Sloping Sensorineural Hearing Loss Research Articles

Objective Measure of Listening Effort in HearingImpaired Individuals With and Without Tinnitus.

Tinnitus is a perception of sound in the brain without any external stimulus. Tinnitus patients often complain of more efforts required in listening. They may be ineffective in inhibiting their attention, driven to irrelevant ringing sounds in their ear rather than attending to the relevant target speech stimulus. The study's objective was to evaluate an allocation of cognitive resources among tinnitus patients for concurrent tasks required for understanding speech using an objective dual-task paradigm to assess listening effort. We recruited 40 participants with mild to moderately severe sloping sensorineural hearing loss within 60-70 years. They were subgrouped into control and clinical groups. The clinical group had a severe degree of tonal tinnitus bilaterally. The objective listening task used listening effort, and a subjective questionnaire to assess the effort in listening was assessed by each study participant. The results indicated poorer recognition and reduced recall scores in a clinical group than the control group in each signal-to-noise ratio. The recall score in objective listening effort measurement was strongly correlated with subjective questions assessed effort in listening among the clinical group at each signal-to-noise ratio. However, in the control group, the correlation was to a mild degree at 0 dB signal-to-noise ratio only. Annoyance caused by tinnitus disrupts attention, thereby limiting the effective use of cognitive resources for concurrent speech processing and recalling reflected in the listening effort task.

Bluetooth Coupling in Hearing Aids: Effect on Audiovisual Speech Recognition and Quality Rating of Compressed Speech in Older Individuals with Sloping Hearing Loss.

Introduction Older individuals often report that they find it difficulty in enjoying watching television since they find it hard to follow the rapid intensity variations, and voice changes from scene to scene. Objective The present study investigated the effect of coupling the hearing aid with the television via Bluetooth on audiovisual speech recognition and quality rating of compressed speech in older individuals with hearing loss. Method Twenty participants in the age range of 60 to 75 years who had moderate to moderately severe sloping sensorineural hearing loss were bilaterally fitted with digital receiver in the canal hearing aids. The hearing aid was coupled with a television via Bluetooth using a streamer. The video recorded stimuli were presented at 65 dB SPL at normal rate, 35% compression and 45% compression conditions. Speech recognition scores and quality ratings were obtained for each condition with and without the Bluetooth streamer connected to the hearing aids. Results Speech recognition scores were significantly better with Bluetooth coupling compared with conventional hearing aid use at 40% compressed speech rate. The quality was also rated higher in almost all parameters across speech rates when Bluetooth was used. Conclusions The improved clarity and nullification of room reverberation offered by Bluetooth coupling can potentially compensate for the age-related temporal processing deficit contributing to ease of listening.

Tinnitus, Aural Fullness, and Hearing Loss in a Patient with Acoustic Neuroma and Pituitary Macroadenoma

We report the case of a 51-year-old woman with multiple otologic and vestibular symptoms. She presented with two different types of tinnitus in her right ear, vertigo, and fluctuating aural symptoms in the left ear. She also complained of disequilibrium; chronic headache; hyperhidrosis; amenorrhea; insomnia; broadened hands and feet; and widened, thickened, and stubby fingers. The patient underwent careful collection of medical history, otomiscroscopy, pure tone audiometry, tympanometry, reflex threshold measurements, vestibular assessments, blood tests, magnetic resonance imaging (MRI), and cone beam computed tomography (CBTC) of the head. The audiogram showed: (1) a mild low-to-mid frequency conductive hearing loss, and a sharply sloping sensorineural hearing loss above 4000 Hz in the right ear; (2) a mild low-frequency sensorineural hearing loss in the left ear. MRI with 3D FLAIR sequences detected an acoustic neuroma (7.4 mm × 5.2 mm) in the middle-third of the right internal auditory canal, a pituitary macroadenoma (13 mm × 10 mm × 10 mm) and left saccular hydrops. The CBCT scan documented an outbreak of otosclerosis (3 mm) around the fissula ante fenestram in the right ear. Therefore, acoustic neuroma (right ear), growth hormone-secreting macroadenoma of the pituitary gland, Menière’s disease (left ear), and otosclerosis (right ear) were diagnosed/strongly suspected. A watch-and-wait strategy was adopted for acoustic neuroma and otosclerosis, while transsphenoidal surgery was successfully performed to remove the pituitary macroadenoma. This case report confirms that multiple otologic disorders can occur simultaneously in the same patient, requiring prompt audiological and imaging evaluations.

