Muddy, muddled, or muffled? Understanding the perception of audio quality in music by hearing aid users.

Introduction: Previous work on audio quality evaluation has demonstrated a developing convergence of the key perceptual attributes underlying judgments of quality, such as timbral, spatial and technical attributes. However, across existing research there remains a limited understanding of the crucial perceptual attributes that inform audio quality evaluation for people with hearing loss, and those who use hearing aids. This is especially the case with music, given the unique problems it presents in contrast to human speech. Method: This paper presents a sensory evaluation study utilising descriptive analysis methods, in which a panel of hearing aid users collaborated, through consensus, to identify the most important perceptual attributes of music audio quality and developed a series of rating scales for future listening tests. Participants (N = 12), with a hearing loss ranging from mild to severe, first completed an online elicitation task, providing single-word terms to describe the audio quality of original and processed music samples; this was completed twice by each participant, once with hearing aids, and once without. Participants were then guided in discussing these raw terms across three focus groups, in which they reduced the term space, identified important perceptual groupings of terms, and developed perceptual attributes from these groups (including rating scales and definitions for each). Results: Findings show that there were seven key perceptual dimensions underlying music audio quality (clarity, harshness, distortion, spaciousness, treble strength, middle strength, and bass strength), alongside a music audio quality attribute and possible alternative frequency balance attributes. Discussion: We outline how these perceptual attributes align with extant literature, how attribute rating instruments might be used in future work, and the importance of better understanding the music listening difficulties of people with varied profiles of hearing loss.

Tinnitus, Suicide, and Suicidal Ideation: A Scoping Review of Primary Research.

Tinnitus (the perception of sound in the absence of any corresponding external source) is highly prevalent and can be distressing. There are unanswered questions about how tinnitus, suicidal thoughts, and suicidal behaviours co-occur and interact. To establish the extent of scientific literature, this scoping review catalogued primary reports addressing the associations between tinnitus, suicidal ideation, attempted suicide, and death by suicide. We searched OvidSP, Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, EThoS, and ProQuest for all studies and case reports on ideation and/or attempted and/or completed suicide in the context of tinnitus. Twenty-three studies were included, and data were charted according to study type. Several epidemiological and other observational studies gave evidence of risk factors and an association between suicidal ideation, suicidal behaviour, and tinnitus. However, there was no evidence of the direction of causality. Qualitative studies are indicated to explore the patient's experience and understand the dynamics of any interaction between tinnitus and suicidal thoughts and behaviours. A theory-informed model of tinnitus and suicide needs to be developed to inform the development of interventions and how tinnitus patients are supported clinically.

Combining Multiple Psychophysiological Measures of Listening Effort: Challenges and Recommendations.

About one-third of all recently published studies on listening effort have used at least one physiological measure, providing evidence of the popularity of such measures in listening effort research. However, the specific measures employed, as well as the rationales used to justify their inclusion, vary greatly between studies, leading to a literature that is fragmented and difficult to integrate. A unified approach that assesses multiple psychophysiological measures justified by a single rationale would be preferable because it would advance our understanding of listening effort. However, such an approach comes with a number of challenges, including the need to develop a clear definition of listening effort that links to specific physiological measures, customized equipment that enables the simultaneous assessment of multiple measures, awareness of problems caused by the different timescales on which the measures operate, and statistical approaches that minimize the risk of type-I error inflation. This article discusses in detail the various obstacles for combining multiple physiological measures in listening effort research and provides recommendations on how to overcome them.

Alpha Oscillations During Effortful Continuous Speech: From Scalp EEG to Ear-EEG.

OBJECTIVE: The purpose of this study was to investigate alpha power as an objective measure of effortful listening in continuous speech with scalp and ear-EEG. METHODS: Scalp and ear-EEG were recorded simultaneously during presentation of a 33-s news clip in the presence of 16-talker babble noise. Four different signal-to-noise ratios (SNRs) were used to manipulate task demand. The effects of changes in SNR were investigated on alpha event-related synchronization (ERS) and desynchronization (ERD). Alpha activity was extracted from scalp EEG using different referencing methods (common average and symmetrical bi-polar) in different regions of the brain (parietal and temporal) and ear-EEG. RESULTS: Alpha ERS decreased with decreasing SNR (i.e., increasing task demand) in both scalp and ear-EEG. Alpha ERS was also positively correlated to behavioural performance which was based on the questions regarding the contents of the speech. CONCLUSION: Alpha ERS/ERD is better suited to track performance of a continuous speech than listening effort. SIGNIFICANCE: EEG alpha power in continuous speech may indicate of how well the speech was perceived and it can be measured with both scalp and Ear-EEG.

