Journal articles: 'Hearing aid prescription' – Grafiati (2024)

Abstract:

In our paper we would like to emphasize the complexity of hearing aid prescription process. It is connected to a series of factors which impact the choice of hearing aid; type of hearing loss, degree of hearing loss according to the average hearing threshold expressed within the range from 500 Hz to 4000 Hz on a tonal audiogram, audiometric curve configuration, speech discrimination ability, patients? age at which the hearing impairment occurred, time elapsed between the occurrence of hearing impairment and prescription of a hearing aid, patients? age, physical and mental health and their cognitive function, anatomical characteristics of the auricle and external auditory canal, patient and parent motivation, cosmetic factors, financial abilities, cooperation with hearing aids manufacturers. This paper is important for everyday practice and can be used as a kind of guideline to the hearing aid prescription process.

Abstract:

Background: An important goal of providing amplification to children with hearing loss is to ensure that hearing aids are adjusted to match targets of prescriptive procedures as closely as possible. The Desired Sensation Level (DSL) v5 and the National Acoustic Laboratories’ prescription for nonlinear hearing aids, version 1 (NAL-NL1) procedures are widely used in fitting hearing aids to children. Little is known about hearing aid fitting outcomes for children with severe or profound hearing loss. Purpose: The purpose of this study was to investigate the prescribed and measured gain of hearing aids fit according to the NAL-NL1 and the DSL v5 procedure for children with moderately severe to profound hearing loss; and to examine the impact of choice of prescription on predicted speech intelligibility and loudness. Research Design: Participants were fit with Phonak Naida V SP hearing aids according to the NAL-NL1 and DSL v5 procedures. The Speech Intelligibility Index (SII) and estimated loudness were calculated using published models. Study Sample: The sample consisted of 16 children (30 ears) aged between 7 and 17 yr old. Data Collection and Analysis: The measured hearing aid gains were compared with the prescribed gains at 50 (low), 65 (medium), and 80 dB SPL (high) input levels. The goodness of fit-to-targets was quantified by calculating the average root-mean-square (RMS) error of the measured gain compared with prescriptive gain targets for 0.5, 1, 2, and 4 kHz. The significance of difference between prescriptions for hearing aid gains, SII, and loudness was examined by performing analyses of variance. Correlation analyses were used to examine the relationship between measures. Results: The DSL v5 prescribed significantly higher overall gain than the NAL-NL1 procedure for the same audiograms. For low and medium input levels, the hearing aids of all children fit with NAL-NL1 were within 5 dB RMS of prescribed targets, but 33% (10 ears) deviated from the DSL v5 targets by more than 5 dB RMS on average. For high input level, the hearing aid fittings of 60% and 43% of ears deviated by more than 5 dB RMS from targets of NAL-NL1 and DSL v5, respectively. Greater deviations from targets were associated with more severe hearing loss. On average, the SII was higher for DSL v5 than for NAL-NL1 at low input level. No significant difference in SII was found between prescriptions at medium or high input level, despite greater loudness for DSL v5 than for NAL-NL1. Conclusions: Although targets between 0.25 and 2 kHz were well matched for both prescriptions in commercial hearing aids, gain targets at 4 kHz were matched for NAL-NL1 only. Although the two prescriptions differ markedly in estimated loudness, they resulted in comparable predicted speech intelligibility for medium and high input levels.

Abstract:

Background: Johnson and Dillon (2011) provided a model-based comparison of current generic hearing aid prescriptive methods for adults with hearing loss based on the attributes of speech intelligibility, loudness, and bandwidth. Purpose: This study compared the National Acoustic Laboratories—Non-linear 2 (NAL-NL2) and Cambridge Method for Loudness Equalization 2—High-Frequency (CAM2) prescriptive methods using adult participants with less high-frequency hearing loss than Johnson and Dillon (2011). Of study interest was quantification of prescribed audibility, speech intelligibility, and loudness. The preferences of participants for either NAL-NL2 or CAM2 and preferred deviations from prescribed settings are also reported. Research Design: Using a single-blind, counter-balanced, randomized design, preference judgments for the prescriptive methods with regard to sound quality of speech and music stimuli were obtained. Preferred gain adjustments from the prescription within the 4–10 kHz frequency range were also obtained from each participant. Speech intelligibility and loudness model calculations were completed on the prescribed and adjusted amplification. Study Sample: Fourteen male Veterans, whose average age was 65 yr and whose hearing sensitivity averaged normal to borderline normal through 1000 Hz sloping to a moderately severe sensorineural loss, served as participants. Data Collection and Analysis: Following a brief listening time (˜10 min), typical of an initial fitting visit, the participants made paired comparison of sound quality between the NAL-NL2 and CAM2 prescriptive settings. Participants were also asked to modify each prescription in the range of 4–10 kHz using an overall gain control and make subsequent comparisons of sound quality preference between prescriptive and adjusted settings. Participant preferences were examined with respect to quantitative analysis of loudness modeling, speech intelligibility modeling, and measured high-frequency bandwidth audibility. Results: Consistent with the lack of difference in predicted speech intelligibility between the two prescriptions, sound quality preferences on the basis of clarity were split across participants while some participants did not have a discernable preference. Considering sound quality judgments of pleasantness, the majority of participants preferred the sound quality of the NAL-NL2 (8 of 14) prescription instead of the CAM2 prescription (2 of 14). Four of the 14 participants showed no preference on the basis of pleasantness for either prescription. Individual subject preferences were supported by loudness modeling that indicated NAL-NL2 was the softer of the two prescriptions and CAM2 was the louder. CAM2 did provide more audibility to the higher frequencies (5–8 kHz) than NAL-NL2. Participants turned the 4–10 kHz gain recommendation of CAM2 lower, on average, by a significant amount of 4 dB when making adjustments while no significant adjustment was made to the initial NAL-NL2 recommendation. Conclusions: NAL-NL2 prescribed gains were more often preferred at the initial fitting by the majority of participating veterans. For those patients with preference for a louder fitting than NAL-NL2, CAM2 is a good alternative. When the participant adjustment from the prescription between 4 and 10 kHz exceeded 4 dB from either NAL-NL2 (2 of 14) or CAM2 (11 of 14), the participants demonstrated a later preference for that adjustment 69% of the time. These findings are viewed as limited evidence that some individuals may have a preference for high-frequency gain that differs from the starting prescription.

