Evaluating Quality, Credibility, and Readability of Online Over-the-Counter Hearing Aid Information.

OBJECTIVE: With over-the-counter hearing aids being recently approved by the United States Food and Drug Administration, the accuracy and usefulness of online information has not yet been examined. This study evaluates the quality, credibility, readability, and accessibility of online over-the-counter hearing aids education materials. METHODS: Google was queried using the search term "over-the-counter hearing aids". The top 50 results were categorized into healthcare versus non-healthcare authored resources. The Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) tests were utilized to assess readability, whereas the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test and DISCERN instruments were used to assess quality and credibility. The number of clicks taken to access relevant information on each website was used to assess accessibility. RESULTS: There was no significant difference in FRES or FKGL readability scores between healthcare and non-healthcare authored websites (p = 0.5548, p = 0.5981, respectively), but both readability scores were higher than that of the recommended reading level for patient education materials. There was no significant difference in CRAAP and DISCERN scores between both groups (p = 0.5746, p = 0.1699, respectively). The number of clicks did not significantly differ between healthcare and non-healthcare authored resources (p = 0.4932). CONCLUSION: This study highlights poor readability and accessibility of virtual healthcare information regarding OTC hearing aids. Although credibility in articles authored by healthcare and non-healthcare professionals was adequate, readability was greatly compromised due to the written information exceeding the recommended United States reading level. Accessibility posed a similar issue, as many sites required multiple clicks to access product information. LEVEL OF EVIDENCE: NA Laryngoscope, 134:3302-3309, 2024.

Association of In-Ear Device Use With Communication Quality Among Individuals Wearing Personal Protective Equipment in a Simulated Operating Room.

Importance: The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators. Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date. Objective: To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR]) in the operating room. Design, Setting, and Participants: This quality improvement study was conducted in June 2020. Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited. All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital. Exposures: All participants performed the speech intelligibility tasks with and without an in-ear communication device. Main Outcomes and Measures: Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100%) was obtained for each speech intelligibility test. Listening effort was assessed using the NASA Task Load Index. An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained. Results: A total of 12 participants were included (mean [SD] age, 31.2 [1.9] years; 8 women [66.7%]). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8%) without the in-ear device vs 94.3% (7.4%) with the device. While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4%) without the in-ear device vs 90.8% (8.9%) with the device. While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8%) without the in-ear device vs 94.5% (5.5%) with the device. Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3%; 95% CI, 23.8%-40.7%; P < .001) and the PAPR (9.9%; 95% CI, 1.4%-18.3%; P = .01). Furthermore, use of the device was associated with decreased listening effort. The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device. While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device. While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device. Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI, 23.5-53.3; P < .001) and the PAPR (18.4; 95% CI, 0.4-36.4; P = .04). Conclusions and Relevance: This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort. Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.

Speaker separation in realistic noise environments with applications to a cognitively-controlled hearing aid.

Future wearable technology may provide for enhanced communication in noisy environments and for the ability to pick out a single talker of interest in a crowded room simply by the listener shifting their attentional focus. Such a system relies on two components, speaker separation and decoding the listener's attention to acoustic streams in the environment. To address the former, we present a system for joint speaker separation and noise suppression, referred to as the Binaural Enhancement via Attention Masking Network (BEAMNET). The BEAMNET system is an end-to-end neural network architecture based on self-attention. Binaural input waveforms are mapped to a joint embedding space via a learned encoder, and separate multiplicative masking mechanisms are included for noise suppression and speaker separation. Pairs of output binaural waveforms are then synthesized using learned decoders, each capturing a separated speaker while maintaining spatial cues. A key contribution of BEAMNET is that the architecture contains a separation path, an enhancement path, and an autoencoder path. This paper proposes a novel loss function which simultaneously trains these paths, so that disabling the masking mechanisms during inference causes BEAMNET to reconstruct the input speech signals. This allows dynamic control of the level of suppression applied by BEAMNET via a minimum gain level, which is not possible in other state-of-the-art approaches to end-to-end speaker separation. This paper also proposes a perceptually-motivated waveform distance measure. Using objective speech quality metrics, the proposed system is demonstrated to perform well at separating two equal-energy talkers, even in high levels of background noise. Subjective testing shows an improvement in speech intelligibility across a range of noise levels, for signals with artificially added head-related transfer functions and background noise. Finally, when used as part of an auditory attention decoder (AAD) system using existing electroencephalogram (EEG) data, BEAMNET is found to maintain the decoding accuracy achieved with ideal speaker separation, even in severe acoustic conditions. These results suggest that this enhancement system is highly effective at decoding auditory attention in realistic noise environments, and could possibly lead to improved speech perception in a cognitively controlled hearing aid.

