The Cambridge aided loudness profile (CALP): item choices and data for unaided listening by young and older normal-hearing listeners and older hearing-impaired listeners.

OBJECTIVE: To develop an improved version of the profile of aided loudness (PAL), intended for assessment of the appropriateness of the loudness of everyday sounds. DESIGN: Initially, 16 participants with a range of ages and degrees of hearing loss indicated whether they encountered each situation described in the PAL and how specific they considered the description to be. Based on the responses, most situations from the PAL were eliminated and new situations were introduced, giving the Cambridge Aided Loudness Profile (CALP). The CALP was administered to 80 young and 22 older participants with normal hearing, who rated the loudness of each situation and satisfaction with this loudness (as for the original PAL). Satisfaction was strongly negatively correlated with loudness, suggesting that satisfaction was largely based on loudness. The CALP was then administered to 32 new young normal-hearing participants and 49 older participants with hearing loss, most of whom used hearing aids, who rated loudness and the appropriateness of loudness. RESULTS: Some situations were rated as loud but appropriate in loudness, indicating that the CALP can distinguish these aspects. CONCLUSIONS: The CALP questions were understood by all participants. The CALP may be useful for assessing the appropriateness of loudness.

Effects of hearing loss, age, noise exposure, and listening skills on envelope regularity discrimination.

The envelope regularity discrimination (ERD) test assesses the ability to discriminate irregular from regular amplitude modulation (AM). The measured threshold is called the irregularity index (II). It was hypothesized that the II at threshold should be almost unaffected by the loudness recruitment that is associated with cochlear hearing loss because the effect of recruitment is similar to multiplying the AM depth by a certain factor, and II values depend on the amount of envelope irregularity relative to the baseline modulation depth. To test this hypothesis, the ERD test was administered to 60 older adults with varying degrees of hearing loss, using carrier frequencies of 1 and 4 kHz. The II values for the two carrier frequencies were highly correlated, indicating that the ERD test was measuring a consistent characteristic of each subject. The II values at 1 and 4 kHz were not significantly correlated with the audiometric thresholds at the corresponding frequencies, consistent with the hypothesis. The II values at 4 kHz were significantly positively correlated with age. There was an unexpected negative correlation between II values and a measure of noise exposure. This is argued to reflect the confounding effects of listening skills.

The effect of recreational noise exposure on amplitude-modulation detection, hearing sensitivity at frequencies above 8 kHz, and perception of speech in noise.

Psychoacoustic and speech perception measures were compared for a group who were exposed to noise regularly through listening to music via personal music players (PMP) and a control group without such exposure. Lifetime noise exposure, quantified using the NESI questionnaire, averaged ten times higher for the exposed group than for the control group. Audiometric thresholds were similar for the two groups over the conventional frequency range up to 8 kHz, but for higher frequencies, the exposed group had higher thresholds than the control group. Amplitude modulation detection (AMD) thresholds were measured using a 4000-Hz sinusoidal carrier presented in threshold-equalizing noise at 30, 60, and 90 dB sound pressure level (SPL) for modulation frequencies of 8, 16, 32, and 64 Hz. At 90 dB SPL but not at the lower levels, AMD thresholds were significantly higher (worse) for the exposed than for the control group, especially for low modulation frequencies. The exposed group required significantly higher signal-to-noise ratios than the control group to understand sentences in noise. Otoacoustic emissions did not differ for the two groups. It is concluded that listening to music via PMP can have subtle deleterious effects on speech perception, AM detection, and hearing sensitivity over the extended high-frequency range.

Psychometric evaluation of the tinnitus impact questionnaire using patients seeking help for tinnitus or tinnitus with hyperacusis.

