Hearing Technology Research Articles

Age-related hearing loss and "hearables": An agenda for moral considerations.

Rapid advances in digital hearing technologies, also known as hearables, are expected to disrupt the direct-to-consumer health market. For older adults with higher incidence of hearing loss, such disruption could reduce hearing problems, increase accessibility to hearing aids, and mitigate related stigmas. This paper delves into the intersection of disruptive innovation and hearables within the realm of biomedical ethics. Through a comprehensive exploration, we shed light on the ethical implications surrounding hearables. By critically evaluating the key ethical advantages and drawbacks, we find that no single concern presents an insurmountable a priori objection to hearables. We conclude with some ideas to maximize the benefits of hearables and further promote opportunities for equitable hearing health.

Perceptions of hearing loss and hearing technology among the general public and healthcare providers: a scoping review

ObjectivesSynthesise literature related to perceptions of hearing loss and hearing technology (hearing aids, cochlear implants) among the general public and healthcare providers who do not specialise in ear and hearing...

Brain-Controlled Augmented Hearing for Spatially Moving Conversations in Multi-Talker Environments.

Focusing on a specific conversation amidst multiple interfering talkers is challenging, especially for those with hearing loss. Brain-controlled assistive hearing devices aim to alleviate this problem by enhancing the attended speech based on the listener's neural signals using auditory attention decoding (AAD). Departing from conventional AAD studies that relied on oversimplified scenarios with stationary talkers, a realistic AAD task that involves multiple talkers taking turns as they continuously move in space in background noise is presented. Invasive electroencephalography (iEEG) data are collected from three neurosurgical patients as they focused on one of the two moving conversations. An enhanced brain-controlled assistive hearing system that combines AAD and a binaural speaker-independent speech separation model is presented. The separation model unmixes talkers while preserving their spatial location and provides talker trajectories to the neural decoder to improve AAD accuracy. Subjective and objective evaluations show that the proposed system enhances speech intelligibility and facilitates conversation tracking while maintaining spatial cues and voice quality in challenging acoustic environments. This research demonstrates the potential of this approach in real-world scenarios and marks a significant step toward developing assistive hearing technologies that adapt to the intricate dynamics of everyday auditory experiences.

Applying relational autonomy in US special education: Educators’ role in supporting parents’ decisions for deaf or hard-of-hearing children

ABSTRACT The concept of relational autonomy is widely applied in bioethics research to elucidate how patients’ abilities in agentively making medical decisions are constrained within a complex structural system and set of relations; thus, rather than being individualistic in nature, autonomy is relationally and interdependently situated. While this perspective is thought-provoking, it is seldom explored in settings outside of healthcare. An equally critical site of decision-making processes is found in special education, where parents of children with disabilities must contend with information from both teachers and physicians to make choices that best support their child’s learning and development. Families of deaf or hard-of-hearing (D/HH) children in particular are uniquely positioned to encounter decisions that intersect educational, medical, and sociocultural levels – that is, in the earliest years of a D/HH child’s life, parents must make decisions about the child’s medical care and whether they will receive hearing technology or treatments, which in turn shapes the inherently cultural decision of linguistic choice, which in turn shapes educational decisions about the type of schooling environment for the child. This study broadly asks: In the field of special education, how do parents make decisions for their D/HH child? Data is drawn from semi-structured, ethnographic interviews with 16 educators of the deaf or hard-of-hearing (EODs) across public, private, and state levels in California. IMPACT STATEMENT The findings can help contribute academic research into conversation with social justice-oriented work to improve language and educational access for D/HH children.

