Implementing Ecological Momentary Assessment in Audiological Research: Opportunities and Challenges.

Ecological momentary assessment (EMA) is a way to evaluate experiences in everyday life. It is a powerful research tool but can be complex and challenging for beginners. Application of EMA in audiological research brings with it opportunities and challenges that differ from other research disciplines. This tutorial discusses important considerations when conducting EMA studies in hearing care. While more research is needed to develop specific guidelines for the various potential applications of EMA in hearing research, we hope this article can alert hearing researchers new to EMA to pitfalls when using EMA and help strengthen their study design. The current article elaborates study design details, such as choice of participants, representativeness of the study period for participants' lives, and balancing participant burden with data requirements. Mobile devices and sensors to collect objective data on the acoustic situation are reviewed alongside different possibilities for EMA setups ranging from online questionnaires paired with a timer to proprietary apps that also have access to parameters of a hearing device. In addition to considerations for survey design, a list of questionnaire items from previous studies is provided. For each item, an example and a list of references are given. EMA typically provides data sets that are rich but also challenging in that they are noisy, and there is often unequal amount of data between participants. After recommendations on how to check the data for compliance, reactivity, and careless responses, methods for statistical analysis on the individual level and on the group level are discussed including special methods for direct comparison of hearing device programs.

Effects of entropy in real-world noise on speech perception in listeners with normal hearing and hearing lossa).

Hearing aids show more benefit in traditional laboratory speech-in-noise tests than in real-world noisy environments. Real-world noise comprises a large range of acoustic properties that vary randomly and rapidly between and within environments, making quantifying real-world noise and using it in experiments and clinical tests challenging. One approach is to use acoustic features and statistics to quantify acoustic properties of real-world noise and control for them or measure their relationship to listening performance. In this study, the complexity of real-world noise from different environments was quantified using entropy in both the time- and frequency-domains. A distribution of noise segments from low to high entropy were extracted. Using a trial-by-trial design, listeners with normal hearing and hearing loss (in aided and unaided conditions) repeated back sentences embedded in these noise segments. Entropy significantly affected speech perception, with a larger effect of entropy in the time-domain than the frequency-domain, a larger effect for listeners with normal hearing than for listeners with hearing loss, and a larger effect for listeners with hearing loss in the aided than unaided condition. Speech perception also differed between most environment types. Combining entropy with the environment type improved predictions of speech perception above the environment type alone.

Efficacy and Effectiveness of Evidence-Based Non-Self-Fitting Presets Compared to Prescription Hearing Aid Fittings and a Personal Sound Amplification Product.

PURPOSE: In this study, we compare the efficacy and effectiveness of gain-frequency responses of evidence-based presets developed by our lab for over-the-counter hearing aids to conventional National Acoustic Laboratories' nonlinear fitting procedure, version 2 (NAL-NL2) gain-frequency response and to gain-frequency response of a personal sound amplification product (PSAP). We hypothesized that the hearing aids with our presets would perform better than a PSAP with poor frequency response and comparably to the hearing aid with NAL-NL2 frequency response. METHOD: We used a single-blinded, randomized cross-over design to compare audibility, speech recognition, sound quality, listening effort, and subjective preferences in 37 participants in laboratory settings and following field trials. RESULTS: The presets developed in our lab showed comparable outcomes to the hearing aids with NAL-NL2 gain-frequency response in most measured domains. Performance with the presets was better than the PSAP gain-frequency response in the domains of listening effort and sound quality in laboratory testing and speech recognition in our real-world measures. We also found that most participants (54.05%) preferred our presets over the PSAPs and were willing to pay significantly more to purchase the hearing aids with our presets. CONCLUSION: Our evidence-based presets have better outcomes than a PSAP with a single, poorly suited frequency response while performing comparably to the clinical best-practice National Acoustic Laboratories condition.

Facial Expressions as an Index of Listening Difficulty and Emotional Response.

