Showing papers in "Journal of The American Academy of Audiology in 2016"

The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia.

Abstract: Background: Hearing loss and dementia are both prevalent in late adulthood. The most common test used to determine cognitive status in late adulthood, the Mini–Mental State Examination (MMSE), is presented face to face, usually in the context of the physician’s office in the presence of background noise. Despite the problems of hearing loss and cognitive problems in late life, there is an absence of evidence linking hearing-related deficits to performance on the MMSE and dementia diagnoses. Purpose: This study examined the effect of decreased audibility on performance on the MMSE. Research Design: A between-subjects design was implemented. Participants were randomly assigned to one of five degrees of simulated hearing loss conditions and were blinded to condition assignment. Study Sample: One hundred and twenty-five young normal-hearing participants were randomized into five conditions of varying degrees of simulated hearing loss. Data Collection and Analysis: Performance on the MMSE was scored and cognitive status was categorized based on the scores. Analysis of variance with conditions as a between-subjects factor was conducted with post hoc multiple comparisons to determine the effect of audibility on performance. Results: Reduced audibility significantly affected performance on the MMSE in a sample of young adults, resulting in greater apparent cognitive deficits as audibility decreased. Conclusions: Apparent cognitive deficits based on MMSE scores obtained in test conditions in which audibility is reduced could result in incorrectly identified cognitive loss if clinicians are not alert to hearing loss when patients are evaluated. Furthermore, health care providers should be cautious when using family report of cognitive impairment to diagnose dementia without accounting for hearing loss because the impression of family members may be based on misinterpretation of the effects of hearing loss.

Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program.

Abstract: Background: Guidelines and protocols for pediatric hearing aid fitting are necessary to meet the goals of Early Hearing Detection and Intervention (EHDI) programs. The American Academy of Audiology published an update to their Pediatric Amplification Guideline in 2013. Ontario's Infant Hearing Program (IHP) offers specific protocols that aim to fulfill recommended guidelines. It has recently been updated to align with the American Academy of Audiology Guideline and other evidence. Purpose: A summary of the updates to the Ontario IHP’s Amplification Protocol is described. In addition, data illustrating hearing-related outcomes of the program are offered. Research Design: The updated Ontario protocol is based on evidence, wherever possible. Where research is not yet available, clinical decision support has been described in a systematic way. Outcomes of the Ontario IHP were obtained through a longitudinal clinical observation study. Study Sample: One hundred and fifteen children with hearing loss, who wore hearing aids, were included in the outcome analyses (mean = 28.6 mo; range = 1.3–115.3 mo). Hearing losses ranged from mild to profound, unilateral or bilateral sensorineural (pure-tone average = 52.3 dB HL). They were recruited from four IHP clinics within Ontario. Children with complexities in addition to hearing loss were included. Intervention: The children were fitted with hearing aids following Ontario's Amplification Protocol. Data Collection and Analyses: During routine clinical appointments, IHP Audiologists administered questionnaires to the parents of their pediatric patients using a systematic outcome measurement protocol (University of Western Ontario Pediatric Audiological Monitoring Protocol). Hearing aid fitting details (e.g., speech intelligibility index) were also gathered to describe the quality of the hearing aid fittings in relation to the functional outcomes. Regression analyses were conducted to characterize scores on the questionnaires and the impact of important variables. Children with complexities were analyzed separately from those who were typically developing. Results: Important updates to Ontario's Amplification Protocol offer new details about candidacy considerations as well as technical updates. Outcomes from the IHP reveal protocol elements can be executed clinically and when they are, typically developing children who wear hearing aids are meeting auditory development and performance milestones. Conclusions: Updates to Ontario's Amplification Protocol are necessary to support the evolution of EHDI programs and the evidence which sustains them. With advances in technology and additional research, pediatric hearing aid fitting will continue to progress and support systematic measurement of outcomes for children who wear hearing aids. The application of state-of-the-art hearing aid fitting practices to the pediatric population within EHDI programs supports good outcomes for infants and children with hearing loss.

Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes.

Abstract: Background Up to 15% of children with permanent hearing loss have auditory neuropathy spectrum disorder (ANSD), which involves normal outer hair cell function and disordered afferent neural activity in the auditory nerve or brainstem. Given the varying presentations of ANSD in children, there is a need for more evidence-based research on appropriate clinical interventions for this population.

The Effects of Hearing Aid Directional Microphone and Noise Reduction Processing on Listening Effort in Older Adults with Hearing Loss.

Abstract: Background: Older listeners with hearing loss may exert more cognitive resources to maintain a level of listening performance similar to that of younger listeners with normal hearing. Unfortunately, this increase in cognitive load, which is often conceptualized as increased listening effort, may come at the cost of cognitive processing resources that might otherwise be available for other tasks. Purpose: The purpose of this study was to evaluate the independent and combined effects of a hearing aid directional microphone and a noise reduction (NR) algorithm on reducing the listening effort older listeners with hearing loss expend on a speech-in-noise task. Research Design: Participants were fitted with study worn commercially available behind-the-ear hearing aids. Listening effort on a sentence recognition in noise task was measured using an objective auditory–visual dual-task paradigm. The primary task required participants to repeat sentences presented in quiet and in a four-talker babble. The secondary task was a digital visual pursuit rotor-tracking test, for which participants were instructed to use a computer mouse to track a moving target around an ellipse that was displayed on a computer screen. Each of the two tasks was presented separately and concurrently at a fixed overall speech recognition performance level of 50% correct with and without the directional microphone and/or the NR algorithm activated in the hearing aids. In addition, participants reported how effortful it was to listen to the sentences in quiet and in background noise in the different hearing aid listening conditions. Study Sample: Fifteen older listeners with mild sloping to severe sensorineural hearing loss participated in this study. Results: Listening effort in background noise was significantly reduced with the directional microphones activated in the hearing aids. However, there was no significant change in listening effort with the hearing aid NR algorithm compared to no noise processing. Correlation analysis between objective and self-reported ratings of listening effort showed no significant relation. Conclusions: Directional microphone processing effectively reduced the cognitive load of listening to speech in background noise. This is significant because it is likely that listeners with hearing impairment will frequently encounter noisy speech in their everyday communications.

Factors Affecting Daily Cochlear Implant Use in Children: Datalogging Evidence.

