Pediatric Hearing Aid Daily Wear Time Is Significantly Impacted by Clinician-Family Language Discordance.

PURPOSE: The purpose of this study was to evaluate the potential contribution of limited English proficiency on daily hearing aid wear time for children with hearing loss. METHOD: A retrospective chart review was completed to evaluate hearing aid wear time based on data logging information available at the time of a follow-up visit following an initial hearing aid fitting. Children were included in the study if they had permanent bilateral hearing loss and were less than 60 months of age at the time of their first follow-up visit. Wear time was compared between children who attended an interpreter-mediated appointment and those who did not have an interpreter present. The presence of an interpreter at the appointment was the study indicator that the family had limited English proficiency. RESULTS: Children from families with limited English proficiency exhibited significantly shorter daily wear time (M = 1.3 hr) than their peers whose families were English-proficient speakers, thus, having a shared language with their audiologists (M = 5.2 hr). CONCLUSIONS: Results of this study suggest that family-clinician language discordance might put children at greater risk of shorter hearing aid wear time than children whose caregivers share a common language with their child's audiologist. There can be many linguistic, cultural, and educational factors that contribute to hearing aid wear time in children whose families have limited English proficiency as well as different approaches to improving that wear time. Efforts should ensure that hearing and hearing aid-related information is accessible to all families, especially those with clinician-family language discordance. Such efforts can include, among others, training that improves clinicians' cultural and linguistic responsiveness to the diverse families they serve.

Listening-Related Fatigue in New and Experienced Adult Cochlear Implant Users.

OBJECTIVES: Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue. DESIGN: Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined. RESULTS: Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue). CONCLUSIONS: Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap.

Probabilities of Isolated and Co-Occurring Vestibular Disorder Symptom Clusters Identified Using the Dizziness Symptom Profile.

OBJECTIVES: Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders. DESIGN: All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders. RESULTS: There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported. CONCLUSIONS: Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders.

A Comparison of Listening Skills of Autistic and Non-Autistic Youth While Using and Not Using Remote Microphone Systems.

OBJECTIVES: The purposes of this study were to compare (a) listening-in-noise (accuracy and effort) and (b) remote microphone (RM) system benefits between autistic and non-autistic youth. DESIGN: Groups of autistic and non-autistic youth that were matched on chronological age and biological sex completed listening-in-noise testing when wearing and not wearing an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in type (syllables, words, sentences, and passages). Several putative moderators of RM system effects on outcomes of interest were also evaluated. RESULTS: Autistic youth outperformed non-autistic youth in some conditions on listening-in-noise accuracy; listening effort between the two groups was not significantly different. RM system use resulted in listening-in-noise accuracy improvements that were nonsignificantly different across groups. Benefits of listening-in-noise accuracy were all large in magnitude. RM system use did not have an effect on listening effort for either group. None of the putative moderators yielded effects of the RM system on listening-in-noise accuracy or effort for non-autistic youth that were significant and interpretable, indicating that RM system benefits did not vary according to any of the participant characteristics assessed. CONCLUSIONS: Contrary to expectations, autistic youth did not demonstrate listening-in-noise deficits compared to non-autistic youth. Both autistic and non-autistic youth appear to experience RM system benefits marked by large gains in listening-in-noise performance. Thus, the use of this technology in educational and other noisy settings where speech perception needs enhancement might be beneficial for both groups of children.

Spectral weighting functions for localization of complex sound. II. The effect of competing noise.

Spectral weighting of sound localization cues was measured in the presence of three levels of competing noise presented in the free field. Target stimuli were complex tones containing seven tonal components, presented from an ∼120° range of frontal azimuths. Competitors were two independent Gaussian noises presented from 90° left and right azimuth at one of three levels yielding +9, 0, and -6 dB signal-to-noise ratio. Results revealed the greatest perceptual weight for components within the interaural time difference (ITD) "dominance region," which was found previously to peak around the 800-Hz component in quiet [Folkerts and Stecker (2022) J. Acoust. Soc. Am. 151, 3409-3425]. Here, peak weights were shifted toward lower-frequency components (i.e., 400 Hz) in all competing noise conditions. These results contradict the hypothesis of a shift in the peak weights toward higher frequencies based on previous behavioral localization performance in competing noise but are consistent with binaural cue sensitivity, availability, and reliability; measured low-frequency ITD cues within the dominance region were least disrupted by the presence of competing noise.

