Real Ear Measurements Research Articles

Over-the-Counter Hearing Aids Versus Traditional Hearing Aids in Patients With Mild-to-Moderate Hearing Loss: Protocol for a Noninferiority Randomized Controlled Trial.

With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation. This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs. We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories-Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority. This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year. Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation. PRR1-10.2196/59894.

Does the Receiver Type Used in Receiver-in-Canal Hearing Aids Have an Effect on Real-Ear-to-Coupler Difference and Coupler Response for Flat Insertion Gain Values?

Background and Aim: Real-Ear-to-Coupler Difference (RECD) is affected by the type of transducer and its coupling method. This study aimed to investigate the effect of receiver type used in Receiver-in-Canal (RIC) hearing aids on RECD and Coupler Response for Flat Insertion Gain (CORFIG) obtained by the same coupling method. Methods: In this study, the right ears of 30 normal-hearing adults (25 men and 5 women, with a mean age of 28.13±5.62 years) were studied. We used the RIC hearing aids with two standard and power receivers. The foam of the ER-3A insert earphone was used as a coupling system in both receivers. By using the Audiogram Direct test within Phonak’s fitting software, 70 dB HL intensity was produced at different frequencies, once in the real- ear and again in the HA-1 coupler. By assessing the difference between real-ear and HA-1 coupler measurements, the RECD was first obtained. Then, the CORFIG was obtained at different frequencies by subtracting the Microphone Location Effect (MLE) and RECD from Real-Ear Unaided Gain (REUG). Results: The RECD and CORFIG values obtained from the standard receiver at all frequencies were significantly different from those from the power receiver (p<0.05), where the use of the power receiver resulted in lower RECD and higher CORFIG. With the increase in frequency, the RECD increased. A small frequency changes of 50 Hz had a significant effect on RECD and CORFIG. Conclusion: The type of receiver used in RIC hearing aids has a significant effect on the RECD and CORFIG values. Keywords: Real-ear measurement; real-ear-to-coupler difference; insertion gain; hearing aid

Automated Real Ear Measures (AutoREM)-Based Hearing Aid Fitting in Adults Sensorineural Hearing Loss Patients

Automated Real Ear Measures (AutoREM)-Based Hearing Aid Fitting in Adults Sensorineural Hearing Loss Patients

Comparison between the international outcome inventory for hearing aids questionnaire and real-ear measurement.

The international outcome inventory for hearing aids (IOI-HA) is a questionnaire widely used to assess the subjective benefits of hearing aids. This study aimed to evaluate the relationship between IOI-HA outcomes and target mismatch in real-ear measurement (REM). Thirty-four ears of 25 patients who had worn hearing aids were evaluated using the Korean version of the IOI-HA and REM after fitting for 2 months. Real-ear insertion gain (REIG) was measured at three different levels of input intensity-50, 65, and 80 dB sound pressure level (SPL)-and a frequency range of 0.25 to 6 kHz. Factors 1 and 2 and total IOI-HA scores were compared with the mismatches of REIGs and target gains of REM. Factor 1, Factor 2, and total IOI-HA scores were 14.6 ± 3.5, 11.4 ± 2.2, and 25.9 ± 5.1, respectively. The averages of the difference of REIGs and target gains in REM at 50, 65, and 80 dB SPL input levels were -3.1 ± 6.7, -2.3 ± 7.2, and -3.0 ± 8.2, respectively. Factors 1 and 2 scores of the IOI-HA showed significant correlations with target mismatch in REM at 1 kHz and 0.75 kHz frequencies, respectively. Total IOI-HA scores had significant correlations with target mismatches in REM at 0.75 and 1 kHz frequencies. IOI-HA scores correlated with target mismatch in REM at mid frequencies. The IOI-HA can be a useful screening measure for evaluating the necessity of further adjustments in hearing aids through REM at mid frequencies.