Measuring benefit from non-surgical interventions in otolaryngology for different conditions, using the revised 5-factor Glasgow Benefit Inventory.

OBJECTIVES: The Glasgow Benefit Inventory (GBI) has been extensively used to report the benefit from otolaryngological surgery. Benefit from non-surgical management has not been reported, despite this being the outcome of most otolaryngology and audiology consultations. DESIGN: GBI responses from 4543 adults from the Scottish ENT Outcome Study were categorised by diagnosis. Benefit scores for different interventions within diagnostic categories for which surgery was not a potential management are reported using the revised 5-factor Glasgow Benefit Inventory (GBI-5F; 15 questions and 5 factors). SETTING: Adult otolaryngology outpatient clinics in six university hospitals. PARTICIPANTS: Adults seen with conditions that had no surgical option and given non-surgical management. RESULTS: Overall, 80% of participants managed in Scottish Ear Nose and Throat Outcome Study (SENTOS) did not have surgery. A total of 1373 (30%) participants with various diagnoses were given reassurance and advice with no active intervention. There was no change in their GBI-5F total or factor scores, suggesting that they did not come to harm from their lack of active intervention. Hearing aids for bilateral sensorineural hearing loss gave greater benefit than reassurance in all factors, though individuals with a conductive impairment reported greater benefit in the Quality of life factor than those with a sensorineural impairment. Hearing aids and maskers produced benefit in the Support factor for patients with tinnitus. Epley's manoeuvre for benign paroxysmal positional vertigo gave benefit in the total score and the Quality of life factor compared with reassurance. Systemic medication for laryngo-pharyngeal reflux and topical medication for otitis externa gave no greater benefit in any factor or the total score compared with reassurance. CONCLUSION: The GBI-5F and its five factors give useful information for reporting the benefit of non-surgical interventions in adult otolaryngology and audiology clinics.

Audiometric profiles and patterns of benefit: a data-driven analysis of subjective hearing difficulties and handicaps.

OBJECTIVE: Hearing rehabilitation attempts to compensate for auditory dysfunction, reduce hearing difficulties and minimise participation restrictions that can lead to social isolation. However, there is no systematic approach to assess the quality of the intervention at an individual level that might help to evaluate the need of further hearing rehabilitation in the hearing care clinic. DESIGN: A data-driven analysis on subjective data reflecting hearing disabilities and handicap was chosen to explore "benefit patterns" as a result of rehabilitation in different audiometric groups. The method was based on (1) dimensionality reduction; (2) stratification; (3) archetypal analysis; (4) clustering; (5) item importance estimation. STUDY SAMPLE: 572 hearing-aid users completed questionnaires of hearing difficulties (speech, spatial and qualities hearing scale; SSQ) and hearing handicap (HHQ). RESULTS: The data-driven approach revealed four benefit profiles that were different for each audiometric group. The groups with low degree of high-frequency hearing loss (HLHF) showed a priority for rehabilitating hearing handicaps, whereas the groups with HLHF > 50 dB HL showed a priority for improvements in speech understanding. CONCLUSIONS: The patterns of benefit and the stratification approach might guide the clinical intervention strategy and improve the efficacy and quality of service in the hearing care clinic.

Changes in Orientation Behavior due to Extended High-Frequency (5 to 10 kHz) Spatial Cues.

OBJECTIVES: Current hearing aids have a limited bandwidth, which limits the intelligibility and quality of their output, and inhibits their uptake. Recent advances in signal processing, as well as novel methods of transduction, allow for a greater useable frequency range. Previous studies have shown a benefit for this extended bandwidth in consonant recognition, talker-sex identification, and separating sound sources. To explore whether there would be any direct spatial benefits to extending bandwidth, we used a dynamic localization method in a realistic situation. DESIGN: Twenty-eight adult participants with minimal hearing loss reoriented themselves as quickly and accurately as comfortable to a new, off-axis near-field talker continuing a story in a background of far-field talkers of the same overall level in a simulated large room with common building materials. All stimuli were low-pass filtered at either 5 or 10 kHz on each trial. To further simulate current hearing aids, participants wore microphones above the pinnae and insert earphones adjusted to provide a linear, zero-gain response. RESULTS: Each individual trajectory was recorded with infra-red motion-tracking and analyzed for accuracy, duration, start time, peak velocity, peak velocity time, complexity, reversals, and misorientations. Results across listeners showed a significant increase in peak velocity and significant decrease in start and peak velocity time with greater (10 kHz) bandwidth. CONCLUSIONS: These earlier, swifter orientations demonstrate spatial benefits beyond static localization accuracy in plausible conditions; extended bandwidth without pinna cues provided more salient cues in a realistic mixture of talkers.