Dual-Task Paradigm Measures of Listening Effort: To Include or Not to Include Secondary Task Responses with Incorrect Primary Task Responses.

Response time-based dual-task paradigms are commonly adopted to measure behavioral listening effort. Most extant studies used an all-response approach that included secondary task responses under both correct and incorrect primary task responses during analysis. However, evidence supporting this strategy is limited. Therefore, the current study investigated the potential differences between including all responses versus only including correct responses. Data from two previous studies were reanalyzed. Experiment 1 included 16 listeners and used a dual-task paradigm to examine the effect of introducing background noise on listening effort. Experiment 2 included 19 participants and used a different dual-task paradigm to examine the effect of reverberation and loudspeaker-to-listener distance on listening effort. ANOVA results obtained using both analysis approaches were compared. The all-response and correct-only approaches revealed similar results. However, larger effect sizes and an additional main effect were found with the all-response approach. The current study supports the use of an all-response approach due to its greater sensitivity to changes in behavioral listening effort. However, a correct-only approach could be utilized to suit specific study purposes.

Consumer Survey on Hearing Aid Benefit and Satisfaction.

PURPOSE: There is unexplained variability in self-reported hearing aid outcomes. The aim of this study was to evaluate determinants of hearing aid benefit and satisfaction ratings using a large-scale customer survey and to analyze the relation between demographic variables, hearing aid attributes, benefit, and satisfaction. METHOD: The study used a retrospective design wherein 2,109 hearing aid users, recruited by Hearing Tracker and Hearing Loss Association of America, completed an online survey. The survey included questions about demographics, perceived hearing loss, devices, service delivery, cost, benefit, and satisfaction. The analytic approach included descriptive summaries and regression models to evaluate potential determinants of hearing aid benefit and satisfaction ratings. RESULTS: Hearing aid sound quality, fit and comfort, and battery life were related to both benefit and satisfaction. Respondents who rated these outcomes favorably were also likely to benefit from, and be satisfied with, their hearing aids. Benefit was also related to degree of hearing loss, hearing aid experience, and cost. Hearing aid users with greater self-perceived hearing loss, more hearing aid experience, and more expensive hearing aids reported more benefit. Satisfaction was also related to age, employment status, and brand. Younger respondents, those who were students, and those using certain brands reported more satisfaction. CONCLUSIONS: The results highlight importance of good hearing aid outcomes (quality, fit/comfort, and battery life) for benefit and satisfaction ratings. Professionals who fit hearing aids should strive to focus on achieving these outcomes and researchers should strive to explain the remaining variability in ratings of benefit and satisfaction. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22280854.

An evaluation of newborn hearing screening brochures and parental understanding of screening result terminology.

OBJECTIVE: To assess the suitability of newborn hearing screening brochures by evaluating current state-level brochures and pregnant people's understanding of screening result terminology. DESIGN: In Study 1, state-level brochures were evaluated based on readability, design, picture appropriateness, and use of the word "refer." In Study 2, pregnant people completed a questionnaire that queried their understanding of and expected anxiety about three newborn hearing screening outcomes ("refer," "did not pass," and "pass"). STUDY SAMPLE: In Study 1, 59 newborn hearing screening brochures were analysed. In Study 2, 43 pregnant people completed surveys during a prenatal appointment. RESULTS: Most of the brochures were found deficient on at least one element. Thirty percent of brochures used the word "refer" to indicate a hearing screening failure; yet, fewer than half of participants understood its meaning. Ratings of expected anxiety were highest in response to the term "did not pass." CONCLUSIONS: Based on four study criteria of brochure suitability, 88% of available state-level newborn hearing screening brochures should be modified to make them readily understandable by a broad educational demographic. Discretion in use of the term "refer" should be made when indicating screening results, because the term is not readily understood.

Benefits of Text Supplementation on Sentence Recognition and Subjective Ratings With and Without Facial Cues for Listeners With Normal Hearing.