Comparing Self-Fitting Strategies for Over-the-Counter Hearing Aids

Fewer than 20% of US adults with hearing loss use hearing aids due to barriers like high cost. Over-the-counter (OTC) hearing aids offer a potential solution, incorporating self-fitting strategies via smartphone apps. Self-fitting strategies have been validated for Food and Drug Administration (FDA)-approved OTC hearing aids compared with prescription-based approaches. However, no direct comparative analysis exists between in situ audiometry and self-adjustment strategies using self-fitting OTC (OTC-SF) hearing aids. To compare self-adjustment and in situ audiometry self-fitting strategies in OTC-SF hearing aids for adults with mild to moderate hearing difficulties. A crossover, within-participant pseudorandomized clinical trial was conducted between July and November 2023. Twenty-eight participants were pseudo-randomly assigned to 1 of the 2 self-fitting strategies, and they experienced both interventions for 4 consecutive weeks. The self-adjustment group manually adjusted settings, including overall gain and spectral tilt, using Lexie B2 hearing aids, while the in situ audiometry group used Lexie B2 Plus hearing aids (Lexie Hearing by hearX Group), with an automated fitting based on in situ tests conducted through the app. The primary outcome was Abbreviated Profile of Hearing Aid Benefit (APHAB). Secondary outcomes were International Outcome Inventory for Hearing Aids (IOI-HA), speech-in-noise tests (DIN and QuickSIN), and real-ear measurements (REMs). Measures were completed at baseline and after the 4-week field trial using each strategy. Twenty-eight participants (mean [SD] age, 60.2 [12.0] years) were included; 14 men and 14 women. Self-adjustment and in situ audiometry strategies produced no clinically meaningful differences across various outcome measures, including overall APHAB benefit (Cohen d = 0.2; 95% CI, -0.2 to 0.6) and overall IOI-HA satisfaction (Rosenthal r = 0.0; 95% CI, -0.3 to 0.2). Self-adjustment users reported higher satisfaction (Rosenthal r = -0.4; 95% CI, -0.6 to -0.1) and longer daily use (Rosenthal r = -0.3; 95% CI, -0.5 to 0.0) compared with those using in situ audiometry. No clinically meaningful differences were observed in speech-in-noise benefit and real-ear measurements. In this clinical trial of OTC-SF hearing aids, self-adjustment and in situ audiometry strategies resulted in similar outcomes. However, self-adjustment may produce higher satisfaction and longer daily use, highlighting the potential advantages of active user involvement in the fitting process. Further investigation is needed for long-term outcomes. ClinicalTrials.gov Identifier: NCT05782153.

Open-fitting hearing aids: a comparative analysis between open behind-the-ear and open completely-in-the-canal instant-fit devices.

Our study aims to assess the open-fitting capabilities and vent properties of traditional open-fitting behind-the-ear (open BTE) hearing aids to instant-fit open-fitting completely-in-the-canal (open CIC) systems. The study analysed data from 40 patients grouped in two groups based on the used hearing aids. Free field pure tone and speech audiometry were performed to obtain the free-field pure tone average and free-field word recognition score (WRS). The matrix sentence test was employed to evaluate the auditory performance and functional outcomes of patients. The Satisfaction with Amplification in Daily Life (SADL) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire were used to assess the personal satisfaction and benefit provided by the hearing aid. Real ear measurements were conducted to objectively evaluate the Real-Ear Unaided Gain (REUG) and Real-Ear Occluded Gain (REOG) of the two groups. For this purpose, six frequency bands (band 1 from 125 to 200Hz, band 2 from 250 to 400Hz, band 3 from 500 to 800Hz, band 4 from 1000 to 1600Hz, band 5 from 2000 to 3150Hz, and band 6 from 4000 to 6300Hz) were defined and compared. Free-field WRS exhibited a significant difference (p-value = 0.004) between open BTE and open CIC, with better results for the open BTE. Matrix test speech reception threshold scores did not differ significantly between groups. No statistical significant difference were observed between APHAB and SADL total scores. Correlation tests revealed a negative correlation between SRT and APHAB scores in the open BTE group, not seen in the open CIC. No statistically significant difference was observed for all bands of REUG values, demonstrating comparability in terms of acoustic resonance of the external auditory canal. Comparing the REOG recorded in the two groups a significant difference was observed for bands 2 through 6. While the average REOG values for bands 5 and 6 were higher in patients with traditional open BTE aids, in contrast, for bands 2, 3, and 4, the REOG values for the open CIC group were higher and statistically significant compared to patients wearing traditional open-fitting BTE hearing aids. Patients with open CIC seem to perform worse in quiet environments compared to noisy ones, as indicated by the free field WRS score. However, the absence of differences in functional performance assessed with the matrix sentence test, and in the psychosocial aspects, makes these devices a good solution for individuals who reject hearing aids due to aesthetic concerns. The differences in terms of real ear measurements, while statistically significant, do not negatively impact overall performance.

