Improvement In Speech Reception Threshold Research Articles

High sentence predictability increases the fluctuating masker benefit.

This study examined the effects of sentence predictability and masker modulation type on the fluctuating masker benefit (FMB), the improvement in speech reception thresholds resulting from fluctuations imposed on a steady-state masker. Square-wave modulations resulted in a larger FMB than sinusoidal ones. FMBs were also larger for high compared to low-predictability sentences, indicating that high sentence predictability increases the benefits from glimpses of the target speech in the dips of the fluctuating masker. In addition, sentence predictability appears to have a greater effect on sentence intelligibility when the masker is fluctuating than when it is steady-state.

Innovation in abutment-free bone-anchored hearing devices in children: Updated results and experience

IntroductionBone-anchored hearing devices are an accepted treatment option for hearing restoration in various types of hearing loss. Traditional devices have a percutaneous abutment for attachment of the sound processor that contributes to a high complication rate. Previously, our institution reported on the Sophono (Boulder, CO, USA) abutment-free system that produced similar audiologic results to devices with abutments. Recently, Cochlear Americas (Centennial, CO, USA) released an abutment-free bone-anchored hearing device, the BAHA Attract. In contrast to the Sophono implant, the BAHA Attract utilizes an osseointegrated implant. ObjectivesThis study aims to demonstrate patient benefit abutment-free devices, compare the results of the two abutment-free devices, and examine complication rates. MethodsA retrospective chart review was conducted for the first eleven Sophono implanted patients and for the first six patients implanted with the BAHA Attract at our institution. Subsequently, we analyzed patient demographics, audiometric data, clinical course and outcomes. ResultsAverage improvement for the BAHA Attract in pure-tone average (PTA) and speech reception threshold (SRT) was 41dB hearing level (dBHL) and 56dBHL, respectively. Considering all frequencies, the BAHA Attract mean improvement was 39dBHL (range 32–45dBHL). The Sophono average improvement in PTA and SRT was 38dBHL and 39dBHL, respectively. The mean improvement with Sophono for all frequencies was 34dBHL (range 24–43dBHL). ConclusionSignificant improvements in both pure-tone averages and speech reception threshold for both devices were achieved. In direct comparison of the two separate devices using the chi-square test, the PTA and SRT data between the two devices do not show a statistically significant difference (p-value 0.68 and 0.56, respectively). The complication rate for these abutment-free devices is lower than that of those featuring the transcutaneous abutment, although more studies are needed to further assess this potential advantage.

Steroid-based treatments for patients with total sudden sensorineural hearing loss

Conclusions: In patients with total sudden sensorineural hearing loss (SSNHL), oral prednisone (OP) alone or intratympanic dexamethasone (ITD) alone have comparable results. The addition of salvage ITD following OP does not seem to add over either single modality treatment. Objectives: To study the effect of steroid-based treatments in patients with total SSNHL. Methods: The medical charts of 59 patients with total loss of hearing, defined as pure tone thresholds in the profound range (> 90 dB) with an unobtainable speech reception threshold (SRT) that were treated with OP (n = 20), ITD (n = 13), or OP followed by salvage ITD (n = 26) were analyzed. Response to treatment was evaluated by means of pure tone thresholds, SRT, and speech discrimination score (SDS), immediately after treatment and on a follow-up visit. Results: Forty-nine patients (83%) responded to treatment, with mean significant improvements of 36, 34, 31, and 25 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean improvement in SRT was 33 dB, and SDS improved by 32%. There were no differences in improvement in pure tone thresholds and SRT among the three treatment groups. The late effect of OP was similar to the effect of salvage ITD.

