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.

Examining Force Level Output of Skin-Drive Bone Conduction Hearing Devices in Adults With Simulated Conductive Hearing Loss.

PURPOSE: Bone conduction hearing devices (BCDs) that deliver sound across the skin (i.e., transcutaneous) are suitable for some individuals who have conductive or mixed hearing losses. Prescriptive targets for percutaneous devices are available, for example, from the Desired Sensation Level-Bone Conduction Hearing Device (DSL-BCD) algorithm. These targets, however, may require modification for use with transcutaneous BCDs. The current study investigated three key variables that may inform target modification: (a) comparison of thresholds measured using an audiometric bone conduction (BC) transducer versus transcutaneous BCDs that offer in situ threshold measurement, (b) transcutaneous BCD default force level outputs versus recommended DSL percutaneous BC targets, and (c) the preferred listening levels (PLLs) of adults wearing transcutaneous BCDs in a laboratory setting. METHOD: Bilateral conductive hearing loss was simulated in 20 normal-hearing adults via earplugs. Thresholds were measured using a B-71 BC transducer and two commercially available BCDs coupled to a soft headband. DSL percutaneous BC targets were generated, and PLLs were obtained for a 60-dB SPL speech stimulus. Force level outputs were measured using a skull simulator on the Audioscan Verifit2 at the hearing aids' default settings and at the participants' PLL for each device. RESULTS: On average, audiometric BC thresholds were significantly better than those measured in situ with each BCD. PLLs were similar to prescribed targets for one device with the smoother response shape and agreed in the high frequencies for both devices. CONCLUSIONS: In situ thresholds are significantly higher than audiometric BC thresholds, suggesting that device-based in situ measurement more accurately accounts for the signal transmission from transcutaneous BCDs. PLLs differed from the percutaneous targets and varied between devices, which may indicate that either target modifications or manipulations of device frequency response shaping are needed to approximate PLL with transcutaneous BCD devices.

Development and initial evaluation of the Hearing Aid Attribute and Feature Importance Evaluation (HAFIE) questionnaire.

OBJECTIVES: To develop and validate a novel questionnaire aimed at providing a structured, evidence-based methodology for hearing aid recommendation and selection using self-reported importance ratings for different modern hearing aid features. DESIGN: The initial questionnaire items were created through a concept mapping approach that involved input from hearing aid users. Hearing care professional focus groups (n = 10) were conducted to assess questionnaire content and design, and to guide modifications. Validation of this initial 34-item version of the questionnaire was conducted using an anonymous online survey tool (Qualtrics). Exploratory factor analysis was used to assess the factor structure of the dataset, using principal axis factoring. Questionnaire reliability and inter-item correlation were assessed. Items with low factor loading and high cross-loading were removed. STUDY SAMPLE: Two hundred and eighteen adult participants with a self-reported hearing loss (median age = 48 years, range = 18-95 years) completed the questionnaire. RESULTS: Analysis and item removal resulted in a 28-item questionnaire. Three factors were identified, dividing the hearing aid features into the subscales: "Advanced connectivity & streaming", "Physical attributes & usability", and "Sound quality & intelligibility". CONCLUSION: This study has resulted in a patient-oriented questionnaire that allows clinicians to gather patient input in a structured manner.

Validation of an integrated pressure level measured earmold wideband real-ear-to-coupler difference measurement.