Device and Fitting Protocol for a Transitional Intervention for Debilitating Hyperacusis.

This report describes a hearing device and corresponding fitting protocol designed for use in a transitional intervention for debilitating loudness-based hyperacusis. The intervention goal is to transition patients with hyperacusis from their typical counterproductive sound avoidance behaviors (i.e., sound attenuation and limited exposure to healthy low-level sounds) into beneficial sound therapy treatment that can expand their dynamic range to the point where they can tolerate everyday sounds and experience an improved quality of life. This requires a combination of counseling and sound therapy, the latter of which is provided via the hearing device technology, signal processing, and precision fitting approach described in this report. The device combines a miniature behind-the-ear sound processor and a custom earpiece designed to maximize the attenuation of external sounds. Output-limiting loudness suppression is used to restrict exposure to offending high-level sounds while unity gain amplification maximizes exposure to healthy and tolerable lower level sounds. The fitting process includes measurement of the real-ear unaided response, the real-ear measurement (REM) system noise floor, the real-ear occluded response, real-ear insertion gain, and the output limit. With these measurements, the device can achieve the prescribed unity gain needed to provide transparent access to comfortable sound levels. It also supports individualized configuration of the therapeutic noise from an on-board sound generator and adaptive output limiting based on treatment-induced increases in dynamic range. The utility of this device and fitting protocol, in combination with structured counseling, is highlighted in the outcomes of a successful 6-month trial of the transitional intervention described in a companion report in this issue.

Remote or in-clinic? The effect of service delivery mode on hearing aid output: study protocol for a double-blinded, randomised trial in adults with mild to moderate sensorineural hearing loss

BackgroundTeleaudiology can potentially improve access to hearing healthcare services. Remote hearing aid fittings offer a new mode of service delivery that removes barriers of geography and access to an audiologist. Real-ear measurements (REMs) are the gold standard for hearing aid output verification but require in-clinic appointments. This study will investigate whether remote hearing aid fittings can provide clinically equivalent outcomes when compared to current, in-clinic, best practice guidelines.Research designA repeated measure, double-blinded crossover design will be used. Participants will be randomly allocated to one of two groups to determine order of intervention, balanced for degree of hearing loss.Study sampleSixty adults with mild to moderate hearing loss and at least 1 year of experience with hearing aids will be recruited.Data collection and analysisParticipants will complete two hearing aid fitting protocols, one using an in-clinic fitting process and the other using a remote (at-home) fitting process. In-clinic fittings will include REMs with adjustments to standard (NAL-NL2) prescription targets. The two fitting protocols will then be randomly assigned to participants in a crossover design, so participants and researchers will be blinded to the order of the two fitting protocols. Participants will then have a 4-week period with follow-up appointments for participant-directed gain adjustment. For each fitting protocol, participants will complete objective measurements of final hearing aid output with REMs, speech-in-noise testing, subjective measurements of hearing aid performance, and quality of life measurements. They will then begin an identical period of living with, adjusting, and objective assessment with the other fitting protocol. Data will be analysed as repeated measures with statistical control for potential confounding variables.ResultsData will compare the four-frequency average real-ear aided response (4FREAR) for hearing aids programmed in-clinic and hearing aids programmed remotely, after participant-directed gain adjustments. Secondary measures will assess clinically significant differences in estimated speech intelligibility, hearing-related quality of life, hearing aid benefit, sound quality and preference, and speech-in-noise ability.ConclusionsThis study will inform the development of best practice guidelines for remote hearing aid fittings. If no clinically significant differences are found between in-clinic and remote fit hearing aids, it has the potential to expand teleaudiology initiatives.Trial registrationAustralian New Zealand Clinical Trial Registry, ACTRN12623000028606p. Date of registration: 12 January 2023.

