Entropy as a Measure of Auditory Environment Diversity: An Ecological Momentary Assessment (EMA) Approach.

OBJECTIVES: To determine the validity and usefulness of entropy computed using ecological momentary assessment (EMA) data as a measure of auditory environment diversity. DESIGN: We conducted two secondary analyses on existing EMA datasets. The first determined the construct validity of auditory environment entropy by examining the effect of COVID-19 on entropy. To demonstrate entropy's usefulness, the second examined if entropy could predict the benefit of hearing aid (HA) noise reduction features. RESULTS: Consistent with the known effect of COVID-19 on social lifestyle, COVID-19 significantly reduced auditory environment diversity, supporting entropy's construct validity. HA users with higher entropy reported poorer outcomes and perceived more benefit from HA features, supporting the feasibility of using entropy to predict communication performance and feature benefit. CONCLUSIONS: Entropy derived from EMA data is a valid and useful auditory environment diversity measure. This measure could allow researchers to better understand the communication needs of people with hearing loss.

The Influence of Forced Social Isolation on the Auditory Ecology and Psychosocial Functions of Listeners With Cochlear Implants During COVID-19 Mitigation Efforts.

OBJECTIVES: The impact of social distancing on communication and psychosocial variables among individuals with hearing impairment during COVID-19 pandemic. It was our concern that patients who already found themselves socially isolated (Wie et al. 2010) as a result of their hearing loss would be perhaps more susceptible to changes in their communication habits resulting in further social isolation, anxiety, and depression. We wanted to better understand how forced social isolation (as part of COVID-19 mitigation) effected a group of individuals with hearing impairment from an auditory ecology and psychosocial perspective. We hypothesized that the listening environments would be different as a result of social isolation when comparing subject's responses regarding activities and participation before COVID-19 and during the COVID-19 pandemic. This change would lead to an increase in experienced and perceived social isolation, anxiety, and depression. DESIGN: A total of 48 adults with at least 12 months of cochlear implant (CI) experience reported their listening contexts and experiences pre-COVID and during-COVID using Ecological Momentary Assessment (EMA; methodology collecting a respondent's self-reports in their natural environments) through a smartphone-based app, and six paper and pencil questionnaires. The Smartphone app and paper-pencil questionnaires address topics related to their listening environment, social isolation, depression, anxiety, lifestyle and demand, loneliness, and satisfaction with amplification. Data from these two-time points were compared to better understand the effects of social distancing on the CI recipients' communication abilities. RESULTS: EMA demonstrated that during-COVID CI recipients were more likely to stay home or be outdoors. CI recipients reported that they were less likely to stay indoors outside of their home relative to the pre-COVID condition. Social distancing also had a significant effect on the overall signal-to-noise ratio of the environments indicating that the listening environments had better signal-to-noise ratios. CI recipients also reported better speech understanding, less listening effort, less activity limitation due to hearing loss, less social isolation due to hearing loss, and less anxiety due to hearing loss. Retrospective questionnaires indicated that social distancing had a significant effect on the social network size, participant's personal image of themselves, and overall loneliness. CONCLUSIONS: Overall, EMA provided us with a glimpse of the effect that forced social isolation has had on the listening environments and psychosocial perspectives of a select number of CI listeners. CI participants in this study reported that they were spending more time at home in a quieter environments during-COVID. Contrary to our hypothesis, CI recipients overall felt less socially isolated and reported less anxiety resulting from their hearing difficulties during-COVID in comparison to pre-COVID. This, perhaps, implies that having a more controlled environment with fewer speakers provided a more relaxing listening experience.

GPS predicts stability of listening environment characteristics in one location over time among older hearing aid users.

OBJECTIVE: Hearing aid technology can allow users to "geo-tag" hearing aid preferences using the Global Positioning System (GPS). This technology assumes that listening environment characteristics that affect hearing aid benefit change little in a location over time. The purpose of this study was to investigate whether certain characteristics (reverberation, signal type, listening activity, noise location, noisiness, talker familiarity, talker location, and visual cues) changed in a location over time. Design: Participants completed GPS-tagged surveys on smartphones to report on characteristics of their listening environments. Coordinates were used to create indices that described how much listening environment characteristics changed in a location over time. Indices computed in one location were compared to indices computed across all locations for each participant. Study sample: 54 adults with hearing loss participated in this study (26 males and 38 females; 30 experienced hearing aid users and 24 new users). Results: A location dependency was observed for all characteristics. Characteristics were significantly different from one another in their stability over time. Conclusions: Listening environment characteristics changed less over time in a given location than in participants' lives generally. The effectiveness of GPS-dependent hearing aid settings likely depends on the accuracy and location definition of the GPS feature.

Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss.