OBJECTIVE: To validate measurement of predicted earmold wideband real-ear-to-coupler difference (wRECD) using an integrated pressure level (IPL) calibrated transducer and the incorporation of an acoustically measured tubing length correction. DESIGN: Unilateral earmold SPL wRECD using varied hearing aid tubing length and the proposed predicted earmold IPL wRECD measurement procedure were completed on all participants and compared. STUDY SAMPLE: 22 normal hearing adults with normal middle ear status were recruited. RESULTS: There were no clinically significant differences between probe-microphone and predicted earmold IPL wRECD measurements between 500 and 2500 Hz. Above 5000 Hz, the predicted earmold IPL wRECD exceeded earmold SPL wRECDs due to lack of standing wave interference. Test-retest reliability of IPL wRECD measurement exceeded the reliability of earmold SPL wRECD measurement across all assessed frequencies, with the greatest improvements in the high frequencies. The acoustically measured tubing length correction largely accounted for acoustic effects of the participant's earmold. CONCLUSIONS: IPL-based measurements provide a promising alternative to probe-microphone earmold wRECD procedures. Predicted earmold IPL wRECD is measured without probe-microphone placement, agrees well with earmold SPL wRECDs and is expected to extend the valid bandwidth of wRECD measurement.

Modified Multiple Stimulus With Hidden Reference and Anchors-Gabrielsson Total Impression Sound Quality Rating Comparisons for Speech in Quiet, Noise, and Reverberation.

PURPOSE: The purpose of the study was to obtain, analyze, and compare subjective sound quality data for the same test stimuli using modified multistimulus MUSHRA (Multiple Stimulus with Hidden Reference and Anchors) based procedures (viz., MUSHRA with custom anchors and MUSHRA without anchor) and the single-stimulus Gabrielsson's total impression rating procedure. METHOD: Twenty normally hearing young adults were recruited in this study. Participants completed sound quality ratings on two different hearing aid recording data sets-Data Set A contained speech recordings from four different hearing aids under a variety of noisy and processing conditions, and Data Set B contained speech recordings from a single hearing aid under a combination of different noisy, reverberant, and signal processing conditions. Recordings in both data sets were rated for their quality using the total impression rating procedure. In addition, quality ratings of Data Set A recordings were obtained using a MUSHRA with custom anchors, while the ratings of Data Set B recordings were collected using a MUSHRA without anchor. RESULTS: Statistical analyses revealed a high test-retest reliability of quality ratings for the same stimuli that were rated multiple times. In addition, high-interrater reliability was observed with all three rating procedures. Further analyses indicated (a) a high correlation between the total impression rating and the two modified MUSHRA ratings and (b) a similar relationship between the average and standard deviation of the subjective rating data obtained by the total impression rating and MUSHRA with custom anchors on Data Set A, and the total impression rating and the MUSHRA without anchor on Data Set B. CONCLUSION: Both sound quality procedures, namely, the MUSHRA-based procedures and the total impression rating scale, obtained similar quality ratings of varied hearing aid speech recordings with high reliability.

Validity and reliability of integrated pressure level real-ear-to-coupler difference measurements.

OBJECTIVES: (1) To validate the measurement of foam-tip real-ear-to-coupler differences (wRECD) using an integrated pressure level (IPL) method and (2) to compare the reliability of this method to SPL-based measurement of the wRECD. DESIGN: SPL-based wRECD and the proposed IPL wRECD measurement were completed bilaterally. Test-retest reliability of IPL wRECD was determined with full re-insertion into the ear canal and compared to published SPL wRECD test-retest data. STUDY SAMPLE: 22 adults with normal hearing and middle ear status were recruited. RESULTS: Differences between SPL-based wRECD and IPL wRECD measurements were within 1.51 dB on average below 5000 Hz. At and above 5000 Hz, IPL wRECD exceeded SPL wRECDs by 6.11 dB on average. The average test-retest difference for IPL wRECD across all assessed frequencies was 0.75 dB with the greatest improvements in reliability found below 750 Hz and above 3000 Hz. CONCLUSIONS: IPL wRECD yielded improved estimates compared to SPL wRECD in high frequencies, where standing-wave interference is present. Independence from standing wave interference resulted in increased wRECD values above 4000 Hz using the IPL measurement paradigm. IPL wRECD is more reliable than SPL wRECD, does not require precise probe-microphone placement, and provides a wider valid wRECD bandwidth than SPL-based measurement.