Selective spatial attention modulates bottom-up informational masking of speech

To hear out a conversation against other talkers listeners overcome energetic and informational masking. Largely attributed to top-down processes, information masking has also been demonstrated using unintelligible speech and amplitude-modulated maskers suggesting bottom-up processes. We examined the role of speech-like amplitude modulations in information masking using a spatial masking release paradigm. Separating a target talker from two masker talkers produced a 20 dB improvement in speech reception threshold; 40% of which was attributed to a release from informational masking. When across frequency temporal modulations in the masker talkers are decorrelated the speech is unintelligible, although the within frequency modulation characteristics remains identical. Used as a masker as above, the information masking accounted for 37% of the spatial unmasking seen with this masker. This unintelligible and highly differentiable masker is unlikely to involve top-down processes. These data provides strong evidence of bottom-up masking involving speech-like, within-frequency modulations and that this, presumably low level process, can be modulated by selective spatial attention.

Changes in children's speech discrimination and spatial release from masking between 2 and 4 years after sequential cochlear implantation

Objective: To document changes in speech reception thresholds (SRTs) and spatial release from masking (SRM) for sequentially implanted children at 2 and 4 years after they received their second cochlear implant (CI2).Methods: Participants were 17 children who consistently used two sequentially implanted and optimally programmed CIs. SRTs were measured monaurally in quiet and binaurally in noise using the adaptive McCormick toy discrimination test. Speech signals were presented from 0° azimuth and noise from 0°, +90° or −90° azimuth. SRM was calculated from SRTs in noise. Measurements were made at 2 and 4 year post-CI2.Results: There were significant improvements over time in SRTs in quiet, SRTs in noise and SRM. SRTs in quiet improved more for CI2 than for the first implant (CI1). SRTs in noise and SRM improved more when noise was presented closest to CI1 than when closest to CI2. Performance became more symmetrical over time.Discussion: Despite prolonged periods of unilateral auditory deprivation sequentially implanted children exhibited continued improvement in SRT and SRM. These results are valuable in setting expectations for and counselling families of children considering sequential CIs.

The effect of spatial separation in distance on the intelligibility of speech in rooms.

The influence of spatial separation in source distance on speech reception thresholds (SRTs) is investigated. In one scenario, the target was presented at 0.5 m distance, and the masker varied from 0.5 m distance up to 10 m. In a second scenario, the masker was presented at 0.5 m distance and the target distance varied. The stimuli were synthesized using convolution with binaural room impulse responses (BRIRs) measured on a dummy head in a reverberant auditorium, and were equalized to compensate for distance-dependent spectral and intensity changes. All sources were simulated directly in front of the listener. SRTs decreased monotonically when the target was at 0.5 m and the speech-masker was moved further away, resulting in a SRT improvement of up to 10 dB. When the speech masker was at 0.5 m and the target was moved away, a large variation across subjects was observed. Neither short-term signal-to-noise ratio (SNR) improvements nor cross-ear glimpsing could account for the observed improvement in intelligibility. However, the effect might be explained by an improvement in the SNR in the modulation domain and a decrease in informational masking. This study demonstrates that distance-related cues can play a significant role when listening in complex environments.

Audio-visual speech intelligibility benefits with bilateral cochlear implants when talker location varies.

One of the key benefits of using cochlear implants (CIs) in both ears rather than just one is improved localization. It is likely that in complex listening scenes, improved localization allows bilateral CI users to orient toward talkers to improve signal-to-noise ratios and gain access to visual cues, but to date, that conjecture has not been tested. To obtain an objective measure of that benefit, seven bilateral CI users were assessed for both auditory-only and audio-visual speech intelligibility in noise using a novel dynamic spatial audio-visual test paradigm. For each trial conducted in spatially distributed noise, first, an auditory-only cueing phrase that was spoken by one of four talkers was selected and presented from one of four locations. Shortly afterward, a target sentence was presented that was either audio-visual or, in another test configuration, audio-only and was spoken by the same talker and from the same location as the cueing phrase. During the target presentation, visual distractors were added at other spatial locations. Results showed that in terms of speech reception thresholds (SRTs), the average improvement for bilateral listening over the better performing ear alone was 9 dB for the audio-visual mode, and 3 dB for audition-alone. Comparison of bilateral performance for audio-visual and audition-alone showed that inclusion of visual cues led to an average SRT improvement of 5 dB. For unilateral device use, no such benefit arose, presumably due to the greatly reduced ability to localize the target talker to acquire visual information. The bilateral CI speech intelligibility advantage over the better ear in the present study is much larger than that previously reported for static talker locations and indicates greater everyday speech benefits and improved cost-benefit than estimated to date.