Abstract: BACKGROUND Children with profound hearing loss can gain access to sound through cochlear implants (CIs), but these devices must be worn consistently to promote auditory development. Although subjective parent reports have identified several factors limiting long-term CI use in children, it is also important to understand the day-to-day issues which may preclude consistent device use. In the present study, objective measures gathered through datalogging software were used to quantify the following in children: (1) number of hours of CI use per day, (2) practical concerns including repeated disconnections between the external transmission coil and the internal device (termed "coil-offs"), and (3) listening environments experienced during daily use. PURPOSE This study aimed to (1) objectively measure daily CI use and factors influencing consistent device use in children using one or two CIs and (2) evaluate the intensity levels and types of listening environments children are exposed to during daily CI use. RESEARCH DESIGN Retrospective analysis. STUDY SAMPLE Measures of daily CI use were obtained from 146 pediatric users of Cochlear Nucleus 6 speech processors. The sample included 5 unilateral, 40 bimodal, and 101 bilateral CI users (77 simultaneously and 24 sequentially implanted). DATA COLLECTION AND ANALYSIS Daily CI use, duration, and frequency of coil-offs per day, and the time spent in multiple intensity ranges and environment types were extracted from the datalog saved during clinic appointments. Multiple regression analyses were completed to predict daily CI use based on child-related demographic variables, and to evaluate the effects of age on coil-offs and environment acoustics. RESULTS Children used their CIs for 9.86 ± 3.43 hr on average on a daily basis, with use exceeding 9 hr per day in ∼64% of the children. Daily CI use reduced significantly with increasing durations of coil-off (p = 0.027) and increased significantly with longer CI experience (p < 0.001) and pre-CI acoustic experience (p < 0.001), when controlled for the child's age. Total time in sound (sum of CI and pre-CI experience) was positively correlated with CI use (r = 0.72, p < 0.001). Longer durations of coil-off were associated with higher frequency of coil-offs (p < 0.001). The frequency of coil-offs ranged from 0.99 to 594.10 times per day and decreased significantly with age (p < 0.001). Daily CI use and frequency of coil-offs did not vary significantly across known etiologies. Listening environments of all children typically ranged between 50 and 70 dBA. Children of all ages were exposed to speech in noisy environments. Environment classified as "music" was identified more often in younger children. CONCLUSIONS The majority of children use their CIs consistently, even during the first year of implantation. The frequency of coil-offs is a practical challenge in infants and young children, and demonstrates the need for improved coil retention methods for pediatric use. Longer hearing experience and shorter coil-off time facilitates consistent CI use. Children are listening to speech in noisy environments most often, thereby indicating a need for better access to binaural cues, signal processing, and stimulation strategies to aid listening. Study findings could be useful in parent counseling of young and/or new CI users.

Effects of Hearing Loss on Dual-Task Performance in an Audiovisual Virtual Reality Simulation of Listening While Walking.

Abstract: Background Most activities of daily living require the dynamic integration of sights, sounds, and movements as people navigate complex environments. Nevertheless, little is known about the effects of hearing loss (HL) or hearing aid (HA) use on listening during multitasking challenges. Purpose The objective of the current study was to investigate the effect of age-related hearing loss (ARHL) on word recognition accuracy in a dual-task experiment. Virtual reality (VR) technologies in a specialized laboratory (Challenging Environment Assessment Laboratory) were used to produce a controlled and safe simulated environment for listening while walking. Research design In a simulation of a downtown street intersection, participants completed two single-task conditions, listening-only (standing stationary) and walking-only (walking on a treadmill to cross the simulated intersection with no speech presented), and a dual-task condition (listening while walking). For the listening task, they were required to recognize words spoken by a target talker when there was a competing talker. For some blocks of trials, the target talker was always located at 0° azimuth (100% probability condition); for other blocks, the target talker was more likely (60% of trials) to be located at the center (0° azimuth) and less likely (40% of trials) to be located at the left (270° azimuth). Study sample The participants were eight older adults with bilateral HL (mean age = 73.3 yr, standard deviation [SD] = 8.4; three males) who wore their own HAs during testing and eight controls with normal hearing (NH) thresholds (mean age = 69.9 yr, SD = 5.4; two males). No participant had clinically significant visual, cognitive, or mobility impairments. Data collection and analysis Word recognition accuracy and kinematic parameters (head and trunk angles, step width and length, stride time, cadence) were analyzed using mixed factorial analysis of variances with group as a between-subjects factor. Task condition (single versus dual) and probability (100% versus 60%) were within-subject factors. In analyses of the 60% listening condition, spatial expectation (likely versus unlikely) was a within-subject factor. Differences between groups in age and baseline measures of hearing, mobility, and cognition were tested using t tests. Results The NH group had significantly better word recognition accuracy than the HL group. Both groups performed better when the probability was higher and the target location more likely. For word recognition, dual-task costs for the HL group did not depend on condition, whereas the NH group demonstrated a surprising dual-task benefit in conditions with lower probability or spatial expectation. For the kinematic parameters, both groups demonstrated a more upright and less variable head position and more variable trunk position during dual-task conditions compared to the walking-only condition, suggesting that safe walking was prioritized. The HL group demonstrated more overall stride time variability than the NH group. Conclusions This study provides new knowledge about the effects of ARHL, HA use, and aging on word recognition when individuals also perform a mobility-related task that is typically experienced in everyday life. This research may help inform the development of more effective function-based approaches to assessment and intervention for people who are hard-of-hearing.

Hearing Aid Benefit in Patients with Mild Sensorineural Hearing Loss: A Systematic Review

Abstract: Background: Untreated sensorineural hearing loss (SNHL) is associated with chronic health-care conditions, isolation, loneliness, and reduced quality of life. Although hearing aids can minimize the negative effects of SNHL, only about one in five persons with SNHL seeks help for communication problems. Many persons wait 10 yr or more from the time they first notice a problem before pursuing amplification. Further, little information about the benefits of amplification is available for persons with mild SNHL (MSNHL), who likely defer treatment even longer. Purpose: To conduct a systematic review to weigh the evidence regarding benefits derived from the use of amplification by adults with MSNHL. Research Design: Systematic review with meta-analysis. Study Sample: Adult hearing aid wearers with bilateral average pure-tone thresholds ≤45 dB HL at 500, 1000, 2000, and 4000 Hz. Data Collection and Analysis: PubMed, Cumulative Index to Nursing and Allied-Health Literature, Cochrane Collaboration, and Google Scholar were searched independently by the authors during September 2013. The authors used a consensus approach to assess the quality and extract data for the meta-analysis. Results: Of 106 articles recovered for full-text review, only 10 met inclusion criteria (at least Level IV of evidence and involved and reported separate pre-/postfitting hearing aid outcomes for patients with MSNHL). Included studies involved mainly middle-aged to elderly patients using hearing aids of various styles and circuitry. Results from all of the studies indicated positive benefits from amplification for patients with MSNHL. Data from five studies were suitable for a meta-analysis, which produced a small-to-medium effect size of 0.85 (95% confidence intervals = 0.44–1.25) after adjusting for a small publication bias. This evidence confirmed benefits from the use of amplification in adults with MSNHL. Conclusions: Evidence exists supporting the notion that adults with MSNHL benefit from hearing aids. This information is important and useful to audiologists, patients, and third-party payers, even considering that most of the studies in this systematic review were limited, somewhat dated, and used analog and early digital technology available when the studies were conducted. Clinical recommendations may be even stronger as future studies become available for patients fit with modern styles and high-technology hearing aids.

Spatial Acoustic Scenarios in Multichannel Loudspeaker Systems for Hearing Aid Evaluation.