Effects of earlens lens placement on sound field thresholds, tympanometric measurements and wideband acoustic immittance.

OBJECTIVE: The Earlens is a direct-drive hearing device consisting of a lens which physically displaces the umbo to achieve appropriate gain. The objective is to determine the clinical acceptability of clinical immittance measurements in Earlens wearers. DESIGN: Controlled before-after within-subjects repeated measures study. STUDY SAMPLE: Data is reported for measurements obtained on 15 subjects (average age of 72.2 years) with data from 30 ears. RESULTS: There was a small effect of lens placement on sound field thresholds in most subjects. The largest damping effect of 4 dB was observed at 1000 Hz. An average reduction of 0.17 mL was identified in compliance following lens placement (p < 0.05). An effect of the lens on power absorbance obtained at ambient and peak pressure was found. The lens resulted in an increase in power absorbance at low frequencies (below 500 Hz) and a decrease in the mid to high-frequency range of approximately 500-3500 Hz (p < 0.05). CONCLUSIONS: Lens wear had a small effect on audiometric thresholds and tympanometry for most patients. Clinicians who use compliance and power absorbance should take into consideration lens effects on these measurements. Additional work is required to develop clinical normative ranges of these measures for wearers of the Earlens.

An evaluation of the CARL manikin for use in "patient-free" real ear measurement: consistency and comparison to normative data.

OBJECTIVE: Simulation-based learning experiences provide low-risk opportunities for procedural training and practice in audiology. A series of real ear measurements (REM) were completed using Clinical Assistant for Research and Learning (CARL) manikins to determine expected responses and to compare to normative data. DESIGN: (1) Real-ear Unaided Response (REUR) curves were measured with one CARL and each of three ear styles. (2) Test/retest reliability was evaluated by repeating each REUR. (3) Real ear to coupler difference (RECD) values for foam-tip and custom earmolds were calculated. (4) The reliability across copies of the CARL heads was evaluated by comparing REUR measurement from one set of ears on 4 heads. STUDY SAMPLE: Four adult CARL manikins and thirty ears (5 sets of large, small, and bent). RESULTS: Within each ear category, the average difference across frequencies from one ear to the next was less than 2.5 dB with no significant individual difference more than 5.8 dB. Test/retest reliability was excellent. Typical REUR and RECD curves were created for each ear style and compared to published data on human ears. CONCLUSIONS: REM using the adult CARL head are predictable and repeatable making this simulator a good tool for audiological training.

Variability in the Estimated Amplitude of Vowel-Evoked Envelope Following Responses Caused by Assumed Neurophysiologic Processing Delays.

Vowel-evoked envelope following responses (EFRs) reflect neural encoding of the fundamental frequency of voice (f0). Accurate analysis of EFRs elicited by natural vowels requires the use of methods like the Fourier analyzer (FA) to consider the production-related f0 changes. The FA's accuracy in estimating EFRs is, however, dependent on the assumed neurophysiological processing delay needed to time-align the f0 time course and the recorded electroencephalogram (EEG). For male-spoken vowels (f0 ~ 100 Hz), a constant 10-ms delay correction is often assumed. Since processing delays vary with stimulus and physiological factors, we quantified (i) the delay-related variability that would occur in EFR estimation, and (ii) the influence of stimulus frequency, non-f0 related neural activity, and the listener's age on such variability. EFRs were elicited by the low-frequency first formant, and mid-frequency second and higher formants of /u/, /a/, and /i/ in young adults and 6- to 17-year-old children. To time-align with the f0 time course, EEG was shifted by delays between 5 and 25 ms to encompass plausible response latencies. The delay-dependent range in EFR amplitude did not vary by stimulus frequency or age and was significantly smaller when interference from low-frequency activity was reduced. On average, the delay-dependent range was < 22% of the maximum variability in EFR amplitude that could be expected by noise. Results suggest that using a constant EEG delay correction in FA analysis does not substantially alter EFR amplitude estimation. In the present study, the lack of substantial variability was likely facilitated by using vowels with small f0 ranges.

