Hearing Aid Settings Research Articles

Would a comprehensive hearing aid fitting process lead to placebo effects compared to a simple process?

ObjectivesPlacebo effects refer to the impact of a treatment on health outcomes that cannot be attributed to the treatment itself. The current study aimed to investigate whether a comprehensive hearing aid fitting process would induce placebo effects compared to a simple process, and whether personal attributes such as personality traits could predict susceptibility to these effects.DesignThirty adults with hearing loss completed the study. The study began with a fitting session in which the field trial hearing aid configuration (the actual fitting) was set, followed by two experimental conditions. Each condition involved a fake hearing aid fitting and a 3-week field trial. In the fake fitting, bilateral hearing aids were fitted using the Comprehensive protocol (CM) that included multiple assessments and probe-microphone verification or the Streamlined protocol (ST) that did not involve any assessments other than a hearing test. The same hearing aid amplification settings established in the actual fitting, rather than the settings from the fake fittings, were used in the field trials for both conditions. Patient outcomes were measured using the International Outcome Inventory for Hearing Aids (IOI-HA), which was administered as both retrospective self-reports and ecological momentary assessment (EMA) surveys. Personality was assessed using the NEO Five-Factor Inventory. Upon completion of the study, participants expressed their hearing aid preferences based on hearing aids' real-world performances (prefer CM, prefer ST, or no preference).ResultsFor both retrospective self-reports and EMA, the IOI-HA scores of the CM and ST conditions did not significantly differ. Among the 30 participants, 22 expressed a preference for either CM (n = 14) or ST (n = 8). Younger participants and those with higher levels of agreeableness were more likely to have a hearing aid preference.ConclusionsAt the group level, comprehensive hearing aid fitting process did not generate a placebo effect leading to better outcomes compared to a simple process. However, despite the absence of differences in hearing aid settings, most (73%) participants were affected by placebo effects, believing that one fitting process yielded better real-world outcomes than the other. Personal attributes including personality traits and age are associated with susceptibility to placebo effects.

A spectro-temporal modulation test for predicting speech reception in hearing-impaired listeners with hearing aids

Spectro-temporal modulation (STM) detection sensitivity has been shown to be associated with speech-in-noise reception in hearing-impaired (HI) individuals. Based on previous research, a recent study [Zaar, Simonsen, Dau, and Laugesen (2023). Hear Res 427:108650] introduced an STM test paradigm with audibility compensation, employing STM stimulus variants using noise and complex tones as carrier signals. The study demonstrated that the test was suitable for the target population of elderly individuals with moderate-to-severe hearing loss and showed promising predictions of speech-reception thresholds (SRTs) measured in a realistic set up with spatially distributed speech and noise maskers and linear audibility compensation. The present study further investigated the suggested STM test with respect to (i) test-retest variability for the most promising STM stimulus variants, (ii) its predictive power with respect to realistic speech-in-noise reception with non-linear hearing-aid amplification, (iii) its connection to effects of directionality and noise reduction (DIR+NR) hearing-aid processing, and (iv) its relation to DIR+NR preference. Thirty elderly HI participants were tested in a combined laboratory and field study, collecting STM thresholds with a complex-tone based and a noise-based STM stimulus design, SRTs with spatially distributed speech and noise maskers using hearing aids with non-linear amplification and two different levels of DIR+NR, as well as subjective reports and preference ratings obtained in two field periods with the two DIR+NR hearing-aid settings. The results indicate that the noise-carrier based STM test variant (i) showed optimal test-retest properties, (ii) yielded a highly significant correlation with SRTs (R2=0.61) exceeding and complementing the predictive power of the audiogram, (iii) yielded significant correlation (R2=0.51) with the DIR+NR-induced SRT benefit, and (iv) did not provide significant correlation with subjective preference for DIR+NR settings in the field. Overall, the suggested STM test represents a valuable tool for diagnosing speech-reception problems that remain when hearing-aid amplification has been provided and the resulting need for and benefit from DIR+NR hearing-aid processing.

