Subjective Speech Intelligibility Drives Noise-Tolerance Domain Use During the Tracking of Noise-Tolerance Test.

OBJECTIVES: Recently, the Noise-Tolerance Domains Test (NTDT) was applied to study the noise-tolerance domains used by young normal-hearing (NH) listeners during noise acceptance decisions. In this study, we examined how subjective speech intelligibility may drive noise acceptance decisions by applying the NTDT on NH and hearing-impaired (HI) listeners at the signal to noise ratios (SNRs) around the Tracking of Noise-Tolerance (TNT) thresholds. DESIGN: A single-blind, within-subjects design with 22 NH and 17 HI older adults was followed. Listeners completed the TNT to determine the average noise acceptance threshold (TNTAve). Then, listeners completed the NTDT at the SNRs of 0, ±3 dB (re: TNTAve) to estimate the weighted noise-tolerance domain ratings (WNTDRs) for each domain criterion. Listeners also completed the Objective and Subjective Intelligibility Difference (OSID) Test to establish the individual intelligibility performance-intensity (P-I) functions of the TNT materials. All test measures were conducted at 75 and 82 dB SPL speech input levels. NH and HI listeners were tested in the unaided mode. The HI listeners were also tested using a study hearing aid. The WNTDRs were plotted against subjective speech intelligibilities extrapolated from individual P-I of the OSID at the SNRs corresponding to NTDT test conditions. Listeners were grouped according to their most heavily weighed domain and a regression analysis was performed against listener demographics as well as TNT and OSID performances to determine which variable(s) affected listener grouping. RESULTS: Three linear mixed effects (LMEs) models were used to examine whether WNTDRs changed with subjective speech intelligibility. All three LMEs found significant fixed effects of domain criteria, subjective intelligibility, and speech input level on WNTDRs. In general, heavier weights were assigned to speech interference and loudness domains at poorer intelligibility levels (<50%) with reversals to distraction and annoyance at higher intelligibility levels (>80%). The comparison between NH and HI-unaided showed that NH listeners assigned greater weights to loudness than the HI-unaided listeners. The comparison between NH and HI-aided groups showed similar weights between groups. The comparison between HI-unaided and HI-aided found that HI listeners assigned lower weights to speech interference and greater weights to loudness when tested in aided compared with unaided modes. In all comparisons, loudness was weighed heavier at the 82 dB SPL input level than at the 75 dB SPL input level with greater weights to annoyance in the NH versus HI-unaided comparison and lower weights to distraction in the HI-aided versus HI-unaided comparison. A generalized linear model determined that listener grouping was best accounted for by subjective speech intelligibility estimated at TNTAve. CONCLUSIONS: The domain criteria used by listeners were driven by their subjective speech intelligibility regardless of their hearing status (i.e., NH versus HI). In general, when subjective intelligibility was poor, the domains of speech interference and loudness were weighed the heaviest. As subjective intelligibility improved, the weightings on annoyance and distraction increased. Furthermore, a listener's criterion for >90% subjective speech understanding at the TNTAve may allow one to profile the listener.

Alpha-Band Dynamics of Hearing Aid Wearers Performing the Repeat-Recall Test (RRT).

This study measured electroencephalographic activity in the alpha band, often associated with task difficulty, to physiologically validate self-reported effort ratings from older hearing-impaired listeners performing the Repeat-Recall Test (RRT)-an integrative multipart assessment of speech-in-noise performance, context use, and auditory working memory. Following a single-blind within-subjects design, 16 older listeners (mean age = 71 years, SD = 13, 9 female) with a moderate-to-severe degree of bilateral sensorineural hearing loss performed the RRT while wearing hearing aids at four fixed signal-to-noise ratios (SNRs) of -5, 0, 5, and 10 dB. Performance and subjective ratings of listening effort were assessed for complementary versions of the RRT materials with high/low availability of semantic context. Listeners were also tested with a version of the RRT that omitted the memory (i.e., recall) component. As expected, results showed alpha power to decrease significantly with increasing SNR from 0 through 10 dB. When tested with high context sentences, alpha was significantly higher in conditions where listeners had to recall the sentence materials compared to conditions where the recall requirement was omitted. When tested with low context sentences, alpha power was relatively high irrespective of the memory component. Within-subjects, alpha power was related to listening effort ratings collected across the different RRT conditions. Overall, these results suggest that the multipart demands of the RRT modulate both neural and behavioral measures of listening effort in directions consistent with the expected/designed difficulty of the RRT conditions.

Cortical sensory gating and reactions to dynamic speech-in-noise in older normal-hearing and hearing-impaired adults.

