Hearing Technology Research Articles

Language experience matters for the emergence of early numerical concepts

Research has shown a link between the acquisition of numerical concepts and language, but exactly how linguistic input matters for numerical development remains unclear. Here, we examine both symbolic (number word knowledge) and non-symbolic (numerical discrimination) numerical abilities in a population in which access to language is limited early in development—oral deaf and hard of hearing (DHH) preschoolers born to hearing parents who do not know a sign language. The oral DHH children demonstrated lower numerical discrimination skills, verbal number knowledge, conceptual understanding of the word “more”, and vocabulary relative to their hearing peers. Importantly, however, analyses revealed that group differences in the numerical tasks, but not vocabulary, disappeared when differences in the amount of time children had had auditory access to spoken language input via hearing technology were taken into account. Results offer insights regarding the role language plays in emerging number concepts.

Spoken language bilingualism for deaf students

Language has always been at the core of our practice in deaf education, but in the current context, it is time to explore new language possibilities for deaf students. Over the past two decades, the combination of widespread implementation of universal newborn hearing screening (UNHS) and early amplification with hearing technologies, including cochlear implants (CIs), has afforded meaningful access to spoken language during the critical language development period for most deaf children. Early interventionists and educators have taken a new perspective of encouraging spoken language bilingualism in home languages and the majority language. This shift has opened doors to education in spoken language bilingual settings (e.g., French immersion), doors formerly closed to deaf students. This paper presents some preliminary qualitative data, highlighting parent decision-making, from a mixed method case study of deaf Francophone participants (N = 4) enrolled in grades 4-12 at French minority schools in southern Ontario.

What Kind of Information Is Provided to Families of Children with Hearing Loss in Early Education Practices?

It is known that children with hearing loss may experience delays in language development and other developmental areas compared to their peers, depending on their disabilities. Early diagnosis, benefiting from hearing technologies, and participation in early education environments with their families are very important in minimizing these delays that children with hearing loss may experience. The purpose of this research is, therefore, to examine the information presented to families in early education practices with children with hearing loss and their families. The data of this case study, one of the qualitative research methods, was collected through observations, semi-structured interviews, documents, and products. The data was analyzed inductively. The findings showed that the information presented to the families is transmitted in a way that is based on continuous interaction, includes open and responsive interactions, encourages the family, and that feeds and expands cyclically from the previous information. It was also found that the educator received information about the history of the child and family, device use, daily routines, and that the families needed information about their children's development, coping with behavioral problems and future expectations. Additionally, that the educators ensured that the families received information on the use of hearing aids, language support and communication skills, enrichment of daily routines, and additional deficiencies were revealed. In early education implementations, materials such as toys, picture cards, story books, song texts were used and forms for informing families were used for registration as a product of the information presented.

Opinions of hearing-impaired individuals about social media: A preliminary study

Objectives: The study examined the opinions of hearing-impaired individuals about the content on social media platforms, their social media usage tendencies, and their feelings, thoughts, and experiences during their use. Patients and Methods: Forty individuals aged 18 years and older who are native Turkish speakers diagnosed with hearing loss regardless of the type and degree of hearing loss participated in this cross-sectional survey study between November 1, 2021, and September 1, 2022. Individuals with advanced vision problems and illiterate individuals were excluded from the study. The questionnaire consisted of four sections: (i) demographic data and hearing loss characteristics; (ii) social media usage and purposes; (iii) opinions about the content on social media; and (iv) feelings, thoughts, and experiences about social media. Responses were evaluated on a 5-point Likert-type scale. Results: The most common purposes of using social media were doing research and getting information about hearing loss and the technologies they use. Of the participants, 45.5% stated that they do not prefer their devices to be seen in the photos they share on social media platforms and that they are undecided about the ease of use of existing social media platforms for the hearing impaired. Conclusion: It is important to determine what hearing-impaired individuals feel about hearing loss and technologies, both to guide hearing care professionals and health institutions in creating content on these issues and to improve these platforms.

