness should be similar to that evoked in a normal listener by 65-dB speech. This is achieved using the 'Cambridge' formula. For hearing aids where the compression threshold in each channel can be set to a very low value, an additional constraint is used: speech with an overall level of 45 dB SPL should be audible over its entire dynamic range in all frequency channels from 500 Hz up to about 4 kHz. For hearing aids where the compression thresholds cannot be set to very low values, a different additional constraint is used: the specific loudness pattern evoked by speech of a high level (85 dB SPL, and with the spectral characteristics of shouted speech) should be reasonably flat, and the overall loudness should be similar to that evoked in a normal listener by 85-dB speech. For both cases, compression ratios are limited to values below 3. For each of these two cases, we show how to derive compression ratios and gains, and for the first case, compression thresholds, for each channel. The derivations apply to systems with any number of channels. A computer program implementing the derivations is described. The program also calculates target insertion gains at the centre frequency of each channel for input levels of 50, 65 and 80 dB SPL, and target gains at the eardrum measured relative to the level at the reference microphone of a probe microphone system.     

Improvements in speech intelligibility in quiet and in noise produced by two-channel compression hearing aids

Eight subjects suffering from bilateral sensorineural hearing losses with recruitment were fitted binaurally with two-channel compression hearing aids, worn behind the ear. After they had worn the aids for some time, measures of speech intelligibility were compared for two conditions: listening unaided, and listening aided. the dynamic range for speech, defined as the difference in level between the speech reception threshold in quiet and the highest comfortable level for speech, was substantially increased in the aided condition for seven of the eight subjects (the exception was a subject with almost normal low-frequency hearing). Speech reception thresholds were also measured in two levels of background noise ('babble'), 60 and 75 dB SPL. Seven of the eight subjects showed a reduced speech reception threshold (i.e. an improvement) in the aided condition for at least one of the two noise levels, although the size of the improvement differed considerably from one subject to another. The subjects were also given a battery of psycho-acoustical tests in an attempt to better characterise their hearing loss, and to gain more insight into individual differences. Results of measurements of frequency selectivity, frequency discrimination, temporal acuity and temporal masking are described and related to the measures of speech intelligibility.     

Fitting range of the BAHA Cordelle

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30 and 70 dB HL, and an additional air-bone gap of about at least 30 dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.     

Comparison of linear gain and wide dynamic range compression hearing aid circuits: aided speech perception measures

OBJECTIVES: The goal of this study was to test the theoretical advantages of a single-channel wide dynamic range compression (WDRC) circuit for speech intelligibility and loudness comfort for five speech spectra. DESIGN: Twelve adolescents and young adults with moderate to severe hearing loss were fitted with the Siemens Viva 2 Pro behind-the-ear instrument set to DSL 4.0 targets for both linear gain and WDRC processing. Speech intelligibility was measured in the unaided, linear gain and WDRC conditions using two tasks in quiet: nonsense words and sentences. The items were digitally filtered to represent five speech spectra: average speech at 4 m, average speech at 1 m, own voice at ear level, classroom at 1 m, and shouted speech at 1 m. The subjects also rated the loudness of each hearing aid/speech spectrum combination using a categorical rating scale. RESULTS: Both the linear gain and WDRC settings provided improved speech recognition relative to the unaided condition, and the two circuits resulted in equivalent performance for average speech input levels. On average, the WDRC aid resulted in high and uniform speech recognition scores across the five spectra. In contrast, the linear gain aid resulted in a lower recognition score for soft speech and shouted speech relative to that obtained with an average speech level. Analysis of individual speech recognition benefit scores revealed that 11 out of 12 subjects had equal or greater performance with the WDRC processing than the linear processing. Subjective loudness ratings in the linear gain condition were compatible with decreased sensation level for soft speech and loudness discomfort for shouted speech. CONCLUSIONS: WDRC processing has potential applications in hearing aid fittings for listeners with moderate to severe hearing loss because it provides a consistently audible and comfortable signal across a wide range of listening conditions in quiet without the need for volume control adjustments.     

Comparison of performance with wide dynamic range compression and linear amplification

This study compared subject performance and preference using a compression-limiting hearing aid set to linear amplification (program 1) and wide dynamic range compression (WDRC, program 2). The frequency responses of the hearing aid were matched to a 65 dB SPL signal and maximum output to a 90 dB SPL signal. Twenty subjects with moderate to moderately severe sensorineural hearing loss were tested. Speech recognition scores and speech reception thresholds were obtained both in quiet and in noise. Subjective preference for WDRC or linear amplification was measured via a paired-comparison procedure on "loudness appropriateness," "clarity," and "pleasantness" to continuous discourse presented in quiet and in noise. Results suggested that WDRC yielded better speech intelligibility in quiet for low-level signals and no difference in speech intelligibility in noise compared to linear amplification. Subjects preferred WDRC for loudness to both high- and low-level signals and for pleasantness to high-level signals.     

