The Effect of Stimulus Audibility on the Relationship between Pure-Tone Average and Speech Recognition in Noise Ability.

BACKGROUND: The literature presents conflicting reports on the relationship between pure-tone threshold average and speech recognition in noise ability. PURPOSE: The purpose of this retrospective study and meta-analysis was to determine the effect of stimulus audibility on the relationship between speech recognition in noise ability and bilateral pure-tone average (BPTA). RESEARCH DESIGN: Pure-tone threshold and Hearing in Noise Test (HINT) data from two data sets were evaluated. The HINT data from both data sets were divided into groups with complete and partial audibility of the HINT stimuli delivered at 65 dBA. STUDY SAMPLE: Normal and hearing-impaired participants were included in this retrospective study. For data set 1 (n = 215), a relatively weak relationship had been found between HINT thresholds and BPTA. For data set 2 (n = 55), a relatively strong relationship had been found between HINT thresholds and BPTA. For data set 1, only 10% of the participants had partial audibility of the HINT stimuli. For data set 2, 16% of the participants had partial audibility of the HINT stimuli. DATA COLLECTION AND ANALYSIS: Pure-tone thresholds and HINT data were obtained from published and unpublished studies. HINT data were collected in a simulated soundfield environment under headphones using the standard HINT protocol. Statistical analyses included descriptive statistics, correlations, and a two-way analysis of variance (ANOVA), and multiple regression. RESULTS: A two-way ANOVA followed by post hoc analyses revealed a greater difference between the data sets for the Noise Front thresholds obtained with partial rather than complete audibility of the stimuli. A weak and nonsignificant relationship was found between BPTA(0.5, 1.0, 2.0, 3.0, 6.0 kHz) versus HINT Noise Front thresholds for complete audibility data (r = 0.060, p = 0.356) and a strong relationship was found for the partial audibility data (r = 0.863, p < 0.001). CONCLUSIONS: The proportion of partial audibility data in a given data set may influence the relative strength of the relationship between BPTA and HINT Noise Front thresholds. This brings into question the convention of using pure-tone average as a predictor of speech recognition in noise ability.

Extended High-Frequency Bandwidth Improves Speech Reception in the Presence of Spatially Separated Masking Speech.

OBJECTIVES: The hypothesis that extending the audible frequency bandwidth beyond the range currently implemented in most hearing aids can improve speech understanding was tested for normal-hearing and hearing-impaired participants using target sentences and spatially separated masking speech. DESIGN: The Hearing In Speech Test (HIST) speech corpus was re-recorded, and four masking talkers were recorded at a sample rate of 44.1 kHz. All talkers were male native speakers of American English. For each subject, the reception threshold for sentences (RTS) was measured in two spatial configurations. In the asymmetric configuration, the target was presented from -45° azimuth and two colocated masking talkers were presented from +45° azimuth. In the diffuse configuration, the target was presented from 0° azimuth and four masking talkers were each presented from a different azimuth: +45°, +135°, -135°, and -45°. The new speech sentences, masking materials, and configurations were presented using low-pass filter cutoff frequencies of 4, 6, 8, and 10 kHz. For the normal-hearing participants, stimuli were presented in the sound field using loudspeakers. For the hearing-impaired participants, the spatial configurations were simulated using earphones, and a multiband wide-dynamic-range compressor with a modified CAM2 fitting algorithm was used to compensate for each participant's hearing loss. RESULTS: For the normal-hearing participants (N = 24, mean age 40 years), the RTS improved significantly by 3.0 dB when the bandwidth was increased from 4 to 10 kHz, and a significant improvement of 1.3 dB was obtained from extending the bandwidth from 6 to 10 kHz, in both spatial configurations. Hearing-impaired participants (N = 25, mean age 71 years) also showed a significant improvement in RTS with extended bandwidth, but the effect was smaller than for the normal-hearing participants. The mean decrease in RTS when the bandwidth was increased from 4 to 10 kHz was 1.3 dB for the asymmetric condition and 0.5 dB for the diffuse condition. CONCLUSIONS: Extending bandwidth from 4 to 10 kHz can improve the ability of normal-hearing and hearing-impaired participants to understand target speech in the presence of spatially separated masking speech. Future studies of the benefits of extended high-frequency amplification should investigate other realistic listening situations, masker types, spatial configurations, and room reverberation conditions, to determine added value in overcoming the technical challenges associated with implementing a device capable of providing extended high-frequency amplification.