OBJECTIVES: Recognizing speech through telecommunication can be challenging in unfavorable listening conditions. Text supplementation or provision of facial cues can facilitate speech recognition under some circumstances. However, our understanding of the combined benefit of text and facial cues in telecommunication is limited. The purpose of this study was to investigate the potential benefit of text supplementation for sentence recognition scores and subjective ratings of spoken speech with and without facial cues available. DESIGN: Twenty adult females (M = 24 years, range 21 to 29 years) with normal hearing performed a sentence recognition task and also completed a subjective rating questionnaire in 24 conditions. The conditions varied by integrity of the available facial cues (clear facial cues, slight distortion facial cues, great distortion facial cues, no facial cues), signal-to-noise ratio (quiet, +1 dB, -3 dB), and text availability (with text, without text). When present, the text was an 86 to 88% accurate transcription of the auditory signal presented at a 500 ms delay relative to the auditory signal. RESULTS: The benefits of text supplementation were largest when facial cues were not available and when the signal-to-noise ratio was unfavorable. Although no recognition score benefit was present in quiet, recognition benefit was significant in all levels of background noise for all levels of facial cue integrity. Moreover, participant subjective ratings of text benefit were robust and present even in the absence of recognition benefit. Consistent with previous literature, facial cues were beneficial for sentence recognition scores in the most unfavorable signal-to-noise ratio, even when greatly distorted. It is interesting that, although all levels of facial cues were beneficial for recognition scores, participants rated a significant benefit only with clear facial cues. CONCLUSIONS: The benefit of text for auditory-only and auditory-visual speech recognition is evident in recognition scores and subjective ratings; the benefit is larger and more robust for subjective ratings than for scores. Therefore, text supplementation might provide benefit that extends beyond speech recognition scores. Combined, these findings support the use of text supplementation in telecommunication, even when facial cues are concurrently present, such as during teleconferencing or watching television.

Hearing Aid Benefit and Satisfaction Results from the MarkeTrak 2022 Survey: Importance of Features and Hearing Care Professionals.

The hearing aid market is rapidly evolving with advancements in features and potential changes in service delivery models, including the new over-the-counter device category. Data from the MarkeTrak 2022 survey indicate most hearing aid owners report regular quality-of-life benefits from hearing aids, even more than in previous surveys. The increased likelihood of hearing aid benefits might be attributable to modern hearing aid features advancements, such as wireless connectivity and rechargeable batteries. Hearing aid satisfaction rates have been relatively stable over the years, indicating that more than 80% of hearing aid owners are satisfied with their devices. Hearing aid satisfaction rates do not appreciably vary by fitting channel; hearing aid owners fitted in person, fitted remotely, or self-fit are similarly likely to report high satisfaction with their device. However, only respondents in the in-person channel gave establishment ratings (reflecting their willingness to recommend) that resulted and reflected a positive net promoter score. Given the potential for net promoter scores to be related to brand growth and customer loyalty, this finding has implications for the development of over-the-counter hearing aid service-delivery models. Additional work is warranted to explore the factors that negatively affect hearing aid owners' satisfaction with the companies delivering limited services.

Effects of Critical Distance and Reverberation on Listening Effort in Adults.

PURPOSE: Mixed historical data on how listening effort is affected by reverberation and listener-to-speaker distance challenge existing models of listening effort. This study investigated the effects of reverberation and listener-to-speaker distance on behavioral and subjective measures of listening effort: (a) when listening at a fixed signal-to-noise ratio (SNR) and (b) at SNRs that were manipulated so that word recognition would be comparable across different reverberation times and listening distances. It was expected that increased reverberation would increase listening effort but only when listening outside critical distance. METHOD: Nineteen adults (21-40 years) with no hearing loss completed a dual-task paradigm. The primary task was word recognition and the secondary task was timed word categorization; response times indexed behavioral listening effort. Additionally, participants provided subjective ratings in each condition. Testing was completed at two reverberation levels (moderate and high, RT30 = 469 and 1,223 ms, respectively) and at two listener-to-speaker distances (inside and outside critical distance for the test room, 1.25 and 4 m, respectively). RESULTS: Increased reverberation and listening distances worsened word recognition performance and both behavioral and subjective listening effort. The effect of reverberation was exacerbated when listeners were outside critical distance. Subjective experience of listening effort persisted even when word recognition was comparable across conditions. CONCLUSIONS: Longer reverberation times or listening outside the room's critical distance negatively affected behavioral and subjective listening effort. This study extends understanding of listening effort in reverberant rooms by highlighting the effect of listener's position relative to the room's critical distance.