OBJECTIVE: To examine whether cortical sensory gating predicts how older adults with and without hearing loss perform the Tracking of Noise Tolerance (TNT) test. DESIGN: Single-blind mixed design. TNT performance was defined by average tolerated noise relative to speech levels (TNTAve) and by an average range of noise levels over a two-minute trial (excursion). Sensory gating of P1-N1-P2 components was measured using pairs of 1 kHz tone pips. STUDY SAMPLE: Twenty-three normal-hearing (NH) and 16 hearing-impaired (HI) older adults with a moderate-to-severe degree of sensorineural hearing loss. RESULTS: NH listeners tolerated significantly more noise than HI listeners, but the two groups did not differ in their excursion. Both NH and HI listeners exhibited significant gating of P1 amplitudes and N1P2 peak-to-peak amplitudes with no difference in gating magnitudes between listener groups. Sensory gating magnitudes of P1 and N1P2 did not predict TNTAve scores, but N1P2 gating negatively predicted excursion after accounting for listener age and hearing thresholds. CONCLUSIONS: Listeners' reactivity to a roving noise (excursion), but not their average noise tolerance (TNTAve), was predicted by sensory gating at N1P2 generators. These results suggest that temporal aspects of speech-in-noise processing may be affected by declines in the central inhibition of older adults.

Characteristics of the quick repeat-recall test (Q-RRT).

OBJECTIVE: To determine the reliability and validity of the Quick Repeat-Recall Test (Q-RRT). DESIGN: Within-subject repeated measures. Participants completed the Q-RRT at a speech level of 75 dB SPL in 2 noise configurations at signal-to-noise ratios of 5, 10, and 15 dB in a counterbalanced order, along with the full-RRT. The Q-RRT was repeated after 1-3 weeks to estimate within-session and between-session reliability. Participants also completed external validation measures relating speech-in-noise ability (Hearing-In-Noise Test, HINT), memory (Reading Span Test, RST; Forward Digit Span Test, DST-F), and noise acceptance (Tracking of Noise Tolerance, TNT). STUDY SAMPLE: Twenty-five normal-hearing listeners (mean age = 63.9 years). RESULTS: Group Repeat and Recall scores were similar between the full-RRT and the Q-RRT. However, Listening Effort and Tolerable Time ratings were significantly poorer for the full-RRT than the Q-RRT. The average repeat scores correlated with the HINT scores, while the recall scores correlated with the DST-F and RST scores. Tolerable Time ratings also correlated with the TNT scores. Within-session and between-session test-retest reliability using intraclass correlation coefficients were fair-to-excellent (0.41-0.91) depending on the outcome measures. CONCLUSIONS: The Q-RRT is a reliable and valid measure of speech-in-noise ability, working memory, listening effort, and noise acceptance.

Measuring objective and subjective intelligibility using speech materials from the Tracking of Noise Tolerance (TNT) test.

BACKGROUND: The results of tests measuring objective speech intelligibility are similar to those measuring subjective speech intelligibility using speech materials with minimal context. It is unclear if such is the case with contextual materials. PURPOSE: To compare objective and subjective intelligibility difference (OSID) between normal-hearing (NH) and hearing-impaired (HI) listeners in the unaided and aided modes using speech materials adapted from the Tracking of Noise Tolerance (TNT) test. RESEARCH DESIGN: Single-blind within-subjects design. STUDY SAMPLE: Twenty-four NH and 17 HI older adults. DATA COLLECTION AND ANALYSIS: Listeners completed the objective and subjective intelligibility measures at 75 dB SPL and 82 dB SPL speech input levels. Five signal-to-noise ratios (SNR) were tested to generate the objective and subjective speech intelligibility performance-intensity (P-I) functions. Both NH and HI listeners were tested in the unaided mode. The HI listeners were also tested using their own hearing aids (HAs). Objective and subjective speech-reception thresholds at a 50% criterion (SRT50s) were estimated from each individual P-I function. The difference between the objective SRT50 and subjective SRT50 was used to estimate OSID. RESULTS: Objective and subjective SRT50s were significantly better in NH than in HI listeners (χ2(1) = 26.29, p < 0.001) at each speech input level in the unaided mode. However, there was a significant interaction between listener group and intelligibility type (χ2(1) = 9.43, p = 0.002) where SRT50s were lower for subjective than objective P-I functions only in the HI group. The SRT50s of HI listeners were also affected by hearing mode, where both objective and subjective intelligibility was improved when HI listeners were tested while wearing their own HAs. In general, objective and subjective SRT50s showed moderate-to-strong correlations across most combinations of listener groups and test conditions (r = 0.59-0.86, p < 0.01) except for HI listeners tested with their own HAs (r = 0.39, p = 0.128). CONCLUSIONS: Similar objective and subjective intelligibility was observed in NH listeners but better subjective intelligibility than objective intelligibility was noted in HI listeners when tested in the unaided and aided modes.

Performance of older normal-hearing listeners on the tracking of noise tolerance (TNT) test.