Effectiveness of Television Streaming on Hearing Aid User Performance and Satisfaction in Quiet and in Noise.

The purpose of this study was to determine the effectiveness of television (TV) streaming on hearing aid user performance and satisfaction in quiet and in noise. Twenty experienced hearing aid users were evaluated in quiet and in noise (5 dB SNR) under three hearing aid conditions: hearing aids, streaming with hearing aid microphones attenuated by 6 dB, and streaming with hearing aid microphones muted. The audiovisual Connected Speech Test served as the signal, and the ipsilateral competing message from the Synthetic Sentence Identification-Ipsilateral Competing Message (SSI-ICM) served as the noise. Measures of speech understanding, satisfaction with sound quality and clarity, and preference were obtained. Speech understanding was significantly better in quiet than in noise, and streaming improved performance in noise when the hearing aid microphones were muted. Sound quality satisfaction was significantly better in quiet than in noise but was not impacted significantly by the hearing aid settings. Speech clarity satisfaction was significantly better in quiet than in noise, and streaming improved satisfaction in noise when the hearing aid microphones were muted. More participants preferred streaming with the microphones muted in quiet, in noise, and overall; however, results did not reach statistical significance. Hearing aid users did not benefit from TV streaming with the microphones attenuated or muted when listening in quiet. TV streaming was more beneficial to hearing aid users when listening in noise with the microphones muted. Hearing aid users should be counseled on the impact of the hearing aid microphone settings when using a TV streamer, particularly in noise.

Live evaluation of auditory preference for group conversations

Improving hearing-impaired people's ability to participate in conversations is important. To date, few outcome measures let us relate conversation success to hearing impairment and hearing-aid function. In a previous study, we developed the LEAP test (Smeds et al. 2021), where a test leader guided one participant through a set of listening scenarios, in which the participant compared two hearing-aid settings and reported the preferred setting. The current study extends the LEAP test to unsupervised group conversations. Nine groups of three participants held conversations sparked by so-called consensus questions. Two test scenarios were used: “business meeting” (where a projector created low-level background noise) and “dinner party” (where an ambisonics recording reproduced in 2-D was used as background). Two test paradigms were evaluated: direct comparisons, where participants toggled between the two hearing-aid settings during a conversation and then selected their preferred setting, and indirect comparisons, where one hearing-aid setting was used at the time and participants after each conversation rated how well the hearing aids worked in the current setting, and the preferred setting was determined by comparing the two ratings. The reliability of the two test paradigms was evaluated. At the time of the submission of this abstract, analyses are ongoing.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults.

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

Automatic User Preferences Selection of Smart Hearing Aid Using BioAid.

Noisy environments, changes and variations in the volume of speech, and non-face-to-face conversations impair the user experience with hearing aids. Generally, a hearing aid amplifies sounds so that a hearing-impaired person can listen, converse, and actively engage in daily activities. Presently, there are some sophisticated hearing aid algorithms available that operate on numerous frequency bands to not only amplify but also provide tuning and noise filtering to minimize background distractions. One of those is the BioAid assistive hearing system, which is an open-source, freely available downloadable app with twenty-four tuning settings. Critically, with this device, a person suffering with hearing loss must manually alter the settings/tuning of their hearing device when their surroundings and scene changes in order to attain a comfortable level of hearing. However, this manual switching among multiple tuning settings is inconvenient and cumbersome since the user is forced to switch to the state that best matches the scene every time the auditory environment changes. The goal of this study is to eliminate this manual switching and automate the BioAid with a scene classification algorithm so that the system automatically identifies the user-selected preferences based on adequate training. The aim of acoustic scene classification is to recognize the audio signature of one of the predefined scene classes that best represent the environment in which it was recorded. BioAid, an open-source biological inspired hearing aid algorithm, is used after conversion to Python. The proposed method consists of two main parts: classification of auditory scenes and selection of hearing aid tuning settings based on user experiences. The DCASE2017 dataset is utilized for scene classification. Among the many classifiers that were trained and tested, random forests have the highest accuracy of 99.7%. In the second part, clean speech audios from the LJ speech dataset are combined with scenes, and the user is asked to listen to the resulting audios and adjust the presets and subsets. A CSV file stores the selection of presets and subsets at which the user can hear clearly against the scenes. Various classifiers are trained on the dataset of user preferences. After training, clean speech audio was convolved with the scene and fed as input to the scene classifier that predicts the scene. The predicted scene was then fed as input to the preset classifier that predicts the user’s choice for preset and subset. The BioAid is automatically tuned to the predicted selection. The accuracy of random forest in the prediction of presets and subsets was 100%. This proposed approach has great potential to eliminate the tedious manual switching of hearing assistive device parameters by allowing hearing-impaired individuals to actively participate in daily life by automatically adjusting hearing aid settings based on the acoustic scene.

