Comparison of Speech Perception Performance According to Prosody Change Between People With Normal Hearing and Cochlear Implant Users.

Background and Objectives: : Cochlear implants (CIs) are well known to improve audibility and speech recognition in individuals with hearing loss, but some individuals still struggle with many aspects in communication, such as prosody. This study explores how prosodic elements are perceived by those with normal hearing (NH) and CIs. Subjects and Methods: : Thirteen individuals with NH and thirteen CI users participated in this study and completed speech perception, speech prosody perception, speech prosody production, pitch difference discrimination, and melodic contour perception testing. Results: : NH listeners performed significantly better than CI users on speech perception, speech prosody perception (except for words with neutral meaning and a negative prosody change and when words were repeated twice), pitch difference discrimination, and melodic contour perception testing. No statistical significance was observed for speech prosody production for both groups. Conclusions: : Compared to NH listeners, CI users had limited ability to recognize prosodic elements. The study findings highlight the necessity of an assessment tool and signal processing algorithm for CIs, specifically targeting prosodic elements in clinical settings.

The Effectiveness of a Smartphone Application for Tinnitus Relief.

BACKGROUND: There has been a growing interest in the provision of smartphone- or internet-based tinnitus management. Studies have shown a positive impact of the smartphone applications on tinnitus symptoms. However, research into a relatively long-term effect of these applications on tinnitus relief as well as sound preferences has been sparse. This study explored the potential benefit of a tinnitus application in tinnitus relief over a period of six months. METHODS: Twenty-two participants with subjective tinnitus were enrolled in the study. Puretone audiometry, tinnitus pitch and loudness matching, stress assessment, and questionnaires were completed at the initial visit and three and six months after the first visit. The participants used the tinnitus application for six months. RESULTS: A significant reduction in subjective tinnitus loudness and annoyance and subjective stress level was observed. The Tinnitus Handicap Inventory scores were also significantly decreased after six months. The participants also reported high satisfaction with the application. Music and environmental sounds were the most preferred sound stimuli. CONCLUSIONS: The findings of this study demonstrate the potential benefit of the tinnitus application for tinnitus improvement.

Comparison of speech recognition performance with and without a face mask between a basic and a premium hearing aid in hearing-impaired listeners.

BACKGROUND: The mask mandate during the COVID-19 pandemic leads to communication challenges as sound energy gets reduced and the visual cues are lost due to the face mask. This study examines the impact of a face mask on sound energy and compares speech recognition performance between a basic and a premium hearing aid. METHODS: Participants watched four video clips (a female and a male speaker with and without a face mask) and repeated the target sentences in various test conditions. Real-ear measurement was performed to investigate the changes in sound energy in no mask, surgical, and N95 mask conditions. RESULTS: With the face mask on, sound energy significantly decreased for all types of masks. For speech recognition, the premium hearing aid showed significant improvement in the mask condition. CONCLUSION: The findings emphasize and encourage health care professionals to actively use communication strategies, such as speaking slowly and reducing background noise, when interacting with individuals with hearing loss.

How Does a Face Mask Impact Speech Perception?

Face masks are mandatory during the COVID-19 pandemic, leading to attenuation of sound energy and loss of visual cues which are important for communication. This study explores how a face mask affects speech performance for individuals with and without hearing loss. Four video recordings (a female speaker with and without a face mask and a male speaker with and without a face mask) were used to examine individuals' speech performance. The participants completed a listen-and-repeat task while watching four types of video recordings. Acoustic characteristics of speech signals based on mask type (no mask, surgical, and N95) were also examined. The availability of visual cues was beneficial for speech understanding-both groups showed significant improvements in speech perception when they were able to see the speaker without the mask. However, when the speakers were wearing the mask, no statistical significance was observed between no visual cues and visual cues conditions. Findings of the study demonstrate that provision of visual cues is beneficial for speech perception for individuals with normal hearing and hearing impairment. This study adds value to the importance of the use of communication strategies during the pandemic where visual information is lost due to the face mask.

