Loudness and annoyance of disturbing sounds – perception by normal hearing subjects

Objective: Sounds in the daily environment may cause loudness and annoyance. The present study investigated the perception of loudness and annoyance for eight different sounds present in a daily sound environment and at nine different levels varying by ±20?dB around the recorded level. The outcomes were related to tests of participants’ auditory and cognitive abilities. Design: The participants undertook auditory and working memory (WM) tests prior to ratings of everyday sounds previously shown to be disturbing for persons with hearing impairment (hearing aid users). Study sample: Twenty-one participants aged between 24 and 71 years, with normal hearing threshold levels. Results: Both perceived loudness and annoyance were primarily driven by the sound level. Sounds emitted from paper were rated as having greater loudness and being more annoying than the other sound sources at the same sound level. Auditory and cognitive abilities did not influence the perception of loudness and annoyance. Conclusions: Loudness and annoyance ratings were mainly driven by sound level. Expectations of a sound seemed to influence the assessment of loudness and annoyance while auditory performance and WM capacity showed no influence on the ratings.     

Placebo effects in hearing-aid trials are reliable

Abstract

Objective: A recent study suggested that placebo effects are a source of bias in non-blinded hearing-aid trials. Given the potential impact of this finding on the interpretation of non-blinded trials and design of future research trials, the objective of the present study was to investigate the reliability of this effect. Design: Using the same procedure as an earlier study, participants were told that they were taking part in a trial of new hearing-aid technology. Participants compared two devices that were acoustically identical, except one was described as “new” and the other as “conventional”. Participants completed a speech-in-noise test, sound quality ratings, and rated overall personal preference for both hearing aids. Study sample: Sixteen adult hearing-aid users. Results: Participants had significantly better mean speech-in-noise performance (70.9% versus 66.8%, Z = 2.30, p = 0.02, effect size Pearson's r = 0.15) and sound quality ratings for the “new” hearing aid (8.1 versus 7.4, Z = ? 2.99, p = 0.003, r = 0.28). A significant proportion of participants (75%) expressed an overall preference for the “new” hearing aid (p = 0.001, effect size φ_c = 0.66). Conclusion: Placebo effects reliably impact on hearing-aid trials. In order to control for placebo effects, double-blind methodology is optimal. However, when double-blinding is not possible other strategies may be appropriate.     

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.     

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.     

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.     

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.     

Investigation of hearing aid users' speech understanding in noise and their spectral-temporal resolution skills

PurposeOur study aims to compare speech understanding in noise and spectral- temporal resolution skills with regard to the degree of hearing loss, age, hearing aid use experience and gender of hearing aid users.MethodsOur study included sixty-eight hearing aid users aged between 40-70 years, with bilateral mild and moderate symmetrical sensorineural hearing loss. Random gap detection test, Turkish matrix test and spectral-temporally modulated ripple test were implemented on the participants with bilateral hearing aids. The test results acquired were compared statistically according to different variables and the correlations were examined.ResultsNo statistically significant differences were observed for speech-in-noise recognition, spectral-temporal resolution among older and younger adults in hearing aid users (p>0.05). There wasn’t found a statistically significant difference among test outcomes as regards different hearing loss degrees (p>0.05). Higher performances were obtained in terms of temporal resolution in male participants and participants with more hearing aid use experience (p<0.05). Significant correlations were obtained between the results of speech-in-noise recognition, temporal resolution and spectral resolution tests performed with hearing aids (p<0.05).ConclusionOur study findings emphasized the importance of regular hearing aid use and it showed that some auditory skills can be improved with hearing aids. Observation of correlations among the speech-in-noise recognition, temporal resolution and spectral resolution tests have revealed that these skills should be evaluated as a whole to maximize the patient's communication abilities.     

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.     

Identifying the barriers and facilitators to optimal hearing aid self-efficacy

Abstract

Objective: Many older adults with hearing impairment are not confident in their ability to use hearing aids (i.e. experience low hearing aid self-efficacy), which has been found to be a barrier to hearing help-seeking and hearing aid use. This study aimed to determine what factors were associated with achieving adequate hearing aid self-efficacy. Design: A retrospective research design was employed wherein hearing aid self-efficacy was the primary outcome. Explanatory variables included personal demographics, visual disability, and experiences related to participants’ hearing ability and hearing aids. Study sample: A total of 307 older adults with hearing impairment participated in the study (147 non hearing aid owners and 160 hearing aid owners). Results: Non-hearing aid owners were more likely to report adequate hearing aid self-efficacy if they reported no visual disability, had experienced hearing loss for longer, reported more positive support from a significant other, and were not anxious about wearing hearing aids. Hearing aid owners were more likely to report adequate hearing aid self-efficacy if they had had a positive hearing aid experience and no visual disability. Conclusions: More research is needed to develop and evaluate intervention approaches that promote optimal levels of hearing aid self-efficacy among older adults with hearing impairment.     