Evoked otoacoustic emission in conduction of dehydration tests in patients with Meniere's disease

We studied potentiality of the test of evoked otoacoustic emission (EOAE) for monitoring of dynamic changes in the internal ear in conduction of dehydration tests. In parallel to registration of tonal hearing thresholds and speech intelligibility in conduction of dehydration tests we registered two classes of EOAE: delayed EOAE (DEOAE) and distortion product otoacoustic emission (DPOAE). Of 36 examinees, we registered DEOAE prior to dehydration in 22 patients. By audiometry, these patients had hearing under 40 dB lower the hearing threshold at frequencies 250-4000 Hz. In registration of DEOAE in dynamics a maximal amplitude increase was seen 2 hours after intake of glycerin. A mean amplitude increase was 7.0+/-2.3 dB. Before dehydration DEOAE was recorded in 26 of 36 patients. Two hours laser otoacoustic response was registered in 29 patients. Hearing loss was not more than 60 dB at frequencies 250-4000 Hz. A maximal amplitude increase was seen in 2 hours. A mean amplitude increase in dehydration was 7.3+/-3.7 dB.     

Auditory detection, discrimination and speech processing in ageing, noise-sensitive and hearing-impaired listeners

The aims of this research were to document changes in hearing and speech intelligibility in noise that occur with ageing, noise sensitivity, and progressive bilateral sensorineural hearing loss. Five groups defined by age, clinical complaint and degree of hearing loss were tested. Each of 73 subjects participated in nine different procedures, including detection in quiet and in continuous 90 dB SPL helicopter noise, frequency and duration discrimination, consonant recognition and word identification. The effects of different types of background noise and speech-to-noise ratio were investigated. Ageing, without concomitant hearing loss, resulted in significantly greater DLs both for frequency and for duration with a 20 ms standard at both 500 Hz and 4,000 Hz. Hearing loss, unconfounded by ageing, affected masked detection and frequency discrimination at 4,000 Hz and speech intelligibility in noise. The sole finding for subjects with noise sensitivity was an upward spread of masking for detection. Across tests, the best predictors of speech processing decrements were the detection thresholds for 2,000 Hz and 4,000 Hz in quiet or in noise.     

Variability of most comfortable and uncomfortable loudness levels to speech stimuli in the hearing impaired

Methods for determining hearing aid settings often incorporate measurements of most comfortable loudness (MCL) and uncomfortable loudness (UCL) levels. This study examined the variability of loudness measures and their correlation to threshold data, using speech stimuli presented to hearing-impaired subjects. MCLs, UCLs, speech reception, and speech detection thresholds were obtained from 50 subjects having sensorineural impairments. The stimuli were CID W-2 spondees spoken by three female clinicians. Three MCLs and UCLs were obtained within each session, using ascending runs and a closed-set response list. Fifteen subjects were retested twice over intervals ranging from a week to several months. Between-session variability for the loudness measurements was less than or equal to 10 dB across sessions and speakers for the majority of subjects, with a tendency for the MCL and UCL to increase slightly over time. Significant variability was attributed to the use of live-voice presentation by different clinicians. High positive correlation was found between threshold and loudness data for subjects with relatively flat audiometric configurations but not for subjects demonstrating sharply sloping hearing losses.     

Relationship between pure-tone and speech loudness discomfort levels among hearing-impaired subjects

The purpose of this study was to investigate how accurately pure-tone (250-6000 Hz) loudness discomfort levels (LDLs) predict speech (CID Test W-22) LDLs. One ear was tested in each of 50 elderly subjects with mild-to-moderate sensorineural hearing loss. The results revealed poor-to-fair correlations (r = 0.00 to 0.42) and large standard errors of estimate (approximately 9.5 dB). Thus, it was concluded that pure-tone LDLs are not accurate predictors of the speech LDL, and, if the clinician wants to ascertain the upper intensity for listening to speech, this measurement must be made directly.     

Fitting range of the BAHA Cordelle

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30?and 70 dB HL, and an additional air-bone gap of about at least 30?dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.     

The use of High-Pass amplification for Broad-Frequency sensorineural hearing loss

Recent research suggests that persons with sensorineural hearing impairment should derive extra benefit from amplification that eliminates or greatly reduces low frequencies, i.e. frequencies below 1 500 or 2 000 Hz. Such amplification seems to reduce the detrimental effects of the upward spread of masking on speech intelligibility, especially when listening in noisy environments. Also, current research indicates that extended high-frequency amplification, between 4 000 and 6 500 Hz is especially beneficial for optimal speech intelligibility. 9 patients with a relatively flat, moderate to severe sensorineural hearing loss were evaluated in the clinic and for daily listening situations while wearing conventional broad-frequency hearing aids with an upper range of about 4 500 Hz. They were also evaluated under these same circumstances with a hearing aid that reduces low frequencies and extends the high frequencies to nearly 6 500 Hz. Results indicate that these patients performed better and preferred the hearing aid that extends the high and reduces the low frequencies, particularly in noisy places. As a group, they did not prefer this type of amplification in quiet listening situations.     