Abstract:

Background: Despite evidence suggesting inaccuracy in the default fittings provided by hearing aid manufacturers, the use of probe-microphone measures for the verification of fitting accuracy is routinely used by fewer than half of practicing audiologists. Purpose: The present study examined whether self-perception of hearing aid benefit, as measured through the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), differed as a function of hearing aid fitting method, specifically, manufacturer's initial-fit approach versus a verified prescription. The prescriptive fit began at NAL-NL1 targets, with adjustments based on participant request. Each of the two fittings included probe-microphone measurement. Research Design: A counterbalanced, cross-over, repeated-measures, single-blinded design was utilized to address the research objectives. Study Sample: Twenty-two experienced hearing aid users from the general Bay Pines VA Healthcare System audiology clinic population were randomized into one of two intervention groups. Intervention: At the first visit, half of the participants were fit with new hearing aids via the manufacturer's initial fit while the second half were fit to a verified prescription using probe-microphone measurement. After a wear period of 4–6 wk, the participants' hearing aids were refit via the alternate method and worn for an additional 4–6 wk. Participants were blinded to the method of fitting by utilizing probe-microphone measures with both approaches. Data Collection and Analysis: The APHAB was administered at baseline and at the end of each intervention trial. At the end of the second trial period, the participants were asked to identify which hearing aid fitting was “preferred.” The APHAB data were subjected to a general linear model repeated-measures analysis of variance. Results: For the three APHAB communication subscales (i.e., Ease of Communication, Reverberation, and Background Noise) mean scores obtained with the verified prescription were higher than those obtained with the initial-fit approach, indicating greater benefit with the former. The main effect of hearing aid fitting method was statistically significant [F (1, 21) = 4.69, p = 0.042] and accounted for 18% of the variance in the data (partial eta squared = 0.183). Although the mean benefit score for the APHAB Aversiveness subscale was also better (i.e., lower) for the verified prescription than the initial-fit approach, the difference was not statistically significant. Of the 22 participants, 7 preferred their hearing aids programmed to initial-fit settings and 15 preferred their hearing aids programmed to the verified prescription. Conclusions: The data support the conclusion that hearing aids fit to experienced hearing aid wearers using a verified prescription are more likely to yield better self-perceived benefit as measured by the APHAB than if fit using the manufacturer's initial-fit approach.

Abstract:

The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.

Abstract:

Abstract Background Hearing aid prescriptive methods are a commonly recommended component of evidence-based preferred practice guidelines and are often implemented in the hearing aid programming software. Previous studies evaluating hearing aid manufacturers' software-derived fittings to prescriptions have shown significant deviations from targets. However, few such studies examined the accuracy of software-derived fittings for the Desired Sensation Level (DSL) v5.0 prescription. Purpose The purpose of this study was to evaluate the accuracy of software-derived fittings to the DSL v5.0 prescription, across a range of hearing aid brands, audiograms, and test levels. Research Design This study is a prospective chart review with simulated cases. Data Collection and Analysis A set of software-derived fittings were created for a six-month-old test case, across audiograms ranging from mild to profound. The aided output from each fitting was verified in the test box at 55-, 65-, 75-, and 90-dB SPL, and compared with DSL v5.0 child targets. The deviations from target across frequencies 250-6000 Hz were calculated, together with the root-mean-square error (RMSE) from target. The aided Speech Intelligibility Index (SII) values generated for the speech passages at 55- and 65-dB SPL were compared with published norms. Study Sample Thirteen behind-the-ear style hearing aids from eight manufacturers were tested. Results The amount of deviation per frequency was dependent on the test level and degree of hearing loss. Most software-derived fittings for mild-to-moderately severe hearing losses fell within ± 5 dB of the target for most frequencies. RMSE results revealed more than 84% of those hearing aid fittings for the mild-to-moderate hearing losses were within 5 dB at all test levels. Fittings for severe to profound hearing losses had the greatest deviation from target and RMSE. Aided SII values for the mild-to-moderate audiograms fell within the normative range for DSL pediatric fittings, although they fell within the lower portion of the distribution. For more severe losses, SII values for some hearing aids fell below the normative range. Conclusions In this study, use of the software-derived manufacturers' fittings based on the DSL v5.0 pediatric targets set most hearing aids within a clinically acceptable range around the prescribed target, particularly for mild-to-moderate hearing losses. However, it is likely that clinician adjustment based on verification of hearing aid output would be required to optimize the fit to target, maximize aided SII, and ensure appropriate audibility across all degrees of hearing loss.

Abstract:

The amplification outcomes of two hearing aid prescriptions, NAL-NL1 and Digital Perception Processing (DPP), of nine moderate to moderately severe hearing-impaired adults were compared in the same digital hearing instrument. NAL-NL1 aims at optimizing speech intelligibility while amplifying the speech signal to a normal overall loudness level (Dillon, 1999). DPP focuses on restoring loudness based on normal and impaired cochlear excitation models (Launer and Moore, 2003). In this comparison, DPP resulted in better sentence recognition performance than the NAL-NL1 algorithm in the signal-front/noise-side condition, and the two prescriptions gave similar performance in the signal-front/noise-front condition. Subjective evaluations by the participants using the Abbreviated Profile for Hearing Aid Benefit and sound quality comparisons did not give conclusive results between the two prescriptions.With each hearing aid prescription, the ability of the hearing aid circuitry to reduce the effects of noise was evaluated by a sentence-in-noise test in three conditions: (1) adaptive directional microphone (DAZ), (2) multichannel noise reduction system (FNC), and (3) a combination of FNC and DAZ (FNC + DAZ). In the signal-front/noise-side condition, DAZ and FNC + DAZ gave better performance than FNC in nearly all participants, whereas in the signal-front and noise-front evaluation, the conditions revealed no significant differences.

Abstract:

PurposeThe aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit.MethodThis prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study.ResultsNo differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization.ConclusionOur results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.