Amplification Strategies to Reduce Tinnitus: A Paired Comparison Method.

Background : The study investigates the best amplification strategy that provides tinnitus relief in a quiet environment, for individuals with sensorineural hearing loss with bothersome tinnitus.Methods: The repeated measures research design was utilized. Twenty participants (age range 25 years to 65 years; mean: 48.28 years) with bilateral symmetrical sloping sensorineural hearing loss with bothersome unilateral tinnitus were recruited. They were sub-grouped into low- and high-pitched tinnitus groups. A preference score was obtained for each of the strategies in hearing aid fitting, using the paired comparison method. The 4 strategies used were the desired sensation level (input/output) and the National Acoustic Laboratories’ nonlinear fitting method (version 1), at each of the low (30 dB SPL) and high (50 dB SPL) compression thresholds. Besides, the severity of tinnitus was assessed using the tinnitus severity index before and after 1 month of using the hearing aid in the best-selected strategy. Results: A repeated-measure ANOVA revealed no significant effect of the group on the preference score but was significant for strategies on relief from tinnitus. The desired sensation level (input/output) at a low compression threshold was the best strategy for alleviating tinnitus. Thirty-five percent of the study participants preferred the desired sensation level (input/output) strategy at low and high compression threshold, respectively. The remaining 25% preferred the National Acoustic Laboratories’ nonlinear hearing aid (version 1) at low compression threshold, and 5% selected the same device at high compression threshold. Furthermore, a significant association was observed in the severity of tinnitus before and after the hearing aid fitting set at the preferred program. Conclusion: The desired sensation level (input/output) method at the low compression threshold is the best program to alleviate bothersome tinnitus.

Perception of Deep Band Modulated Speech in the Presence of Noise by Elderly Individuals with Hearing Impairment

Background: Deep band modulation (DBM) is an envelope enhancement strategy that enhances temporal modulation and may provide a cue for speech understanding among individuals who suffer from temporal processing deficits. Objective: To investigate the effect of deep band modulation on phrase recognition scores at different signal-to-noise ratios (SNRs) among older adults having hearing loss classified as good and poor performers based on temporal resolution ability. Method: Phrase recognition score was obtained for unprocessed and DBM phrases at three SNRs (4, 5, and - 4 dB signal to noise ratio) in 25 (age range 60 to 82 years, mean age 71.48 years) older adults having bilateral mild to moderately severe sloping sensorineural hearing loss. In addition, the gap detection test was also administered to the study participants. Results: A significant better recognition score was obtained in DBM than the unprocessed phrase. The magnitude of improvement from DBM was not the same in all the participants. Thus, the participants were classified into good and poor performers based on their temporal processing ability. The mean unprocessed and DBM phrase recognition scores in each SNR were higher for good performers than the poor performers. The benefit of deep band modulation was evident for the good performers, especially at high SNR, which was moderately correlated with age and temporal processing ability. Conclusion: The benefit from DBM on recognition score for the good performers is predicted from the temporal resolution abilities and age. However, the benefit is minuscule for the poor performers in noise.