Influence of the Noise-Canceling Technology on How We Hear Sounds.

PURPOSE: This study explores the influence of the noise-canceling technology in commercial earphones on sound pressure levels and preferred listening levels in terms of hearing protection. MATERIALS AND METHODS: Thirty individuals completed puretone audiometry and real-ear measurements to assess sound pressure levels at the level of the eardrum with and without the activation of the noise-canceling function. The Knowles Electronics Manikin for Acoustic Research was used to investigate the acoustic characteristics of two environmental sounds (bus and café). Two types of earphones (wireless and wired canal type) were utilized in the study. RESULTS: For both bus and café noises, in the low-frequency range, sound pressure levels were significantly decreased for all types of earphones when the noise-canceling function was turned on. The same results were observed for the whole frequency range. In terms of preferred listening levels, the wireless canal type and wired canal type earphones showed significant reduction in volume levels. CONCLUSION: The findings of the study show that for both low- and whole frequency range, the use of noise-canceling function significantly decreases the sound pressure levels of the signal for all styles of earphones, suggesting a potential of the noise-canceling technology in hearing protection.

Percutaneous Bone-Anchored Hearing Implant: Is It Clinically Useful in Korean?

BACKGROUND: The aim of this study is to investigate the clinical effectiveness of Ponto in Korea, a recently released percutaneous bone-anchored hearing implant. METHODS: 16 patients with single-sided deafness (SSD) and mixed or conductive hearing loss who underwent Ponto implantation from December 2018 to September 2020 were enrolled in the study. Puretone audiometry, the Korean version of the Hearing in Noise Test (K-HINT), sound localization test (SLT), and Pupillometry were performed pre- and three months post-operation. Standardized questionnaires, the Hearing Handicap Inventory for the Elderly (HHIE) and Speech, Spatial and Qualities of Hearing Scale (SSQ), were administered. RESULTS: The mean age of subjects was 55.5 (range, 48-67) years. Four males and 12 females participated in the study. The mean puretone average was 73.17 dB hearing level (HL) before surgery and significantly improved to 36.72 dB HL three months after surgery. The mean word recognition score improved from 26.0% to 90.75% after implantation. In the case of K-HINT, there was a significant difference in summation (Z = -2.250, P = 0.024) and head shadow effects (Z = -3.103, P = 0.002). There was no significant difference in root mean square error degree (RMSE) and hemifield identification scores for SLT testing. Pupillometry was performed to measure listening effort and the results revealed that the degree of pupillary dilatation decreased under the condition of quiet, 0 dB signal to noise ratio (SNR) and 3 dB SNR. The total score for HHIE decreased significantly (Z = -3.130, P = 0.002) while the SSQ score increased significantly (Z = -2.216, P = 0.027). CONCLUSIONS: The Ponto bone-anchored hearing system showed significant clinical benefit in Korean patients with conductive and mixed hearing loss and SSD.

Factors Influencing Hearing Aid Satisfaction in South Korea.

PURPOSE: The purpose of this study is three-fold: 1) to evaluate factors influencing hearing aid (HA) satisfaction; 2) to provide a profile of HA satisfaction in daily life; and 3) to examine the reasons why people gave up using HAs. MATERIALS AND METHODS: Data for 1148 respondents were statistically analyzed and reported. RESULTS: In the study, age (ß=-0.03, p<0.01), level of education (ß=1.21, p<0.01), HA purchase price (ß=1.50, p<0.01), bilateral amplification (ß=1.23, p<0.01), wearing time (ß=0.28, p<0.01), and HA fitting and fine tuning on a regular basis (ß=1.71, p<0.01) significantly influenced HA satisfaction. In addition, the authors observed that the most satisfactory factors were clarity of sound (53.5%), people's trust in their HA (61.7%), and listening from a quiet environment (72.8%) in the domains of sound quality, HA features, and listening environments, respectively. Finally, with multiple choices being possible, 65% of the 40 respondents who no longer used HAs answered that their HAs ended up in a drawer since the background noise was annoying and distracting. CONCLUSION: This study is significant in that it is a large-scale multi-center research to comprehensively examine the factors influencing HA satisfaction in South Korea. This data will provide helpful information that could lead to the successful rehabilitation of hearing loss with HAs.

