Subjective benefits from wearing self-fitting over-the-counter hearing aids in the real world.

Introduction: In 2022, the US Food and Drug Administration enacted final regulations to establish the category of over-the-counter (OTC) hearing aids aimed at reducing barriers to access hearing health care for individuals with self-perceived mild to moderate hearing loss. However, given the infancy of this device category, the effectiveness of OTC hearing aids in real-world environments is not yet well understood. Methods and results: To gain insights into the perceived benefit of self-fitting OTC hearing aids, a two-pronged investigation was conducted. In the primary investigation, 255 active users of a self-fitting OTC hearing aid were surveyed on their perceived benefit using an abridged form of the Satisfaction with Amplification in Daily Living (SADL) scale. The mean global (4.9) and subscale scores (Positive Effect (PE): 4.3; Negative Features (NF): 4.3; Personal Image (PI): 6.1) were within the range of those previously reported for users of prescription hearing aids. In the secondary investigation, 29 individuals with self-reported hearing impairment but no prior experience with the investigational self-fitting OTC hearing aids used the devices and reported their perceived benefit and satisfaction following short-term usage. For this prospective group, the global SADL (5.4) and subscale scores (PE: 4.8; NF: 4.9; PI: 6.5) following a minimum of 10 weeks of real-world use were also within the range of those previously reported for traditional hearing aid users. In addition, this prospective group was also asked quality of life questions which assessed psychological benefits of hearing aid use. Responses to these items suggest hearing aid related improvements in several areas spanning emotional health, relationships at home and at work, social life, participation in group activities, confidence and feelings about one's self, ability to communicate effectively, and romance. Discussion: Converging data from these investigations suggest that self-fitting OTC hearing aids can potentially provide their intended users with a level of subjective benefit comparable to what prescription hearing aid users might experience.

Binaural consequences of speech envelope enhancement.

The potential binaural consequences of two envelope-based speech enhancement strategies (broadband compression and expansion) were examined. Sensitivity to interaural time differences imposed on four single-word stimuli was measured in listeners with normal hearing and sensorineural hearing loss. While there were no consistent effects of compression or expansion across all words, some potentially interesting word-specific effects were observed.

Audibility emphasis of low-level sounds improves consonant identification while preserving vowel identification for cochlear implant users.

Consonant perception is challenging for listeners with hearing loss, and transmission of speech over communication channels further deteriorates the acoustics of consonants. Part of the challenge arises from the short-term low energy spectro-temporal profile of consonants (for example, relative to vowels). We hypothesized that an audibility enhancement approach aimed at boosting the energy of low-level sounds would improve identification of consonants without diminishing vowel identification. We tested this hypothesis with 11 cochlear implant users, who completed an online listening experiment remotely using the media device and implant settings that they most commonly use when making video calls. Loudness growth and detection thresholds were measured for pure tone stimuli to characterize the relative loudness of test conditions. Consonant and vowel identification were measured in quiet and in speech-shaped noise for progressively difficult signal-to-noise ratios (+12, +6, 0, -6 dB SNR). These conditions were tested with and without an audibility-emphasis algorithm designed to enhance consonant identification at the source. The results show that the algorithm improves consonant identification in noise for cochlear implant users without diminishing vowel identification. We conclude that low-level emphasis of audio can improve speech recognition for cochlear implant users in the case of video calls or other telecommunications where the target speech can be preprocessed separately from environmental noise.

Spectro-temporal weighting of interaural time differences in speech.

Numerous studies have demonstrated that the perceptual weighting of interaural time differences (ITDs) is non-uniform in time and frequency, leading to reports of spectral and temporal "dominance" regions. It is unclear however, how these dominance regions apply to spectro-temporally complex stimuli such as speech. The authors report spectro-temporal weighting functions for ITDs in a pair of naturally spoken speech tokens ("two" and "eight"). Each speech token was composed of two phonemes, and was partitioned into eight frequency regions over two time bins (one time bin for each phoneme). To derive lateralization weights, ITDs for each time-frequency bin were drawn independently from a normal distribution with a mean of 0 and a standard deviation of 200 µs, and listeners were asked to indicate whether the speech token was presented from the left or right. ITD thresholds were also obtained for each of the 16 time-frequency bins in isolation. The results suggest that spectral dominance regions apply to speech, and that ITDs carried by phonemes in the first position of the syllable contribute more strongly to lateralization judgments than ITDs carried by phonemes in the second position. The results also show that lateralization judgments are partially accounted for by ITD sensitivity across time-frequency bins.