The effect of stimulus duration on preferences for gain adjustments when listening to speech.

OBJECTIVES: In the personalisation of hearing-aid fittings, gain is often adjusted to suit patient preferences using live speech. When using brief sentences as stimuli, the minimum gain adjustments necessary to elicit consistent preferences ("preference thresholds") were previously found to be much greater than typical adjustments in current practice. The current study examined the role of duration on preference thresholds. DESIGN: Participants heard 2, 4 and 6-s segments of a continuous monologue presented successively in pairs. The first segment of each pair was presented at each individual's real-ear or prescribed gain. The second segment was presented with a ±0-12 dB gain adjustment in one of three frequency bands. Participants judged whether the second was "better", "worse" or "no different" from the first. STUDY SAMPLE: Twenty-nine adults, all with hearing-aid experience. RESULTS: The minimum gain adjustments needed to elicit "better" or "worse" judgments decreased with increasing duration for most adjustments. Inter-participant agreement and intra-participant reliability increased with increasing duration up to 4 s, then remained stable. CONCLUSIONS: Providing longer stimuli improves the likelihood of patients providing reliable judgments of hearing-aid gain adjustments, but the effect is limited, and alternative fitting methods may be more viable for effective hearing-aid personalisation.

Clinical Trials and Outcome Measures in Adults With Hearing Loss.

Clinical trials are designed to evaluate interventions that prevent, diagnose or treat a health condition and provide the evidence base for improving practice in health care. Many health professionals, including those working within or allied to hearing health, are expected to conduct or contribute to clinical trials. Recent systematic reviews of clinical trials reveal a dearth of high quality evidence in almost all areas of hearing health practice. By providing an overview of important steps and considerations concerning the design, analysis and conduct of trials, this article aims to give guidance to hearing health professionals about the key elements that define the quality of a trial. The article starts out by situating clinical trials within the greater scope of clinical evidence, then discusses the elements of a PICO-style research question. Subsequently, various methodological considerations are discussed including design, randomization, blinding, and outcome measures. Because the literature on outcome measures within hearing health is as confusing as it is voluminous, particular focus is given to discussing how hearing-related outcome measures affect clinical trials. This focus encompasses how the choice of measurement instrument(s) affects interpretation, how the accuracy of a measure can be estimated, how this affects the interpretation of results, and if differences are statistically, perceptually and/or clinically meaningful to the target population, people with hearing loss.

Conversation in small groups: Speaking and listening strategies depend on the complexities of the environment and group.

Many conversations in our day-to-day lives are held in noisy environments - impeding comprehension, and in groups - taxing auditory attention-switching processes. These situations are particularly challenging for older adults in cognitive and sensory decline. In noisy environments, a variety of extra-linguistic strategies are available to speakers and listeners to facilitate communication, but while models of language account for the impact of context on word choice, there has been little consideration of the impact of context on extra-linguistic behaviour. To address this issue, we investigate how the complexity of the acoustic environment and interaction situation impacts extra-linguistic conversation behaviour of older adults during face-to-face conversations. Specifically, we test whether the use of intelligibility-optimising strategies increases with complexity of the background noise (from quiet to loud, and in speech-shaped vs. babble noise), and with complexity of the conversing group (dyad vs. triad). While some communication strategies are enhanced in more complex background noise, with listeners orienting to talkers more optimally and moving closer to their partner in babble than speech-shaped noise, this is not the case with all strategies, as we find greater vocal level increases in the less complex speech-shaped noise condition. Other behaviours are enhanced in the more complex interaction situation, with listeners using more optimal head orientations, and taking longer turns when gaining the floor in triads compared to dyads. This study elucidates how different features of the conversation context impact individuals' communication strategies, which is necessary to both develop a comprehensive cognitive model of multimodal conversation behaviour, and effectively support individuals that struggle conversing.

Revised 15-item Glasgow Benefit Inventory with five factors based on analysis of a large population study of medical and surgical otorhinolaryngological interventions.