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.     

Hearing-aid use and long-term health outcomes: Hearing handicap,mental health,social engagement,cognitive function,physical health,and mortality

Objective: To clarify the impact of hearing aids on mental health, social engagement, cognitive function, and physical health outcomes in older adults with hearing impairment. Design: We assessed hearing handicap (hearing handicap inventory for the elderly; HHIE-S), cognition (mini mental state exam, trail making, auditory verbal learning, digit-symbol substitution, verbal fluency, incidence of cognitive impairment), physical health (SF-12 physical component, basic and instrumental activities of daily living, mortality), social engagement (hours per week spent in solitary activities), and mental health (SF-12 mental component) at baseline, five years prior to baseline, and five and 11 years after baseline. Study sample: Community-dwelling older adults with hearing impairment (N = 666) from the epidemiology of hearing loss study cohort. Results: There were no significant differences between hearing-aid users and non-users in cognitive, social engagement, or mental health outcomes at any time point. Aided HHIE-S was significantly better than unaided HHIE-S. At 11 years hearing-aid users had significantly better SF-12 physical health scores (46.2 versus 41.2; p = 0.03). There was no difference in incidence of cognitive impairment or mortality. Conclusion: There was no evidence that hearing aids promote cognitive function, mental health, or social engagement. Hearing aids may reduce hearing handicap and promote better physical health.     

Self-reported disability and handicap after hearing-aid fitting and benefit of hearing aids: comparison of fitting procedures, degree of hearing loss, experience with hearing aids and uni- and bilateral fittings

Self-reported outcome on hearing disability and handicap as well as overall health-related quality of life were measured after hearing-aid fitting in a large-scale clinical population. Fitting was performed according to two different procedures in a double-blind study design. We used a comparative procedure based on optimizing speech intelligibility scores and a strictly implemented fitting formula. Hearing disability and handicap were assessed with the hearing handicap and disability inventory and benefit of hearing aids with the abbreviated profile of hearing aid benefit. Effects on health-related quality of life and depression were assessed with the EuroQol-5D questionnaire and the geriatric depression scale. We found that hearing-aid fitting according to either procedure had a significantly positive effect on disability and handicap associated with hearing loss. This effect lasted for several months. Only the effect on disability persisted after 1-year of follow-up. Self-reported benefit from hearing aids was comparable for both fitting procedures. Unaided hearing disability was more pronounced in groups of participants with greater hearing loss, while the benefit of hearing aids was independent from the degree of hearing impairment. First-time hearing aid users reported greater benefit from their hearing aids. The added value from a bilateral hearing-aid fitting was not significant. Overall health-related quality of life and incidence of depression did not alter after hearing-aid fitting.     

Hearing aid and hearing assistance technology use in Aotearoa/New Zealand

Objective: The purpose of this study was to describe factors that are related to hearing aid and hearing assistance technology ownership and use in Aotearoa/New Zealand. Design: Adults with hearing impairment living in New Zealand were surveyed regarding health-related quality of life and device usage. Audiometric data (hearing sensitivity and speech in noise) were collected. Study sample: Data were obtained from 123 adults with hearing impairment: 73 reported current hearing-aid use, 81 reported current hearing assistance technology use. Results: In both analyses, device users had more difficulty understanding speech in background noise, had poor hearing in both their better and worse hearing ears, and perceived more consequences of hearing impairment in their everyday lives (both emotionally and socially) than non-hearing-aid users. Discriminant analyses showed that the social consequences of hearing impairment and the better ear hearing best classified hearing aid users from non-users but social consequences and worse ear hearing best classified hearing assistance technology users from non-users. Conclusions: Quality of life measurements and speech-in-noise assessments provide useful clinical information. Hearing-impaired adults in New Zealand who use hearing aids also tend to use hearing assistance technology, which has important clinical implications.     

Comparison of the CAM2A and NAL-NL2 hearing-aid fitting methods for participants with a wide range of hearing losses

Objective: To compare preferences for sounds processed via a simulated five-channel compression hearing aid fitted using CAM2A and NAL-NL2. Design: Within a trial, the same segment of sound was presented twice, once with CAM2A settings and once with NAL-NL2 settings, in random order. The participant indicated which one was preferred and by how much. Stimuli included female and male speech in quiet and four types of music. The compression speed was slow or fast and the input sound level was 50, 65, or 80 dB SPL. Study sample: Sixteen experienced hearing-aid users with a wide range of sensorineural hearing losses. Results: For both compression speeds, CAM2A was slightly preferred over NAL-NL2 for input levels of 65 and 80 dB, but NAL-NL2 was slightly preferred at 50 dB SPL. Conclusions: Preferences for CAM2A relative to NAL-NL2 vary with input level. The results suggest that preferences for CAM2A might be increased by using lower gains for high frequencies and low input levels.     