Binaural sensitivity and release from speech-on-speech masking in listeners with and without hearing loss.

Listeners with sensorineural hearing loss routinely experience less spatial release from masking (SRM) in speech mixtures than listeners with normal hearing. Hearing-impaired listeners have also been shown to have degraded temporal fine structure (TFS) sensitivity, a consequence of which is degraded access to interaural time differences (ITDs) contained in the TFS. Since these "binaural TFS" cues are critical for spatial hearing, it has been hypothesized that degraded binaural TFS sensitivity accounts for the limited SRM experienced by hearing-impaired listeners. In this study, speech stimuli were noise-vocoded using carriers that were systematically decorrelated across the left and right ears, thus simulating degraded binaural TFS sensitivity. Both (1) ITD sensitivity in quiet and (2) SRM in speech mixtures spatialized using ITDs (or binaural release from masking; BRM) were measured as a function of TFS interaural decorrelation in young normal-hearing and hearing-impaired listeners. This allowed for the examination of the relationship between ITD sensitivity and BRM over a wide range of ITD thresholds. This paper found that, for a given ITD sensitivity, hearing-impaired listeners experienced less BRM than normal-hearing listeners, suggesting that binaural TFS sensitivity can account for only a modest portion of the BRM deficit in hearing-impaired listeners. However, substantial individual variability was observed.

Revisiting the detection of interaural time differences in listeners with hearing loss.

Sensitivity to interaural time differences (ITDs) was measured in two groups of listeners, one with normal hearing and one with sensorineural hearing loss. ITD detection thresholds were measured for pure tones and for speech (a single word), in quiet and in the presence of noise. It was predicted that effects of hearing loss would be reduced for speech as compared to tones due to the redundancy of information across frequency. Thresholds were better overall, and the effects of hearing loss less pronounced, for speech than for tones. There was no evidence that effects of hearing loss were exacerbated in noise.

Determining the energetic and informational components of speech-on-speech masking in listeners with sensorineural hearing loss.

The ability to identify the words spoken by one talker masked by two or four competing talkers was tested in young-adult listeners with sensorineural hearing loss (SNHL). In a reference/baseline condition, masking speech was colocated with target speech, target and masker talkers were female, and the masker was intelligible. Three comparison conditions included replacing female masker talkers with males, time-reversal of masker speech, and spatial separation of sources. All three variables produced significant release from masking. To emulate energetic masking (EM), stimuli were subjected to ideal time-frequency segregation retaining only the time-frequency units where target energy exceeded masker energy. Subjects were then tested with these resynthesized "glimpsed stimuli." For either two or four maskers, thresholds only varied about 3 dB across conditions suggesting that EM was roughly equal. Compared to normal-hearing listeners from an earlier study [Kidd, Mason, Swaminathan, Roverud, Clayton, and Best, J. Acoust. Soc. Am. 140, 132-144 (2016)], SNHL listeners demonstrated both greater energetic and informational masking as well as higher glimpsed thresholds. Individual differences were correlated across masking release conditions suggesting that listeners could be categorized according to their general ability to solve the task. Overall, both peripheral and central factors appear to contribute to the higher thresholds for SNHL listeners.

Tracking the dynamic representation of consonants from auditory periphery to cortex.

In order to perceive meaningful speech, the auditory system must recognize different phonemes amidst a noisy and variable acoustic signal. To better understand the processing mechanisms underlying this ability, evoked cortical responses to different spoken consonants were measured with electroencephalography (EEG). Using multivariate pattern analysis (MVPA), binary classifiers attempted to discriminate between the EEG activity evoked by two given consonants at each peri-stimulus time sample, providing a dynamic measure of their cortical dissimilarity. To examine the relationship between representations at the auditory periphery and cortex, MVPA was also applied to modelled auditory-nerve (AN) responses of consonants, and time-evolving AN-based and EEG-based dissimilarities were compared with one another. Cortical dissimilarities between consonants were commensurate with their articulatory distinctions, particularly their manner of articulation, and to a lesser extent, their voicing. Furthermore, cortical distinctions between consonants in two periods of activity, centered at 130 and 400 ms after onset, aligned with their peripheral dissimilarities in distinct onset and post-onset periods, respectively. In relating speech representations across articulatory, peripheral, and cortical domains, the understanding of crucial transformations in the auditory pathway underlying the ability to perceive speech is advanced.