OBJECTIVE: To gather preliminary reference data on older normal-hearing (NH) adults for the refined Tracking of Noise Tolerance (TNT) test. DESIGN: Within-subject repeated measures. Participants were tested on the TNT in the sound-field and under headphones. In the sound-field, speech stimuli were presented at 75 dB SPL and 82 dB SPL from 0° with a speech-shaped noise presented either from 0° or 180° at a level controlled by the participants. The order of signal level, mode of presentation, noise azimuth, and TNT passages were counterbalanced across listeners. Testing was repeated for one condition after 1-3 weeks to estimate within-session and between-session reliability. STUDY SAMPLE: Twenty-five NH listeners (51-82 yrs of age). RESULTS: Mean TNT scores (TNTAve) were about 4 dB at a speech input of 75 dB SPL and 3 dB at 82 dB SPL. The TNTAve was similar between the headphone and sound-field presentations in the co-located noise. TNTAve scores measured with noise-back were about 1 dB better than those measured from the front. The 95% confidence intervals of absolute test-retest differences were about 1.2 dB within-session and 2.0 dB between sessions. CONCLUSIONS: The refined TNT may be a reliable tool to measure noise acceptance and subjective speech intelligibility.

Measuring the effect of adaptive directionality and split processing on noise acceptance at multiple input levels.

OBJECTIVE: This study used the multi-level Tracking of Noise Tolerance (TNT) test to compare Augmented Focus (AF) or split processing over non-AF processing with adaptive directionality (non-AF-dirm) and with an omnidirectional microphone (non-AF-omni). DESIGN: This was a single-blind, within-subject repeated measures design. STUDY SAMPLE: Nineteen listeners with a mild-to-moderate hearing loss. The listeners' task was to determine their tolerable noise level (TNL) in the sound-field at four fixed speech levels (i.e. 62, 68, 75, and 85 dB SPL) in the unaided condition and the different aided conditions. The speech passages were presented from 0° while a continuous speech-shaped noise was presented from 180°. Each condition was tested twice, each in a different counterbalanced order. RESULTS: AF improved TNL by an average of 2.9 dB over non-AF-dirm. Adaptive directionality improved the aided TNL by 4.7 dB over the non-AF-omni condition. The unaided TNL was similar to the aided non-AF-omni TNL. Whereas a stable TNL was reached in 20-30 s for non-AF-dirm, it took AF < 15 s to reach a stable TNL at all input levels. CONCLUSIONS: This study shows that AF allowed 2.9 dB of signal-to-noise ratio (SNR) improvement over that of non-AF-dirm and 7.6 dB over the aided non-AF-omni condition.

Left Lateralization of the Cortical Auditory-Evoked Potential Reflects Aided Processing and Speech-in-Noise Performance of Older Listeners With a Hearing Loss.

OBJECTIVES: We analyzed the lateralization of the cortical auditory-evoked potential recorded previously from aided hearing-impaired listeners as part of a study on noise-mitigating hearing aid technologies. Specifically, we asked whether the degree of leftward lateralization in the magnitudes and latencies of these components was reduced by noise and, conversely, enhanced/restored by hearing aid technology. We further explored if individual differences in lateralization could predict speech-in-noise abilities in listeners when tested in the aided mode. DESIGN: The study followed a double-blind within-subjects design. Nineteen older adults (8 females; mean age = 73.6 years, range = 56 to 86 years) with moderate to severe hearing loss participated. The cortical auditory-evoked potential was measured over 400 presentations of a synthetic /da/ stimulus which was delivered binaurally in a simulated aided mode using shielded ear-insert transducers. Sequences of the /da/ syllable were presented from the front at 75 dB SPL-C with continuous speech-shaped noise presented from the back at signal-to-noise ratios of 0, 5, and 10 dB. Four hearing aid conditions were tested: (1) omnidirectional microphone (OM) with noise reduction (NR) disabled, (2) OM with NR enabled, (3) directional microphone (DM) with NR disabled, and (4) DM with NR enabled. Lateralization of the P1 component and N1P2 complex was quantified across electrodes spanning the mid-coronal plane. Subsequently, listener speech-in-noise performance was assessed using the Repeat-Recall Test at the same signal-to-noise ratios and hearing aid conditions used to measure cortical activity. RESULTS: As expected, both the P1 component and the N1P2 complex were of greater magnitude in electrodes over the left compared to the right hemisphere. In addition, N1 and P2 peaks tended to occur earlier over the left hemisphere, although the effect was mediated by an interaction of signal-to-noise ratio and hearing aid technology. At a group level, degrees of lateralization for the P1 component and the N1P2 complex were enhanced in the DM relative to the OM mode. Moreover, linear mixed-effects models suggested that the degree of leftward lateralization in the N1P2 complex, but not the P1 component, accounted for a significant portion of variability in speech-in-noise performance that was not related to age, hearing loss, hearing aid processing, or signal-to-noise ratio. CONCLUSIONS: A robust leftward lateralization of cortical potentials was observed in older listeners when tested in the aided mode. Moreover, the degree of lateralization was enhanced by hearing aid technologies that improve the signal-to-noise ratio for speech. Accounting for the effects of signal-to-noise ratio, hearing aid technology, semantic context, and audiometric thresholds, individual differences in left-lateralized speech-evoked cortical activity were found to predict listeners' speech-in-noise abilities. Quantifying cortical auditory-evoked potential component lateralization may then be useful for profiling listeners' likelihood of communication success following clinical amplification.

Use of Emotional and Neutral Speech in Evaluating Compression Speeds.

