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.     

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.     

Comparison of speech perception in background noise with acceptance of background noise in aided and unaided conditions.

Background noise is a significant factor influencing hearing-aid satisfaction and is a major reason for rejection of hearing aids. Attempts have been made by previous researchers to relate the use of hearing aids to speech perception in noise (SPIN), with an expectation of improved speech perception followed by an increased acceptance of hearing aids. Unfortunately, SPIN was not related to hearing-aid use or satisfaction. A new measure of listener reaction to background noise has been proposed. The acceptable noise level (ANL), expressed in decibels, is defined as a difference between the most comfortable listening level for speech and the highest background noise level that is acceptable when listening to and following a story. The ANL measure assumes that speech understanding in noise may not be as important as is the willingness to listen in the presence of noise. It has been established that people who accept background noise have smaller ANLs and tend to be "good" users of hearing aids. Conversely, people who cannot accept background noise have larger ANLs and may only use hearing aids occasionally or reject them altogether. Because this is a new measure, it was important to determine the reliability of the ANL over time with and without hearing aids, to determine the effect of acclimatization to hearing aids, and to compare the ANL to well-established measures such as speech perception scores collected with the SPIN test. Results from 50 listeners indicate that for both good and occasional hearing aid users, the ANL is comparable in reliability to the SPIN test and that both measures do not change with acclimatization. The ANLs and SPIN scores are unrelated. Although the SPIN scores improve with amplification, the ANLs are unaffected by amplification, suggesting that the ANL is inherent to an individual and can be established prior to hearing aid fitting as a possible predictor of hearing-aid use.     

The objective and subjective evaluation of multichannel expansion in wide dynamic range compression hearing instruments.

PURPOSE: The effects of multichannel expansion on the objective and subjective evaluation of 20 listeners fitted binaurally with 4-channel, digital in-the-ear hearing instruments were investigated. METHOD: Objective evaluations were conducted in quiet using the Connected Speech Test (CST) and in noise using the Hearing in Noise Test (HINT) at 40, 50, and 60 dB SPL. Subjective evaluations were conducted by having each participant (a) rate their satisfaction regarding the amount of noise reduction they perceived daily and (b) indicate which expansion condition they preferred overall after a 2-week trial. Three expansion settings were programmed into the hearing aids: 4-channel expansion, expansion restricted to Channels 1 and 2 only, and expansion off. RESULTS: Listeners performed significantly better in quiet (CST) and in noise (HINT) for the off condition than for either multichannel condition; however, restricting expansion to Channels 1 and 2 improved objective performance in quiet and in noise relative to the 4-channel condition. Conversely, satisfaction ratings were significantly greater for both multichannel conditions than for the off condition; however, satisfaction ratings were similar for the restricted and the 4-channel conditions. Overall, listeners preferred any form of multichannel expansion to no expansion; however, overall preference was similar for the restricted and the 4-channel conditions. CONCLUSIONS: Hearing instrument users prefer the use of multichannel expansion despite the fact multichannel expansion may significantly reduce the recognition of low-level speech in quiet and in noise. Although restricting expansion to Channels 1 and 2 (i.e., 2000 Hz and below) maintained subjective benefit for wide dynamic range compression hearing instrument users, the recognition of low-level speech was not completely preserved.     

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.     

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.     

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.     

Acceptable noise level: reliability measures and comparison to preference for background sounds

The present study (1) assessed the reliability of the acceptable noise level (ANL) measure using speech-spectrum and speech-babble noises as the competing stimuli, and (2) investigated the relationship between ANL and preference for background sounds in 30 young adults with normal hearing sensitivity. Listeners were evaluated during three test sessions approximately one week apart. Results demonstrated that ANLs are highly reliable over short periods of time, independent of the background noise distraction. Mean ANLs, however, were affected by type of background noise distraction, indicating ANLs obtained using different competing stimuli should not be compared directly. Results further demonstrated that participants' ratings of preference for background sound were consistent over time; however, listeners' preference for background sound was not related to their acceptance of background noise (i.e., ANL). This may indicate listeners cannot accurately assess their ability to accept background sounds, at least with the questionnaire used in the present study.     