[Do hearing aids live up to their promises?] / Doen hoortoestellen wel wat ze beloven?

The main type of acquired hearing impairment is presbycusis (age-related hearing impairment). In presbycusis, mainly the high tones are no longer heard properly. In the Netherlands, approximately 2 million people are hard of hearing. About one third of all hearing impaired people have 1 or 2 hearing aids. 90% of the group of hearing aid users consists of people over 65. 15% of hearing aid users never or rarely use their hearing aid. The main complaint of hearing aid users is a reduced understanding of speech in noise. When the hearing impaired start to avoid a noisy setting, this can lead to symptoms of sadness and loneliness. Hearing aids live only partially up to promises. Both more information about hearing aids and more support for hearing aid users are necessary to achieve greater satisfaction.

A Set of Time-and-Frequency-Localized Short-Duration Speech-Like Stimuli for Assessing Hearing-Aid Performance via Cortical Auditory-Evoked Potentials.

Short-duration speech-like stimuli, for example, excised from running speech, can be used in the clinical setting to assess the integrity of the human auditory pathway at the level of the cortex. Modeling of the cochlear response to these stimuli demonstrated an imprecision in the location of the spectrotemporal energy, giving rise to uncertainty as to what and when of a stimulus caused any evoked electrophysiological response. This article reports the development and assessment of four short-duration, limited-bandwidth stimuli centered at low, mid, mid-high, and high frequencies, suitable for free-field delivery and, in addition, reproduction via hearing aids. The durations were determined by the British Society of Audiology recommended procedure for measuring Cortical Auditory-Evoked Potentials. The levels and bandwidths were chosen via a computational model to produce uniform cochlear excitation over a width exceeding that likely in a worst-case hearing-impaired listener. These parameters produce robustness against errors in insertion gains, and variation in frequency responses, due to transducer imperfections, room modes, and age-related variation in meatal resonances. The parameter choice predicts large spectral separation between adjacent stimuli on the cochlea. Analysis of the signals processed by examples of recent digital hearing aids mostly show similar levels of gain applied to each stimulus, independent of whether the stimulus was presented in isolation, bursts, continuous, or embedded in continuous speech. These stimuli seem to be suitable for measuring hearing-aided Cortical Auditory-Evoked Potentials and have the potential to be of benefit in the clinical setting.

Candidacy for Amplification in Children With Hearing Loss: A Review of Guidelines and Recommendations.