Measuring and modeling context-dependent preferences for hearing aid settings

Despite having individual perceptual preferences toward sounds, hearing aid users often end up with default hearing aid settings that have no contextual awareness. However, the introduction of smartphone-connected hearing aids has enabled a rethinking of hearing aids as user-adaptive systems considering both individual and contextual differences. In this study, we aimed to investigate the feasibility of such context-aware system for providing hearing aid users with a number of relevant hearing aid settings to choose from. During normal real-world hearing aid usage, we applied a smartphone-based method for capturing participants’ listening experience and audiological preference for different intervention levels of three audiological parameters (Noise Reduction, Brightness, Soft Gain). Concurrently, we collected contextual data as both self-reports (listening environment and listening intention) and continuous data logging of the acoustic environment (sound pressure level, signal-to-noise ratio). First, we found that having access to different intervention levels of the Brightness and Soft Gain parameters affected listening satisfaction. Second, for all three audiological parameters, the perceived usefulness of having access to different intervention levels was significantly modulated by context. Third, contextual data improved the prediction of both explicit and implicit intervention level preferences. Our findings highlight that context has a significant impact on hearing aid preferences across participants and that contextual data logging can help reduce the space of potential interventions in a user-adaptive system so that the most useful and preferred settings can be offered. Moreover, the proposed mixed-effects model is suitable for capturing predictions on an individual level and could also be expanded to predictions on a group level by including relevant user features.

Comparison of laboratory and clinical computational metrics of acoustic measures of hearing-aid processed speech

Computational auditory metrics are used to characterize hearing-aid fittings in the laboratory and the clinic. The purpose of this study is to compare the speech intelligibility index (SII) as a clinical metric to the laboratory based SII and the hearing-aid speech perception index (HASPI) and hearing-aid speech quality index (HASQI) laboratory metrics. These comparisons are drawn from a comprehensive dataset of hearing-aid fittings for 120 hearing-aid recipients from a hospital-based audiology clinic. Hearing-aid devices are drawn from multiple manufacturers and multiple technology levels, and a total of nine hearing-aid devices are included. Acoustic recordings are made with the hearing-aids positioned on the KEMAR manikin and include multiple hearing-aid settings for each patient (manufacturer’s recommended fit, first fit by the audiologist, and the final fitting selected by the patient). Metric values are computed for each of the settings, and these metric comparisons highlight the advantages and challenges of each metric in characterizing hearing-aid signal processing. In addition, the results provide insight regarding hearing-aid fittings from the manufacturer’s fitting versus clinician/patient driven fittings. [Work supported by NIH R01 DC012289, NIH NRSA T32DC012280, and GN Hearing OCG6790B.]

