On the Feasibility of Using Behavioral Listening Effort Test Methods to Evaluate Auditory Performance in Cochlear Implant Users.

Realistic outcome measures that reflect everyday hearing challenges are needed to assess hearing aid and cochlear implant (CI) fitting. Literature suggests that listening effort measures may be more sensitive to differences between hearing-device settings than established speech intelligibility measures when speech intelligibility is near maximum. Which method provides the most effective measurement of listening effort for this purpose is currently unclear. This study aimed to investigate the feasibility of two tests for measuring changes in listening effort in CI users due to signal-to-noise ratio (SNR) differences, as would arise from different hearing-device settings. By comparing the effect size of SNR differences on listening effort measures with test-retest differences, the study evaluated the suitability of these tests for clinical use. Nineteen CI users underwent two listening effort tests at two SNRs (+4 and +8 dB relative to individuals' 50% speech perception threshold). We employed dual-task paradigms-a sentence-final word identification and recall test (SWIRT) and a sentence verification test (SVT)-to assess listening effort at these two SNRs. Our results show a significant difference in listening effort between the SNRs for both test methods, although the effect size was comparable to the test-retest difference, and the sensitivity was not superior to speech intelligibility measures. Thus, the implementations of SVT and SWIRT used in this study are not suitable for clinical use to measure listening effort differences of this magnitude in individual CI users. However, they can be used in research involving CI users to analyze group data.

Self-motion with Hearing Impairment and (Directional) Hearing Aids.

When listening to a sound source in everyday situations, typical movement behavior is highly individual and may not result in the listener directly facing the sound source. Behavioral differences can affect the performance of directional algorithms in hearing aids, as was shown in previous work by using head movement trajectories of normal-hearing (NH) listeners in acoustic simulations for noise-suppression performance predictions. However, the movement behavior of hearing-impaired (HI) listeners with or without hearing aids may differ, and hearing-aid users might adapt their self-motion to improve the performance of directional algorithms. This work investigates the influence of hearing impairment on self-motion, and the interaction of hearing aids with self-motion. In order to do this, the self-motion of three HI participant groups----aided with an adaptive differential microphone (ADM), aided without ADM, and unaided-was measured and compared to previously measured self-motion data from younger and older NH participants. Self-motion was measured in virtual audiovisual environments (VEs) in the laboratory, and the signal-to-noise ratios (SNRs) and SNR improvement of the ADM resulting from the head movements of the participants were estimated using acoustic simulations. HI participants did almost all of the movement with their head and less with their eyes compared to NH participants, which led to a 0.3 dB increase in estimated SNR and to differences in estimated SNR improvement of the ADM. However, the self-motion of the HI participants aided with ADM was similar to that of other HI participants, indicating that the ADM did not cause listeners to adapt their self-motion.

Review of Self-Motion in the Context of Hearing and Hearing Device Research.

The benefit from directional hearing devices predicted in the lab often differs from reported user experience, suggesting that laboratory findings lack ecological validity. This difference may be partly caused by differences in self-motion between the lab and real-life environments. This literature review aims to provide an overview of the methods used to measure and quantify self-motion, the test environments, and the measurement paradigms. Self-motion is the rotation and translation of the head and torso and movement of the eyes. Studies were considered which explicitly assessed or controlled self-motion within the scope of hearing and hearing device research. The methods and outcomes of the reviewed studies are compared and discussed in relation to ecological validity. The reviewed studies demonstrate interactions between hearing device benefit and self-motion, such as a decreased benefit from directional microphones due to a more natural head movement when the test environment and task include realistic complexity. Identified factors associated with these interactions include the presence of audiovisual cues in the environment, interaction with conversation partners, and the nature of the tasks being performed. This review indicates that although some aspects of the interactions between self-motion and hearing device benefit have been shown and many methods for assessment and analysis of self-motion are available, it is still unclear to what extent individual factors affect the ecological validity of the findings. Further research is required to relate lab-based measures of self-motion to the individual's real-life hearing ability.

Movement and Gaze Behavior in Virtual Audiovisual Listening Environments Resembling Everyday Life.

Recent achievements in hearing aid development, such as visually guided hearing aids, make it increasingly important to study movement behavior in everyday situations in order to develop test methods and evaluate hearing aid performance. In this work, audiovisual virtual environments (VEs) were designed for communication conditions in a living room, a lecture hall, a cafeteria, a train station, and a street environment. Movement behavior (head movement, gaze direction, and torso rotation) and electroencephalography signals were measured in these VEs in the laboratory for 22 younger normal-hearing participants and 19 older normal-hearing participants. These data establish a reference for future studies that will investigate the movement behavior of hearing-impaired listeners and hearing aid users for comparison. Questionnaires were used to evaluate the subjective experience in the VEs. A test-retest comparison showed that the measured movement behavior is reproducible and that the measures of movement behavior used in this study are reliable. Moreover, evaluation of the questionnaires indicated that the VEs are sufficiently realistic. The participants rated the experienced acoustic realism of the VEs positively, and although the rating of the experienced visual realism was lower, the participants felt to some extent present and involved in the VEs. Analysis of the movement data showed that movement behavior depends on the VE and the age of the subject and is predictable in multitalker conversations and for moving distractors. The VEs and a database of the collected data are publicly available.

Horizontal sound localization in cochlear implant users with a contralateral hearing aid.

Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.