Purpose The 1st point in the intervention process for the majority of children is the fitting of hearing devices. The objective of this review was to compile guidelines and recommendations for candidacy criteria for children with hearing loss. Method Electronic databases (e.g., MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature) and websites were searched. Any document referring to children with hearing loss that discussed amplification guidelines or protocols was included. Documents specific to implantable devices or addressing only remote microphone systems were excluded. One reviewer screened all potentially relevant documents, and a subset was screened by a 2nd reviewer. Guidelines/recommendations referring to pediatric amplification candidacy were extracted. Results A total of 40 documents were included for data extraction. Studies were categorized according to hearing loss of any degree, with separate categories for documents providing specific criteria for mild bilateral, unilateral, and auditory neuropathy spectrum disorders. Guidelines ranged from generic statements about the need for amplification to criteria based on specific audiometric thresholds. In guidelines recommending audiometric cut-points, the majority considered > 25 dB HL as a criterion for consideration for amplification. Overall, guidelines for children with mild bilateral and unilateral loss remain more ambiguous, and there was some variation across the recommendations. Guidelines for auditory neuropathy spectrum disorder stressed the need to obtain results from behavioral audiometry before considering amplification. Conclusions Numerous organizations have established candidacy guidelines for pediatric amplification. Most guidelines specify criteria for amplification as audiometric threshold levels. There is considerable variation in the guidelines for mild bilateral and unilateral hearing loss with candidacy criteria ranging from 15 to 30 dB HL, and many guidelines recommend a case-by-case decision approach.

Elaboration of an instrument to evaluate the recognition of Brazilian melodies in children / Criação de um instrumento para avaliar o reconhecimento de melodias brasileiras em crianças

Abstract Introduction: There is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception. Objective: To develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing. Methods: The study was carried out after approval of the research ethics committee (1.198.607). The instrument was developed in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded in piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 schooled children, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65 dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database. Results: The instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: http://192.185.216.17/ivan/home/login.php by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3′15″. Conclusion: The development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users.

Resumo Introdução: Há evidências que apontam para a importância da avaliação da percepção musical através de instrumentos objetivos e subjetivos. No Brasil, há escassez de instrumentos que avaliem a percepção musical. Objetivo: Desenvolver um instrumento para avaliar o reconhecimento de melodias tradicionais brasileiras e investigar o desempenho de crianças com audição típica. Método: O estudo foi desenvolvido após aprovação do comitê de ética em pesquisa (1.198.607). O instrumento foi desenvolvido em formato de software com acesso ao site, com as linguagens de programação PHP 5.5.12, Javascript, Cascade Style Sheets e HTML5; banco de dados MYSQL 5.6.17 no servidor Apache 2.4.9. Quinze melodias de canções folclóricas brasileiras foram gravadas com timbre sintetizado em piano, com 12 segundos de reprodução da melodia e quatro segundos de intervalo entre elas. Participaram do estudo 155 crianças, alfabetizadas, entre oito e 11 anos, de ambos os sexos, com audição típica. O teste foi feito em sala silenciosa com estímulo sonoro amplificado por uma caixa sonora a 65 dB NA, posicionada a 0 azimute e a um metro do participante e o notebook foi usado para que as crianças brincassem na tela com o título e a ilustração da melodia que eles reconheceram que ouviam. As respostas foram registradas em seu próprio banco de dados. Resultados: O instrumento intitulado "Avaliação do reconhecimento de melodias tradicionais em crianças" pode ser executado em vários dispositivos (computadores, notebooks, tablets, telefones celulares) e sistemas operacionais (Windows, Macintosh, Android, Linux). Acesse: http://192.185.216.17/ivan/home/login.php através de login e senha. A melodia mais facilmente reconhecida foi "Cai cai balão" (89%) e a menos reconhecida foi "Capelinha de melão" (25,2%). O tempo médio para fazer o teste foi de 3′15″. Conclusão: O desenvolvimento e a aplicação do software se mostraram eficazes para a população estudada. Esse instrumento pode contribuir para o aprimoramento de protocolos de avaliação da percepção musical em crianças usuárias de próteses auditivas e/ou usuárias de implante coclear.

The use of remote microphone systems in unilateral hearing loss: a preliminary study among Brazilian children and teenagers.