[Measuring the cochlea using a tablet-based software package: influence of imaging modality and rater background]. / Vermessung der Cochlea mittels eines Tablet-basierten Softwarepakets: Einfluss der Bildgebungsmodalität und des Untersucherhintergrunds.

BACKGROUND: Cochlear duct length (CDL) is subject to significant individual variation. In the context of cochlear implantation, adapting the electrode array length to the CDL is of potential interest, as it has been associated with improvements in both speech recognition and sound quality. Using a tablet-based software package, it is possible to measure CDL at the level of the organ of Corti (CDLOC) to select appropriate electrode array lengths based on individual cochlear anatomy. OBJECTIVE: To identify effects of imaging modality and rater background on CDL estimates. METHODS: Magnetic resonance imaging (MRI) and flat-panel volume CT (fpVCT) scans of 10 patients (20 cochleae) were analyzed using the OTOPLAN software package (MED-EL, Innsbruck, Austria). Raters were an otorhinolaryngology (ORL) specialist, an ORL resident, and an audiologist. To analyze effects of rater background and imaging modality on CDL measurements, linear mixed models were constructed. RESULTS: Measurements showed mean CDLOC(fpVCT) = 36.69 ± 1.78 mm and CDLOC(MRI) = 36.81 ± 1.87 mm. Analyses indicated no significant effect of rater background (F(2, 105) = 0.84; p = 0.437) on CDL estimates. Imaging modality, on the other hand, significantly affected CDL (F (1, 105) = 20.70; p < 0.001), whereby estimates obtained using MRI were 0.89 mm larger than those obtained using fpVCT. CONCLUSION: No effect of rater background on CDL estimates could be identified, suggesting that comparable measurements could be obtained by personnel other than specially trained neurootologists. While imaging modality (fpVCT vs. MRI) did impact CDL results, the difference was small and of questionable clinical significance.

Applying the Hearing Aid Fitting Standard to Selection for Adults.

The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus on the selection of unilateral/bilateral hearing aids, hearing aid style, and coupling, in addition to feature selection. The standard emphasizes that decisions around these three aspects should be recommended for a patient in an individualized manner, based on their needs assessment. For these decisions, the needs assessment might include measures of speech-in-noise ability, social network size, patient preference, and a trial period. Additional elements could include assessments of manual dexterity, binaural interference, and attitude toward hearing aids. However, there are a multitude of ways to practice clinically and still meet the items outlined in the standard. As long as the selection decisions consider individualized patient factors and are capable of meeting validated prescriptive targets, a clinician would be meeting the adult hearing aid fitting minimum standard guidance. In addition, despite the large number of past studies supporting these standards, additional, high-quality research including randomized, controlled, clinical trials are still needed to further support appropriate minimum standard recommendations.

Emotional Responses to Non-Speech Sounds for Hearing-aid and Bimodal Cochlear-Implant Listeners.

The purpose of this project was to evaluate differences between groups and device configurations for emotional responses to non-speech sounds. Three groups of adults participated: 1) listeners with normal hearing with no history of device use, 2) hearing aid candidates with or without hearing aid experience, and 3) bimodal cochlear-implant listeners with at least 6 months of implant use. Participants (n = 18 in each group) rated valence and arousal of pleasant, neutral, and unpleasant non-speech sounds. Listeners with normal hearing rated sounds without hearing devices. Hearing aid candidates rated sounds while using one or two hearing aids. Bimodal cochlear-implant listeners rated sounds while using a hearing aid alone, a cochlear implant alone, or the hearing aid and cochlear implant simultaneously. Analysis revealed significant differences between groups in ratings of pleasant and unpleasant stimuli; ratings from hearing aid candidates and bimodal cochlear-implant listeners were less extreme (less pleasant and less unpleasant) than were ratings from listeners with normal hearing. Hearing aid candidates' ratings were similar with one and two hearing aids. Bimodal cochlear-implant listeners' ratings of valence were higher (more pleasant) in the configuration without a hearing aid (implant only) than in the two configurations with a hearing aid (alone or with an implant). These data support the need for further investigation into hearing device optimization to improve emotional responses to non-speech sounds for adults with hearing loss.