The relationship between high-frequency pure-tone hearing loss, hearing in noise test (HINT) thresholds, and the articulation index.

BACKGROUND: Speech recognition in noise testing has been conducted at least since the 1940s (Dickson et al, 1946). The ability to recognize speech in noise is a distinct function of the auditory system (Plomp, 1978). According to Kochkin (2002), difficulty recognizing speech in noise is the primary complaint of hearing aid users. However, speech recognition in noise testing has not found widespread use in the field of audiology (Mueller, 2003; Strom, 2003; Tannenbaum and Rosenfeld, 1996). The audiogram has been used as the "gold standard" for hearing ability. However, the audiogram is a poor indicator of speech recognition in noise ability. PURPOSE: This study investigates the relationship between pure-tone thresholds, the articulation index, and the ability to recognize speech in quiet and in noise. RESEARCH DESIGN: Pure-tone thresholds were measured for audiometric frequencies 250-6000 Hz. Pure-tone threshold groups were created. These included a normal threshold group and slight, mild, severe, and profound high-frequency pure-tone threshold groups. Speech recognition thresholds in quiet and in noise were obtained using the Hearing in Noise Test (HINT) (Nilsson et al, 1994; Vermiglio, 2008). The articulation index was determined by using Pavlovic's method with pure-tone thresholds (Pavlovic, 1989, 1991). STUDY SAMPLE: Two hundred seventy-eight participants were tested. All participants were native speakers of American English. Sixty-three of the original participants were removed in order to create groups of participants with normal low-frequency pure-tone thresholds and relatively symmetrical high-frequency pure-tone threshold groups. The final set of 215 participants had a mean age of 33 yr with a range of 17-59 yr. DATA COLLECTION AND ANALYSIS: Pure-tone threshold data were collected using the Hughson-Weslake procedure. Speech recognition data were collected using a Windows-based HINT software system. Statistical analyses were conducted using descriptive, correlational, and multivariate analysis of covariance (MANCOVA) statistics. RESULTS: The MANCOVA analysis (where the effect of age was statistically removed) indicated that there were no significant differences in HINT performances between groups of participants with normal audiograms and those groups with slight, mild, moderate, or severe high-frequency hearing losses. With all of the data combined across groups, correlational analyses revealed significant correlations between pure-tone averages and speech recognition in quiet performance. Nonsignificant or significant but weak correlations were found between pure-tone averages and HINT thresholds. CONCLUSIONS: The ability to recognize speech in steady-state noise cannot be predicted from the audiogram. A new classification scheme of hearing impairment based on the audiogram and the speech reception in noise thresholds, as measured with the HINT, may be useful for the characterization of the hearing ability in the global sense. This classification scheme is consistent with Plomp's two aspects of hearing ability (Plomp, 1978).

Cochlear implant patients' localization using interaural level differences exceeds that of untrained normal hearing listeners.

Bilateral cochlear implant patients are unable to localize as well as normal hearing listeners. Although poor sensitivity to interaural time differences clearly contributes to this deficit, it is unclear whether deficits in terms of interaural level differences are also a contributing factor. In this study, localization was tested while manipulating interaural time and level cues using head-related transfer functions. The results indicate that bilateral cochlear implant users' ability to localize based on interaural level differences is actually greater than that of untrained normal hearing listeners.

The effect of different cochlear implant microphones on acoustic hearing individuals' binaural benefits for speech perception in noise.