Caregiver response types and children language outcomes in preschoolers with and without hearing loss in Aotearoa New Zealand

ABSTRACT Recent advances in audiological early intervention and hearing technologies have significantly improved access to spoken language for children with hearing loss (CwHL), but many CwHL require additional support to match the language development of their peers with normal hearing (PwNH). Programmes such as It Takes Two to Talk®, the Hanen Program® and Talking Matters focus on supporting parents to enhance children’s language development in natural environments. Analysis of response types has become a significant trend, facilitated by technological developments like Language ENvironment Analysis (LENA®), which provides uninterrupted recordings and automated calculations of adult–child interactions. This research examined three child language measures, child vocalisation counts, total number of words, and mean length of utterance, comparing CwHL and PwNH. Transcribed excerpts of LENA recordings were coded to determine caregivers’ use of ‘high-level’ responses in exchanges with their children and were correlated with child language outcomes. The results confirm the crucial role of caregiver response types in enhancing child language outcomes and exemplify the bidirectional relationship of caregiver-child interactions. The findings add to the literature to suggest that families and educators would benefit from guidance and coaching to acquire and apply high-level response types during natural spoken language interactions with CwHL.

Performance of Malayalam Speaking Children Fitted with Hearing Aids on PEACH Scale

Abstract: Parental questionnaires impart a better understanding of hearing technology utilization by children with Hearing loss(HL). They provide insights into the functional abilities and accomplishments of children equipped with Hearing Aids (HA). The present study aimed to translate and adapt the PEACH questionnaire into Malayalam language and evaluating its effectiveness in discriminating the functional hearing abilities of Malayalam speaking children with HL fitted with HAs at various stages of life. The Malayalam PEACH questionnaire was aPdministered to parents/caregivers of 40 Malayalamspeaking children aged 3 to 6, divided into two groups based on whether they received HA before or after the age of 2. Results revealed that children fitted with HA before 2 years of age demonstrated superior performance in quiet, noisy, and overall situations compared to those fitted after 2 years of age highlighting the importance of early identification of HL in children. Additionally, the questionnaire exhibited high reliability upon retesting across all of the three hearing situations (quiet,noise and overall). Therefore, the Malayalam PEACH questionnaire emerges as a dependable and effective tool for evaluating and monitoring the functional hearing abilities and communication skills of children fitted with HA or Cochlear Implants (CI) in their everyday lives

Self-reported social well-being of children with hearing loss in 2023

Objectives To study the level of social well-being for children with hearing loss (HL) using self-completed questionnaires. Methods The data sample relates to a total of 22 children representing a new group of children with HL. This new group is defined as HL detected through neonatal hearing screening and fitted with hearing technology when relevant before 6 months, received bilateral cochlear implants before one year of age followed by specific educational training using the auditory-verbal practice. The age range was from 9 to 12 years. Two self-completed questionnaires were used: The California Bullying Victimisation Scale (CBVS) and the Strengths and Difficulties Questionnaire (SDQ). The project design was a prospective case series. Results Self-completed assessments revealed levels of social well-being for both questionnaires comparable to populations with normal hearing. CBVS results showed that a total of 52.6% reported being ‘not a victim’, 36.8% peer victims and 10.5% bully victims. Results from SDQ revealed that 94.7% of the children reported being within the normal level for scores on both social strength and difficulties, 5.3% scored slightly raised/lowered and 0% had high/low scores or very high/low scores. Conclusion The new group of children with HL presented with self-completed scores comparable to peers with normal hearing. It is time to raise expectations for children with HL in terms of not only outcomes on audition and spoken language but also most importantly on levels of social well-being. Furthermore, it is discussed whether this new group can also be defined as a new generation of children with HL.

The technology or the child? Moving beyond technological fixes in deaf education in India and elsewhere

ABSTRACT As cochlear implants become the gold standard in intervening on deafness around the world, teachers of deaf children are increasingly expected to have technological expertise and to ensure that cochlear implants, and other hearing technology, are being used and that they are working. Students are only considered “ready to learn” if they are using their technology. Drawing from ethnographic research and semi-structured interviews with educators, families, surgeons, speech and language therapists, and audiologists in Indian cities, this article mobilises two conceptual frameworks from medical anthropology and public health – the “biotechnical embrace” and the “structural competency framework” to argue that teachers of deaf children, both in India and internationally, need to think and work beyond technology. Ultimately, focusing on a child does not mean focusing (only) on technology but rather on seeing a child as enmeshed in social, political, educational, and economic structures and relations. Expanding educators’ focus to consider micro and macro scales is especially urgent now, as countries around the world implement programmes in which technology is the goal.