Hearing aid and cochlear implant use in children with hearing loss at three years of age: Predictors of use and predictors of changes in use

Objective: To examine usage patterns of hearing aids and cochlear implants in children up to three years of age, how usage changes longitudinally, and factors associated with device usage. Design: Parent report and Parent’s Evaluation of Aural/oral Performance of Children (PEACH) data were obtained at six and twelve months after hearing-aid fitting or cochlear implant switch-on, and again at three years of age. The effect of device use on auditory functional performance was investigated using the PEACH questionnaire. Study sample: Four hundred and thirteen participants from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study were included for analysis. Results: For users of hearing aids, higher usage at three years was associated with higher maternal education, and more severe hearing loss. For users of cochlear implants, higher usage was associated with higher maternal education and the absence of additional disabilities. Higher PEACH scores were associated with higher usage scores. After allowing for the effects of demographic characteristics, device use was not a significant predictor of functional performance. Conclusions: Sixty-two percent of children achieved consistent use (> 75% of waking hours) within the first year of receiving a hearing aid or a cochlear implant, and 71% by three years of age.     

Provision,perception and use of trainable hearing aids in Australia: a survey of clinicians and hearing impaired adults

Objective: This study set out to obtain information on the impact of trainable hearing aids among clinicians and hearing aid users and candidates. Design: Two online adaptive surveys were developed to evaluate provision, uptake and experience or expectation of trainable hearing aids. Study sample: Responses from 259 clinicians, 81 hearing aid users and 23 candidates for hearing aids were included. Results: Over half of the clinicians surveyed activated trainable features in hearing aids. Most of these clinicians activated trainable features for selected users and reported positive findings. Most commonly trainable features were not activated because the hearing aid controls had already been disabled for management or client preference. One-third reported that they had no access to trainable aids or they were unsure about the presence or activation of trainable features. The remaining clinicians never activated trainable features. One in five users reported having used trainable aids and 93% would train again. Over 85% of the remaining hearing-impaired adults were interested in trainable aids.

Conclusions: Positive reports from most providers and users who had experience with the trainable feature support the provision of trainable aids to selected clients, pending more evidence-based data to support the clinical management of such devices.     

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.     

Hearing Aid Technology to Improve Speech Intelligibility in Noise: Wind Noise Management in Hearing Aids

Many hearing aid users are negatively impacted by wind noise when spending time outdoors. Turbulent airflow around hearing aid microphones caused by the obstruction of wind can result in noise that is not only perceived as annoying but may also mask desirable sounds in the listening environment, such as speech. To mitigate the adverse effects of wind noise, hearing aid developers have introduced several technological solutions to reduce the amount of wind noise at the hearing aid output. Some solutions are based on mechanical modifications; more recently, sophisticated signal processing algorithms have also been introduced. By offering solutions to the wind noise problem, these signal processing algorithms can promote more optimal use of hearing aids during outdoor activities. This article reviews how wind noise is generated in hearing aids, outlines the technological challenges in wind noise management, and summarizes the technological solutions that have been proposed and/or implemented in modern hearing aids.     

Validation of the Chinese version “satisfaction with amplification in daily life (SADL)” survey for hearing-aid users

Abstract

Objective: Satisfaction with amplification in daily life (SADL) may quantify satisfaction with hearing aids. We translated and validated a Chinese version of SADL (CSADL). Design: The SADL was translated from English to Mandarin Chinese by two bilingual physicians. The CSADL was administered to hearing-aid users and tested for reliability and validity. Study sample: There were 155 hearing-aid users who completed the CSADL prospectively, and 39 subjects were retested after 4 to 6 weeks for test-retest reliability. Results: The CSADL had good internal consistency (Cronbach α = 0.63 to 0.92), within survey reliability (r = 0.54 to 0.69; P ≤ .05), and test-retest reliability (r = 0.93 to 0.98; P ≤ .05). The CSADL dimensions correlated well with worse-ear speech discrimination score (P ≤ .05). The CSADL global score significantly correlated with the general health (r = 0.236; P ≤ .05), vitality (r = 0.162; P ≤ .05), social functioning (r = 0.190; P ≤ .05), and mental health (r = 0.224; P ≤ .05) subscales of the Mandarin Chinese Taiwan version of the medical outcome 36-item short-form health survey. Conclusions: The CSADL is a valid and reliable questionnaire to evaluate satisfaction among Chinese hearing-aid users.