Effect of adaptive beamforming and noise reduction algorithms on speech intelligibility and noise tolerance in bimodal cochlear implant users

Objective To evaluate the effect of a directional microphone (beamformer) and continuous noise reduction algorithms (CNRs) in bimodally aided cochlear implant (CI) users and to find the optimum hearing aid (HA) and CI settings of the beamformer and CNRs. Methods Speech reception threshold (SRT) and acceptable noise level (ANL) were assessed in twelve adult CI users for unilateral CI, unilateral HA and bimodal listening. To assess the effect of the UltraZoom beamformer and the ClearVoice™ and NoiseBlock CNRs on SRT and ANL, speech was presented from the front in multi-source speech-shaped noise. Results With unilateral CI, application of UltraZoom resulted in a significant improvement of the median SRT and ANL by 3.8 and 4.3 dB, respectively. For bimodal listening with UltraZoom, a significant improvement of 3.5 dB in median SRT was found. There was no significant effect of using the CNRs on speech intelligibility in noise or noise tolerance in either listening condition. Conclusion UltraZoom should be applied on the CI to improve speech intelligibility in face to face conversations with multi-source background noise. However, due to the heterogeneous data, no recommendations for the settings of UltraZoom on the HA or of ClearVoice/NoiseBlock on either device can be given. Trial registration German Clinical Trials Register identifier: DRKS00010807

Smartphone-Connected Hearing Aids Enable and Empower Self-Management of Hearing Loss: A Qualitative Interview Study Underpinned by the Behavior Change Wheel.

To identify patient-reported barriers and facilitators to using smartphone-connected hearing aids, using the Behavior Change Wheel (BCW) to understand experiences and how these can be addressed. A single-center, prospective, observational study. Eight hearing aid users (new = 1, existing = 7; mean age = 71.75 years, SD = 5.23, range = 65 to 81 years) were identified through convenience sampling from 44 participants who took part in a 7-week evaluation of smartphone-connected hearing aids controlled by a prototype app. The app allowed users to manually control settings such as gain, noise reduction, and microphone directionality, preset, and customized programmes. Participants were assigned to one of two focus groups following trial of the app. Focus group transcripts were thematically analyzed and underpinned by the COM-B (Capability, Opportunity, Motivation-Behavior) model and Theoretical Domains Framework to identify barriers and facilitators to using smartphone-connected hearing aids (the target behavior). Mapping of themes to the BCW allowed use of the Behavior Change Technique Taxonomy (version 1) to identify behavior change techniques that audiologists could implement in clinical practice to address the barriers and facilitators. Capability: The app increased participants' knowledge of hearing aid controls, encouraging use of the app for improved hearing loss self-management. However, barriers to using the app included perception of insufficient digital literacy skills for smartphone-connected hearing aid use and an increased cognitive load caused by decisions over which controls to use. Opportunity: Perceived smartphone norms (i.e., acceptable occasions to use smartphones) and differing listening contexts acted as both facilitators and barriers. Motivation: The ability to control hearing aid settings in any listening situation (e.g., to reduce noise) empowered users to successfully self-manage their hearing loss, leading to greater confidence and participation in everyday life. The app also reduced hearing aid-related and self-stigma, and the ability to self-adjust hearing aids benefitted both participants and communication partners. It was the adjustability and interaction afforded by the app that empowered users, rather than the hearing aid technology itself. Perceived beliefs and knowledge about digital literacy skills, and specifically abilities to use a smartphone, were perceived to be barriers in this typically older population, particularly when they compared themselves to younger generations. Using the Behavior Change Technique Taxonomy (version 1), behavior change techniques that could be used by audiologists to address these barriers included enablement, goal setting, reframing perceptions toward technology, and addressing patient educational needs. Smartphone-connected hearing aids, when used in their everyday lives, were viewed positively by participants across a range of domains, empowering them and enabling hearing loss self-management. Audiologists should consider smartphone-connected hearing aid candidacy for all who have access to smartphones and are willing to use one. Use of the BCW has identified that modifiable barriers to using smartphone-connected hearing aids exist. Audiologists could use these evidence-based behavior change techniques to support patients in adopting and using these technologies to successfully self-manage hearing loss. Overall, by reframing smartphone technologies as a tool to remain connected with society, smartphone-connected hearing aids could shift the power of managing hearing loss from clinician to patient.