Deep learning-based auditory attention decoding in listeners with hearing impairment * *This paper’s data analysis is based on a Master’s Thesis work [].

Objective. This study develops a deep learning (DL) method for fast auditory attention decoding (AAD) using electroencephalography (EEG) from listeners with hearing impairment (HI). It addresses three classification tasks: differentiating noise from speech-in-noise, classifying the direction of attended speech (left vs. right) and identifying the activation status of hearing aid noise reduction algorithms (OFF vs. ON). These tasks contribute to our understanding of how hearing technology influences auditory processing in the hearing-impaired population. Approach. Deep convolutional neural network (DCNN) models were designed for each task. Two training strategies were employed to clarify the impact of data splitting on AAD tasks: inter-trial, where the testing set used classification windows from trials that the training set had not seen, and intra-trial, where the testing set used unseen classification windows from trials where other segments were seen during training. The models were evaluated on EEG data from 31 participants with HI, listening to competing talkers amidst background noise. Main results. Using 1 s classification windows, DCNN models achieve accuracy (ACC) of 69.8%, 73.3% and 82.9% and area-under-curve (AUC) of 77.2%, 80.6% and 92.1% for the three tasks respectively on inter-trial strategy. In the intra-trial strategy, they achieved ACC of 87.9%, 80.1% and 97.5%, along with AUC of 94.6%, 89.1%, and 99.8%. Our DCNN models show good performance on short 1 s EEG samples, making them suitable for real-world applications. Conclusion: Our DCNN models successfully addressed three tasks with short 1 s EEG windows from participants with HI, showcasing their potential. While the inter-trial strategy demonstrated promise for assessing AAD, the intra-trial approach yielded inflated results, underscoring the important role of proper data splitting in EEG-based AAD tasks. Significance. Our findings showcase the promising potential of EEG-based tools for assessing auditory attention in clinical contexts and advancing hearing technology, while also promoting further exploration of alternative DL architectures and their potential constraints.

Costs of Severe to Profound Hearing Loss & Cost Savings of Cochlear Implants.

To estimate costs of severe to profound hearing loss, including costs and cost-savings associated with cochlear implantation. Data was obtained from the National Health Interview Survey, the National Health and Nutrition Examination Survey and national Medicare rates. We used continuous time state transition models with individual patient simulations to estimate the costs of severe to profound hearing loss (SPHL) across the lifespan. The model included four states, normal hearing, severe to profound hearing loss, cochlear implantation, and death. The estimated lifetime cost of an individual born with SPHL is $489,274 [377,518; 616,519]. Costs are lower for those who received a cochlear implant before 18 months of age $390,931 [311,976; 471,475], compared to those who are not implanted $608,167 [442,544; 791,719]. For individuals with a later onset of hearing loss (60 years old) lifetime costs were $154,536 [7,093; 302,936]. The annual societal costs for the US population were estimated to be $37 [8; 187] billion. SPHL is a costly condition, with the primary driver being lost productivity. Medical costs were higher for cochlear implantation, however, the higher income earnings offset the higher medical costs. Overall, early implantation substantially reduced lifetime costs. Access to hearing health care and technology is critical given the documented benefits for language, education, and quality of life. Government and insurance policies should be modified to allow for equal access and coverage for hearing technology, which will ultimately reduce lifetime and societal costs. N/A The current study used existing nationally representative datasets. Thus, these levels of evidence do not apply. Laryngoscope, 134:4358-4365, 2024.

'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course.

Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.

Reliability and Validity of the Turkish Version of the Vanderbilt Fatigue Scale for Adults.

