Auditory Environments and Hearing Aid Feature Activation Among Younger and Older Listeners in an Urban and Rural Area.

OBJECTIVES: The purpose of this study was to investigate differences in auditory environments and hearing aid feature activation between younger listeners with normal hearing and older listeners with hearing loss in an urban and rural location. We hypothesized that (1) urban dwellers and younger listeners would encounter more diverse and demanding auditory environments than rural dwellers and older listeners, respectively; (2) the advanced hearing aid features (noise reduction and directional microphone) of urban dwellers and younger listeners would be activated more frequently than rural dwellers and older listeners, respectively. DESIGN: The design of this study was cross-sectional with repeated measures. A total of 12 older adults with hearing loss (OHL-U) and 11 younger adults with normal hearing (YNH-U) were recruited from an urban area (Berkeley, California) and 13 older adults with hearing loss (OHL-R) and 10 YNH-U were recruited from a rural area (Iowa City, Iowa). Participants wore hearing aids that recorded data about their listening environments and completed ecological momentary assessments for 1 week. RESULTS: The YNH-U group experienced higher sound pressure levels and hearing aid features were activated more frequently than in the OHL groups. The OHL-R group experienced significantly less diverse sound pressure levels than the YNH-U group. The YNH-R group had sound levels between the YNH-U group and the OHL groups but without significant differences from any other group. The YNH groups showed a greater likelihood of hearing aid feature activation than the OHL-R group. CONCLUSIONS: Demographics affect auditory environments and the activation of hearing aid features. Younger urban dwellers have the most diverse or demanding auditory environments and hearing aid feature activation, and older, rural dwellers with hearing loss have the least diverse or demanding auditory environments and hearing aid feature activation. Future studies of real-world auditory environments and audiology intervention effectiveness should consider location in recruitment and interpretation of results.

Remote Microphone Systems for Cochlear Implant Recipients in Small Group Settings.

PURPOSE: Cochlear implant (CI) recipients often experience speech recognition difficulty in noise in small group settings with multiple talkers. In traditional remote microphones systems, one talker wears a remote microphone that wirelessly delivers speech to the CI processor. This system will not transmit signals from multiple talkers in a small group. However, remote microphone systems with multiple microphones allowing for adaptive beamforming may be beneficial for small group situations with multiple talkers. Specifically, a remote microphone with an adaptive multiple-microphone beamformer may be placed in the center of the small group, and the beam (i.e., polar lobe) may be automatically steered toward the direction associated with the most favorable speech-to-noise ratio. The signal from the remote microphone can then be wirelessly delivered to the CI sound processor. Alternately, each of the talkers in a small group may use a remote microphone that is part of a multi-talker network that wirelessly delivers the remote microphone signal to the CI sound processor. The purpose of this study was to compare the potential benefit of an adaptive multiple-microphone beamformer remote microphone system and a multi-talker network remote microphone system. METHOD: Twenty recipients, ages 12 to 84 years, with Advanced Bionics CIs completed sentence-recognition-in-noise tasks while seated at a desk surrounded by three loudspeakers at 0, 90, and 270 degrees. These speakers randomly presented the target speech while competing noise was presented from four loudspeakers located in the corners of the room. Testing was completed in three conditions: 1) CI alone, 2) Remote microphone system with an adaptive multiple-microphone beamformer, and 3) and a multi-talker network remote microphone system each with five different signal levels (15 total conditions). RESULTS: Significant differences were found across all signal levels and technology conditions. Relative to the CI alone, sentence recognition improvements ranged from 14-23 percentage points with the adaptive multiple-microphone beamformer and 27-47 percentage points with the multi-talker network with superior performance for the latter remote microphone system. CONCLUSIONS: Both remote microphone systems significantly improved speech recognition in noise of CI recipients when listening in small group settings, but the multi-talker network provided superior performance.

Why Ecological Momentary Assessment Surveys Go Incomplete: When It Happens and How It Impacts Data.