Live Evaluation of Auditory Preference, a Laboratory Test for Evaluating Auditory Preference.

Many laboratory tests are performed under unrealistic conditions. Tasks, such as repeating words or sentences, are performed in simple loudspeaker setups. Currently, many research groups focus on realistic audiovisual laboratory setups. Fewer groups focus on the tasks performed during testing. A semicontrolled laboratory test method focusing on the tasks performed, the Live Evaluation of Auditory Preference (LEAP) was evaluated. LEAP is developed to evaluate hearing-instrument performance in test scenarios that represent everyday listening situations. LEAP was evaluated in a feasibility study. The method comprises conversations between a test participant and one or two test leaders, enabling evaluation of the test participant's own voice. The method allows for visual cues (when relevant) and introduce social pressure to participate in the conversation. In addition, other everyday listening tasks, such as watching television (TV) and listening to radio, are included. In this study, LEAP was used to assess preference for two hearing aid settings using paired comparisons. Nineteen experienced hearing aid users (13 females and 6 males; mean age 74 years), participated in the study. LEAP was performed at three visits to the laboratory. In addition, participants conducted a field trial where the two hearing aid programs were compared using Ecological Momentary Assessments (EMA). During LEAP testing, six mandatory test cases were used, representing commonly occurring everyday listening situations. Individual test cases were also included, selected from individually experienced listening situations during the field trial. Within- and between-session reliability of the LEAP test was investigated. Validity was investigated by comparing the LEAP and the EMA results. For the current signal-processing evaluation, the test was judged to have acceptable reliability and validity. The inclusion of individually selected test cases increased the representativeness of the LEAP test, but it did not substantially alter the results in the current study. LEAP in its current implementation seems suitable for investigating signal-processing preference in the laboratory in a way that is indicative of everyday preference. The LEAP method represents one step forward in bringing the real world into the laboratory.

Evaluating the Service Quality of Mobile Health Versus Clinic Based Intervention in Hearing Healthcare. A Comparative Study

Hearing Healthcare is in midst of a paradigm shift and the use of mobile health technologies plays therefore a major role. Through the Bluetooth connectivity between the hearing aids and the smartphone with an accompanying app, the HCP can remotely access hearing aid settings during an online video session. In this study, 30 subjects were divided into a tele-audiology intervention and a clinic-based control group and followed up after an initial fitting for four weeks. At the beginning, structured interviews were used to determine the expectations on the service quality of a Hearing Aid Company, and these were compared with the actual perceived performances at the end of the study using the SERVQUAL model. Various advantages and disadvantages of both forms of intervention were identified. It could be concluded that a combination of both variants ensures the greatest possible perception of service quality.

Manipulation of Hearing Aid Gain and Tinnitus Relief: A Paired Comparison Study.

Objectives:The objective of the study is to compare amplification strategies on tinnitus relief. A repeated measure research design was used to determine the best strategy that provides a significant relief on tinnitus and improvements in speech perception.Methods: We recruited 20 participants in the age range of 30-60 years (mean age = 47.95 years) having mild to moderately severe sloping sensorineural hearing loss with continuous tonal tinnitus. We grouped the participants into mild and severe, based on the scores obtained in the Tinnitus Handicap Inventory. We evaluated tinnitus pitch and loudness using the adaptive method. Besides, we assessed signal to noise ratio 50 (SNR 50) from each of the programs. We carried out a paired comparison method to determine the best strategy among the 3 in which the maximum preference score was obtained on tinnitus relief by a test hearing aid programmed with 3 programs.Results: Each group of participants significantly preferred the strategy for the gain in hearing aid set at tinnitus pitch on tinnitus. However, there was no significant difference between the SNR 50 scores in the 3 gain settings.Conclusion: An additional gain set at tinnitus pitch after alleviating hearing loss by the prescriptive method was found to be the best strategy for effective masking of tinnitus and that led to tinnitus relief without compromising speech perception.

