Abstract
The acceptable noise level (ANL) test, in which individuals indicate what level of noise they are willing to put up with while following speech, has been used to guide hearing aid fitting decisions and has been found to relate to prospective hearing aid use. Unlike objective measures of speech perception ability, ANL outcome is not related to individual hearing loss or age, but rather reflects an individual’s inherent acceptance of competing noise while listening to speech. As such, the measure may predict aspects of hearing aid success. Crucially, however, recent studies have questioned its repeatability (test–retest reliability). The first question for this study was whether the inconsistent results regarding the repeatability of the ANL test may be due to differences in speech material types used in previous studies. Second, it is unclear whether meaningfulness and semantic coherence of the speech modify ANL outcome. To investigate these questions, we compared ANLs obtained with three types of materials: the International Speech Test Signal (ISTS), which is non-meaningful and semantically non-coherent by definition, passages consisting of concatenated meaningful standard audiology sentences, and longer fragments taken from conversational speech. We included conversational speech as this type of speech material is most representative of everyday listening. Additionally, we investigated whether ANL outcomes, obtained with these three different speech materials, were associated with self-reported limitations due to hearing problems and listening effort in everyday life, as assessed by a questionnaire. ANL data were collected for 57 relatively good-hearing adult participants with an age range representative for hearing aid users. Results showed that meaningfulness, but not semantic coherence of the speech material affected ANL. Less noise was accepted for the non-meaningful ISTS signal than for the meaningful speech materials. ANL repeatability was comparable across the speech materials. Furthermore, ANL was found to be associated with the outcome of a hearing-related questionnaire. This suggests that ANL may predict activity limitations for listening to speech-in-noise in everyday situations. In conclusion, more natural speech materials can be used in a clinical setting as their repeatability is not reduced compared to more standard materials.
Highlights
One of the most frequent complaints of adult hearing aid users is that comprehending speech is challenging in noisy environments (Cord et al, 2004; Killion et al, 2004; Nábelek et al, 2006) insufficient benefit of hearing aids in noisy situations seems to be an important reason for people fitted with a hearing aid not to use it
We investigate whether acceptable noise level (ANL) depends on meaningfulness and coherence by using three different stimulus types that differ in meaningfulness (ISTS vs. concatenated sentences and fragments of conversational speech) and coherence
Table 4) showed that ANLs for the meaningful materials (SENT, conversational material (CONV)) were significantly different from those for the non-meaningful International Speech Test Signal (ISTS) material [χ2(1, Research Question 1B: Does ANL Outcome Depend on the Semantic Coherence of the Speech Material?
Summary
One of the most frequent complaints of adult hearing aid users is that comprehending speech is challenging in noisy environments (Cord et al, 2004; Killion et al, 2004; Nábelek et al, 2006) insufficient benefit of hearing aids in noisy situations seems to be an important reason for people fitted with a hearing aid not to use it. The use of assistive listening devices could be applied early on for individuals who can be expected to be unsatisfied with hearing devices in noisy environments in order to minimize disappointment with the device, activity limitations and participation restrictions related to hearing disabilities (cf Nábelek et al, 2006; Kim et al, 2015) This raises the question of how to identify future hearing aid users who may be discouraged from using hearing aids because of difficulty listening in noise. One obvious approach would be to measure the individual’s objective ability to understand speech in noise (e.g., the standard speech-reception threshold measure) Such objective performance measures are not predictive of hearing aid benefit or success (Bender et al, 1993; Humes et al, 1996; Nábelek et al, 2006). It may be a better indicator of successful hearing aid uptake than the individual’s objective ability to understand speech in noise as it is more telling about the individual’s wishes, motivation, and intentions
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