OBJECTIVES: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. DESIGN: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. RESULTS: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants' daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. CONCLUSIONS: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study's generalizability (e.g., participant's lifestyle) are discussed.

Characteristics of Real-World Signal to Noise Ratios and Speech Listening Situations of Older Adults With Mild to Moderate Hearing Loss.

OBJECTIVES: The first objective was to determine the relationship between speech level, noise level, and signal to noise ratio (SNR), as well as the distribution of SNR, in real-world situations wherein older adults with hearing loss are listening to speech. The second objective was to develop a set of prototype listening situations (PLSs) that describe the speech level, noise level, SNR, availability of visual cues, and locations of speech and noise sources of typical speech listening situations experienced by these individuals. DESIGN: Twenty older adults with mild to moderate hearing loss carried digital recorders for 5 to 6 weeks to record sounds for 10 hours per day. They also repeatedly completed in situ surveys on smartphones several times per day to report the characteristics of their current environments, including the locations of the primary talker (if they were listening to speech) and noise source (if it was noisy) and the availability of visual cues. For surveys where speech listening was indicated, the corresponding audio recording was examined. Speech-plus-noise and noise-only segments were extracted, and the SNR was estimated using a power subtraction technique. SNRs and the associated survey data were subjected to cluster analysis to develop PLSs. RESULTS: The speech level, noise level, and SNR of 894 listening situations were analyzed to address the first objective. Results suggested that as noise levels increased from 40 to 74 dBA, speech levels systematically increased from 60 to 74 dBA, and SNR decreased from 20 to 0 dB. Most SNRs (62.9%) of the collected recordings were between 2 and 14 dB. Very noisy situations that had SNRs below 0 dB comprised 7.5% of the listening situations. To address the second objective, recordings and survey data from 718 observations were analyzed. Cluster analysis suggested that the participants' daily listening situations could be grouped into 12 clusters (i.e., 12 PLSs). The most frequently occurring PLSs were characterized as having the talker in front of the listener with visual cues available, either in quiet or in diffuse noise. The mean speech level of the PLSs that described quiet situations was 62.8 dBA, and the mean SNR of the PLSs that represented noisy environments was 7.4 dB (speech = 67.9 dBA). A subset of observations (n = 280), which was obtained by excluding the data collected from quiet environments, was further used to develop PLSs that represent noisier situations. From this subset, two PLSs were identified. These two PLSs had lower SNRs (mean = 4.2 dB), but the most frequent situations still involved speech from in front of the listener in diffuse noise with visual cues available. CONCLUSIONS: The present study indicated that visual cues and diffuse noise were exceedingly common in real-world speech listening situations, while environments with negative SNRs were relatively rare. The characteristics of speech level, noise level, and SNR, together with the PLS information reported by the present study, can be useful for researchers aiming to design ecologically valid assessment procedures to estimate real-world speech communicative functions for older adults with hearing loss.

Psychometric Functions of Dual-Task Paradigms for Measuring Listening Effort.

OBJECTIVES: The purpose of the study was to characterize the psychometric functions that describe task performance in dual-task listening effort measures as a function of signal to noise ratio (SNR). DESIGN: Younger adults with normal hearing (YNH, n = 24; experiment 1) and older adults with hearing impairment (n = 24; experiment 2) were recruited. Dual-task paradigms wherein the participants performed a primary speech recognition task simultaneously with a secondary task were conducted at a wide range of SNRs. Two different secondary tasks were used: an easy task (i.e., a simple visual reaction-time task) and a hard task (i.e., the incongruent Stroop test). The reaction time (RT) quantified the performance of the secondary task. RESULTS: For both participant groups and for both easy and hard secondary tasks, the curves that described the RT as a function of SNR were peak shaped. The RT increased as SNR changed from favorable to intermediate SNRs, and then decreased as SNRs moved from intermediate to unfavorable SNRs. The RT reached its peak (longest time) at the SNRs at which the participants could understand 30 to 50% of the speech. In experiments 1 and 2, the dual-task trials that had the same SNR were conducted in one block. To determine if the peak shape of the RT curves was specific to the blocked SNR presentation order used in these experiments, YNH participants were recruited (n = 25; experiment 3) and dual-task measures, wherein the SNR was varied from trial to trial (i.e., nonblocked), were conducted. The results indicated that, similar to the first two experiments, the RT curves had a peak shape. CONCLUSIONS: Secondary task performance was poorer at the intermediate SNRs than at the favorable and unfavorable SNRs. This pattern was observed for both YNH and older adults with hearing impairment participants and was not affected by either task type (easy or hard secondary task) or SNR presentation order (blocked or nonblocked). The shorter RT at the unfavorable SNRs (speech intelligibility < 30%) possibly reflects that the participants experienced cognitive overload and/or disengaged themselves from the listening task. The implication of using the dual-task paradigm as a listening effort measure is discussed.