Междисциплинарный подход в сурдологии – опыт слухопротезирования детей с нарушением слуха

Objectives – to develop an algorithm for the interaction between an audiologist and speech-language therapist in initial amplification for hearing impaired children. Material and methods. 219 children with hearing impairments aged from 2 months to 16 years were divided into 2 groups. The experimental group consisted of children who got a special course of medical, psychological and pedagogical rehabilitation at the stage of initial fitting, based on the new algorithm of interdisciplinary interaction between an audiologist and a speech-language therapist. The control group included children with traditional procedure of hearing aids’ fitting, in which the audiologist did not interact with the speech therapist. Results. The algorithm for the interaction of an audiologist and speech-language therapist included 3 stages of hearing aids fitting (preparation, initial fitting, adaptation and fine tuning of hearing aids). The tasks of each specialist at these stages were identified, including the parents’ involvement in the process of fitting. The exchange of information between specialists was organised by a developed protocol. The algorithm was implemented in a special course of medical-psychological-pedagogical rehabilitation in the Center of Pediatric Audiology. It was found that in 1 month after the primary fitting among children who underwent this course, the significantly larger number of children used the hearing aids for more than 8 hours a day and reached the integral criterion of effective hearing aids’ fitting, if compared to the control group. These children also took less time to adjust their hearing aid settings during the repeated fitting sessions. Conclusion. A structured interdisciplinary interaction between an audiologist and speech-language therapist at the stage of initial amplification significantly increases the effectiveness of medical technology for restoring hearing function in children.

INTERDISCIPLINARY APPROACH IN AUDIOLOGY – AN EXPERIENCE OF PEDIATRIC AMPLIFICATION

Abstract
 The aim of the study was to develop an algorithm for the interaction between an audiologist and speech-language therapist in initial amplification for hearing impaired children.
 Methods. 219 children aged 2 months to 16 years with hearing impairments were divided into 2 groups. The experimental group consisted of children who got a special course of medical, psychological and pedagogical rehabilitation at the stage of initial fitting, based on the new algorithm of interdisciplinary interaction between an audiologist and a speech-language therapist. The control group included children with traditional procedure of hearing aids fitting, in which the audiologist didnt interact with the speech therapist.
 Results. An algorithm for the interaction of an audiologist and speech-language therapist included 3 stages of hearing aids fitting (preparation, initial fitting, adaptation and fine tuning of hearing aids), the tasks of each specialist at these stages were identified, including the parents involvement in the process of fitting, a development of the protocol for the exchange of information between specialists. The algorithm was implemented in a special course of medical-psychological-pedagogical rehabilitation in the Center of Pediatric Audiology. It was found that in 1 month after the primary fitting among children who underwent this course, significantly more children used hearing aids for more than 8 hours a day and reached the integral criterion of effective hearing aids fitting compared with the control group. These children also took less time to adjust their hearing aid settings during repeated fitting sessions.
 Conclusion. A structured interdisciplinary interaction between an audiologist and speech-language therapist at the stage of initial amplification significantly increases the effectiveness of medical technology for restoring hearing function in children.

The Effect of Cognition on the Aided Benefit in Terms of Speech Understanding and Listening Effort Obtained With Digital Hearing Aids: A Systematic Review.

