Impact of Hearing Aid Processing Delay on Stop Consonant Voicing Perception in Open Fittings.

PURPOSE: Hearing aid (HA) processing delay results in asynchronous overlap of the input sound and the delayed amplified sound at the eardrum in open-ear fittings. This may distort the temporal cues used for stop-consonant voicing distinctions. The current study evaluated the impact of HA processing delay on voiced-voiceless categorization of syllable initial consonants /d/ and /t/ for a range of voice onset times (VOTs). METHOD: Nineteen older listeners (Mage = 73 years) with mild-moderate sensorineural hearing loss participated. All listeners performed the voiced-voiceless categorization task in double-blind within-subjects design. Thirteen stimulus tokens along the /di:/ - /ti:/ continuum were created by varying VOTs. Stimuli were then processed using an HA simulator, which simulated the overall sound pressure levels measured at the eardrum in open-ear fittings with four processing delay times (0, 0.5, 5, and 8 ms). Individualized stimuli were generated for each listener based on their audiogram and presented via calibrated ear inserts at the most comfortable listening level. Performance across all VOT intervals was fitted with psychometric functions, which were then used to estimate the voiced-voiceless crossover point and the slope parameter for each simulated delay condition. RESULTS: The crossover point along the voiced-voiceless continuum shifted systematically with increased processing delay toward voiced /di:/ over unvoiced /ti:/ percepts. The shift in the crossover point between the 0-ms reference condition and the 8-ms processing delay condition corresponded to 5.8 ms of change in VOT. The 8-ms processing delay condition resulted in significantly shallower categorization slopes compared to the 0- and 0.5-ms delay conditions. CONCLUSIONS: Temporal distortions created by HA processing delay in open-ear fittings impacted voicing perception of syllable initial stop-consonant stimuli near the voiced-voiceless crossover point. Short HA processing delay should be considered for open-ear fittings to preserve the natural VOT cues used for voicing detection.

The Audiological Profile and Rehabilitation of Patients with Incomplete Partition Type II and Large Vestibular Aqueducts.

BACKGROUND:  Incomplete partition type II (IP-II) malformation is often accompanied by a large vestibular aqueduct (LVA). In IP anomalies, the patient's auditory rehabilitation requirements are decided according to the presence of inner ear structures and the degree of hearing loss (HL). There has been limited research on auditory rehabilitation (AR) requirement selection in patients diagnosed with IP-II and LVA. This study investigated the typical characteristics of HL and AR choices in patients diagnosed with IP-II and LVA. METHODS:  Patients with IP-II and LVA (n=55; 25 women and 30 men) were identified, and audiological evaluations were performed. The patient's demographic characteristics, the type and degree of HL, the AR method, age at diagnosis, and educational status were retrospectively compared. RESULTS:  The distribution of our 55 patients according to cochlear implants, hearing aids (HA), and bimodal applications was 29.1% (n=16), 43.6% (n=24), and 27.3% (n=15), respectively. Statistical analyses using chi-square tests found no significant differences in the incidence of dizziness/imbalance, tinnitus, HL progression, or the degree and onset of HL among the patients. CONCLUSION:  The data revealed different audiological characteristics among patients with IP-II and LVA, as well as different AR solutions. The most widely used AR modality was found to be HA. Prediction of sudden versus progressive HL development among patients is challenging, and the characteristics of IP-II vary. Therefore, they should be interpreted with caution.

[Advances in vestibular function and rehabilitation of large vestibular aqueduct syndrome].

Large vestibular aqueduct syndrome（LVAS） is a common recessive hereditary hearing loss disease, and some patients may also experience vestibular dysfunction. With the wide application of cochlear implant（CI） and the development of vestibular medicine, the pathophysiological mechanism of LVAS and the influence mechanism of CI on vestibular function are gradually elucidated. Consequently, the evaluation and rehabilitation of vestibular dysfunction function have also become research hotspots. This article reviews studies on vestibular function and related rehabilitation in patients with large vestibular aqueduct syndrome.

Long-Term Outcomes of Cochlear Implantation in Usher Syndrome.