Knowledge about listening difficulty experienced during a task can be used to better understand speech perception processes, to guide amplification outcomes, and can be used by individuals to decide whether to participate in communication. Another factor affecting these decisions is individuals' emotional response which has not been measured objectively previously. In this study, we describe a novel method of measuring listening difficulty and affect of individuals in adverse listening situations using automatic facial expression algorithm. The purpose of our study was to determine if facial expressions of confusion and frustration are sensitive to changes in listening difficulty. We recorded speech recognition scores, facial expressions, subjective listening effort scores, and subjective emotional responses in 33 young participants with normal hearing. We used the signal-to-noise ratios of -1, +2, and +5 dB SNR and quiet conditions to vary the difficulty level. We found that facial expression of confusion and frustration increased with increase in difficulty level, but not with change in each level. We also found a relationship between facial expressions and both subjective emotion ratings and subjective listening effort. Emotional responses in the form of facial expressions show promise as a measure of affect and listening difficulty. Further research is needed to determine the specific contribution of affect to communication in challenging listening environments.

Auditory environment diversity quantified using entropy from real-world hearing aid data.

Introduction: Using data collected from hearing aid users' own hearing aids could improve the customization of hearing aid processing for different users based on the auditory environments they encounter in daily life. Prior studies characterizing hearing aid users' auditory environments have focused on mean sound pressure levels and proportions of environments based on classifications. In this study, we extend these approaches by introducing entropy to quantify the diversity of auditory environments hearing aid users encounter. Materials and Methods: Participants from 4 groups (younger listeners with normal hearing and older listeners with hearing loss from an urban or rural area) wore research hearing aids and completed ecological momentary assessments on a smartphone for 1 week. The smartphone was programmed to sample the processing state (input sound pressure level and environment classification) of the hearing aids every 10 min and deliver an ecological momentary assessment every 40 min. Entropy values for sound pressure levels, environment classifications, and ecological momentary assessment responses were calculated for each participant to quantify the diversity of auditory environments encountered over the course of the week. Entropy values between groups were compared. Group differences in entropy were compared to prior work reporting differences in mean sound pressure levels and proportions of environment classifications. Group differences in entropy measured objectively from the hearing aid data were also compared to differences in entropy measured from the self-report ecological momentary assessment data. Results: Auditory environment diversity, quantified using entropy from the hearing aid data, was significantly higher for younger listeners than older listeners. Entropy measured using ecological momentary assessment was also significantly higher for younger listeners than older listeners. Discussion: Using entropy, we show that younger listeners experience a greater diversity of auditory environments than older listeners. Alignment of group entropy differences with differences in sound pressure levels and hearing aid feature activation previously reported, along with alignment with ecological momentary response entropy, suggests that entropy is a valid and useful metric. We conclude that entropy is a simple and intuitive way to measure auditory environment diversity using hearing aid data.

Entropy as a Measure of Auditory Environment Diversity: An Ecological Momentary Assessment (EMA) Approach.

OBJECTIVES: To determine the validity and usefulness of entropy computed using ecological momentary assessment (EMA) data as a measure of auditory environment diversity. DESIGN: We conducted two secondary analyses on existing EMA datasets. The first determined the construct validity of auditory environment entropy by examining the effect of COVID-19 on entropy. To demonstrate entropy's usefulness, the second examined if entropy could predict the benefit of hearing aid (HA) noise reduction features. RESULTS: Consistent with the known effect of COVID-19 on social lifestyle, COVID-19 significantly reduced auditory environment diversity, supporting entropy's construct validity. HA users with higher entropy reported poorer outcomes and perceived more benefit from HA features, supporting the feasibility of using entropy to predict communication performance and feature benefit. CONCLUSIONS: Entropy derived from EMA data is a valid and useful auditory environment diversity measure. This measure could allow researchers to better understand the communication needs of people with hearing loss.

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.

Input-related demands: vocoded sentences evoke different pupillometrics and subjective listening effort than sentences in speech-shaped noise.