BACKGROUND: Emotional speech differs from neutral speech in its envelope characteristics. Use of emotional speech materials may be more sensitive for evaluating signal processing algorithms that affect the temporal envelope. PURPOSE: Subjective listener preference was compared between variable speed compression (VSC) and fast acting compression (FAC) amplitude compression algorithms using neutral and emotional speech. RESEARCH DESIGN: The study used a single-blinded, repeated measures design. STUDY SAMPLE: Twenty hearing-impaired (HI) listeners with a bilaterally symmetrical, mild- to-moderately severe sensorineural hearing loss and 21 listeners with normal hearing (NH) participated. INTERVENTION: Speech was processed using FAC and VSC algorithms. DATA COLLECTION AND ANALYSIS: A paired-comparison paradigm assessed subjective preference for FAC versus VSC using emotional and neutral speech materials. The significance of subjective preference for compression algorithm (FAC or VSC) was evaluated using a linear mixed effects model at each combination of stimulus type (emotional or neutral speech) and hearing group (NH or HI). RESULTS: HI listeners showed a preference for VSC over FAC when listening to emotional speech. The same listeners showed a nonsignificant, preference for VSC over FAC when listening to neutral speech. NH listeners showed preference for VSC over FAC for both neutral and emotional speech materials. CONCLUSION: These results suggest that the subjective sound quality of emotional speech is more susceptible than neutral speech to changes in the signal introduced by FAC. Clinicians should consider including emotional speech materials when evaluating listener preference for different compression speeds in the clinic.

Performance of normal-hearing listeners on the Repeat-Recall test in different noise configurations.

OBJECTIVE: This study measured the performance of normal-hearing listeners on the Repeat-Recall Test (RRT) in two noise types (2-talker babble [2TBN] and continuous speech-shaped noise [SSN]) by two noise azimuths (0° and 180°) configurations at signal-to-noise ratios (SNRs) of 0, 5, 10, and 15 dB and quiet. DESIGN: Within-subject repeated measures. STUDY SAMPLE: Twenty-one listeners with normal hearing who also passed cognitive screening were tested in the sound-field with the speech stimulus presented from 0° at 75 dB SPL in 4 noise configurations. The order of SNRs, noise configurations, and RRT topic conditions was counterbalanced across listeners. RESULTS: Analysis revealed that repeat scores were significantly better for 2TBN, for noise at 180°, and for high context (HC) sentences. Recall performance was significantly better for SSN and HC sentences. Listening effort ratings were higher for SSN and for noise front condition at SNR ≤ 10 dB. The 2TBN noise was tolerated longer than SSN. Performance on all measures improved with SNRs. CONCLUSIONS: These data showed performance differences among noise configurations and provided a preliminary basis for comparison with hearing-impaired listeners' performance on the RRT.

Effects of Directional Microphone and Noise Reduction on Subcortical and Cortical Auditory-Evoked Potentials in Older Listeners With Hearing Loss.

OBJECTIVES: Understanding how signal processing influences neural activity in the brain with hearing loss is relevant to the design and evaluation of features intended to alleviate speech-in-noise deficits faced by many hearing aid wearers. Here, we examine whether hearing aid processing schemes that are designed to improve speech-in-noise intelligibility (i.e., directional microphone and noise reduction) also improve electrophysiological indices of speech processing in older listeners with hearing loss. DESIGN: The study followed a double-blind within-subjects design. A sample of 19 older adults (8 females; mean age = 73.6 years, range = 56-86 years; 17 experienced hearing aid users) with a moderate to severe sensorineural hearing impairment participated in the experiment. Auditory-evoked potentials associated with processing in cortex (P1-N1-P2) and subcortex (frequency-following response) were measured over the course of two 2-hour visits. Listeners were presented with sequences of the consonant-vowel syllable /da/ in continuous speech-shaped noise at signal to noise ratios (SNRs) of 0, +5, and +10 dB. Speech and noise stimuli were pre-recorded using a Knowles Electronics Manikin for Acoustic Research (KEMAR) head and torso simulator outfitted with hearing aids programmed for each listener's loss. The study aid programs were set according to 4 conditions: (1) omnidirectional microphone, (2) omnidirectional microphone with noise reduction, (3) directional microphone, and (4) directional microphone with noise reduction. For each hearing aid condition, speech was presented from a loudspeaker located at 1 m directly in front of KEMAR (i.e., 0° in the azimuth) at 75 dB SPL and noise was presented from a matching loudspeaker located at 1 m directly behind KEMAR (i.e., 180° in the azimuth). Recorded stimulus sequences were normalized for speech level across conditions and presented to listeners over electromagnetically shielded ER-2 ear-insert transducers. Presentation levels were calibrated to match the output of listeners' study aids. RESULTS: Cortical components from listeners with hearing loss were enhanced with improving SNR and with use of a directional microphone and noise reduction. On the other hand, subcortical components did not show sensitivity to SNR or microphone mode but did show enhanced encoding of temporal fine structure of speech for conditions where noise reduction was enabled. CONCLUSIONS: These results suggest that auditory-evoked potentials may be useful in evaluating the benefit of different noise-mitigating hearing aid features.