Measuring listening effort: driving simulator versus simple dual-task paradigm.

OBJECTIVES: The dual-task paradigm has been widely used to measure listening effort. The primary objectives of the study were to (1) investigate the effect of hearing aid amplification and a hearing aid directional technology on listening effort measured by a complicated, more real world dual-task paradigm and (2) compare the results obtained with this paradigm to a simpler laboratory-style dual-task paradigm. DESIGN: The listening effort of adults with hearing impairment was measured using two dual-task paradigms, wherein participants performed a speech recognition task simultaneously with either a driving task in a simulator or a visual reaction-time task in a sound-treated booth. The speech materials and road noises for the speech recognition task were recorded in a van traveling on the highway in three hearing aid conditions: unaided, aided with omnidirectional processing (OMNI), and aided with directional processing (DIR). The change in the driving task or the visual reaction-time task performance across the conditions quantified the change in listening effort. RESULTS: Compared to the driving-only condition, driving performance declined significantly with the addition of the speech recognition task. Although the speech recognition score was higher in the OMNI and DIR conditions than in the unaided condition, driving performance was similar across these three conditions, suggesting that listening effort was not affected by amplification and directional processing. Results from the simple dual-task paradigm showed a similar trend: hearing aid technologies improved speech recognition performance, but did not affect performance in the visual reaction-time task (i.e., reduce listening effort). The correlation between listening effort measured using the driving paradigm and the visual reaction-time task paradigm was significant. The finding showing that our older (56 to 85 years old) participants' better speech recognition performance did not result in reduced listening effort was not consistent with literature that evaluated younger (approximately 20 years old), normal hearing adults. Because of this, a follow-up study was conducted. In the follow-up study, the visual reaction-time dual-task experiment using the same speech materials and road noises was repeated on younger adults with normal hearing. Contrary to findings with older participants, the results indicated that the directional technology significantly improved performance in both speech recognition and visual reaction-time tasks. CONCLUSIONS: Adding a speech listening task to driving undermined driving performance. Hearing aid technologies significantly improved speech recognition while driving, but did not significantly reduce listening effort. Listening effort measured by dual-task experiments using a simulated real-world driving task and a conventional laboratory-style task was generally consistent. For a given listening environment, the benefit of hearing aid technologies on listening effort measured from younger adults with normal hearing may not be fully translated to older listeners with hearing impairment.

The effect of hearing aid signal-processing schemes on acceptable noise levels: perception and prediction.

OBJECTIVES: The acceptable noise level (ANL) test determines the maximum noise level that an individual is willing to accept while listening to speech. The first objective of the present study was to systematically investigate the effect of wide dynamic range compression processing (WDRC), and its combined effect with digital noise reduction (DNR) and directional processing (DIR), on ANL. Because ANL represents the lowest signal-to-noise ratio (SNR) that a listener is willing to accept, the second objective was to examine whether the hearing aid output SNR could predict aided ANL across different combinations of hearing aid signal-processing schemes. DESIGN: Twenty-five adults with sensorineural hearing loss participated in the study. ANL was measured monaurally in two unaided and seven aided conditions, in which the status of the hearing aid processing schemes (enabled or disabled) and the location of noise (front or rear) were manipulated. The hearing aid output SNR was measured for each listener in each condition using a phase-inversion technique. The aided ANL was predicted by unaided ANL and hearing aid output SNR, under the assumption that the lowest acceptable SNR at the listener's eardrum is a constant across different ANL test conditions. RESULTS: Study results revealed that, on average, WDRC increased (worsened) ANL by 1.5 dB, while DNR and DIR decreased (improved) ANL by 1.1 and 2.8 dB, respectively. Because the effects of WDRC and DNR on ANL were opposite in direction but similar in magnitude, the ANL of linear/DNR-off was not significantly different from that of WDRC/DNR-on. The results further indicated that the pattern of ANL change across different aided conditions was consistent with the pattern of hearing aid output SNR change created by processing schemes. CONCLUSIONS: Compared with linear processing, WDRC creates a noisier sound image and makes listeners less willing to accept noise. However, this negative effect on noise acceptance can be offset by DNR, regardless of microphone mode. The hearing aid output SNR derived using the phase-inversion technique can predict aided ANL across different combinations of signal-processing schemes. These results suggest a close relationship between aided ANL, signal-processing scheme, and hearing aid output SNR.

Hearing-aid users' voices: a factor that could affect directional benefit.

