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

Abstract

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

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

Abstract

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

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

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

Acceptance of noise growth patterns in hearing aid users.

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

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Acceptable noise level as a predictor of hearing aid use

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

A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users

Abstract

Objective: Previous research shows that the internet can be used in the rehabilitation of hearing-aid users. By further developing the online program, it might be possible to foster behavioral changes that will positively affect hearing-aid users. Design: A randomized controlled study with two groups of participants. The intervention group underwent a five-week online intervention while the control group was referred to a waiting list. Questionnaires were used as outcome measures. Study sample: Seventy-six experienced hearing-aid users participated in the study, ranging in age from 26 to 81 years (mean 69.3 years). Results: The findings showed significant improvements in the intervention group after the intervention, measured by the hearing handicap inventory for the elderly. The effects were maintained and improved at the follow-up. Furthermore, the results indicated that the participants in the intervention group improved at two items of the international outcome inventory for hearing aids, and the effects were partly maintained at the follow-up. Finally, significant improvements in the domain of psychosocial wellbeing were found at the follow-up. Conclusions: This study provides further evidence that the internet can be used to deliver intervention of rehabilitation to hearing-aid users.     

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.     

The acceptance of background noise in adult cochlear implant users.

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

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.     

The relationship of locus of control,self-control,and acceptable noise levels for young listeners with normal hearing

Abstract

Objective: Background noise acceptance while listening to speech, assessed via the acceptable noise level (ANL) measure, has been shown to be an accurate predictor of hearing-aid success. No specific listener characteristics have been identified as being related to a listener's ability to accept background noise. The purpose of this study was to determine whether or not locus of control and self-control are related to ANL. Design: Correlational design. Study sample: Participants were seventy young adults (21 male, 49 female; aged 19 to 39 years) with normal hearing. Participants completed psychological profiles that evaluated locus of control and self-control and their ANLs were measured. Results: Results revealed correlations between ANL and self-control. Listeners with higher levels of self-control accepted more background noise than listeners with lower levels of self-control. Conclusions: This research suggests that exercises aimed at strengthening a listener's auditory self-control may lead to improved background noise acceptance. Improvement in background noise acceptance could lead to improved hearing-aid success. Future research should explore these possibilities.     

Relationship between acceptable noise level and the abbreviated profile of hearing aid benefit.

PURPOSE: This study investigated the relationship between acceptable noise levels (ANLs) and the Abbreviated Profile of Hearing Aid Benefit (APHAB; R. M. Cox & G. C. Alexander, 1995). This study further examined the APHAB's ability to predict hearing aid use. METHOD: ANL and APHAB data were collected for 191 listeners with impaired hearing, separated into 3 groups based on hearing aid use: full-time, part-time, or nonuse. RESULTS: Results demonstrated ANLs were not correlated with APHAB scores. Results further demonstrated 2 of the 4 APHAB subscales (Ease of Communication [EC] and Background Noise [BN]) predicted hearing aid success with 60% accuracy, which is 25% poorer than that observed using the ANL alone. When combining the ANL with the EC and BN subscales, accuracy of the prediction increased to 91%. Lastly, 3 of the 4 APHAB subscales (EC, BN, and Reverberation) enhanced the present prediction of hearing aid use for patients with mid-range ANLs. CONCLUSIONS: These results indicate that ANLs and APHAB scores provide unique information regarding hearing aid use. These results further indicate that the prediction can be enhanced by administering both the ANL and the EC and BN APHAB subscales. Lastly, some of the ambiguity of the prediction of hearing aid use for listeners with mid-range ANLs may be eliminated.     

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

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

Sex-specific predictors of hearing-aid use in older persons: The age,gene/environment susceptibility - Reykjavik study

Objective: We estimate the prevalence of hearing-aid use in Iceland and identify sex-specific factors associated with use. Design: Population-based cohort study. Study sample: A total of 5172 age, gene/environment susceptibility - Reykjavik study (AGES-RS) participants, aged 67 to 96 years (mean age 76.5 years), who completed air-conduction and pure-tone audiometry. Results: Hearing-aid use was reported by 23.0% of men and 15.9% of women in the cohort, although among participants with at least moderate hearing loss in the better ear (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz ≥ 35 dB hearing level [HL]) it was 49.9% and did not differ by sex. Self-reported hearing loss was the strongest predictor of hearing-aid use in men [OR: 2.68 (95% CI: 1.77, 4.08)] and women [OR: 3.07 (95% CI: 1.94, 4.86)], followed by hearing loss severity based on audiometry. Having diabetes or osteoarthritis were significant positive predictors of use in men, whereas greater physical activity and unimpaired cognitive status were important in women. Conclusions: Hearing-aid use was comparable in Icelandic men and women with moderate or greater hearing loss. Self-recognition of hearing loss was the factor most predictive of hearing-aid use; other influential factors differed for men and women.     

An Australian version of the acceptable noise level test and its predictive value for successful hearing aid use in an older population

Abstract

Objective: The acceptable noise level (ANL), a measure of noise tolerance, has been proposed as a predictor for successful hearing aid use. The aims of this study were to obtain normative data, and to evaluate the clinical feasibility and predictive value of an Australian version of the ANL test in an older population. Design: Repeated ANL measurements were presented diotically using earphones. All participants provided demographic information and hearing aid owners were asked about their aid use. Study sample: A total of 290 older adults were assessed; 166 participants had a hearing impairment and 96 owned a hearing aid. Results: The mean ANL was lower than previously reported. While age and gender had no effect on ANL, a significant, but weak, correlation was found between ANL and hearing loss. The test-retest reliability showed the results were clinically unreliable. In addition, the ANL did not predict hours or pattern of hearing aid use. Conclusions: While the Australian ANL test showed several similar characteristics to previous versions of the test, low test-retest reliability raised questions about its clinical value as a predictor for long-term hearing aid use.     

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.     

Hearing-aid outcomes in Chinese adults: Clinical application and psychometric properties of the Chinese version of the Satisfaction with Amplification in Daily Life questionnaire

Objective: To adapt the Satisfaction with Amplification in Daily Life questionnaire into Chinese (the SADL-CH questionnaire) and investigate hearing-aid satisfaction in a group of adult Hong Kong Chinese fitted with free hearing aids. Design: Cross-sectional survey. Study sample: One hundred and twenty-five experienced hearing-aid users. Methods: The subjects completed a history form seeking demographic data and a questionnaire combining the SADL-CH instrument with questions seeking subjects’ subjective ratings of satisfaction with some hearing-aid features and overall satisfaction with their hearing aid. Results: The SADL-CH questionnaire had a good internal consistency reliability estimate (α =?0.79) comparable to that of the original version. SADL-CH scores were observed to have significant correlations with other satisfaction ratings on some hearing-aid features and the overall satisfaction measure. A high degree of test-retest reliability (intraclass correlation coefficient =?0.79) was observed. Confirmatory factor analysis revealed that the SADL-CH questionnaire had a four-factor structure. Interim norms were derived for the SADL-CH questionnaire. The level of hearing-aid satisfaction in Chinese adults was generally lower than that reported in studies conducted among Western populations. Conclusion: The SADL-CH questionnaire is a reliable and valid instrument for measuring hearing-aid satisfaction.