Performance of Statistical Indicators in the Objective Detection of Speech-Evoked Envelope Following Responses.

OBJECTIVES: To assess the sensitivity of statistical indicators used for the objective detection of speech-evoked envelope following responses (EFRs) in infants and adults. DESIGN: Twenty-three adults and 21 infants with normal hearing participated in this study. A modified/susa∫i/speech token was presented at 65 dB SPL monoaurally. Presentation level in infants was corrected using in-ear measurements. EFRs were recorded between high forehead and ipsilateral mastoid. Statistical post-processing was completed using F -test, Magnitude-Square Coherence, Rayleigh test, Rayleigh-Moore test, and Hotelling's T 2 test. Logistic regression models assessed the sensitivity of each statistical indicator in both infants and adults as a function of testing duration. RESULTS: The Rayleigh-Moore and Rayleigh tests were the most sensitive statistical indicators for speech-evoked EFR detection in infants. Comparatively, Magnitude-Square Coherence and Hotelling's T 2 also provide clinical benefit for infants in all conditions after ~30 minutes of testing, whereas the F -test failed to detect responses to EFRs elicited by vowels with accuracy greater than chance. In contrast, the F-test was the most sensitive for vowel-elicited response detection for adults in short tests (<10 minute) and performed comparatively with the Rayleigh-Moore and Rayleigh test during longer test durations. Decreased sensitivity was observed in infants relative to adults across all testing durations and statistical indicators, but the effects were largest in low frequency stimuli and seemed to be mostly, but not wholly, caused by differences in response amplitude. CONCLUSIONS: The choice of statistical indicator significantly impacts the sensitivity of speech-evoked EFR detection. In both groups and for all stimuli, the Rayleigh test and Rayleigh-Moore tests have high sensitivity. Differences in EFR detection are present between infants and adults regardless of statistical indicator; however, these effects are largest for low-frequency EFR stimuli and for amplitude-based statistical indicators.

Venting Corrections Improve the Accuracy of Coupler-Based Simulated Real-Ear Verification for Use with Adult Hearing Aid Fittings.

BACKGROUND: Hearing aid responses can be verified with the Real-Ear Aided Response (REAR). Procedures for predicting the REAR from coupler-based verification exist, but have not incorporated corrections for venting, limiting their use and validity for vented and open fittings. A commercially available system for including venting effects in simulated real-ear measurement (S-REM) has recently been developed. PURPOSE: To evaluate the accuracy of a vent-corrected S-REM for predicting the REAR across test levels, for fittings with a wide range of coupling styles including modular domes. RESEARCH DESIGN: This was a within-subject comparison study using technical measures. Retrospective file review was used to obtain previously measured REARs from 104 fittings in 52 adults and three hearing aid styles. Prospective data collection was used to re-measure each fitting at three test levels using S-REM with and without venting corrections. Comparison of differences by frequency band was performed to assess the impact of the venting correction. RESULTS: The vent model reduced low-frequency error by up to 11 dB, and the effects were consistent with the expected effects of venting in hearing aid fitting: fittings with more open dome or tip styles had a larger improvement when the vent model was added. A larger sample of fittings was obtained for dome/sleeve couplings than for custom fittings. CONCLUSIONS: The vent-corrected S-REM system evaluated in this study provides improved fitting accuracy for dome or sleeve-fitted hearing aids for adults and supports the use of vented S-REM for open fittings. Further studies to examine a representative sample of custom tip or mold fittings, and fittings for children are future directions.

Clinical consensus document for fitting non-surgical transcutaneous bone conduction hearing devices to children.