OBJECTIVE: Backward-facing directional processing (Back-DIR) is an algorithm that employs an anti-cardioid directivity pattern to enhance speech arriving from behind the listener. An experiment that was originally designed to evaluate Back-DIR, together with its follow-up experiment, are reported to illustrate how hearing-aid users' voices could affect directional benefit. DESIGN: Speech recognition performance was measured in a speech-180°/noise-0° configuration, with aids programmed to Back-DIR enabled or omnidirectional processing. In the original experiment, the conventional hearing-in-noise test (HINT) was used, wherein listeners repeated heard sentences. In the follow-up experiment, a modified HINT was used, wherein a carrier phrase was presented before each sentence. STUDY SAMPLE: Fifteen adults with sensorineural hearing loss participated in both experiments. RESULTS: Significant Back-DIR benefit (relative to omnidirectional processing) was observed in the follow-up experiment, while not in the original experiment. CONCLUSIONS: In the original experiment, hearing aids were affected by listeners' voices such that Back-DIR was not always activated when the target speech was presented. In the follow-up experiment, listeners' voice effects were eliminated by the carrier phrase activating Back-DIR before the sentences were presented. The results suggest that the effect of hearing-aid technologies is highly dependent on the characteristics of listening conditions.

The equivalence of acceptable noise level (ANL) with English, Mandarin, and non-semantic speech: a study across the U.S. and Taiwan.

OBJECTIVE: Acceptable noise level (ANL) determines the maximum noise level that a listener is willing to accept while listening to speech. The objective of this study was to determine the equivalence of ANL measured using different speech stimuli for native speakers who lived in the U.S. and Taiwan. DESIGN: ANLs were measured using English, Mandarin, and the international speech test signal (ISTS) at each site. The same babble noise was used across speech stimuli. The ANLs were considered equivalent if the difference was unlikely to be greater than 3 dB. STUDY SAMPLE: Thirty adults with normal hearing were recruited at each site. RESULTS: For each site, the equivalence test suggested that the native-language and foreign-language ANLs were equivalent. Between the two sites, ANLs measured using the listener's native language were also equivalent. Although the ISTS ANL obtained within each site was equivalent to, and highly correlated to, the native-language ANL, the data were unable to confirm the equivalence of the ISTS ANLs obtained from the two sites. CONCLUSIONS: The results suggested the possibility of directly comparing ANL measures carried out in different countries using different languages. However, it remains unclear if the ISTS can serve as an international ANL stimulus.

The effect of hearing aid technologies on listening in an automobile.

BACKGROUND: Communication while traveling in an automobile often is very difficult for hearing aid users. This is because the automobile/road noise level is usually high, and listeners/drivers often do not have access to visual cues. Since the talker of interest usually is not located in front of the listener/driver, conventional directional processing that places the directivity beam toward the listener's front may not be helpful and, in fact, could have a negative impact on speech recognition (when compared to omnidirectional processing). Recently, technologies have become available in commercial hearing aids that are designed to improve speech recognition and/or listening effort in noisy conditions where talkers are located behind or beside the listener. These technologies include (1) a directional microphone system that uses a backward-facing directivity pattern (Back-DIR processing), (2) a technology that transmits audio signals from the ear with the better signal-to-noise ratio (SNR) to the ear with the poorer SNR (Side-Transmission processing), and (3) a signal processing scheme that suppresses the noise at the ear with the poorer SNR (Side-Suppression processing). PURPOSE: The purpose of the current study was to determine the effect of (1) conventional directional microphones and (2) newer signal processing schemes (Back-DIR, Side-Transmission, and Side-Suppression) on listener's speech recognition performance and preference for communication in a traveling automobile. RESEARCH DESIGN: A single-blinded, repeated-measures design was used. STUDY SAMPLE: Twenty-five adults with bilateral symmetrical sensorineural hearing loss aged 44 through 84 yr participated in the study. DATA COLLECTION AND ANALYSIS: The automobile/road noise and sentences of the Connected Speech Test (CST) were recorded through hearing aids in a standard van moving at a speed of 70 mph on a paved highway. The hearing aids were programmed to omnidirectional microphone, conventional adaptive directional microphone, and the three newer schemes. CST sentences were presented from the side and back of the hearing aids, which were placed on the ears of a manikin. The recorded stimuli were presented to listeners via earphones in a sound-treated booth to assess speech recognition performance and preference with each programmed condition. RESULTS: Compared to omnidirectional microphones, conventional adaptive directional processing had a detrimental effect on speech recognition when speech was presented from the back or side of the listener. Back-DIR and Side-Transmission processing improved speech recognition performance (relative to both omnidirectional and adaptive directional processing) when speech was from the back and side, respectively. The performance with Side-Suppression processing was better than with adaptive directional processing when speech was from the side. The participants' preferences for a given processing scheme were generally consistent with speech recognition results. CONCLUSIONS: The finding that performance with adaptive directional processing was poorer than with omnidirectional microphones demonstrates the importance of selecting the correct microphone technology for different listening situations. The results also suggest the feasibility of using hearing aid technologies to provide a better listening experience for hearing aid users in automobiles.