Comparative Effectiveness of Personal Sound Amplification Products Versus Hearing Aids for Unilateral Hearing Loss: A Prospective Randomized Crossover Trial.

This study compared hearing outcomes with use of personal sound amplification products (PSAPs) and hearing aids (HAs) in patients with moderate to moderately severe unilateral hearing loss. Thirty-nine participants were prospectively enrolled, and randomly assigned to use either one HA (basic or premium type) or one PSAP (basic or high-end type) for the first 8 weeks and then the other device for the following 8 weeks. Participants underwent a battery of examinations at three visits, including sound-field audiometry, word recognition score (WRS), speech perception in quiet and in noise, real-ear measurement, and self-report questionnaires. Functional gain was significantly higher with HAs across all frequencies (P < 0.001). While both PSAPs and HAs improved WRS from the unaided condition, HAs were superior to PSAPs. The speech recognition threshold in quiet conditions and signal-to-noise ratio in noisy conditions were significantly lower in the HA-aided condition than in the PSAP-aided condition, and in the PSAP-aided condition than in the unaided condition. Subjective satisfaction also favored HAs than PSAPs in questionnaires, Abbreviated Profile of Hearing Aid Benefit, International Outcome Inventory for Hearing Aids, and Host Institutional Questionnaire. While PSAPs provide some benefit for moderate to moderately severe unilateral hearing loss, HAs are more effective. This underscores the potential role of PSAPs as an accessible, affordable first-line intervention in hearing rehabilitation, particularly for individuals facing challenges in accessing conventional HAs.

In-situ Audiometry Compared to Conventional Audiometry for Hearing Aid Fitting.

The use of in-situ audiometry for hearing aid fitting is appealing due to its reduced resource and equipment requirements compared to standard approaches employing conventional audiometry alongside real-ear measures. However, its validity has been a subject of debate, as previous studies noted differences between hearing thresholds measured using conventional and in-situ audiometry. The differences were particularly notable for open-fit hearing aids, attributed to low-frequency leakage caused by the vent. Here, in-situ audiometry was investigated for six receiver-in-canal hearing aids from different manufacturers through three experiments. In Experiment I, the hearing aid gain was measured to investigate whether corrections were implemented to the prescribed target gain. In Experiment II, the in-situ stimuli were recorded to investigate if corrections were directly incorporated to the delivered in-situ stimulus. Finally, in Experiment III, hearing thresholds using in-situ and conventional audiometry were measured with real patients wearing open-fit hearing aids. Results indicated that (1) the hearing aid gain remained unaffected when measured with in-situ or conventional audiometry for all open-fit measurements, (2) the in-situ stimuli were adjusted for up to 30 dB at frequencies below 1000 Hz for all open-fit hearing aids except one, which also recommends the use of closed domes for all in-situ measurements, and (3) the mean interparticipant threshold difference fell within 5 dB for frequencies between 250 and 6000 Hz. The results clearly indicated that modern measured in-situ thresholds align (within 5 dB) with conventional thresholds measured, indicating the potential of in-situ audiometry for remote hearing care.