Hearables as a Gateway to Hearing Health Care.

The market for hearing technology is evolving-with the emergence of hearables, it now extends beyond hearing aids and includes any ear-level devices with wireless connectivity (i.e., wireless earbuds). However, will this evolving marketplace bring forth opportunities or challenges to individuals' hearing health care and the profession of audiology and otolaryngology? The debate has been ongoing. This study explores the wide spectrum of hearables available in the market and discusses the necessity of high-quality clinical evidence prior to the implementation of over-the-counter devices into clinical practice.

Hearing and Speech Perception for People With Hearing Loss Using Personal Sound Amplification Products.

BACKGROUND: Hearing loss (HL) is the most common chronic disease and has been linked to negative health outcomes. Hearing aids (HAs) are regarded as the gold standard for HL management, however, the adoption rate of HAs is relatively low for various reasons. With this background, hearing devices, such as personal sound amplification products (PSAPs) received significant attention as an alternative to conventional HAs. This study aimed to evaluate the clinical efficacy of PSAPs in patients with mild to moderately severe HL. METHODS: Nineteen patients with mild hearing loss (MHL), 23 with moderate hearing loss (MDHL), and 15 with moderately severe hearing loss (MSHL) participated in the study. Electroacoustic analysis, simulated real-ear measurements (REMs), and three clinical evaluations were implemented. RESULTS: All devices satisfied the electroacoustic tolerances. All devices provided sufficient gain for MHL and MDHL audiograms. However, in MSHL audiogram, the gains of PSAPs were insufficient, especially for high frequencies. In terms of clinical evaluations, sound-field audiometry showed significant improvements between aided and unaided thresholds in all groups for all devices (P < 0.001). Significant improvements of word recognition scores were only shown for HAs between aided and unaided conditions. The Korean version of the Hearing In Noise Test did not show any consistent findings for all devices and groups. CONCLUSION: Certain PSAPs are beneficial for improving hearing and speech perception in patients with HL. Well-chosen PSAPs could be an alternative hearing rehabilitation option for these patients.

Factors Influencing Hearing Aid Adoption in Patients With Hearing Loss in Korea.

BACKGROUND: The purpose of this study was two-fold: 1) to identify differences in the characteristics of adopters and non-adopters of hearing aids (HAs); and 2) to investigate factors influencing the purchase of HA. METHODS: This study was conducted among 1,464 subjects (818 male and 646 female) with hearing loss. A national face-to-face survey was performed from August 2019 to October 2020 by otologists or HA experts. The questionnaire consisted of three domains: demographic, audiological, and HA-related domains. Multivariate logistic regression analysis was performed after adjusting for degree of hearing loss. RESULTS: The mean age of the participants was 70.4 ± 12.2 years. Of the 1,464 respondents, 1,190 (81.3%) had already purchased HA. We identified educational level, household income, hearing loss period, place of HA purchase, and government HA assistance program status as factors influencing HA adoption. Among these factors, third party reimbursement was the most important factor affecting HA purchase intent. The main reasons for not adopting HA were feeling that their hearing was adequate, inability to afford HA, and perceptions that HA are uncomfortable. CONCLUSION: Various factors are involved in the purchase of HA, but disabled registration status and third party reimbursement were identified as the most critical factors. In the future, the government should take a more active role in increasing the distribution of HA to patients with hearing loss.

Feasibility of Personal Sound Amplification Products in Patients With Moderate Hearing Loss: A Pilot Study.