Personal Characteristics Associated with Ecological Momentary Assessment Compliance in Adult Cochlear Implant Candidates and Users.

BACKGROUND: Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden could result in noncompliance with the EMA sampling scheme protocol. It has been a concern that certain types of participants could be more likely to have low compliance, such as those who have severe hearing loss and poor speech recognition performance, are employed, are not familiar with technologies used to implement EMA (e.g., smartphones), and have poorer cognitive abilities. Noncompliance dependent on personal characteristics could negatively impact the generalizability of EMA research. PURPOSE: This article aims to determine personal characteristics associated with EMA compliance in a group of adult cochlear implant (CI) candidates and users. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Fifty-eight adults who were either scheduled to received CIs or were experienced CI users completed the study. DATA COLLECTION AND ANALYSIS: Participants conducted smartphone-based EMA designed to assess an individual's daily auditory ecology for 1 week. EMA compliance was quantified using two metrics: the number of completed surveys and the response rate to the notification delivered by the EMA app. Personal characteristics (i.e., predictors) included age, gender, CI status (candidate or user), employment status (employed or not employed), smartphone ownership, speech recognition performance, social network size, level of depressive symptoms, and neurocognitive abilities. A word recognition test, questionnaires, and a test battery of neurocognitive assessments were used to measure the predictors. We used negative binomial regression and logistic mixed models to determine the factors associated with the number of completed surveys and the response rate, respectively. We hypothesized that, for example, employed participants with poorer speech recognition performance would have lower compliance. RESULTS: Contrary to the hypothesis, word recognition score was negatively associated with the number of completed surveys (p = 0.022). Holding all other variables constant, a 10-point (i.e., 10%) word recognition score decrease was associated with an 11% increase in the number of completed surveys. For the response rate, employment status was the only significant predictor (p < 0.0001). Consistent with our hypothesis, the odds of responding to EMA notifications for those who are not employed are 82% higher than the odds for those who are employed. No other studied personal characteristic was associated with compliance. CONCLUSION: For CI candidates and users, EMA compliance could be affected by personal characteristics such as speech recognition performance and employment status. Because (1) participants with poorer speech recognition performance do not necessarily have lower compliance and (2) most personal characteristics investigated in the present study (e.g., age, gender, smartphone ownership, and neurocognitive abilities) do not predict compliance, a wide range of participants could successfully conduct smartphone-based EMA.

Why Ecological Momentary Assessment Surveys Go Incomplete: When It Happens and How It Impacts Data.

BACKGROUND: Ecological momentary assessment (EMA) often requires respondents to complete surveys in the moment to report real-time experiences. Because EMA may seem disruptive or intrusive, respondents may not complete surveys as directed in certain circumstances. PURPOSE: This article aims to determine the effect of environmental characteristics on the likelihood of instances where respondents do not complete EMA surveys (referred to as survey incompletion), and to estimate the impact of survey incompletion on EMA self-report data. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Ten adults hearing aid (HA) users. DATA COLLECTION AND ANALYSIS: Experienced, bilateral HA users were recruited and fit with study HAs. The study HAs were equipped with real-time data loggers, an algorithm that logged the data generated by HAs (e.g., overall sound level, environment classification, and feature status including microphone mode and amount of gain reduction). The study HAs were also connected via Bluetooth to a smartphone app, which collected the real-time data logging data as well as presented the participants with EMA surveys about their listening environments and experiences. The participants were sent out to wear the HAs and complete surveys for 1 week. Real-time data logging was triggered when participants completed surveys and when participants ignored or snoozed surveys. Data logging data were used to estimate the effect of environmental characteristics on the likelihood of survey incompletion, and to predict participants' responses to survey questions in the instances of survey incompletion. RESULTS: Across the 10 participants, 715 surveys were completed and survey incompletion occurred 228 times. Mixed effects logistic regression models indicated that survey incompletion was more likely to happen in the environments that were less quiet and contained more speech, noise, and machine sounds, and in the environments wherein directional microphones and noise reduction algorithms were enabled. The results of survey response prediction further indicated that the participants could have reported more challenging environments and more listening difficulty in the instances of survey incompletion. However, the difference in the distribution of survey responses between the observed responses and the combined observed and predicted responses was small. CONCLUSION: The present study indicates that EMA survey incompletion occurs systematically. Although survey incompletion could bias EMA self-report data, the impact is likely to be small.

Test-Retest Reliability of Ecological Momentary Assessment in Audiology Research.

