Speech Reception Threshold In Noise Research Articles

Three-year audiological outcomes of the latest generation middle ear transducer (MET) implant

PurposeTo evaluate the long-term audiological outcomes and safety of the latest generation of middle ear transducer (MET) among a group of Polish patients.MethodsTen patients aged 48–72 years with bilateral sensorineural hearing loss (n = 8) and mixed hearing loss (n = 2) were included in this study. Pure tone audiometry, sound thresholds, word recognition scores in quiet and speech reception thresholds in noise were assessed. Medical and technical complication information was gathered.ResultsAll the patients underwent unilateral implantation with the latest generation Cochlear MET between 2014 and 2016. Mean length of follow-up was 3.7 years. Compared to the unaided condition, the implant provided significant functional gain (mean M = 26.1 dB) at 12 months follow-up. Compared to before surgery, average word recognition in quiet at 65 dB and at 80 dB SPL, as well as speech reception threshold in noise, were significantly better at 12 months. However, postoperative air conduction thresholds 6 months after implantation worsened by 10.3 dB (standard deviation SD = 5.8 dB). Postoperatively, three patients had skin problems around the processor, and one of them completely resigned from using the device 5 months after activation. Technical failures occurred in 4 cases. There were 9 out of 10 patients who still used the MET, but only 5 of them used the processor regularly (every day).ConclusionDespite changes in the transducer implemented by the manufacturer, we observed a significant number of adverse events in users of the latest generation of MET.

The efficacy of microphone directionality in improving speech recognition in noise for three commercial cochlear-implant systems

Objectives: To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-implant (CI) use for three different CI systems.Methods: Twenty-four CI recipients with bilateral severe-to-profound hearing loss participated in the study. Eight recipients of each CI system were enrolled, and their SRT in noise was measured when the speech and noise signals were co-located in the front to serve as a baseline. The acute effect of different microphone directionalities on SRT in noise was measured with the noise emanating at 90° in the horizontal plane from the side of the CI sound processor (S0NCI).Results: When compared to the baseline condition, the individual data revealed fairly similar patterns within each CI system. In the S0NCI condition, the average improvement in SRT in noise for fixed and adaptive directionalities over the omnidirectional mode was statistically significant and ranged from 1.2 to 6.0 dB SNR and from 3.7 to 12.7 dB SNR depending on the CI system, respectively.Discussion: Directional microphones significantly improve SRT in noise for all three CI systems. However, relatively large differences were observed in the directional microphone efficacy between CI systems.

English language and language-free detection of spatial processing disorders in Aboriginal and Torres Strait Islander children

Objective The aim of this study was to compare speech reception thresholds in noise measured with the Listening in Spatialised Noise – Universal test (LiSN-U; which requires no English knowledge) with those measured from the relevant conditions of the LiSN – Sentences test (LiSN-S; a test requiring knowledge of English) in Aboriginal and Torres Strait Islander children. A second aim was to compare the ability of the two tests to detect spatial processing disorder. Design Participants completed audiometry, the LiSN-S, and the LiSN-U. Study sample 90 Aboriginal and Torres Strait Islander children aged six to 14 years tested in a school setting. Results Strong correlations were found between speech reception thresholds in noise for the two tests. A moderate correlation was found between the difference scores that each test uses to detect spatial processing disorder. Consistent diagnoses of whether a child had spatial processing disorder or not on both tests were found for 72% of children. Conclusions The moderate-to-strong relationships and agreement between diagnoses found for the LiSN-S and LiSN-U show promise for the LiSN-U being used as a tool to investigate spatial processing disorder in children, without requiring the test to use a language familiar to the children being tested.

