Can real-ear insertion gain deviations from generic fitting prescriptions predict self-reported outcomes?

OBJECTIVE: The aim of this study was to determine whether the differences in insertion gains from the first fit to generic prescriptions of hearing aids can predict the self-reported hearing aid (HA) outcomes for first-time and experienced HA users. DESIGN: This was a prospective observational study. STUDY SAMPLE: The study included 885 first-time and 330 experienced HA users with a valid real-ear measurement on both ears and answers to the abbreviated version of the Speech, Spatial, and Quality of Hearing (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires. RESULTS: K-means clustering of gain differences between individual real-ear insertion gain to three generic gain prescriptions (NAL-NL2, NAL-RP, and one-third gain rules) was performed. The gain difference at higher frequencies generally differentiated the clusters. The experienced users in the cluster with fittings closest to NAL-NL2 and NAL-RP prescription were found to exhibit a higher IOI-HA Factor 1 score (representing the overall benefit of the hearing aid use). The gain differences to generic prescription did not affect other self-reported outcomes for first-time and experienced HA users. CONCLUSION: The experienced HA users with minimal gain deviations from generic prescriptions reported better self-perceived benefits than users with larger deviations. However, this was not apparent in first-time users.

Towards Auditory Profile-Based Hearing-Aid Fittings: BEAR Rationale and Clinical Implementation.

(1) Background: To improve hearing-aid rehabilitation, the Danish 'Better hEAring Rehabilitation' (BEAR) project recently developed methods for individual hearing loss characterization and hearing-aid fitting. Four auditory profiles differing in terms of audiometric hearing loss and supra-threshold hearing abilities were identified. To enable auditory profile-based hearing-aid treatment, a fitting rationale leveraging differences in gain prescription and signal-to-noise (SNR) improvement was developed. This report describes the translation of this rationale to clinical devices supplied by three industrial partners. (2) Methods: Regarding the SNR improvement, advanced feature settings were proposed and verified based on free-field measurements made with an acoustic mannikin fitted with the different hearing aids. Regarding the gain prescription, a clinically feasible fitting tool and procedure based on real-ear gain adjustments were developed. (3) Results: Analyses of the collected real-ear gain and SNR improvement data confirmed the feasibility of the clinical implementation. Differences between the auditory profile-based fitting strategy and a current 'best practice' procedure based on the NAL-NL2 fitting rule were verified and are discussed in terms of limitations and future perspectives. (4) Conclusion: Based on a joint effort from academic and industrial partners, the BEAR fitting rationale was transferred to commercially available hearing aids.

A binaural auditory steering strategy based hearing-aid algorithm design.

Beamforming techniques are widely used in hearing aids to enhance the intelligibility of speech from a target direction, but they tend to isolate the listener from their acoustic environment and distort spatial cues. The main reason for this is that a typical beamformer method alters the head-related transfer function of the individual users' ears and functions under monaural assumptions instead of a binaural model. In this letter, a binaural auditory steering strategy (BASS) is proposed for the design of asymmetrically presented spatial filters which improves awareness of the surrounding acoustic environment while preserving intelligibility from a target direction. Additionally, an objective metric and the results of a subjective study to evaluate the effectiveness of the BASS are presented.

Modeling within- and across-channel processes in comodulation masking release.

The relative contributions of within-channel and across-channel processes to perceptual comodulation masking release (CMR) were investigated in the framework of an auditory processing model. A generalized version of the computational auditory signal processing and perception model [CASP; Jepsen et al., J. Acoust. Soc. Am. 124, 422-438 (2008)] was used and extended by an across-channel modulation processing stage according to Piechowiak et al. [J. Acoust. Soc. Am. 121, 2111-2126 (2007)]. Five experimental paradigms were considered: CMR with a broadband noise masker as a function of the masker spectrum level; CMR with four widely spaced flanking bands (FBs) varying in overall level; CMR with one FB varying in frequency and level relative to the on-frequency band (OFB); CMR with one FB varying in frequency; and CMR as a function of the number of FBs. The predictions suggest that at least three different mechanisms contribute to overall CMR in the considered conditions: (1) a within-channel process based on changes in the envelope characteristic due to the addition of the signal to the masker; (2) a within-channel process based on nonlinear peripheral processing of the OFB's envelope caused by the FB(s); and (3) an across-channel process that is robust across presentation levels but relatively small (2-5 dB).

Modeling comodulation masking release using an equalization-cancellation mechanism.

This study presents an auditory processing model that accounts for the perceptual phenomenon of comodulation masking release (CMR). The model includes an equalization-cancellation (EC) stage for the processing of activity across the audio-frequency axis. The EC process across frequency takes place at the output of a modulation filterbank assumed for each audio-frequency channel. The model was evaluated in three experimental conditions: (i) CMR with four widely spaced flanking bands in order to study pure across-channel processing, (ii) CMR with one flanking band varying in frequency in order to study the transition between conditions dominated by within-channel processing and those dominated by across-channel processing, and (iii) CMR obtained in the "classical" band-widening paradigm in order to study the role of across-channel processing in a condition which always includes within-channel processing. The simulations support the hypothesis that within-channel contributions to CMR can be as large as 15 dB. The across-channel process is robust but small (about 2-4 dB) and only observable at small masker bandwidths. Overall, the proposed model might provide an interesting framework for the analysis of fluctuating sounds in the auditory system.