Abstract: Background: Field tests and guided walks in real environments show that the benefit from hearing aid (HA) signal processing in real-life situations is typically lower than the predicted benefit found in laboratory studies. This suggests that laboratory test outcome measures are poor predictors of real-life HA benefits. However, a systematic evaluation of algorithms in the field is difficult due to the lack of reproducibility and control of the test conditions. Virtual acoustic environments that simulate real-life situations may allow for a systematic and reproducible evaluation of HAs under more realistic conditions, thus providing a better estimate of real-life benefit than established laboratory tests. Purpose: To quantify the difference in HA performance between a laboratory condition and more realistic conditions based on technical performance measures using virtual acoustic environments, and to identify the factors affecting HA performance across the tested environments. Research Design: A set of typical HA beamformer algorithms was evaluated in virtual acoustic environments of different complexity. Performance was assessed based on established technical performance measures, including perceptual model predictions of speech quality and speech intelligibility. Virtual acoustic environments ranged from a simple static reference condition to more realistic complex scenes with dynamically moving sound objects. Results: HA benefit, as predicted by signal-to-noise ratio (SNR) and speech intelligibility measures, differs between the reference condition and more realistic conditions for the tested beamformer algorithms. Other performance measures, such as speech quality or binaural degree of diffusiveness, do not show pronounced differences. However, a decreased speech quality was found in specific conditions. A correlation analysis showed a significant correlation between room acoustic parameters of the sound field and HA performance. The SNR improvement in the reference condition was found to be a poor predictor of HA performance in terms of speech intelligibility improvement in the more realistic conditions. Conclusions: Using several virtual acoustic environments of different complexity, a systematic difference in HA performance between a simple reference condition and more realistic environments was found, which may be related to the discrepancy between laboratory and real-life HA performance reported previously.

Pediatric Audiology in North America: Current Clinical Practice and How It Relates to the American Academy of Audiology Pediatric Amplification Guideline.

Abstract: Background There is broad consensus that screening and diagnosis of permanent hearing loss in children must be embedded within a comprehensive, evidence-based, family-centered intervention program. Clinical practice guidelines (CPGs) for pediatric hearing assessment and hearing aid verification aim to reduce variability in practice and increase the use of effective evidence-based diagnostic and treatment options so that optimal outcomes may be achieved. To be of value, guidelines must be translated and implemented into practice and ongoing monitoring of their use in practice should occur. Purpose This paper provides the results of two studies that aim to examine current pediatric audiology and amplification practice in North America. Research design A concurrent embedded mixed methods design was used. Study sample An electronic survey was distributed to North American audiologists who delivered pediatric audiology services with 350 audiologists participating in study 1 and 63 audiologists participating in study 2. Data collection and analysis A quantitative approach was the predominant method of data collection. Respondents were prompted to provide additional qualitative text and detail regarding their quantitative response choice. This qualitative text was used during the analysis phase and combined with quantitative results to assist understanding of respondents' knowledge, skills, and barriers/facilitators to implement best practice in pediatric amplification. Results Approximately 70% of audiologists reported using best-practice protocols for pediatric hearing aid fitting. Despite widespread knowledge and increased use of CPGs over the last 18 yrs, results of these studies show that variation in practice patterns continue to exist. Several examples of implementation challenges are discussed with recommendations provided. Conclusions In order for audiologists working with children who are deaf or hard of hearing and their families to achieve the principles of family-centered early intervention, practice guidelines must continue to be developed, disseminated, and translated as they have a positive impact on the services provided. Researchers and clinical audiologists who deliver services must continue to collaborate to understand the "how" and "why" of implementing guidelines into practice and to identify the barriers/facilitators encountered in trying to do so.

Common Sound Scenarios: A Context-Driven Categorization of Everyday Sound Environments for Application in Hearing-Device Research.

Abstract: Background: Evaluation of hearing-device signal-processing features is performed for research and development purposes, but also in clinical settings. Most people agree that the benefit experienced in a hearing-device user’s daily life is most important, but laboratory tests are popular since they can be performed uniformly for all participants in a study using sensitive outcome measures. In order to design laboratory tests that have the potential of indicating real-life benefit, there is a need for more information about the acoustic environments and listening situations encountered by hearing-device users as well as by normal-hearing people. Purpose: To investigate the acoustic environments and listening situations people encounter, and to provide a structured framework of common sound scenarios (CoSS) that can be used for instance when designing realistic laboratory tests. Research Design: A literature search was conducted. Extracted acoustic environments and listening situations were categorized using a context-based approach. A set of common sound scenarios was established based on the findings from the literature. Data Collection: A number of publications providing data on encountered acoustic environments and listening situations were identified. Focus was on studies including informants who reported or recorded information in field trials. Nine relevant references were found. In combination with data collected at our laboratory, 187 examples of acoustic environments or listening situations were found. Results: Based on the extracted data, a categorization approach based on context (intentions and tasks) was used when creating CoSS. Three intention categories, “speech communication,” “focused listening,” and “nonspecific” were divided into seven task categories. In each task category, two sound scenarios were described, creating in total 14 common sound scenarios. The literature search showed a general lack of studies investigating acoustic environments and listening situations, in particular studies where normal-hearing informants are included and studies performed outside North America and Western Europe. Conclusions: A structured framework was developed. Intentions and tasks constitute the main categories in the framework, and 14 common sound scenarios were selected and described. The framework can for instance be used when developing hearing-device signal-processing features, in the evaluation of such features in realistic laboratory tests, and for demonstration of feature effects to hearing-device wearers.

Smartphone-Based System for Learning and Inferring Hearing Aid Settings.

Abstract: BACKGROUND Previous research has shown that hearing aid wearers can successfully self-train their instruments' gain-frequency response and compression parameters in everyday situations. Combining hearing aids with a smartphone introduces additional computing power, memory, and a graphical user interface that may enable greater setting personalization. To explore the benefits of self-training with a smartphone-based hearing system, a parameter space was chosen with four possible combinations of microphone mode (omnidirectional and directional) and noise reduction state (active and off). The baseline for comparison was the "untrained system," that is, the manufacturer's algorithm for automatically selecting microphone mode and noise reduction state based on acoustic environment. The "trained system" first learned each individual's preferences, self-entered via a smartphone in real-world situations, to build a trained model. The system then predicted the optimal setting (among available choices) using an inference engine, which considered the trained model and current context (e.g., sound environment, location, and time). PURPOSE To develop a smartphone-based prototype hearing system that can be trained to learn preferred user settings. Determine whether user study participants showed a preference for trained over untrained system settings. RESEARCH DESIGN An experimental within-participants study. Participants used a prototype hearing system-comprising two hearing aids, Android smartphone, and body-worn gateway device-for ∼6 weeks. STUDY SAMPLE Sixteen adults with mild-to-moderate sensorineural hearing loss (HL) (ten males, six females; mean age = 55.5 yr). Fifteen had ≥6 mo of experience wearing hearing aids, and 14 had previous experience using smartphones. INTERVENTION Participants were fitted and instructed to perform daily comparisons of settings ("listening evaluations") through a smartphone-based software application called Hearing Aid Learning and Inference Controller (HALIC). In the four-week-long training phase, HALIC recorded individual listening preferences along with sensor data from the smartphone-including environmental sound classification, sound level, and location-to build trained models. In the subsequent two-week-long validation phase, participants performed blinded listening evaluations comparing settings predicted by the trained system ("trained settings") to those suggested by the hearing aids' untrained system ("untrained settings"). DATA COLLECTION AND ANALYSIS We analyzed data collected on the smartphone and hearing aids during the study. We also obtained audiometric and demographic information. RESULTS Overall, the 15 participants with valid data significantly preferred trained settings to untrained settings (paired-samples t test). Seven participants had a significant preference for trained settings, while one had a significant preference for untrained settings (binomial test). The remaining seven participants had nonsignificant preferences. Pooling data across participants, the proportion of times that each setting was chosen in a given environmental sound class was on average very similar. However, breaking down the data by participant revealed strong and idiosyncratic individual preferences. Fourteen participants reported positive feelings of clarity, competence, and mastery when training via HALIC. CONCLUSIONS The obtained data, as well as subjective participant feedback, indicate that smartphones could become viable tools to train hearing aids. Individuals who are tech savvy and have milder HL seem well suited to take advantages of the benefits offered by training with a smartphone.