BACKGROUND: Ecological momentary assessment (EMA) is a methodology involving repeated surveys to collect in situ data that describe respondents' current or recent experiences and related contexts in their natural environments. Audiology literature investigating the test-retest reliability of EMA is scarce. PURPOSE: This article examines the test-retest reliability of EMA in measuring the characteristics of listening contexts and listening experiences. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Fifty-one older adults with hearing loss. DATA COLLECTION AND ANALYSIS: The study was part of a larger study that examined the effect of hearing aid technologies. The larger study had four trial conditions and outcome was measured using a smartphone-based EMA system. After completing the four trial conditions, participants repeated one of the conditions to examine the EMA test-retest reliability. The EMA surveys contained questions that assessed listening context characteristics including talker familiarity, talker location, and noise location, as well as listening experiences including speech understanding, listening effort, loudness satisfaction, and hearing aid satisfaction. The data from multiple EMA surveys collected by each participant were aggregated in each of the test and retest conditions. Test-retest correlation on the aggregated data was then calculated for each EMA survey question to determine the reliability of EMA. RESULTS: At the group level, listening context characteristics and listening experience did not change between the test and retest conditions. The test-retest correlation varied across the EMA questions, with the highest being the questions that assessed talker location (median r = 1.0), reverberation (r = 0.89), and speech understanding (r = 0.85), and the lowest being the items that quantified noise location (median r = 0.63), talker familiarity (r = 0.46), listening effort (r = 0.61), loudness satisfaction (r = 0.60), and hearing aid satisfaction (r = 0.61). CONCLUSION: Several EMA questions yielded appropriate test-retest reliability results. The lower test-retest correlations for some EMA survey questions were likely due to fewer surveys completed by participants and poorly designed questions. Therefore, the present study stresses the importance of using validated questions in EMA. With sufficient numbers of surveys completed by respondents and with appropriately designed survey questions, EMA could have reasonable test-retest reliability in audiology research.

Comparison of In-Situ and Retrospective Self-Reports on Assessing Hearing Aid Outcomes.

BACKGROUND: Ecological momentary assessment (EMA) is a methodology involving repeated surveys to collect in-situ self-reports that describe respondents' current or recent experiences. Audiology literature comparing in-situ and retrospective self-reports is scarce. PURPOSE: To compare the sensitivity of in-situ and retrospective self-reports in detecting the outcome difference between hearing aid technologies, and to determine the association between in-situ and retrospective self-reports. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Thirty-nine older adults with hearing loss. DATA COLLECTION AND ANALYSIS: The study was part of a larger clinical trial that compared the outcomes of a prototype hearing aid (denoted as HA1) and a commercially available device (HA2). In each trial condition, participants wore hearing aids for 4 weeks. Outcomes were measured using EMA and retrospective questionnaires. To ensure that the outcome data could be directly compared, the Glasgow Hearing Aid Benefit Profile was administered as an in-situ self-report (denoted as EMA-GHABP) and as a retrospective questionnaire (retro-GHABP). Linear mixed models were used to determine if the EMA- and retro-GHABP could detect the outcome difference between HA1 and HA2. Correlation analyses were used to examine the association between EMA- and retro-GHABP. RESULTS: For the EMA-GHABP, HA2 had significantly higher (better) scores than HA1 in the GHABP subscales of benefit, residual disability, and satisfaction (p = 0.029-0.0015). In contrast, the difference in the retro-GHABP score between HA1 and HA2 was significant only in the satisfaction subscale (p = 0.0004). The correlations between the EMA- and retro-GHABP were significant in all subscales (p = 0.0004 to <0.0001). The strength of the association ranged from weak to moderate (r = 0.28-0.58). Finally, the exit interview indicated that 29 participants (74.4%) preferred HA2 over HA1. CONCLUSION: The study suggests that in-situ self-reports collected using EMA could have a higher sensitivity than retrospective questionnaires. Therefore, EMA is worth considering in clinical trials that aim to compare the outcomes of different hearing aid technologies. The weak to moderate association between in-situ and retrospective self-reports suggests that these two types of measures assess different aspects of hearing aid outcomes.

Using Smartphone-Based Ecological Momentary Assessment in Audiology Research: The Participants' Perspective.

Purpose The article's purpose was to examine participants' impressions and experiences with smartphone-based ecological momentary assessment (EMA) to inform future EMA study design. Method Adults with hearing impairment (HI, n = 9) and with normal hearing (NH, n = 10) participated in a study using a smartphone-based EMA system to measure their auditory lifestyles. A 14-item survey was scheduled to deliver every 45 min by an EMA app. After a 1-week trial, participants were interviewed regarding their study experiences. The app log files were analyzed to understand how the participants interacted with the app. Results Across the two groups, 1,295 surveys were completed (compliance rate 74.4%). On average, HI participants completed 10.0 and NH participants completed 9.1 surveys per day. The mean survey completion time for HI and NH groups were 72 s and 51 s, respectively. For both groups, about 90% of the participants reported the app as easy to use; about 60% of the participants reported that repetitive surveys interrupted or somewhat interrupted their activities. Participants reported surveys disrupting situations, for example, working, driving, and social events, and that they were more likely to skip surveys in these situations. Additionally, 50% of NH and 30% of HI participants indicated that the survey was not delivered too frequently and none indicated that the survey was too long. Conclusion Overall, the app and EMA design seem to be appropriate. Insights from this study can help researchers design their studies to adequately assess listeners' experience in the field with optimal compliance and data quality.