A "Buildup" of Speech Intelligibility in Listeners With Normal Hearing and Hearing Loss.

The perception of simple auditory mixtures is known to evolve over time. For instance, a common example of this is the "buildup" of stream segregation that is observed for sequences of tones alternating in pitch. Yet very little is known about how the perception of more complicated auditory scenes, such as multitalker mixtures, changes over time. Previous data are consistent with the idea that the ability to segregate a target talker from competing sounds improves rapidly when stable cues are available, which leads to improvements in speech intelligibility. This study examined the time course of this buildup in listeners with normal and impaired hearing. Five simultaneous sequences of digits, varying in length from three to six digits, were presented from five locations in the horizontal plane. A synchronized visual cue at one location indicated which sequence was the target on each trial. We observed a buildup in digit identification performance, driven primarily by reductions in confusions between the target and the maskers, that occurred over the course of three to four digits. Performance tended to be poorer in listeners with hearing loss; however, there was only weak evidence that the buildup was diminished or slowed in this group.

Effects of reverberation and noise on speech intelligibility in normal-hearing and aided hearing-impaired listeners.

Many hearing-aid wearers have difficulties understanding speech in reverberant noisy environments. This study evaluated the effects of reverberation and noise on speech recognition in normal-hearing listeners and hearing-impaired listeners wearing hearing aids. Sixteen typical acoustic scenes with different amounts of reverberation and various types of noise maskers were simulated using a loudspeaker array in an anechoic chamber. Results showed that, across all listening conditions, speech intelligibility of aided hearing-impaired listeners was poorer than normal-hearing counterparts. Once corrected for ceiling effects, the differences in the effects of reverberation on speech intelligibility between the two groups were much smaller. This suggests that, at least, part of the difference in susceptibility to reverberation between normal-hearing and hearing-impaired listeners was due to ceiling effects. Across both groups, a complex interaction between the noise characteristics and reverberation was observed on the speech intelligibility scores. Further fine-grained analyses of the perception of consonants showed that, for both listener groups, final consonants were more susceptible to reverberation than initial consonants. However, differences in the perception of specific consonant features were observed between the groups.

Use of a glimpsing model to understand the performance of listeners with and without hearing loss in spatialized speech mixtures.

In many situations, listeners with sensorineural hearing loss demonstrate reduced spatial release from masking compared to listeners with normal hearing. This deficit is particularly evident in the "symmetric masker" paradigm in which competing talkers are located to either side of a central target talker. However, there is some evidence that reduced target audibility (rather than a spatial deficit per se) under conditions of spatial separation may contribute to the observed deficit. In this study a simple "glimpsing" model (applied separately to each ear) was used to isolate the target information that is potentially available in binaural speech mixtures. Intelligibility of these glimpsed stimuli was then measured directly. Differences between normally hearing and hearing-impaired listeners observed in the natural binaural condition persisted for the glimpsed condition, despite the fact that the task no longer required segregation or spatial processing. This result is consistent with the idea that the performance of listeners with hearing loss in the spatialized mixture was limited by their ability to identify the target speech based on sparse glimpses, possibly as a result of some of those glimpses being inaudible.

Determining the energetic and informational components of speech-on-speech masking.

Identification of target speech was studied under masked conditions consisting of two or four independent speech maskers. In the reference conditions, the maskers were colocated with the target, the masker talkers were the same sex as the target, and the masker speech was intelligible. The comparison conditions, intended to provide release from masking, included different-sex target and masker talkers, time-reversal of the masker speech, and spatial separation of the maskers from the target. Significant release from masking was found for all comparison conditions. To determine whether these reductions in masking could be attributed to differences in energetic masking, ideal time-frequency segregation (ITFS) processing was applied so that the time-frequency units where the masker energy dominated the target energy were removed. The remaining target-dominated "glimpses" were reassembled as the stimulus. Speech reception thresholds measured using these resynthesized ITFS-processed stimuli were the same for the reference and comparison conditions supporting the conclusion that the amount of energetic masking across conditions was the same. These results indicated that the large release from masking found under all comparison conditions was due primarily to a reduction in informational masking. Furthermore, the large individual differences observed generally were correlated across the three masking release conditions.

Role of Binaural Temporal Fine Structure and Envelope Cues in Cocktail-Party Listening.