On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies.

Abstract: BACKGROUND In the field of audiology a test protocol (index test) is used to determine the presence or absence of a target condition. The value of an index test rests in its diagnostic accuracy. Results from an index test must be verified through the use of a reference standard. The clinician and researcher should determine the quality and applicability of diagnostic accuracy studies. The Standards for Reporting of Diagnostic Accuracy (STARD) statement was published in response to the low quality of research conducted across many fields of study. It provides guidelines for the development and interpretation of diagnostic accuracy studies. PURPOSE The primary purpose of this article is to assess the degree to which the main principles of diagnostic accuracy studies are used for the detection of central auditory nervous system lesions and a central auditory processing disorder (CAPD). The secondary purpose is to compare the design of these studies to select key guidelines from the STARD statement. The third purpose of this article is to present an argument against the reassignment of diagnostic accuracy values of a particular index test for one target condition (e.g., a central site of lesion) to a different target condition (e.g., a CAPD). RESULTS A review of diagnostic accuracy literature on the detection of a central site of lesion reveals the use of a reference standard for the independent verification of the index test results. However, diagnostic accuracy studies involving index tests for the detection of a CAPD show that independent verification of index test results is nonexistent or at best questionable. CONCLUSION For a particular index test, while the diagnostic accuracy for detection of a central site of lesion may have been determined appropriately, it is inappropriate to reassign these diagnostic accuracy values to a different diagnostic target such as a CAPD.

Evaluation of Loudspeaker-Based Virtual Sound Environments for Testing Directional Hearing Aids.

Abstract: Background Assessments of hearing aid (HA) benefits in the laboratory often do not accurately reflect real-life experience. This may be improved by employing loudspeaker-based virtual sound environments (VSEs) that provide more realistic acoustic scenarios. It is unclear how far the limited accuracy of these VSEs influences measures of subjective performance. Purpose Verify two common methods for creating VSEs that are to be used for assessing HA outcomes. Research design A cocktail-party scene was created inside a meeting room and then reproduced with a 41-channel loudspeaker array inside an anechoic chamber. The reproduced scenes were created either by using room acoustic modeling techniques or microphone array recordings. Study sample Participants were 18 listeners with a symmetrical, sloping, mild-to-moderate hearing loss, aged between 66 and 78 yr (mean = 73.8 yr). Data collection and analysis The accuracy of the two VSEs was assessed by comparing the subjective performance measured with two-directional HA algorithms inside all three acoustic environments. The performance was evaluated by using a speech intelligibility test and an acceptable noise level task. Results The general behavior of the subjective performance seen in the real environment was preserved in the two VSEs for both directional HA algorithms. However, the estimated directional benefits were slightly reduced in the model-based VSE, and further reduced in the recording-based VSE. Conclusions It can be concluded that the considered VSEs can be used for testing directional HAs, but the provided sensitivity is reduced when compared to a real environment. This can result in an underestimation of the provided directional benefit. However, this minor limitation may be easily outweighed by the high realism of the acoustic scenes that these VSEs can generate, which may result in HA outcome measures with a significantly higher ecological relevance than provided by measures commonly performed in the laboratory or clinic.

Audiologist Practices: Parent Hearing Aid Education and Support.

Abstract: Background: Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits. Purpose: The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents. Research Design: A cross-sectional, population-based survey was used. Study Sample: Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States. Data Collection and Analysis: Responses were collected through the mail and online. Descriptive statistics were used to analyze the information. Results: More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53–79%), regardless of their previous training experience. Conclusions: For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Validation of a Mobile Device for Acoustic Coordinated Reset Neuromodulation Tinnitus Therapy.

Abstract: BACKGROUND Sound-based tinnitus intervention stimuli include broad-band noise signals with subjectively adjusted bandwidths used as maskers delivered by commercial devices or hearing aids, environmental sounds broadly described and delivered by both consumer devices and hearing aids, music recordings specifically modified and delivered in a variety of different ways, and other stimuli. Acoustic coordinated reset neuromodulation therapy for tinnitus reduction has unique and more stringent requirements compared to all other sound-based tinnitus interventions. These include precise characterization of tinnitus pitch and loudness, and effective provision of patient-controlled daily therapy signals at defined frequencies, levels, and durations outside of the clinic. PURPOSE The purpose of this study was to evaluate an approach to accommodate these requirements including evaluation of a mobile device, validation of an automated tinnitus pitch-matching algorithm and assessment of a patient's ability to control stimuli and collect repeated outcome measures. RESEARCH DESIGN The experimental design involved direct laboratory measurements of the sound delivery capabilities of a mobile device, comparison of an automated, adaptive pitch-matching method to a traditional manual method and measures of a patient's ability to understand and manipulate a mobile device graphic user interface to both deliver the therapy signals and collect the outcome measures. STUDY SAMPLE This study consisted of 5 samples of a common mobile device for the laboratory measures and a total of 30 adult participants: 15 randomly selected normal-hearing participants with simulated tinnitus for validation of a tinnitus pitch-matching algorithm and 15 sequentially selected patients already undergoing tinnitus therapy for evaluation of patient usability. INTERVENTION No tinnitus intervention(s) were specifically studied as a component of this study. DATA COLLECTION AND ANALYSIS Data collection involved laboratory measures of mobile devices, comparison of manual and automated adaptive tinnitus pitch-matching psychoacoustic procedures in the same participant analyzed for absolute differences (t test), variance differences (f test), and range comparisons, and assessment of patient usability including questionnaire measures and logs of patient observations. RESULTS Mobile devices are able to reliably and accurately deliver the acoustic therapy signals. There was no difference in mean pitch matches (t test, p > 0.05) between an automated adaptive method compared to a traditional manual pitch-matching method. However, the variability of the automated pitch-matching method was much less (f test, p < 0.05) with twice as many matches within the predefined error range (±5%) compared to the manual pitch-matching method (80% versus 40%). After a short initial training, all participants were able to use the mobile device effectively and to perform the required tasks without further professional assistance.

Prevalence of Auditory Processing Disorder in School-Aged Children in the Mid-Atlantic Region.