Remote Microphone Systems Can Improve Listening-in-Noise Accuracy and Listening Effort for Youth With Autism.

OBJECTIVES: This study examined whether remote microphone (RM) systems improved listening-in-noise performance in youth with autism. We explored effects of RM system use on both listening-in-noise accuracy and listening effort in a well-characterized sample of participants with autism. We hypothesized that listening-in-noise accuracy would be enhanced and listening effort reduced, on average, when participants used the RM system. Furthermore, we predicted that effects of RM system use on listening-in-noise accuracy and listening effort would vary according to participant characteristics. Specifically, we hypothesized that participants who were chronologically older, had greater nonverbal cognitive and language ability, displayed fewer features of autism, and presented with more typical sensory and multisensory profiles might exhibit greater benefits of RM system use than participants who were younger, had less nonverbal cognitive or language ability, displayed more features of autism, and presented with greater sensory and multisensory disruptions. DESIGN: We implemented a within-subjects design to investigate our hypotheses, wherein 32 youth with autism completed listening-in-noise testing with and without an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in complexity (i.e., syllable-, word-, sentence-, and passage-level). In addition, several putative moderators of RM system effects (i.e., sensory and multisensory function, language, nonverbal cognition, and broader features of autism) on outcomes of interest were evaluated. RESULTS: Overall, RM system use resulted in higher listening-in-noise accuracy in youth with autism compared with no RM system use. The observed benefits were all large in magnitude, although the benefits on average were greater for more complex stimuli (e.g., key words embedded in sentences) and relatively smaller for less complex stimuli (e.g., syllables). Notably, none of the putative moderators significantly influenced the effects of the RM system on listening-in-noise accuracy, indicating that RM system benefits did not vary according to any of the participant characteristics assessed. On average, RM system use did not have an effect on listening effort across all youth with autism compared with no RM system use but instead yielded effects that varied according to participant profile. Specifically, moderated effects indicated that RM system use was associated with increased listening effort for youth who had (a) average to below-average nonverbal cognitive ability, (b) below-average language ability, and (c) reduced audiovisual integration. RM system use was also associated with decreased listening effort for youth with very high nonverbal cognitive ability. CONCLUSIONS: This study extends prior work by showing that RM systems have the potential to boost listening-in-noise accuracy for youth with autism. However, this boost in accuracy was coupled with increased listening effort, as indexed by longer reaction times while using an RM system, for some youth with autism, perhaps suggesting greater engagement in the listening-in-noise tasks when using the RM system for youth who had lower cognitive abilities, were less linguistically able, and/or have difficulty integrating seen and heard speech. These findings have important implications for clinical practice, suggesting RM system use in classrooms could potentially improve listening-in-noise performance for some youth with autism.

Automated Audiometry in Quiet and Simulated Exam Room Noise for Listeners with Normal Hearing and Impaired Hearing.

BACKGROUND: Up to 80% of audiograms could be automated which would allow more time for provision of specialty services. Ideally, automated audiometers would provide accurate results for listeners with impaired hearing as well as normal hearing. Additionally, accurate results should be provided both in controlled environments like a sound-attenuating room but also in test environments that may support greater application when sound-attenuating rooms are unavailable. Otokiosk is an iOS-based system that has been available for clinical use, but there are not yet any published validation studies using this product. PURPOSE: The purpose of this project was to complete a validation study on the OtoKiosk automated audiometry system in quiet and in low-level noise, for listeners with normal hearing and for listeners with impaired hearing. RESEARCH DESIGN: Pure tone air conduction thresholds were obtained for each participant for three randomized conditions: standard audiometry, automated testing in quiet, and automated testing in noise. Noise, when present, was 35 dBA overall and was designed to emulate an empty medical exam room. STUDY SAMPLE: Participants consisted of 11 adults with hearing loss and 15 adults with normal hearing recruited from the local area. DATA COLLECTION AND ANALYSIS: Thresholds were measured at 500, 1,000, 2,000, and 4,000 Hz using the Otokiosk system that incorporates a modified Hughson-Westlake method. Results were analyzed using descriptive statistics and also by a linear mixed-effects model to compare thresholds obtained in each condition. RESULTS: Across condition and participant group 73.6% of thresholds measured with OtoKiosk were within ± 5 dB of the conventionally measured thresholds; 92.8% were within ± 10 dB. On average, differences between tests were small. Pairwise comparisons revealed thresholds were ∼3.5-4 dB better with conventional audiometry than with the mobile application in quiet and in noise. Noise did not affect thresholds measured with OtoKiosk. CONCLUSIONS: The OtoKiosk automated hearing test measured pure tone air conduction thresholds from 500 to 4,000 Hz at slightly higher thresholds than conventional audiometry, but less than the smallest typical 5 dB clinical step-size. Our results suggest OtoKiosk is a reasonable solution for sound booths and exam rooms with low-level background noise.