Due to the large number of individuals with Unilateral Hearing Loss (UHL) and the recommendation to use hearing assistive devices, studies are required to define possibilities of intervention for this population. OBJECTIVE: To evaluate the performance of the Remote Microphone System (RMS) in children with UHL. METHODOLOGY: Prospective clinical study with a convenience sample. Eleven children (mean age of 9.2 years) with severe and profound sensorineural UHL, hearing aid users and enrolled in regular schools participated in the study. They were evaluated using the Hearing in Noise Test (HINT), the Classroom Participation Questionnaire (CPQ), and the Sustained Auditory Attention Ability Test (SAAAT) with RMS. RESULTS: HINT results were analyzed using variance to three criteria of repeated measures, which revealed differences between intervention, position, and time factors and significant interaction between these three factors. The comparative analysis of the results from CPQ showed significant differences in the statistical t-test (p=<0.001) for all subscales. The analysis of variance at two repeated measures criteria used in the study of SAAAT revealed a difference between intervention and time, and both interacted significantly. CONCLUSION: The RMS associated with a hearing aid was effective for individuals with UHL.

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.

Access to adults' hearing aids: policies and technologies used in eight countries.

As the proportion of older adults in the world's total population continues to grow, the adverse health outcomes of age-related hearing loss are becoming increasingly recognized. While research has shown that age-related hearing loss is the single greatest modifiable risk factor for dementia, use of hearing aids remains low worldwide, even in many middle- and high-income countries. Reasons for poor uptake of hearing aids are likely to involve a combination of factors, ranging from increasing costs of hearing aid technology to a widespread lack of insurance coverage. This article aims to identify the current state of access to hearing aids, focusing on eight middle- and high-income countries. We discuss how to facilitate greater access to hearing aids for patients by addressing changes in how devices are regulated, technological advancements in hearing devices, the need to adjust reimbursement schemes and the importance of adaptation among the community workforce for hearing-care.

Alors que la proportion de personnes âgées au sein de la population mondiale totale continue à croître, les effets néfastes sur la santé de la perte de l'acuité auditive liée à l'âge sont de plus en plus reconnus. Bien que la recherche ait démontré que la perte de l'acuité auditive liée à l'âge est le principal facteur de risque modifiable de la démence, l'utilisation de prothèses auditives reste limitée à l'échelle mondiale, y compris dans de nombreux pays à revenu intermédiaire et élevé. Les raisons de ce recours limité aux prothèses auditives tiennent probablement à une combinaison de facteurs qui vont des coûts croissants de la technologie des appareils auditifs à un manque généralisé de couverture médicale. Cet article vise à déterminer l'état actuel de l'accès aux prothèses auditives en se concentrant sur huit pays à revenu intermédiaire et élevé. Nous étudions comment permettre aux patients d'accéder plus facilement aux prothèses auditives en tenant compte de la réglementation applicable aux appareils, des progrès technologiques relatifs aux appareils auditifs, de la nécessité d'ajuster les systèmes de remboursement et de l'importance de l'adaptation au sein de la main-d'œuvre locale pour les soins auditifs.

A medida que la proporción de adultos mayores en la población total del mundo continúa creciendo, los resultados adversos para la salud de la pérdida de audición relacionada con la edad son cada vez más reconocidos. Aunque las investigaciones han demostrado que la pérdida de audición relacionada con la edad es el mayor factor de riesgo modificable para la demencia, el uso de audífonos sigue siendo bajo en todo el mundo, incluso en muchos países de ingresos medios y altos. Las causas de la escasa aceptación de los audífonos pueden ser una combinación de factores, que van desde el aumento de los costes de la tecnología de los audífonos hasta la falta generalizada de cobertura de seguro. Este artículo pretende identificar el estado actual del acceso a los audífonos, centrándose en ocho países de ingresos medios y altos. Discutimos cómo facilitar un mayor acceso a los audífonos para los pacientes abordando los cambios en cómo se regulan los dispositivos, los avances tecnológicos en los audífonos, la necesidad de ajustar los esquemas de reembolso y la importancia de la adaptación entre los trabajadores de la comunidad para el cuidado de la audición.

On the limitations of sound localization with hearing devices.