The relation of hearing-specific patient-reported outcome measures with speech perception measures and acceptable noise levels in cochlear implant users

Objective: To investigate the relation of a hearing-specific patient-reported outcome measure (PROM) with speech perception and noise tolerance measurements. It was hypothesised that speech intelligibility in noise and noise tolerance may explain a larger part of the variance in PROM scores than speech intelligibility in quiet.Design: This cross-sectional study used the Speech, Spatial, Qualities (SSQ) questionnaire as a PROM. Speech recognition in quiet, the Speech Reception Threshold in noise and noise tolerance as measured with the acceptable noise level (ANL) were measured with sentences.Study sample: A group of 48 unilateral post-lingual deafened cochlear implant (CI) users.Results: SSQ scores were moderately correlated with speech scores in quiet and noise, and also with ANLs. Speech scores in quiet and noise were strongly correlated. The combination of speech scores and ANL explained 10–30% of the variances in SSQ scores, with ANLs adding only 0–9%.Conclusions: The variance in the SSQ as hearing-specific PROM in CI users was not better explained by speech intelligibility in noise than by speech intelligibility in quiet, because of the remarkably strong correlation between both measures. ANLs made only a small contribution to explain the variance of the SSQ. ANLs seem to measure other aspects than the SSQ.

Hearing Aid Treatment for Patients with Mixed Hearing Loss. Part II: Speech Recognition in Comparison to Direct Acoustic Cochlear Stimulation

Background: The conventional therapy for severe mixed hearing loss is middle ear surgery combined with a power hearing aid. However, a substantial group of patients with severe mixed hearing loss cannot be treated adequately with today’s state-of-the-art (SOTA) power hearing aids, as predicted by the accompanying part I of this publication, where we compared the available maximum power output (MPO) and gain from technical specifications to requirements for optimum benefit using a common fitting rule. Here, we intended to validate the theoretical assumptions from part I experimentally in a mixed hearing loss cohort fitted with SOTA power hearing aids. Additionally, we compared the results with an implantable hearing device that circumvents the impaired middle ear, directly stimulating the cochlea, as this might be a better option. Objectives: Speech recognition outcomes obtained from patients with severe mixed hearing loss supplied acutely with a SOTA hearing aid were studied to validate the outcome predictions as described in part I. Further, the results obtained with hearing aids were compared to those in direct acoustic cochlear implant (DACI) users. Materials and Methods: Twenty patients (37 ears with mixed hearing loss) were provided and fitted with a SOTA power hearing aid. Before and after an acclimatization period of at least 4 weeks, word recognition scores (WRS) in quiet and in noise were studied, as well as the speech reception threshold in noise (SRT). The outcomes were compared retrospectively to a second group of 45 patients (47 ears) using the DACI device. Based on the severity of the mixed hearing loss and the available gain and MPO of the SOTA hearing aid, the hearing aid and DACI users were subdivided into groups with prediction of sufficient, partially insufficient, or very insufficient hearing aid performance. Results: The patients with predicted adequate SOTA hearing aid performance indeed showed the best WRS in quiet and in noise when compared to patients with predicted inferior outcomes. Insufficient hearing aid performance at one or more frequencies led to a gradual decrease in hearing aid benefit, validating the criteria used here and in the accompanying paper. All DACI patients showed outcomes at the same level as the adequate hearing aid performance group, being significantly better than those of the groups with inadequate hearing aid performance. Whereas WRS in quiet and noise were sensitive to insufficient gain or output, showing significant differences between the SOTA hearing aid and DACI groups, the SRT in noise was less sensitive. Conclusions: Limitations of outcomes in mixed hearing loss individuals due to insufficient hearing aid performance can be accurately predicted by applying a commonly used fitting rule and the 35-dB dynamic range rule on the hearing aid specifications. Evidently, when outcomes in patients with mixed hearing loss using the most powerful hearing aids are insufficient, bypassing the middle ear with a powerful active middle ear implant or direct acoustic implant can be a promising alternative treatment.

Robust Data-Driven Auditory Profiling Towards Precision Audiology.

The sources and consequences of a sensorineural hearing loss are diverse. While several approaches have aimed at disentangling the physiological and perceptual consequences of different etiologies, hearing deficit characterization and rehabilitation have been dominated by the results from pure-tone audiometry. Here, we present a novel approach based on data-driven profiling of perceptual auditory deficits that attempts to represent auditory phenomena that are usually hidden by, or entangled with, audibility loss. We hypothesize that the hearing deficits of a given listener, both at hearing threshold and at suprathreshold sound levels, result from two independent types of “auditory distortions.” In this two-dimensional space, four distinct “auditory profiles” can be identified. To test this hypothesis, we gathered a data set consisting of a heterogeneous group of listeners that were evaluated using measures of speech intelligibility, loudness perception, binaural processing abilities, and spectrotemporal resolution. The subsequent analysis revealed that distortion type-I was associated with elevated hearing thresholds at high frequencies and reduced temporal masking release and was significantly correlated with elevated speech reception thresholds in noise. Distortion type-II was associated with low-frequency hearing loss and abnormally steep loudness functions. The auditory profiles represent four robust subpopulations of hearing-impaired listeners that exhibit different degrees of perceptual distortions. The four auditory profiles may provide a valuable basis for improved hearing rehabilitation, for example, through profile-based hearing-aid fitting.