Using the Repeat-Recall Test to Examine Factors Affecting Context Use.

BACKGROUND: The effect of context on speech processing has been studied using different speech materials and response criteria. The Repeat-Recall Test (RRT) evaluates listener performance using high context (HC) and low context (LC) sentences; this may offer another platform for studying context use (CU). OBJECTIVE: This article aims to evaluate if the RRT may be used to study how different signal-to-noise ratios (SNRs), hearing aid technologies (directional microphone and noise reduction), and listener working memory capacities (WMCs) interact to affect CU on the different measures of the RRT. DESIGN: Double-blind, within-subject repeated measures design. STUDY SAMPLE: Nineteen listeners with a mild-to-moderately severe hearing loss. DATA COLLECTION: The RRT was administered with participants wearing the study hearing aids under two microphone (omnidirectional vs. directional) by two noise reduction (on vs. off) conditions. Speech was presented from 0 degree at 75 dB sound pressure level and a continuous speech-shaped noise from 180 degrees at SNRs of 0, 5, 10, and 15 dB. The order of SNR and hearing aid conditions was counterbalanced across listeners. Each test condition was completed twice in two 2-hour sessions separated by 1 month. RESULTS: CU was calculated as the difference between HC and LC sentence scores for each outcome measure (i.e., repeat, recall, listening effort, and tolerable time). For all outcome measures, repeated measures analyses of variance revealed that CU was significantly affected by the SNR of the test conditions. For repeat, recall, and listening effort measures, these effects were qualified by significant two-way interactions between SNR and microphone mode. In addition, the WMC group significantly affected CU during recall and rating of listening effort, the latter of which was qualified by an interaction between the WMC group and SNR. Listener WMC affected CU on estimates of tolerable time as qualified by significant two-way interactions between SNR and microphone mode. CONCLUSION: The study supports use of the RRT as a tool for measuring how listeners use sentence context to aid in speech processing. The degree to which context influenced scores on each outcome measure of the RRT was found to depend on complex interactions between the SNR of the listening environment, hearing aid features, and the WMC of the listeners.

An Integrative Evaluation of the Efficacy of a Directional Microphone and Noise-Reduction Algorithm under Realistic Signal-to-Noise Ratios.

BACKGROUND: Many studies on the efficacy of directional microphones (DIRMs) and noise-reduction (NR) algorithms were not conducted under realistic signal-to-noise ratio (SNR) conditions. A Repeat-Recall Test (RRT) was developed previously to partially address this issue. PURPOSE: This study evaluated whether the RRT could provide a more comprehensive understanding of the efficacy of a DIRM and NR algorithm under realistic SNRs. Possible interaction with listener working memory capacity (WMC) was assessed. RESEARCH DESIGN: This study uses a double-blind, within-subject repeated measures design. STUDY SAMPLE: Nineteen listeners with a moderate degree of hearing loss participated. DATA COLLECTION AND ANALYSIS: The RRT was administered with participants wearing the study hearing aids (HAs) under two microphones (omnidirectional versus directional) by two NR (on versus off) conditions. Speech was presented from 0° at 75 dB SPL and a continuous noise from 180° at SNRs of 0, 5, 10, and 15 dB. The order of SNR and HA conditions was counterbalanced across listeners. Each test condition was completed twice in two 2-hour sessions separated by one month. RESULTS: The recall scores of listeners were used to group listeners into good and poor WMC groups. Analysis using linear mixed-effects models revealed significant effects of context, SNR, and microphone for all four measures (repeat, recall, listening effort, and tolerable time). NR was only significant on the listening effort scale in the DIRM mode at an SNR of 5 dB. Listeners with good WMC performed better on all measures of the RRT and benefitted more from context. Although DIRM benefitted listeners with good and poor WMC, the benefits differed by context and SNR. CONCLUSIONS: The RRT confirmed the efficacy of DIRM and NR on several outcome measures under realistic SNRs. It also highlighted interactions between WMC and sentence context on feature efficacy.

Evaluation of the Efficacy of a Dual Variable Speed Compressor over a Single Fixed Speed Compressor.