Abstract: Background Although auditory processing disorder (APD) is a widely recognized impairment, its prevalence and demographic characteristics are not precisely known in the pediatric population. Purpose To examine the demographic characteristics of children diagnosed with APD at a tertiary health-care facility and the prevalence of pediatric APD. Research design A cross-sectional study. Study sample A total of 243 children (149 boys and 94 girls) who were referred to the Nemours Audiology Clinics in the Delaware Valley for an APD evaluation. The mean ages were 9.8 yr for boys and 9.7 yr for girls. Out of 243 children referred for an APD evaluation, 94 children exhibited one or more auditory processing deficits in the areas of auditory closure, auditory figure ground, binaural integration, binaural separation, and temporal processing. Data collection and analysis Demographic and audiological data, clinical history (parental reports on prenatal and postnatal information, birth weight and height, medical and developmental history, otologic/audiological history, education information, behavioral characteristics), and results of the APD test battery were retrospectively obtained from the electronic medical records of each participant. The prevalence of APD was estimated using the total number of students enrolled in the same school attended by each participant in the 2011 academic year as cohort. Results The prevalence of APD was 1.94 per 1,000 children in this study. We found that prevalence of APD among the children who attended private schools was more than two times higher than the children who attended public schools. The results also revealed that the majority of children referred to the clinics were Caucasian (85.6%), whereas minority groups were underrepresented for this geographical area with only 3.7% of Hispanic or Latino children and 5.8% of Black or African American children. Conclusions The estimated prevalence of APD in the current study was lower than the previously published estimates. The difference might be due to the diagnosis criteria of APD among studies as well as the use of school enrollment number as the referenced population to estimate prevalence in our study. We also found a significant difference in APD prevalence depending on the school types. The findings of higher prevalence rates among the children attending private schools and higher proportion of Caucasians children referred for APD evaluation suggest that more children among those in public schools and in the Hispanic and African American groups should have been referred for an APD evaluation. Hence, the current estimate is likely an underestimate of the actual APD prevalence. The low percentage of Hispanic or African American children referred to the clinic for APD evaluations may be related to the socioeconomic status and linguistic differences among the concerned families. The results of this study raise the importance of adapting the APD test battery for children with a different linguistic background as well as increasing awareness of available clinical resources to all families in our area.

The Dichotic Digits difference Test (DDdT): Development, Normative Data, and Test-Retest Reliability Studies Part 1.

Abstract: Partsof the research described in this paper were presented at the XXX11 World Congress of Audiology, Brisbane, Australia, May 2014.

Theoretical Issues of Validity in the Measurement of Aided Speech Reception Threshold in Noise for Comparing Nonlinear Hearing Aid Systems.

Abstract: Background: Adaptive Speech Reception Threshold in noise (SRTn) measurements are often used to make comparisons between alternative hearing aid (HA) systems. Such measurements usually do not constrain the signal-to-noise ratio (SNR) at which testing takes place. Meanwhile, HA systems increasingly include nonlinear features that operate differently in different SNRs, and listeners differ in their inherent SNR requirements. Purpose: To show that SRTn measurements, as commonly used in comparisons of alternative HA systems, suffer from threats to their validity, to illustrate these threats with examples of potentially invalid conclusions in the research literature, and to propose ways to tackle these threats. Research Design: An examination of the nature of SRTn measurements in the context of test theory, modern nonlinear HAs, and listener diversity. Study Sample, Data Collection, and Analysis: Examples from the audiological research literature were used to estimate typical interparticipant variation in SRTn and to illustrate cases where validity may have been compromised. Results and Conclusions: There can be no doubt that SRTn measurements, when used to compare nonlinear HA systems, in principle, suffer from threats to their internal and external/ecological validity. Interactions between HA nonlinearities and SNR, and interparticipant differences in inherent SNR requirements, can act to generate misleading results. In addition, SRTn may lie at an SNR outside the range for which the HA system is designed or expected to operate in. Although the extent of invalid conclusions in the literature is difficult to evaluate, examples of studies were nevertheless identified where the risk of each form of invalidity is significant. Reliable data on ecological SNRs is becoming available, so that ecological validity can be assessed. Methodological developments that can reduce the risk of invalid conclusions include variations on the SRTn measurement procedure itself, manipulations of stimulus or scoring conditions to place SRTn in an ecologically relevant range, and design and analysis approaches that take account of interparticipant differences.

A Dynamic Speech Comprehension Test for Assessing Real-World Listening Ability.

Abstract: Background Many listeners with hearing loss report particular difficulties with multitalker communication situations, but these difficulties are not well predicted using current clinical and laboratory assessment tools. Purpose The overall aim of this work is to create new speech tests that capture key aspects of multitalker communication situations and ultimately provide better predictions of real-world communication abilities and the effect of hearing aids. Research design A test of ongoing speech comprehension introduced previously was extended to include naturalistic conversations between multiple talkers as targets, and a reverberant background environment containing competing conversations. In this article, we describe the development of this test and present a validation study. Study sample Thirty listeners with normal hearing participated in this study. Data collection and analysis Speech comprehension was measured for one-, two-, and three-talker passages at three different signal-to-noise ratios (SNRs), and working memory ability was measured using the reading span test. Analyses were conducted to examine passage equivalence, learning effects, and test-retest reliability, and to characterize the effects of number of talkers and SNR. Results Although we observed differences in difficulty across passages, it was possible to group the passages into four equivalent sets. Using this grouping, we achieved good test-retest reliability and observed no significant learning effects. Comprehension performance was sensitive to the SNR but did not decrease as the number of talkers increased. Individual performance showed associations with age and reading span score. Conclusions This new dynamic speech comprehension test appears to be valid and suitable for experimental purposes. Further work will explore its utility as a tool for predicting real-world communication ability and hearing aid benefit.

Assessing Auditory Processing Abilities in Typically Developing School-Aged Children.

Abstract: Background: Large discrepancies exist in the literature regarding definition, diagnostic criteria, and appropriate assessment for auditory processing disorder (APD). Therefore, a battery of tests with normative data is needed. Purpose: The purpose of this study is to collect normative data on a variety of tests for APD on children aged 7–12 yr, and to examine effects of outside factors on test performance. Research Design: Children aged 7–12 yr with normal hearing, speech and language abilities, cognition, and attention were recruited for participation in this normative data collection. Study Sample: One hundred and forty-seven children were recruited using flyers and word of mouth. Of the participants recruited, 137 children qualified for the study. Participants attended schools located in areas that varied in terms of socioeconomic status, and resided in six different states. Data Collection and Analysis: Audiological testing included a hearing screening (15 dB HL from 250 to 8000 Hz), word recognition testing, tympanometry, ipsilateral and contralateral reflexes, and transient-evoked otoacoustic emissions. The language, nonverbal IQ, phonological processing, and attention skills of each participant were screened using the Clinical Evaluation of Language Fundamentals-4 Screener, Test of Nonverbal Intelligence, Comprehensive Test of Phonological Processing, and Integrated Visual and Auditory-Continuous Performance Test, respectively. The behavioral APD battery included the following tests: Dichotic Digits Test, Frequency Pattern Test, Duration Pattern Test, Random Gap Detection Test, Compressed and Reverberated Words Test, Auditory Figure Ground (signal-to-noise ratio of +8 and +0), and Listening in Spatialized Noise-Sentences Test. Mean scores and standard deviations of each test were calculated, and analysis of variance tests were used to determine effects of factors such as gender, handedness, and birth history on each test. Results: Normative data tables for the test battery were created for the following age groups: 7- and 8-yr-olds (n = 49), 9- and 10-yr-olds (n = 40), and 11- and 12-yr-olds (n = 48). No significant effects were seen for gender or handedness on any of the measures. Conclusions: The data collected in this study are appropriate for use in clinical diagnosis of APD. Use of a low-linguistically loaded core battery with the addition of more language-based tests, when language abilities are known, can provide a well-rounded picture of a child’s auditory processing abilities. Screening for language, phonological processing, attention, and cognitive level can provide more information regarding a diagnosis of APD, determine appropriateness of the test battery for the individual child, and may assist with making recommendations or referrals. It is important to use a multidisciplinary approach in the diagnosis and treatment of APD due to the high likelihood of comorbidity with other language, learning, or attention deficits. Although children with other diagnoses may be tested for APD, it is important to establish previously made diagnoses before testing to aid in appropriate test selection and recommendations.