Difference in SII provided by initial fit and NAL-NL2 and its relation to self-reported hearing aid outcomes

Objective The speech intelligibility index (SII) is used to quantify the audibility of the speech. This study examined the relationship between self-reported hearing aid (HA) outcomes and the difference in aided SII (SIIA) calculated from the initial fit (IF) gain and that prescribed as per the second generation of National Acoustic Laboratory Non-Linear (NAL-NL2). Design A prospective observational study. Study sample The study included 718 first-time and 253 experienced HA users. All users had a valid real-ear measurement (REM) at three input levels (55, 65 and 80 dB SPL). Results The gain provided by IF was lower than NAL-NL2 at 55 and 65 dB SPL. IF gain exhibited reduced compression than NAL-NL2 as input levels increased from 55 to 80 dB SPL. On average, the SIIA provided by IF was significantly lower than that for NAL-NL2 at all input levels. The difference in SIIA between IF and NAL-NL2 at 80 dB SPL input level with 0 dB signal-to-noise ratio (SNR) turned out to be a predictor for self-reported outcome for first-time HA users. Conclusion The study suggests that an SIIA close to that provided by NAL-NL2 at high input levels would be preferred to obtain a better self-reported outcome.

Correlation between Aural/Oral Performance and Fit-to-Target Gain among Children with Moderate-to- Profound Hearing Loss Aged 5–10 Years

Background and Aim: Real-Ear Measurement (REM) enables proper fitting of the hear- ing aids to achieve the required level of amplification. This study aims to investigate the relationship between aural/oral performance and fit-to-target gain of hearing aids in chil- dren with moderate-to-profound hearing loss.&#x0D; Methods: This cross-sectional study was conducted on 30 children with moderate-to-pro- found hearing loss aged 5–10 years. First, the parents’ evaluation of aural/oral perfor- mance of children (PEACH) questioanire was completed. Then, REM was performed using digital speech at 50, 65, 80, and 90 dB SPL at 250–8000 Hz to obtain the fit to the desired sensation level, version 5 (DSL v5) target gain.&#x0D; Results: A significant negative correlation was found between the total score of the PEACH (51.66) and the fit-to-target gain at high frequencies (r=–0.482, p=0.01). The maximum fit-to-target gain was 77.5 dB for 65 dB SPL at 6000 Hz. Most of the cases (75%) failed to come within ±5 dB of the target gain. There was a significant difference in the fit-to-target gain between low and high frequencies and between high frequencies with similar input levels.&#x0D; Conclusion: A negative correlation between aural/oral performance of children with moderate-to-profound hearing loss and fit-to-target gain of their hearing aids may indicate that a low fit-to-target gain can improve their aural/oral performance. Regular use of REM is recommended in prescribing hearing aids to these children.&#x0D; Keywords: Children; fit to target gain; hearing loss; aural/oral performance

Impact of hearing aid technology level at first-fit on self-reported outcomes in patients with presbycusis: a randomized controlled trial.

To provide clinical guidance in hearing aid prescription for older adults with presbycusis, we investigated differences in self-reported hearing abilities and hearing aid effectiveness for premium or basic hearing aid users. Secondly, as an explorative analysis, we investigated if differences in gain prescription verified with real-ear measurements explain differences in self-reported outcomes. The study was designed as a randomized controlled trial in which the patients were blinded towards the purpose of the study. In total, 190 first-time hearing aid users (>60years of age) with symmetric bilateral presbycusis were fitted with either a premium or basic hearing aid. The randomization was stratified on age, sex, and word recognition score. Two outcome questionnaires were distributed: the International Outcome Inventory for Hearing Aids (IOI-HA) and the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ-12). In addition, insertion gains were calculated from real-ear measurements at first-fit for all fitted hearing aids. Premium hearing aid users reported 0.7 (95%CI: 0.2; 1.1) scale points higher total SSQ-12 score per item and 0.8 (95%CI: 0.2; 1.4) scale points higher speech score per item, as well as 0.6 (95%CI: 0.2; 1.1) scale points higher qualities score compared to basic-feature hearing aid users. No significant differences in reported hearing aid effectiveness were found using the IOI-HA. Differences in the prescribed gain at 1 and 2kHz were observed between premium and basic hearing aids within each company. Premium-feature devices yielded slightly better self-reported hearing abilities than basic-feature devices, but a statistically significant difference was only found in three out of seven outcome variables, and the effect was small. The generalizability of the study is limited to community-dwelling older adults with presbycusis. Thus, further research is needed for understanding the potential effects of hearing aid technology for other populations. Hearing care providers should continue to insist on research to support the choice of more costly premium technologies when prescribing hearing aids for older adults with presbycusis. Clinical Trial Registration: https://register.clinicaltrials.gov/, identifier NCT04539847.