Two-microphone spatial filtering improves speech reception for cochlear-implant users in reverberant conditions with multiple noise sources.

This study evaluates a spatial-filtering algorithm as a method to improve speech reception for cochlear-implant (CI) users in reverberant environments with multiple noise sources. The algorithm was designed to filter sounds using phase differences between two microphones situated 1 cm apart in a behind-the-ear hearing-aid capsule. Speech reception thresholds (SRTs) were measured using a Coordinate Response Measure for six CI users in 27 listening conditions including each combination of reverberation level (T60 = 0, 270, and 540 ms), number of noise sources (1, 4, and 11), and signal-processing algorithm (omnidirectional response, dipole-directional response, and spatial-filtering algorithm). Noise sources were time-reversed speech segments randomly drawn from the Institute of Electrical and Electronics Engineers sentence recordings. Target speech and noise sources were processed using a room simulation method allowing precise control over reverberation times and sound-source locations. The spatial-filtering algorithm was found to provide improvements in SRTs on the order of 6.5 to 11.0 dB across listening conditions compared with the omnidirectional response. This result indicates that such phase-based spatial filtering can improve speech reception for CI users even in highly reverberant conditions with multiple noise sources.

Outcome of Tympanomastoidectomy in Children with Chronic Otitis Media

Objectives: Analyze outcomes of tympanomastoidectomy for chronic otitis media in children at a tertiary care referral center with a high prevalence of patients with genetic syndromes, craniofacial anomalies, and medical comorbidities. Methods: A retrospective review of tympanomastoidectomy performed for chronic otitis media at a single pediatric tertiary care hospital from 1995 through 2013 was performed. Factors evaluated included presence of immunodeficiency or craniofacial anomaly, change in air-bone gap and speech reception threshold, and need for additional otologic procedures. Results: Fifty-six tympanomastoidectomies on 47 patients were evaluated. A total of 25% of the children had a genetic syndrome and 17% had an immunodeficiency. Average age at surgery was 7.5 years with an average duration of follow-up of 2.7 years. Previous treatment included prolonged oral antibiotics (43), prolonged intravenous antibiotics (11), and middle ear irrigation and exchange of tympanostomy tube (7). Twenty-nine ears had undergone 2 or more tympanostomy tube insertion. A total of 28 (50%) ears continued to have some otorrhea postoperatively. Complete audiologic data were available for 23 patients. Improvement in air-bone gap was seen in 87% of cases, with an average improvement of 11.9 dB ( P = .01). Improvement in speech reception threshold was seen in 65%, with an average decrease in threshold of 10 dB ( P = .27). Of the cases, 8.9% required revision tympanoplasty following tympanomastoidectomy. Conclusions: Tympanomastoidectomy in children with severe chronic otitis media improves hearing function and may be beneficial in some patients to cease otorrhea. This should be considered as a treatment option in children that have failed previous conservative management.