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

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

Intelligibility of British- and American-Accented Sentences for American Younger and Older Listeners With and Without Hearing Loss

Older adults with hearing loss often report difficulty understanding British-accented speech, such as in television or movies, after having understood such speech in the past. A few studies have examined the intelligibility of various United States regional and non-U.S. varieties of English for American listeners, but only for young adults with normal hearing. This preliminary study sought to determine whether British-accented sentences were less intelligible than American-accented sentences for American younger and older adults with normal hearing and for older adults with hearing loss. A mixed-effects design, with talker accent and listening condition as within-subjects factors and listener group as a between-subjects factor. Three listener groups consisting of 16 young adults with normal hearing, 15 older adults with essentially normal hearing, and 22 older adults with sloping sensorineural hearing loss. Sentences produced by one General American English speaker and one British English speaker were presented to listeners at 70 dB sound pressure level in quiet and in babble. Signal-to-noise ratios for the latter varied among the listener groups. Responses were typed into a textbox and saved on each trial. Effects of accent, listening condition, and listener group were assessed using linear mixed-effects models. American- and British-accented sentences were equally intelligible in quiet, but intelligibility in noise was lower for British-accented sentences than American-accented sentences. These intelligibility differences were similar for all three groups. British-accented sentences were less intelligible than those produced by an American talker, but only in noise.

A Computationally Efficient 11 Band Non-Uniform Filter Bank for Hearing Aids Targeting Moderately Sloping Sensorineural Hearing Loss

A computationally efficient 11 band non-uniform filter bank addressing low or moderately sloping sensorineural hearing loss - the most common type of hearing problem- is proposed. This structure is suitable for low cost, small area implementations of hearing aids. The computational efficiency is achieved by adopting the Frequency Response Masking technique, which uses only two prototype filters with a total of 19 multipliers at 80dB stopband attenuation for the design of entire non-uniform filter bank. The computational complexity analysis shows that the proposed method provides about a 70-90% reduction in computational resources compared to non-FRM methods and about a 40-80% reduction in computational resources compared to the other FRM methods. The audiogram matching performance analysis shows that the matching error of the proposed filter bank is negligible even without optimization. The delay performance of the filter bank is acceptable for both Closed Canal Fittings and Open Canal Fittings.

Acoustic characteristics of conversational and clear speech produced in quiet and in noise by older adults with hearing loss

When communication occurs in noise or with hearing-impaired listeners, talkers often modify their speech. Speech produced in noise, or “Lombard speech,” and speech produced by talkers instructed to speak as though their communication partner has a hearing loss, or “clear speech,” usually feature a reduced speaking rate and a higher and more variable voice pitch than quiet and/or conversational-style speech. Both styles are also generally more intelligible than quiet/conversational speech. Although clear speech in particular is meant to accommodate the needs of listeners with hearing loss, most of the talkers in previous studies have been young adults with normal hearing. We hypothesize that talkers with hearing loss, having experience as listeners with hearing loss, would better know what listeners with hearing loss need than talkers with normal hearing, and that the magnitude of the acoustic differences would change accordingly. In the present study, talkers aged 65–85 years with bilateral mild-to-moderately severe sloping sensorineural hearing loss were recorded reading sentences in quiet and in the presence of white noise under instructions to speak conversationally and then clearly. Acoustic differences between the styles for these talkers will be compared to those observed previously in young normal-hearing adults using the same recording protocol.

Altered Functional Connectivity in Patients With Sloping Sensorineural Hearing Loss