OBJECTIVES: To review, using confirmatory factor analysis, the widely used 18-question Glasgow Benefit Inventory [GBI] that has three factors. Thereafter to develop, using exploratory factor analysis, a more coherent, revised version of the GBI. DESIGN: Confirmatory and exploratory factor analysis of a large national GBI data set of ORL interventions. SETTING: Adult otorhinolaryngology outpatient clinics in six University Hospital departments. PARTICIPANTS: One thousand nine hundred eighty adult patients who had complete GBI data and who underwent an active (medical or surgical) intervention, out of the total data set of 9005 patients from the original Scottish ENT Outcome Study [SENTOS]. RESULTS: One of the 18 questions was discarded from the data base because it was not answered by 8% of respondents. Two of the original factors remained (Physical Health, renamed General Health, and Social Support, renamed Support). The General factor was split into three new factors (Quality of Life, Self-Confidence and Social Involvement). The three new factors were found to give additional information regarding the area of benefit. This reduced number of questions does not make any material difference to the results of the >196 existing GBI papers in the literature. CONCLUSION: A 15-question GBI with five factors is provided that is more explanatory of the areas of benefit.

Exploring the Factor Structure of the Glasgow Children's Benefit Inventory: New Recommendations for Reporting Results.

OBJECTIVE: Patient-reported outcomes can be useful for reporting benefit from non-life-saving interventions, but often they report a single overall score, which means that much information on the specific areas of benefit is lost. Our aim was to perform a new factor analysis on the Glasgow Children's Benefit Inventory (GCBI) to create subscales reflecting domains of benefit. Further aims were to assess the internal consistency of the GCBI, and to develop guidelines for reporting both a total score and sub-scales in future studies. METHODS: We collected 4 existing datasets of GCBI data from children who have undergone tonsillectomy, ventilation tube insertion, pinnaplasty, and submucous diathermy to the inferior turbinates. We performed exploratory factor analysis with principal axis factoring with varimax rotation, we sought redundancy in question items, and we measured internal consistency. RESULTS: Using the combined dataset of 772 cases, we found 4 factors which accounted for 64% of the variance and which we have labeled "Psycho-social," "Physical health," "Behavior," and "Vitality." Subscale results varied in predictable ways depending on the nature of the intervention. Cronbach's alpha was 0.928. Item-total correlations were high, and no item could be deleted to improve alpha. Floor effects were apparent for various questions but were not consistent between different interventions. CONCLUSIONS: The GCBI contains a range of questions which each add value in different clinical interventions. We can now make recommendations for reporting the results of the GCBI and its 4 new subscales.

The perceptual limitations of troubleshooting hearing-aids based on patients' descriptions.

OBJECTIVES: Hearing-aid frequency-gain responses are routinely adjusted by clinicians to patient preferences and descriptions. This study measured the minimum gain adjustments required to elicit preferences, and the assignment of descriptors to gain adjustments, to perceptually evaluate description-based troubleshooting. DESIGN: Participants judged whether short sentences with ±0-12 dB gain adjustments in one of three frequency bands were "better", "worse" or "no different" from the same sentence at their individual real-ear or prescribed gain. If judged "better" or "worse", participants were then asked to assign one of the six common sound-quality descriptors to their preference. STUDY SAMPLE: Thirty-two adults (aged 51-75 years) all with hearing-aid experience. RESULTS: Median preference thresholds, the minimum gain adjustments to elicit "better" or "worse" judgments, ranged from 4 to 12 dB, increasing with frequency. There was some between-participant agreement in preferences: participants generally preferred greater low-frequency gain. Within-participant reliability for preferences was moderate. There was, however, little between-participant agreement in descriptor selection for gain adjustments. Furthermore, within-participant reliability for descriptor selection was lacking. CONCLUSIONS: The scale of gain adjustments necessary to elicit preferences, along with the low agreement and reliability in descriptors for these adjustments questions the efficiency and efficacy of current description-based troubleshooting, especially with short speech stimuli.

An exploratory Study of EEG Alpha Oscillation and Pupil Dilation in Hearing-Aid Users During Effortful listening to Continuous Speech.