10-Year Follow-Up Results of The Netherlands Longitudinal Study on Hearing: Trends of Longitudinal Change in Speech Recognition in Noise.

Previous findings of longitudinal cohort studies indicate that acceleration in age-related hearing decline may occur. Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) showed that around the age of 50 years, the decline in speech recognition in noise accelerates compared with the change in hearing in younger participants. Other longitudinal studies confirm an accelerated loss in speech recognition in noise but mostly use older age groups as a reference. In the present study, we determined the change in speech recognition in noise over a period of 10 years in participants aged 18 to 70 years at baseline. We additionally investigated the effects of age, sex, educational level, history of tobacco smoking, and alcohol use on the decline of speech recognition in noise. Baseline (T0), 5-year (T1), and 10-year (T2) follow-up data of the NL-SH collected until May 2017 were included. The NL-SH is a web-based prospective cohort study which started in 2006. Central to the NL-SH is the National Hearing test (NHT) which was administered to the participants at all three measurement rounds. The NHT uses three-digit sequences which are presented in a background of stationary noise. The listener is asked to enter the digits using the computer keyboard. The outcome of the NHT is the speech reception threshold in noise (SRT) (i.e., the signal to noise ratio where a listener recognizes 50% of the digit triplets correctly). In addition to the NHT, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics at T0, T1, and T2. A linear mixed model was used for the analysis of longitudinal changes in SRT. Data of 1349 participants were included. At the start of the study, the mean age of the participants was 45 years (SD 13 years) and 61% of the participants were categorized as having good hearing ability in noise. SRTs significantly increased (worsened) over 10 years (p < 0.001). After adjustment for age, sex, and a history of tobacco smoking, the mean decline over 10 years was 0.89 dB signal to noise ratio. The decline in speech recognition in noise was significantly larger in groups aged 51 to 60 and 61 to 70 years compared with younger age groups (18 to 30, 31 to 40, and 41 to 50 years) (p < 0.001). Speech recognition in noise in participants with a history of smoking declined significantly faster during the 10-year follow-up interval (p = 0.003). Sex, educational level, and alcohol use did not appear to influence the decline of speech recognition in noise. This study indicated that speech recognition in noise declines significantly over a 10-year follow-up period in adults aged 18 to 70 years at baseline. It is the first longitudinal study with a 10-year follow-up to reveal that the increased rate of decline in speech recognition ability in noise already starts at the age of 50 years. Having a history of tobacco smoking increases the decline of speech recognition in noise. Hearing health care professionals should be aware of an accelerated decline of speech recognition in noise in adults aged 50 years and over.

Relationship between cochlear mechanics and speech-in-noise reception performance

Some normal-hearing listeners report difficulties in speech perception in noisy environments, and the cause is not well understood. The present study explores the correlation between speech-in-noise reception performance and cochlear mechanical characteristics, which were evaluated using a principal component analysis of the otoacoustic emission (OAE) spectra. A principal component, specifically a characteristic dip at around 2-2.5 kHz in OAE spectra, correlated with speech reception thresholds in noise but not in quiet. The results suggest that subclinical cochlear dysfunction specifically contributes to difficulties in speech perception in noisy environments, which is possibly a new form of "hidden hearing deficits."

