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.     

Perceived listening effort and speech intelligibility in reverberation and noise for hearing-impaired listeners

Objective: The purpose of this study was to assess perceived listening effort and speech intelligibility in reverberant and noisy conditions for hearing-impaired listeners for conditions that are similar according to the speech transmission index (STI). Design: Scaled listening effort was measured in four different conditions at five different STI generated using various relative contributions of noise and reverberant interferences. Intelligibility was measured for a subset of conditions. Study sample: Twenty mildly to moderately hearing-impaired listeners. Results: In general, listening effort decreased and speech intelligibility increased with increasing STI. For simulated impulse responses consisting of white Gaussian noise exponentially decaying in time, a good agreement between conditions of different relative contributions of noise and reverberation was found. For real impulse responses, the STI slightly overestimated the effect of reverberation on the perceived listening effort and underestimated its effect on speech intelligibility. Including the average hearing loss in the calculation of the STI led to a better agreement between STI predictions and subjective data. Conclusion: Speech intelligibility and listening effort provide complementary tools to evaluate speech perception over a broad range of acoustic scenarios. In addition, when incorporating hearing loss information the STI provides a rough prediction of listening effort in these acoustic scenarios.     

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.     

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.     

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.     

Investigating Speech Recognition and listening effort with different device configurations in adult cochlear implant users

Objectives: The purpose of this study was to investigate speech recognition in noise and listening effort among a group of adults with cochlear implants (CIs). Two main research questions were addressed. First, what are the effects of omni versus directional microphone configuration on speech recognition and listening effort for noisy conditions? Second, what is the effect of unilateral versus bimodal or bilateral CI listening on speech recognition and listening effort in noisy conditions?

Design: Sixteen adults (mean age 58 years) with CIs participated. Listening effort was measured using a dual-task paradigm and also using a self-reported rating of difficulty scale. In the dual-task measure, participants were asked to repeat monosyllabic words while at the same time press a button in response to a visual stimulus. Participants were tested in two baseline conditions (speech perception alone and visual task alone) and in the following experimental conditions: (1) quiet with an omnidirectional microphone, (2) noise with an omnidirectional microphone, (3) noise with a directional microphone, and (4) noise with a directional microphone and with a second sided CI or hearing aid. When present, the noise was fixed with a +5?dB signal-to-noise ratio. After each listening condition, the participants rated the degree of listening difficulty.

Results: Changing the microphone from omni to directional mode significantly enhanced speech recognition in noise performance. There were no significant changes in speech recognition between the unilateral and bimodal/bilateral CI listening conditions. Listening effort, as measured by reaction time, increased significantly between the baseline and omnidirectional quiet listening condition though did not change significantly across the remaining listening conditions. Self-perceived listening effort revealed a greater effort for the noisy conditions, and reduced effort with the move from an omni to a directional microphone.

Conclusions: Directional microphones significantly improve speech in noise recognition over omnidirectional microphones and allowed for decreased self-perceived listening effort. The dual task used in this study failed to show any differences in listening effort across the experimental conditions and may not be sensitive enough to detect changes in listening effort.     

Impact of noise source configuration on directional hearing aid benefit and performance

OBJECTIVE: To evaluate the impact of the position of noise source(s) and reverberation on the directional benefit and performance of three commercially available directional hearing aids. DESIGN: Directional benefit and performance were measured for four different configurations of competing noise source(s) in two different reverberant rooms. Three pairs of hearing aids representing three commercial models were selected based on electroacoustic evaluation of directivity. Directional benefit and performance of 25 subjects with symmetrical, sloping, sensorineural hearing loss were measured in all test environments using a modified version of the Hearing in Noise Test. RESULTS: Both reverberation and configuration of the competing noise source(s) significantly affected directional benefit and performance. There was no significant correlation between directional benefit and directional performance. The order of benefit and performance across hearing aid brands (from best to worst) varied depending on the noise source configuration. CONCLUSIONS: Data revealed increasing reverberation significantly decreased directional benefit and performance. The absolute and relative (rank ordering) directional benefit and performance varied across hearing aid brand, with noise source configuration. These results suggest that data collected in traditional test environments (e.g., a single competing noise placed at 180 degrees azimuth) cannot be used to accurately predict directional benefit or performance in the majority of other test and real-world environments. The impact of reverberation and noise source configuration on directional benefit/performance can be explained fairly well by the interaction between the spatial properties of the noise source(s) and the polar directivity patterns of the hearing aids.     