Limited abilities to localize sound sources and other reduced spatial hearing capabilities remain a largely unsolved issue in hearing devices like hearing aids or hear-through headphones. Hence, the impact of the microphone location, signal bandwidth, different equalization approaches, as well as processing delays in superposition with direct sound leaking through a vent was addressed in this study. A localization experiment was performed with normal-hearing subjects using individual binaural synthesis to separately assess the above-mentioned potential limiting issues for localization in the horizontal and vertical plane with linear hearing devices. To this end, listening through hearing devices was simulated utilizing transfer functions for six different microphone locations, measured both individually and on a dummy head. Results show that the microphone location is the governing factor for localization abilities with linear hearing devices, and non-optimal microphone locations have a disruptive influence on localization in the vertical domain, and an effect on lateral sound localization. Processing delays cause additional detrimental effects for lateral sound localization; and diffuse-field equalization to the open-ear response leads to better localization performance than free-field equalization. Stimuli derived from dummy head measurements are unsuited for evaluating individual localization abilities with a hearing device.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions.

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight (N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23-48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

On the Interaction of Head and Gaze Control With Acoustic Beam Width of a Simulated Beamformer in a Two-Talker Scenario.

Superdirectional acoustic beamforming technology provides a high signal-to-noise ratio, but potential speech intelligibility benefits to hearing aid users are limited by the way the users move their heads. Steering the beamformer using eye gaze instead of head orientation could mitigate this problem. This study investigated the intelligibility of target speech with a dynamically changing direction when heard through gaze-controlled (GAZE) or head-controlled (HEAD) superdirectional simulated beamformers. The beamformer provided frequency-independent noise attenuation of either 8 dB (WIDE [moderately directional]) or 12 dB (NARROW [highly directional]) relative to no beamformer referred as the OMNI (omni-directional) condition. Before the main experiment, signal-to-noise ratios were normalized for each participant and each beam width condition to yield equal percentage of correct performance in a reference condition. Hence, results are presented as normalized speech intelligibility (NSI). In an ongoing presentation, the participants (n = 17), of varying degree of hearing loss, heard single-word targets every 1.5 s coming from either left (-30°) or right (+30°) presented in continuous, spatially distributed, speech-shaped noise. When the target was static, NSI was better in the GAZE than in the HEAD condition, but only when the beam was NARROW. When the target switched location without warning, NSI performance dropped. In this case, the WIDE HEAD condition provided the best average NSI performance, because some participants tended to orient their head in between the targets, allowing them to hear out the target regardless of location. The difference in NSI between GAZE and HEAD conditions for individual participants was related to the observed head-orientation strategy, which varied widely across participants.

Comparative analysis of the NAL-NL2 and DSL v5.0a prescription procedures in the adaptation of hearing aids in the elderly. / Análise comparativa dos métodos prescritivos NAL-NL2 e DSL v5.0a na adaptação do AASI em idosos.

PURPOSE: To comparatively analyze the NAL-NL2 and DSL v5.0a prescriptive methods according to the hearing aids individualized programming for the elderly with hearing loss. METHODS: The study included 60 elderly individuals with hearing loss, who underwent RECD (Real Ear to Coupler Difference) measurement and hearing aids individualized programming by NAL-NL2 and DSL v5.0a prescriptive methods. The performance verification for each prescription was performed using REAR measurements (Real Ear Aided Response), SII calculation (Speech Intelligibility Index) and HINT (Hearing In Noise Test). The comparative statistical analysis was performed using the paired t-test. RESULTS: The NAL-NL2 method presented a better performance in the REAR evaluation in low and high frequency bands for medium and loud intensity input sounds, in the high frequency range for low intensity input sounds, and in the SII calculation for soft input sounds. The DSL v5.0a presented better results in the REAR evaluation in medium frequencies for medium input sounds, in low and medium frequencies for soft input sounds, in the SII calculation for medium and loud input sound, and in the HINT test in silent and noisy situations. CONCLUSION: The findings of this study point to an equivalent performance between the DSL v5.0a and NAL-NL2 procedures in the adaptation of hearing aids in the elderly with hearing loss. The amplification calculated by DSL v5.0a provided better speech perception in silence.