This clinical consensus document addresses the assessment, selection, and fitting considerations for non-surgical bone conduction hearing devices (BCHD) for children under the age of 5 years identified as having unilateral or bilateral, permanent conductive or mixed hearing losses. Children with profound unilateral sensorineural hearing losses are not addressed. The document was developed based on evidence review and consensus by The Paediatric Bone Conduction Working Group, which is composed of audiologists from North America who have experience working with BCHDs in children. The document aims to provide clinical direction for an area of paediatric audiology practice that is under development and is therefore lacking in standard protocols or guidelines. This work may serve as a basis for future research and clinical contributions to support prospective paediatric audiology practices.

The Influence of Sensation Level on Speech-Evoked Envelope Following Responses.

OBJECTIVES: To evaluate sensation level (SL)-dependent characteristics of envelope following responses (EFRs) elicited by band-limited speech dominant in low, mid, and high frequencies. DESIGN: In 21 young normal hearing adults, EFRs were elicited by 8 male-spoken speech stimuli-the first formant, and second and higher formants of /u/, /a/ and /i/, and modulated fricatives, /∫/ and /s/. Stimulus SL was computed from behaviorally measured thresholds. RESULTS: At 30 dB SL, the amplitude and phase coherence of fricative-elicited EFRs were ~1.5 to 2 times higher than all vowel-elicited EFRs, whereas fewer and smaller differences were found among vowel-elicited EFRs. For all stimuli, EFR amplitude and phase coherence increased by roughly 50% for every 10 dB increase in SL between ~0 and 50 dB. CONCLUSIONS: Stimulus and frequency dependency in EFRs exist despite accounting for differences in audibility of speech sounds. The growth rate of EFR characteristics with SL is independent of stimulus and its frequency.

Premium versus entry-level hearing aids: using group concept mapping to investigate the drivers of preference.

OBJECTIVES: To investigate the difference in outcome measures and drivers of user preference between premium and entry-level hearing aids using group concept mapping. DESIGN: A single-blind crossover trial was conducted. Aided behavioural outcomes measured were loudness rating, speech/consonant recognition, and speech quality. Preference between hearing aids was measured with a 7-point Likert scale. Group concept mapping was utilised to investigate preference results. Participants generated statements based on what influenced their preferences. These were sorted into categories with underlying themes. Participants rated each statement on a 5-point Likert scale of importance. STUDY SAMPLE: Twenty-three adult participants (mean: 62.4 years; range: 24-78) with mild to moderately severe bilateral SNHL (PTA500-4000 Hz > 20 dB HL). RESULTS: A total of 83 unique statements and nine distinct clusters, with underlying themes driving preference, were generated. Clusters that differed significantly in importance between entry-level and premium hearing aid choosers were: Having access to smartphone application-based user-controlled settings, the ability to stream calls and music, and convenience features such as accessory compatibility. CONCLUSION: This study has identified non-signal-processing factors which significantly influenced preference for a premium hearing aid over an entry-level hearing aid, indicating the importance of these features as drivers of user preference.

Characteristics of Speech-Evoked Envelope Following Responses in Infancy.

Envelope following responses (EFRs) may be a useful tool for evaluating the audibility of speech sounds in infants. The present study aimed to evaluate the characteristics of speech-evoked EFRs in infants with normal hearing, relative to adults, and identify age-dependent changes in EFR characteristics during infancy. In 42 infants and 21 young adults, EFRs were elicited by the first (F1) and the second and higher formants (F2+) of the vowels /u/, /a/, and /i/, dominant in low and mid frequencies, respectively, and by amplitude-modulated fricatives /s/ and /∫/, dominant in high frequencies. In a subset of 20 infants, the in-ear stimulus level was adjusted to match that of an average adult ear (65 dB sound pressure level [SPL]). We found that (a) adult-infant differences in EFR amplitude, signal-to-noise ratio, and intertrial phase coherence were larger and spread across the frequency range when in-ear stimulus level was adjusted in infants, (b) adult-infant differences in EFR characteristics were the largest for low-frequency stimuli, (c) infants demonstrated adult-like phase coherence when they received a higher (i.e., unadjusted) stimulus level, and (d) EFR phase coherence and signal-to-noise ratio changed with age in the first year of life for a few F2+ vowel stimuli in a level-specific manner. Together, our findings reveal that development-related changes in EFRs during infancy likely vary by stimulus frequency, with low-frequency stimuli demonstrating the largest adult-infant differences. Consistent with previous research, our findings emphasize the significant role of stimulus level calibration methods while investigating developmental trends in EFRs.