OBJECTIVES: Cochlear implant microphones differ in placement, frequency response, and other characteristics such as whether they are directional. Although normal-hearing (NH) individuals are often used as controls in studies examining cochlear implant users' binaural benefits, the considerable differences across cochlear implant microphones make such comparisons potentially misleading. The goal of this study was to examine binaural benefits for speech perception in noise for NH individuals using stimuli processed by head-related transfer functions (HRTFs) based on the different cochlear implant microphones. DESIGN: HRTFs were created for different cochlear implant microphones and used to test participants on the Hearing in Noise Test. Experiment 1 tested cochlear implant users and NH individuals with HRTF-processed stimuli and with sound field (SF) testing to determine whether the HRTFs adequately simulated SF testing. Experiment 2 determined the measurement error and performance-intensity function for the Hearing in Noise Test with NH individuals listening to stimuli processed with the various HRTFs. Experiment 3 compared NH listeners' performance across HRTFs to determine how the HRTFs affected performance. Experiment 4 evaluated binaural benefits for NH listeners using the various HRTFs, including ones that were modified to investigate the contributions of interaural time and level cues. RESULTS: The results indicated that the HRTFs adequately simulated SF testing for the Hearing in Noise Test. They also demonstrated that the test-retest reliability and performance-intensity function were consistent across HRTFs, and that the measurement error for the test was 1.3 dB, with a change in signal-to-noise ratio of 1 dB reflecting a 10% change in intelligibility. There were significant differences in performance when using the various HRTFs, with particularly good thresholds for the HRTF based on the directional microphone when the speech and masker were spatially separated, emphasizing the importance of measuring binaural benefits separately for each HRTF. Evaluation of binaural benefits indicated that binaural squelch and spatial release from masking were found for all HRTFs, and binaural summation was found for all but one HRTF, although binaural summation was less robust than the other types of binaural benefits. In addition, the results indicated that neither interaural time nor level cues dominated binaural benefits for the NH participants. CONCLUSIONS: This study provides a means to measure the degree to which cochlear implant microphones affect acoustic hearing with respect to speech perception in noise. It also provides measures that can be used to evaluate the independent contributions of interaural time and level cues. These measures provide tools that can aid researchers in understanding and improving binaural benefits in acoustic hearing individuals listening via cochlear implant microphones.

The use of interaural time and level difference cues by bilateral cochlear implant users.

While considerable evidence suggests that bilateral cochlear implant (CI) users' sound localization abilities rely primarily on interaural level difference (ILD) cues, and only secondarily, if at all, on interaural time difference (ITD) cues, this evidence has largely been indirect. This study used head-related transfer functions (HRTFs) to independently manipulate ITD and ILD cues and directly measure their contribution to bilateral CI users' localization abilities. The results revealed a strong reliance on ILD cues, but some CI users also made use of ITD cues. The results also suggest a complex interaction between ITD and ILD cues.

Evaluation of binaural functions in bilateral cochlear implant users.

Binaural abilities are difficult to assess, yet important to understand, in the course of rehabilitating bilateral cochlear implantees. One purpose of this research was to develop a binaural assessment methodology using direct electrical input to the cochlear implant, ''direct connect assessment'', pre-processed by appropriate headrelated transfer functions (HRTFs) to simulate the binaural cues for spatial release from masking and sound localization. A second purpose was to create and evaluate new, modified rules for adaptively measuring the speech reception threshold in noise with the Hearing In Noise Test (HINT) for use with cochlear implant subjects. A third purpose was to develop a new sound localization protocol whose difficulty is adjusted to the sound localization ability of the individual cochlear implant subject. These new protocols were combined with the direct connect method and evaluated in acoustic hearing subjects and cochlear implant subjects. HINT thresholds and sound localization scores measured in the sound field and with the direct connect method did not differ significantly and were highly correlated in both groups. Measures of spatial release from masking, head shadow effects, binaural squelch, and binaural summation derived from the thresholds also were comparable for both methods. The alternative adaptive rules for HINT were found to measure different points on the same performance-intensity function. These rules allowed all cochlear implant subjects in the study to be tested adaptively and their thresholds to be compared to norms. Sound localization was measured successfully in all subjects with a sector localization protocol whose difficulty is to be adjusted to the localization ability of the subject. This protocol reduced by one-third to one-half the time required to complete the assessment of the localization ability.