Listening-related fatigue (LRF) is a prominent topic of research interest. The purpose of this study is to investigate the reliability and validity of the Turkish version of the 40-item Vanderbilt Fatigue Scale for Adults (TR-VFS-A-40). This study included 317 adults with no hearing loss and 260 adults with hearing loss in the study group, totaling 577 adults aged 18-75 years. While 31 adults in the study group did not use any hearing technology, there were 96 hearing aid users and 123 cochlear implant (CI) users. A subset of 80 CI users completed the TR-VFS-A-40 a second time, 2 weeks later, to assess test-retest reliability. Intraclass correlation coefficients were used to assess test-retest reliability. Cronbach's alpha was used to evaluate internal consistency. To examine construct validity, a confirmatory factor analysis (CFA) was performed. For concurrent validity analysis, the Checklist Individual Strength (CIS) and TR-VFS-A-40 scores were analyzed using the Spearman correlation test. Cronbach's alpha values were excellent for the total scale of .987 and the cognitive, emotional, physical, and social subscales (.953, .954, .955, and .946, respectively). Analyses of concurrent validity revealed strong and significant correlations between CIS and TR-VFS-A-40 scores, indicating a good concurrent validity. The CFA determined that the construct validity of the TR-VFS-A-40 was satisfactory. The TR-VFS-A-40 is a valid and reliable measure of LRF. https://doi.org/10.23641/asha.25457752.

Hearing Aid Fitting and Fine-tuning Strategies Implemented by Certified Audiologists in India

Background: Management of hearing-impaired individuals using hearing aids requires expertise in fitting formulas, compression methods, frequency adjustments, microphone directionality, noise reduction algorithms, and feedback management. There are abundant online resources/guidelines for programming and fine-tuning hearing aids. The fitting strategies for hearing aids can differ among professionals based on their expertise and convenience. Aims and Objectives: The survey study aimed to gain comprehension of the methods used by audiologists practicing in Indian subcontinent in choosing, fitting, and tuning hearing aids for adults with hearing impairment. Materials and Methods: A web-based survey with a 25-item questionnaire was carried out among audiologists nationwide, addressing topics such as hearing aid selection and fitting techniques. Among the audiologists practicing in India, 77 audiologists from various workplaces across India responded to the survey. The data gathered were then subjected to descriptive analysis. Results: The study showed that the selection of hearing aids depended on the extent of hearing loss and the main listening needs of the person. Audiologists generally used manufacturers’ initial fit and their expertise to adjust different signal processing features and considered patient feedback for additional adjustments. Most audiologists use only pure-tone audiometry for the initial evaluation of hearing abilities. Conclusion: The findings of the research underscore the absence of standardized procedures for audiologists in the fitting of hearing aids, considering the numerous signal-processing approaches present in contemporary hearing technology. Despite exponential advancements in hearing aid technology, there remains a scarcity of concise and accessible information that would enable audiologists to utilize such sophisticated technologies during fitting and tuning effectively.

Urban background sound recordings for virtual acoustics under various weather conditions

One of the major challenges in the auralization of complex urban simulations is the presence of ambience, for example background sounds. Omitting them can result in a sterile and implausible impression. In this work we present a dataset of spatially recorded ambient sounds with metadata on meteorological and acoustical parameters. The recordings are ready to be admixed with simulated soundscapes corresponding to various weather conditions. In particular, 28 soundscapes have been recorded at the IHTApark (green space next to the Institute for Hearing Technology and Acoustics) in Aachen (Germany) in winter and spring. They have been segmented into 30-s auralizable snippets. Moreover, the database contains a statistical and psychoacoustical evaluation of the recordings.