Purpose Hearing aids are the primary rehabilitation devices used to compensate for presbycusis, though large intersubject variability in hearing aid benefit has been reported. This systematic review aimed to investigate how intersubject differences in cognition could influence the aided benefit for speech understanding and listening effort with bilateral digital hearing aids. Method Articles were selected through systematic searches in MEDLINE, Embase, Central, and reference lists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results The initial search resulted in 1,092 unique hits, of which 16 were included. The effect of cognition on the aided benefit in terms of speech understanding and listening effort was examined in 12 and four studies, respectively. The aided speech and listening effort benefit obtained from hearing aid use in general or from a specific digital feature (i.e., microphone directionality, noise reduction, amplitude compression, and frequency compression) was associated with four cognitive functions (i.e., working memory, processing speed, selective attention, and executive functions). Conclusions Hearing aid users with poorer cognitive functioning derived more aided benefit in terms of speech understanding from hearing aid settings facilitating the matching process between the incoming auditory signal and representations stored in long-term memory. However, since the number of included studies was limited, this trend should be interpreted with caution. Supplemental Material https://doi.org/10.23641/asha.13626509.

Towards Auditory Profile-Based Hearing-Aid Fitting: Fitting Rationale and Pilot Evaluation.

Background—The clinical characterization of hearing deficits for hearing-aid fitting purposes is typically based on the pure-tone audiogram only. In a previous study, a group of hearing-impaired listeners completed a comprehensive test battery that was designed to tap into different dimensions of hearing abilities. A data-driven analysis of the data yielded four clinically relevant patient sub-populations or “auditory profiles”. The purpose of the current study was to propose and pilot-test profile-based hearing-aid settings in order to explore their potential for providing more targeted hearing-aid treatment. Methods—Four candidate hearing-aid settings were developed and evaluated by a subset of the participants tested previously. The evaluation consisted of multi-comparison preference ratings that were carried out in realistic sound scenarios. Results—Listeners belonging to the different auditory profiles showed different patterns of preference for the tested hearing-aid settings that were largely consistent with the expectations. Conclusions—The results of this pilot evaluation support further investigations into stratified, profile-based hearing-aid fitting with wearable hearing aids.

Effects of Directionality, Compression, and Working Memory on Speech Recognition.

Previous research has shown that the association between hearing aid-processed speech recognition and individual working memory ability becomes stronger in more challenging conditions (e.g., higher background noise levels) and with stronger hearing aid processing (e.g., fast-acting wide dynamic range compression, WDRC). To date, studies have assumed omnidirectional microphone settings and collocated speech and noise conditions to study such relationships. Such conditions fail to recognize that most hearing aids are fit with directional processing that may improve the signal to noise ratio (SNR) and speech recognition in spatially separated speech and noise conditions. Here, we considered the possibility that directional processing may reduce the signal distortion arising from fast-acting WDRC and in turn influence the relationship between working memory ability and speech recognition with WDRC processing. The combined effects of hearing aid processing (WDRC and directionality) and SNR were quantified using a signal modification metric (cepstral correlation), which measures temporal envelope changes in the processed signal with respect to a linearly amplified reference. It was hypothesized that there will be a weaker association between working memory ability and speech recognition for hearing aid processing conditions that result in overall less signal modification (i.e., fewer changes to the processed envelope). Twenty-three individuals with bilateral, mild to moderately severe sensorineural hearing loss participated in the study. Participants were fit with a commercially available hearing aid, and signal processing was varied in two dimensions: (1) Directionality (omnidirectional [OMNI] versus fixed-directional [DIR]), and (2) WDRC speed (fast-acting [FAST] versus slow-acting [SLOW]). Sentence recognition in spatially separated multi-talker babble was measured across a range of SNRs: 0 dB, 5 dB, 10 dB, and quiet. Cumulative signal modification was measured with individualized hearing aid settings, for all experimental conditions. A linear mixed-effects model was used to determine the relationship between speech recognition, working memory ability, and cumulative signal modification. Signal modification results showed a complex relationship between directionality and WDRC speed, which varied by SNR. At 0 and 5 dB SNRs, signal modification was lower for SLOW than FAST regardless of directionality. However, at 10 dB SNR and in the DIR listening condition, there was no signal modification difference between FAST and SLOW. Consistent with previous studies, the association of speech recognition in noise with working memory ability depended on the level of signal modification. Contrary to the hypothesis above, however, there was a significant association of speech recognition with working memory only at lower levels of signal modification, and speech recognition increased at a faster rate for individuals with better working memory as signal modification decreased with DIR and SLOW. This research suggests that working memory ability remains a significant predictor of speech recognition when WDRC and directionality are applied. Our findings revealed that directional processing can reduce the detrimental effect of fast-acting WDRC on speech cues at higher SNRs, which affects speech recognition ability. Contrary to some previous research, this study showed that individuals with better working memory ability benefitted more from a decrease in signal modification than individuals with poorer working memory ability.