OBJECTIVES: The Framework for Effortful Listening (FUEL) suggests five input-related demands can alter listening effort: source, transmission, listener, message and context factors. We hypothesised that vocoded sentences represented a source factor degradation and sentences in speech-shaped noise represented a transmission factor degradation. We used pupillometry and a subjective scale to examine our hypothesis. DESIGN: Participants listened to vocoded sentences and sentences in speech-shaped noise at several difficulty levels designed to produce similar word recognition abilities; they also listened to unprocessed sentences. Within-participant pupillometrics and subjective listening effort were analysed. Post-hoc analyses were performed to examine if word recognition accuracy differentially influenced pupil responses. STUDY SAMPLES: Twenty young adults with normal hearing. RESULTS: Baseline pupil diameter was significantly smaller, peak pupil dilation was significantly larger, peak pupil dilation latency was significantly shorter, and subjective listening effort was significantly greater for the vocoded sentences than the sentences-in-noise. Word recognition ability also affected pupillometrics, but only for the vocoded sentences. CONCLUSIONS: Our findings suggest that source factor degradations result in greater listening effort than transmission factor degradations. Future research should address how clinical interventions tailored towards different input-related demands may lead to reduced listening effort and improve patient outcomes.

Effect of high pressure pretreatment on myrosinase-glucosinolate system, physicochemical and bacterial properties during fermentation of brine-pickled radishes.

The myrosinase-glucosinolate system, physicochemical properties, and bacterial community were profiled during fermentation of high hydrostatic pressure (HHP) pretreated brine-pickled radishes; traditionally brine-pickled radishes were utilised as the control. Scanning electron microscopy (SEM) analysis revealed that 300 MPa pretreatment promoted brine infiltration in radish cells and damaged cellular microstructures, which activated the myrosinase-glucosinolate system. The conversion of glucosinolate (GLs) to isothiocyanates (ITC) increased and significantly enhanced the raphasatin and sulforaphene contents of pickled radish. However, 600 MPa pretreatment suppressed myrosinase activity. HHP pretreatment altered the natural radish bacterial communities by reducing the total bacterial and lactic acid bacteria counts. Lactobacillus spp. became the dominant bacterial genus within 15 d of fermentation. However, the destruction of cellular structures by HHP pretreatment also significantly decreased hardness and caused the dissolution of amino acids and TTA into brine. This caused reduced amino acid and TTA contents compared to the control group, as well as decreases in pH. HHP pretreatment suppressed the growth of spoilage bacteria (e.g. Pseudomonas, Staphylococcus, and Shewanella genera). This study provides new insight into the potential applications of HHP treatment in pickling, as it demonstrates that HHP can increase the ITC conversion rate of pickled radish, modify its physiochemical characteristics, and decrease microbial risk. Therefore, HHP is a promising preprocessing technique to be used for pickle manufacturing industry.

Effects of high-pressure processing on the physicochemical properties and glycemic index of fruit puree in a hyperglycemia mouse model.

BACKGROUND: In this study, the duration of high-pressure processing (HPP) required to achieve a 5 log reduction of Escherichia coli O157:H7 in fruit purees was evaluated. Banana, cantaloupe, and dragon fruit purees were subjected to HPP at 600 MPa for 300, 270, and 270 s, respectively, and their physicochemical properties and enzyme activities were then analysed. Diabetic mice were fed fresh and HPP-treated purees to observe their effects on the glycemic index (GI) and postprandial blood glucose response. RESULTS: Compared with their fresh counterparts, the HPP-treated banana and dragon fruit purees exhibited significantly higher viscosities, lower glucose concentrations, and higher glucose dialysis retardation indices and showed disrupted sucrose invertase and polygalacturonase activities. The GI and postprandial blood glucose response were not significantly different between the fresh and HPP-treated cantaloupe purees. By contrast, the peak time of glucose response (Tmax ) was delayed from 30 min to 60 min, and the area under the receiver operating characteristic curve was reduced by 40% in the mice fed HPP-treated banana and dragon fruit purees. The GIs of the HPP-treated banana and dragon fruit purees (were 50.3 and 44.8, respectively) were significantly lower than those of their fresh counterparts (85.1 and 75.2, respectively). CONCLUSION: HPP can change the physicochemical properties of fruit purees, resulting in stabilized blood glucose levels and lower GIs after consumption. Therefore, purees processed in this manner would benefit consumers and patients with diabetes/pre-diabetes who need to maintain stable blood glucose levels (Fig. S1). © 2022 Society of Chemical Industry.