OBJETIVO: Analisar comparativamente os métodos prescritivos NAL-NL2 e DSL v5.0a de acordo com programação individualizada do AASI para o indivíduo idoso com deficiência auditiva. MÉTODO: Participaram do estudo 60 indivíduos idosos com deficiência auditiva, submetidos à mensuração da RECD (Real Ear to Coupler Difference) e programação individualizada do AASI com os métodos prescritivos NAL-NL2 e DSL v5.0a. A verificação do desempenho com cada prescrição foi realizada por meio das medidas da REAR (Real Ear Aided Response), cálculo do SII (Speech Intelligibility Index) e teste HINT (Hearing In Noise Test). A análise estatística comparativa foi realizada por meio do teste "t" pareado. RESULTADOS: O método NAL-NL2 apresentou melhor desempenho na avaliação da REAR em frequências baixas e altas para sons de média e forte intensidade, em frequências altas para sons de fraca intensidade, e no cálculo do SII para sons fracos. O método DSL v5.0a apresentou melhores resultados na avaliação da REAR em frequências médias para sons médios, em frequências baixas e médias para sons fracos, no cálculo do SII para sons médios e fortes, e no teste HINT no silêncio e ruído. CONCLUSÃO: Os achados deste estudo apontam para um desempenho equivalente entre os métodos DSL v5.0a e NAL-NL2 na adaptação do AASI em idosos com deficiência auditiva. A amplificação calculada pela DSL v5.0a forneceu melhor percepção de fala no silêncio.

Using a Bone-Conduction Headset to Improve Speech Discrimination in Children With Otitis Media With Effusion.

The recommended management for children with otitis media with effusion (OME) is 'watchful waiting' before considering grommet surgery. During this time speech and language, listening skills, quality of life, social skills, and outcomes of education can be jeopardized. Air-conduction (AC) hearing aids are problematic due to fluctuating AC hearing loss. Bone-conduction (BC) hearing is stable, but BC hearing aids can be uncomfortable. Both types of hearing aids are costly. Given the high prevalence of OME and the transitory nature of the accompanying hearing loss, cost-effective solutions are needed. The leisure industry has developed relatively inexpensive, comfortable, high-quality BC headsets for transmission of speech or music. This study assessed whether these headsets, paired with a remote microphone, improve speech discrimination for children with OME. Nineteen children aged 3 to 6 years receiving recommended management in the United Kingdom for children with OME participated. Word-discrimination thresholds were measured in a sound-treated room in quiet and with 65 dB(A) speech-shaped noise, with and without a headset. The median threshold in quiet (N = 17) was 39 dB(A) (range: 23-59) without a headset and 23 dB(A) (range: 9-35) with a headset (Z = -3.519, p < .001). The median threshold in noise (N = 19) was 59 dB(A) (range: 50-63) without a headset and 45 dB(A) (range: 32-50) with a headset (Z = -3.825, p < .001). Thus, the use of a BC headset paired with a remote microphone significantly improved speech discrimination in quiet and in noise for children with OME.

Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics.