BACKGROUND: It has been suggested that hearing-impaired listeners with a good working memory (WM) should be fitted with a compression system using short time constants (i.e., fast-acting compression [FAC]), whereas those with a poorer WM should be fitted with a longer time constant (i.e., slow-acting compression [SAC]). However, commercial hearing aids (HAs) seldom use a fixed speed of compression. PURPOSE: The performance of a variable speed compression (VSC) system relative to a fixed speed compressor (FAC and SAC) on measures of speech intelligibility, recall, and subjective report of listening effort and tolerable time was evaluated. The potential interaction with the listeners' WM capacity (WMC) was also examined. RESEARCH DESIGN: A double-blinded, repeated measures design. STUDY SAMPLE: Seventeen HA wearers (16 with greater than one year HA experience) with a bilaterally symmetrical, mild to moderately severe sensorineural hearing loss participated in the study. DATA COLLECTION AND ANALYSIS: Participants wore the study HAs at three compression speeds (FAC, SAC, and VSC). Each listener was evaluated on the Office of Research in Clinical Amplification-nonsense syllable test (NST) at 50 dB SPL (signal-to-noise ratio [SNR] = +15 dB), 65 dB SPL (SNR = +5 dB), 80 dB SPL (SNR = 0 dB), and a split (80 dB SPL-50 dB SPL) condition. Listeners were also evaluated on a Repeat Recall Test (RRT), where they had to repeat six short sentences (both high- and low-context sentences) after each was presented. Listeners recalled target words in all six sentences after they were presented. They also rated their listening effort and the amount of time they would tolerate listening under the specific condition. RRT sentences were presented at 75 dB SPL in quiet, as well as SNR = 0, 5, 10, and 15 dB. A Reading Span Test (RST) was also administered to assess listeners' WMC. Analysis of variance using RST scores as a covariate was used to examine differences in listener performance among compressor speeds. RESULTS: Listener performance on the NST was similar among all three compression speeds at 50, 65, and 80 dB SPL. Performance with FAC was significantly better than SAC for the split condition; however, performance did not differ between FAC and VSC or between SAC and VSC. Performance on the NST was not affected by listeners' RST scores. On the RRT, there was no effect of compressor speed on measures of repeat, recall, listening effort, and tolerable time. However, VSC resulted in significantly lower (better) speech reception threshold at the 85% correct recognition criterion (SRT85) than FAC and SAC. Listener RST scores significantly affected recall performance on the RRT but did not affect SRT85, repeat, listening effort, or tolerable time. CONCLUSION: These results suggest that the VSC, FAC, and SAC yield similar performance in most but not all test conditions. FAC outperforms SAC, where the stimulus levels change abruptly (i.e., split condition). The VSC yields a lower SRT85 than a fixed compression speed at a moderately high level with a favorable SNR. There is no interaction between compression speed and the participants' WMC.

Tracking of Noise Tolerance to Predict Hearing Aid Satisfaction in Loud Noisy Environments.

BACKGROUND: A method that tracked tolerable noise level (TNL) over time while maintaining subjective speech intelligibility was reported previously. Although this method was reliable and efficacious as a research tool, its clinical efficacy and predictive ability of real-life hearing aid satisfaction were not measured. PURPOSE: The study evaluated an adaptive method to estimate TNL using slope and variance of tracked noise level as criteria in a clinical setting. The relationship between TNL and subjective hearing aid satisfaction in noisy environments was also investigated. RESEARCH DESIGN: A single-blinded, repeated-measures design. STUDY SAMPLE: Seventeen experienced hearing aid wearers with bilateral mild-to-moderately-severe sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: Participants listened to 82-dB SPL continuous speech and tracked the background noise level that they could "put up with" while subjectively understanding >90% of the speech material. Two trials with each babble noise and continuous speech-shaped noise were measured in a single session. All four trials were completed aided using the participants' own hearing aids. The stimuli were presented in the sound field with speech from 0° and noise from the 180° azimuth. The instantaneous tolerable noise level was measured using a custom program and scored in two ways; the averaged TNL (aTNL) over the 2-min trial and the estimated TNL (eTNL) as soon as the listeners reached a stable noise estimate. Correlation between TNL and proportion of satisfied noisy environments was examined using the MarkeTrak questionnaire. RESULTS: All listeners completed the tracking of noise tolerance procedure within 2 min with good reliability. Sixty-five percent of the listeners yielded a stable noise estimate after 59.9 sec of actual test time. The eTNL for all trials was 78.6 dB SPL (standard deviation [SD] = 4.4 dB). The aTNL for all trials was 78.0 dB SPL (SD = 3.3 dB) after 120 sec. The aTNL was 79.2 dB SPL (SD = 5.4 dB) for babble noise and 77.0 dB SPL (SD = 5.9 dB) for speech-shaped noise. High within-session test-retest reliability was evident. The 95% confidence interval was 1.5 dB for babble noise and 2.8 dB for continuous speech-shaped noise. No significant correlation was measured between overall hearing aid satisfaction and the aTNL (ρ = 0.20 for both noises); however, a significant relationship between aTNL and proportion of satisfied noisy situations was evident (ρ = 0.48 for babble noise and ρ = 0.55 for speech-shaped noise). CONCLUSION: The eTNL scoring method yielded similar results as the aTNL method although requiring only half the time for 65% of the listeners. This time efficiency, along with its reliability and the potential relationship between TNL and hearing aid satisfaction in noisy listening situations suggests that this procedure may be a good clinical tool to evaluate whether specific features on a hearing aid would improve noise tolerance and predict wearer satisfaction with the selected hearing aid in real-life loud noisy situations. A larger sample of hearing aid wearers is needed to further validate these potential uses.

Tracking of Noise Tolerance to Measure Hearing Aid Benefit.