Symmetrical and asymmetrical directional benefits are present for talkers at the front and side.

OBJECTIVE: The purpose of the study was to examine the effects of symmetrical and asymmetrical directional microphone settings on speech recognition, localisation and microphone preference in listening conditions with on- and off-axis talkers. DESIGN: A within-subjects repeated-measure evaluation of three hearing aid microphone settings (bilateral omnidirectional, bilateral directional, asymmetrical directional) was completed in a moderately reverberant laboratory. An exploratory analysis of the potential relationship between microphone preference and unaided measures was also completed. STUDY SAMPLE: Twenty adult listeners with mild to moderately severe bilateral hearing loss participated. RESULTS: The directional and asymmetric microphone settings resulted in equivalent benefits for sentence recognition in noise, word recall, and localisation speed regardless of the speech loudspeaker location (on- or off-axis). However, localisation accuracy was significantly worse with the asymmetric fitting than the directional setting when speech was presented from the rear hemisphere. Listeners who always preferred directional microphones had significantly poorer unaided speech recognition than those who preferred the omnidirectional setting for one or more listening condition. CONCLUSIONS: Benefits from directional and asymmetric processing were small in the current study, but generally similar to each other. Unaided speech recognition in noise performance may have utility as a clinical predictor of preference for directional processing.

Effects of text supplementation on speech intelligibility for listeners with normal and impaired hearing: a systematic review with implications for telecommunication.

OBJECTIVE: Telecommunication can be difficult in the presence of noise or hearing loss. The purpose of this study was to systematically review evidence regarding the effects of text supplementation (e.g. captions, subtitles) of auditory or auditory-visual signals on speech intelligibility for listeners with normal or impaired hearing. DESIGN: Three databases were searched. Articles were evaluated for inclusion based on the Population Intervention Comparison Outcome framework. The Effective Public Health Practice Project instrument was used to evaluate the quality of the identified articles. STUDY SAMPLE: After duplicates were removed, the titles and abstracts of 2019 articles were screened. Forty-six full texts were reviewed; ten met inclusion criteria. RESULTS: The quality of all ten articles was moderate or strong. The articles demonstrated that text added to auditory (or auditory-visual) signals improved speech intelligibility and that the benefits were largest when auditory signal integrity was low, accuracy of the text was high, and the auditory signal and text were synchronous. Age and hearing loss did not affect benefits from the addition of text. CONCLUSIONS: Although only based on ten studies, these data support the use of text as a supplement during telecommunication, such as while watching television or during telehealth appointments.

A Comparison between a remote testing and a laboratory test setting for evaluating emotional responses to non-speech sounds.

OBJECTIVE: To evaluate remote testing as a tool for measuring emotional responses to non-speech sounds. DESIGN: Participants self-reported their hearing status and rated valence and arousal in response to non-speech sounds on an Internet crowdsourcing platform. These ratings were compared to data obtained in a laboratory setting with participants who had confirmed normal or impaired hearing. STUDY SAMPLE: Adults with normal and impaired hearing. RESULTS: In both settings, participants with hearing loss rated pleasant sounds as less pleasant than did their peers with normal hearing. The difference in valence ratings between groups was generally smaller when measured in the remote setting than in the laboratory setting. This difference was the result of participants with normal hearing rating sounds as less extreme (less pleasant, less unpleasant) in the remote setting than did their peers in the laboratory setting, whereas no such difference was noted for participants with hearing loss. Ratings of arousal were similar from participants with normal and impaired hearing; the similarity persisted in both settings. CONCLUSIONS: In both test settings, participants with hearing loss rated pleasant sounds as less pleasant than did their normal hearing counterparts. Future work is warranted to explain the ratings of participants with normal hearing.