Abstract:

Hearing aids are typically fitted using speech-based prescriptive formulae to make speech more intelligible. Individual preferences may vary from these prescriptions and may also vary with signal type. It is important to consider what motivates listener preferences and how those preferences can inform hearing aid processing so that assistive listening devices can best be tailored for hearing aid users. Therefore, this study explored preferred frequency-gain shaping relative to prescribed gain for speech and music samples. Preferred gain was determined for 22 listeners with mild sloping to moderately severe hearing loss relative to individually prescribed amplification while listening to samples of male speech, female speech, pop music, and classical music across low-, mid-, and high-frequency bands. Samples were amplified using a fast-acting compression hearing aid simulator. Preferences were determined using an adaptive paired comparison procedure. Listeners then rated speech and music samples processed using prescribed and preferred shaping across different sound quality descriptors. On average, low-frequency gain was significantly increased relative to the prescription for all stimuli and most substantially for pop and classical music. High-frequency gain was decreased significantly for pop music and male speech. Gain adjustments, particularly in the mid- and high-frequency bands, varied considerably between listeners. Music preferences were driven by changes in perceived fullness and sharpness, whereas speech preferences were driven by changes in perceived intelligibility and loudness. The results generally support the use of prescribed amplification to optimize speech intelligibility and alternative amplification for music listening for most listeners.

Abstract:

Background: Hearing aid prescriptive recommendations for hearing losses having a conductive component have received less clinical and research interest than for losses of a sensorineural nature; as a result, much variation remains among current prescriptive methods in their recommendations for conductive and mixed hearing losses (Johnson and Dillon, 2011). Purpose: The primary intent of this brief clinical note is to demonstrate differences between two algebraically equivalent expressions of hearing loss, which have been approaches used historically to generate a prescription for hearing losses with a conductive component. When air and bone conduction thresholds are entered into hearing aid prescriptions designed for nonlinear hearing aids, it was hypothesized that that two expressions would not yield equivalent amounts of prescribed insertion gain and output. These differences are examined for their impact on the maximum power output (MPO) requirements of the hearing aid. Subsequently, the MPO capabilities of two common behind-the-ear (BTE) receiver placement alternatives, receiver-in-aid (RIA) and receiver-in-canal (RIC), are examined. Study Samples: The two expressions of hearing losses examined were the 25% ABG + AC approach and the 75% ABG + BC approach, where ABG refers to air-bone gap, AC refers to air-conduction threshold, and BC refers to bone-conduction threshold. Example hearing loss cases with a conductive component are sampled for calculations. The MPO capabilities of the BTE receiver placements in commercially-available products were obtained from hearing aids on the U.S. federal purchasing contract. Results: Prescribed gain and the required MPO differs markedly between the two approaches. The 75% ABG + BC approach prescribes a compression ratio that is reflective of the amount of sensorineural hearing loss. Not all hearing aids will have the MPO capabilities to support the output requirements for fitting hearing losses with a large conductive component particularly when combined with significant sensorineural hearing loss. Generally, current RIA BTE products have greater output capabilities than RIC BTE products. Conclusions: The 75% ABG + BC approach is more appropriate than the 25% ABG + AC approach because the latter approach inappropriately uses AC thresholds as the basis for determining the compression ratio. That is, for hearing losses with a conductive component, the AC thresholds are not a measure of sensorineural hearing loss and cannot serve as the basis for determining the amount of desired compression. The Australian National Acoustic Laboratories has been using the 75% ABG + BC approach in lieu of the 25% ABG + AC approach since its release of the National Acoustic Laboratories—Non-linear 1 (NAL-NL1) prescriptive method in 1999. Future research may examine whether individuals with conductive hearing loss benefit or prefer more than 75% restoration of the conductive component provided adequate MPO capabilities to support such restoration.

Abstract:

Fitting a multiple-memory programmable hearing instrument presents a new set of challenges to the dispenser, compared to conventional fittings. Rather than having to compromise on a single frequency-gain response (the prescriptive target), it is now possible to create a family of hearing aid responses from which the user can select an appropriate response for a given situation. This philosophy is also applicable in the prescription of compression characteristics. The flexibility designed into the 3M two-channel compression system allows the dispenser to program very different types of signal processing strategies (low frequency compression, high frequency compression, full spectrum compression, or linear processing) into a single instrument to match the requirements of different listening environments and to meet the needs of different users. Utilizing this approach, comfort, speech intelligibility, and sound quality can be optimized in a variety of situations by considering the listener's acoustic environment and the input signals to which the hearing aid must respond.

Abstract:

A successful Hearing-Aid Fitting (HAF) is more than just selecting an appropriate HearingAid (HA) device for a patient with Hearing Loss (HL). The initial fitting is given by the prescriptionbased on user’s hearing loss; however, it is often necessary for the audiologist to readjust someparameters to satisfy the user demands. Therefore, in this paper, we concentrated on a new applicationof Neural Network (NN) combined with a Transfer Learning (TL) strategy to develop a fittingalgorithm with the prescription database for hearing loss and readjusted gain to minimize the gapbetween fitting satisfaction. As prior information, we generated the data set from two popularhearing-aid fitting software, then fed the training data to our proposed model, and verified theperformance of the architecture. Pondering real life circumstances, where numerous fitting recordsmay not always be accessible, we first investigated the number of minimum fitting records requiredfor possible sufficient training. After that, we evaluated the performance of the proposed algorithmin two phases: (a) NN with refined hyper parameter showed enhanced performance in compareto state-of-the-art DNN approach, and (b) the TL approach boosted the performance of the NNalgorithm in a broad way. Altogether, our model provides a pragmatic and promising tool for HAF.

Abstract:

Background: Although the benefits of amplification for persons with impaired hearing are well established, many potential candidates do not obtain and use hearing aids. In some cases, this is because the individual is not convinced that amplification will be of sufficient benefit in those everyday listening situations where he or she is experiencing difficulties. Purpose: To describe the development of a naturalistic approach to assessing hearing aid candidacy and motivating hearing aid use based on patient preferences for unamplified and amplified sound samples typical of those encountered in everyday living and to assess the validity of these preference ratings to predict hearing aid candidacy. Research Design: Prospective experimental study comparing preference ratings for unamplified and amplified sound samples of patients with a clinical recommendation for hearing aid use and patients for whom amplification was not prescribed. Study Sample: Forty-eight adults self-referred to the Army Audiology and Speech Center for a hearing evaluation. Data Collection and Analysis: Unamplified and amplified sound samples were presented to potential hearing aid candidates using a three-alternative forced-choice paradigm. Participants were free to switch at will among the three processing options (no gain, mild gain, moderate gain) until the preferred option was determined. Following this task, each participant was seen for a diagnostic hearing evaluation by one of eight staff audiologists with no knowledge of the preference data. Patient preferences for the three processing options were used to predict the attending audiologists' recommendations for amplification based on traditional audiometric measures. Results: Hearing aid candidacy was predicted with moderate accuracy from the patients' preferences for amplified sounds typical of those encountered in everyday living, although the predictive validity of the various sound samples varied widely. Conclusions: Preferences for amplified sounds were generally predictive of hearing aid candidacy. However, the predictive validity of the preference ratings was not sufficient to replace traditional clinical determinations of hearing aid candidacy in individual patients. Because the sound samples are common to patients' everyday listening experiences, they provide a quick and intuitive method of demonstrating the potential benefit of amplification to patients who might otherwise not accept a prescription for hearing aids.