Speech polar plots for different directionality settings of SONNET cochlear implant processor

Objectives: The newest CI processor from MED-EL company, the SONNET, has two new directional microphone settings. Besides the Omnidirectional microphone mode, it has the possibility to switch to Natural or Adaptive directionality. Both new modes favour perception of sound coming from a front-facing direction compared to sounds from sources at alternate azimuths. Natural directionality mimics the pinna effect of the normal external ear.Design: We undertook to verify the effect of these options in vivo by means of clinical audiological tests. Speech reception thresholds were successively measured for a variety of speech presentation azimuths while keeping the noise azimuths constant. Complete ‘Speech Reception Threshold (SRT)-Polar-Plots’ were obtained from these data for the Omnidirectional and Natural directionality modes of the SONNET. In addition, one ‘SRT-point’ was also measured in the ‘Adaptive’ mode for speech coming from 45° azimuth.Study sample: A group of 13 adult CI recipients participated. Only one of these subjects had previous experience with the SONNET processor.Results: Complete ‘SRT-Polar-Plots’ could be measured in Natural and Omnidirectional modes in CI recipients within an acceptable timeframe. The pinna-following directionality for Natural mode could be confirmed. Median SRT in noise for speech coming from the 45° azimuth speaker was −5.6 dB SNR for Omnidirectional, −9.1 dB SNR for Natural and −12.8 dB SNR for Adaptive microphone. Natural and Adaptive significantly improved performance compared to Omnidirectional mode at this optimal azimuth of 45° with a median improvement in SRT of 3.5 and 7.2 dB respectively.Conclusions: A novel audiological method, ‘SRT-Polar-Plot’, was developed and described. Significant directionality benefits for Natural and Adaptive mode were confirmed in vivo using this technique.

The Bonebridge in Adults with Mixed and Conductive Hearing Loss: Audiological and Quality of Life Outcomes

Background: Considering that hearing loss has a significant impact on social functioning, everyday activity and a person’s emotional state, one of the most important goals of hearing rehabilitation with bone conduction devices is improvement in a patient’s quality of life. Objectives: To measure self-assessed quality of life in patients implanted with the Bonebridge, a bone conduction device. Method: Prospective, observational, longitudinal study with one treatment group. Twenty-one patients with mixed or conductive hearing loss were included, and each individual served as its own control. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to measure patient-reported quality of life before intervention and at 3 and 6 months after activation of the device. At the same time frames, pure-tone audiometry and speech understanding in quiet and in noise were tested. Results: Hearing-specific quality of life increased significantly after intervention and remained stable up to 6 months. Both word recognition in quiet and speech reception threshold in noise were significantly better after 6 months compared to before surgery. Outcomes of aided speech understanding were independent of initial bone conduction thresholds and equally high (word recognition score >75%) across the device’s indication range. Conclusions: The Bonebridge provides not only significant audiological benefit in both speech understanding in quiet and in noise, but also increases self-perceived quality of life in patients suffering from mixed and conductive hearing loss. Together with a very low rate and minor nature of adverse events, it is the state-of-the-art solution for hearing rehabilitation in patients with mixed or conductive hearing loss up to a bone conduction threshold of 45 dB HL.

Poorer Speech Reception Threshold in Noise Is Associated With Lower Brain Volume in Auditory and Cognitive Processing Regions.

Purpose Hearing loss is associated with changes in brain volume in regions supporting auditory and cognitive processing. The purpose of this study was to determine whether there is a systematic association between hearing ability and brain volume in cross-sectional data from a large nonclinical cohort of middle-aged adults available from the UK Biobank Resource ( http://www.ukbiobank.ac.uk ). Method We performed a set of regression analyses to determine the association between speech reception threshold in noise (SRTn) and global brain volume as well as predefined regions of interest (ROIs) based on T1-weighted structural images, controlling for hearing-related comorbidities and cognition as well as demographic factors. In a 2nd set of analyses, we additionally controlled for hearing aid (HA) use. We predicted statistically significant associations globally and in ROIs including auditory and cognitive processing regions, possibly modulated by HA use. Results Whole-brain gray matter volume was significantly lower for individuals with poorer SRTn. Furthermore, the volume of 9 predicted ROIs including both auditory and cognitive processing regions was lower for individuals with poorer SRTn. The greatest percentage difference (-0.57%) in ROI volume relating to a 1 SD worsening of SRTn was found in the left superior temporal gyrus. HA use did not substantially modulate the pattern of association between brain volume and SRTn. Conclusions In a large middle-aged nonclinical population, poorer hearing ability is associated with lower brain volume globally as well as in cortical and subcortical regions involved in auditory and cognitive processing, but there was no conclusive evidence that this effect is moderated by HA use. This pattern of results supports the notion that poor hearing leads to reduced volume in brain regions recruited during speech understanding under challenging conditions. These findings should be tested in future longitudinal, experimental studies. Supplemental Material https://doi.org/10.23641/asha.7949357.

