Detecting components of hearing aid fitting using a self-assessment-inventory

The evaluation of hearing-aid fitting includes numerous assessments such as electro- and psychoacoustic tests. The subjective estimation of the hearing aid user can be elicited with self-assessment inventories encompassing various parameters, e.g., benefit, satisfaction and usage. A questionnaire comprising 11 domains (disability, handicap, frequency and significance of the listening situation, importance of the hearing aid, expectation, demand, aided performance, benefit, satisfaction and usage) within three different conditions (speech in quiet and in noise and listening to sounds) was used to detect components underlying hearing aid fitting. The data show a three-factor structure (situation-, restriction- and aid-related variables) independent from the conditions. Usage depends on all of the three factors. Disability and handicap reveal the highest values for speech in noise, whereas the aid-related factor shows the lowest values for this condition. Global satisfaction with the hearing aid is significantly correlated with the aid-related factor, but independent from the restriction of hearing. The aid-related factor is positively influenced by the amount of social activity because more active persons report higher benefit and satisfaction for all listening conditions. Age does not exhibit a significant relationship to one of the components. Basically, all correlation coefficients are only intermediate, revealing that inter-individual differences of the patients are rather high. The data indicate that extra-audiological factors might also play an important role in the success of hearing aid fitting.     

60岁以上听功能障碍者助听器远程验配86例

目的 分析186例60岁以上听功能障碍患者助听器验配情况,探讨老年听功能障碍者听力及助听器选配特点,为助听器验配寻找新思路。方法 统计186例250～8 000 Hz的纯音听阈,根据听力情况,进行常规助听器验配和调试100例, 利用网络远程助听器验配86例, 跟踪最终验配情况。结果 远程验配及常规验配两组患者佩戴助听器后听力提高和言语分辨率提高结果相同, 差异无统计学意义。结论 常规和远程验配均可以给听功能障碍患者选配正确的助听器, 能够有效改善老年患者耳聋症状,提高老年患者听力。远程验配可以减少患者验配成本, 更好地保障验配服务。     

Comparison of three procedures for initial fitting of compression hearing aids. III. Inexperienced versus experienced users

We assessed whether gain requirements differ for experienced users and new users when fitted with multi-band compression hearing aids. Three procedures for initial fitting were used: the Cambridge method for loudness equalization (CAMEQ), the Cambridge method for loudness restoration (CAMREST), and the desired sensation level input/output (DSL[i/o]) method. Twenty experienced hearing aid users and 20 new users with mild-to-severe sensorineural loss were fitted with Danalogic 163D digital hearing aids, using each procedure in turn in a counter-balanced order. The new users were given a pre-fitting with slightly reduced gains prior to the ‘formal’ fitting. Immediately after formal fitting with a given procedure, and 1 week after fitting, the gains were adjusted by the minimum amount necessary to achieve acceptable fittings. The amount of adjustment required provided the main measure of the adequacy of the initial fitting. On average, new users required decreases in gain for all procedures, the decreases being larger for DSL[i/o] than for CAMEQ or CAMREST. For experienced users, gain adjustments were small for CAMEQ and CAMREST, but were larger and mostly negative for DSL[i/o]. After these gain adjustments, users wore the aids for at least 3 weeks before filling out the Abbreviated Profile of Hearing Aid Benefit (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 75dBSPL. 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]. For inexperienced users, gains typically need to be reduced by about 3 dB relative to those prescribed by CAMEQ or CAMREST, although the amount of reduction may depend on hearing loss. An analysis of gain adjustments as a function of order of testing provided some evidence for increased tolerance to high-frequency amplification with increasing experience during the 4-month course of the trial, but this effect did not differ for the experienced and new users.     

家长／教师助听器效果评估问卷在听障儿童助听器验配中的应用

目的客观、全面地评估听障儿童助听器验配效果。方法采用家长／教师助听器效果评估问卷来评估听障儿童配戴助听器后的效果,探讨该方法在听障儿童助听器效果评估中的可行性。结果家长、教师对助听器效果的满意度逐渐提高。家长、教师关于“非常满意”评价结果的一致性逐渐提高。结论家长／教师助听器效果评估问卷可应用于听障儿童助听效果评估。     

Interactive fitting of multiple algorithms implemented in the same digital hearing aid

The main purpose of this study is to examine the applicability of an adaptive and interactive optimization strategy to fine-tune three hearing-aid algorithms simultaneously: dynamic compression, temporal signal enhancement, and noise reduction. The optimal combination of these three algorithms was determined by a multidirectional pattern search with an adaptive step size. Additionally, we applied a round-robin procedure to validate the results of the optimization procedure. For both procedures the listeners were asked to compare two consecutive, differently processed sentences in continuous and fluctuating background noises on speech intelligibility. Ten hearing-impaired and four normal-hearing subjects participated. The reliability and consistency of the multidirectional pattern search was low, especially for the fluctuating noise condition. The results of the round-robin procedure did not correspond closely with the pattern search results. These findings suggest that the current implementation of a multidirectional optimization procedure has not yet proven to be applicable for the necessary individual fine tuning of complex signal processing strategies, when the objective is to maximize speech intelligibility.     

组合听力测试在聋儿早期验配助听器中的作用

目的：探讨短声听觉脑干反应（ABR）和行为测听2种测试组合在聋儿早期验配助听器中的作用。方法：对52例1～9岁聋儿进行行为测听或ABR测试,找到较准确的听阈值。采用理想感觉级配方法选配助听器,以真耳测试及声场测试判断助听效果,进行随访并定期调试助听器。结果：单纯ABR测试有反应耳与组合听力测试有反应耳比较,差异有统计学意义（P〈0．05）。助听效果明显改善41例,无效4例,失访7例。结论：聋儿听力评估应主、客观测听联合使用,助听器验配应遵循“三早”原则,即早期发现,早期诊断,早期进行听力康复。     

A preliminary investigation into hearing aid fitting based on automated real-ear measurements integrated in the fitting software: test–retest reliability,matching accuracy and perceptual outcomes

Objective: The recent integration of automated real-ear measurements (REM) in the fitting software facilitates the hearing aid fitting process. Such a fitting strategy, TargetMatch (TM), was evaluated. Test–retest reliability and matching accuracy were quantified, and compared to a REM-based fitting with manual adjustment. Also, it was investigated whether TM leads to better perceptual outcomes compared to a FirstFit (FF) approach, using software predictions only.

Design and study sample: Ten hearing impaired participants were enrolled in a counterbalanced single-blinded cross-over study comparing TM and FF. Aided audibility, speech intelligibility and real-life benefits were assessed. Repeated measurements of both TM and REMs with manual adjustment were performed.

Results: Compared to a REM-based fitting with manual adjustment, TM had higher test–retest reliability. Also, TM outperformed the other fitting strategies in terms of matching accuracy. Compared to a FF, improved aided audibility and real-life benefits were found. Speech intelligibility did not improve.

Conclusions: Preliminary data suggest that automated REMs increase the likelihood of meeting amplification targets compared with a FF. REMs integrated in the fitting software provide additional reliability and accuracy compared to traditional REMs. Findings need to be verified in a larger and more varied sample.