A Comparison of Personal Sound Amplification Products and Hearing Aids in Ecologically Relevant Test Environments.

PURPOSE: The aim of this study was to compare the benefit of self-adjusted personal sound amplification products (PSAPs) to audiologist-fitted hearing aids based on speech recognition, listening effort, and sound quality in ecologically relevant test conditions to estimate real-world effectiveness. METHOD: Twenty-five older adults with bilateral mild-to-moderate hearing loss completed the single-blinded, crossover study. Participants underwent aided testing using 3 PSAPs and a traditional hearing aid, as well as unaided testing. PSAPs were adjusted based on participant preference, whereas the hearing aid was configured using best-practice verification protocols. Audibility provided by the devices was quantified using the Speech Intelligibility Index (American National Standards Institute, 2012). Outcome measures assessing speech recognition, listening effort, and sound quality were administered in ecologically relevant laboratory conditions designed to represent real-world speech listening situations. RESULTS: All devices significantly improved Speech Intelligibility Index compared to unaided listening, with the hearing aid providing more audibility than all PSAPs. Results further revealed that, in general, the hearing aid improved speech recognition performance and reduced listening effort significantly more than all PSAPs. Few differences in sound quality were observed between devices. All PSAPs improved speech recognition and listening effort compared to unaided testing. CONCLUSIONS: Hearing aids fitted using best-practice verification protocols were capable of providing more aided audibility, better speech recognition performance, and lower listening effort compared to the PSAPs tested in the current study. Differences in sound quality between the devices were minimal. However, because all PSAPs tested in the study significantly improved participants' speech recognition performance and reduced listening effort compared to unaided listening, PSAPs could serve as a budget-friendly option for those who cannot afford traditional amplification.

Using a Digital Language Processor to Quantify the Auditory Environment and the Effect of Hearing Aids for Adults with Hearing Loss.

BACKGROUND: Auditory environments can influence the communication function of individuals with hearing loss and the effects of hearing aids. Therefore, a tool that can objectively characterize a patient's real-world auditory environments is needed. PURPOSE: To use the Language Environment Analysis (LENA) system to quantify the auditory environments of adults with hearing loss, to examine if the use of hearing aids changes a user's auditory environment, and to determine the association between LENA variables and self-report hearing aid outcome measures. RESEARCH DESIGN: This study used a crossover design. STUDY SAMPLE: Participants included 22 adults with mild-to-moderate hearing loss, age 64-82 yr. INTERVENTION: Participants were fitted with bilateral behind-the-ear hearing aids from a major manufacturer. DATA COLLECTION AND ANALYSIS: The LENA system consists of a digital language processor (DLP) that is worn by an individual and records up to 16 hr of the individual's auditory environment. The recording is then automatically categorized according to time spent in different types of auditory environments (e.g., meaningful speech and TV/electronic sound) by the LENA algorithms. The LENA system also characterizes the user's auditory environment by providing the sound levels of different auditory categories. Participants in the present study wore a LENA DLP in an unaided condition and aided condition, which each lasted six to eight days. Participants wore bilateral hearing aids in the aided condition. Percentage of time spent in each auditory environment, as well as median levels of TV/electronic sounds and speech, were compared between subjects' unaided and aided conditions using paired sample t tests. LENA data were also compared to self-report measures of hearing disability and hearing aid benefit using Pearson correlations. RESULTS: Overall, participants spent the greatest percentage of time in silence (∼40%), relative to other auditory environments. Participants spent ∼12% and 26% of their time in meaningful speech and TV/electronic sound environments, respectively. No significant differences were found between mean percentage of time spent in each auditory environment in the unaided and aided conditions. Median TV/electronic sound levels were on average 2.4 dB lower in the aided condition than in the unaided condition; speech levels were not significantly different between the two conditions. TV/electronic sound and speech levels did not significantly correlate with self-report data. CONCLUSIONS: The LENA system can provide rich data to characterize the everyday auditory environments of older adults with hearing loss. Although TV/electronic sound level was significantly lower in the aided than unaided condition, the use of hearing aids seemed not to substantially change users' auditory environments. Because there is no significant association between objective LENA variables and self-report questionnaire outcomes, these two types of measures may assess different aspects of communication function. The feasibility of using LENA in clinical settings is discussed.

Is the Device-Oriented Subjective Outcome (DOSO) Independent of Personality?