BACKGROUND: The benefits offered by noise reduction (NR) features on a hearing aid had been studied traditionally using test conditions that set the hearing aids into a stable state of performance. While adequate, this approach does not allow the differentiation of two NR algorithms that differ in their timing characteristics (i.e., activation and stabilization time). PURPOSE: The current study investigated a new method of measuring noise tolerance (Tracking of Noise Tolerance [TNT]) as a means to differentiate hearing aid technologies. The study determined the within-session and between-session reliability of the procedure. The benefits provided by various hearing aid conditions (aided, two NR algorithms, and a directional microphone algorithm) were measured using this procedure. Performance on normal-hearing listeners was also measured for referencing. RESEARCH DESIGN: A single-blinded, repeated-measures design was used. STUDY SAMPLE: Thirteen experienced hearing aid wearers with a bilaterally symmetrical (≤10 dB) mild-to-moderate sensorineural hearing loss participated in the study. In addition, seven normal-hearing listeners were tested in the unaided condition. DATA COLLECTION AND ANALYSIS: Participants tracked the noise level that met the criterion of tolerable noise level (TNL) in the presence of an 85 dB SPL continuous discourse passage. The test conditions included an unaided condition and an aided condition with combinations of NR and microphone modes within the UNIQUE hearing aid (omnidirectional microphone, no NR; omnidirectional microphone, NR; directional microphone, no NR; and directional microphone, NR) and the DREAM hearing aid (omnidirectional microphone, no NR; omnidirectional microphone, NR). Each tracking trial lasted 2 min for each hearing aid condition. Normal-hearing listeners tracked in the unaided condition only. Nine of the 13 hearing-impaired listeners returned after 3 mo for retesting in the unaided and aided conditions with the UNIQUE hearing aid. The individual TNL was estimated for each participant for all test conditions. The TNT index was calculated as the difference between 85 dB SPL and the TNL. RESULTS: The TNT index varied from 2.2 dB in the omnidirectional microphone, no NR condition to -4.4 dB in the directional microphone, NR on condition. Normal-hearing listeners reported a TNT index of -5.7 dB using this procedure. The averaged improvement in TNT offered by the NR algorithm on the UNIQUE varied from 2.1 dB when used with a directional microphone to 3.0 dB when used with the omnidirectional microphone. The time course of the NR algorithm was different between the UNIQUE and the DREAM hearing aids, with the UNIQUE reaching a stable TNL sooner than the DREAM. The averaged improvement in TNT index from the UNIQUE directional microphone was 3.6 dB when NR was activated and 4.4 dB when NR was deactivated. Together, directional microphone and NR resulted in a total TNT improvement of 6.5 dB. The test-retest reliability of the procedure was high, with an intrasession 95% confidence interval (CI) of 2.2 dB and an intersession 95% CI of 4.2 dB. CONCLUSIONS: The effect of the NR and directional microphone algorithms was measured to be 2-3 and 3.6-4.4 dB, respectively, using the TNT procedure. Because of its tracking property and reliability, this procedure may hold promise in differentiating among some hearing aid features that also differ in their time course of action.

The Effectiveness of the Progression of Widex Zen Tinnitus Therapy: A Pilot Study.

PURPOSE: The aim of this study was to measure the progression of benefits to individuals with tinnitus from providing informational counseling, hearing aids, a brief tinnitus activities treatment and Zen therapy. METHOD: Several magnitude estimation scales and tinnitus handicap scales were administered for the duration of the study to 20 participants. RESULTS: Results indicated that all participants benefited from this sequential approach of providing different components of this tinnitus treatment. Large benefits were observed following the tinnitus activities treatment and the Zen treatments. CONCLUSION: We conclude that the progressive approach of treatment demonstrated here should be of benefit to most individuals with tinnitus and that the Widex Zen sound therapy is a worthwhile treatment for many tinnitus sufferers.

Evaluation of a Wind Noise Attenuation Algorithm on Subjective Annoyance and Speech-in-Wind Performance.

BACKGROUND: Wind noise is a common problem reported by hearing aid wearers. The MarkeTrak VIII reported that 42% of hearing aid wearers are not satisfied with the performance of their hearing aids in situations where wind is present. PURPOSE: The current study investigated the effect of a new wind noise attenuation (WNA) algorithm on subjective annoyance and speech recognition in the presence of wind. RESEARCH DESIGN: A single-blinded, repeated measures design was used. STUDY SAMPLE: Fifteen experienced hearing aid wearers with bilaterally symmetrical (≤10 dB) mild-to-moderate sensorineural hearing loss participated in the study. DATA COLLECTION AND ANALYSIS: Subjective rating for wind noise annoyance was measured for wind presented alone from 0° and 290° at wind speeds of 4, 5, 6, 7, and 10 m/sec. Phoneme identification performance was measured using Widex Office of Clinical Amplification Nonsense Syllable Test presented at 60, 65, 70, and 75 dB SPL from 270° in the presence of wind originating from 0° at a speed of 5 m/sec. RESULTS: The subjective annoyance from wind noise was reduced for wind originating from 0° at wind speeds from 4 to 7 m/sec. The largest improvement in phoneme identification with the WNA algorithm was 48.2% when speech was presented from 270° at 65 dB SPL and the wind originated from 0° azimuth at 5 m/sec. CONCLUSION: The WNA algorithm used in this study reduced subjective annoyance for wind speeds ranging from 4 to 7 m/sec. The algorithm was effective in improving speech identification in the presence of wind originating from 0° at 5 m/sec. These results suggest that the WNA algorithm used in the current study could expand the range of real-life situations where a hearing-impaired person can use the hearing aid optimally.