OBJECTIVES: This study was conducted to investigate the electroacoustic characteristics of personal sound amplification products (PSAPs), to identify whether PSAPs provide adequate gain and output for three common hearing loss (HL) configurations, and to compare the benefits of a representative PSAP (RPSAP) and a conventional hearing aid (HA) for clinical hearing outcomes as a pilot study. METHODS: The study comprised three phases: electroacoustic analysis, simulated real-ear measurements (REMs), and clinical hearing experiments. Electroacoustic analysis and simulated REMs were performed for three basic PSAPs (BeethoSOL, EarJJang, and Geniesori2) and three high-end PSAPs (Hearing Able, Olive Smart Ear, and SoriIn) using the Aurical Hearing Instrument Test box with a 2-mL coupler. Four electroacoustic characteristics (maximum output sound pressure level at 90 dB SPL, frequency range, equivalent input noise, and total harmonic distortion) were investigated. By simulated REMs, appropriate levels of the six PSAPs for three common HL configurations (mild-to-moderate high-frequency HL, moderate to moderately severe sloping HL, and moderate flat HL) were determined. Clinical experiments compared the performance of RPSAP to HA, both of which were fitted by audiologists using REMs. Clinical experiments were administered using functional gain, a word recognition test, and the Korean version of the Hearing in Noise Test in six participants with bilateral moderate sensorineural HL. RESULTS: The two high-end devices met all tolerances. One basic and two high-end PSAPs showed appropriate levels for three common HL configurations. In the clinical experiments, the RPSAP showed better performance than unaided, but slightly worse than HA under all test conditions. CONCLUSION: Certain PSAPs met all specified tolerances for electroacoustic analysis and approximated prescriptive targets in well-controlled laboratory conditions. The pilot clinical experiments explored the possibility that the RPSAP could serve as a hearing assistive device for patients with moderate HL.

Correction: Feasibility of Virtual Reality Audiological Testing: Prospective Study.

[This corrects the article DOI: 10.2196/26976.].

Feasibility of Virtual Reality Audiological Testing: Prospective Study.

BACKGROUND: It has been noted in the literature that there is a gap between clinical assessment and real-world performance. Real-world conversations entail visual and audio information, yet there are not any audiological assessment tools that include visual information. Virtual reality (VR) technology has been applied to various areas, including audiology. However, the use of VR in speech-in-noise perception has not yet been investigated. OBJECTIVE: The purpose of this study was to investigate the impact of virtual space (VS) on speech performance and its feasibility to be used as a speech test instrument. We hypothesized that individuals' ability to recognize speech would improve when visual cues were provided. METHODS: A total of 30 individuals with normal hearing and 25 individuals with hearing loss completed pure-tone audiometry and the Korean version of the Hearing in Noise Test (K-HINT) under three conditions-conventional K-HINT (cK-HINT), VS on PC (VSPC), and VS head-mounted display (VSHMD)-at -10 dB, -5 dB, 0 dB, and +5 dB signal-to-noise ratios (SNRs). Participants listened to target speech and repeated it back to the tester for all conditions. Hearing aid users in the hearing loss group completed testing under unaided and aided conditions. A questionnaire was administered after testing to gather subjective opinions on the headset, the VSHMD condition, and test preference. RESULTS: Provision of visual information had a significant impact on speech performance between the normal hearing and hearing impaired groups. The Mann-Whitney U test showed statistical significance (P<.05) between the two groups under all test conditions. Hearing aid use led to better integration of audio and visual cues. Statistical significance through the Mann-Whitney U test was observed for -5 dB (P=.04) and 0 dB (P=.02) SNRs under the cK-HINT condition, as well as for -10 dB (P=.007) and 0 dB (P=.04) SNRs under the VSPC condition, between hearing aid and non-hearing aid users. Participants reported positive responses across almost all items on the questionnaire except for the weight of the headset. Participants preferred a test method with visual imagery, but found the headset to be heavy. CONCLUSIONS: Findings are in line with previous literature that showed that visual cues were beneficial for communication. This is the first study to include hearing aid users with a more naturalistic stimulus and a relatively simple test environment, suggesting the feasibility of VR audiological testing in clinical practice.