Conservation of low-frequency hearing in cochlear implantation

OBJECTIVES: As results with cochlear implants have continued to improve, patients with some remaining cochlear function have become eligible for cochlear implantation. Thus, preservation of acoustic hearing after implantation has gained importance. Hearing preservation can be considered a benchmark for atraumatic implantation preventing neural degeneration from loss of residual hair cells or subsequent to local trauma. In this prospective study, the possibility of preserving low-frequency hearing in cochlear implantation using a modified surgical technique has been explored. MATERIAL AND METHODS: In a prospective study design, 14 subjects with considerable low-frequency hearing of 20-60 dB in the frequency range 125-500 Hz but with unsatisfactory speech understanding with hearing aids of < 35% monosyllabic word understanding were implanted with a MED-EL COMBI-40+ cochlear implant. The insertion depth was intentionally limited to 19-24 mm to prevent damage to low-frequency regions of the cochlea. Pre- and postoperative pure-tone thresholds were measured. RESULTS: Hearing was conserved within 0-10 dB in 9/14 subjects and within 11-20 dB in 3/14; in 2/14 subjects hearing was completely lost in the implanted ear. Thus hearing could at least partially be conserved in 12/14 subjects (86%). Median threshold values decreased by 10, 15, 17.5 and 5 dB at 125, 250, 500 and 1000 Hz, respectively. Even high levels of hearing, e.g. 30 dB at 500 Hz, could be maintained after implantation in some subjects. CONCLUSIONS: This study reports successful conservation of hearing after cochlear implantation using a modified surgical technique. Even high levels of hearing could be maintained, showing that implantation of an intracochlear electrode can be performed atraumatically with preservation of functional structures.     

Comparison of three procedures for initial fitting of compression hearing aids. I. Experienced users, fitted bilaterally

We compared the effectiveness of three procedures for the initial fitting of hearing aids with multi-band compression: (1) CAMEQ, which aims to amplify speech so as to give equal loudness per critical band over the frequency range important for speech intelligibility, and to give similar overall loudness to 'normal': (2) CAMREST, which aims to amplify speech so as to restore 'normal' specific loudness patterns, over a wide range of speech levels; (3) DSL I/O, which aims to map the dynamic range of normally hearing people into the reduced dynamic range of hearing-impaired people, with 'full' restoration of audibility. Ten experienced hearing aid users with moderate sensorineural loss were fitted bilaterally with Danalogic 163D digital hearing aids, using each procedure in turn; the order was counterbalanced across subjects. The fitting required specification of gains for input levels of 55 and 80 dB SPL at six centre frequencies. Real-ear measurements were made to ensure that target gains were reached (+/-3 dB). Immediately after fitting with a given procedure, and one week after fitting, the gains were adjusted when required by the minimum amount necessary to achieve acceptable fittings. The amount of adjustment required provides one measure of the adequacy of the initial fitting. On average, the adjustments were smallest for the CAMEQ procedure. The gain changes were slightly larger for the CAMREST procedure and were largest of all for DSL I/O. For the latter, the gain changes were mostly negative, especially for high frequencies and the higher input level. This indicates that the DSL I/O procedure prescribes more high-frequency gain than is preferred by adult users. After these gain adjustments, users wore the aids for at least three weeks before filling out the APHAB questionnaire and taking part in laboratory measurements of the speech reception threshold (SRT) for sentences in quiet and in steady and fluctuating background noise at levels of 60 and 75 dB SPL. Following these tests, the hearing aids were re-fitted with the next procedure. The scores on the APHAB test and the SRTs did not differ significantly for the three procedures. We conclude that the CAMEQ and CAMREST procedures provide more appropriate initial fittings than DSL I/O.     

Growth of Loudness in Listeners with Cochlear Hearing Losses: Recruitment Reconsidered

This article examines how loudness grows with increasing intensity near threshold in five listeners with hearing losses of predominantly cochlear origin. It provides evidence against the pervasive and long-held notion that such listeners show abnormally rapid loudness growth near their elevated thresholds. As in a previous study for listeners with normal hearing, loudness functions near threshold were derived from loudness matches between a pure tone and four- or ten-tone complexes using a simple model of loudness summation. This study assumed that the loudness function had the same form for any component of a complex, but a scale factor that depended on the amount of hearing loss allowed the loudness at threshold to vary with frequency. The best-fitting loudness functions had low-level local exponents [i.e., slopes of the low-level loudness function plotted as log(loudness) versus log(intensity)] that were within the normal range. At 0 dB SL, the average local exponents were 1.26 for the listeners with hearing losses compared with 1.31 for normal listeners, which indicates that loudness near threshold grows at similar rates in normal listeners and listeners with hearing losses. The model also indicated that, on average, the loudness at threshold doubled for every 16 dB of hearing loss. The increased loudness at threshold, together with somewhat enlarged local exponents around 20 dB SL, accounts for the near-normal loudness often obtained for high-SPL tones in listeners with hearing losses. Such loudness functions are consistent with the steep functions shown by classical data on loudness matches between tones for which thresholds are normal and tones for which thresholds are elevated. Thus, the present data indicate that an abnormally large loudness at an elevated threshold is likely to be a better definition of recruitment than the classical definition of it as an abnormally rapid growth of loudness above an elevated threshold.