BackgroundSensory deprivation, such as hearing loss, has been demonstrated to change the intrinsic functional connectivity (FC) of the brain, as measured with resting-state functional magnetic resonance imaging (rs-fMRI). Patients with sloping sensorineural hearing loss (SNHL) are a unique population among the hearing impaired, as they have all been exposed to some auditory input throughout their lifespan and all use spoken language.Materials and MethodsTwenty patients with SNHL and 21 control subjects participated in a rs-fMRI study. Whole-brain seed-driven FC maps were obtained, with audiological scores of patients, including hearing loss severity and speech performance, used as covariates.ResultsMost profound differences in FC were found between patients with prelingual (before language development, PRE) vs. postlingual onset (after language development, POST) of SNHL. An early onset was related to enhancement in long-range network connections, including the default-mode network, the dorsal-attention network and the fronto-parietal network, as well as in local sensory networks, the visual and the sensorimotor. A number of multisensory brain regions in frontal and parietal cortices, as well as the cerebellum, were also more internally connected. We interpret these effects as top-down mechanisms serving optimization of multisensory experience in SNHL with a prelingual onset. At the same time, POST patients showed enhanced FC between the salience network and multisensory parietal areas, as well as with the hippocampus, when they were compared to those with PRE hearing loss. Signal in several cortex regions subserving visual processing was also more intra-correlated in POST vs. PRE patients. This outcome might point to more attention resources directed to multisensory as well as memory experience. Finally, audiological scores correlated with FC in several sensory and high-order brain regions in all patients.ConclusionThe results show that a sloping hearing loss is related to altered resting-state brain organization. Effects were shown in attention and cognitive control networks, as well as visual and sensorimotor regions. Specifically, we found that even in a partial hearing deficit (affecting only some of the hearing frequency ranges), the age at the onset affects the brain function differently, pointing to the role of sensitive periods in brain development.

The Effect of Digital Noise Reduction on Annoyance and Speech Perception in Low and High Acceptable Noise Level Groups.

Introduction Studies have reported that although speech perception in noise was unaltered with and without digital noise reduction (DNR), the annoyance toward noise measured by acceptable noise level (ANL) was significantly improved by DNR with the range between 2.5 and 4.5 dB. It is unclear whether a similar improvement would be observed in those individuals who have an ANL ≥ 14 dB (predictive of poor hearing aid user) often rejects their aid because of annoyance toward noise. Objectives (a) To determine the effect of activation of DNR on the improvement in the aided ANL from low- and high-ANL groups; and (b) to predict the change in ANL when DNR was activated. Method Ten bilateral mild to severe sloping sensorineural hearing loss (SNHL) participants in each of the low- and high-ANL groups were involved. These participants were bilaterally fitted with receiver in canal (RIC) hearing aids (Oticon, Smorum, Egedal, Denmark) with a DNR processor. Both SNR-50% (Signal to noise ratio (in dB) required to achieve 50 % speech recognition) and ANL were assessed in DNR-on and DNR-off listening conditions. Results Digital noise reduction has no effect on SNR-50 in each group. The annoyance level was significantly reduced in the DNR-on than DNR-off condition in the low-ANL group. In the high-ANL group, a strong negative correlation was observed between the ANL in DNR off and a change in ANL after DNR was employed in the hearing aid (benefit). The benefit of DNR on annoyance can be effectively predicted by baseline-aided ANL by linear regression. Conclusion Digital noise reduction reduced the annoyance level in the high-ANL group, and the amount of improvement was related to the baseline-aided ANL value.

Cochlear Implantation in Children with Postlingual Progressive Steeply Sloping High-Frequency Hearing Loss.

Children with steeply sloping sensorineural hearing loss (SNHL) lack access to critical high-frequency cues despite the use of advanced hearing aid technology. In addition, their auditory-only aided speech perception abilities often meet Food and Drug Administration criteria for cochlear implantation. The objective of this study was to describe hearing preservation and speech perception outcomes in a group of young children with steeply sloping SNHL who received a cochlear implant (CI). Retrospective case series. Eight children with steeply sloping postlingual progressive SNHL who received a unilateral traditional CI at Seattle Children's Hospital between 2009 and 2013 and had follow-up data available up to 24 mo postimplant were included. A retrospective chart review was completed. Medical records were reviewed for demographic information, preoperative and postoperative behavioral hearing thresholds, and speech perception scores. Paired t tests were used to analyze speech perception data. Hearing preservation results are reported. Rapid improvement of speech perception scores was observed within the first month postimplant for all participants. Mean monosyllabic word scores were 76% and mean phoneme scores were 86.7% at 1-mo postactivation compared to mean preimplant scores of 19.5% and 31.0%, respectively. Hearing preservation was observed in five participants out to 24-mo postactivation. Two participants lost hearing in both the implanted and unimplanted ear, and received a sequential bilateral CI in the other ear after progression of the hearing loss. One participant had a total loss of hearing in only the implanted ear. Results reported in this article are from the ear implanted first. Bilateral outcomes are not reported. CIs provided benefit for children with steeply sloping bilateral hearing loss for whom hearing aids did not provide adequate auditory access. In our cohort, significant improvements in speech understanding occurred rapidly postactivation. Preservation of residual hearing in children with a traditional CI electrode is possible.