OBJECTIVES: Usher syndrome (USH), characterized by bilateral sensorineural hearing loss (SNHL) and retinitis pigmentosa (RP), prompts increased reliance on hearing due to progressive visual deterioration. It can be categorized into three subtypes: USH type 1 (USH1), characterized by severe to profound congenital SNHL, childhood-onset RP, and vestibular areflexia; USH type 2 (USH2), presenting with moderate to severe progressive SNHL and RP onset in the second decade, with or without vestibular dysfunction; and USH type 3 (USH3), featuring variable progressive SNHL beginning in childhood, variable RP onset, and diverse vestibular function. Previous studies evaluating cochlear implant (CI) outcomes in individuals with USH used varying or short follow-up durations, while others did not evaluate outcomes for each subtype separately. This study evaluates long-term CI performance in subjects with USH, at both short-term and long-term, considering each subtype separately. DESIGN: This retrospective, observational cohort study identified 36 CI recipients (53 ears) who were categorized into four different groups: early-implanted USH1 (first CI at ≤7 years of age), late-implanted USH1 (first CI at ≥8 years of age), USH2 and USH3. Phoneme scores at 65 dB SPL with CI were evaluated at 1 year, ≥2 years (mid-term), and ≥5 years postimplantation (long-term). Each subtype was analyzed separately due to the significant variability in phenotype observed among the three subtypes. RESULTS: Early-implanted USH1-subjects (N = 23 ears) achieved excellent long-term phoneme scores (100% [interquartile ranges {IQR} = 95 to 100]), with younger age at implantation significantly correlating with better CI outcomes. Simultaneously implanted subjects had significantly better outcomes than sequentially implanted subjects ( p = 0.028). Late-implanted USH1 subjects (N = 3 ears) used CI solely for sound detection and showed a mean phoneme discrimination score of 12% (IQR = 0 to 12), while still expressing satisfaction with ambient sound detection. In the USH2 group (N = 23 ears), a long-term mean phoneme score of 85% (IQR = 81 to 95) was found. Better outcomes were associated with younger age at implantation and higher preimplantation speech perception scores. USH3-subjects (N = 7 ears) achieved a mean postimplantation phoneme score of 71% (IQR = 45 to 91). CONCLUSIONS: This study is currently one of the largest and most comprehensive studies evaluating CI outcomes in individuals with USH, demonstrating that overall, individuals with USH benefit from CI at both short- and long-term follow-up. Due to the considerable variability in phenotype observed among the three subtypes, each subtype was analyzed separately, resulting in smaller sample sizes. For USH1 subjects, optimal CI outcomes are expected with early simultaneous bilateral implantation. Late implantation in USH1 provides signaling function, but achieved speech recognition is insufficient for oral communication. In USH2 and USH3, favorable CI outcomes are expected, especially if individuals exhibit sufficient speech recognition with hearing aids and receive ample auditory stimulation preimplantation. Early implantation is recommended for USH2, given the progressive nature of hearing loss and concomitant severe visual impairment. In comparison with USH2, predicting outcomes in USH3 remains challenging due to the variability found. Counseling for USH2 and USH3 should highlight early implantation benefits and encourage hearing aid use.

Hearing at the Mall: Multibeam Processing Technology Improves Hearing Group Conversations in a Real-World Food Court Environment.

PURPOSE: This study aimed to evaluate conversation hearing with an adaptive beamforming hearing aid that supports adaptive tracking of multiple talkers in an ecologically valid, real-world food court environment in a busy mall. METHOD: Twenty older adult experienced hearing aid wearers with sensorineural hearing loss were fitted in the lab with binaural receiver-in-the-canal style hearing aids set with two programs, each having a different beamforming strategy. The participant and two researchers then met in a moderately noisy and reverberant food court at a local mall where the participant was asked to listen to a conversation between the two researchers. Participants rated the extent of their agreement with 10 positively worded statements specific to the conversation twice, once for each program. Participants then provided program-preference ratings for seven different aspects of a conversation during which the programs were switched back and forth by the researcher, so that participants were unaware of the condition to which they were listening. RESULTS: Real-world subjective ratings for all domains resulted in positive values on average for both programs. Pairwise comparisons indicated that the intervention algorithm had higher absolute ratings on five of the 10 criteria including understanding, clarity, focus, listening effort, and background noise. Ratings for preference between programs indicated a significant preference for the intervention algorithm for all seven criteria. CONCLUSIONS: In a real-world setting, the use of hearing aids with separate processing of sounds from the front and back hemisphere provided positive subjective ratings. However, following a group conversation with multiple conversation partners, improvements in the algorithm to account for the locations of interlocutors and the natural head turning of the hearing aid wearer that occurs during a conversation by adding and controlling multiple adaptive beams in the front hemisphere significantly influenced preference for all aspects rated.