Comparison of speech recognition performance with and without a face mask between a basic and a premium hearing aid in hearing-impaired listeners

BackgroundThe mask mandate during the COVID-19 pandemic leads to communication challenges as sound energy gets reduced and the visual cues are lost due to the face mask. This study examines the impact of a face mask on sound energy and compares speech recognition performance between a basic and a premium hearing aid. MethodsParticipants watched four video clips (a female and a male speaker with and without a face mask) and repeated the target sentences in various test conditions. Real-ear measurement was performed to investigate the changes in sound energy in no mask, surgical, and N95 mask conditions. ResultsWith the face mask on, sound energy significantly decreased for all types of masks. For speech recognition, the premium hearing aid showed significant improvement in the mask condition. ConclusionThe findings emphasize and encourage health care professionals to actively use communication strategies, such as speaking slowly and reducing background noise, when interacting with individuals with hearing loss.

Parametric model of young infants’ eardrum and ear canal impedances supporting immittance measurement results. Part II: Prediction of eardrum and ear canal impedances for frequent pathological middle ear conditions

In order to gain a better understanding of wideband acoustic immitance (WAI) measurements, in this second part of a two-part paper, the parametric electro-acoustic model of the ear canal and the middle ear of young infants proposed in the first part is extended. The extension allows predictions of the influence of the pathological middle ear conditions middle ear effusion and negative static air pressure difference between the middle ear and the ear canal. Comparisons of the acoustic input impedance of the ear predicted by the model with real ear measurements in young infants’ ears with middle ear effusion show that the effects due to the pathology can be predicted well. For the negative static air pressure, a modeling approach was proposed but could not be confirmed yet, due to a lack of available measurement data. Furthermore, comparisons between different middle ear states (healthy, middle ear effusion and static air pressure difference) predicted by the model showed characteristic differences in all relevant WAI measures. However, it is also shown that WAI measures requiring an estimate of the cross-sectional area at the measurement position, i.e., absorbance and reflectance, are highly sensitive to this estimate.

Investigation of the current supply system for hearing aids at stores in Japan

ObjectiveThis study aimed to examine the status of the supply system for hearing aids at stores in Japan. MethodsThis was a cross-sectional, observational study. We mailed questionnaires to 4502 hearing aid stores in Japan and analyzed the responses. ResultsOf the 4502 stores, 1032 (23%) responded.Most stores accessed audiogram information and adjusted hearing aids using computer fitting software. Overall, 43% of the stores only used the manufacturer's original prescription formula to adjust the hearing aid, and 47% of stores lacked a device for measuring the frequency response of the hearing aids. Moreover, 20% of the stores lacked both a sound field threshold measurement system and a real-ear measurement device. Objective evaluations, including functional gain, rear-ear insertion gain, and frequency response data, were not performed by 14% stores. Speech-language-hearing therapists were present in only 5.6% stores. ConclusionThe findings revealed several key shortcomings in the hearing aid supply system at hearing aid stores in Japan.

An objective bone conduction verification tool using a piezoelectric thin-film force transducer.

All hearing aid fittings should be validated with appropriate outcome measurements, whereas there is a lack of well-designed objective verification methods for bone conduction (BC) hearing aids, compared to the real-ear measurement for air conduction hearing aids. This study aims to develop a new objective verification method for BC hearing aids by placing a piezoelectric thin-film force transducer between the BC transducer and the stimulation position. The newly proposed method was compared with the ear canal method and the artificial mastoid method through audibility estimation. The audibility estimation adopted the responses from the transducers that correspond to the individual BC hearing thresholds and three different input levels of pink noise. Twenty hearing-impaired (HI) subjects without prior experience with hearing aids were recruited for this study. The measurement and analysis results showed that the force transducer and ear canal methods almost yielded consistent results, while the artificial mastoid method exhibited significant differences from these two methods. The proposed force transducer method showed a lower noise level and was less affected by the sound field signal when compared with other methods. This indicates that it is promising to utilize a piezoelectric thin-film force transducer as an in-situ objective measurement method of BC stimulation.