UNLABELLED: While conversing in a crowded social setting, a listener is often required to follow a target speech signal amid multiple competing speech signals (the so-called "cocktail party" problem). In such situations, separation of the target speech signal in azimuth from the interfering masker signals can lead to an improvement in target intelligibility, an effect known as spatial release from masking (SRM). This study assessed the contributions of two stimulus properties that vary with separation of sound sources, binaural envelope (ENV) and temporal fine structure (TFS), to SRM in normal-hearing (NH) human listeners. Target speech was presented from the front and speech maskers were either colocated with or symmetrically separated from the target in azimuth. The target and maskers were presented either as natural speech or as "noise-vocoded" speech in which the intelligibility was conveyed only by the speech ENVs from several frequency bands; the speech TFS within each band was replaced with noise carriers. The experiments were designed to preserve the spatial cues in the speech ENVs while retaining/eliminating them from the TFS. This was achieved by using the same/different noise carriers in the two ears. A phenomenological auditory-nerve model was used to verify that the interaural correlations in TFS differed across conditions, whereas the ENVs retained a high degree of correlation, as intended. Overall, the results from this study revealed that binaural TFS cues, especially for frequency regions below 1500 Hz, are critical for achieving SRM in NH listeners. Potential implications for studying SRM in hearing-impaired listeners are discussed. SIGNIFICANCE STATEMENT: Acoustic signals received by the auditory system pass first through an array of physiologically based band-pass filters. Conceptually, at the output of each filter, there are two principal forms of temporal information: slowly varying fluctuations in the envelope (ENV) and rapidly varying fluctuations in the temporal fine structure (TFS). The importance of these two types of information in everyday listening (e.g., conversing in a noisy social situation; the "cocktail-party" problem) has not been established. This study assessed the contributions of binaural ENV and TFS cues for understanding speech in multiple-talker situations. Results suggest that, whereas the ENV cues are important for speech intelligibility, binaural TFS cues are critical for perceptually segregating the different talkers and thus for solving the cocktail party problem.

Executive Function, Visual Attention and the Cocktail Party Problem in Musicians and Non-Musicians.

The goal of this study was to investigate how cognitive factors influence performance in a multi-talker, "cocktail-party" like environment in musicians and non-musicians. This was achieved by relating performance in a spatial hearing task to cognitive processing abilities assessed using measures of executive function (EF) and visual attention in musicians and non-musicians. For the spatial hearing task, a speech target was presented simultaneously with two intelligible speech maskers that were either colocated with the target (0° azimuth) or were symmetrically separated from the target in azimuth (at ±15°). EF assessment included measures of cognitive flexibility, inhibition control and auditory working memory. Selective attention was assessed in the visual domain using a multiple object tracking task (MOT). For the MOT task, the observers were required to track target dots (n = 1,2,3,4,5) in the presence of interfering distractor dots. Musicians performed significantly better than non-musicians in the spatial hearing task. For the EF measures, musicians showed better performance on measures of auditory working memory compared to non-musicians. Furthermore, across all individuals, a significant correlation was observed between performance on the spatial hearing task and measures of auditory working memory. This result suggests that individual differences in performance in a cocktail party-like environment may depend in part on cognitive factors such as auditory working memory. Performance in the MOT task did not differ between groups. However, across all individuals, a significant correlation was found between performance in the MOT and spatial hearing tasks. A stepwise multiple regression analysis revealed that musicianship and performance on the MOT task significantly predicted performance on the spatial hearing task. Overall, these findings confirm the relationship between musicianship and cognitive factors including domain-general selective attention and working memory in solving the "cocktail party problem".

Informational Masking in Normal-Hearing and Hearing-Impaired Listeners Measured in a Nonspeech Pattern Identification Task.

Individuals with sensorineural hearing loss (SNHL) often experience more difficulty with listening in multisource environments than do normal-hearing (NH) listeners. While the peripheral effects of sensorineural hearing loss certainly contribute to this difficulty, differences in central processing of auditory information may also contribute. To explore this issue, it is important to account for peripheral differences between NH and these hearing-impaired (HI) listeners so that central effects in multisource listening can be examined. In the present study, NH and HI listeners performed a tonal pattern identification task at two distant center frequencies (CFs), 850 and 3500 Hz. In an attempt to control for differences in the peripheral representations of the stimuli, the patterns were presented at the same sensation level (15 dB SL), and the frequency deviation of the tones comprising the patterns was adjusted to obtain equal quiet pattern identification performance across all listeners at both CFs. Tonal sequences were then presented at both CFs simultaneously (informational masking conditions), and listeners were asked either to selectively attend to a source (CF) or to divide attention between CFs and identify the pattern at a CF designated after each trial. There were large differences between groups in the frequency deviations necessary to perform the pattern identification task. After compensating for these differences, there were small differences between NH and HI listeners in the informational masking conditions. HI listeners showed slightly greater performance asymmetry between the low and high CFs than did NH listeners, possibly due to central differences in frequency weighting between groups.