BACKGROUND: Ecological momentary assessment (EMA) often requires respondents to complete surveys in the moment to report real-time experiences. Because EMA may seem disruptive or intrusive, respondents may not complete surveys as directed in certain circumstances. PURPOSE: This article aims to determine the effect of environmental characteristics on the likelihood of instances where respondents do not complete EMA surveys (referred to as survey incompletion), and to estimate the impact of survey incompletion on EMA self-report data. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Ten adults hearing aid (HA) users. DATA COLLECTION AND ANALYSIS: Experienced, bilateral HA users were recruited and fit with study HAs. The study HAs were equipped with real-time data loggers, an algorithm that logged the data generated by HAs (e.g., overall sound level, environment classification, and feature status including microphone mode and amount of gain reduction). The study HAs were also connected via Bluetooth to a smartphone app, which collected the real-time data logging data as well as presented the participants with EMA surveys about their listening environments and experiences. The participants were sent out to wear the HAs and complete surveys for 1 week. Real-time data logging was triggered when participants completed surveys and when participants ignored or snoozed surveys. Data logging data were used to estimate the effect of environmental characteristics on the likelihood of survey incompletion, and to predict participants' responses to survey questions in the instances of survey incompletion. RESULTS: Across the 10 participants, 715 surveys were completed and survey incompletion occurred 228 times. Mixed effects logistic regression models indicated that survey incompletion was more likely to happen in the environments that were less quiet and contained more speech, noise, and machine sounds, and in the environments wherein directional microphones and noise reduction algorithms were enabled. The results of survey response prediction further indicated that the participants could have reported more challenging environments and more listening difficulty in the instances of survey incompletion. However, the difference in the distribution of survey responses between the observed responses and the combined observed and predicted responses was small. CONCLUSION: The present study indicates that EMA survey incompletion occurs systematically. Although survey incompletion could bias EMA self-report data, the impact is likely to be small.

Using Smartphone-Based Ecological Momentary Assessment in Audiology Research: The Participants' Perspective.

Purpose The article's purpose was to examine participants' impressions and experiences with smartphone-based ecological momentary assessment (EMA) to inform future EMA study design. Method Adults with hearing impairment (HI, n = 9) and with normal hearing (NH, n = 10) participated in a study using a smartphone-based EMA system to measure their auditory lifestyles. A 14-item survey was scheduled to deliver every 45 min by an EMA app. After a 1-week trial, participants were interviewed regarding their study experiences. The app log files were analyzed to understand how the participants interacted with the app. Results Across the two groups, 1,295 surveys were completed (compliance rate 74.4%). On average, HI participants completed 10.0 and NH participants completed 9.1 surveys per day. The mean survey completion time for HI and NH groups were 72 s and 51 s, respectively. For both groups, about 90% of the participants reported the app as easy to use; about 60% of the participants reported that repetitive surveys interrupted or somewhat interrupted their activities. Participants reported surveys disrupting situations, for example, working, driving, and social events, and that they were more likely to skip surveys in these situations. Additionally, 50% of NH and 30% of HI participants indicated that the survey was not delivered too frequently and none indicated that the survey was too long. Conclusion Overall, the app and EMA design seem to be appropriate. Insights from this study can help researchers design their studies to adequately assess listeners' experience in the field with optimal compliance and data quality.

Preferences for digital noise reduction and microphone mode settings in hearing-impaired listeners with low and high tolerances for background noise.

Objective: To examine whether people with low and high acceptable noise levels (ANLs) have different preferences for aggressiveness of noise reduction (NR) and microphone mode, and whether they get different noise tolerance benefit with these two features.Design: Participants completed laboratory tests of unaided ANL and aided modified ANLs (with speech fixed at two levels) and preferences (at two SNRs) while listening to four levels of NR, three microphone modes and four combinations of NR/directionality.Study sample: Twenty adults with hearing loss; 10 with low ANLs and 10 with high ANLs.Results: Seven individuals with low ANLs and 10 individuals with high ANLs preferred the maximum NR setting; the remaining three individuals with low ANLs had inconsistent preference for NR. Eight people in each ANL group preferred the maximum directional setting (broadband (BB) directionality), the remaining two people in each group had inconsistent preferences for microphone mode.Conclusions: Because most participants preferred the maximum NR and directionality settings, ANLs could not be used to differentially prescribe these hearing aid settings.

Psychometric Comparison of the Hearing in Noise Test and the American English Matrix Test.