Application of frequency importance functions to directivity for prediction of benefit in uniform fields

OBJECTIVE: The purpose of the current investigation was to systematically examine two of the assumptions central to the application of Articulation Index weighted Directivity Index (AI-DI) to the prediction of directional benefit across three groups of listeners differentiated by degree and configuration of hearing loss. Specifically, the assumption that (1) changes in speech recognition performance are predictable from frequency specific changes in calculated audibility after applying directivity index (DI) values and (2) applying appropriate frequency importance functions would increase the accuracy of AI-DI predictions of directional benefit were evaluated. DESIGN: The output of a single hearing aid for a speech in noise input was recorded to produce high and low directivity (directional and omnidirectional microphone modes) segments. These segments were then high-pass and low-pass filtered into low- and high-frequency regions and acoustically mixed to generate the eight frequency-specific directivity combinations. All recordings were made through an acoustic manikin placed in a single room, surrounded by five uncorrelated noise sources. The aided sentence recognition, in noise, for three groups of 12 adult participants with symmetrical sensorineural hearing impairment, was then measured across the eight listening conditions. The three groups were differentiated by degree and type of hearing loss including "sloping," "flat," and "severe" configurations.The frequency-specific DI values for each of the eight listening conditions were applied to the calculation of frequency specific noise levels. These corrected noise levels were then used to calculate an Articulation Index using the Speech Intelligibility Index (SII, ). These SII values were then compared with measured speech recognition under the same eight listening conditions.Directional benefit values were then calculated by subtracting the performance of individual participants on the Connected Speech Test (CST) in omnidirectional mode from performance in all other filter conditions. The changes in average DI and AI-DI (using three different frequency importance functions) that existed between omnidirectional and the other seven filter conditions were then calculated for comparison to directional benefit values. RESULTS: The speech recognition data revealed a complex interaction between filter condition and group. Despite this interaction, highly significant positive correlations were found between participants' speech recognition scores and the corresponding SII calculation for all three hearing loss groups.Individual subjects' measured directional benefit was highly correlated with changes in DI. Similar correlations were found for average DI and all three AI-DI weighting methods. CONCLUSIONS: As expected, performance and calculated SII values were in good agreement across conditions supporting the hypothesis that DI provides a reasonable frequency-specific estimate of signal-to-noise ratio changes in the test environment. The results further support the use of AI-DI or average DI for prediction of directional benefit. The choice of importance weighting across frequency (flat or frequency importance function based), however, did not improve the accuracy of these predictions; therefore, a simple average DI is advocated. Further, the prediction of absolute directional benefit across hearing loss groups from traditional AI-DI calculations may lead to error if the negative effects of hearing loss on speech understanding, and how these effects vary with degree of hearing loss, are not considered as a contributing factor.     

A directional remote-microphone for bimodal cochlear implant recipients

Abstract

To evaluate whether speech recognition in noise differs according to whether a wireless remote microphone is connected to just the cochlear implant (CI) or to both the CI and to the hearing aid (HA) in bimodal CI users. The second aim was to evaluate the additional benefit of the directional microphone mode compared with the omnidirectional microphone mode of the wireless microphone. This prospective study measured Speech Recognition Thresholds (SRT) in babble noise in a ‘within-subjects repeated measures design’ for different listening conditions. Eighteen postlingually deafened adult bimodal CI users. No difference in speech recognition in noise in the bimodal listening condition was found between the wireless microphone connected to the CI only and to both the CI and the HA. An improvement of 4.1?dB was found for switching from the omnidirectional microphone mode to the directional mode in the CI only condition. The use of a wireless microphone improved speech recognition in noise for bimodal CI users. The use of the directional microphone mode led to a substantial additional improvement of speech perception in noise for situations with one target signal.     

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.     

Directional benefit in simulated classroom environments

PURPOSE: To examine speech recognition performance and subjective ratings for directional and omnidirectional microphone modes across a variety of simulated classroom environments. METHOD: Speech recognition was measured in a group of 26 children age 10-17 years in up to 8 listening environments. RESULTS: Significant directional benefit was found when the sound source(s) of interest was in front, and directional decrement was measured when the sound source of interest was behind the participants. Of considerable interest is that a directional decrement was observed in the absence of directional benefit when sources of interest were both in front of and behind the participants. In addition, limiting directional processing to the low frequencies eliminated both the directional deficit and the directional advantage. CONCLUSIONS: Although these data support the use of directional hearing aids in some noisy school environments, they also suggest that use of the directional mode should be limited to situations in which all talkers of interest are located in the front hemisphere. These results highlight the importance of appropriate switching between microphone modes in the school-age population.     

