Investigating Real-World Benefits of High-Frequency Gain in Bone-Anchored Users with Ecological Momentary Assessment and Real-Time Data Logging.

Arjan J Bosman,Tove Rosenbom,François Patou,Arno Janssen,Myrthe K S Hol,Jeppe Høy Christensen

doi:10.3390/jcm10173923

Abstract

Purpose: To compare listening ability (speech reception thresholds) and real-life listening experience in users with a percutaneous bone conduction device (BCD) with two listening programs differing only in high-frequency gain. In situ real-life experiences were recorded with ecological momentary assessment (EMA) techniques combined with real-time acoustical data logging and standard retrospective questionnaires. Methods: Nineteen experienced BCD users participated in this study. They all used a Ponto 4 BCD from Oticon Medical during a 4-week trial period. Environmental data and device parameters (i.e., device usage and volume control) were logged in real-time on an iPhone via a custom iOS research app. At the end of the trial period, subjects filled in APHAB, SSQ, and preference questionnaires. Listening abilities with the two programs were evaluated with speech reception threshold tests. Results: The APHAB and SSQ questionnaires did not reveal any differences between the two listening programs. The EMAs revealed group-level effects, indicating that in speech and noisy listening environments, subjects preferred the default listening program, and found the program with additional high-frequency gain too loud. This finding was corroborated by the volume log—subjects avoided the higher volume control setting and reacted more to changes in environmental sound pressure levels when using the high-frequency gain program. Finally, day-to-day changes in EMAs revealed acclimatization effects in the listening experience for ratings of “sound quality” and “program suitability” of the BCD, but not for ratings of “loudness perception” and “speech understanding”. The acclimatization effect did not differ among the listening programs. Conclusion: Adding custom high-frequency amplification to the BCD target-gain prescription improves speech reception in laboratory tests under quiet conditions, but results in poorer real-life listening experiences due to loudness.

Highlights

A percutaneous bone conduction device (BCD) is a viable solution for patients with a conductive or mixed hearing loss (HL) [1,2,3], or with single-sided deafness [4]
The sound processor converts sounds into mechanical vibrations that are transferred through abutment, implant, and skull to the cochlea
The limited sample size (i.e., N = 19) restricted further investigation into the effect of HL classification on listening experiences. This novel approach to evaluating BCD performance opens up interesting possibilities for optimizing device settings by combining real-life in situ subjective experiences with listening environments and device parameters

Summary

Introduction

A percutaneous bone conduction device (BCD) is a viable solution for patients with a conductive or mixed hearing loss (HL) [1,2,3], or with single-sided deafness [4]. In patients with conductive losses and average BC thresholds of 10 or 20 dB HL, an effective gain was found of −6 dB [6] or −7 dB [7], respectively These findings were corroborated by [5], showing negative effective gain values in patients with average bone conduction thresholds at 1, 2, and 4 kHz, up to 25 dB HL. It is worth investigating whether increasing gain relative to a default BCD target-gain prescription is beneficial to the listener. Given the small headroom of BCD devices for frequencies below 1 kHz [8], and the relatively small contribution of low frequencies to speech intelligibility [9], we decided to increase gain only for frequencies above 1 kHz

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Methods

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Discussion

Conclusion