Detection, Speech Recognition, Loudness, and Preference Outcomes With a Direct Drive Hearing Aid: Effects of Bandwidth.

Direct drive hearing devices, which deliver a signal directly to the middle ear by vibrating the tympanic membrane via a lens placed in contact with the umbo, are designed to provide an extension of audible bandwidth, but there are few studies of the effects of these devices on preference, speech intelligibility, and loudness. The current study is the first to compare aided speech understanding between narrow and extended bandwidth conditions for listeners with hearing loss while fitted with a direct drive hearing aid system. The study also explored the effect of bandwidth on loudness perception and investigated subjective preference for bandwidth. Fifteen adult hearing aid users with symmetrical sensorineural hearing loss participated in a prospective, within-subjects, randomized single-blind repeated-measures study. Participants wore the direct drive hearing aids for 4 to 15 weeks (average 6 weeks) prior to outcome measurement. Outcome measures were completed in various bandwidth conditions achieved by reducing the gain of the device above 5000 Hz or by filtering the stimuli. Aided detection thresholds provided evidence of amplification to 10000 Hz. A significant improvement was found in high-frequency consonant detection and recognition, as well as for speech in noise performance in the full versus narrow bandwidth conditions. Subjective loudness ratings increased with provision of the full bandwidth available; however, real-world trials showed most participants were able to wear the full bandwidth hearing aids with only small adjustments to the prescription method. The majority of participants had either no preference or a preference for the full bandwidth setting.

The use of ecological momentary assessment to evaluate real-world aided outcomes with children.

BACKGROUND: Ecological momentary assessment (EMA) methods allow for real-time, real-world survey data collection. Studies with adults have reported EMA as a feasible and valid tool in the measurement of real-world listening experience. Research is needed to investigate the use of EMA with children who wear hearing aids. OBJECTIVES: This study explored the implementation of EMA with children using a single-blinded repeated measures design to evaluate real-world aided outcome. METHODS: Twenty-nine children, aged 7-17, used manual program switching to access hearing aid programs, fitted according to Desired Sensation Level (DSL) version 5.0 child quiet and noise prescriptive targets. Aided outcome was measured using participant-triggered twice-daily EMA entries, across listening situations and hearing dimensions. RESULTS: Adherence to the EMA protocol by the children was high (82.4% compliance rate). Speech loudness, understanding and preference results were found to relate to both the hearing aid program and the listening situation. Aided outcomes related to prescription-based noise management were found to be highest in noisy situations. CONCLUSIONS: Mobile device-based EMA methods can be used to inform daily life listening experience with children. Prescription-based noise management was found to decrease perceived loudness in noisy, non-school environments; this should be evaluated in combination with hearing aid noise reductions features.

Perceived Sound Quality Dimensions Influencing Frequency-Gain Shaping Preferences for Hearing Aid-Amplified Speech and Music.