Prognostic Value of Electrophysiological and MRI Findings for Pediatric Cochlear Implant Outcomes: A Systematic Review.

PURPOSE: Magnetic resonance imaging (MRI), electric compound action potential (eCAP), and electric auditory brainstem response (eABR) are among the routine assessments performed before and/or after cochlear implantation. The objective of this review was to systematically summarize and critically appraise existing evidence of the prognostic value of eCAP, eABR, and MRI for predicting post-cochlear implant (CI) speech perception outcomes in children, with a particular focus on the lesion site. METHOD: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Three electronic databases (ProQuest, PubMed, and Scopus) were searched with no restrictions on language, publication status, or year of publication. Studies on children identified with sensorineural hearing loss, auditory neuropathy spectrum disorder, cochlear nerve deficiency, or cochleovestibular nerve abnormalities reporting the relevance of eCAP, eABR, and/or MRI results to CI speech perception outcomes were included. The literature search yielded 1,887 publications. Methodological quality and strength of evidence were assessed by the Crowe Critical Appraisal Tool and the Grading of Recommendations Assessment, Development, and Evaluation tool, respectively. RESULTS: Of the 25 included studies, the relevance of eCAP, eABR, and/or MRI findings to post-CI speech perception outcomes was reported in 10, 11, and 11 studies, respectively. The studies were strongly in support of the prognostic value of eABR and MRI for CI outcomes. However, the relevance of eCAP findings to speech perception outcomes was uncertain. CONCLUSION: Despite the promising findings, caution is warranted in interpreting them due to the observational and retrospective design of the included studies, as well as the heterogeneity of the population and the limited control of confounding factors within these studies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26169859.

Effect of Digital Noise Reduction in Hearing Aids on Speech Intelligibility in Both Quiet and Noisy Environments.

AIMS: Digital noise reduction (DNR) minimizes the effect of noise on speech signals by continuously monitoring frequency bands in the presence of noise. In the present study, we explored the effect of DNR technology on speech intelligibility in individuals using hearing aids (HAs) and investigated implications for daily use. METHODS AND MATERIAL: Eighteen participants with bilateral moderate sensorineural hearing loss (aged 16-45 years) were included. Bilateral receiver-in-the-ear HAs were fitted in the participants. The adaptive and nonadaptive (with a signal-to-noise ratio (SNR) of +5 and -5 dB, respectively) Turkish matrix sentence test (TURMatrix) in noise and free-field hearing assessments, including hearing thresholds with hearing aids, speech recognition thresholds (SRT), and speech discrimination scores, were conducted in two different conditions: HA in the DNR-on and DNR-off conditions. RESULTS: No significant difference was observed between free-field hearing assessments with the HA in the DNR-off and DNR-on conditions (P > 0.05). Furthermore, the adaptive and nonadaptive TURMatrix revealed significant differences between the scores under the DNR-on and DNR-off conditions (P < 0.05). Nevertheless, under the DNR-on condition, there was no correlation between free-field hearing assessments with HA and TURMatrix results (P > 0.05). However, a significant correlation was observed between SRT scores with HA and TURMatrix scores (adaptive and nonadaptive, +5 and -5 dB SNR, respectively) under the DNR-off condition (P < 0.05). CONCLUSION: Our study findings suggest that DNR can improve speech intelligibility in noisy environments. Therefore, DNR can enhance an individual's auditory comfort by improving their capacity to grasp speech in background noise.

Vestibular evaluation with video head impulse test in pediatric cochlear implant patients.

BACKGROUND: The cochlear implant (CI) is effective for rehabilitating patients with severe to profound sensorineural hearing loss. However, its placement and use have been associated with various complications, such as those affecting the vestibular system. The objective of this study was to compare vestibular function using the video head impulse test (vHIT) in pediatric patients before and after CI placement. METHODS: A descriptive and retrospective study was conducted. The outcomes of 11 pediatric patients of both sexes with a history of profound hearing loss were evaluated. The results of vestibular-ocular reflex (VOR) gain, saccades, asymmetry, Pérez Rey (PR) index, and VOR/saccade ratio for both ears obtained by the vHIT test before and after CI placement were compared. RESULTS: Of the 11 patients evaluated, the VOR gain showed that 81.8% had normal function, 18.2% had hypofunction, and no patients had hyperfunction before implantation. No statistically significant differences were found when compared with post-implant off and post-implant on conditions (p > 0.05). The extracted variables, asymmetry, PR index, and the VOR/saccades ratio also showed no statistically significant differences between the pre- and post-implant conditions, whether off or on. CONCLUSIONS: The vestibular function of pediatric patients did not show significant changes before and after CI placement. The vHIT test is a valuable tool for assessing vestibular function and could be considered a criterion for surgical and rehabilitation decisions in patients undergoing CI placement.