Acceptance of background noise levels in bilingual (Korean-English) listeners

The acceptable noise level (ANL) is the maximum amount of background noise that listeners are willing to accept while listening to speech. ANL has not been studied in listeners who use languages other than English. The purpose of this study was to explore whether ANLs obtained from Korean listeners in both English and Korean were comparable to ANLs obtained from monolingual English listeners. The results showed that ANLs obtained in English (ANL-E) did not differ significantly for the bilingual and monolingual listeners. Additionally, a cross-language comparison, within bilinguals, showed that ANLs obtained using Korean (ANL-K) speech stimuli were not significantly different from ANL-E. Finally, speech perception in noise did not correlate with ANLs in English or Korean for the bilingual listeners. Results suggest that the ANL measure is language independent within bilinguals and may be of potential clinical use in minority language groups.     

Entwicklung und Anwendung einer APHAB-Datenbank

A specific quality assurance questionnaire concerned with the provision of hearing aids was introduced that assesses elements of patient satisfaction within Germany’s statutory healthcare system. A questionnaire-based assessment is now relevant for all physicians involved in the care of statutorily insured patients in Germany. The APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire is the most widely used. The APHAB assesses several different situations: the normal hearing situation, hearing in noise, comprehension of speech in situations of echo or reverberation and hearing in loud situations. The APHAB questionnaire-based patient evaluation of the benefit of hearing aids represents the third pillar of audiological diagnostics, alongside classical pure-tone and speech audiometry. The objective of the APHAB database is to allow evaluation of individual patient data on the basis of a larger volume of data.     

The effects of digital noise reduction on the acceptance of background noise

Modern hearing aids commonly employ digital noise reduction (DNR) algorithms. The potential benefit of these algorithms is to provide improved speech understanding in noise or, at the least, to provide relaxed listening or increased ease of listening. In this study, 22 adults were fitted with 16-channel wide-dynamic-range compression hearing aids containing DNR processing. The DNR includes both modulation-based and Wiener-filter-type algorithms working simultaneously. Both speech intelligibility and acceptable noise level (ANL) were assessed using the Hearing in Noise Test (HINT) with DNR on and DNR off. The ANL was also assessed without hearing aids. The results showed a significant mean improvement for the ANL (4.2 dB) for the DNR-on condition when compared to DNR-off condition. Moreover, there was a significant correlation between the magnitude of ANL improvement (relative to DNR on) and the DNR-off ANL. There was no significant mean improvement for the HINT for the DNR on condition, and on an individual basis, the HINT score did not significantly correlate with either aided ANL (DNR on or DNR off). These findings suggest that at least within the constraints of the DNR algorithms and test conditions employed in this study, DNR can significantly improve the clinically measured ANL, which may result in improved ease of listening for speech-in-noise situations.     

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.     

Speech recognition abilities of adults using cochlear implants with FM systems

Speech recognition was evaluated for ten adults with normal hearing and eight adults with Nucleus cochlear implants (CIs) at several different signal-to-noise ratios (SNRs) and with three frequency modulated (FM) system arrangements: desktop, body worn, and miniature direct connect. Participants were asked to repeat Hearing in Noise Test (HINT) sentences presented with speech noise in a classroom setting and percent correct word repetition was determined. Performance was evaluated for both normal-hearing and CI participants with the desktop soundfield system. In addition, speech recognition for the CI participants was evaluated using two FM systems electrically coupled to their speech processors. When comparing the desktop sound field and the No-FM condition, only the listeners with normal hearing made significant improvements in speech recognition in noise. When comparing the performance across the three FM conditions for the CI listeners, the two electrically coupled FM systems resulted in significantly greater improvements in speech recognition in noise relative to the desktop soundfield system.     

