A comparison of speech intelligibility and subjective quality with hearing-aid processing in older adults with hearing loss.

OBJECTIVE: This study characterised the relationship between speech intelligibility and quality in listeners with hearing loss for a range of hearing-aid processing settings and acoustic conditions. DESIGN: Binaural speech intelligibility scores and quality ratings were measured for sentences presented in babble noise and processed through a hearing-aid simulation. The intelligibility-quality relationship was investigated by (1) assessing the effects of experimental conditions on each task; (2) directly comparing intelligibility scores and quality ratings for each participant across the range of conditions; and (3) comparing the association between signal envelope fidelity (represented by a cepstral correlation metric) and intelligibility and quality. STUDY SAMPLE: Participants were 15 adults (7 females; age range 59-81 years) with mild to moderately severe sensorineural hearing loss. RESULTS: Intelligibility and quality showed a positive association both with each other and with changes to signal fidelity introduced by the entire acoustic and signal-processing system including the additive noise and the hearing-aid output. As signal fidelity decreased, quality ratings changed at a slower rate than intelligibility scores. Individual psychometric functions were more variable for quality compared to intelligibility. CONCLUSIONS: Variability in the intelligibility-quality relationship reinforces the importance of measuring both intelligibility and quality in clinical hearing-aid fittings.

Lower spatial QRS-T angle rules out sustained ventricular arrhythmias in children with hypertrophic cardiomyopathy.

Introduction The spatial peaks QRS-T angle accurately distinguishes children with hypertrophic cardiomyopathy from their healthy counterparts. The spatial peaks QRS-T angle is also useful in risk stratification for ventricular arrhythmias. We hypothesised that the spatial peaks QRS-T angle would be useful for the prediction of ventricular arrhythmias in hypertrophic cardiomyopathy patients under 23 years of age. METHODS: Corrected QT interval and spatial peaks QRS-T angles were retrospectively assessed in 133 paediatric hypertrophic cardiomyopathy patients (12.4±6.6 years) with versus without ventricular arrhythmias of 30 seconds or longer. Significance, positive/negative predictive values, and odds ratios were calculated based on receiver operating characteristic curve cut-off values. RESULTS: In total, 10 patients with ventricular arrhythmias were identified. Although the corrected QT interval did not differentiate those with versus without ventricular arrhythmias, the spatial peaks QRS-T angle did (151.4±19.0 versus 116.8±42.6 degrees, respectively, p<0.001). At an optimal cut-off value (124.1 degrees), the positive and negative predictive values of the spatial peaks QRS-T angle were 15.4 and 100.0%, respectively, with an odds ratio of 25.9 (95% CI 1.5-452.2). CONCLUSION: In children with hypertrophic cardiomyopathy, the spatial peaks QRS-T angle is associated with ventricular arrhythmia burden with high negative predictive value and odds ratio.

The spatial QRS-T angle outperforms the Italian and Seattle ECG-based criteria for detection of hypertrophic cardiomyopathy in pediatric patients.

INTRODUCTION: The spatial peaks QRS-T angle has been shown to differentiate adult patients with hypertrophic cardiomyopathy (HCM) from controls. We hypothesized that the spatial peaks QRS-T angle would, in isolation, be more accurate than the Italian 12-lead ECG Pre-participation Screening criteria or the Seattle criteria for detecting hypertrophic cardiomyopathy (HCM) in pediatric patients. METHODS: A retrospective study of pediatric patients with HCM compared to age and gender-matched control patients was undertaken. Significance, odds ratios, sensitivity and specificity of HCM detection of the visually derived spatial peaks QRS-T angle were compared to those of traditional 12-lead ECG criteria using: 1) Italy's National Pre-participation Screening Programme criteria; and 2) described criteria from Seattle. RESULTS: ECG results from 130 pediatric HCM patients (14.2±4.4years) were compared to 470 control patients (normal echocardiograms, mean age 13.4±4.6years). Mean±standard deviation (SD) values for spatial peaks QRS-T angles were 120.4±40.7 and 21.3±13.7 degrees for HCM and controls, respectively (P<0.001). A spatial peaks QRS-T angle cutoff value of >54.9 degrees yielded greater sensitivity and specificity (93.1% and 98.7%, respectively) for detecting HCM over ECG criteria from Italy (68.5% and 48.1%, respectively) or Seattle (64.6% and 78.9%, respectively) with odds ratios at 1039.70 (95% CI 363.03 to 2977.67), 2.01 (95% CI 1.33 to 3.04) and 6.84 (4.49-10.44), respectively. CONCLUSION: In our cohort, a visually derived spatial peaks QRS-T angle has increased sensitivity and specificity for detection of HCM in pediatric patients compared to currently utilized Italian or Seattle ECG criteria.

Do Patients Benefit From a Cochlear Implant When They Qualify Only in the Presence of Background Noise?

OBJECTIVE: To compare the difference in pre- to postoperative speech performance of patients qualifying for a cochlear implant (CI) in quiet, +10 dB signal-to-noise ratio (SNR), and +5 dB SNR. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Fifty-eight post-lingually deafened, unilateral CI recipients from three Groups were included: 1) those who met CI candidacy criteria with AzBio sentences in quiet, 2) in noise at +10 dB SNR but not in quiet, 3) and in noise at +5 dB SNR but not in quiet or +10 dB SNR. INTERVENTION: Unilateral CI. MAIN OUTCOME MEASURES: Pre- and 1 year postoperative speech recognition scores. RESULTS: Best-aided AzBio speech recognition of individuals in Group 1 improved significantly for all test conditions and improved significantly for Groups 2 and 3 in the +10 and +5 dB SNR test conditions postoperatively. When tested with their CI alone however, while AzBio speech recognition of individuals in Group 1 and Group 2 improved significantly in the quiet and +10 dB SNR conditions, speech recognition was not significantly changed postoperatively under any testing condition for individuals in Group 3. CONCLUSIONS: While individuals qualifying for a CI only in the +5 dB SNR condition may derive significant benefit from implantation in best aided conditions, speech understanding outcomes can be more variable thus warranting additional counseling before implantation and case-by-case consideration of listening needs and goals.

The Type of Noise Influences Quality Ratings for Noisy Speech in Hearing Aid Users.

Purpose The overall goal of the current study was to determine whether noise type plays a role in perceptual quality ratings. We compared quality ratings using various noise types and signal-to-noise ratio (SNR) ranges using hearing aid simulations to consider the effects of hearing aid processing features. Method Ten older adults with bilateral mild to moderately severe sensorineural hearing loss rated the sound quality of sentences processed through a hearing aid simulation and presented in the presence of five different noise types (six-talker babble, three-talker conversation, street traffic, kitchen, and fast-food restaurant) at four SNRs (3, 8, 12, and 20 dB). Results Everyday noise types differentially affected sound quality ratings even when presented at the same SNR: Kitchen and three-talker noises were rated significantly higher than restaurant, traffic, and multitalker babble, which were not different from each other. The effects of noise type were most pronounced at poorer SNRs. Conclusions The findings of this study showed that noise types differentially affected sound quality ratings. The differences we observed were consistent with the acoustic characteristics of the noise types. Noise types having lower envelope fluctuations yielded lower quality ratings than noise types characterized by sporadic high-intensity events at the same SNR.