INTRODUCCIÓN: El implante coclear es un dispositivo eficaz para la rehabilitación de pacientes con hipoacusia neurosensorial severa a profunda. Sin embargo, su colocación y uso se ha asociado a diversas complicaciones, entre ellas a nivel del sistema vestibular. El objetivo del presente estudio fue comparar la función vestibular mediante la prueba de videoimpulso cefálico (vHIT) de pacientes pediátricos antes y después de la colocación del implante coclear. MÉTODOS: Se llevó a cabo un estudio descriptivo y retrospectivo. Se evaluaron los resultados de 11 pacientes pediátricos de ambos sexos con antecedente de hipoacusia profunda. Se compararon los resultados de ganancia del VOR, sacadas, asimetría, índice PR así como la relación VOR/sacadas para ambos oídos obtenidos mediante la prueba vHIT antes y después de la colocación del implante coclear. RESULTADOS: De los 11 pacientes evaluados, la ganancia del VOR mostró que el 81.8% tenía normofunción, 18.2% hipofunción y ningún paciente hiperfunción antes del implante. Al compararlo con la ganancia post implante apagado y post implante encendido no se encontraron diferencias estadísticamente significativas (p > 0.05). Las variables sacadas, asimetría, índice PR así como la relación VOR/sacadas tampoco mostraron diferencias estadísticamente significativas entre las condiciones pre y pos implante ya sea apagado o encendido. CONCLUSIONES: La función vestibular de pacientes pediátricos no mostró cambios significativos previo y posterior a la colocación del implante coclear. La prueba vHIT es una herramienta útil que permite evaluar la función vestibular y que podría considerarse como criterio para tomar decisiones quirúrgicas en pacientes que se encuentran en protocolo para implante coclear.

Barriers to Meeting National Early Hearing Detection and Intervention Guidelines in a Diverse Patient Cohort.

OBJECTIVES: To determine our audiology clinics status in meeting the Joint Committee on Infant Hearing recommended 1-3-6 benchmarks for identification and intervention for congenital sensorineural hearing loss and identify those factors contributing to delay in identification and intervention. DESIGN: This is a retrospective case series. Children with sensorineural hearing loss who underwent auditory brainstem response (ABR) testing, hearing aid evaluation, or cochlear implant mapping at our tertiary pediatric medical center between January 2018 and December 2021 were included. Simple and multiple linear regression analyses were used to identify social, demographic, and health factors associated with primary outcomes, defined as age at hearing loss identification, age at intervention (here defined as amplification start), and interval between identification and intervention. RESULTS: Of 132 patients included, mean age was 2.4 years, 48% were male, and 51% were Hispanic. There was significant association between each Hispanic ethnicity ( p = 0.005, p = 0.04, respectively), insurance type ( p = 0.02, p = 0.001, respectively), and later age at identification and intervention. In multivariable analyses, Hispanic ethnicity was significantly associated with both delays in identification and intervention ( p = 0.03 and p = 0.03, respectively), and public insurance was associated with delays in intervention ( p = 0.01). In addition, the total number of ABRs was significantly associated with both older age of identification and intervention ( p < 0.001, p < 0.001, respectively). Mediator analysis demonstrated that the effect of ethnicity on age at identification is mediated by the total number of ABRs performed. CONCLUSIONS: A significant association between total number of ABRs and age at identification and intervention for children with hearing loss exists. Hispanic ethnicity was associated with delays in meeting milestones, further mediated by the number of ABRs, providing a potential avenue for intervention in addressing this disparity.

Binaural hearing aid intervention for a patient with nonserviceable hearing loss after surgery for vestibular schwannoma: A case report.