Effects of Training on the Use of a Manual Microphone Shutoff on a BiCROS Device.

BACKGROUND: Bilateral contralateral routing of signals (BiCROS) hearing aids function to restore audibility of sounds originating from the side of the unaidable ear. However, when speech is presented to the side of the aidable ear and noise to the side of the unaidable ear, a BiCROS arrangement may reduce intelligibility of the speech signal. This negative effect may be circumvented if an on/off switch is available on the contralateral routing of signals (CROS) transmitter. PURPOSE: This study evaluated if the proper use of the on/off switch on a CROS transmitter could enhance speech recognition in noise and sound localization abilities. The participants' subjective reactions to the use of the BiCROS, including the use of the on/off switch in real-life were also evaluated. RESEARCH DESIGN: A between-subjects, repeated-measures design was used to assess differences in speech recognition (in quiet and in noise) and localization abilities under four hearing aid conditions (unaided, unilaterally aided, fixed BiCROS setting, and adjusted BiCROS setting) with speech and noise stimuli presented from different azimuths. Participants were trained on the use of the on/off switch on the BiCROS transmitter before testing in the adjusted BiCROS settings. Subjective ratings were obtained with the Speech, Spatial, and Sound Quality (SSQ) questionnaire and a custom questionnaire. STUDY SAMPLE: Nine adult BiCROS candidates participated in this study. DATA COLLECTION AND ANALYSIS: Participants wore the Widex Dream-m-CB hearing aid on the aidable ear for 1 week. They then wore the BiCROS for the remainder of the study. Speech recognition and localization testing were completed in four hearing aid conditions (unaided, unilateral aided, fixed BiCROS, and adjusted BiCROS). Speech recognition was evaluated during the first three visits, whereas localization was evaluated over the course of the study. Participants completed the SSQ questionnaire before each visit. The CROS questionnaire was completed at the final visit. A repeated measures analysis of variance with Bonferroni post hoc analysis was used to evaluate the significance of the results on speech recognition, localization, and the SSQ. RESULTS: The results revealed that the adjusted BiCROS condition improved speech recognition scores by 20 rau (rationalized arcsine unit) when speech was presented to the aidable ear and localization by 37% when sounds are presented from the side of the unaidable ear over the fixed BiCROS condition. Statistically significant benefit on the SSQ was also noted with the adjusted BiCROS condition compared to the unilateral fitting. CONCLUSIONS: These findings supported the value of an on/off switch on a CROS transmitter because it allows convenient selective transmission of sounds. It also highlighted the importance of instructions and practice in using the BiCROS hearing aid successfully.

Speech intelligibility benefits of hearing AIDS at various input levels.

BACKGROUND: Although the benefits of hearing aids are generally recognized for soft- and conversational-level sounds, most studies have reported negative benefits (i.e., poorer aided than unaided performance) at high noise inputs. Advances in digital signal processing such as compression, noise reduction, and directional microphone could improve speech perception at high input levels. This could alter our view on the efficacy of hearing aids in loud, noisy situations. PURPOSE: The current study compared the aided versus the unaided speech intelligibility performance of hearing-impaired (HI) listeners at various input levels (from 50-100 dB SPL) and signal-to-noise ratios (SNRs; quiet, +6, +3, and -3 dB) in order to document the benefits of modern hearing aids. In addition, subjective preference between aided and unaided sounds (speech and music) at various input levels was also compared. RESEARCH DESIGN: The experiment used a factorial repeated-measures design. STUDY SAMPLE: A total of 10 HI adults with symmetrical moderate to severe hearing losses served as test participants. In addition, speech intelligibility scores of five normal-hearing (NH) listeners were also measured for comparison. INTERVENTION: Speech perception was studied at 50 and 65 dB SPL input levels in quiet and also in noise at levels of 65, 85, and 100 dB SPL with SNRs of +6, +3, and -3 dB. This was done for all participants (HI and NH). In addition, the HI participants compared subjective preference between the aided and unaided presentations of speech and music stimuli at 50, 65, 85, and 100 dB SPL in quiet. DATA COLLECTION AND ANALYSIS: The data were analyzed with repeated-measures analysis of variance. RESULTS: The results showed a decrease in aided benefits as input levels increased. However, even at the two highest input levels (i.e., 85 and 100 dB SPL), aided speech scores were still higher than the unaided speech scores. Furthermore, NH listeners and HI listeners in the aided condition showed stable speech-in-noise performance between 65 and 100 dB SPL input levels, except that the absolute performance of the NH listeners was higher than that of the HI listeners. Subjective preference for the unaided sounds versus the aided sounds increased as input level increased, with a crossover intensity at approximately 75 dB SPL for speech and 80 dB SPL for music. CONCLUSIONS: The results supported the hypothesis that the study hearing aid can provide aided speech-in-noise benefit at very high noise inputs in a controlled environment.