Individuals with hearing loss allocate cognitive resources to comprehend noisy speech in everyday life scenarios. Such a scenario could be when they are exposed to ongoing speech and need to sustain their attention for a rather long period of time, which requires listening effort. Two well-established physiological methods that have been found to be sensitive to identify changes in listening effort are pupillometry and electroencephalography (EEG). However, these measurements have been used mainly for momentary, evoked or episodic effort. The aim of this study was to investigate how sustained effort manifests in pupillometry and EEG, using continuous speech with varying signal-to-noise ratio (SNR). Eight hearing-aid users participated in this exploratory study and performed a continuous speech-in-noise task. The speech material consisted of 30-second continuous streams that were presented from loudspeakers to the right and left side of the listener (±30° azimuth) in the presence of 4-talker background noise (+180° azimuth). The participants were instructed to attend either to the right or left speaker and ignore the other in a randomized order with two different SNR conditions: 0 dB and -5 dB (the difference between the target and the competing talker). The effects of SNR on listening effort were explored objectively using pupillometry and EEG. The results showed larger mean pupil dilation and decreased EEG alpha power in the parietal lobe during the more effortful condition. This study demonstrates that both measures are sensitive to changes in SNR during continuous speech.

Discrimination of Gain Increments in Speech.

During a hearing-aid fitting, the gain applied across frequencies is often adjusted from an initial prescription in order to meet individual needs and preferences. These gain adjustments in one or more frequency bands are commonly verified using speech in quiet (e.g., the clinician's own voice). Such adjustments may be unreliable and inefficient if they are not discriminable. To examine what adjustments are discriminable when made to speech, this study measured the just-noticeable differences (JNDs) for gain increments in male, single-talker sentences. Sentences were presented with prescribed gains to the better ears of 41 hearing-impaired listeners. JNDs were measured at d' of 1 for octave-band, dual-octave-band, and broadband increments using a fixed-level, same-different task. The JNDs and interquartile ranges for 0.25, 1, and 4 kHz octave-band increments were 6.3 [4.0­7.8], 6.7 [4.6­9.1], and 9.6 [7.3­12.4] dB, respectively. The JNDs and interquartile ranges for low-, mid-, and high-frequency dual-octave-band increments were 3.7 [2.5­4.6], 3.8 [2.9­4.7], and 6.8 [4.7­9.1] dB, respectively. The JND for broadband increments was 2.0 [1.5­2.7] dB. High-frequency dual-octave-band JNDs were positively correlated with high-frequency pure-tone thresholds and sensation levels, suggesting an effect of audibility for this condition. All other JNDs were independent of pure-tone threshold and sensation level. JNDs were independent of age and hearing-aid experience. These results suggest using large initial adjustments when using short sentences in a hearing-aid fitting to ensure patient focus, followed by smaller subsequent adjustments, if necessary, to ensure audibility, comfort, and stability.

Speech, movement, and gaze behaviours during dyadic conversation in noise.

How do people have conversations in noise and make themselves understood? While many previous studies have investigated speaking and listening in isolation, this study focuses on the behaviour of pairs of individuals in an ecologically valid context. Specifically, we report the fine-grained dynamics of natural conversation between interlocutors of varying hearing ability (n = 30), addressing how different levels of background noise affect speech, movement, and gaze behaviours. We found that as noise increased, people spoke louder and moved closer together, although these behaviours provided relatively small acoustic benefit (0.32 dB speech level increase per 1 dB noise increase). We also found that increased noise led to shorter utterances and increased gaze to the speaker's mouth. Surprisingly, interlocutors did not make use of potentially beneficial head orientations. While participants were able to sustain conversation in noise of up to 72 dB, changes in conversation structure suggested increased difficulty at 78 dB, with a significant decrease in turn-taking success. Understanding these natural conversation behaviours could inform broader models of interpersonal communication, and be applied to the development of new communication technologies. Furthermore, comparing these findings with those from isolation paradigms demonstrates the importance of investigating social processes in ecologically valid multi-person situations.

Discrimination of Gain Increments in Speech-Shaped Noises.

Frequency-dependent gain adjustments are routine in hearing-aid fittings, whether in matching to real-ear targets or fine-tuning to patient feedback. Patient feedback may be unreliable and fittings inefficient if adjustments are not discriminable. To examine what gain adjustments are discriminable, we measured the just-noticeable differences (JNDs) for level increments in speech-shaped noises processed with prescription gains. JNDs were measured in the better ears of 38 participants with hearing impairment using a fixed-level, same-different task. JNDs were measured for increments at six individual frequency-bands: a 0.25-kHz low-pass band; octave-wide bands at 0.5, 1, 2, and 4 kHz; and a 6-kHz high-pass band. JNDs for broadband increments were also measured. JNDs were estimated at d' of 1 for a minimally discriminable increment in optimal laboratory conditions. The JND for frequency-band increments was 2.8 dB excluding the 0.25-kHz low-pass band, for which the JND was 4.5 dB. The JND for broadband increments was 1.5 dB. Participants' median frequency-band and broadband JNDs were positively correlated. JNDs were mostly independent of age, pure-tone thresholds, and cognitive score. In consideration of self-fitting adjustments in noisier conditions, JNDs were additionally estimated at a more sensitive d' of 2. These JNDs were 6 dB for bands below 1 kHz, and 5 dB for bands at and above 1 kHz. Overall, the results suggest noticeable fine-tuning adjustments of 3 dB and self-fitting adjustments of 5 dB.