OBJECTIVE: To evaluate the psychometric properties of the Tinnitus Impact Questionnaire (TIQ), whose questions focus on assessing the impact of tinnitus on the patient's day to day activities, mood, and sleep, and not on hearing difficulties. DESIGN: This was a retrospective cross-sectional study. STUDY SAMPLE: Data were included for 172 adult patients who attended a tinnitus and hyperacusis clinic in the UK within a six-month period and who had completed the TIQ. RESULTS: Two items whose scores were very highly correlated with those for other items were removed, leaving seven items. Exploratory factor analysis suggested a single factor for the TIQ. A multiple causes multiple indicator model showed significant but very small direct effects of age on TIQ scores for two items, after adjustment for gender. The TIQ had excellent internal consistency, with Cronbach's alpha = 0.89. The total TIQ score was moderately to strongly correlated with scores for the Tinnitus Handicap Inventory, Screening for Anxiety and Depression-Tinnitus questionnaire, Hyperacusis Questionnaire, and Hyperacusis Impact Questionnaire, indicating convergent validity. The TIQ score was weakly correlated with the pure-tone average hearing threshold, indicating discriminant validity. CONCLUSIONS: The TIQ is a brief, valid and internally consistent questionnaire for assessing the impact of tinnitus.

A comparison of interaural asymmetry, audiogram slope, and psychometric measures of tinnitus, hyperacusis, anxiety and depression for patients with unilateral and bilateral tinnitus.

OBJECTIVE: To evaluate differences in tinnitus impact, hyperacusis and hearing threshold level (HTL) between patients with unilateral and bilateral tinnitus. For patients with unilateral tinnitus, to compare audiological variables for the tinnitus ear and the non-tinnitus ear. To assess whether the presence of unilateral tinnitus increases the likelihood of interaural hearing asymmetry (relative to bilateral tinnitus) that warrants referral for an MRI scan. DESIGN: Retrospective cross-sectional. STUDY SAMPLE: Data regarding HTLs and responses to self-report questionnaires were collected from the records of 311 patients attending a tinnitus clinic. RESULTS: 38.5% had unilateral tinnitus and the ears with tinnitus had higher HTLs and greater HTL slopes than the ears without tinnitus. There was no significant difference in tinnitus impact and hyperacusis between patients with unilateral and bilateral tinnitus. 40% of patients with unilateral tinnitus and 13% of patients with bilateral tinnitus had a between-ear difference in HTL ≥15 dB at two adjacent frequencies (2AF15 asymmetry). Unilateral tinnitus increased the risk of 2AF15 asymmetry by a factor of 4.4. CONCLUSIONS: Unilateral tinnitus increases the risk of having interaural asymmetry in HTLs that warrants referral for an MRI scan.

An association between auditory responsiveness of children and duration of entertainment screen time in the early years of life.

OBJECTIVE: To examine whether the responsiveness of young children to simple sounds was associated with entertainment screen time (EST), opportunities for social interaction, and social and communication skills. DESIGN: Parents completed a questionnaire covering, for years one and two, the number of times the child met with other children; the number of words the child spoke; and the daily amount of EST. Social, attention and communication skills were assessed. STUDY SAMPLE: Participants were 118 children, aged 15 to 46 months. They were initially assessed behaviourally using simple sounds. Children who responded to such sounds were denoted the Responsive group. Children who did not were assessed using familiar songs and denoted the Unresponsive group. RESULTS: The two groups did not differ significantly in mean age or the number of opportunities to meet other children. The Unresponsive group had significantly fewer words than the Responsive group at 12 and 24 months and had significantly higher EST than the Responsive group for years 1 and 2. The Unresponsive group showed lower social, attention and communication skills than the Responsive group. CONCLUSIONS: High EST was associated with poorer auditory and social skills. Hence, it may be wise to limit the EST of young children.

Partial visual loss disrupts the relationship between judged room size and sound source distance.

Visual spatial information plays an important role in calibrating auditory space. Blindness results in deficits in a number of auditory abilities, which have been explained in terms of the hypothesis that visual information is needed to calibrate audition. When judging the size of a novel room when only auditory cues are available, normally sighted participants may use the location of the farthest sound source to infer the nearest possible distance of the far wall. However, for people with partial visual loss (distinct from blindness in that some vision is present), such a strategy may not be reliable if vision is needed to calibrate auditory cues for distance. In the current study, participants were presented with sounds at different distances (ranging from 1.2 to 13.8 m) in a simulated reverberant (T60 = 700 ms) or anechoic room. Farthest distance judgments and room size judgments (volume and area) were obtained from blindfolded participants (18 normally sighted, 38 partially sighted) for speech, music, and noise stimuli. With sighted participants, the judged room volume and farthest sound source distance estimates were positively correlated (p < 0.05) for all conditions. Participants with visual losses showed no significant correlations for any of the conditions tested. A similar pattern of results was observed for the correlations between farthest distance and room floor area estimates. Results demonstrate that partial visual loss disrupts the relationship between judged room size and sound source distance that is shown by sighted participants.