Speech perception in noise: directional microphones versus frequency modulation (FM) systems

The major consequence of sensorineural hearing loss (SNHL) is communicative difficulty, especially with the addition of noise and/or reverberation. The purpose of this investigation was to compare two types of technologies that have been shown to improve the speech-perception performance of individuals with SNHL: directional microphones and frequency modulation (FM) systems. Forty-six adult subjects with slight to severe SNHL served as subjects. Speech perception was assessed using the Hearing in Noise Test (HINT) with correlated diffuse noise under five different listening conditions. Results revealed that speech perception was significantly better with the use of the FM system over that of any of the hearing aid conditions, even with the use of the directional microphone. Additionally, speech perception was significantly better with the use of two hearing aids used in conjunction with two FM receivers rather than with just one FM receiver. Directional microphone performance was significantly better than omnidirectional microphone performance. All aided listening conditions were significantly better than the unaided listening condition.     

How directional microphones affect speech recognition,listening effort and localisation for listeners with moderate-to-severe hearing loss

Objective: The purpose of this study was to evaluate the effects of directional microphone use on laboratory measures of sentence recognition, listening effort and localisation. An additional purpose of this study was to evaluate the effects of asymmetric directional microphone use on the same laboratory measures. Design: Three hearing aid conditions were evaluated: (1) bilateral omnidirectional microphones, (2) bilateral directional microphones and (3) asymmetric microphones (directional microphone for only one hearing aid). Sentence recognition performance was evaluated using a connected speech test. Listening effort was evaluated using a dual-task paradigm with a response time-based secondary task requiring word categorisation. Localisation was examined using a complex task requiring localisation and recall of speech originating from one of four loudspeakers in the horizontal plane (?60°, ?45°,?+45°,?+60°). Study sample: Eighteen adults (M?=?61.8 years) with symmetrical, moderate-to-severe hearing loss participated. Results: Performance on each task was analysed separately using a repeated measures analysis of variance. Results revealed directional benefits for sentence recognition and listening effort, but microphone setting did not affect localisation. Performance was equivalent with symmetric and asymmetric directional configurations. Conclusions: Bilateral and asymmetric directional microphone configurations equally improved sentence recognition and listening effort; neither affected localisation or recall.     

Predictive measures of directional benefit part 2: verification of different approaches to estimating directional benefit

OBJECTIVE: In this investigation, the relation between various directivity measures and subject performance with directional microphone hearing aids was determined. DESIGN: Test devices included first- and second-order directional microphones. Recordings of sentences and noise (Hearing in Noise Test, HINT) were made through each test device in simple, complex, and anisotropic background noise conditions. Twenty-six subjects, with normal hearing, were administered the HINT test recordings and directional benefit was computed. These measures were correlated to theoretical, free-field, and Knowles Electronic Manikin for Acoustic Research (KEMAR) directivity index (DI) values, as well as front-to-back ratios (FBR), in situ signal-to-noise ratios (SNR), and a newly proposed Db SNR, wherein a predictive value of the SNR improvement is calculated as a function of the noise source incidence. RESULTS: The different predictive scores showed high correlation to the measured directional benefit scores in the complex (diffuse-like) background noise condition (r = 0.89 to 0.97, p < 0.05) but not across all background noise conditions (r = 0.45 to 0.97, p < 0.05). The Db SNR approach and the in situ SNR measures provided excellent prediction of subject performance in all background noise conditions (0.85 to 0.97, p < 0.05). None of the predictive measures could account for the effects of reverberation on the speech signal (r = 0.35 to 0.40, p < 0.05). CONCLUSIONS: For environments that included a discrete number of noise sources, the in situ SNR and Db SNR estimates were most predictive of subject performance. No predictive approach was indicative of the directional benefit achieved when the speech was also subjected to reverberation (temporal distortion). This finding has implications for real-world estimates of directional benefit.     