A vestibular schwannoma is a benign tumor; however, the schwannoma itself and interventions can cause sensorineural hearing loss. Most vestibular schwannomas are unilateral tumors that affect hearing only on one side. Attention has focused on improving the quality of life for patients with unilateral hearing loss and therapeutic interventions to address this issue have been emphasized. Herein, we encountered a patient who was a candidate for hearing preservation surgery based on preoperative findings and had nonserviceable hearing after the surgery, according to the Gardner-Robertson classification. Postoperatively, the patient had decreased listening comprehension and ability to localize sound sources. He was fitted with bilateral hearing aids, and his ability to localize sound sources improved. Although the patient had postoperative nonserviceable hearing on the affected side and age-related hearing loss on the unaffected side, hearing aids in both ears were useful for his daily life. Therefore, the patient was able to maintain a binaural hearing effect and the ability to localize the sound source improved. This report emphasizes the importance of hearing preservation with vestibular schwannomas, and the demand for hearing loss rehabilitation as a postoperative complication can increase, even if hearing loss is nonserviceable.

Neural Envelope Processing at Low Frequencies Predicts Speech Understanding of Children With Hearing Loss in Noise and Reverberation.

OBJECTIVE: Children with hearing loss experience greater difficulty understanding speech in the presence of noise and reverberation relative to their normal hearing peers despite provision of appropriate amplification. The fidelity of fundamental frequency of voice (f0) encoding-a salient temporal cue for understanding speech in noise-could play a significant role in explaining the variance in abilities among children. However, the nature of deficits in f0 encoding and its relationship with speech understanding are poorly understood. To this end, we evaluated the influence of frequency-specific f0 encoding on speech perception abilities of children with and without hearing loss in the presence of noise and/or reverberation. METHODS: In 14 school-aged children with sensorineural hearing loss fitted with hearing aids and 29 normal hearing peers, envelope following responses (EFRs) were elicited by the vowel /i/, modified to estimate f0 encoding in low (<1.1 kHz) and higher frequencies simultaneously. EFRs to /i/ were elicited in quiet, in the presence of speech-shaped noise at +5 dB signal to noise ratio, with simulated reverberation time of 0.62 sec, as well as both noise and reverberation. EFRs were recorded using single-channel electroencephalogram between the vertex and the nape while children watched a silent movie with captions. Speech discrimination accuracy was measured using the University of Western Ontario Distinctive Features Differences test in each of the four acoustic conditions. Stimuli for EFR recordings and speech discrimination were presented monaurally. RESULTS: Both groups of children demonstrated a frequency-dependent dichotomy in the disruption of f0 encoding, as reflected in EFR amplitude and phase coherence. Greater disruption (i.e., lower EFR amplitudes and phase coherence) was evident in EFRs elicited by low frequencies due to noise and greater disruption was evident in EFRs elicited by higher frequencies due to reverberation. Relative to normal hearing peers, children with hearing loss demonstrated: (a) greater disruption of f0 encoding at low frequencies, particularly in the presence of reverberation, and (b) a positive relationship between f0 encoding at low frequencies and speech discrimination in the hardest listening condition (i.e., when both noise and reverberation were present). CONCLUSIONS: Together, these results provide new evidence for the persistence of suprathreshold temporal processing deficits related to f0 encoding in children despite the provision of appropriate amplification to compensate for hearing loss. These objectively measurable deficits may underlie the greater difficulty experienced by children with hearing loss.

Predicting Individual Hearing-Aid Preference From Self-Reported Listening Experiences in Daily Life.

OBJECTIVES: The study compared the utility of two approaches for collecting real-world listening experiences to predict hearing-aid preference: a retrospective questionnaire (Speech, Spatial, and Qualities of Hearing Scale [SSQ]) and in-situ Ecological Momentary Assessment (EMA). The rationale being that each approach likely provides different and yet complementary information. In addition, it was examined how self-reported listening activity and hearing-aid data-logging can augment EMAs for individualized and contextualized hearing outcome assessments. DESIGN: Experienced hearing-aid users (N = 40) with mild-to-moderate symmetrical sensorineural hearing loss completed the SSQ questionnaire and gave repeated EMAs for two wear periods of 2-weeks each with two different hearing-aid models that differed mainly in their noise reduction technology. The EMAs were linked to a self-reported listening activity and sound environment parameters (from hearing-aid data-logging) recorded at the time of EMA completion. Wear order was randomized by hearing-aid model. Linear mixed-effects models and Random Forest models with five-fold cross-validation were used to assess the statistical associations between listening experiences and end-of-trial preferences, and to evaluate how accurately EMAs predicted preference within individuals. RESULTS: Only 6 of the 49 SSQ items significantly discriminated between responses made for the end-of-trial preferred versus nonpreferred hearing-aid model. For the EMAs, questions related to perception of the sound from the hearing aids were all significantly associated with preference, and these associations were strongest in EMAs completed in sound environments with predominantly low SNR and listening activities related to television, people talking, nonspecific listening, and music listening. Mean differences in listening experiences from SSQ and EMA correctly predicted preference in 71.8% and 72.5% of included participants, respectively. However, a prognostic classification of single EMAs into end-of-trial preference with a Random Forest model achieved a 93.8% accuracy when contextual information was included. CONCLUSIONS: SSQ and EMA predicted preference equally well when considering mean differences, however, EMAs had a high prognostic classifications accuracy due to the repeated-measures nature, which make them ideal for individualized hearing outcome investigations, especially when responses are combined with contextual information about the sound environment.