High hydrostatic pressure treatment induced microstructure changes and isothiocyanates biosynthesis in kale.

Effects of high-pressure processing (HPP) on the myrosinase activity, glucosinolate (GLS) content, isothiocyanate (ITC) conversion rate, color, and bacterial count of kale leaves were investigated. Thermal process at 100 °C were used as negative control groups. The sample processed at 600 MPa exhibited the highest myrosinase activity and ITC conversion rate of 70.4%, while the GLS content was significantly lower than those in the raw and the thermally processed samples. However, processing of the samples at elevated temperatures results in gradual loss of myrosinase activity. SEM images showed that HPP induces irregular crushing damage to the veins, edges, and surfaces of the leaves, thereby promoting the conversion process in the myrosinase-GLS-ITC system. Additionally, HPP caused less significant color change of the kale leaves than thermal treatment. HPP achieved the same level of pasteurization as thermal treatment in terms of bacterial count.

Personalizing over-the-counter hearing aids using pairwise comparisons.

Over-the-counter hearing aids enable more affordable and accessible hearing health care by shifting the burden of configuring the device from trained audiologists to end-users. A critical challenge is to provide users with an easy-to-use method for personalizing the many parameters which control sound amplification based on their preferences. This paper presents a novel approach to fitting hearing aids that provides a higher degree of personalization than existing methods by using user feedback more efficiently. Our approach divides the fitting problem into two parts. First, we discretize an initial 24-dimensional space of possible configurations into a small number of presets. Presets are constructed to ensure that they can meet the hearing needs of a large fraction of Americans with mild-to-moderate hearing loss. Then, an online agent learns the best preset by asking a sequence of pairwise comparisons. This learning problem is an instance of the multi-armed bandit problem. We performed a 35-user study to understand the factors that affect user preferences and evaluate the efficacy of multi-armed bandit algorithms. Most notably, we identified a new relationship between a user's preference and presets: a user's preference can be represented as one or more preference points in the initial configuration space with stronger preferences expressed for nearby presets (as measured by the Euclidean distance). Based on this observation, we have developed a Two-Phase Personalizing algorithm that significantly reduces the number of comparisons required to identify a user's preferred preset. Simulation results indicate that the proposed algorithm can find the best configuration with a median of 25 comparisons, reducing by half the comparisons required by the best baseline. These results indicate that it is feasible to configure over-the-counter hearing aids using a small number of pairwise comparisons without the help of professionals.

Effect of Noise Reduction on Cortical Speech-in-Noise Processing and Its Variance due to Individual Noise Tolerance.

OBJECTIVES: Despite the widespread use of noise reduction (NR) in modern digital hearing aids, our neurophysiological understanding of how NR affects speech-in-noise perception and why its effect is variable is limited. The current study aimed to (1) characterize the effect of NR on the neural processing of target speech and (2) seek neural determinants of individual differences in the NR effect on speech-in-noise performance, hypothesizing that an individual's own capability to inhibit background noise would inversely predict NR benefits in speech-in-noise perception. DESIGN: Thirty-six adult listeners with normal hearing participated in the study. Behavioral and electroencephalographic responses were simultaneously obtained during a speech-in-noise task in which natural monosyllabic words were presented at three different signal-to-noise ratios, each with NR off and on. A within-subject analysis assessed the effect of NR on cortical evoked responses to target speech in the temporal-frontal speech and language brain regions, including supramarginal gyrus and inferior frontal gyrus in the left hemisphere. In addition, an across-subject analysis related an individual's tolerance to noise, measured as the amplitude ratio of auditory-cortical responses to target speech and background noise, to their speech-in-noise performance. RESULTS: At the group level, in the poorest signal-to-noise ratio condition, NR significantly increased early supramarginal gyrus activity and decreased late inferior frontal gyrus activity, indicating a switch to more immediate lexical access and less effortful cognitive processing, although no improvement in behavioral performance was found. The across-subject analysis revealed that the cortical index of individual noise tolerance significantly correlated with NR-driven changes in speech-in-noise performance. CONCLUSIONS: NR can facilitate speech-in-noise processing despite no improvement in behavioral performance. Findings from the current study also indicate that people with lower noise tolerance are more likely to get more benefits from NR. Overall, results suggest that future research should take a mechanistic approach to NR outcomes and individual noise tolerance.