Validation of the Home Hearing Test

Abstract: BACKGROUND The Home Hearing Test™ (HHT) is an automated pure-tone threshold test that obtains an air-conduction audiogram at five test frequencies. It was developed to provide increased access to hearing testing and support home telehealth programs. PURPOSE The study was conducted as part of an audiology telehealth trial based at the U.S. Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Air-conduction audiograms obtained by the HHT were compared to results obtained in the clinic. RESEARCH DESIGN Prospective, repeated measures. STUDY SAMPLE Twenty-eight participants, aged 44-88 yr (mean = 65) were recruited from the Nashville U.S. Department of Veterans Affairs audiology clinic. Participants were required to have a Windows personal computer in the home and were self-reported to be comfortable with using computers. Two participants had normal hearing and 26 had hearing loss of various severities and configurations. DATA COLLECTION AND ANALYSIS Audiograms were obtained in the audiology clinic by experienced audiologists following standard clinical protocols. Participants were provided with a kit for installing HHT on their home computers. The HHT air-conduction audiogram is obtained with Automated Method for Testing Auditory Sensitivity (AMTAS(®)), described in previous publications. Threshold pairs (clinic versus HHT) were analyzed by determining distributions of threshold differences and absolute differences. These were compared to distributions of differences between manual threshold pairs obtained by two audiologists and AMTAS(®) versus manual threshold pairs obtained under laboratory conditions. RESULTS Threshold differences (clinic versus HHT) were slightly larger than differences between thresholds obtained by two audiologists and AMTAS(®) versus manual threshold differences obtained under laboratory conditions. The differences were not statistically significant. CONCLUSIONS HHT air-conduction audiograms agree well with audiograms obtained in the clinic. HHT is well suited to home telehealth applications and personal use.

Hearing Aid Patient Education Materials: Is There Room for Improvement?

Abstract: Purpose The purpose of this study was to analyze and compare the readability of patient education materials (PEMs) from leading manufacturers of behind-the-ear style hearing aids and popular hearing aid information Web sites to determine if they meet guidelines recommended by public health agencies. Research design Analysis of hearing aid PEMs. Methods Printed user guides from six of the leading manufacturers of BTE hearing aids and 15 of the most popular hearing aid-information Web sites were accessed online and analyzed for readability using the Gunning-Fog Index, New Fog Count, Raygor Estimate Graph, Simple Measure of Gobbledygook, and Flesch Reading Ease score. Results Overall average grade-level readability for all six printed manufacturer user manuals was calculated to be written at a 10th grade reading level. Overall average grade-level readabilities for all 15 popular online hearing aid-information Web sites representing professional organizations, suppliers, and health information services were calculated to be written at 10th, 10th, and 11th grade reading levels, respectively. Average Flesch Reading Ease scores for all printed guides and online patient information Web sites were calculated to fall within the fairly difficult category for readability. Conclusions PEMs provided by top hearing aid manufactures and popular hearing aid Web sites are written well above the reading level recommended by the National Institutes of Health. Consideration should be given toward simplifying these materials in order to enhance user experience and increase compliance among behind-the-ear hearing aid users.

A Phoneme Perception Test Method for High-Frequency Hearing Aid Fitting.

Abstract: BACKGROUND Outcomes with hearing aids (HAs) can be assessed using various speech tests, but many tests are not sensitive to changes in high-frequency audibility PURPOSE A Phoneme Perception Test (PPT), designed for the phonemes /s/ and /ʃ/, has been developed to investigate whether detection and recognition tasks are able to measure individual differences in phoneme audibility and recognition for various hearing instrument settings These capabilities were studied using two different fricative stimulus materials The first set of materials preserves natural low-level sound components in the low- and mid-frequency ranges (LF set); the second set of materials attempts to limit the audibility to high-frequency fricative noise (nLF set) To study the effect on phoneme detection and recognition when auditory representations of /s/ and /ʃ/ are modified, a too strong nonlinear frequency compression (NLFC) setting was applied RESEARCH DESIGN Repeated measure design was used under several different conditions STUDY SAMPLE A total of 31 hearing-impaired individuals participated in this study Of the 31 participants, 10 individuals did not own HAs but were provided with them during the study and 21 individuals owned HAs and were experienced users All participants had a symmetrical sensorineural hearing loss DATA COLLECTION AND ANALYSIS The present study applied a phoneme detection test and a recognition test with two different stimulus sets under different amplification conditions The statistical analysis focused on the capability of the PPT to measure the effect on audibility and perception of high-frequency information with and without HAs, and between HAs with two different NLFC settings ("default" and "too strong") RESULTS Detection thresholds (DTs) and recognition thresholds (RTs) were compared with respective audiometric thresholds in the free field for all available conditions Significant differences in thresholds between LF and nLF stimuli were observed The thresholds for nLF stimuli showed higher correlation to the corresponding audiometric thresholds than the thresholds for LF stimuli The difference in thresholds for unaided and aided conditions was larger for the stimulus set nLF than for the stimulus set LF Also, thresholds were similar in both aided conditions for stimulus set LF, whereas a large difference between amplifications was observed for the stimulus set nLF When NLFC was set "too strong," DTs and RTs differed significantly for /s/ CONCLUSIONS The findings from this study strongly suggest that measuring DTs and RTs with the stimulus set nLF is beneficial and useful to quantify the effects of HAs and NLFC on high-frequency speech cues for detection and recognition tasks The findings also suggest that both tests are necessary because they assess audibility as well as recognition abilities, particularly as they relate to speech modification algorithms The experiments conducted in this study did not allow for any acclimatization of the participants to increased high-frequency gain or NLFC Further investigations should therefore examine the impact on DTs and RTs in the PPT as well as the contrasting effects of strong setting of NLFC to DTs and RTs because of (re)learning of modified auditory representations of /s/ and /ʃ/ as caused by NLFC

Fitting frequency-lowering signal processing applying the American Academy of audiology pediatric amplification guideline: Updates and protocols

Abstract: Background: Although guidelines for fitting hearing aids for children are well developed and have strong basis in evidence, specific protocols for fitting and verifying technologies can supplement such guidelines. One such technology is frequency-lowering signal processing. Children require access to a broad bandwidth of speech to detect and use all phonemes including female /s/. When access through conventional amplification is not possible, the use of frequency-lowering signal processing may be considered as a means to overcome limitations. Fitting and verification protocols are needed to better define candidacy determination and options for assessing and fine tuning frequency-lowering signal processing for individuals. Purpose: This work aims to (1) describe a set of calibrated phonemes that can be used to characterize the variation in different brands of frequency-lowering processors in hearing aids and the verification with these signals and (2) determine whether verification with these signal are predictive of perceptual changes associated with changes in the strength of frequency-lowering signal processing. Finally, we aimed to develop a fitting protocol for use in pediatric clinical practice. Study Sample: Study 1 used a sample of six hearing aids spanning four types of frequency lowering algorithms for an electroacoustic evaluation. Study 2 included 21 adults who had hearing loss (mean age 66 yr). Data Collection and Analysis: Simulated fricatives were designed to mimic the level and frequency shape of female fricatives extracted from two sources of speech. These signals were used to verify the frequency-lowering effects of four distinct types of frequency-lowering signal processors available in commercial hearing aids, and verification measures were compared to extracted fricatives made in a reference system. In a second study, the simulated fricatives were used within a probe microphone measurement system to verify a wide range of frequency compression settings in a commercial hearing aid, and 27 adult listeners were tested at each setting. The relation between the hearing aid verification measures and the listener’s ability to detect and discriminate between fricatives was examined. Results: Verification measures made with the simulated fricatives agreed to within 4 dB, on average, and tended to mimic the frequency response shape of fricatives presented in a running speech context. Some processors showed a greater aided response level for fricatives in running speech than fricatives presented in isolation. Results with listeners indicated that verified settings that provided a positive sensation level of /s/ and that maximized the frequency difference between /s/ and /∫/ tended to have the best performance. Conclusions: Frequency-lowering signal processors have measureable effects on the high-frequency fricative content of speech, particularly female /s/. It is possible to measure these effects either with a simple strategy that presents an isolated simulated fricative and measures the aided frequency response or with a more complex system that extracts fricatives from running speech. For some processors, a more accurate result may be achieved with a running speech system. In listeners, the aided frequency location and sensation level of fricatives may be helpful in predicting whether a specific hearing aid fitting, with or without frequency-lowering, will support access to the fricatives of speech.