Music Keeps the Hearing Brain Young

It's a story so familiar that it's become a clinical cliché: A retiree comes to the audiology clinic because she's having trouble hearing in daily settings. Her audiogram shows a sloping sensorineural hearing loss, and hearing aids are recommended. Two months later, she comes back for a check-up, and reports that the hearing aids have significantly helped her speech understanding in quiet settings, such as at home. Unfortunately, she still can't understand people in noisy environments like restaurants.hearing loss, music, cognitionSuccessful speech understanding in noisy environments hinges on factors that extend beyond the ear, including cognitive abilities and the integrity of sound processing in the brain. Musical training is a robust approach to strengthen these factors—and converging evidence shows that individuals with musical training hear better in noisy environments than their non-musician peers (Hear Res. 2017;352:49). What evidence is there that music might be a viable therapeutic approach for our retiree who needs more than her hearing aids? MUSIC AND THE AGING BRAIN Multiple studies have shown that a life of playing music mitigates age-related decline in the auditory brain. Music specifically strengthens the aspects of sound processing that are hallmarks of auditory aging. For example, older adults have slower neural responses to speech than younger adults. However, the brains of older adult musicians pick up the details of speech sounds as quickly as those of young, non-musician adults (Neurobiol Aging. 2012;33[7]:1483.e1). Older adults with musical training also have larger, more consistent, and more accurate neural responses to speech than older non-musicians with normal hearing or hearing loss (Front Aging Neurosci. 2012;4[30]). Moreover, older adult musicians show stronger functional connections between multiple auditory areas in the brain (J Neurosci. 2015;35[3]:1240). This suggests that musical training actively strengthens the brain mechanisms that support auditory processing, including in noisy environments. Together, this shows that a life of musical training mitigates age-related decline in auditory perception and the auditory brain. But is it too late for our retiree who needs more than hearing aids to boost her hearing skills? MUSIC AS AN INTERVENTION To date, relatively few studies have used musical training as an intervention for older adults. An encouraging piece of evidence comes from studies of more basic auditory training in older adults and animal models. For example, computerized auditory training speeds up neural timing and improves speech-in-noise perception in older adults (PNAS. 2013;12[11]:4357). This demonstrates that the aging brain still has the potential to benefit from training-induced neuroplasticity, providing support for a musical intervention. At the Neurosciences and Music VI – Music, Sound, and Health conference in Boston in June 2017, early results were presented from high-quality clinical trials of musical interventions for older adults. One major strength of these studies is that they employ medical models of research, including randomized assignment and placebo control groups. Although work is ongoing, early evidence suggests that musical training initiated later in life confers similar (albeit more modest) benefits as lifelong musical training. When evaluating clinical interventions, it's important to consider their economics in addition to their efficacy. These include the actual financial costs (such as instructors and classroom space), which are relatively low for group music classes. But another crucial factor in clinical interventions is the opportunity cost—in this case, the question is if patients undergoing musical training could spend their time more effectively doing something else. One of the reasons we think music has a low opportunity cost is because it confers health benefits beyond the hearing brain. There is emotional satisfaction that comes from engaging in music, and using a group lesson model for older adults provides an opportunity for social engagement. The high cognitive load involved in making music engages key systems such as attention and working memory. Music also engages the sensorimotor system through rhythm, which could mitigate older adults’ risk for falls. As we've discussed in previous columns in The Hearing Journal, hearing is connected to feeling, thinking, and moving—so the emotional, cognitive, and sensorimotor benefits of musical training could cascade to provide further reinforcement for hearing skills beyond their broader health benefits (Hearing Journal. 2017;70[9]:52; Trends Cogn Sci. 2015;19[11]:642). Ongoing research suggests musical training as a strategy to supplement amplification and aural rehabilitation to improve hearing health in older adults.Figure: Nina Kraus, PhDFigure: Travis White-Schwoch