Personal Characteristics Associated with Ecological Momentary Assessment Compliance in Adult Cochlear Implant Candidates and Users.

BACKGROUND: Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden could result in noncompliance with the EMA sampling scheme protocol. It has been a concern that certain types of participants could be more likely to have low compliance, such as those who have severe hearing loss and poor speech recognition performance, are employed, are not familiar with technologies used to implement EMA (e.g., smartphones), and have poorer cognitive abilities. Noncompliance dependent on personal characteristics could negatively impact the generalizability of EMA research. PURPOSE: This article aims to determine personal characteristics associated with EMA compliance in a group of adult cochlear implant (CI) candidates and users. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Fifty-eight adults who were either scheduled to received CIs or were experienced CI users completed the study. DATA COLLECTION AND ANALYSIS: Participants conducted smartphone-based EMA designed to assess an individual's daily auditory ecology for 1 week. EMA compliance was quantified using two metrics: the number of completed surveys and the response rate to the notification delivered by the EMA app. Personal characteristics (i.e., predictors) included age, gender, CI status (candidate or user), employment status (employed or not employed), smartphone ownership, speech recognition performance, social network size, level of depressive symptoms, and neurocognitive abilities. A word recognition test, questionnaires, and a test battery of neurocognitive assessments were used to measure the predictors. We used negative binomial regression and logistic mixed models to determine the factors associated with the number of completed surveys and the response rate, respectively. We hypothesized that, for example, employed participants with poorer speech recognition performance would have lower compliance. RESULTS: Contrary to the hypothesis, word recognition score was negatively associated with the number of completed surveys (p = 0.022). Holding all other variables constant, a 10-point (i.e., 10%) word recognition score decrease was associated with an 11% increase in the number of completed surveys. For the response rate, employment status was the only significant predictor (p < 0.0001). Consistent with our hypothesis, the odds of responding to EMA notifications for those who are not employed are 82% higher than the odds for those who are employed. No other studied personal characteristic was associated with compliance. CONCLUSION: For CI candidates and users, EMA compliance could be affected by personal characteristics such as speech recognition performance and employment status. Because (1) participants with poorer speech recognition performance do not necessarily have lower compliance and (2) most personal characteristics investigated in the present study (e.g., age, gender, smartphone ownership, and neurocognitive abilities) do not predict compliance, a wide range of participants could successfully conduct smartphone-based EMA.

Statistical Considerations for Analyzing Ecological Momentary Assessment Data.

PURPOSE: The analysis of Ecological Momentary Assessment (EMA) data can be difficult to conceptualize due to the complexity of how the data are collected. The goal of this tutorial is to provide an overview of statistical considerations for analyzing observational data arising from EMA studies. METHOD: EMA data are collected in a variety of ways, complicating the statistical analysis. We focus on fundamental statistical characteristics of the data and general purpose statistical approaches to analyzing EMA data. We implement those statistical approaches using a recent study involving EMA. RESULTS: The linear or generalized linear mixed-model statistical approach can adequately capture the challenges resulting from EMA collected data if properly set up. Additionally, while sample size depends on both the number of participants and the number of survey responses per participant, having more participants is more important than the number of responses per participant. CONCLUSION: Using modern statistical methods when analyzing EMA data and adequately considering all of the statistical assumptions being used can lead to interesting and important findings when using EMA. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.17155961.