The multichannel vibrotactile gloves: A transmodal technology to feel sound through touch

Development of devices for transmitting sounds through touch is motivated by needs coming from diverse disciplines. Hard-of-hearing individuals could benefit from vibrations to overcome the limitations of existing hearing technologies. Adding tactile cues can be useful for all in contexts where the acoustic information is limited due to sounds coming from multiple sources or noise. The potential sensory augmentation provided by the technology is also interesting in an entertainment context in order to offer immersive experiences. A transdisciplinary approach based on a framework recently developed in our laboratory was used to design this technology that enables the transmission of acoustic signals through touch. Validation experiments were carried out via electro-acoustic measurements as well as behavioral measurements in human subjects (n = 5). Electro-acoustic and behavioral measures support that the system provides uniform stimulation across hands and actuators. The frequency response curve as well as the summation effect measured via behavioral threshold measurements support that the tactile receptors are accurately stimulated by the devices. The multichannel vibrotactile gloves offer the flexibility to transmit diverse acoustic features to individual actuators, making them a valuable tool for research and a prospective technology capable of substituting, compensating, or extending sensory perception.

Comparing LTASS across languages using natural and AI speech samples

Hearing aid prescription protocols rely on estimates of speech spectra. One such estimate, the International Long-Term Average Speech Spectrum (ILTASS), is a common reference for the distribution of spectral energy within speech signals. However, recent research has suggested differences in speech spectra between some languages and the ILTASS standard. These disparities raise questions regarding the applicability of a language-general approach to hearing aid gain application. This study presents a comparative analysis of Long-Term Average Speech Spectra (LTASS) across various languages. Utilizing speech samples from both human and AI sources, LTASS was measured for speakers of different languages. Subsequently, these LTASS profiles were contrasted with the established ILTASS reference. Results reveal that while LTASS was very similar across languages, deviations were observed between LTASS derived from the human speech and AI speech data compared to ILTASS. Specifically, measured LTASS demonstrated a reduced 500 Hz peak in contrast to ILTASS. This research underscores the importance of accounting for spectral variations introduced during the recording process in the field of speech and hearing research. It also emphasizes the importance of standardized recording protocols to enhance the precision of hearing technologies.

Predictors for estimating subcortical EEG responses to continuous speech.

Perception of sounds and speech involves structures in the auditory brainstem that rapidly process ongoing auditory stimuli. The role of these structures in speech processing can be investigated by measuring their electrical activity using scalp-mounted electrodes. However, typical analysis methods involve averaging neural responses to many short repetitive stimuli that bear little relevance to daily listening environments. Recently, subcortical responses to more ecologically relevant continuous speech were detected using linear encoding models. These methods estimate the temporal response function (TRF), which is a regression model that minimises the error between the measured neural signal and a predictor derived from the stimulus. Using predictors that model the highly non-linear peripheral auditory system may improve linear TRF estimation accuracy and peak detection. Here, we compare predictors from both simple and complex peripheral auditory models for estimating brainstem TRFs on electroencephalography (EEG) data from 24 participants listening to continuous speech. We also investigate the data length required for estimating subcortical TRFs, and find that around 12 minutes of data is sufficient for clear wave V peaks (>3 dB SNR) to be seen in nearly all participants. Interestingly, predictors derived from simple filterbank-based models of the peripheral auditory system yield TRF wave V peak SNRs that are not significantly different from those estimated using a complex model of the auditory nerve, provided that the nonlinear effects of adaptation in the auditory system are appropriately modelled. Crucially, computing predictors from these simpler models is more than 50 times faster compared to the complex model. This work paves the way for efficient modelling and detection of subcortical processing of continuous speech, which may lead to improved diagnosis metrics for hearing impairment and assistive hearing technology.

Extending Subcortical EEG Responses to Continuous Speech to the Sound-Field.

The auditory brainstem response (ABR) is a valuable clinical tool for objective hearing assessment, which is conventionally detected by averaging neural responses to thousands of short stimuli. Progressing beyond these unnatural stimuli, brainstem responses to continuous speech presented via earphones have been recently detected using linear temporal response functions (TRFs). Here, we extend earlier studies by measuring subcortical responses to continuous speech presented in the sound-field, and assess the amount of data needed to estimate brainstem TRFs. Electroencephalography (EEG) was recorded from 24 normal hearing participants while they listened to clicks and stories presented via earphones and loudspeakers. Subcortical TRFs were computed after accounting for non-linear processing in the auditory periphery by either stimulus rectification or an auditory nerve model. Our results demonstrated that subcortical responses to continuous speech could be reliably measured in the sound-field. TRFs estimated using auditory nerve models outperformed simple rectification, and 16 minutes of data was sufficient for the TRFs of all participants to show clear wave V peaks for both earphones and sound-field stimuli. Subcortical TRFs to continuous speech were highly consistent in both earphone and sound-field conditions, and with click ABRs. However, sound-field TRFs required slightly more data (16 minutes) to achieve clear wave V peaks compared to earphone TRFs (12 minutes), possibly due to effects of room acoustics. By investigating subcortical responses to sound-field speech stimuli, this study lays the groundwork for bringing objective hearing assessment closer to real-life conditions, which may lead to improved hearing evaluations and smart hearing technologies.