Abstract:

IntroductionUsing a probe-tube microphone to measure and adjust the real-ear performance of the hearing aid to match the prescription target is recommended and widely used in clinical practice. Hearing aid fitting software can approximately match the amplification characteristics of the hearing aid to the prescription without real-ear measurements (REMs), but using REM improves the match to the prescribed target. What is unclear is if the improved match results in a better patient-reported outcome. The primary objective of this review is to determine whether the use of REM improves patient-reported outcomes in adult hearing aid users.Methods and analysisThe review’s methods are in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and CENTRAL via Cochrane Library will be searched to identify relevant studies. The review’s population of interest will include adults with any degree of sensorineural or mixed hearing loss who have been prescribed with acoustic hearing aids. The included studies should compare REM fitting to the initial fit provided by the manufacturer’s fitting software. Hearing-specific health-related quality of life is the primary outcome but secondary outcomes include self-reported listening ability, speech recognition scores, generic health-related quality of life, hours of use, number of required follow-up sessions and adverse events. Randomised and non-randomised controlled trials will be included. The risk of bias in the included studies will be evaluated using Down and Black’s checklist. The quality of the overall evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations tool.Ethics and disseminationEthical approval will not be sought because this systematic review will only retrieve and analyse data from published studies. Review results will be published in a peer-reviewed journal and presented at relevant scientific conferences.PROSPERO registration numberCRD42020166074.

Abstract:

While listening to recorded sentences with a sound-field level of 65 dB SPL, 24 adults with hearing-aid experience used the “Goldilocks” explore-and-select procedure to adjust level and spectrum of amplified speech to preference. All participants started adjustment from the same generic response. Amplification was provided by a custom-built Master Hearing Aid with online processing of microphone input. Primary goals were to assess the effects of including a formal speech-perception test between repeated self-adjustments and of adding multitalker babble (signal-to-noise ratio +6 dB) during self-adjustment. The speech test did not affect group-mean self-adjusted output, which was close to the National Acoustics Laboratories’ prescription for Non-Linear hearing aids. Individuals, however, showed a wide range of deviations from this prescription. Extreme deviations at the first self-adjustment fell by a small but significant amount at the second. The multitalker babble had negligible effect on group-mean self-selected output but did have predictable effects on word recognition in sentences and on participants’ opinion regarding the most important subjective criterion guiding self-adjustment. Phoneme recognition in monosyllabic words was better with the generic starting response than without amplification and improved further after self-adjustment. The findings continue to support the efficacy of hearing aid self-fitting, at least for level and spectrum. They do not support the need for inclusion of a formal speech-perception test, but they do support the value of completing more than one self-adjustment. Group-mean data did not indicate a need for threshold-based prescription as a starting point for self-adjustment.

Abstract:

AbstractA questionnaire survey was carried out to examine the views of general practitioners in one Northern city regarding whether or not they thought that hearing aids should be prescribed from general practice, who they thought should prescribe them and whether or not additional resources and training would be needed if the responsibility for hearing aid prescription for the elderly was placed upon general practitioners.The survey indicated that whereas many general practitioners would be in favour of prescribing hearing aids from Health Centres, many would need extra training and resources to enable them to do so.

Abstract:

Purpose The purpose of this study was to measure the range of fit to Desired Sensation Level version 5.0 (DSL v5.0) targets in pediatric practice environments. Results will be used in the future to develop clinical-aided speech intelligibility index typical performance data. Method Clinical partners collected data from 161 final hearing aid settings for children aged ≤ 10 years. Measured data were obtained by performing 2-cm 3 coupler-simulated real-ear measurements using the DSL v5.0 implementation on the Audioscan VF-1 (Etymonic Design Inc., Dorchester, ON, Canada) for soft, average, and loud speech inputs and maximum hearing aid output levels. Results Fittings were within ± 5-dB root-mean-square (RMS) error of target for 77%, 80%, and 82% of fittings for the soft, medium, and loud speech test levels, respectively. Aided maximum power output measures were within ± 5-dB RMS error in 72% of cases. Degree of hearing loss, test frequency, and frequency by test level were significant factors in deviation from target. The range of aided speech intelligibility index values exhibited a strong correlation with the hearing levels of the children tested. Conclusion This study provides evidence that typical hearing aid fittings for children can be achieved within ± 5-dB RMS error of the DSL v5.0 target. Greater target deviations were observed at extreme frequencies and as the severity of hearing loss increased.

Abstract:

AbstractThe purpose of providing amplification for children with hearing loss is to make speech audible across a range of frequencies and intensities. Children with hearing aids (HAs) that closely approximate prescriptive targets have better audibility than peers with HA output below prescriptive targets. Poor aided audibility puts children with hearing loss at risk for delays in communication, social, and academic development.The goals of this study were to determine how well HAs match prescriptive targets across ranges of frequency and intensity of speech and to determine how level- and frequency-dependent deviations from prescriptive target affect speech recognition in quiet and in background noise.One-hundred sixty-six children with permanent mild to severe hearing loss who were between 6 months and 8 years of age and who wore HAs participated in the study.Hearing aid verification and speech recognition data were collected as part of a longitudinal study of communication development in children with HAs. Hearing aid output at levels of soft and average speech and maximum power output were compared with each child’s prescriptive targets. The deviations from prescriptive target were quantified based on the root-mean-square (RMS) error and absolute deviation from target for octave frequencies. Children were classified into groups based on the number of level-dependent deviations from prescriptive target. Frequency-specific deviations from prescriptive target and sensation levels (SLs) were used to estimate the proximity of fittings across the frequency range. Lexical Neighborhood Test (LNT) word recognition in quiet and Computer-Assisted Speech Perception Assessment (CASPA) phoneme recognition in noise were compared across level-dependent error groups and as a function of SL at 4 kHz.Children who had deviations from prescriptive target at all three input levels had poorer LNT word recognition in quiet than children who had fittings that matched prescriptive target within 5 dB RMS at all three input levels. Children with lower 4 kHz SLs through their HAs had poorer LNT recognition in quiet and CASPA phoneme recognition in noise than children with higher aided SLs.Children with HAs fitted to provide audibility for speech across a range of inputs and frequencies had better speech recognition outcomes than peers with HAs that were not optimally fitted to prescriptive targets.