Clinical Outcomes of the Cochlear™ Nucleus(®) 5 Cochlear Implant System and SmartSound™ 2 Signal Processing.

Abstract: BACKGROUND While published data exist regarding cochlear implant (CI) outcomes from large academic programs, evidence of benefit based on national, multicenter clinical trials is needed for information regarding typical patient outcomes of devices implanted by U.S. centers representing larger academic to smaller hospital-based programs. PURPOSE This nationwide trial evaluated outcomes in a group of newly implanted adult recipients of the Cochlear™ Nucleus(®) 5 CI system and SmartSound™ 2 signal processing. Unlike previous clinical trials, the AzBio sentence test was used and represents recent transition in our field to use of more challenging test materials. It was hypothesized that (1) speech perception scores in quiet with SmartSound™ 2 signal processing would not be statistically different from previous-generation devices; (2) speech perception scores in noise with SmartSound™ 2 signal processing would be better with enhanced microphone directionality; (3) speech perception scores in noise will be better with the preferred SmartSound™ 2 program for listening in noise; and (4) cochlear implantation would improve quality of life as assessed by the updated Health Utility Index Mark 3 (HUI3). A secondary purpose was to examine the relationships among the current and previously used speech perception tests of the Minimum Speech Test Battery (MSTB). It was hypothesized that speech perception scores within the same test interval would show predictive relationships. RESEARCH DESIGN Prospective, single-arm, repeated-measures study across 13 CI centers in the United States between February 2010 and June 2012. The participating centers ranged from larger academic to smaller hospital-based programs to accurately represent the diversity of programs in the United States. STUDY SAMPLE Participants were 38 postlingually deafened adult CI candidates. DATA COLLECTION AND ANALYSIS Primary measures were Consonant-Nucleus-Consonant (CNC) words in quiet and the AzBio Sentence Test in Quiet (AzBioQ) and in Noise (AzBioN) tested at preoperative, and 3-, 6-, and 12-mo postactivation intervals. Quality of life was measured with the HUI3. For the secondary objective, statistical analyses were performed to investigate the predictive properties between current and previously used MSTB tests. RESULTS Mean CNC scores were significantly higher compared to the Nucleus(®) 24 Contour™ at 3 mo (p < 0.05) postactivation and showed no difference compared to the Nucleus(®) Freedom™ at 6 mo postactivation. Both SmartSound™ 2 FOCUS and NOISE programs provided significant improvements in performance in noise over the EVERYDAY program (p < 0.001), and performance with the FOCUS program was significantly better compared to the NOISE program (p < 0.001). Speech perception in noise was not related to patients' subjective program preferences. Quality-of-life outcomes showed significant improvements from the preoperative to 6-mo postactivation interval (p < 0.05-0.001). Strong and significant correlations were found between preoperative CNC and AzBioQ and preoperative Hearing-in-Noise Test sentences in Quiet (HINTQ) and AzBioQ. At 12-mo postactivation, there were strong and highly significant correlations between CNC and AzBioQ, HINTQ and AzBioQ, and Hearing-in-Noise Test sentences in Noise and AzBioN (all p < 0.001). CONCLUSIONS Results of this national clinical trial showed significant improvements in speech perception and quality of life following cochlear implantation. SmartSound™ 2 signal processing features showed a significant benefit of FOCUS when listening in noise, although preference of signal processing feature did not correlate with performance. Significant correlations were observed between speech perception tests. The findings of this study can be applied in clinical assessment, programming, and follow-up for CI candidates and recipients.

Directional Processing and Noise Reduction in Hearing Aids: Individual and Situational Influences on Preferred Setting.

Abstract: Background: A better understanding of individual differences in hearing aid (HA) outcome is a prerequisite for more personalized HA fittings. Currently, knowledge of how different user factors relate to response to directional processing (DIR) and noise reduction (NR) is sparse. Purpose: To extend a recent study linking preference for DIR and NR to pure-tone average hearing thresholds (PTA) and cognitive factors by investigating if (1) equivalent links exist for different types of DIR and NR, (2) self-reported noise sensitivity and personality can account for additional variability in preferred DIR and NR settings, and (3) spatial target speech configuration interacts with individual DIR preference. Research Design: Using a correlational study design, overall preference for different combinations of DIR and NR programmed into a commercial HA was assessed in a complex speech-in-noise situation and related to PTA, cognitive function, and different personality traits. Study Sample: Sixty experienced HA users aged 60–82 yr with controlled variation in PTA and working memory capacity took part in this study. All of them had participated in the earlier study, as part of which they were tested on a measure of “executive control” tapping into cognitive functions such as working memory, mental flexibility, and selective attention. Data Collection and Analysis: Six HA settings based on unilateral (within-device) or bilateral (across-device) DIR combined with inactive, moderate, or strong single-microphone NR were programmed into a pair of behind-the-ear HAs together with individually prescribed amplification. Overall preference was assessed using a free-field simulation of a busy cafeteria situation with either a single frontal talker or two talkers at ±30° azimuth as the target speech. In addition, two questionnaires targeting noise sensitivity and the “Big Five” personality traits were administered. Data were analyzed using multiple regression analyses and repeated-measures analyses of variance with a focus on potential interactions between the HA settings and user factors. Results: Consistent with the earlier study, preferred HA setting was related to PTA and executive control. However, effects were weaker this time. Noise sensitivity and personality did not interact with HA settings. As expected, spatial target speech configuration influenced preference, with bilateral and unilateral DIR “winning” in the single- and two-talker scenario, respectively. In general, participants with higher PTA tended to more strongly prefer bilateral DIR than participants with lower PTA. Conclusions: Although the current study lends some support to the view that PTA and cognitive factors affect preferred DIR and NR setting, it also indicates that these effects can vary across noise management technologies. To facilitate more personalized HA fittings, future research should investigate the source of this variability.

A Method for Assessing Auditory Spatial Analysis in Reverberant Multitalker Environments.