Frequency-Specific Hearing Outcomes in Pediatric Type I Tympanoplasty

Middle ear disease is the primary cause of hearing loss in children and has a significant impact on language development and academic performance. Multiple prognostic factors have previously been examined, but there is little published data regarding frequency-specific hearing outcomes. To examine the relationship between type I tympanoplasty in a pediatric population and frequency-specific hearing changes, as well as the relationship between several prognostic factors and graft retention. Retrospective medical chart review (February 2006 to October 2011) of 492 consecutive pediatric otolaryngology patients undergoing type I tympanoplasty for tympanic membrane (TM) perforation of any etiology at a tertiary-care pediatric otolaryngology practice. Type I tympanoplasty. Preoperative and postoperative audiometric data were collected for patients undergoing successful TM repair. It was hypothesized before data collection that conductive hearing would improve at all frequencies with no significant change in sensorineural hearing. Data collected included air conduction at 250 to 8000 Hz, speech reception thresholds, bone conduction at 500 to 4000 Hz, and air-bone gap at 500 to 4000 Hz. Demographic data obtained included sex, age, size, mechanism, location of perforation, and operative repair technique. Of 492 patients, 320 were excluded; results were thus examined for 172 patients. Surgery was successful for 73.8% of patients. Perforation size was significantly associated with repair success (mean [SD] surgical success rate of 38.6% [15.3%] vs surgical failure rate of 31.4% [15.0%]; P < .01); however, mean (SD) age (9.02 [3.89] years [surgical success] vs 8.52 [3.43] years [surgical failure]; P > .05) and repair technique (medial [73.08%] vs lateral [76.47%] graft success; P > .99) were not. Air conduction significantly improved from 250 to 2000 Hz (P < .001), did not significantly improve at 4000 Hz (P = .08), and there was a nonsignificant decline at 8000 Hz (P = .12). Speech reception threshold significantly improved (20 vs 15 dB; P < .001). This large review found an association of TM perforation size with surgical success and an improvement in speech reception threshold, air conduction at 250 to 2000 Hz, air-bone gap at 500 to 2000 Hz, and worsening bone conduction at 4000 Hz. Patients with high-frequency hearing loss due to TM perforation should not anticipate significant recovery from type I tympanoplasty. Hearing loss at higher frequencies may require postoperative hearing rehabilitation.

Effects of Site-Specific Level Adjustments on Speech Recognition With Cochlear Implants

Modulation detection thresholds (MDTs) vary across stimulation sites in a cochlear implant (CI) electrode array in a manner that is subject and ear specific. Previous studies have demonstrated that speech recognition with a CI can be improved by site-selection strategies, where selected stimulation sites with poor modulation sensitivity are removed from a subject's processor MAP. Limitations of site-selection strategies are that they can compromise spectral resolution and distort frequency-place mapping because the frequencies assigned to the removed sites are usually reallocated to other sites, and site bandwidths are broadened. The objective of the present study was to test an alternative approach for rehabilitation that aimed at improving the across-site mean MDTs by adjusting stimulation parameters at the poorly performing sites. On the basis of previous findings that modulation detection contributes to speech recognition and improves significantly with stimulus level, the authors hypothesized that modulation sensitivity at the poor sites could be improved by artificially increasing stimulation levels at those sites in the speech processor, which then would lead to improved speech recognition. Nine postlingually deafened ears implanted with Nucleus CIs were evaluated for MDTs, absolute-detection threshold levels (T levels), and the maximum loudness levels (C levels) on each of the available stimulation sites. For each ear, the minimum stimulation level settings in the speech-processor MAP were raised by 5%, and alternatively by 10%, of the dynamic range (DR) from true thresholds on five stimulation sites with the poorest MDTs. For comparison, a 5% level raise was applied globally to all stimulation sites. The C levels were fixed during these level manipulations. MDTs at the five poorest stimulation sites were compared at 20% DR before and after the level adjustments. Speech-reception thresholds (SRTs), that is, signal to noise ratios required for 50% correct speech recognition, were evaluated for these MAPs using CUNY sentences. The site-specific level-adjusted MAPs were compared with the global-level-adjusted MAP and the MAP without level adjustment. The effects on speech recognition of adjusting the minimal stimulation level settings on the five poorest stimulation sites were also compared with effects of removing these sites from the speech-processor MAP. The 5% level increase on the five electrodes with the worst MDTs resulted in an improvement in the group mean SRT of 2.36 dB SNR relative to the MAP without level adjustment. The magnitude of level increase that resulted in the greatest SRT improvement for individuals varied across ears. MDTs measured at 20% DR significantly improved on the poor sites after the level adjustment that resulted in the best SRT for that ear was applied. Increasing the minimal stimulation levels on all stimulation sites or removing sites selected for rehabilitation, the parsimonious approaches, did not improve SRTs. The site-specific adjustments of the T level settings improved modulation sensitivity at low levels and significantly improved subjects' SRTs. Thus, this site-rehabilitation strategy was an effective alternative to site-selection strategies for improving speech recognition in CI users.