BACKGROUND: The hearing in noise test (HINT) is the most popular adaptive test used to evaluate speech in noise performance, especially in context of hearing aid features. However, the number of conditions that can be tested on the HINT is limited by a small speech corpus. The American English Matrix test (AEMT) is a new alternative adaptive speech in noise test with a larger speech corpus. The study examined the relationships between the performance of hearing aid wearers on the HINT and the AEMT. PURPOSE: To examine whether there was a difference in performance of hearing aid wearers on the HINT and the AEMT. A secondary purpose, given the AEMT's steep performance-intensity function, was to determine whether the AEMT is more sensitive to changes in speech recognition resulting from directional (DIR) microphone processing in hearing aids. RESEARCH DESIGN: A repeated measures design was used in this study. Multiple measurements were made on each subject. Each measurement involved a different experimental condition. STUDY SAMPLE: Ten adults with hearing loss participated in this study. DATA COLLECTION AND ANALYSIS: All participants completed the AEMT and HINT, using adaptive and fixed test formats while wearing hearing aids. Speech recognition was assessed in two hearing aid microphone settings-omnidirectional and fixed DIR. All testing was conducted via sound field presentation. Performance on HINT and AEMT were systematically compared across all test conditions using a linear model with repeated measures. RESULTS: The results of this study revealed that adult hearing aid users perform differently on the HINT and AEMT, with adaptive AEMT testing yielding significantly better (more negative) thresholds than the HINT. Slopes of performance intensity functions obtained by testing at multiple fixed signal-to-noise ratios, revealed a somewhat steeper slope for the HINT compared with the AEMT. Despite this steeper slope, the benefit provided by DIR microphones was not significantly different between the two speech tests. CONCLUSIONS: The observation of similar DIR benefits of the HINT and AEMT suggests that the HINT and AEMT are equally sensitive to changes in speech recognition thresholds following intervention. Therefore, the decision to use the AEMT or the HINT will depend on the purpose of the study and/or the technology being investigated. Other test related factors such as available sentence corpus, learning effects and test time will also influence test selection.

Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

OBJECTIVE: The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies. DESIGN: This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field. STUDY SAMPLE: The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials. RESULTS: The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements. CONCLUSIONS: Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.

The Effects of Varying Directional Bandwidth in Hearing Aid Users' Preference and Speech-in-Noise Performance.

PURPOSE: Directional microphone systems are typically used to improve hearing aid users' understanding of speech in noise. However, directional microphones also increase internal hearing aid noise. The purpose of this study was to investigate how varying directional microphone bandwidth affected listening preference and speech-in-noise performance. METHOD: Ten participants with normal hearing and 10 participants with hearing impairment compared internal noise levels between hearing aid memories with 4 different microphone modes: omnidirectional, full directional, high-frequency directionality with directional processing above 900 Hz, and high-frequency directionality with directional processing above 2000 Hz. Speech-in-noise performance was measured with each memory for the participants with hearing impairment. RESULTS: Participants with normal hearing preferred memories with less directional bandwidth. Participants with hearing impairment also tended to prefer the memories with less directional bandwidth. However, the majority of participants with hearing impairment did not indicate a preference between omnidirectional and directional above 2000 Hz memories. Average hearing-in-noise performance improved with increasing directional bandwidth. CONCLUSIONS: Most participants preferred memories with less directional bandwidth in quiet. Participants with hearing impairment indicated no difference in preference between directional above 2000 Hz and the omnidirectional memories. Speech recognition in noise performance improved with increasing directional bandwidth.

Outcomes of Hearing Aid Use by Individuals with Unilateral Sensorineural Hearing Loss (USNHL).