Estimation of all-cause noise exposure for U.S. adults from national survey data.

Millions of adults are at risk of hearing loss resulting from exposure to occupational and recreational noises. Data from the combined National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2015-2016 datasets were used to establish the prevalence of occupational and recreational noise exposures through self-report questions. For recreational noise exposures, NHANES asked about the use of firearms, including the use of hearing protection devices (HPDs) while shooting, and off-work exposures to very loud noise. For work exposures, NHANES asked about exposures to loud and very loud noise. For four of these five questions, graded responses on a 5- or 7-point scale were available. Receiver-operating-characteristic analyses were used to optimize the criterion response for identification of hearing loss for each question with graded responses using the unweighted data. Correlations among the graded responses supported reduction to two measures: (1) rounds fired combined with use of HPDs while shooting and (2) work exposure to loud and very loud noise combined. Logistic-regression analyses of various measures of pure-tone hearing loss were performed to examine the effects of recreational and occupational noise exposures on hearing loss. The odds of hearing loss were significantly greater for those who reported recreational and combined noise exposures.

A deep learning solution to the marginal stability problems of acoustic feedback systems for hearing aids.

For hearing aids, it is critical to reduce the acoustic coupling between the receiver and microphone to ensure that prescribed gains are below the maximum stable gain, thus preventing acoustic feedback. Methods for doing this include fixed and adaptive feedback cancellation, phase modulation, and gain reduction. However, the behavior of hearing aids in situations where the prescribed gain is only just below the maximum stable gain, called here "marginally stable gain," is not well understood. This paper analyzed marginally stable systems and identified three problems, including increased gain at frequencies with the smallest gain margin, short whistles caused by the limited rate of decay of the output when the input drops, and coloration effects. A deep learning framework, called deep marginal feedback cancellation (DeepMFC), was developed to suppress short whistles, and reduce coloration effects, as well as to limit excess amplification at certain frequencies. To implement DeepMFC, many receiver signals in closed-loop systems and corresponding open-loop systems were simulated, and the receiver signals of the closed-loop and open-loop systems were paired together to obtain parallel signals for training. DeepMFC achieved much better performance than existing feedback control methods using objective and subjective measures.

The effect of age and hearing sensitivity at frequencies above 8 kHz on auditory stream segregation and speech perception.

The effects of age and mild hearing loss over the extended high-frequency (EHF) range from 9000 to 16 000 Hz on speech perception and auditory stream segregation were assessed using four groups: (1) young with normal hearing threshold levels (HTLs) over both the conventional and EHF range; (2) older with audiograms matched to those for group 1; (3) young with normal HTLs over the conventional frequency range and elevated HTLs over the EHF range; (4) older with audiograms matched to those for group 3. For speech in quiet, speech recognition thresholds and speech identification scores did not differ significantly across groups. For monosyllables in noise, both greater age and hearing loss over the EHF range adversely affected performance, but the effect of age was much larger than the effect of hearing status. Stream segregation was assessed using a rapid sequence of vowel stimuli differing in fundamental frequency (F0). Larger differences in F0 were required for stream segregation for the two groups with impaired hearing in the EHF range, but there was no significant effect of age. It is argued that impaired hearing in the EHF range is associated with impaired auditory function at lower frequencies, despite normal audiometric thresholds at those frequencies.

Psychometric evaluation of the 4C tinnitus management questionnaire for patients with tinnitus alone or tinnitus combined with hyperacusis.

OBJECTIVE: To assess the psychometric properties of a new questionnaire evaluating patients' confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. DESIGN: Retrospective cross-sectional based on patient records. STUDY SAMPLES: 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. RESULTS: Cronbach's alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. CONCLUSIONS: The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients' confidence in managing their tinnitus.

Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms.

OBJECTIVES: The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population. DESIGN: This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9. RESULTS: Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with highest overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%. CONCLUSIONS: The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis.

Factors Affecting Auditory Estimates of Virtual Room Size: Effects of Stimulus, Level, and Reverberation.