A Randomized Crossover Study in Single-Sided Deafness Comparing a Cartilage Conduction CROS System and an Air-Conduction CROS System.

OBJECTIVE: To investigate if cartilage conduction (CC) rerouting devices are noninferior to air-conduction (AC) rerouting devices for single-sided deafness (SSD) patients by measuring objective and subjective performance using speech-in-noise tests that resemble a realistic hearing environment, sound localization tests, and standardized questionnaires. STUDY DESIGN: Prospective, single-subject randomized, crossover study. SETTING: Anechoic room inside a university. PATIENTS: Nine adults between 21 and 58 years of age with severe or profound unilateral sensorineural hearing loss. INTERVENTIONS: Patients' baseline hearing was assessed; they then used both the cartilage conduction contralateral routing of signals device (CC-CROS) and an air-conduction CROS hearing aid (AC-CROS). Patients wore each device for 2 weeks in a randomly assigned order. MAIN OUTCOME MEASURES: Three main outcome measures were 1) speech-in-noise tests, measuring speech reception thresholds; 2) proportion of correct sound localization responses; and 3) scores on the questionnaires, "Abbreviated Profile of Hearing Aid Benefit" (APHAB) and "Speech, Spatial, and Qualities of Hearing Scale" with 12 questions (SSQ-12). RESULTS: Speech reception threshold improved significantly when noise was ambient, and speech was presented from the front or the poor-ear side with both CC-CROS and AC-CROS. When speech was delivered from the better-ear side, AC-CROS significantly improved performance, whereas CC-CROS had no significant effect. Both devices mainly worsened sound localization, whereas the APHAB and SSQ-12 scores showed benefits. CONCLUSION: CC-CROS has noninferior hearing-in-noise performance except when the speech was presented to the better ear under ambient noise. Subjective measures showed that the patients realized the effectiveness of both devices.

The Optimal Speech-to-Background Ratio for Balancing Speech Recognition With Environmental Sound Recognition.

OBJECTIVES: This study aimed to determine the speech-to-background ratios (SBRs) at which normal-hearing (NH) and hearing-impaired (HI) listeners can recognize both speech and environmental sounds when the two types of signals are mixed. Also examined were the effect of individual sounds on speech recognition and environmental sound recognition (ESR), and the impact of divided versus selective attention on these tasks. DESIGN: In Experiment 1 (divided attention), 11 NH and 10 HI listeners heard sentences mixed with environmental sounds at various SBRs and performed speech recognition and ESR tasks concurrently in each trial. In Experiment 2 (selective attention), 20 NH listeners performed these tasks in separate trials. Psychometric functions were generated for each task, listener group, and environmental sound. The range over which speech recognition and ESR were both high was determined, as was the optimal SBR for balancing recognition with ESR, defined as the point of intersection between each pair of normalized psychometric functions. RESULTS: The NH listeners achieved greater than 95% accuracy on concurrent speech recognition and ESR over an SBR range of approximately 20 dB or greater. The optimal SBR for maximizing both speech recognition and ESR for NH listeners was approximately +12 dB. For the HI listeners, the range over which 95% performance was observed on both tasks was far smaller (span of 1 dB), with an optimal value of +5 dB. Acoustic analyses indicated that the speech and environmental sound stimuli were similarly audible, regardless of the hearing status of the listener, but that the speech fluctuated more than the environmental sounds. Divided versus selective attention conditions produced differences in performance that were statistically significant yet only modest in magnitude. In all conditions and for both listener groups, recognition was higher for environmental sounds than for speech when presented at equal intensities (i.e., 0 dB SBR), indicating that the environmental sounds were more effective maskers of speech than the converse. Each of the 25 environmental sounds used in this study (with one exception) had a span of SBRs over which speech recognition and ESR were both higher than 95%. These ranges tended to overlap substantially. CONCLUSIONS: A range of SBRs exists over which speech and environmental sounds can be simultaneously recognized with high accuracy by NH and HI listeners, but this range is larger for NH listeners. The single optimal SBR for jointly maximizing speech recognition and ESR also differs between NH and HI listeners. The greater masking effectiveness of the environmental sounds relative to the speech may be related to the lower degree of fluctuation present in the environmental sounds as well as possibly task differences between speech recognition and ESR (open versus closed set). The observed differences between the NH and HI results may possibly be related to the HI listeners' smaller fluctuating masker benefit. As noise-reduction systems become increasingly effective, the current results could potentially guide the design of future systems that provide listeners with highly intelligible speech without depriving them of access to important environmental sounds.