BACKGROUND: Unilateral sensorineural hearing loss (USNHL) can have a negative impact on functions associated with the advantages of balanced, binaural hearing. Although single-sided deafness, which is a complete loss of audibility in one ear, has gained increased interest in the published research, there is a gap in the literature concerning hearing aid outcomes for individuals with residual, or otherwise "aidable," hearing in the affected ear. PURPOSE: To assess hearing aid outcomes for a group of individuals with USNHL with residual, aidable function. RESEARCH DESIGN: A quasi-experimental study of hearing aid outcomes with paired comparisons made between unaided and aided test conditions. STUDY SAMPLE: A convenience sample of twenty-two individuals with USNHL, with sufficient residual hearing in the affected ear as to receive audibility from use of a hearing aid, were recruited into the study from September 2011 to August 2012. INTERVENTION: Each participant was fit with a digital behind-the-ear hearing aid coupled to a custom ear mold. DATA COLLECTION AND ANALYSIS: Assessments were performed at baseline (unaided) and after a three-month field trial (aided) with primary outcomes involving objective measures in sound field yielding signal-to-noise ratio loss (SNR Loss) via the Quick Speech-in-Noise Test and word recognition scores (WRS) via the Northwestern University Auditory Test, No. 6. Outcomes also involved the administration of two well-established subjective benefit questionnaires: The Abbreviated Profile of Hearing Aid Benefit (APHAB) and the 49-item Speech, Spatial, and Qualities of Hearing Scale (SSQ49). RESULTS: As a group, participants showed significantly improved median SNR Loss thresholds when aided in a test condition that included spatial separation of speech and noise, with speech stimuli directed toward the worse ear and noise stimuli directed toward the better ear (diff. = -4.5; p < 0.001). Hearing aid use had a small, though statistically significant, negative impact on median SNR Loss thresholds, when speech and noise stimuli originated from the same 0° azimuth (diff. = 1.0; p = 0.018). This was also evidenced by the median WRS in sound field (diff. = -6.0; p = 0.006), which was lowered from 98% in the unaided state to 92% in the aided state. Results from the SSQ49 showed statistically significant improvement on all subsection means when participants were aided (p < 0.05), whereas results from the APHAB were generally found to be unremarkable between unaided and aided conditions as benefit was essentially equal to the 50th percentile of the normative data. At the close of the study, it was observed that only slightly more than half of all participants chose to continue use of a hearing aid after their participation. CONCLUSIONS: We observed that hearing aid use by individuals with USNHL can improve the SNR Loss associated with the interference of background noise, especially in situations when there is spatial separation of the stimuli and speech is directed toward the affected ear. In addition, hearing aid use by these individuals can provide subjective benefit, as evidenced by the APHAB and SSQ49 subjective benefit questionnaires.

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient-Clinician Interactions.

BACKGROUND: Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients' needs, and attentive to society's influence. PURPOSE: The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. "Connected" refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. RESEARCH DESIGN: The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. STUDY SAMPLE: The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. DATA COLLECTION AND ANALYSIS: The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. RESULTS: The clinician case highlighted clinicians' heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed patients' perceptions of themselves as technologically competent or incompetent, and descriptions of how they learned to use the new technology. Between cases, the study found a difference in the response to how the connected hearing aid changed the clinician-patient relationship. While clinicians valued the increased time they spent "getting to know" their patients, patients experienced some frustration specific to the additional troubleshooting related to Bluetooth connectivity. Across cases, there was a resounding theme of "normalization" of hearing aids via their integration with a "normal" technology (mobile phones) and general lack of concern about privacy in relation to the smartphone application and its tracking and geotagging features. Both audiologists and patients credited the connected hearing aids with increased opportunities to participate more fully in everyday life. CONCLUSIONS: The introduction of smartphone-connected hearing aids influenced the identities and candidate profiles of hearing aid users, and the nature of time spent in clinical interactions, in important and interesting ways. The influence of connected hearing aids on patient experience and audiology practice calls for continued research and clinical consideration, with implications for clinical decision-making regarding hearing aid candidacy. Further study should look critically at normalization and possible unintended stigmatizing effects of making hearing aids increasingly discreet.

Directional Microphone Hearing Aids in School Environments: Working Toward Optimization.

Purpose: The hearing aid microphone setting (omnidirectional or directional) can be selected manually or automatically. This study examined the percentage of time the microphone setting selected using each method was judged to provide the best signal-to-noise ratio (SNR) for the talkers of interest in school environments. Method: A total of 26 children (aged 6-17 years) with hearing loss were fitted with study hearing aids and evaluated during 2 typical school days. Time-stamped hearing aid settings were compared with observer judgments of the microphone setting that provided the best SNR on the basis of the specific listening environment. Results: Despite training for appropriate use, school-age children were unlikely to consistently manually switch to the microphone setting that optimized SNR. Furthermore, there was only fair agreement between the observer judgments and the hearing aid setting chosen by the automatic switching algorithm. Factors contributing to disagreement included the hearing aid algorithm choosing the directional setting when the talker was not in front of the listener or when noise arrived only from the front quadrant and choosing the omnidirectional setting when the noise level was low. Conclusion: Consideration of listener preferences, talker position, sound level, and other factors in the classroom may be necessary to optimize microphone settings.

The Benefit of Remote Microphones Using Four Wireless Protocols.