Tonotopic organisation of the auditory cortex in sloping sensorineural hearing loss

Although the tonotopic organisation of the human primary auditory cortex (PAC) has already been studied, the question how its responses are affected in sensorineural hearing loss remains open. Twenty six patients (aged 38.1 ± 9.1 years; 12 men) with symmetrical sloping sensorineural hearing loss (SNHL) and 32 age- and gender-matched controls (NH) participated in an fMRI study using a sparse protocol. The stimuli were binaural 8s complex tones with central frequencies of 400 HzCF, 800 HzCF, 1600 HzCF, 3200 HzCF, or 6400 HzCF, presented at 80 dB(C). In NH responses to all frequency ranges were found in bilateral auditory cortices. The outcomes of a winnermap approach, showing a relative arrangement of active frequency-specific areas, was in line with the existing literature and revealed a V-shape high-frequency gradient surrounding areas that responded to low frequencies in the auditory cortex. In SNHL frequency-specific auditory cortex responses were observed only for sounds from 400 HzCF to 1600 HzCF, due to the severe or profound hearing loss in higher frequency ranges. Using a stringent statistical threshold (p < 0.05; FWE) significant differences between NH and SNHL were only revealed for mid and high-frequency sounds. At a more lenient statistical threshold (p < 0.001, FDRc), however, the size of activation induced by 400 HzCF in PAC was found statistically larger in patients with a prelingual, as compared to a postlingual onset of hearing loss. In addition, this low-frequency range was more extensively represented in the auditory cortex when outcomes obtained in all patients were contrasted with those revealed in normal hearing individuals (although statistically significant only for the secondary auditory cortex). The outcomes of the study suggest preserved patterns of large-scale tonotopic organisation in SNHL which can be further refined following auditory experience, especially when the hearing loss occurs prelingually. SNHL can induce both enlargement and reduction of the extent of responses in the topically organized auditory cortex.

Effects of Simulated Hearing Loss on Bilingual Children's Consonant Recognition in Noise.