Direct-to-consumer (DTC) hearing devices can be purchased without consulting a hearing health professional. This project aims to compare 28 DTC devices with the most popular hearing aid supplied by the U.K. National Health Service (NHS). The comparison was based on technical performance, cosmetic acceptability, and the ability to match commonly used gain and slope targets. Electroacoustic performance was evaluated in a 2-cc coupler. Match to prescription target for both gain and slope was measured on a Knowles Electronic Manikin for Acoustic Research using a mild and also a moderate sloping hearing loss. Using an online blinded paired comparison of each DTC and the NHS reference device, 126 participants (50 were hearing aid users and 76 were nonhearing aid users) assessed the cosmetic appearance and rated their willingness-to-wear the DTC devices. The results revealed that higher purchase prices were generally associated with a better match to prescribed gain-frequency response shapes, lower distortion, wider bandwidth, better cosmetic acceptability, and higher willingness-to-wear. On every parameter measured, there were devices that performed worse than the NHS device. Most of the devices were rated lower in terms of aesthetic design than the NHS device and provided gain-frequency responses and maximum output levels that were markedly different from those prescribed for commonly encountered audiograms. Because of the absence or inflexibility of most of the devices, they have the potential to deliver poor sound quality and uncomfortably loud sounds. The challenge for manufacturers is to develop low-cost products with cosmetic appeal and appropriate electroacoustic characteristics.

A deep learning algorithm to increase intelligibility for hearing-impaired listeners in the presence of a competing talker and reverberation.

For deep learning based speech segregation to have translational significance as a noise-reduction tool, it must perform in a wide variety of acoustic environments. In the current study, performance was examined when target speech was subjected to interference from a single talker and room reverberation. Conditions were compared in which an algorithm was trained to remove both reverberation and interfering speech, or only interfering speech. A recurrent neural network incorporating bidirectional long short-term memory was trained to estimate the ideal ratio mask corresponding to target speech. Substantial intelligibility improvements were found for hearing-impaired (HI) and normal-hearing (NH) listeners across a range of target-to-interferer ratios (TIRs). HI listeners performed better with reverberation removed, whereas NH listeners demonstrated no difference. Algorithm benefit averaged 56 percentage points for the HI listeners at the least-favorable TIR, allowing these listeners to perform numerically better than young NH listeners without processing. The current study highlights the difficulty associated with perceiving speech in reverberant-noisy environments, and it extends the range of environments in which deep learning based speech segregation can be effectively applied. This increasingly wide array of environments includes not only a variety of background noises and interfering speech, but also room reverberation.

Comparison of effects on subjective intelligibility and quality of speech in babble for two algorithms: A deep recurrent neural network and spectral subtraction.

The effects on speech intelligibility and sound quality of two noise-reduction algorithms were compared: a deep recurrent neural network (RNN) and spectral subtraction (SS). The RNN was trained using sentences spoken by a large number of talkers with a variety of accents, presented in babble. Different talkers were used for testing. Participants with mild-to-moderate hearing loss were tested. Stimuli were given frequency-dependent linear amplification to compensate for the individual hearing losses. A paired-comparison procedure was used to compare all possible combinations of three conditions. The conditions were: speech in babble with no processing (NP) or processed using the RNN or SS. In each trial, the same sentence was played twice using two different conditions. The participants indicated which one was better and by how much in terms of speech intelligibility and (in separate blocks) sound quality. Processing using the RNN was significantly preferred over NP and over SS processing for both subjective intelligibility and sound quality, although the magnitude of the preferences was small. SS processing was not significantly preferred over NP for either subjective intelligibility or sound quality. Objective computational measures of speech intelligibility predicted better intelligibility for RNN than for SS or NP.

Perceptual contributions of vowels and consonant-vowel transitions in simulated electric-acoustic hearing.

The present work assessed the perceptual impact of vowels and consonant-vowel transitions in simulated electric-acoustic hearing. Mandarin sentences were processed by two vocoder models simulating electric and electric-acoustic stimulation, followed by a noise-replacement paradigm to preserve target speech segments and replace the rest with noise, and finally presented to normal-hearing listeners to recognize. The results demonstrated a much larger perceptual advantage of vowels than consonants to sentence intelligibility, and showed the combined-stimulation advantage under segmental conditions containing vowels. Adding consonant-vowel transitions in combined electric-acoustic stimulation yielded sentence recognition performance equivalent to that observed with electric stimulation and full speech segments.