Hearing aids are typically fitted using speech-based prescriptive formulae to make speech more intelligible. Individual preferences may vary from these prescriptions and may also vary with signal type. It is important to consider what motivates listener preferences and how those preferences can inform hearing aid processing so that assistive listening devices can best be tailored for hearing aid users. Therefore, this study explored preferred frequency-gain shaping relative to prescribed gain for speech and music samples. Preferred gain was determined for 22 listeners with mild sloping to moderately severe hearing loss relative to individually prescribed amplification while listening to samples of male speech, female speech, pop music, and classical music across low-, mid-, and high-frequency bands. Samples were amplified using a fast-acting compression hearing aid simulator. Preferences were determined using an adaptive paired comparison procedure. Listeners then rated speech and music samples processed using prescribed and preferred shaping across different sound quality descriptors. On average, low-frequency gain was significantly increased relative to the prescription for all stimuli and most substantially for pop and classical music. High-frequency gain was decreased significantly for pop music and male speech. Gain adjustments, particularly in the mid- and high-frequency bands, varied considerably between listeners. Music preferences were driven by changes in perceived fullness and sharpness, whereas speech preferences were driven by changes in perceived intelligibility and loudness. The results generally support the use of prescribed amplification to optimize speech intelligibility and alternative amplification for music listening for most listeners.

Fit-to-Targets and Aided Speech Intelligibility Index Values for Hearing Aids Fitted to the DSL v5-Adult Prescription.

BACKGROUND: Matching hearing aid output levels to prescribed targets is a component of preferred practice, yet recent normative data on appropriateness of fittings are lacking. Verification measures that assess closeness of fit-to-target include raw deviations from target, root-mean-squared-error (RMSE) deviations from target, and aided Speech Intelligibility Index (SII) values. Establishing normative ranges for these measures may help hearing professionals determine whether a patient's fit-to-targets and/or aided speech audibility is typical for his or her degree of hearing loss. PURPOSE: This article aims to characterize the range of fit-to-target and the range of aided SII associated with hearing aid fittings using the Desired Sensation Level version 5.0 (DSL v5-adult) prescription with adults, considering also hearing aid style, venting, and audiometric characteristics. RESEARCH DESIGN: A descriptive and correlational study of data collected from a retrospective chart review. RESULTS: Hearing aid fittings to 281 ears were compiled. The four-frequency average deviation from target (RMSE) was within ± 5 dB of target in 77% of fittings for mid-level speech. Deviation from targets increased with hearing loss, particularly when the loss is greater than 85 dB hearing level or if the loss was steeply sloping. Venting increased the deviation from targets in the low frequencies. Aided SII values strongly correlated with the participants' hearing thresholds. Clinical ranges for RMSE and aided SII were developed for characterization of fitting outcomes. CONCLUSION: Fitting to DSL v5-adult targets was observed within ± 5 dB absolute deviation, or within 5 dB RMSE, on average for typical adult hearing aid fittings. Confidence intervals for deviation from target and aided SII are proposed.

Evaluating the Accuracy of Step Tracking and Fall Detection in the Starkey Livio Artificial Intelligence Hearing Aids: A Pilot Study.

Purpose The primary purpose of this study was to examine the efficacy and the effectiveness of Starkey Livio Artificial Intelligence hearing aids in tracking step count. A secondary purpose was to investigate the accuracy of the fall detection and alert system of Livio hearing aids in detecting fall maneuvers. Method A participant wore Binaural Starkey Livio receiver-in-the-canal style hearing aids, a Sportline pedometer, and a Fitbit Charge 3 concurrently during both real-world and treadmill walking conditions. The real-world condition was conducted over a 5-day period. Step count for the treadmill protocol was assessed at six different treadmill speeds (2 mph, 2.5 mph, 3 mph, 3.5 mph, 4 mph, 4.5 mph, and 5 mph). The fall detection and alert system were assessed through falling maneuvers of activities of daily living. Results In the real-world condition, Livio, Sportline, and Fitbit recorded steps within 1 SD of each other. In addition, Livio recorded the most accurate steps compared to actual physical steps taken. In the treadmill condition, Livio recorded the least number of steps across all walking paces compared to the rest of the devices. Also, Livio hearing aids detected majority of the engaged falling maneuvers. Conclusions The Livio was found to be feasible, consistent, and sensitive in detecting steps and falls. Further research of higher sample size and recruitment of individuals with hearing loss are suggested.