Abstract: Background: Deficits in spatial hearing can have a negative impact on listeners’ ability to orient in their environment and follow conversations in noisy backgrounds and may exacerbate the experience of hearing loss as a handicap. However, there are no good tools available for reliably capturing the spatial hearing abilities of listeners in complex acoustic environments containing multiple sounds of interest. Purpose: The purpose of this study was to explore a new method to measure auditory spatial analysis in a reverberant multitalker scenario. Research Design: This study was a descriptive case control study. Study Sample: Ten listeners with normal hearing (NH) aged 20–31 yr and 16 listeners with hearing impairment (HI) aged 52–85 yr participated in the study. The latter group had symmetrical sensorineural hearing losses with a four-frequency average hearing loss of 29.7 dB HL. Data Collection and Analysis: A large reverberant room was simulated using a loudspeaker array in an anechoic chamber. In this simulated room, 96 scenes comprising between one and six concurrent talkers at different locations were generated. Listeners were presented with 45-sec samples of each scene, and were required to count, locate, and identify the gender of all talkers, using a graphical user interface on an iPad. Performance was evaluated in terms of correctly counting the sources and accuracy in localizing their direction. Results: Listeners with NH were able to reliably analyze scenes with up to four simultaneous talkers, while most listeners with hearing loss demonstrated errors even with two talkers at a time. Localization performance decreased in both groups with increasing number of talkers and was significantly poorer in listeners with HI. Overall performance was significantly correlated with hearing loss. Conclusions: This new method appears to be useful for estimating spatial abilities in realistic multitalker scenes. The method is sensitive to the number of sources in the scene, and to effects of sensorineural hearing loss. Further work will be needed to compare this method to more traditional single-source localization tests.

The Effects of Hearing Impairment, Age, and Hearing Aids on the Use of Self-Motion for Determining Front/Back Location.

Abstract: Background: There are two cues that listeners use to disambiguate the front/back location of a sound source: high-frequency spectral cues associated with the head and pinnae, and self-motion‐related binaural cues. The use of these cues can be compromised in listeners with hearing impairment and users of hearing aids. Purpose: To determine how age, hearing impairment, and the use of hearing aids affect a listener’s ability to determine front from back based on both self-motion and spectral cues. Research Design: We used a previously published front/back illusion: signals whose physical source location is rotated around the head at twice the angular rate of the listener’s head movements are perceptually located in the opposite hemifield from where they physically are. In normal-hearing listeners, the strength of this illusion decreases as a function of low-pass filter cutoff frequency, this is the result of a conflict between spectral cues and dynamic binaural cues for sound source location. The illusion was used as an assay of self-motion processing in listeners with hearing impairment and users of hearing aids. Study Sample: We recruited 40 hearing-impaired participants, with an average age of 62 yr. The data for three listeners were discarded because they did not move their heads enough during the experiment. Data Collection and Analysis: Listeners sat at the center of a ring of 24 loudspeakers, turned their heads back and forth, and used a wireless keypad to report the front/back location of statically presented signals and of dynamically moving signals with illusory locations. Front/back accuracy for static signals, the strength of front/back illusions, and minimum audible movement angle were measured for each listener in each condition. All measurements were made in each listener both aided and unaided. Results: Hearing-impaired listeners were less accurate at front/back discrimination for both static and illusory conditions. Neither static nor illusory conditions were affected by high-frequency content. Hearing aids had heterogeneous effects from listener to listener, but independent of other factors, on average, listeners wearing aids exhibited a spectrally dependent increase in “front” responses: the more high-frequency energy in the signal, the more likely they were to report it as coming from the front. Conclusions: Hearing impairment was associated with a decrease in the accuracy of self-motion processing for both static and moving signals. Hearing aids may not always reproduce dynamic self-motion‐related cues with sufficient fidelity to allow reliable front/back discrimination.

Factors Affecting Speech Discrimination in Children with Cochlear Implants: Evidence from Early-Implanted Infants.

Abstract: BACKGROUND To learn words and acquire language, children must be able to discriminate and correctly perceive phonemes. Although there has been much research on the general language outcomes of children with cochlear implants (CIs), little is known about the development of speech perception with regard to specific speech processes, such as speech discrimination. PURPOSE The purpose of this study was to investigate the development of speech discrimination in infants with CIs and identify factors that might correlate with speech discrimination skills. RESEARCH DESIGN Using a Hybrid Visual Habituation procedure, we tested infants with CIs on their ability to discriminate the vowel contrast /i/-/u/. We also gathered demographic and audiological information about each infant. STUDY SAMPLE Children who had received CIs before 2 yr of age served as participants. We tested the children at two post cochlear implantation intervals: 2-4 weeks post CI stimulation (N = 17) and 6-9 mo post CI stimulation (N = 10). DATA COLLECTION AND ANALYSIS The infants' mean looking times during the novel versus old trials of the experiment were measured. A linear regression model was used to evaluate the relationship between the normalized looking time difference and the following variables: chronological age, age at CI stimulation, gender, communication mode, and best unaided pure-tone average. RESULTS We found that the best unaided pure-tone average predicted speech discrimination at the early interval. In contrast to some previous speech perception studies that included children implanted before 3 yr of age, age at CI stimulation did not predict speech discrimination performance. CONCLUSIONS The results suggest that residual acoustic hearing before implantation might facilitate speech discrimination during the early period post cochlear implantation; with more hearing experience, communication mode might have a greater influence on the ability to discriminate speech. This and other studies on age at cochlear implantation suggest that earlier implantation might not have as large an effect on speech perception as it does on other language skills.

Diagnostic Hearing Assessment in Schools: Validity and Time Efficiency of Automated Audiometry.

Abstract: Background Poor follow-up compliance from school-based hearing screening typically undermines the efficacy of school-based hearing screening programs. Onsite diagnostic audiometry with automation may reduce false positives and ensure directed referrals. Purpose To investigate the validity and time efficiency of automated diagnostic air- and bone-conduction audiometry for children in a natural school environment following hearing screening. Research design A within-subject repeated measures design was employed to compare air- and bone-conduction pure-tone thresholds (0.5-4 kHz), measured by manual and automated pure-tone audiometry. Study sample Sixty-two children, 25 males and 37 females, with an average age of 8 yr (standard deviation [SD] = 0.92; range = 6-10 yr) were recruited for this study. The participants included 30 children who failed on a hearing screening and 32 children who passed a hearing screening. Data analysis Threshold comparisons were made for air- and bone-conduction thresholds across ears tested with manual and automated audiometry. To avoid a floor effect thresholds of 15 dB HL were excluded in analyses. The Wilcoxon signed ranked test was used to compare threshold correspondence for manual and automated thresholds and the paired samples t-test was used to compare test time. Statistical significance was set as p ≤ 0.05. Results 85.7% of air-conduction thresholds and 44.6% of bone-conduction thresholds corresponded within the normal range (15 dB HL) for manual and automated audiometry. Both manual and automated audiometry air- and bone-conduction thresholds exceeded 15 dB HL in 9.9% and 34.0% of thresholds, respectively. For these thresholds, average absolute differences for air- and bone-conduction thresholds were 6.3 (SD = 8.3) and 2.2 dB (SD = 3.6) and they corresponded within 10 dB across frequencies in 87.7% and 100.0%, respectively. There was no significant difference between manual and automated air- and bone-conduction across frequencies for these thresholds. Conclusion Using onsite automated diagnostic audiometry for children who fail hearing screening may improve the efficacy of school-based screening programs by reducing false positives and ensuring directed referrals for audiological or medical intervention or both.