Abstract:

This study investigated three issues involving corrections for individual ear acoustics in hearing aid prescriptions: (a) the extent to which inconsistencies in the sound-field reference position can affect comparative corrections for the real-ear unaided response (REUR); (b) the extent to which individual variability in the real-ear-to-coupler level difference (RECD) supports the use of individual measurements as opposed to an average-ear estimate; and (c) the adequacy of using KEMAR estimates of the effects of the location of the hearing aid microphone. In Experiment 1, KEMAR REURs using over-the-ear and under-the-ear reference positions were compared with KEMAR REURs using a center-of-head reference position. Maximum differences of 4–9 dB were found in the 1500- to 5000-Hz range, depending on test conditions. In Experiment 2, the ear canal response of an insert earphone was compared to the 2-cc coupler response of the same earphone to calculate the RECD. Individual RECDs for a population of hearing aid candidates were compared to the RECD for KEMAR. For 8 of the 15 subjects (9 of 18 ears), the RECD was more than 4 dB different from KEMAR at two or more third-octave frequencies between 500 and 4000 Hz. In Experiment 3, the effect of the location of the hearing aid microphone for in-the-ear (ITE) and in-the-canal (ITC) locations was compared with the over-the-ear (OTE) location for 18 ears and for KEMAR. The effects varied across individual ears, but all ears and KEMAR showed positive gain in the high frequencies for the ITE and ITC locations. The relevance of these results to hearing aid prescription practices is discussed.

Abstract:

Purpose The aim of the study was to investigate the achieved audibility with clinically available, modern, high-end, behind-the-ear hearing aids fitted using the Desired Sensation Level v5.0 child prescription for a clinical sample of children with hearing impairment and the effect of the extended bandwidth provided by the hearing aids on several outcome measures. Method The achieved audibility was measured using the maximum audible output frequency method. Twenty-eight children (7–17 years old) with mild to severe hearing losses completed this study. Two hearing aid conditions were fitted for each participant: an extended bandwidth condition, which was fitted to targets as closely as possible, and a restricted bandwidth condition, for which aided output was restricted above 4.5 kHz. Consonant discrimination in noise, subjective preference, aided loudness growth, and preferred listening levels were evaluated in both conditions. Results The extended bandwidth hearing aid fittings provided speech audibility above 4.5 kHz for all children, with an average maximum audible output frequency of 7376 Hz ( SD = 1669 Hz). When compared to a restricted bandwidth, the extended bandwidth condition led to an improvement of 5.4% for consonant discrimination in noise scores, mostly attributable to /s/, /z/, and /t/ phoneme perception. Aided loudness results and preferred listening levels were not significantly different across bandwidth conditions; however, 65% of the children indicated a subjective preference for the extended bandwidth. Conclusion The study suggests that providing the full bandwidth available, with modern, behind-the-ear hearing aids, leads to improved audibility, when compared to restricted bandwidth hearing aids, and that it leads to beneficial outcomes for children who use hearing aids, fitted to the Desired Sensation Level v5.0 child prescription, without causing significant increases in their loudness perception.

Abstract:

During the early twentieth century, otologists began collaborating with organizers of the New York League for the Hard of Hearing to build a bridge to “adjust the economic ratio” of deafness and create new research avenues for alleviating or curing hearing loss. This collegiality not only defined the medical discourse surrounding hearing impairment, anchoring it in hearing tests and hearing aid prescription, but, in so doing, solidified the notion that deafness was a “problem” in dire need of a “solution.” Public health campaigns thus became pivotal for spreading this message on local and national levels. This paper focuses on how, from the 1920s to 1950s, as otologists became more involved with social projects for the deaf and hard of hearing — advocating lip-reading, community work, and welfare programs — at the same time, they also mandated for greater therapeutic regulation, control of hearing aid distribution, and standardization of hearing tests. The seemingly paradoxical nature of their roles continued to reinforce the stigmatization of deafness: with widespread availability of effective help, the hearing impaired were expected to seek out therapeutic or technological measures rather than live with their affliction.

Abstract:

Insertion gain and saturation sound pressure level (SSPL) characteristics of 71 behind-the-ear hearing aids were evaluated in a computer-assisted analysis as acceptable matches to prescriptive insertion gain and SSPL values derived by a variation of the Prescription of Gain and Output, or POGO, technique (McCandless & Lyregaard, 1983). Stringency criteria in a primary analysis varied from ±6 to ±16 dB and ±2 to ±8 dB for gain and SSPL, respectively. Three audiometric contours and associated loudness discomfort levels were used in the simulation. Findings indicated that the relationship between tolerances and the number of aids selected as optimally appropriate varied substantially as a function of audiometric configuration. Minimum gain and SSPL tolerance values of ±12 dB and ±4 dB, respectively, were required to provide a reasonable choice of instruments for a variety of such configurations. Further analyses shed light on the feasibility of using alternative stringency criteria and on the clinical utility of hearing aid selection using small clinic samples.

Abstract:

The field of audiological rehabilitation in adults faces an array of opportunities. Some of these are technological, as with the advent of fully digital hearing-aids, and some involve clinical practice, such as opportunities for true multidisciplinary working, and for changes in hearing-aid prescription and provision. The development of well-validated questionnaire instruments should facilitate robust research into the effectiveness of clinical interventions in adult audiological rehabilitation, for such evidence is urgently needed if the field is to thrive.

Abstract:

This study evaluated the National Acoustic Laboratories' (NAL) new formula for prescribing the gain and frequency response of a hearing aid. The frequency response prescribed for 44 clients (67 fitted ears) was compared with a series of variations having increased or decreased low-frequency and/or high-frequency emphasis. The evaluations consisted of paired-comparison judgments of the intelligibility of speech in quiet and the pleasantness of speech in noise. There were only 4 ears (6%) where a comparison response was more intelligible than the NAL response, but there were 16 ears (24%) where one of the comparison responses was more pleasant. On the average, hearing aid gain that was used by each subject agreed closely with prescribed gain. These trends were not affected by audiogram configuration, experience in aid usage, or type of aid limiting. The formula was found to be highly effective, but there were some cases where a change in aid prescription was indicated. A simple evaluation procedure using paired-comparison judgments is proposed for detecting such cases.