When vision is unavailable, auditory level and reverberation cues provide important spatial information regarding the environment, such as the size of a room. We investigated how room-size estimates were affected by stimulus type, level, and reverberation. In Experiment 1, 15 blindfolded participants estimated room size after performing a distance bisection task in virtual rooms that were either anechoic (with level cues only) or reverberant (with level and reverberation cues) with a relatively short reverberation time of T60 = 400 milliseconds. Speech, noise, or clicks were presented at distances between 1.9 and 7.1 m. The reverberant room was judged to be significantly larger than the anechoic room (p < .05) for all stimuli. In Experiment 2, only the reverberant room was used and the overall level of all sounds was equalized, so only reverberation cues were available. Ten blindfolded participants took part. Room-size estimates were significantly larger for speech than for clicks or noise. The results show that when level and reverberation cues are present, reverberation increases judged room size. Even relatively weak reverberation cues provide room-size information, which could potentially be used by blind or visually impaired individuals encountering novel rooms.

Sensitivity and specificity of a method for diagnosis of military noise-induced hearing loss.

Moore [(2020). J. Acoust. Soc. Am. 148, 884-894] proposed a method for the diagnosis of hearing loss produced by noise exposure during military service (denoted M-NIHL) based on the audiogram. This letter characterizes the sensitivity and specificity of the method, based on 116 ears of men claiming compensation for M-NIHL and 244 ears of an age-matched non-noise-exposed control group of men screened to match the noise-exposed group in age, absence of conductive hearing loss, no history of ear diseases, and asymmetry across ears ≤10 dB. The sensitivity was 0.97 and the specificity was 0.67, giving a discriminability index d' of 2.3.

Forward masking of amplitude modulation across ears and its tuning in the modulation domain.

Frequency selectivity in the amplitude modulation (AM) domain has been demonstrated using both simultaneous AM masking and forward AM masking. This has been explained using the concept of a modulation filter bank (MFB). Here, we assessed whether the MFB occurs before or after the point of binaural interaction in the auditory pathway by using forward masking in the AM domain in an ipsilateral condition (masker AM and signal AM applied to the left ear with an unmodulated carrier in the right ear) and a contralateral condition (masker AM applied to the right ear and signal AM applied to the left ear). The carrier frequency was 8 kHz, the signal AM frequency, fs, was 40 or 80 Hz, and the masker AM frequency ranged from 0.25 to 4 times fs. Contralateral forward AM masking did occur, but it was smaller than ipsilateral AM masking. Tuning in the AM domain was slightly sharper for ipsilateral than for contralateral masking, perhaps reflecting confusion of the signal and masker AM in the ipsilateral condition when their AM frequencies were the same. The results suggest that there might be an MFB both before and after the point in the auditory pathway where binaural interaction occurs.

Audiometric assessment of hearing loss sustained during military service.

An analysis is presented of the audiograms, obtained using Telephonics TDH39 headphones (Huntington, NY), of 80 men claiming compensation for noise-induced hearing loss (NIHL) sustained during military service. A comparison with an independent database of audiograms collected using other headphones suggested that no adjustment was needed to the hearing threshold levels (HTLs) at 6 kHz to allow for the use of TDH39 headphones. The method of Moore [(2020). J. Acoust. Soc. Am. 148, 884-894] for diagnosing military noise-induced hearing loss (M-NIHL) gave a positive diagnosis for 92.5% of right ears and 97.5% of left ears. The mean HTLs were maximal and similar at 4, 6, and 8 kHz but with considerable individual variability. A comparison with age-expected HTLs showed that M-NIHL was typically greatest at 3, 4, 6, or 8 kHz but with considerable individual variability. M-NIHL values were positive from 0.5 to 8 kHz. The HTLs were significantly higher for the left than for the right ears, but the asymmetry varied across individuals and could usually be ascribed to specific features of the noise exposure. The asymmetry existed over the range from 0.5 to 8 kHz, supporting the idea that M-NIHL occurs over a wide frequency range. Tinnitus was reported by 76 of the 80 men.

Development of binaural temporal fine structure sensitivity in children.