Frequency-lowering processing to improve speech-in-noise intelligibility in patients with age-related hearing loss.

Modern hearing aids use various signal-processing strategies to improve speech intelligibility. In this manuscript, we studied the linear frequency transposition (LFT), a frequency-lowering algorithm, in patients with age-related hearing loss. Frequency-lowering algorithms transpose high-frequency sounds to a lower-frequency band. The study aimed to assess whether LFT could be used as a tool to improve speech intelligibility in patients with a better high-frequency preservation. The study population consisted of 77 patients (age average 74.8 ± 12.4) wearing hearing aids with an open or tulip coupling system with age-related hearing loss. The unaided air conduction pure tone average (PTA) at 500, 1000, 2000Hz was 43.5 ± 14.3dB; the unaided word recognition score (WRS) average was 53.7 ± 12.5%. We compared WRS in all patients with the hearing aid turned on, in "quiet" and using a "pink" and "babble" masking noise. Three hearing aid settings were tested in each acoustic conditions: no transposition (NT), high transposition (HT), and low transposition (LT). "High" and "low" refer to the "start frequency"; all sounds above the start frequency are transposed in a lower-frequency band. When the start frequency was suggested by the fitting software, we called the condition "high transposition"; when the start frequency was set at the lowest possible value provided by the fitting software, we called the condition "low transposition". The quality of the voice was also assessed asking the patient to give a score from 1 to 10, where 10 was the maximum listening comfort [quality of voice score (QVS)]. Collected data were compared for each condition (NT, HT, LT, in quiet, pink noise and babble noise) and no statistically significant differences were found in WRS and QVS (quiet WRS p = 0.07, pink noise WRS p = 0.18, babble noise WRS p = 0.11, QVS p = 0.91). We selected 33 patients with a better WRS in babble noise using transposition (high and low). In this group, the age was significantly lower than patients who did not use transposition (p = 0.01). Linear frequency transposition is not useful to improve speech-in-noise intelligibility in patients with age-related hearing loss. Despite that no statistically significant differences were found, younger people could get advantages from the LFT when babble noise disturbs the listening of speech. The use of FL algorithm as a way to improve speech intelligibility in noisy environments should be always considered.

GPS predicts stability of listening environment characteristics in one location over time among older hearing aid users

Objective Hearing aid technology can allow users to “geo-tag” hearing aid preferences using the Global Positioning System (GPS). This technology assumes that listening environment characteristics that affect hearing aid benefit change little in a location over time. The purpose of this study was to investigate whether certain characteristics (reverberation, signal type, listening activity, noise location, noisiness, talker familiarity, talker location, and visual cues) changed in a location over time. Design: Participants completed GPS-tagged surveys on smartphones to report on characteristics of their listening environments. Coordinates were used to create indices that described how much listening environment characteristics changed in a location over time. Indices computed in one location were compared to indices computed across all locations for each participant. Study sample: 54 adults with hearing loss participated in this study (26 males and 38 females; 30 experienced hearing aid users and 24 new users). Results: A location dependency was observed for all characteristics. Characteristics were significantly different from one another in their stability over time. Conclusions: Listening environment characteristics changed less over time in a given location than in participants’ lives generally. The effectiveness of GPS-dependent hearing aid settings likely depends on the accuracy and location definition of the GPS feature.