Direct Bluetooth connectivity results in better hearing aid compliance in children

ObjectiveTo determine if hearing aid use in school aged children is impacted when upgraded to direct Bluetooth® enabled technology. We hypothesized that because children are better able to connect to their devices and headphones, they would be more inclined to use their hearing aids throughout the day, resulting in an increase in hearing aid compliance. MethodsThis retrospective analysis examined changes in datalogging of hours of usage per day in 51 school aged children who underwent an upgrade from non-direct Bluetooth® hearing technology to direct Bluetooth®-enabled hearing technology. ResultsHours per day of hearing aid use in all hearing aid users significantly increased after upgrading to DBT enabled technology (6.82 vs 9.82, <0.001). There were no significant differences noted in hours before and after upgrade depending on race (p = 0.147), gender (p = 0.887), developmental delay (p = 0.749), type of hearing loss (p = 0.218), and degree of hearing loss (p = 0.551). However, when comparing private versus Medicaid insurance, there was noted to be a significant difference with the odds of an increase in hours of usage after upgrade being higher for those patients privately insured (OR = 1.247, p < 0.001, 95 % CI 1.093–1.422). ConclusionDirect Bluetooth® enabled hearing technology positively impacts children's hearing aid compliance, which has the potential improve speech and language outcomes.

A real-time auralization framework for scientific experiments

The software Virtual Acoustics (VA) is an open-source auralization framework developed at the Institute for Hearing Technology and Acoustics, RWTH Aachen University, Germany. Using physics-based models for source emission and sound propagation, it allows plausible rendering of virtual scenes based on purely synthetic data. Its modular design provides a variety of rendering modules using different assumptions for the sound propagation. This allows the rendering of various indoor and outdoor scenarios with adjustable degree of complexity. Based on a similarly modular concept, VA allows a flexible way of reproducing the sound via headphones or loudspeaker arrays. For this purpose, the signals can be spatialized using binaural synthesis, higher-order ambisonics or VBAP. The respective scenarios, including source and receiver movement, can be controlled using the C + +, C#, Matlab, Python programming languages. Additionally, there are interfaces for the Unreal and Unity game engines allowing the combination with sophisticated visual cues, e.g., using HMDs. The software’s flexible structure and configuration possibilities enable the controlled application in listening experiments while providing an adequate level of plausibility. This work discusses the options as well as the limitations of the software and presents application examples in scientific experiments.

The Connected Life: Using Access Technology at Home, at School and in the Community

Hearing technologies such as hearing aids, cochlear implants and bone-anchored devices provide students with hearing loss with far greater access to auditory information (and most importantly, to spoken language) than even a decade ago. However, in a student’s daily life, many situations arise where effective communication and participation can be comprised by factors such as distance, noise, reverberation, difficulty hearing peer input, missing or obscured visual information (e.g., due to masks during the COVID-19 pandemic), speakers with accents or poor auditory/visual quality (e.g., on the phone or during online learning). Access technologies such as remote microphone systems, wireless connectivity platforms and captioning can be used to supplement and/or clarify auditory and visual information, so that students can fully participate in all aspects of their lives. This article discusses how access technologies can provide support for students in preschool, elementary, secondary and postsecondary education. The importance of universal design for access to public spaces, such as schools and community spaces, to ensure that individuals with hearing loss live in an equitable and inclusive world are also discussed.

Predicting EEG Responses to Attended Speech via Deep Neural Networks for Speech.

Attending to the speech stream of interest in multi-talker environments can be a challenging task, particularly for listeners with hearing impairment. Research suggests that neural responses assessed with electroencephalography (EEG) are modulated by listener's auditory attention, revealing selective neural tracking (NT) of the attended speech. NT methods mostly rely on hand-engineered acoustic and linguistic speech features to predict the neural response. Only recently, deep neural network (DNN) models without specific linguistic information have been used to extract speech features for NT, demonstrating that speech features in hierarchical DNN layers can predict neural responses throughout the auditory pathway. In this study, we go one step further to investigate the suitability of similar DNN models for speech to predict neural responses to competing speech observed in EEG. We recorded EEG data using a 64-channel acquisition system from 17 listeners with normal hearing instructed to attend to one of two competing talkers. Our data revealed that EEG responses are significantly better predicted by DNN-extracted speech features than by hand-engineered acoustic features. Furthermore, analysis of hierarchical DNN layers showed that early layers yielded the highest predictions. Moreover, we found a significant increase in auditory attention classification accuracies with the use of DNN-extracted speech features over the use of hand-engineered acoustic features. These findings open a new avenue for development of new NT measures to evaluate and further advance hearing technology.