Content validity of the tinnitus outcome questionnaire for sound management.

Standardized instruments are often used to monitor one's progress in tinnitus relief although they were developed to screen and diagnose tinnitus. The need for the development for a tinnitus outcome assessment tool is high in the field of audiology and otolaryngology. The purpose of this study was to develop a tinnitus outcome questionnaire for sound management (listening to sound stimuli for tinnitus relief) and assess its content validity. A total of 32 questions with six domains (Tinnitus characteristics, the impact of tinnitus, tinnitus and hearing issues, handedness, tinnitus management, and sound management outcome) were generated after closely investigating major tinnitus questionnaires used worldwide (i.e. Tinnitus Handicap Inventory and Tinnitus Handicap Questionnaire) as well as literature. Ten healthcare professionals evaluated the appropriateness of the questionnaire items on a five-point Likert scale, where 1 is strongly inappropriate and 5 is strongly appropriate. Content relevance was assessed by computing the content validity index with the cut-off value of 0.75. Each response was first weighted as follows: 1 = 0; 2 = 0.25; 3 = 0.5; 4 = 0.75; and 5 = 1.0. The weighted average was then calculated. Items with a content validity index less than 0.75 were discarded and some items were revised according to the experts' feedback. As a result, 31 out of the 32 items had the content validity index higher than 0.75, indicating that the items are appropriate to obtain information about the six domains. Reflecting the experts' feedback, some questions were revised to be more specific. The study provides a baseline structure regarding potential questions to be included in a tinnitus outcome questionnaire for sound management. Development and standardization of such questionnaire would be a pathway to validating tinnitus relief via sound therapy.

Experiences With the University Admission Process and Educational Support Among Students With Cochlear Implants in South Korea.

OBJECTIVES: The aim of this study was to investigate the current university admission rate and experiences of educational support among students with cochlear implants (CIs) in South Korea. METHODS: A prospective online survey was conducted to examine the university admission process and academic support for students with CIs. Thirty individuals who took the college entrance exams at least 3 years after CI surgery were invited to participate, although two did not respond. The survey consisted of three topics (demographics, university admission process, and academic support) and 25 items regarding laws and policies related to university admission and support for students with hearing disabilities in Korea. RESULTS: The university matriculation rate for students with CI was 85.7% (24/28), of whom 50% were admitted through the special admission process for students with disabilities. Most universities provided teaching and learning support and rental services for assistive devices for students with disabilities to help them better adapt to school life. However, only a small percentage of the students benefited from accommodation services, and 62.5% and 12.5% of the students received teaching and learning support and used assistive devices, respectively. CONCLUSION: To the best of our knowledge, this is the first study to investigate the university admission process and university disability services for students with CIs in South Korea. The results of this study will be helpful for young CI recipients and their parents as they prepare for university entrance.

Impact of hearing aid noise reduction algorithms on the speech-evoked auditory brainstem response.

The purposes of this study are to investigate the neural representation of a speech stimulus in the auditory system of individuals with normal hearing (NH) and those with hearing aids (HAs) and to explore the impact of noise reduction algorithms (NR) on auditory brainstem response to complex sounds (cABR). Twenty NH individuals and 28 HA users completed puretone audiometry, the Korean version of the Hearing in Noise Test (K-HINT), and cABR. In 0 and +5 dB signal-to-noise ratios (SNRs), the NH group was tested in /da/ only (quiet) and /da/ with white noise (WN) conditions while the HA group was tested in /da/ only, /da/ WN, /da/ WN NR ON, and /da/ WN NR OFF conditions. Significant differences were observed between /da/ only and /da/ WN conditions for F0 in both groups, but no SNR effect was observed for both groups. Findings of this study are consistent with previous literature that diminished cABR amplitudes indicate reduced representation of sounds in the auditory system. This is the first to examine the effect of a specific HA feature on cABR responses.