The effect of speech presentation level on acceptance of background noise in listeners with normal hearing

A method has been established to measure the maximum acceptable background noise level (BNL) for a listener, while listening to speech at the most comfortable listening level (MCL). The acceptable noise level (ANL) is the difference between BNL and MCL. In the present study, the ANL procedure was used to measure acceptance of noise, first, in the presence of speech at MCL and, then, for speech presented at much lower and higher levels in listeners with normal hearing. This study used the term ANL to describe the results obtained at MCL and also at other speech presentation levels. The mean ANL at MCL was 15.5 dB, which is comparable to results obtained by previous investigators. ANL increases systematically with speech presentation level. Mean ANLs ranged from 10.6 dB when speech was presented at 20 dB HL to 24.6 dB when speech was presented at 76 dB HL. The results indicated that the acceptance of noise depends significantly on speech presentation level.     

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.     

Contribution of high-frequency information to the acceptance of background noise in listeners with normal and impaired hearing

PURPOSE: To determine whether information beyond 2.0 kHz affected the acceptance of background noise in listeners with normal and/or impaired hearing. METHOD: Speech stimuli (Arizona Travelogue) and multitalker babble were low-pass filtered at cutoff frequencies of 2.0, 4.0, and 6.0 kHz and presented using an adaptive paradigm to determine the most comfortable level (MCL) and acceptable noise level (ANL) for 4 experimental conditions (unfiltered, 2.0, 4.0, and 6.0 kHz) for each listener. RESULTS: MCL for listening to speech in quiet was significantly increased when the speech stimuli were low-pass filtered at 2.0 kHz relative to the unfiltered and 6.0-kHz conditions. Acceptance of background noise was significantly poorer when the speech and noise stimuli were low-pass filtered at 2.0 kHz relative to the 6.0-kHz condition. Listeners with impaired hearing sensitivity had significantly greater MCL values than listeners with normal hearing, but ANL values were not significantly affected by the hearing sensitivity of the listener. CONCLUSIONS: Information beyond 2.0 kHz significantly affected MCL and ANL values in both listeners with normal hearing and impaired hearing; however, effects for both the MCL and ANL measurements were small and may not be significant clinically.     

Relative benefits of linear analogue and advanced digital hearing aids

Speech recognition performance and self-reported benefit from linear analogue and advanced (digital) hearing aids were compared in 100 first-time hearing aid users with mild-to-moderate sensorineural hearing loss fitted monaurally with a behind-the-ear (BTE) hearing aid in a single-blind randomized crossover trial. Subjects used each aid for 5 weeks in turn, with aid order balanced across subjects. Three alternative models of digital hearing aid were assigned to subjects according to a balanced design. Aid type was disguised to keep subjects blind within practical limitations. Aided speech recognition performance in noise was measured at speech levels of 65 and 75dB at a speech-to-noise ratio (SNR) of +2dB for closed sets of single words. Self-rated benefit was measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Glasgow Hearing Aid Benefit Profile (GHABP). Quality of life, hearing aid use and user preferences were also assessed. Speech recognition scores with the digital aids were significantly better at 75dB than with the analogue aids Self-reported benefit (APHAB, GHABP) and improvement in quality of life were generally not significantly different between analogue and digital aids, although aversiveness measured with the APHAB was significantly lower with digital aids, and satisfaction measured with the GHABP was greater. The digital aids were preferred significantly more often than the analogue aids, with 61 subjects choosing their digital aid, 26 choosing the analogue aid, and nine being equivocal. Overall, this study shows advantages for advanced digital over simple linear analogue aids in terms of both objective and subjective outcomes, although average differences are not large.     

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL)

Objective: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting. Design: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique. Study sample: A total of 132 adults with hearing impairment. Results: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (～18 dB) than first-time hearing-aid users (～10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs. Conclusions: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.