Design and Evaluation of a Multisensory Concert for Cochlear Implant Users

This article describes the design, implementation, and evaluation of vibrotactile concert furniture, aiming to improve the live music experience of people with hearing loss using hearing technology such as cochlear implants (CI). The system was the result of a series of participatory design sessions involving CI users with different hearing assistive setups (bi-implant, bimodal, and monoimplant), and it was evaluated in a concert scenario (drums, bass, and female vocals) at the Royal Danish Academy of Music. The project aimed to improve the music appreciation for CI users by providing a multisensory concert designed with CI challenges in mind, but not excluding normal-hearing individuals or individuals with other forms of hearing aids from participating in the event. The evaluation was based on (video-recorded) observations and postexperience semistructured interviews; the data were analyzed using event analysis and meaning condensation. The results indicate that tactile augmentation provides a pleasant experience for CI users. However, concertgoers with residual hearing reported being overwhelmed if the tactile stimulation amplitude exceeds a certain threshold. Furthermore, devices that highlight instrument segregation are preferred over ones that present a tactile mixdown of multiple auditory streams.

The Modern Hearing Care Landscape: Toward the Provision of Personalized, Dynamic, and Adaptive Care.

New technologies and developments in hearing healthcare are rapidly transforming service models, delivery channels, and available solutions. These advances are reshaping the ways in which care is provided, leading to greater personalization, service efficiencies, and improved access to care, to name a few benefits. Connected hearing care is one model with the potential to embrace this "customized" hearing experience by forging a hybrid of health-technology connections, as well as traditional face-to-face interactions between clients, providers, and persons integral to the care journey. This article will discuss the many components of connected care, encompassing variations of traditional and teleaudiology-focused services, clinic-based and direct-to-consumer channels, in addition to the varying levels of engagement and readiness defining the touch points for clients to access a continuum of connected hearing care. The emerging hearing healthcare system is one that is dynamic and adaptive, allowing for personalized care, but also shifting the focus to the client's needs and preferences. This shift in the care model, largely driven by innovation and the growing opportunities for clients to engage with hearing technology, brings forth new, exciting, and sometimes uncomfortable discussion points for both the provider and client. The modern hearing care landscape benefits clients to better meet their needs and preferences in a more personalized style, and providers to better support and address those needs and preferences.

Effect of Determinants of Health on the Hearing Care Framework: An Economic Perspective.

Hearing care is expanding accessibility to consumers through new service delivery channels and methods of technology distribution (see Brice et al, this issue). This diversification has the potential to overcome longstanding consumer disparities (e.g., health, socioeconomic, psychological, environmental) in receiving care and provider constraints (e.g., accessibility, geography, direct access) to delivering care that adversely impacts quality of life (e.g., social isolation, depression, anxiety, self-esteem). In this article, the reader is provided with an overview of health outcomes factors (i.e., determinants of health)-in the context of an economic framework (i.e., supply, demand)-and their effect on consumer behavior and provider preferences toward hearing healthcare services. This overview also affords readers with strategic business insights to assess and integrate future hearing care services and technology to consumers in their local markets.

Exploring Hearing Care Technology from Clinic to Capability.

Healthcare systems are traditionally a clinician-led and reactive structure that does not promote clients managing their health issues or concerns from an early stage. However, when clients are proactive in starting their healthcare earlier than later, they can achieve better outcomes and quality of life. Hearing healthcare and the rehabilitation journey currently fit into this reactive and traditional model of care. With the development of service delivery models evolving to offer services to the consumer online and where they are predominately getting their healthcare information from the internet and the advancement of digital applications and hearing devices beyond traditional hearing aid structures, we are seeing a change in how consumers engage in hearing care. Similarly, as the range of hearing devices evolves with increasingly blended and standard levels of technology across consumer earbuds/headphones and medical grade hearing aids, we are seeing a convergence of consumers engaging earlier and becoming increasingly aware of hearing health needs. This article will discuss how the channels, service, and technology are coming together to reform traditionally clinician-led healthcare models to an earlier consumer-led model and the benefits and limitations associated with it. Additionally, we look to explore advances in hearing technologies and services, and if these will or can contribute to a behavioral change in the hearing healthcare journey of consumers.