On the Contribution of Target Audibility to Performance in Spatialized Speech Mixtures.

Hearing loss has been shown to reduce speech understanding in spatialized multitalker listening situations, leading to the common belief that spatial processing is disrupted by hearing loss. This paper describes related studies from three laboratories that explored the contribution of reduced target audibility to this deficit. All studies used a stimulus configuration in which a speech target presented from the front was masked by speech maskers presented symmetrically from the sides. Together these studies highlight the importance of adequate stimulus audibility for optimal performance in spatialized speech mixtures and suggest that reduced access to target speech information might explain a substantial portion of the "spatial" deficit observed in listeners with hearing loss.

Consonant identification in noise using Hilbert-transform temporal fine-structure speech and recovered-envelope speech for listeners with normal and impaired hearing.

Consonant-identification ability was examined in normal-hearing (NH) and hearing-impaired (HI) listeners in the presence of steady-state and 10-Hz square-wave interrupted speech-shaped noise. The Hilbert transform was used to process speech stimuli (16 consonants in a-C-a syllables) to present envelope cues, temporal fine-structure (TFS) cues, or envelope cues recovered from TFS speech. The performance of the HI listeners was inferior to that of the NH listeners both in terms of lower levels of performance in the baseline condition and in the need for higher signal-to-noise ratio to yield a given level of performance. For NH listeners, scores were higher in interrupted noise than in steady-state noise for all speech types (indicating substantial masking release). For HI listeners, masking release was typically observed for TFS and recovered-envelope speech but not for unprocessed and envelope speech. For both groups of listeners, TFS and recovered-envelope speech yielded similar levels of performance and consonant confusion patterns. The masking release observed for TFS and recovered-envelope speech may be related to level effects associated with the manner in which the TFS processing interacts with the interrupted noise signal, rather than to the contributions of TFS cues per se.

Benefits of Acoustic Beamforming for Solving the Cocktail Party Problem.

The benefit provided to listeners with sensorineural hearing loss (SNHL) by an acoustic beamforming microphone array was determined in a speech-on-speech masking experiment. Normal-hearing controls were tested as well. For the SNHL listeners, prescription-determined gain was applied to the stimuli, and performance using the beamformer was compared with that obtained using bilateral amplification. The listener identified speech from a target talker located straight ahead (0° azimuth) in the presence of four competing talkers that were either colocated with, or spatially separated from, the target. The stimuli were spatialized using measured impulse responses and presented via earphones. In the spatially separated masker conditions, the four maskers were arranged symmetrically around the target at ±15° and ±30° or at ±45° and ±90°. Results revealed that masked speech reception thresholds for spatially separated maskers were higher (poorer) on average for the SNHL than for the normal-hearing listeners. For most SNHL listeners in the wider masker separation condition, lower thresholds were obtained through the microphone array than through bilateral amplification. Large intersubject differences were found in both listener groups. The best masked speech reception thresholds overall were found for a hybrid condition that combined natural and beamforming listening in order to preserve localization for broadband sources.

Musical training, individual differences and the cocktail party problem.

Are musicians better able to understand speech in noise than non-musicians? Recent findings have produced contradictory results. Here we addressed this question by asking musicians and non-musicians to understand target sentences masked by other sentences presented from different spatial locations, the classical 'cocktail party problem' in speech science. We found that musicians obtained a substantial benefit in this situation, with thresholds ~6 dB better than non-musicians. Large individual differences in performance were noted particularly for the non-musically trained group. Furthermore, in different conditions we manipulated the spatial location and intelligibility of the masking sentences, thus changing the amount of 'informational masking' (IM) while keeping the amount of 'energetic masking' (EM) relatively constant. When the maskers were unintelligible and spatially separated from the target (low in IM), musicians and non-musicians performed comparably. These results suggest that the characteristics of speech maskers and the amount of IM can influence the magnitude of the differences found between musicians and non-musicians in multiple-talker "cocktail party" environments. Furthermore, considering the task in terms of the EM-IM distinction provides a conceptual framework for future behavioral and neuroscientific studies which explore the underlying sensory and cognitive mechanisms contributing to enhanced "speech-in-noise" perception by musicians.