This study investigated the possible impact of simulated hearing loss on speech perception in Spanish-English bilingual children. To avoid confound between individual differences in hearing-loss configuration and linguistic experience, threshold-elevating noise simulating a mild-to-moderate sloping hearing loss was used with normal-hearing listeners. The hypotheses were that: (1) bilingual children can perform similarly to English-speaking monolingual peers in quiet; (2) for both bilingual and monolingual children, noise and simulated hearing loss would have detrimental impacts consistent with their acoustic characteristics (i.e., consonants with high-frequency cues remain highly intelligible in speech-shaped noise, but suffer from simulated hearing loss more than other consonants); (3) differences in phonology and acquisition order between Spanish and English would have additional negative influence on bilingual children's recognition of some English consonants. Listeners were 11 English-dominant, Spanish-English bilingual children (6 to 12 years old) and 12 English-speaking, monolingual age peers. All had normal hearing and age-appropriate nonverbal intelligence and expressive English vocabulary. Listeners performed a listen-and-repeat speech perception task. Targets were 13 American English consonants embedded in vowel-consonant-vowel (VCV) syllables. VCVs were presented in quiet and in speech-shaped noise at signal-to-noise ratios (SNRs) of -5, 0, 5 dB (normal-hearing condition). For the simulated hearing-loss condition, threshold-elevating noise modeling a mild-to-moderate sloping sensorineural hearing loss profile was added to the normal-hearing stimuli for 0, 5 dB SNR, and quiet. Responses were scored for consonant correct. Individual listeners' performance was summarized for average across 13 consonants (overall) and for individual consonants. Groups were compared for the effects of background noise and simulated hearing loss. As predicted, group performed similarly in quiet. The simulated hearing loss had a considerable detrimental impact on both groups, even in the absence of speech-shaped noise. Contrary to our prediction, no group difference was observed at any SNR in either condition. However, although nonsignificant, the greater within-group variance for the bilingual children in the normal-hearing condition indicated a wider "normal" range than for the monolingual children. Interestingly, although it did not contribute to the group difference, bilingual children's overall consonant recognition in both conditions improved with age, whereas such a developmental trend for monolingual children was observed only in the simulated hearing-loss condition, suggesting possible effects of experience. As for the recognition of individual consonants, the influence of background noise or simulated hearing loss was similar between groups and was consistent with the prediction based on their acoustic characteristics. The results demonstrated that school-age, English-dominant, Spanish-English bilingual children can recognize English consonants in a background of speech-shaped noise with similar average accuracy as English-speaking monolingual age peers. The general impact of simulated hearing loss was also similar between bilingual and monolingual children. Thus, our hypothesis that bilingual children's English consonant recognition would suffer from background noise or simulated hearing loss more than the monolingual peers was rejected. However, the present results raise several issues that warrant further investigation, including the possible difference in the "normal" range for bilingual and monolingual children, influence of experience, impact of actual hearing loss on bilingual children, and stimulus quality.

Intelligibility and Clarity of Reverberant Speech: Effects of Wide Dynamic Range Compression Release Time and Working Memory.

The purpose of this study was to examine the effects of varying wide dynamic range compression (WDRC) release time on intelligibility and clarity of reverberant speech. The study also considered the role of individual working memory. Thirty older listeners with mild to moderately-severe sloping sensorineural hearing loss participated. Individuals were divided into high and low working memory groups on the basis of the results of a reading span test. Participants listened binaurally to sentence stimuli simulated at a range of reverberation conditions and WDRC release times using a high compression ratio. Outcome measures included objective intelligibility and subjective clarity ratings. Speech intelligibility and clarity ratings both decreased as a function of reverberation. The low working memory group demonstrated a greater decrease in intelligibility with increasing amounts of reverberation than the high working memory group. Both groups, regardless of working memory, had higher speech intelligibility and clarity ratings with longer WDRC release times. WDRC release time had a larger effect on speech intelligibility under more reverberant conditions. Reverberation significantly affects speech intelligibility, particularly for individuals with lower working memory. In addition, longer release times in hearing aids may improve listener speech intelligibility and clarity in reverberant environments.

Effects of Reverberation and Compression on Consonant Identification in Individuals with Hearing Impairment.

Hearing aids are frequently used in reverberant environments; however, relatively little is known about how reverberation affects the processing of signals by modern hearing-aid algorithms. The purpose of this study was to investigate the acoustic and behavioral effects of reverberation and wide-dynamic range compression (WDRC) in hearing aids on consonant identification for individuals with hearing impairment. Twenty-three listeners with mild to moderate sloping sensorineural hearing loss were tested monaurally under varying degrees of reverberation and WDRC conditions. Listeners identified consonants embedded within vowel-consonant-vowel nonsense syllables. Stimuli were processed to simulate a range of realistic reverberation times and WDRC release times using virtual acoustic simulations. In addition, the effects of these processing conditions were acoustically analyzed using a model of envelope distortion to examine the effects on the temporal envelope. Aided consonant identification significantly decreased as reverberation time increased. Consonant identification was also significantly affected by WDRC release time. This relationship was such that individuals tended to perform significantly better with longer release times. There was no significant interaction between reverberation and WDRC. The application of the acoustic model to the processed signal showed a close relationship between trends in the behavioral performance and distortion to the temporal envelope resulting from reverberation and WDRC. The results of the acoustic model demonstrated the same trends found in the behavioral data for both reverberation and WDRC. Reverberation and WDRC release time both affect aided consonant identification for individuals with hearing impairment, and these condition effects are associated with alterations to the temporal envelope. There was no significant interaction between reverberation and WDRC release time.