Behavioral Evaluation of 3 Smartphone-Based Hearing Aid Apps for Patients with Mild Hearing Loss: An Exploratory Pilot Study.

Background:The aim of this study was to evaluate the behavioral performance of a selection of currently available hearing aid apps in patients with mild hearing loss.Methods:We investigated 3 user-friendly hearing aid apps (EarMachine, Sound Amplifier, and Petralex) with real-ear measurement, warble-tone audiometry, word recognition testing in unaided and aided conditions, and hearing-in-noise tests in quiet and noise-front conditions in a group of users with mild hearing impairment (n = 7) as a pilot for a future long-term investigation. Results from the apps were compared with those of a conventional hearing aid. Results:Hearing aids showed greater gain at 1 and 3 kHz than hearing aid apps in real-ear insertion gain of real-ear measurements. Hearing aids tended to have greater gain than hearing aid apps at 2 and 3 kHz in the sound field audiometry test. The clinical performance of the listeners tended to be better when using a hearing aid and Petralex (13% and 6% improvement in word recognition score, respectively), while EarMachine and Sound Amplifier conferred limited user benefit. The hearing aid apps did not improve signal-to-noise ratio in comparison with the unaided condition in the hearing-in-noise test.Conclusions:Some hearing aid apps were beneficial for patients with mild hearing loss in terms of amplification, but participants using the apps showed no improvements in hearing-in-noise tests.

Real-Ear-to-Coupler Difference: Physical and Perceptual Differences.

The real-ear-to-coupler difference (RECD) is a recommended measure for accurate hearing aid fittings, especially for pediatric populations. However, for adults, many clinicians question whether it is necessary. Hearing aids were fit on two groups of 85 older adults seen at a Veterans Administration audiology clinic. One group was fit using RECD measurements, whereas the second group was fit with population-based average RECD values. The two groups had similar pure-tone hearing thresholds. Like previous studies, there was little difference between the measured RECD for the right and left ears among the participants. Although the majority of the measured RECDs were within 1 SD of the mean, approximately 20% of those measured were outside of the normal range. It also was found that all participants produced lower (improved) Hearing Handicap Inventory for Elderly-Screening (HHIE-S) scores from pre- to postfitting, thus suggesting a reduction in self-perceived hearing handicap. Despite having similar prefitting HHIE-S scores, those participants who had their hearing aids fit using measured RECD values had lower postfitting scores than the group that was fit with average RECD values. Furthermore, there was a significant difference between the groups on several questions of the International Outcome Inventory-Hearing Aids, suggesting that there was higher satisfaction with the fittings based on the custom RECD rather than the fittings based on the average RECD. This study demonstrated that, in addition to performing verification using real-ear measurements, accurate conversion of dB HL to dB SPL using personalized RECD likely improved hearing aid satisfaction.

Influence of the Noise-Canceling Technology on How We Hear Sounds

Purpose: This study explores the influence of the noise-canceling technology in commercial earphones on sound pressure levels and preferred listening levels in terms of hearing protection. Materials and Methods: Thirty individuals completed puretone audiometry and real-ear measurements to assess sound pressure levels at the level of the eardrum with and without the activation of the noise-canceling function. The Knowles Electronics Manikin for Acoustic Research was used to investigate the acoustic characteristics of two environmental sounds (bus and café). Two types of earphones (wireless and wired canal type) were utilized in the study. Results: For both bus and café noises, in the low-frequency range, sound pressure levels were significantly decreased for all types of earphones when the noise-canceling function was turned on. The same results were observed for the whole frequency range. In terms of preferred listening levels, the wireless canal type and wired canal type earphones showed significant reduction in volume levels. Conclusion: The findings of the study show that for both low- and whole frequency range, the use of noise-canceling function significantly decreases the sound pressure levels of the signal for all styles of earphones, suggesting a potential of the noise-canceling technology in hearing protection.