Abstract:

Background: The aim of this study was to compare, in users of bimodal cochlear implants, the performance obtained using their own hearing aids (adjusted with the standard NAL-NL1 fitting formula) with the performance using the Phonak Naìda Link Ultra Power hearing aid adjusted with both NAL-NL1 and a new bimodal system (Adaptive Phonak Digital Bimodal (APDB)) developed by Advanced Bionics and Phonak Corporations. Methods: Eleven bimodal users (Naìda CI Q70 + contralateral hearing aid) were enrolled in our study. The users’ own hearing aids were replaced with the Phonak Naìda Link Ultra Power and fitted following the new formula. Speech intelligibility was assessed in quiet and noisy conditions, and comparisons were made with the results obtained with the users’ previous hearing aids and with the Naída Link hearing aids fitted with the NAL-NL1 generic prescription formula. Results: Using Phonak Naìda Link Ultra Power hearing aids with the Adaptive Phonak Digital Bimodal fitting formula, performance was significantly better than that with the users’ own rehabilitation systems, especially in challenging hearing situations for all analyzed subjects. Conclusions: Speech intelligibility tests in quiet settings did not reveal a significant difference in performance between the new fitting formula and NAL-NL1 fittings (using the Naída Link hearing aids), whereas the performance difference between the two fittings was very significant in noisy test conditions.

Abstract:

Introduction Presbycusis is a consequence of aging. Prescription of hearing aids is part of the treatment, although the prevalence of use by elderly people is still small. Objective To verify whether or not self-assessment of hearing is a predictor for purchase of hearing aids. Methods Quantitative, cross-sectional, descriptive, and observational study. Participants were subjects who sought a private hearing center for selection of hearing aids. During the diagnostic interview, subjects answered the following question: “On a scale of 1 to 10, with 1 being the worst and 10 the best, how would you rate your overall hearing ability?” After that, subjects underwent audiometry, selected a hearing aid, performed a home trial, and decided whether or not to purchase the hearing aid. The variables were associated and analyzed statistically. Results The sample was comprised of 32 subjects, both men and women, with a higher number of women. Mean age was 71.41 ± 12.14 years. Self-assessment of hearing ranged from 2 to 9 points. Overall, 71.9% of the subjects purchased hearing aids. There was no association between scores in the self-assessment and the purchase of hearing aids (p = 0.263). Among those who scored between 2 and 5 points, 64.7% purchased the device; between 6 and 7 points, 76.09% purchased the device; and between 8 and 9 points, 50% purchased the device, respectively. Conclusion There is evidence that low self-assessment scores lead to the purchase of hearing aids, although no significant association was observed in the sample.

Abstract:

Background: Cochlear implant (CI) recipients with postoperative hearing preservation may utilize an ipsilateral bimodal listening condition known as electric-acoustic stimulation (EAS). Studies on EAS have reported significant improvements in speech perception abilities over CI-alone listening conditions. Adjustments to the hearing aid (HA) settings to match prescription targets routinely used in the programming of conventional amplification may provide additional gains in speech perception abilities. Purpose: Investigate the difference in users’ speech perception scores when listening with the recommended HA settings for EAS patients versus HA settings adjusted to match National Acoustic Laboratories’ nonlinear fitting procedure version 1 (NAL-NL1) targets. Research Design: Prospective analysis of the influence of HA settings. Study Sample: Nine EAS recipients with greater than 12 mo of listening experience with the DUET speech processor. Intervention: Subjects were tested in the EAS listening condition with two different HA setting configurations. Speech perception materials included consonant-nucleus-consonant (CNC) words in quiet, AzBio sentences in 10-talker speech babble at a signal-to-noise ratio (SNR) of +10, and the Bamford-Kowal-Bench sentences in noise (BKB-SIN) test. Data Collection and Analysis: The speech perception performance on each test measure was compared between the two HA configurations. Results: Subjects experienced a significant improvement in speech perception abilities with the HA settings adjusted to match NAL-NL1 targets over the recommended HA settings. Conclusions: EAS subjects have been shown to experience improvements in speech perception abilities when listening to ipsilateral combined stimulation. This population’s abilities may be underestimated with current HA settings. Tailoring the HA output to the patient’s individual hearing loss offers improved outcomes on speech perception measures.

Abstract:

Direct drive hearing devices, which deliver a signal directly to the middle ear by vibrating the tympanic membrane via a lens placed in contact with the umbo, are designed to provide an extension of audible bandwidth, but there are few studies of the effects of these devices on preference, speech intelligibility, and loudness. The current study is the first to compare aided speech understanding between narrow and extended bandwidth conditions for listeners with hearing loss while fitted with a direct drive hearing aid system. The study also explored the effect of bandwidth on loudness perception and investigated subjective preference for bandwidth. Fifteen adult hearing aid users with symmetrical sensorineural hearing loss participated in a prospective, within-subjects, randomized single-blind repeated-measures study. Participants wore the direct drive hearing aids for 4 to 15 weeks (average 6 weeks) prior to outcome measurement. Outcome measures were completed in various bandwidth conditions achieved by reducing the gain of the device above 5000 Hz or by filtering the stimuli. Aided detection thresholds provided evidence of amplification to 10000 Hz. A significant improvement was found in high-frequency consonant detection and recognition, as well as for speech in noise performance in the full versus narrow bandwidth conditions. Subjective loudness ratings increased with provision of the full bandwidth available; however, real-world trials showed most participants were able to wear the full bandwidth hearing aids with only small adjustments to the prescription method. The majority of participants had either no preference or a preference for the full bandwidth setting.