A coherence-based noise reduction algorithm for binaural hearing aids

In this study, we present a novel coherence-based noise reduction technique and show how it can be employed in binaural hearing aid instruments in order to suppress any potential noise present inside a realistic low reverberant environment. The technique is based on particular assumptions on the spatial properties of the target and undesired interfering signals and suppresses (coherent) interferences without prior statistical knowledge of the noise environment. The proposed algorithm is simple, easy to implement and has the advantage of high performance in coping with adverse signal conditions such as scenarios in which competing talkers are present. The technique was assessed by measurements with normal-hearing subjects and the processed outputs in each ear showed significant improvements in terms of speech intelligibility (measured by an adaptive speech reception threshold (SRT) sentence test) over the unprocessed signals (baseline). In a mildly reverberant room with T60=200, the average improvement in SRT obtained relative to the baseline was approximately 6.5dB. In addition, the proposed algorithm was found to yield higher intelligibility and quality than those obtained by a well-established interaural time difference (ITD)-based speech enhancement algorithm. These attractive features make the proposed method a potential candidate for future use in commercial hearing aid and cochlear implant devices.

STARR

The objective was to develop and evaluate a new sentence test, the Sentence Test with Adaptive Randomized Roving levels, intended to emulate everyday listening experience, using both normal-hearing (NH) and cochlear implant (CI) groups, examining practicality, learning, test-retest variability, and interlist variability. In experiment 1, each of 25 NH adults was tested using five lists, each comprising 30 sentences. One male and one female speaker each spoke 15 sentences. Ten sentences were presented at each of three presentation levels: 50, 65, and 80 dB SPL. The relative level of a speech-shaped noise was varied adaptively to estimate the speech reception threshold (SRT). Counterbalance for list order was achieved by staggering the allocation of lists to participants. To allow assessment of learning effects, no practice was given. The variability of mean SRTs across lists was small, but correction factors were derived for each list so that, after correction, all lists gave the same mean SRT. Test-retest variability was estimated by examining the corrected SRTs for each subject's five lists. In experiment 2, 25 CI users each received one test list after a small amount of practice. Experiment 3 examined the effect of speech rate using time-compressed speech, for age-matched NH and CI users. The mean SRT for the NH participants was approximately -6 dB and was similar for the male and female speakers. There was a small but significant improvement in SRTs between the first and later lists administered, but no further improvement for subsequent lists. On the basis of the variability of the corrected SRTs within each participant, a 2.2 dB difference in SRT is meaningful for comparisons using one test list per condition, for a single participant. The percentage of key words correct varied with presentation level over a 13% range, being best at 65 dB SPL. Only 40% of the CI group achieved an SRT lower than 20 dB for both speakers. There was large individual variability in the SRTs, and SRTs were higher for the female than for the male speaker. For the CI participants, the percentage of key words correct varied markedly with level, from 19% at the lowest level to 57% at the medium level. Time compression had a small effect for NH participants but a very large effect for CI participants. The Sentence Test with Adaptive Randomized Roving levels seems practical to administer and is reasonably sensitive. For NH participants, a 2.2 dB difference in SRT is meaningful for a single list per condition and a single participant. Although learning effects were small for NH participants, it seems prudent to provide some practice sentences when testing hearing-impaired or CI participants. The very large effect of time compression for the CI group has implications for live voice testing of children, because speech rate is only poorly controlled in such testing.