Lifetime leisure music exposure associated with increased frequency of tinnitus.

Tinnitus has been linked to noise exposure, a common form of which is listening to music as a leisure activity. The relationship between tinnitus and type and duration of music exposure is not well understood. We conducted an internet-based population study that asked participants questions about lifetime music exposure and hearing, and included a hearing test involving speech intelligibility in noise, the High Frequency Digit Triplets Test. 4950 people aged 17-75 years completed all questions and the hearing test. Results were analyzed using multinomial regression models. High exposure to leisure music, hearing difficulty, increasing age and workplace noise exposure were independently associated with increased tinnitus. Three forms of music exposure (pubs/clubs, concerts, personal music players) did not differ in their relationship to tinnitus. More males than females reported tinnitus. The objective measure of speech reception threshold had only a minimal relationship with tinnitus. Self-reported hearing difficulty was more strongly associated with tinnitus, but 76% of people reporting usual or constant tinnitus also reported little or no hearing difficulty. Overall, around 40% of participants of all ages reported never experiencing tinnitus, while 29% reported sometimes, usually or constantly experiencing tinnitus that lasted more than 5 min. Together, the results suggest that tinnitus is much more common than hearing loss, but that there is little association between the two, especially among the younger adults disproportionately sampled in this study.

On Detectable and Meaningful Speech-Intelligibility Benefits.

The most important parameter that affects the ability to hear and understand speech in the presence of background noise is the signal-to-noise ratio (SNR). Despite decades of research in speech intelligibility, it is not currently known how much improvement in SNR is needed to provide a meaningful benefit to someone. We propose that the underlying psychophysical basis to a meaningful benefit should be the just noticeable difference (JND) for SNR. The SNR JND was measured in a series of experiments using both adaptive and fixed-level procedures across participants of varying hearing ability. The results showed an average SNR JND of approximately 3 dB for sentences in same-spectrum noise. The role of the stimulus and link to intelligibility was examined by measuring speech-intelligibility psychometric functions and comparing the intelligibility JND estimated from those functions with measured SNR JNDs. Several experiments were then conducted to establish a just meaningful difference (JMD) for SNR. SNR changes that could induce intervention-seeking behaviour for an individual were measured with subjective scaling and report, using the same stimuli as the SNR JND experiment as pre- and post-benefit examples. The results across different rating and willingness-to-change tasks showed that the mean ratings increased near linearly with a change in SNR, but a change of at least 6 dB was necessary to reliably motivate participants to seek intervention. The magnitude of the JNDs and JMDs for speech-intelligibility benefits measured here suggest a gap between what is achievable and what is meaningful.

The Just-Meaningful Difference in Speech-to-Noise Ratio.

The speech-to-noise ratio (SNR) in an environment plays a vital role in speech communication for both normal-hearing (NH) and hearing-impaired (HI) listeners. While hearing-assistance devices attempt to deliver as favorable an SNR as possible, there may be discrepancies between noticeable and meaningful improvements in SNR. Furthermore, it is not clear how much of an SNR improvement is necessary to induce intervention-seeking behavior. Here, we report on a series of experiments examining the just-meaningful difference (JMD) in SNR. All experiments used sentences in same-spectrum noise, with two intervals on each trial mimicking examples of pre- and post-benefit situations. Different groups of NH and HI adults were asked (a) to rate how much better or worse the change in SNR was in a number of paired examples, (b) if they would swap the worse for the better SNR (e.g., their current device for another), or (c) if they would be willing to go to the clinic for the given increase in SNR. The mean SNR JMD based on better or worse ratings (one arbitrary unit) was similar to the just-noticeable difference, approximately 3 dB. However, the mean SNR JMD for the more clinically relevant tasks-willingness (at least 50% of the time) to swap devices or attend the clinic for a change in SNR--was 6 to 8 dB regardless of hearing ability. This SNR JMD of the order of 6 dB provides a new benchmark, indicating the SNR improvement necessary to immediately motivate participants to seek intervention.