Abstract:

AbstractThe provision of standardized hearing aids is now considered to be a crucial part of the UK National Health Service. Yet this is only explicable through reference to the career of a woman who has, until now, been entirely forgotten. Dr Phyllis Margaret Tookey Kerridge (1901–1940) was an authoritative figure in a variety of fields: medicine, physiology, otology and the construction of scientific apparatus. The astounding breadth of her professional qualifications allowed her to combine features of these fields and, later in her career, to position herself as a specialist to shape the discipline of audiometry. Rather than framing Kerridge in the classic ‘heroic-woman’ narrative, in this article we draw out the complexities of her career by focusing on her pursuit of standardization of hearing tests. Collaboration afforded her the necessary networks to explore the intricacies of accuracy in the measurement of hearing acuity, but her influence was enhanced by her ownership of Britain's first Western Electric (pure-tone) audiometer, which she placed in a specially designed and unique ‘silence room’. The room became the centre of Kerridge's hearing aid clinic that, for the first time, allowed people to access free and impartial advice on hearing aid prescription. In becoming the guardian expert and advocate of the audiometer, Kerridge achieved an objectively quantified approach to hearing loss that eventually made the latter an object of technocratic intervention.

Abstract:

Direct-to-consumer (DTC) hearing devices can be purchased without consulting a hearing health professional. This project aims to compare 28 DTC devices with the most popular hearing aid supplied by the U.K. National Health Service (NHS). The comparison was based on technical performance, cosmetic acceptability, and the ability to match commonly used gain and slope targets. Electroacoustic performance was evaluated in a 2-cc coupler. Match to prescription target for both gain and slope was measured on a Knowles Electronic Manikin for Acoustic Research using a mild and also a moderate sloping hearing loss. Using an online blinded paired comparison of each DTC and the NHS reference device, 126 participants (50 were hearing aid users and 76 were nonhearing aid users) assessed the cosmetic appearance and rated their willingness-to-wear the DTC devices. The results revealed that higher purchase prices were generally associated with a better match to prescribed gain–frequency response shapes, lower distortion, wider bandwidth, better cosmetic acceptability, and higher willingness-to-wear. On every parameter measured, there were devices that performed worse than the NHS device. Most of the devices were rated lower in terms of aesthetic design than the NHS device and provided gain–frequency responses and maximum output levels that were markedly different from those prescribed for commonly encountered audiograms. Because of the absence or inflexibility of most of the devices, they have the potential to deliver poor sound quality and uncomfortably loud sounds. The challenge for manufacturers is to develop low-cost products with cosmetic appeal and appropriate electroacoustic characteristics.

Abstract:

Background: Adults with severe and profound hearing loss tend to be long-term, full-time users of amplification who are highly reliant on their hearing aids. As a result of these characteristics, they are often reluctant to update their hearing aids when new features or signal-processing algorithms become available. Due to the electroacoustic constraints of older devices, many severely and profoundly hearing-impaired adults continue to wear hearing aids that provide more low- and mid-frequency gain and less high-frequency gain than would be prescribed by the National Acoustic Laboratories’ revised formula with profound correction factor (NAL-RP). Purpose: To investigate the effect of a gradual change in gain/frequency response on experienced hearing-aid wearers with moderately severe to profound hearing loss. Research Design: Double-blind, randomized controlled trial. Study Sample: Twenty-three experienced adult hearing-aid users with severe and profound hearing loss participated in the study. Participants were selected for inclusion in the study if the gain/frequency response of their own hearing aids differed significantly from their NAL-RP prescription. Participants were assigned either to a control or to an experimental group balanced for aided ear three-frequency pure-tone average (PTA) and age. Intervention: Participants were fitted with Siemens Artis 2 SP behind-the-ear (BTE) hearing aids that were matched to the gain/frequency response of their own hearing aids for a 65 dB SPL input level. The experimental group progressed incrementally to their NAL-RP targets over the course of 15 wk, while the control group maintained their initial settings throughout the study. Data Collection and Analysis: Aided speech discrimination testing, loudness scaling, and structured questionnaires were completed at 3, 6, 9, 12, and 15 wk postfitting. A paired comparison between the old and new gain/frequency responses was completed at 1 and 15 wk postfitting. Statistical analysis was conducted to examine differences between the experimental and control groups and changes in objective performance and subjective perception over time. Results: The results of the study showed that participants in the experimental group were subjectively accepting of the changes to their amplification characteristics, as evidenced by nonsignificant changes in the ratings of device performance over time. Perception of loudness, sound quality, speech intelligibility, and own voice volume did not change significantly throughout the study. Objectively, participants in the experimental group demonstrated poorer speech discrimination performance as the study progressed, although there was no change in objective loudness perception. According to the paired comparison, there was an overall subjective preference for the original gain/frequency response among all participants, although participants in the experimental group did show an increase in preference for the NAL-RP response by the end of the study. Conclusions: Based on the findings of this study, we suggest that undertaking a gradual change to a new gain/frequency response with severely and profoundly hearing-impaired adults is a feasible procedure. However, we recommend that clinicians select transition candidates carefully and initiate the procedure only if there is a clinical reason for doing so. A validated prescriptive formula should be used as a transition target, and speech discrimination performance should be monitored throughout the transition.

Abstract:

The effect of amplitude-modulated (AM) noise on speech recognition in listeners with normal and impaired hearing was investigated in two experiments. In the first experiment, nonsense syllables were presented in high-pass steady-state or AM noise to determine whether the release from masking in AM noise relative to steady-state noise was significantly different between normal-hearing and hearing-impaired subjects when the two groups listened under equivalent masker conditions. The normal-hearing subjects were tested in the experimental noise under two conditions: (a) in a spectrally shaped broadband noise that produced pure tone thresholds equivalent to those of the hearing-impaired subjects, and (b) without the spectrally shaped broadband noise. The release from masking in AM noise was significantly greater for the normal-hearing group than for either the hearing-impaired or masked normal-hearing groups. In the second experiment, normal-hearing and hearing-impaired subjects identified nonsense syllables in isolation and target words in sentences in steady-state or AM noise adjusted to approximate the spectral shape and gain of a hearing aid prescription. The release from masking was significantly less for the subjects with impaired hearing. These data suggest that hearingimpaired listeners obtain less release from masking in AM noise than do normal-hearing listeners even when both the speech and noise are presented at levels that are above threshold over much of the speech frequency range.