Time-compression thresholds for Mandarin sentences in normal-hearing and cochlear implant listeners

Faster speech may facilitate more efficient communication, but if speech is too fast it becomes unintelligible. The maximum speeds at which Mandarin words were intelligible in a sentence context were quantified for normal hearing (NH) and cochlear implant (CI) listeners by measuring time-compression thresholds (TCTs) in an adaptive staircase procedure. In Experiment 1, both original and CI-vocoded time-compressed speech from the MSP (Mandarin speech perception) and MHINT (Mandarin hearing in noise test) corpora was presented to 10 NH subjects over headphones. In Experiment 2, original time-compressed speech was presented to 10 CI subjects and another 10 NH subjects through a loudspeaker in a soundproof room. Sentences were time-compressed without changing their spectral profile, and were presented up to three times within a single trial. At the end of each trial, the number of correctly identified words in the sentence was scored. A 50%-word recognition threshold was tracked in the psychophysical procedure. The observed median TCTs were very similar for MSP and MHINT speech. For NH listeners, median TCTs were around 16.7 syllables/s for normal speech, and 11.8 and 8.6 syllables/s respectively for 8 and 4 channel tone-carrier vocoded speech. For CI listeners, TCTs were only around 6.8 syllables/s. The interquartile range of the TCTs within each cohort was smaller than 3.0 syllables/s. Speech reception thresholds in noise were also measured in Experiment 2, and were found to be strongly correlated with TCTs for CI listeners. In conclusion, the Mandarin sentence TCTs were around 16.7 syllables/s for most NH subjects, but rarely faster than 10.0 syllables/s for CI listeners, which quantitatively illustrated upper limits of fast speech information processing with CIs.

Evidence for age-related cochlear synaptopathy in humans unconnected to speech-in-noise intelligibility deficits

Cochlear synaptopathy (or the loss of primary auditory synapses) remains a subclinical condition of uncertain prevalence. Here, we investigate whether it affects humans and whether it contributes to suprathreshold speech-in-noise intelligibility deficits. For 94 human listeners with normal audiometry (aged 12–68 years; 64 women), we measured click-evoked auditory brainstem responses (ABRs), self-reported lifetime noise exposure, and speech reception thresholds for sentences (at 65 dB SPL) and words (at 50, 65 and 80 dB SPL) in steady-state and fluctuating maskers. Based on animal research, we assumed that the shallower the rate of growth of ABR wave-I amplitude versus level function, the higher the risk of suffering from synaptopathy. We found that wave-I growth rates decreased with increasing age but not with increasing noise exposure. Speech reception thresholds in noise were not correlated with wave-I growth rates and mean speech reception thresholds were not statistically different for two subgroups of participants (N = 14) with matched audiograms (up to 12 kHz) but different wave-I growth rates. Altogether, the data are consistent with the existence of age-related but not noise-related synaptopathy. In addition, the data dispute the notion that synaptopathy contributes to suprathreshold speech-in-noise intelligibility deficits.

Cochlear implantation for single-sided deafness in children and adolescents

ObjectiveTo evaluate outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation. MethodsA retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage. ResultsNine pediatric and adolescent patients with SSD were implanted between 2011 and 2017. The median age at implantation was 8.9 years (range, 1.5–15.1) and the children had a median duration of deafness 2.9 years (range, 0.8–9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3–27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5% points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5% points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved. ConclusionPediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

Efficient Adaptive Speech Reception Threshold Measurements Using Stochastic Approximation Algorithms.