DEVELOPMENT OF A PARENTING STRESS MEASUREMENT TOOL FOR PARENTS OF CHILDREN WITH COCHLEAR IMPLANTS

Parents of children with hearing loss who use hearing technology, be it hearing aids (ABD) or cochlear implants, are vulnerable to parenting stress. This study aims to develop a measuring instrument that can measure parenting stress in parents with children using cochlear implants in Indonesia. A total of 30 parents of children using cochlear implants were involved in this study. Parenting stress in children with hearing loss is reflected in three aspects, namely parental distress, parent-child dysfunctional relationship, and difficult child. Therefore, the development of measuring instruments is based on these three aspects. Based on the results of statistical tests, the internal consistency reliability was 0.92. Based on this study, the parenting stress measurement tool for parents with children using cochlear implants has met the requirements to be declared as a valid and reliable measuring instrument.

Multimodal Listening as Technologically-Mediated Embodied Musicking

This paper discusses an approach to multimodal listening that draws upon three disparate but related areas of research: the creative music practice of the first author, quantitative evaluation of vibrotactile technology within speech and hearing science aimed at improving music perception and enjoyment for cochlear implant users, and a qualitative study involving the musical experiences of people who routinely wear a variety of assistive hearing technologies. It proposes that listening is an active, embodied process, taking place within the diverse sensorimotor, sociocultural, and aesthetic relationships between listeners and their worlds. These ideas are explored through observations of musical listening experiences that are technologically-mediated in various ways: they are ones which incorporate both the sonic and the tactile, but which do not aim to simply substitute one sensory modality for another. This project is intentionally interdisciplinary in its methodologies with the goal of illuminating how research approaches that work in tension can be productively inventive.

Real-life and real-time hearing aid experiences: Insights from self-initiated ecological momentary assessments and natural language analysis.

Smartphone technology can provide an effective means to bring real-life and (near-)real-time feedback from hearing aid wearers into the clinic. Ecological Momentary Assessment (EMA) encourages listeners to report on their experiences during or shortly after they take place in order to minimize recall bias, e.g., guided by surveys in a mobile application. Allowing listeners to describe experiences in their own words, further, ensures that answers are independent of predefined jargon or of how survey questions are formulated. Through these means, one can obtain ecologically valid sets of data, for instance during a hearing aid trial, which can support clinicians to assess the needs of their clients, provide directions for fine-tuning, and counselling. At a larger scale, such datasets would facilitate training of machine learning algorithms that could help hearing technology to anticipate user needs. In this retrospective, exploratory analysis of a clinical data set, we performed a cluster analysis on 8,793 open-text statements, which were collected through self-initiated EMAs, provided by 2,301 hearing aid wearers as part of their hearing care. Our aim was to explore how listeners describe their daily life experiences with hearing technology in (near-)real-time, in their own words, by identifying emerging themes in the reports. We also explored whether identified themes correlated with the nature of the experiences, i.e., self-reported satisfaction ratings indicating a positive or negative experience. Results showed that close to 60% of listeners' reports related to speech intelligibility in challenging situations and sound quality dimensions, and tended to be valued as positive experiences. In comparison, close to 40% of reports related to hearing aid management, and tended to be valued as negative experiences. This first report of open-text statements, collected through self-initiated EMAs as part of clinical practice, shows that, while EMA can come with a participant burden, at least a subsample of motivated hearing aid wearers could use these novel tools to provide feedback to inform more responsive, personalized, and family-centered hearing care.

Comparing Hearing Aid Outcomes in Adults Using Over-the-Counter and Hearing Care Professional Service Delivery Models.