A Dual-Microphone Algorithm That Can Cope With Competing-Talker Scenarios

This paper introduces a novel technique for signal-to-noise ratio (SNR) estimation for scenarios where two closely-spaced microphones are available. The proposed technique utilizes the real and imaginary parts of the coherence function between the input signals to estimate the SNR without assuming prior knowledge of the noise statistics. The corresponding dual-microphone speech enhancement algorithm utilizes a Wiener filter as a gain function constructed using the SNR values computed by the coherence function. Since the proposed SNR estimation technique does not require access to noise statistics, it can be applied in situations where interfering speakers are present. An adaptive speech reception threshold (SRT) test was used to assess the intelligibility of speech processed by the proposed algorithm in scenarios where one or two interfering talkers were present in anechoic and reverberant conditions. Intelligibility listening tests were conducted with both normal-hearing (NH) and cochlear implant (CI) listeners. Results revealed significant improvements in intelligibility and quality over a (baseline) fixed directional algorithm and a well-established beamformer algorithm. In a nearly anechoic room with competing talkers, the improvement in SRT obtained relative to the directional microphone ranged from 5-10 dB, while the improvement obtained by the beamformer was about 2 dB. In reverberant environments, the improvement in SRT remained high (4-7 dB) at T60 = 220 ms, and decreased to 1-2 dB at T60 = 465 ms. Overall, the proposed algorithm provided significant benefits in intelligibility in anechoic and mildly reverberant environments making it suitable for hearing aid and cochlear implant applications.

Intratympanic Steroid for Sudden Sensorineural Hearing Loss

Objective: Intratympanic (IT) steroids are increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL). The aim of this study is to investigate the effectiveness of IT administration of dexamethasone treatment for SSNHL. Method: We retrospectively reviewed medical records of SSNHL patients who were treated with IT dexamethasone in our hospital from January 2004 to October 2010. Indications for IT treatment: 1) Failure of systemic therapy; 2) Contraindications for systemic therapy; 3) Patients who presented more than 2 weeks after the onset of hearing loss. Results: A total of 117 patients were reviewed. The mean age of the patients was 51.2 years, ranging from 18 to 81 years. Patients were divided into 2 groups: I) Patients who were treated with IT dexamethasone after the failure of initial systemic treatment: n = 80 (68.3%). II) Patients who were treated only with IT dexamethasone: n = 37 (31.6%). Thirty-nine patients (48%) from group I showed improvement of more than 20 dB in SRT while 14 patients (38%) from group II showed similar improvement. Overall, 87 patients (74.35%) showed some improvement in speech reception threshold (SRT). The presence of vertigo had negative effect on the hearing outcome. Conclusion: This study shows that IT prednisone therapy may be beneficial in the treatment of sudden SNHL. Although the results of this study and other similar ones are convincing, a prospective randomized controlled study is warranted.

Speech intelligibility improvements with hearing aids using bilateral and binaural adaptive multichannel Wiener filtering based noise reduction

This paper evaluates noise reduction techniques in bilateral and binaural hearing aids. Adaptive implementations (on a real-time test platform) of the bilateral and binaural speech distortion weighted multichannel Wiener filter (SDW-MWF) and a competing bilateral fixed beamformer are evaluated. As the SDW-MWF relies on a voice activity detector (VAD), a realistic binaural VAD is also included. The test subjects (both normal hearing subjects and hearing aid users) are tested by an adaptive speech reception threshold (SRT) test in different spatial scenarios, including a realistic cafeteria scenario with nonstationary noise. The main conclusions are: (a) The binaural SDW-MWF can further improve the SRT (up to 2 dB) over the improvements achieved by bilateral algorithms, although a significant difference is only achievable if the binaural SDW-MWF uses a perfect VAD. However, in the cafeteria scenario only the binaural SDW-MWF achieves a significant SRT improvement (2.6 dB with perfect VAD, 2.2 dB with real VAD), for the group of hearing aid users. (b) There is no significant degradation when using a real VAD at the input signal-to-noise ratio (SNR) levels where the hearing aid users reach their SRT. (c) The bilateral SDW-MWF achieves no SRT improvements compared to the bilateral fixed beamformer.