Abstract:

During a hearing-aid fitting, the gain applied across frequencies is often adjusted from an initial prescription in order to meet individual needs and preferences. These gain adjustments in one or more frequency bands are commonly verified using speech in quiet (e.g., the clinician’s own voice). Such adjustments may be unreliable and inefficient if they are not discriminable. To examine what adjustments are discriminable when made to speech, this study measured the just-noticeable differences (JNDs) for gain increments in male, single-talker sentences. Sentences were presented with prescribed gains to the better ears of 41 hearing-impaired listeners. JNDs were measured at d’ of 1 for octave-band, dual-octave-band, and broadband increments using a fixed-level, same-different task. The JNDs and interquartile ranges for 0.25, 1, and 4 kHz octave-band increments were 6.3 [4.0–7.8], 6.7 [4.6–9.1], and 9.6 [7.3–12.4] dB, respectively. The JNDs and interquartile ranges for low-, mid-, and high-frequency dual-octave-band increments were 3.7 [2.5–4.6], 3.8 [2.9–4.7], and 6.8 [4.7–9.1] dB, respectively. The JND for broadband increments was 2.0 [1.5–2.7] dB. High-frequency dual-octave-band JNDs were positively correlated with high-frequency pure-tone thresholds and sensation levels, suggesting an effect of audibility for this condition. All other JNDs were independent of pure-tone threshold and sensation level. JNDs were independent of age and hearing-aid experience. These results suggest using large initial adjustments when using short sentences in a hearing-aid fitting to ensure patient focus, followed by smaller subsequent adjustments, if necessary, to ensure audibility, comfort, and stability.

Abstract:

Effective hearing aid (HA) rehabilitation requires personalization of the HA fitting parameters, but in current clinical practice only the gain prescription is typically individualized. To optimize the fitting process, advanced HA settings such as noise reduction and microphone directionality can also be tailored to individual hearing deficits. In two earlier studies, an auditory test battery and a data-driven approach that allow classifying hearing-impaired listeners into four auditory profiles were developed. Because these profiles were found to be characterized by markedly different hearing abilities, it was hypothesized that more tailored HA fittings would lead to better outcomes for such listeners. Here, we explored potential interactions between the four auditory profiles and HA outcome as assessed with three different measures (speech recognition, overall quality, and noise annoyance) and six HA processing strategies with various noise reduction, directionality, and compression settings. Using virtual acoustics, a realistic speech-in-noise environment was simulated. The stimuli were generated using a HA simulator and presented to 49 habitual HA users who had previously been profiled. The four auditory profiles differed clearly in terms of their mean aided speech reception thresholds, thereby implying different needs in terms of signal-to-noise ratio improvement. However, no clear interactions with the tested HA processing strategies were found. Overall, these findings suggest that the auditory profiles can capture some of the individual differences in HA processing needs and that further research is required to identify suitable HA solutions for them.

Abstract:

AbstractIntroduction:The medical impacts of disasters have focused on the injuries, illnesses, and deaths related to the disaster. Little has been written about the impact of disasters on persons who use prescription medications or those medications that require refrigeration, or those who require health aids. The objective of this study was an evaluation of the level of utilization of prescription medications and medications that require refrigeration as well as the use of health aids by the population affected by the disaster.Methods:Following the Northridge earthquake of 1994, a survey of Los Angeles County households was conducted to assess the impact of the earthquake. A total of 1247 households completed the 48 minute telephone interview. As part of the interview, 10 questions assessed the utilization of medications and medical aids by household members and the effects that the earthquake had on those medications and devices. Chi-square, analysis of variance (ANOVA), and logistic regression analysis were applied.Results:Of the 1,212 completed interviews, 21% of the households had a family member taking a prescription medication or a medication requiring refrigeration. Associated factors included gender, race, age, household income, level of education, presence of children, and the intensity of the earthquake (by the Modified Mercalli Index). Only 3% of those that reported medication usage noted problems associated with the use of these medications.Thirty-nine percent of the respondents indicated that someone in the household used a health aid (e.g., eyeglasses, hearing aid, etc.). Usage was related to gender, race, age, household income, level of education, presence of children, and the intensity of the shaking associated with the earthquake. Of these, 6.5% reported difficulty with these aids, usually related to loss or breakage.Conclusions:Although the proportions of the population requiring prescription or refrigerated medications and/or for those using health aids in Los Angeles seemingly are small, this translates to 630,000 households in which someone requires medications and 1.2 million households with a requirement for health aids. Thus, there are a huge number of persons at risk for serious medical problems related to these medications and devices that could produce profound medical problems during a disaster. However, during and following a moderate earthquake, it does not seem that the consequences will be great.

Abstract:

Background: Today's compression hearing aids with noise reduction systems may not manage transient noises effectively because of the short duration of these sounds compared to the onset times of the compressors and/or noise reduction algorithms. Purpose: The current study was designed to evaluate the effect of a transient noise reduction (TNR) algorithm on listening comfort, speech intelligibility in quiet, and preferred wearer gain in the presence of transients. Research Design: A single-blinded, repeated-measures design was used. Study Sample: Thirteen experienced hearing aid users with bilaterally symmetrical (≤7.5 dB) sensorineural hearing loss participated in the study. Results: Speech identification in quiet (no transient noise) was identical between the TNR On and the TNR Off conditions. The participants showed subjective preference for the TNR algorithm when “comfortable listening” was used as the criterion. Participants preferred less gain than the default prescription in the presence of transient noise sounds. However, the preferred gain was 2.9 dB higher when the TNR was activated than when it was deactivated. This translated to 12.1% improvement in phoneme identification over the TNR Off condition for soft speech. Conclusions: This study demonstrated that the use of the TNR algorithm would not negatively affect speech identification. The results also suggested that this algorithm may improve listening comfort in the presence of transient noise sounds and ensure consistent use of prescribed gain. Such an algorithm may ensure more consistent audibility across listening environments.

Abstract:

Recent research has established a connection between hearing aid (HA) users’ cognition and speech recognition performance with short and long compression release times (RT). Contradictive findings prevent researchers from using cognition to predict RT prescription. We hypothesized that the linguistic context of speech recognition test materials was one of the factors that accounted for the inconsistency. The present study was designed to examine the relationship between HA users’ cognition and their aided speech recognition performance with short and long RTs using materials with various linguistic contexts. Thirty-four older HA users’ cognitive abilities were quantified using a reading span test. They were fitted with behind-the-ear style HAs with adjustable RT settings. Three speech recognition tests were used: the word-in-noise (WIN) test, the American four alternative auditory feature (AFAAF) test, and the Bamford-Kowal-Bench speech-in-noise (BKB-SIN) test. The results showed that HA users with high cognitive abilities performed better on the AFAAF and the BKB-SIN than those with low cognitive abilities when using short RT. None of the speech recognition tests produced significantly different performance between the two RTs for either cognitive group. These findings did not support our hypothesis. The results suggest that cognition might not be important in prescribing RT.