Adaptive feedback cancellation in hearing aids with clipping in the feedback path.

Adaptive linear filtering algorithms are commonly used to cancel feedback in hearing aids. The use of these algorithms is based on the assumption that the feedback path is linear, so nonlinearities in the feedback path may affect performance. This study investigated the effect on feedback canceller performance of clipping of the feedback signal arriving at the microphone, as well as the benefit of applying identical clipping to the cancellation signal so that the cancellation path modeled the nonlinearity of the feedback path. Feedback signal clipping limited the amount of added stable gain that the feedback canceller could provide, and caused misadjustment in response to high-level inputs, by biasing adaptive filter coefficients toward lower magnitudes. Cancellation signal clipping mitigated these negative effects, permitting higher amounts of added stable gain and less misadjustment in response to high-level inputs, but the benefit was reduced in the presence of the highest-level inputs.

An objective procedure for evaluation of adaptive antifeedback algorithms in hearing aids.

OBJECTIVE: This study evaluated the performance of nine adaptive antifeedback algorithms. There were two goals: first, to identify objective procedures that are useful for evaluating these algorithms, and second, to identify strengths and weaknesses of existing algorithms. DESIGN: The algorithms were evaluated in behind-the-ear implementations on the Knowles Electronics Manikin for Acoustic Research (KEMAR). Different acoustic conditions were created by placing a telephone handset or a hat on KEMAR. Electroacoustic techniques were devised to measure the following performance aspects of each algorithm: (1) additional gain made available before oscillation, (2) gain lost in specific frequency regions, (3) reduction of suboscillatory peaks in the frequency response, (4) speed of adaptation to changing acoustic conditions, and (5) robustness in the presence of tonal input signals. RESULTS: For each measurement, performance varied widely across algorithms. No single algorithm was clearly superior or inferior to the others. Generally, the feedback cancellation algorithms were less likely to sacrifice gain in specific frequency regions and better at reducing suboscillatory peaks, whereas the algorithms that used noncancellation techniques were more tolerant of tonal input signals. For those algorithms equipped with special operational modes intended for music listening, the music mode improved the response to tonal inputs but sometimes sacrificed other performance aspects. Algorithms that required an acoustic measurement for initialization purposes tended to perform poorly in acoustic conditions dissimilar to the condition in which initialization was performed. CONCLUSIONS: The objective methods devised for this study appear useful for evaluating the performance of adaptive antifeedback algorithms. Currently available algorithms demonstrate a wide range of performance, and further research is required to develop new algorithms that combine the best features of existing algorithms.

The novel use of very high doses of cabergoline and a combination of testosterone and an aromatase inhibitor in the treatment of a giant prolactinoma.

Most prolactinomas respond rapidly to low doses of dopamine agonists. Occasionally, stepwise increases in doses of these agents are needed to achieve gradual prolactin (PRL) reductions. Approximately 50% of treated men remain hypogonadal, yet testosterone replacement may stimulate hyperprolactinemia. A 34-yr-old male with a pituitary macroadenoma was found to have a PRL level of 10,362 micro g/liter and testosterone level of 3.5 nmol/liter. Eleven months of dopamine agonist therapy at standard doses lowered PRL levels to 299 micro g/liter. Subsequent stepwise increases in cabergoline (3 mg daily) further lowered PRL levels to 71 micro g/liter, but hypogonadism persisted. Initiation of testosterone replacement resulted in a rise and discontinuation in a fall of PRL levels. Aromatization of exogenous testosterone to estradiol and subsequent estrogen-stimulated PRL release was suspected. Concomitant use of cabergoline with the aromatase inhibitor anastrozole after resuming testosterone replacement resulted in the maintenance of testosterone levels and restoration of normal sexual function, without increasing PRL. Ultimately, further reduction in PRL on this therapy permitted endogenous testosterone production. Thus, novel pharmacological maneuvers may permit successful medical treatment of some patients with invasive macroprolactinomas.