The effect of intratympanic dexamethasone with oral prednisolone as a primary treatment in idiopathic sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) is a true emergency that must be diagnosed and treated immediately. The purpose of this study is to compare the efficacy of treatment with intratympanic dexamethasone plus oral prednisolone daily or every other day with that of treatment with oral prednisolone alone. Sixty-three patients with SSNHL that had been present for less than 10 days prior to the start of treatment were randomly allocated to three different groups. Patients in group A were treated daily with oral prednisolone 1 mg/kg for 10 days plus intratympanic dexamethasone 2 mg for the first 3 days of treatment. Patients in group B were treated every other day with oral prednisolone 1 mg/kg for 10 days with the addition of intratympanic dexamethasone 2 mg for the first 3 treatments. Patients in group C were treated daily with oral prednisolone 1 mg/kg alone for 10 days. Audiometric parameters including pure tone audiometry (PTA), speech reception threshold (SRT), and speech discrimination score (SDS) were assessed on days 1,5, and 10. There was a significant improvement in PTA, SRT and SDS in each group over the 10 days but the greatest improvement was seen in the SRT measurements of group A in comparison with group B (19.81 ± 2.15, P=0.04) and C (26.26 ± 0.08, P=0.01). The difference in SRT between groups B and C was not statistically significant. The administration of intratympanic dexamethasone 2 mg daily for 3 days has an additive effect to that of 10 days of oral prednisolone 1 mg/kg in the treatment of SSNHL.

Listening in Spatialized Noise—Sentences Test (LiSN-S): Normative and Retest Reliability Data for Adolescents and Adults up to 60 Years of Age

The Australian version of the Listening in Spatialized Noise-Sentences Test (LiSN-S) was originally developed to assess auditory stream segregation skills in children aged 6 to 11 yr with suspected central auditory processing disorder. The LiSN-S creates a three-dimensional auditory environment under headphones. A simple repetition-response protocol is used to assess a listener's speech reception threshold (SRT) for target sentences presented in competing speech maskers. Performance is measured as the improvement in SRT in decibels gained when either pitch, spatial, or both pitch and spatial cues are incorporated in the maskers. To collect additional normative data on the Australian LiSN-S for adolescents and adults up to 60 yr of age, to analyze the effects of age on LiSN-S performance, to examine retest reliability in the older population, and to extrapolate findings from the Australian data so that the North American version of the test can also be used clinically with older adults. In a descriptive design, normative and test-retest reliability data were collected from adolescents and adults and combined with previously published data from Australian children aged 6 to 11 yr. One hundred thirty-two participants with normal hearing aged 12 yr, 0 mo, to 60 yr, 7 mo, took part in the normative data study. Fifty-five participants returned between 2 and 4 mo after the initial assessment for retesting. Analysis of variance revealed a significant effect of age on LiSN-S performance (p < .01 for all LiSN-S measures, ηp2 ranging from 0.16 to 0.54). On the low and high cue SRT measures, planned contrasts revealed significant differences between adults and children aged 13 yr and younger, as well as between 50- to 60-yr-olds and younger adults aged 18-29 yr. Whereas there were significant differences between adults and children on the talker, spatial, and total advantage measures, there were no significant differences in performance in adults aged 18-60 yr. There was a small but significant improvement on retest ranging from 0.5 to 1.2 dB across the four LiSN-S test conditions (p ranging from .01 to <.001). However, there was no significant difference between test and retest on the advantage measures (p ranging from .143 to .768). Test-retest differences across all LiSN-S measures were significantly correlated (r ranging from 0.2 to 0.7, p ranging from .023 to <.00000001) and did not differ as a function of age (p ranging from .178 to .980). As there was no significant difference among adults aged 18-60 yr on the LiSN-S talker, spatial, and total advantage measures, it appears that the decline in ability to understand speech in noise experienced by 50- to 60-yr-olds is not related to their ability to use either spatial or pitch cues. This result suggests that some other factor/s contributes to the decline in speech perception in noise experienced by older adults that is reported in the literature and was demonstrated in this study on the LiSN-S low and high cue SRT measures.