The Influence of Forced Social Isolation on the Auditory Ecology and Psychosocial Functions of Listeners With Cochlear Implants During COVID-19 Mitigation Efforts.

OBJECTIVES: The impact of social distancing on communication and psychosocial variables among individuals with hearing impairment during COVID-19 pandemic. It was our concern that patients who already found themselves socially isolated (Wie et al. 2010) as a result of their hearing loss would be perhaps more susceptible to changes in their communication habits resulting in further social isolation, anxiety, and depression. We wanted to better understand how forced social isolation (as part of COVID-19 mitigation) effected a group of individuals with hearing impairment from an auditory ecology and psychosocial perspective. We hypothesized that the listening environments would be different as a result of social isolation when comparing subject's responses regarding activities and participation before COVID-19 and during the COVID-19 pandemic. This change would lead to an increase in experienced and perceived social isolation, anxiety, and depression. DESIGN: A total of 48 adults with at least 12 months of cochlear implant (CI) experience reported their listening contexts and experiences pre-COVID and during-COVID using Ecological Momentary Assessment (EMA; methodology collecting a respondent's self-reports in their natural environments) through a smartphone-based app, and six paper and pencil questionnaires. The Smartphone app and paper-pencil questionnaires address topics related to their listening environment, social isolation, depression, anxiety, lifestyle and demand, loneliness, and satisfaction with amplification. Data from these two-time points were compared to better understand the effects of social distancing on the CI recipients' communication abilities. RESULTS: EMA demonstrated that during-COVID CI recipients were more likely to stay home or be outdoors. CI recipients reported that they were less likely to stay indoors outside of their home relative to the pre-COVID condition. Social distancing also had a significant effect on the overall signal-to-noise ratio of the environments indicating that the listening environments had better signal-to-noise ratios. CI recipients also reported better speech understanding, less listening effort, less activity limitation due to hearing loss, less social isolation due to hearing loss, and less anxiety due to hearing loss. Retrospective questionnaires indicated that social distancing had a significant effect on the social network size, participant's personal image of themselves, and overall loneliness. CONCLUSIONS: Overall, EMA provided us with a glimpse of the effect that forced social isolation has had on the listening environments and psychosocial perspectives of a select number of CI listeners. CI participants in this study reported that they were spending more time at home in a quieter environments during-COVID. Contrary to our hypothesis, CI recipients overall felt less socially isolated and reported less anxiety resulting from their hearing difficulties during-COVID in comparison to pre-COVID. This, perhaps, implies that having a more controlled environment with fewer speakers provided a more relaxing listening experience.

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.

Comparisons of the Sensitivity and Reliability of Multiple Measures of Listening Effort.