This study examines whether speech-in-noise tests that use adaptive procedures to assess a speech reception threshold in noise (SRT50n) can be optimized using stochastic approximation (SA) methods, especially in cochlear-implant (CI) users. A simulation model was developed that simulates intelligibility scores for words from sentences in noise for both CI users and normal-hearing (NH) listeners. The model was used in Monte Carlo simulations. Four different SA algorithms were optimized for use in both groups and compared with clinically used adaptive procedures. The simulation model proved to be valid, as its results agreed very well with existing experimental data. The four optimized SA algorithms all provided an efficient estimation of the SRT50n. They were equally accurate and produced smaller standard deviations (SDs) than the clinical procedures. In CI users, SRT50n estimates had a small bias and larger SDs than in NH listeners. At least 20 sentences per condition and an initial signal-to-noise ratio below the real SRT50n were required to ensure sufficient reliability. In CI users, bias and SD became unacceptably large for a maximum speech intelligibility score in quiet below 70%. In conclusion, SA algorithms with word scoring in adaptive speech-in-noise tests are applicable to various listeners, from CI users to NH listeners. In CI users, they lead to efficient estimation of the SRT50n as long as speech intelligibility in quiet is greater than 70%. SA procedures can be considered as a valid, more efficient, and alternative to clinical adaptive procedures currently used in CI users.

Improving Localization and Speech Reception in Noise for Bilateral Cochlear Implant Recipients.

This study looked at different methods to preserve interaural level difference (ILD) cues for bilateral cochlear implant (BiCI) recipients. One possible distortion to ILD is from automatic gain control (AGC). Localization accuracy of BiCI recipients using default versus increased AGC threshold and linked AGCs versus independent AGCs was examined. In addition, speech reception in noise was assessed using linked versus independent AGCs and enabling and disabling Autosensitivity™ Control. Subjective information via a diary and questionnaire was also collected about maps with linked and independent AGCs during a take-home experience. Localization accuracy improved in the increased AGC threshold and the linked AGCs conditions. Increasing the AGC threshold resulted in a 4° improvement in root mean square error averaged across all speaker locations. Using linked AGCs, BiCI participants experienced an 8° improvement for all speaker locations and a 19° improvement at the speaker location most affected by the AGC. Speech reception threshold in noise improved by an average of 2.5 dB when using linked AGCs versus independent AGCs. In addition, the effect of linked AGCs on speech in noise was compared with that of Autosensitivity™ Control. The Speech, Spatial, and Qualities of Hearing Scale-12 question comparative survey showed an improvement when using maps with linked AGCs. These findings support the hypothesis that ILD cues may be preserved by increasing the AGC threshold or linking AGCs.

Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise

Objectives:The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise.Design:In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps.Results:Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise.Conclusions:Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older.

Unilateral and Bilateral Audiological Benefit With an Adhesively Attached, Noninvasive Bone Conduction Hearing System.

To assess the audiological benefit of a noninvasive, adhesively attached bone conduction device (BCD1) in subjects with induced bilateral conductive hearing loss. Secondary objectives were to evaluate the additional benefit of bilateral fitting compared with unilateral fitting and to compare the outcomes with bone conduction devices attached to a softband (BCD2). Prospective nonrandomized crossover study. Tertiary referral center. Fifteen subjects with induced bilateral conductive hearing loss. Sound field thresholds, speech understanding in quiet and in multinoise were assessed in unaided, unilateral, and bilateral treatment conditions. In addition, sound localization was evaluated in uni- and bilateral treatment conditions. The outcomes of BCD1 and BCD2 were comparable. Sound field thresholds improved by 24.6 dB (BCD1) and 24.8 dB (BCD2) in the unilateral and 26.8 dB (BCD1) and 25.1 dB (BCD2) in the bilateral treatment condition. Speech reception thresholds (SRTs) in quiet improved by 20.0 dB (BCD1) and 21.7 dB (BCD2) in the unilateral and by 22.7 dB (BCD1) and 21.5 dB (BCD2) in the bilateral condition. If speech was presented from the front, SRTs in noise were improved by 3.6 dB and 4.2 dB (unilateral) and by 4.5 dB and 4.4 dB (bilateral) for BCD1 and BCD2, respectively. With speech presented from the unilateral side, SRTs were improved by 4.0 dB and 4.7 dB (unilateral) and 3.8 dB and 4.8 dB (bilateral) compared with the unaided situation. If noise was presented from the contralateral side, small differences (-0.6 dB and -0.1 dB) were observed. Bilateral fitting brought additional benefits for speech understanding in noise and sound localization. Both bone conduction devices seem to be a valid treatment for patients with conductive hearing loss and minor sensorineural hearing loss component.