Speech perception outcomes in hearing-impaired individuals with microphone & receiver in the ear (M&RIE) hearing aids.

PURPOSE: The Microphone and Receiver in the ear (M&RIE) hearing aid is designed to consider the pinna cues by placing an additional microphone along with a standard receiver at the entrance of the ear canal. There is a need to clinically validate the technology using speech identification measures, as a literature shortage exists. The objective of the study was to evaluate speech identification and quality rating with hearing aids fitted with standard and M&RIE receivers. METHOD: Twenty individuals (mean ± SD age being 34.10 ± 11.9 years) with mild-to-moderately severe sensorineural hearing loss were divided into two groups: naïve and experienced. Their speech identification obtained using the receiver in the ear hearing aid compatible with standard and M&RIE receivers were compared. The study assessed speech identification in quiet using ten sentences, calculated SNR-50 using the Spearman-Karber equation, and used an 11-point scale for self-perceived quality rating. RESULTS: The study analyzed data using SPSS and found no significant difference between naive and experienced hearing aid users in quiet and SNR-50 conditions (p > 0.05). However, naive users rated higher in clarity, naturalness, pleasantness, and overall impression of standard receiver settings. Across different receiver settings, both naïve and experienced groups revealed better speech identification with the M&RIE receiver for both SIS (p < 0.05) and SNR-50 (p < 0.05) measures. CONCLUSION: The study found that placing a third microphone in the ear canal improves speech identification and quality rating in both naïve and experienced users, with pinna and ear canal resonance playing a crucial role in prescribing hearing aid gain.

Spatial Hearing in Children With and Without Hearing Loss: Where and What the Speech Is Matters for Local Speech Intelligibility.

PURPOSE: This study examined children's ability to perceive speech from multiple locations on the horizontal plane. Children with hearing loss were compared to normal-hearing peers while using amplification with and without advanced noise management. METHOD: Participants were 21 children with normal hearing (9-15 years) and 12 children with moderate symmetrical hearing loss (11-15 years). Word recognition, nonword detection, and word recall were assessed. Stimuli were presented randomly from multiple discrete locations in multitalker noise. Children with hearing loss were fit with devices having separate omnidirectional and noise management programs. The noise management feature is designed to preserve audibility in noise by rapidly analyzing input from all locations and reducing the noise management when speech is detected from locations around the hearing aid user. RESULTS: Significant effects of left/right and front/back lateralization occurred as well as effects of hearing loss and hearing aid noise management. Children with normal hearing experienced a left-side advantage for word recognition and a right-side advantage for nonword detection. Children with hearing loss demonstrated poorer performance overall on all tasks with better word recognition from the back, and word recall from the right, in the omnidirectional condition. With noise management, performance improved from the front compared to the back for all three tasks and from the right for word recognition and word recall. CONCLUSIONS: The shape of children's local speech intelligibility on the horizontal plane is not omnidirectional. It is task dependent and shaped further by hearing loss and hearing aid signal processing. Front/back shifts in children with hearing loss are consistent with the behavior of hearing aid noise management, while the right-side biases observed in both groups are consistent with the effects of specialized speech processing in the left hemisphere of the brain.

Alpha-Band Dynamics of Hearing Aid Wearers Performing the Repeat-Recall Test (RRT).