BACKGROUND: Many studies have reported the speech recognition benefits of a personal remote microphone system when used by adult listeners with hearing loss. The advance of wireless technology has allowed for many wireless audio transmission protocols. Some of these protocols interface with commercially available hearing aids. As a result, commercial remote microphone systems use a variety of different protocols for wireless audio transmission. It is not known how these systems compare, with regard to adult speech recognition in noise. PURPOSE: The primary goal of this investigation was to determine the speech recognition benefits of four different commercially available remote microphone systems, each with a different wireless audio transmission protocol. RESEARCH DESIGN: A repeated-measures design was used in this study. STUDY SAMPLE: Sixteen adults, ages 52 to 81 yr, with mild to severe sensorineural hearing loss participated in this study. INTERVENTION: Participants were fit with three different sets of bilateral hearing aids and four commercially available remote microphone systems (FM, 900 MHz, 2.4 GHz, and Bluetooth(®) paired with near-field magnetic induction). DATA COLLECTION AND ANALYSIS: Speech recognition scores were measured by an adaptive version of the Hearing in Noise Test (HINT). The participants were seated both 6 and 12' away from the talker loudspeaker. Participants repeated HINT sentences with and without hearing aids and with four commercially available remote microphone systems in both seated positions with and without contributions from the hearing aid or environmental microphone (24 total conditions). The HINT SNR-50, or the signal-to-noise ratio required for correct repetition of 50% of the sentences, was recorded for all conditions. A one-way repeated measures analysis of variance was used to determine statistical significance of microphone condition. RESULTS: The results of this study revealed that use of the remote microphone systems statistically improved speech recognition in noise relative to unaided and hearing aid-only conditions across all four wireless transmission protocols at 6 and 12' away from the talker. CONCLUSIONS: Participants showed a significant improvement in speech recognition in noise when comparing four remote microphone systems with different wireless transmission methods to hearing aids alone.

The master hearing aid.

As early as the 1930s the term Master Hearing Aid (MHA) described a device used in the fitting of hearing aids. In their original form, the MHA was a desktop system that allowed for simulated or actual adjustment of hearing aid components that resulted in a changed hearing aid response. Over the years the MHA saw many embodiments and contributed to a number of rationales for the fitting of hearing aids. During these same years, the MHA was viewed by many as an inappropriate means of demonstrating hearing aids; the audio quality of the desktop systems was often superior to the hearing aids themselves. These opinions and the evolution of the MHA have molded the modern perception of hearing aids and the techniques used in the fitting of hearing aids. This article reports on a history of the MHA and its influence on the fitting of hearing aids.

Head angle and elevation in classroom environments: implications for amplification.

PURPOSE: The purpose of this study was to examine children's head orientation relative to the arrival angle of competing signals and the sound source of interest in actual school settings. These data were gathered to provide information relative to the potential for directional benefit. METHOD: Forty children, 4-17 years of age, with and without hearing loss, completed the study. Deviation in head angle and elevation relative to the direction of sound sources of interest were measured in 40 school environments. Measurements were made on the basis of physical data and videotapes from 3 cameras placed within each classroom. RESULTS: The results revealed similarly accurate head orientation across children with and without hearing loss when focusing on the 33% proportion of time in which children were most accurate. Orientation accuracy was not affected by age. The data also revealed that children with hearing loss were significantly more likely to orient toward brief utterances made by secondary talkers than were children with normal hearing. CONCLUSIONS: These data are consistent with the hypothesized association between hearing loss and increased visual monitoring. In addition, these results suggest that age does not limit the potential for signal-to-noise improvements from directivity-based interventions in noisy environments.

Directional benefit in simulated classroom environments.

PURPOSE: To examine speech recognition performance and subjective ratings for directional and omnidirectional microphone modes across a variety of simulated classroom environments. METHOD: Speech recognition was measured in a group of 26 children age 10-17 years in up to 8 listening environments. RESULTS: Significant directional benefit was found when the sound source(s) of interest was in front, and directional decrement was measured when the sound source of interest was behind the participants. Of considerable interest is that a directional decrement was observed in the absence of directional benefit when sources of interest were both in front of and behind the participants. In addition, limiting directional processing to the low frequencies eliminated both the directional deficit and the directional advantage. CONCLUSIONS: Although these data support the use of directional hearing aids in some noisy school environments, they also suggest that use of the directional mode should be limited to situations in which all talkers of interest are located in the front hemisphere. These results highlight the importance of appropriate switching between microphone modes in the school-age population.