Noise reduction technologies implemented in head-worn preprocessors for improving cochlear implant performance in reverberant noise fields

The purpose of this study was to investigate whether a multichannel adaptive directional microphone and a modulation-based noise reduction algorithm could enhance cochlear implant performance in reverberant noise fields. A hearing aid was modified to output electrical signals (ePreprocessor) and a cochlear implant speech processor was modified to receive electrical signals (eProcessor). The ePreprocessor was programmed to flat frequency response and linear amplification. Cochlear implant listeners wore the ePreprocessor-eProcessor system in three reverberant noise fields: 1) one noise source with variable locations; 2) three noise sources with variable locations; and 3) eight evenly spaced noise sources from 0° to 360°. Listeners' speech recognition scores were tested when the ePreprocessor was programmed to omnidirectional microphone (OMNI), omnidirectional microphone plus noise reduction algorithm (OMNI?+?NR), and adaptive directional microphone plus noise reduction algorithm (ADM?+?NR). They were also tested with their own cochlear implant speech processor (CI_OMNI) in the three noise fields. Additionally, listeners rated overall sound quality preferences on recordings made in the noise fields. Results indicated that ADM+NR produced the highest speech recognition scores and the most preferable rating in all noise fields. Factors requiring attention in the hearing aid-cochlear implant integration process are discussed.     

Speech-clarity judgments of hearing-aid-processed speech in noise: differing polar patterns and acoustic environments

This investigation assessed the extent to which listeners' preferences for hearing aid microphone polar patterns vary across listening environments, and whether normal-hearing and inexperienced and experienced hearing-impaired listeners differ in such preferences. Paired-comparison judgments of speech clarity (i.e. subjective speech intelligibility) were made monaurally for recordings of speech in noise processed by a commercially available hearing aid programmed with an omnidirectional and two directional polar patterns (cardioid and hypercardioid). Testing environments included a sound-treated room, a living room, and a classroom. Polar-pattern preferences were highly reliable and agreed closely across all three groups of listeners. All groups preferred listening in the sound-treated room over listening in the living room, and preferred listening in the living room over listening in the classroom. Each group preferred the directional patterns to the omnidirectional pattern in all room conditions. We observed no differences in preference judgments between the two directional patterns or between hearing-impaired listeners' extent of amplification experience. Overall, findings indicate that listeners perceived qualitative benefits from microphones having directional polar patterns.     

Speech-clarity judgments of hearing-aid-processed speech in noise: Differing polar patterns and acoustic environments

This investigation assessed the extent to which listeners’ preferences for hearing aid microphone polar patterns vary across listening environments, and whether normal-hearing and inexperienced and experienced hearing-impaired listeners differ in such preferences. Paired-comparison judgments of speech clarity (i.e. subjective speech intelligibility) were made monaurally for recordings of speech in noise processed by a commercially available hearing aid programmed with an omnidirectional and two directional polar patterns (cardioid and hypercardioid). Testing environments included a sound-treated room, a living room, and a classroom. Polar-pattern preferences were highly reliable and agreed closely across all three groups of listeners. All groups preferred listening in the sound-treated room over listening in the living room, and preferred listening in the living room over listening in the classroom. Each group preferred the directional patterns to the omnidirectional pattern in all room conditions. We observed no differences in preference judgments between the two directional patterns or between hearing-impaired listeners’ extent of amplification experience. Overall, findings indicate that listeners perceived qualitative benefits from microphones having directional polar patterns.     

Effects of reverberation and noise on speech recognition by adults with various amounts of sensorineural hearing impairment

Speech recognition was assessed under three levels of room reverberation, each in quiet and noise, for subjects with varying amounts of sensorineural hearing impairment. The three acoustic environments were: sound suite, reverberant room with a reverberation time (T) = 0.54 s and reverberant room with T = 1.55 s. Three groups of subjects were utilized: normal hearing, mild sensorineural hearing impairment and moderate-to-severe sensorineural hearing impairment. Speech recognition ability for each of the three groups of subjects significantly differed from the other two groups for each of the three reverberant conditions. The detrimental influences of noise and reverberation increased with the magnitude of hearing impairment. In addition, there was an interaction between noise and room reverberation, where the detrimental effects of room reverberation were compounded by the addition of noise.     

Effects of Reverberation and Noise on Speech Recognition by Adults with Various Amounts of Sensorineural Hearing Impairment

Speech recognition was assessed under three levels of room reverberation, each in quiet and noise, for subjects with varying amounts of sensorineural hearing impairment. The three acoustic environments were: sound suite, reverberant room with a reverberation time (T) = 0.54 s and reverberant room with T = 1.55 s. Three groups of subjects were utilized: normal hearing, mild sensorineural hearing impairment and moderate-to-severe sensorineural hearing impairment. Speech recognition ability for each of the three groups of subjects significantly differed from the other two groups for each of the three reverberant conditions. The detrimental influences of noise and reverberation increased with the magnitude of hearing impairment. In addition, there was an interaction between noise and room reverberation, where the detrimental effects of room reverberation were compounded by the addition of noise.     

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.