This study measured electroencephalographic activity in the alpha band, often associated with task difficulty, to physiologically validate self-reported effort ratings from older hearing-impaired listeners performing the Repeat-Recall Test (RRT)-an integrative multipart assessment of speech-in-noise performance, context use, and auditory working memory. Following a single-blind within-subjects design, 16 older listeners (mean age = 71 years, SD = 13, 9 female) with a moderate-to-severe degree of bilateral sensorineural hearing loss performed the RRT while wearing hearing aids at four fixed signal-to-noise ratios (SNRs) of -5, 0, 5, and 10 dB. Performance and subjective ratings of listening effort were assessed for complementary versions of the RRT materials with high/low availability of semantic context. Listeners were also tested with a version of the RRT that omitted the memory (i.e., recall) component. As expected, results showed alpha power to decrease significantly with increasing SNR from 0 through 10 dB. When tested with high context sentences, alpha was significantly higher in conditions where listeners had to recall the sentence materials compared to conditions where the recall requirement was omitted. When tested with low context sentences, alpha power was relatively high irrespective of the memory component. Within-subjects, alpha power was related to listening effort ratings collected across the different RRT conditions. Overall, these results suggest that the multipart demands of the RRT modulate both neural and behavioral measures of listening effort in directions consistent with the expected/designed difficulty of the RRT conditions.

Assessing Speech Audibility via Syllabic-Rate Neural Responses in Adults and Children With and Without Hearing Loss.

An objective method for assessing speech audibility is essential to evaluate hearing aid benefit in children who are unable to participate in hearing tests. With consonant-vowel syllables, brainstem-dominant responses elicited at the voice fundamental frequency have proven successful for assessing audibility. This study aimed to harness the neural activity elicited by the slow envelope of the same repetitive consonant-vowel syllables to assess audibility. In adults and children with normal hearing and children with hearing loss wearing hearing aids, neural activity elicited by the stimulus /su∫i/ or /sa∫i/ presented at 55-75 dB SPL was analyzed using the temporal response function approach. No-stimulus runs or very low stimulus level (15 dB SPL) were used to simulate inaudible conditions in adults and children with normal hearing. Both groups of children demonstrated higher response amplitudes relative to adults. Detectability (sensitivity; true positive rate) ranged between 80.1 and 100%, and did not vary by group or stimulus level but varied by stimulus, with /sa∫i/ achieving 100% detectability at 65 dB SPL. The average minimum time needed to detect a response ranged between 3.7 and 6.4 min across stimuli and listener groups, with the shortest times recorded for stimulus /sa∫i/ and in children with hearing loss. Specificity was >94.9%. Responses to the slow envelope of non-meaningful consonant-vowel syllables can be used to ascertain audible vs. inaudible speech with sufficient accuracy within clinically feasible test times. Such responses can increase the clinical usefulness of existing objective approaches to evaluate hearing aid benefit.

A Review of Machine Learning Approaches for the Personalization of Amplification in Hearing Aids.

This paper provides a review of various machine learning approaches that have appeared in the literature aimed at individualizing or personalizing the amplification settings of hearing aids. After stating the limitations associated with the current one-size-fits-all settings of hearing aid prescriptions, a spectrum of studies in engineering and hearing science are discussed. These studies involve making adjustments to prescriptive values in order to enable preferred and individualized settings for a hearing aid user in an audio environment of interest to that user. This review gathers, in one place, a comprehensive collection of works that have been conducted thus far with respect to achieving the personalization or individualization of the amplification function of hearing aids. Furthermore, it underscores the impact that machine learning can have on enabling an improved and personalized hearing experience for hearing aid users. This paper concludes by stating the challenges and future research directions in this area.

Efficacy of vestibular rehabilitation program in children with balance disorders and sensorineural hearing loss.

OBJECTIVE: Asses the efficacy of a Vestibular-balance rehabilitation program to minimize or reverse balance disability in children with sensorineural hearing loss. METHOD: Forty-five hearing-impaired children with balance deficits (i.e., variable degrees of sensorineural hearing loss or auditory neuropathy). Thirty-five were rehabilitated with cochlear implants, and ten with hearing aids. Their age ranged from 4 to 10 years old. A Pre-rehab evaluation was done using questionnaires, neuromuscular evaluation, vestibular and balance office testing, and vestibular lab testing (using cVEMP and caloric test). Customized balances, as well as vestibular rehabilitation exercises, have been applied for three months. That was followed by post-rehab assessment, including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test. RESULTS: There was a statistically significant difference in all measured parameters (including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test) after rehabilitation. CONCLUSIONS: Vestibular-balance rehabilitation intervention positively impacts vestibular and balance functions in hearing-impaired children.