The North American Listening in Spatialized Noise—Sentences Test (NA LiSN-S): Normative Data and Test-Retest Reliability Studies for Adolescents and Young Adults

The Listening in Spatialized Noise-Sentences test (LiSN-S; Cameron and Dillon, 2009) was originally developed to assess auditory stream segregation skills in children aged 6 to 11 yr with suspected central auditory processing disorder. The LiSN-S creates a three-dimensional auditory environment under headphones. A simple repetition-response protocol is used to assess a listener's speech reception threshold (SRT) for target sentences presented in competing speech maskers. Performance is measured as the improvement in SRT in dB gained when either pitch, spatial, or both pitch and spatial cues are incorporated in the maskers. A North American-accented version of the LiSN-S (NA LiSN-S) is available for use in the United States and Canada. To develop normative data for adolescents and adults on the NA LiSN-S, to compare these data with those of children aged 6 to 11 yr as documented in Cameron et al (2009), and to consolidate the child, adolescent, and adult normative and retest data to allow the software to be used with a wider population. In a descriptive design, normative data and test-retest reliability data were collected. One hundred and twenty normally hearing participants took part in the normative data study (67 adolescents aged 12 yr, 1 mo, to 17 yr, 10 mo, and 53 adults aged 19 yr, 10 mo, to 30 yr, 30 mo). Forty-nine participants returned between 1 and 4 mo after the initial assessment for retesting. Participants were recruited from sites in Cincinnati, Dallas, and Calgary. When combined with data collected from children aged 6 to 11 yr, a trend of improved performance as a function of increasing age was found across performance measures. ANOVA (analysis of variance) revealed a significant effect of age on performance. Planned contrasts revealed that there were no significant differences between adults and children aged 13 yr and older on the low-cue SRT; 14 yr and older on talker and spatial advantage; 15 yr and older on total advantage; and 16 yr and older on the high-cue SRT. Mean test-retest differences on the various NA LiSN-S performance measures for the combined child, adult, and adolescent data ranged from 0.05 to 0.5 dB. Paired comparisons revealed test-retest differences were not significant on any measure of the NA LiSN-S except low-cue SRT. Test-retest differences across measures did not differ as a function of age. Test and retest scores were significantly correlated for all NA LiSN-S measures. The ability to use either spatial or talker cues in isolation becomes adultlike by about 14 yr of age, whereas the ability to combine spatial and talker cues does not fully mature until closer to adulthood. By consolidating child, adolescent, and adult normative and retest data the NA LiSN-S can now been utilized to assess auditory processing skills in a wider population.

Long-Term Patient Satisfaction With Different Middle Ear Hearing Implants in Sensorineural Hearing Loss

Introduction: Implantable hearing devices are a viable option for patients with moderate-to-severe sensorineural hearing loss who cannot benefit from the conventional hearing aids. In this study, we focus on the patients' satisfaction with 3 different middle ear implants, the Vibrant SoundBridge (VSB), the semi-implantable Otologics MET implant, and the fully implantable Carina implant. Materials and Methods: Between 1998 and 2008, we have implanted 112 patients with these devices. Hereby, we gathered preimplantation and postimplantation audiologic data to evaluate the functional gains. To assess patient satisfaction, we have used a specific questionnaire focusing on implant dysfunction, audiologic satisfaction in different scenarios, and common daily life practical applications. Our final population included 19 semi-implantable Otologics, 10 Carina, and 45 VSB patients. Results: Free-field functional gain and speech reception threshold improvement were undeniable for all implants. However, this was not reflected in real-life patient satisfaction. Only 20% to 42% of the patients were more satisfied with their implants compared with their contralateral conventional hearing aids. Satisfaction dropped from 70% to 90% during conversations in quiescence to 0% to 20% in crowded situations. Depending on the type of implant, 29% to 67% of patients were satisfied enough to repeat the procedure again. Conclusion: Audiologic results with middle ear implants are encouraging and stable on the long term, but they do not correlate with the patients' index of satisfaction. The implants have to be further improved to offer more patient satisfaction in real-life situations, especially in noisy environments and for multimedia use.