More affordable hearing aids are now available due to over-the-counter (OTC) hearing aid regulations. Although laboratory studies have validated many OTC hearing technologies, there are limited real-world benefit studies. This study compared hearing aid outcomes reported by clients from OTC and conventional hearing care professional (HCP) service delivery models. An ecological, cross-sectional survey design was employed. An online survey was sent to the Hearing Tracker user and OTC Lexie hearing aid user databases. Moreover, 656 hearing aid users completed the survey-406 through conventional HCP services (M age = 66.7 ± 13.0 years) and 250 through the OTC model (M age = 63.7 ± 12.2 years). Self-reported hearing aid benefit and satisfaction were measured with the International Outcome Inventory for Hearing Aids outcome tool. No significant difference for overall hearing aid outcomes between HCP and OTC users was evident using regression analyses, controlling for age, gender, duration of hearing loss, duration before hearing aid purchase, self-reported hearing difficulty, and unilateral versus bilateral fitting. For the "daily use" domain, HCP clients reported significantly longer hours of daily use. For the "residual activity limitations" domain, OTC hearing aid users reported significantly less difficulty hearing in situations where they most wanted to hear better. OTC hearing aid outcomes could complement and provide similar satisfaction and benefit to HCP models for adults. Service delivery aspects such as self-fitting, acclimatization programs, remote support, behavioral incentivization, and payment options should be investigated for their potential role in OTC hearing aid outcomes. https://doi.org/10.23641/asha.22134788.

Audio-visual scene analysis in conditions with head- and eye-steered beamformers in virtual reality

In crowded social settings, listeners often face the challenge of following a conversation in the presence of other conversations. Several factors influence the difficulty of this task, including the number of talkers, the amount of reverberation, and the hearing status. Beamformers in hearing aids have the potential to mitigate these factors by improving the signal-to-noise ratio, but their effectiveness in real-world settings has not yet been clearly demonstrated. Here, we used virtual reality to investigate the effect of head- and eye-steered beamformers on the ability of participants to analyze complex audio-visual scenes. The participants’ task was to find and locate an ongoing story in a mixture of other stories in scenes differing in terms of the number of concurrent talkers and the amount of reverberation. The talkers were distributed in the frontal hemisphere between ±105°. The primary outcome measure was the time taken to identify the location of the target talker. Preliminary results show shorter response times with beamforming (in comparison to an omnidirectional setting), especially when more talkers were present. This framework provides a new means for examining the effects of hearing technologies on behavior in complex audio-visual scenes.

Core Values in the Traditional Provision of Hearing Health Care.

Untreated hearing loss is a significant public health issue affecting the quality of life of millions of Americans. Barriers to treatment invite novel and innovation solutions, but as these solutions create new treatment delivery models, they also may-purposefully or accidentally-challenge the values of the field. Value-sensitive design methodology is used in this study to identify the values in current hearing health care service delivery. We performed qualitative content analysis of questionnaires, clinical practice guidelines, and professional ethics documents that represent the intended and enacted values in audiology. The result is a comprehensive list of values that can be used as a structured codebook for systematic textual analysis of materials representing current best practices in the provision of hearing health care services. A secondary result is an analysis of the relative importance of values in audiology, inferred from the frequency of references to each value. Subjective benefit, professional duties, and self-efficacy were the core values identified in the current provision of audiologic care, and these values should be central to considerations for new hearing health care models and technologies.

Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids.

The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child's unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child's hearing technology or intervention plan. The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay. Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals. Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child's hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation.

Direct Estimation of Linear Filters for EEG Source-Localization in a Competing-Talker Scenario

Hearing-impaired listeners have a reduced ability to selectively attend to sounds of interest amid distracting sounds in everyday environments. This ability is not fully regained with modern hearing technology. A better understanding of the brain mechanisms underlying selective attention during speech processing may lead to brain-controlled hearing aids with improved detection and amplification of the attended speech. Prior work has shown that brain responses to speech, measured with magnetoencephalography (MEG) or electroencephalography (EEG), are modulated by selective attention. These responses can be predicted from the speech signal through linear filters called Temporal Response Functions (TRFs). Unfortunately, these sensor-level predictions are often noisy and do not provide much insight into specific brain source locations. Therefore, a novel method called Neuro-Current Response Functions (NCRFs) was recently introduced to directly estimate linear filters at the brain source level from MEG responses to speech from one talker. However, MEG is not well-suited for wearable and realtime hearing technologies. This work aims to adapt the NCRF method for EEG under more realistic listening environments. EEG data was recorded from a hearing-impaired listener while attending to one of two competing talkers embedded in 16-talker babble noise. Preliminary results indicate that source-localized linear filters can be directly estimated from EEG data in such competing-talker scenarios. Future work will focus on evaluating the current method on a larger dataset and on developing novel methods, which may aid in the improvement of next-generation brain-controlled hearing technology.