Effect of Cochlear Implant Electrode Array Design on Electrophysiological and Psychophysical Measures: Lateral Wall versus Perimodiolar Types.

BACKGROUND AND OBJECTIVES: The present study aims to investigate whether the cochlear implant electrode array design affects the electrophysiological and psychophysical measures. SUBJECTS AND METHODS: Eighty five ears were used as data in this retrospective study. They were divided into two groups by the electrode array design: lateral wall type (LW) and perimodiolar type (PM). The electrode site was divided into three regions (basal, medial, apical). The evoked compound action potential (ECAP) threshold, T level, C level, dynamic range (DR), and aided air conduction threshold were measured. RESULTS: The ECAP threshold was lower for the PM than for the LW, and decreased as the electrode site was closer to the apical region. The T level was lower for the PM than for the LW, and was lower on the apical region than on the other regions. The C level on the basal region was lower for the PM than for the LW whereas the C level was lower on the apical region than on the other regions. The DRs on the apical region was greater for the PM than for the LW whereas the DR was narrower on the apical region than on the other regions. The aided air conduction threshold was not different for the electrode design and frequency. CONCLUSIONS: The current study would support the advantages of the PM over the LW in that the PM had the lower current level and greater DR, which could result in more localized neural stimulation and reduced power consumption.

Clinical Performance Evaluation of a Personal Sound Amplification Product vs a Basic Hearing Aid and a Premium Hearing Aid.

Importance: Hearing loss is a highly prevalent condition with multiple negative associated outcomes, yet few persons with hearing loss have hearing aids (HAs). Personal sound amplification products (PSAPs) could be an alternative low-cost solution to HAs, but data are lacking on the performance of PSAPs. Objective: To evaluate the clinical efficacy of a PSAP by comparing its performance with that of a basic HA and a premium HA in participants with mild, moderate, and moderately severe hearing impairment. Design, Setting, and Participants: A prospective, single-institution cohort study was performed with a total of 56 participants, including 19 with mild hearing loss, 20 with moderate hearing loss, and 17 with moderately severe hearing loss. All participants underwent 4 clinical hearing tests with each of the PSAP, basic HA, and premium HA, and all completed an evaluative questionnaire. Interventions: All hearing devices (PSAP, basic HA, and premium HA) were applied by a clinician to prevent bias and order effects; participants were blinded to the device in use, and sequence of devices was randomized. Main Outcomes and Measures: The study used the Korean version of the hearing in noise test, the speech intelligibility in noise test, listening effort measurement using a dual-task paradigm, pupillometry, and a self-rating questionnaire regarding sound quality and preference. These tests were administered under the following 4 hearing conditions: unaided hearing, use of PSAP, use of basic HA, and use of premium HA. Results: The study included 56 participants with a mean age of 56 years (interquartile range, 48-59 years); 29 (52%) were women. In the mild and moderate hearing loss groups, there was no meaningful difference between PSAP, basic HA, and premium HA for speech perception (Cohen d = 0.06-1.05), sound quality (Cohen d = 0.06-0.71), listening effort (Cohen d = 0.10-0.92), and user preference (PSAP, 41%; basic HA, 28%; premium HA, 31%). However, for the patients with moderately severe hearing loss, the premium HA had better performance across most tests (Cohen d = 0.60-1.59), and 70% of participants preferred to use the premium HA. Conclusions and Relevance: The results indicate that basic and premium HAs were not superior to the PSAP in patients with mild to moderate hearing impairment, which suggests that PSAPs might be used as an alternative to HAs in these patient populations. However, if hearing loss is more severe, then HAs, especially premium HAs, should be considered as an option to manage hearing loss.