BACKGROUND: Self-report questionnaires are a frequently used method of evaluating hearing aid outcomes. Studies have shown that personality can account for 5-20% of the variance in response to self-report measures. As a result, these influences can impact results and limit their generalizability when the purpose of the study is to examine the technological merit of hearing aids. To reduce personality influences on self-report outcome data, the Device-Oriented Subjective Outcome (DOSO) was developed. The DOSO is meant to demonstrate outcomes of the amplification device relatively independent of the individual's personality. Still, it is unknown if the DOSO achieves its original goal. PURPOSE: The purpose of this study was to examine the relationship between personality and the DOSO. The relationship between personality and several widely used hearing-related questionnaires was also examined. RESEARCH DESIGN: This is a nonexperimental study using a correlational design. STUDY SAMPLE: A total of 119 adult hearing aid wearers participated in the study. DATA COLLECTION AND ANALYSIS: The NEO Five-Factor Inventory was used to measure five personality traits (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). The initial (unaided) hearing disablement, residual (aided) hearing disablement, and hearing aid benefit and satisfaction was measured using the DOSO, Hearing Handicap Inventory for the Elderly/Adult, Abbreviated Profile of Hearing Aid Benefit, and Satisfaction with Amplification in Daily Life. The relationship between personality and each questionnaire was examined using a correlation analysis. RESULTS: All of the DOSO subscales were found to be significantly correlated to personality, regardless of whether age and better-ear hearing thresholds were controlled. Individuals who reported poorer hearing aid outcomes tended to have higher Neuroticism scores, while those who scored higher in Extraversion, Openness, and Agreeableness were more likely to report better outcomes. Across DOSO subscales, the maximum variance explained by personality traits ranged from 6% to 11%. Consistent with the literature, ∼3-18% of the variance of other hearing-related questionnaires was attributable to personality. CONCLUSIONS: The degree to which personality affects the DOSO is similar to other hearing-related questionnaires. Although the variance accounted for by personality is not large, researchers and clinicians should not assume that the results of the DOSO are independent of personality.

Construct Validity of the Ecological Momentary Assessment in Audiology Research.

BACKGROUND: Ecological momentary assessment (EMA) is a methodology involving repeated assessments/surveys to collect data describing respondents' current or very recent experiences and related contexts in their natural environments. The use of EMA in audiology research is growing. PURPOSE: This study examined the construct validity (i.e., the degree to which a measurement reflects what it is intended to measure) of EMA in terms of measuring speech understanding and related listening context. Experiment 1 investigated the extent to which individuals can accurately report their speech recognition performance and characterize the listening context in controlled environments. Experiment 2 investigated whether the data aggregated across multiple EMA surveys conducted in uncontrolled, real-world environments would reveal a valid pattern that was consistent with the established relationships between speech understanding, hearing aid use, listening context, and lifestyle. RESEARCH DESIGN: This is an observational study. STUDY SAMPLE: Twelve and twenty-seven adults with hearing impairment participated in Experiments 1 and 2, respectively. DATA COLLECTION AND ANALYSIS: In the laboratory testing of Experiment 1, participants estimated their speech recognition performance in settings wherein the signal-to-noise ratio was fixed or constantly varied across sentences. In the field testing the participants reported the listening context (e.g., noisiness level) of several semicontrolled real-world conversations. Their reports were compared to (1) the context described by normal-hearing observers and (2) the background noise level measured using a sound level meter. In Experiment 2, participants repeatedly reported the degree of speech understanding, hearing aid use, and listening context using paper-and-pencil journals in their natural environments for 1 week. They also carried noise dosimeters to measure the sound level. The associations between (1) speech understanding, hearing aid use, and listening context, (2) dosimeter sound level and self-reported noisiness level, and (3) dosimeter data and lifestyle quantified using the journals were examined. RESULTS: For Experiment 1, the reported and measured speech recognition scores were highly correlated across all test conditions (r = 0.94 to 0.97). The field testing results revealed that most listening context properties reported by the participants were highly consistent with those described by the observers (74-95% consistency), except for noisiness rating (58%). Nevertheless, higher noisiness rating was associated with higher background noise level. For Experiment 2, the EMA results revealed several associations: better speech understanding was associated with the use of hearing aids, front-located speech, and lower dosimeter sound level; higher noisiness rating was associated with higher dosimeter sound level; listeners with more diverse lifestyles tended to have higher dosimeter sound levels. CONCLUSIONS: Adults with hearing impairment were able to report their listening experiences, such as speech understanding, and characterize listening context in controlled environments with reasonable accuracy. The pattern of the data aggregated across multiple EMA surveys conducted in a wide range of uncontrolled real-world environment was consistent with the established knowledge in audiology. The two experiments suggested that, regarding speech understanding and related listening contexts, EMA reflects what it is intended to measure, supporting its construct validity in audiology research.