OBJECTIVES: The objective of this study was to evaluate the sensitivity and reliability of one subjective (rating scale) and three objective (dual-task paradigm, pupillometry, and skin conductance response amplitude) measures of listening effort across multiple signal to noise ratios (SNRs). DESIGN: Twenty adults with normal hearing attended two sessions and listened to sentences presented in quiet and in stationary noise at three different SNRs: 0, -3, and -5 dB. Listening effort was assessed by examining change in reaction time (dual-task paradigm), change in peak to peak pupil diameter (pupillometry), and change in mean skin conductance response amplitude; self-reported listening effort on a scale from 0 to 100 was also evaluated. Responses were averaged within each SNR and based on three word recognition ability categories (≤50%, 51% to 71%, and >71%) across all SNRs. Measures were considered reliable if there were no significant changes between sessions, and intraclass correlation coefficients were a minimum of 0.40. Effect sizes were calculated to compare the sensitivity of the measures. RESULTS: Intraclass correlation coefficient values indicated fair-to-moderate reliability for all measures while individual measurement sensitivity was variable. Self-reports were sensitive to listening effort but were less reliable, given that subjective effort was greater during the dual task than either of the physiologic measures. The dual task was sensitive to a narrow range of word recognition abilities but was less reliable as it exhibited a global decrease in reaction time across sessions. Pupillometry was consistently sensitive and reliable to changes in listening effort. Skin conductance response amplitude was not sensitive or reliable while the participants listened to the sentences. Skin conductance response amplitude during the verbal response was sensitive to poor (≤50%) speech recognition abilities; however, it was less reliable as there was a significant change in amplitude across sessions. CONCLUSIONS: In this study, pupillometry was the most sensitive and reliable objective measure of listening effort. Intersession variability significantly influenced the other objective measures of listening effort, which suggests challenges for cross-study comparability. Therefore, intraclass correlation coefficients combined with other statistical tests more fully describe the reliability of measures of listening effort across multiple difficulties. Minimizing intersession variability will increase measurement sensitivity. Further work toward standardized methods and analysis will strengthen our understanding of the reliability and sensitivity of measures of listening effort and better facilitate cross-modal and cross-study comparisons.

Toward a New Evidence-Based Fitting Paradigm for Over-the-Counter Hearing Aids.

Purpose This dual-aim study was intended to develop and validate a new fitting paradigm for over-the-counter (OTC) hearing aids. Aim 1 was undertaken to create a limited set of evidence-based preconfigured gain-frequency responses ("presets") for use in OTC devices. Aim 2 tested the efficacy of the presets relative to best-practice verification and determined the best method(s) for older adults to self-select amplification from the set. Method In Aim 1, audiometry data from 267 older adults with mild-to-moderate sensorineural hearing loss were obtained from the National Health and Nutrition Examination Survey database. Using these data and the National Acoustic Laboratories-Non-Linear 2 (NAL-NL2) prescriptive formula, a set of four presets were created that can fit a large percentage of older Americans with presbycusis. In Aim 2, 37 older adults with hearing loss used five methods to select presets. The selection methods were select-by-audiogram, select-by-self-test, select-by-trying, select-by-questionnaire, and random assignment. Using a crossover design, each participant completed speech recognition testing and sound quality ratings in quiet and noise for all selection methods and a verified NAL-NL2 condition. Results The set of presets can fit 67.9% of older Americans with mild-to-moderate hearing loss (Aim 1). Controlling for hearing thresholds and sound quality ratings, liner mixed-effects models indicated that speech recognition scores for select-by-audiogram, select-by-self-test, and select-by-trying were not statistically different from the NAL-NL2 condition. Statistical analysis indicated that select-by-self-test produced outcomes most consistent with individual outcomes for the NAL-NL2 condition (Aim 2). Conclusion This newly developed fitting paradigm may provide efficacy comparable to best-practice verification and could be used in OTC hearing aids.

GPS predicts stability of listening environment characteristics in one location over time among older hearing aid users.

OBJECTIVE: Hearing aid technology can allow users to "geo-tag" hearing aid preferences using the Global Positioning System (GPS). This technology assumes that listening environment characteristics that affect hearing aid benefit change little in a location over time. The purpose of this study was to investigate whether certain characteristics (reverberation, signal type, listening activity, noise location, noisiness, talker familiarity, talker location, and visual cues) changed in a location over time. Design: Participants completed GPS-tagged surveys on smartphones to report on characteristics of their listening environments. Coordinates were used to create indices that described how much listening environment characteristics changed in a location over time. Indices computed in one location were compared to indices computed across all locations for each participant. Study sample: 54 adults with hearing loss participated in this study (26 males and 38 females; 30 experienced hearing aid users and 24 new users). Results: A location dependency was observed for all characteristics. Characteristics were significantly different from one another in their stability over time. Conclusions: Listening environment characteristics changed less over time in a given location than in participants' lives generally. The effectiveness of GPS-dependent hearing aid settings likely depends on the accuracy and location definition of the GPS feature.