Retrospective Analysis of Hearing-Impaired Adult Patients Treated With an Active Transcutaneous Bone Conduction Implant.

To determine the therapeutic success and safety of an active transcutaneous bone conduction implant (tBCI) in adult patients with conductive or mixed hearing loss. Retrospective case review. Five university hospitals in Frankfurt, Hannover, Dresden, Würzburg, and Vienna. Data were analyzed from 61 patients (31 women, 30 men) with a mean age of 50 years (min. 26, max. 80). Forty patients had mixed, and 21 conductive hearing loss. Typical etiologies were history of otitis media (n = 20) and cholesteatoma (n = 17). Implantation of the active tBCI. Data were analyzed for the following time points: up to 6 months postoperatively ("short-term"), 6 to 37 months postoperatively ("long-term"), and the last available measurement per patient ("most recent"). Pure-tone audiometry (air and bone conduction, AC and BC) and sound field thresholds with warble tones (WT), word recognition scores with Freiburger monosyllables (WRS), as well as speech reception thresholds (SRT) using the Oldenburg sentence test (OLSA) in quiet (SRT) and in noise (signal-to-noise ratio, SNR) were collected. No significant changes in air- and bone-conduction thresholds were observed after implantation. A mean WRS improvement of 54% using the active tBCI was shown at the short-term assessment, i.e., a mean score of 79% compared with 25% in the unaided condition. Results remained stable, with a mean score of 75% at the long-term assessment. SRT in noise improved by 3.6 dB SNR in the implanted ear at the short-term assessment. Overall six adverse events and four serious adverse events were reported, resulting in a rate of 9.84 and 6.56%, respectively. The tBCI clearly improves speech intelligibility in patients with conductive or mixed hearing loss, showing stable results up to 1 year post-implantation.

Explaining Discrepancies Between the Digit Triplet Speech-in-Noise Test Score and Self-Reported Hearing Problems in Older Adults.

The purpose of this study is to determine which demographic, health-related, mood, personality, or social factors predict discrepancies between older adults' functional speech-in-noise test result and their self-reported hearing problems. Data of 1,061 respondents from the Longitudinal Aging Study Amsterdam were used (ages ranged from 57 to 95 years). Functional hearing problems were measured using a digit triplet speech-in-noise test. Five questions were used to assess self-reported hearing problems. Scores of both hearing measures were dichotomized. Two discrepancy outcomes were created: (a) being unaware: those with functional but without self-reported problems (reference is aware: those with functional and self-reported problems); (b) reporting false complaints: those without functional but with self-reported problems (reference is well: those without functional and self-reported hearing problems). Two multivariable prediction models (logistic regression) were built with 19 candidate predictors. The speech reception threshold in noise was kept (forced) as a predictor in both models. Persons with higher self-efficacy (to initiate behavior) and higher self-esteem had a higher odds to being unaware than persons with lower self-efficacy scores (odds ratio [OR] = 1.13 and 1.11, respectively). Women had a higher odds than men (OR = 1.47). Persons with more chronic diseases and persons with worse (i.e., higher) speech-in-noise reception thresholds in noise had a lower odds to being unaware (OR = 0.85 and 0.91, respectively) than persons with less diseases and better thresholds, respectively. A higher odds to reporting false complaints was predicted by more depressive symptoms (OR = 1.06), more chronic diseases (OR = 1.21), and a larger social network (OR = 1.02). Persons with higher self-efficacy (to complete behavior) had a lower odds (OR = 0.86), whereas persons with higher self-esteem had a higher odds to report false complaints (OR = 1.21). The explained variance of both prediction models was small (Nagelkerke R2 = .11 for the unaware model, and .10 for the false complaints model). The findings suggest that a small proportion of the discrepancies between older individuals' results on a speech-in-noise screening test and their self-reports of hearing problems can be explained by the unique context of these individuals. The likelihood of discrepancies partly depends on a person's health (chronic diseases), demographics (gender), personality (self-efficacy to initiate behavior and to persist in adversity, self-esteem), mood (depressive symptoms), and social situation (social network size). Implications are discussed.