The highest frequency for which the temporal fine structure (TFS) of a sinewave can be compared across ears varies between listeners with an upper limit of about 1400 Hz for young normal-hearing adults (YNHA). In this study, binaural TFS sensitivity was investigated for 63 typically developing children, aged 5 years, 6 months to 9 years, 4 months using the temporal fine structure-adaptive frequency (TFS-AF) test of Füllgrabe, Harland, Sek, and Moore [Int. J. Audiol. 56, 926-935 (2017)]. The test assesses the highest frequency at which an interaural phase difference (IPD) of ϕ° can be distinguished from an IPD of 0°. The values of ϕ were 30° and 180°. The starting frequency was 200 Hz. The thresholds for the children were significantly lower (worse) than the thresholds reported by Füllgrabe, Harland, Sek, and Moore [Int. J. Audiol. 56, 926-935 (2017)] for YNHA. For both values of ϕ, the median age at which children performed above chance level was significantly higher (p < 0.001) than for those who performed at chance. For the subgroup of 40 children who performed above chance for ϕ = 180°, the linear regression analyses showed that the thresholds for ϕ = 180° increased (improved) significantly with increasing age (p < 0.001) with adult-like thresholds predicted to be reached at 10 years, 2 months of age. The implications for spatial release from masking are discussed.

Telehealth tinnitus therapy during the COVID-19 outbreak in the UK: uptake and related factors.

OBJECTIVE: The Audiology Department at the Royal Surrey County Hospital usually offers face-to-face audiologist-delivered cognitive behavioural therapy (CBT) for tinnitus rehabilitation. During COVID-19 lockdown, patients were offered telehealth CBT via video using a web-based platform. This study evaluated the proportion of patients who took up the offer of telehealth sessions and factors related to this. DESIGN: Retrospective service evaluation. STUDY SAMPLE: 113 consecutive patients whose care was interrupted by the lockdown. RESULTS: 80% of patients accepted telehealth. The main reasons for declining were not having access to a suitable device and the belief that telehealth appointments would not be useful. Compared to having no hearing loss in the better ear, having a mild or moderate hearing loss increased the chance of declining telehealth by factors of 3.5 (p = 0.04) and 14.9 (p = 0.038), respectively. High tinnitus annoyance as measured via the visual analogue scale increased the chance of declining telehealth appointments by a factor of 1.4 (p = 0.019). CONCLUSIONS: Although CBT via telehealth was acceptable to most patients, alternatives may be necessary for the 20% who declined. These tended to have worse hearing in their better ear and more annoying tinnitus.

Diagnosis and quantification of military noise-induced hearing loss.

The diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context are usually based on the pattern of hearing loss that is typically associated with long-term exposure to steady broadband noises, such as occur in noisy factories. Evidence is reviewed showing that this pattern is not typical for hearing loss produced by intense impulsive sounds of the type that military personnel are exposed to. The audiometric characteristics of noise-exposed military personnel are reviewed. A set of audiograms from a sample of 58 hearing-impaired noise-exposed military veterans was analyzed and used to develop methods for the diagnosis and quantification of military NIHL. Three requirements are specified for diagnosing military NIHL. Quantification of any loss is done by comparison with audiometric thresholds for non-noise exposed individuals, as specified in ISO7029 [International Organization for Standardization, 2017].

Pitch perception at very high frequencies: On psychometric functions and integration of frequency information.

Lau et al. [J. Neurosci. 37, 9013-9021 (2017)] showed that discrimination of the fundamental frequency (F0) of complex tones with components in a high-frequency region was better than predicted from the optimal combination of information from the individual harmonics. The predictions depend on the assumption that psychometric functions for frequency discrimination have a slope of 1 at high frequencies. This was tested by measuring psychometric functions for F0 discrimination and frequency discrimination. Difference limens for F0 (F0DLs) and difference limens for frequency for each frequency component were also measured. Complex tones contained harmonics 6-10 and had F0s of 280 or 1400 Hz. Thresholds were measured using 210-ms tones presented diotically in diotic threshold-equalizing noise (TEN), and 1000-ms tones presented diotically in dichotic TEN. The slopes of the psychometric functions were close to 1 for all frequencies and F0s. The ratio of predicted to observed F0DLs was around 1 or smaller for both F0s, i.e., not super-optimal, and was significantly smaller for the low than for the high F0. The results are consistent with the idea that place information alone can convey pitch, but pitch is more salient when phase-locking information is available.