Effect of frequency lowering and auditory training on speech perception outcome

Abstract The aim of this study was to investigate the effect of auditory training on speech sound perception tasks in patients with steep sloping high-frequency sensorineural hearing loss using amplification with frequency-lowering hearing aids. This study was conducted on 10 adults with steeply sloping high-frequency sensorineural hearing loss using frequency-lowering hearing aids. Pretraining and post-training evaluation tasks were prepared to evaluate the ability to perceive vowels and consonants of Arabic language using lists of consonant-vowel-consonant and vowel-consonant-vowel syllables. Perception tasks included speech sound recognition and discrimination. Arabic exercise tasks were constructed and applied to provide directed training on voiceless consonant speech sounds. The study demonstrated enhancement in consonant perception using frequency lowering, provided the listeners were trained to conjugate between the newly perceived sounds moved to a functional neurophysiological substrate sensitive to lower frequency sounds. Auditory training with frequency-lowering hearing aids improves consonant perception in individuals with steep sloping sensorineural hearing loss.

Auditory brainstem responses to CE-Chirp® stimuli for normal ears and those with sensorineural hearing loss

Objective: Evaluation of the characteristic differences between click-and CE-Chirp-evoked auditory brainstem responses (ABRs) in normal hearing and sensorineural hearing loss. Design: A prospective study. Ears with normal hearing and with sensorineural hearing loss were evaluated. Pure-tone audiometry and click-and CE-Chirp evoked ABRs exams were conducted for all ears. Visual detection levels, wave-V amplitudes, and latencies of the ABRs were assessed. Study sample: Twenty-two ears with normal hearing and 22 ears with sloping type sensorineural hearing loss were examined. Results: In normal-hearing ears, mean amplitudes were larger for CE-chirps than for clicks at all intensities until 80 dB nHL, at which the amplitudes dropped off, presumably due to upward spread of excitation. In ears with sensorineural hearing loss, however the drop-off was less significant at 80 dB nHL. Comparisons with pure-tone audiometry findings revealed ABRs to CE-Chirps to correlate at 0.5, 1, 2, and 3 kHz, and to clicks at 1, 2, 3, and 4 kHz. Conclusions: The CE-Chirp has advantages over clicks for examining normal ears. However, under high-level stimulation, these advantages are no longer present. In ears with sensorineural hearing loss, the upward spread of excitation is less prominent. The CE-Chirps results correlate significantly to low frequency audiometric findings at 0.5 kHz, while clicks do not.

Consonant recognition in noise for bilingual children with simulated hearing loss

The negative impacts of noisy listening environments and hearing loss on speech communication are known to be greater for children and non-native speakers than adult native speakers. Naturally, the synergistic influence of listening environment and hearing loss is expected to be greater for bilingual children than their monolingual or normal-hearing peers, but limited studies have explored this issue. The present study compared the consonant recognition performance of highly fluent school-age Spanish-English bilingual children to that of monolingual English-speaking peers. Stimulus materials were 13 English consonants embedded in three symmetrical vowel-consonant-vowel (VCV) syllables. To control for variability in hearing loss profiles, mild-to-moderate sloping sensorineural hearing loss modeled after Pittman & Stelmachowicz [Ear Hear 24, 198–205 (2003)] was simulated following the method used by Desloge et al. [Trends Amplification 16(1), 19–39 (2012)]. Listeners heard VCVs in quiet and in the background of speech-shaped noise with and without simulated hearing loss. Overall performance and the recognition of individual consonants will be discussed in terms of the influence of language background (bilingual vs. monolingual), listening condition, simulated hearing loss, and vowel context. [Work supported by NIH.].