Disparities between objectively measured hearing loss and subjectively perceived aided hearing loss: A scoping review.

This scoping review aims to summarize and synthesize research findings on the disparities between audiometrically diagnosed and aided hearing loss versus the individual's own experience of hearing loss. A systematic search strategy was employed across multiple databases to identify studies published between 1990 and October 2023 focusing on the experiences of hearing problems among individuals with aided hearing loss. The selected studies underwent screening based on predetermined inclusion and exclusion criteria. These criteria revolved around including papers featuring a population of adult (+18) individuals with audiometrically measured hearing loss who had undergone technological rehabilitation. Data charting was employed to provide an overview of the studies and was additionally utilized to identify key themes. Narrative analysis was used to identify subthemes within the data set. A total of 11 articles met the inclusion criteria. The analysis identified five themes: "disability experience and discrepancy between measured and self-perceived hearing loss"; "listening effort"; "mental burden/psychological consequences"; "factors that alleviate the consequences of HL"; and "sociodemographic factors." The scoping review shows that, despite the proliferation of technological options, there is a pressing need for a more concentrated effort to identify and scrutinize the supplementary facets of hearing loss that remain inadequately addressed by current hearing technology. This includes subjective experiences associated with hearing loss that may not be effectively treated solely with hearing aids.

Differences in the Development of Language and Social Independence in Children with Speech Delay and Sensorineural Hearing Loss based on Age of Early Intervention and Duration of Auditory Verbal Therapy

Highlights :1. This original research report provides information to the public about the importance of early detection, the use of hearing technology and the advantages of Auditory Verbal Therapy in delayed speech children with sensorineural hearing loss, where this therapy makes it easier for children to achieve language development on par with other children their age.2. Auditory Verbal Therapy as part of the process of learning to speak and hear deaf children is still quite new and unfamiliar among the community, so based on this study it can be seen that AVT has a positive impact on child development. AbstractSpeech delay with sensorineural hearing loss is a delay in a child's speech process compared to normal children of the same age, mostly caused by hearing loss. It can give may affect the development of language and social independence of children. Auditory Verbal Therapy (AVT) as early intervention maximizes the use of residual hearing with hearing aids or a cochlear implant for sound detection. Therapy that is routinely and periodically conducted may affect language development to support children's independence. This study aims to analyze differences in the development of language and social independence of children with delayed speech and sensorineural hearing loss based on the age of early intervention and duration of auditory verbal therapy. This study used an analytical-observational study design with a cross-sectional approach. The samples were obtained by total sampling from all children who underwent routine AVT once a week at the Aurica Surabaya Foundation, with a total sample of 29 children. The instrument used Developmental Pre-Screening Questionnaire. Method of data analysis was bivariate analysis with the Chi-Square (p-value) proportions different test using SPSS . The results regarding language development based on the age of early intervention and the duration of AVT obtained p = value 0.013 (p < 0.05) and p = 0.019 (p < 0.05), while the results of the chi-square test analysis of the development of social independence based on the age of early intervention and duration of AVT obtained p value = 0.229 (p > 0.05) and p-value = 0.111 (p > 0.05). In conclusion, there was a difference between language development based on the age of early intervention and the duration of AVT, but no difference was found between the development of social independence based on the age of early intervention and the duration of AVT.