Development of a Phrase-Based Speech-Recognition Test Using Synthetic Speech.

Speech-recognition tests are widely used in both clinical and research audiology. The purpose of this study was the development of a novel speech-recognition test that combines concepts of different speech-recognition tests to reduce training effects and allows for a large set of speech material. The new test consists of four different words per trial in a meaningful construct with a fixed structure, the so-called phrases. Various free databases were used to select the words and to determine their frequency. Highly frequent nouns were grouped into thematic categories and combined with related adjectives and infinitives. After discarding inappropriate and unnatural combinations, and eliminating duplications of (sub-)phrases, a total number of 772 phrases remained. Subsequently, the phrases were synthesized using a text-to-speech system. The synthesis significantly reduces the effort compared to recordings with a real speaker. After excluding outliers, measured speech-recognition scores for the phrases with 31 normal-hearing participants at fixed signal-to-noise ratios (SNR) revealed speech-recognition thresholds (SRT) for each phrase varying up to 4 dB. The median SRT was -9.1 dB SNR and thus comparable to existing sentence tests. The psychometric function's slope of 15 percentage points per dB is also comparable and enables efficient use in audiology. Summarizing, the principle of creating speech material in a modular system has many potential applications.

Implementing Ecological Momentary Assessment in Audiological Research: Opportunities and Challenges.

Ecological momentary assessment (EMA) is a way to evaluate experiences in everyday life. It is a powerful research tool but can be complex and challenging for beginners. Application of EMA in audiological research brings with it opportunities and challenges that differ from other research disciplines. This tutorial discusses important considerations when conducting EMA studies in hearing care. While more research is needed to develop specific guidelines for the various potential applications of EMA in hearing research, we hope this article can alert hearing researchers new to EMA to pitfalls when using EMA and help strengthen their study design. The current article elaborates study design details, such as choice of participants, representativeness of the study period for participants' lives, and balancing participant burden with data requirements. Mobile devices and sensors to collect objective data on the acoustic situation are reviewed alongside different possibilities for EMA setups ranging from online questionnaires paired with a timer to proprietary apps that also have access to parameters of a hearing device. In addition to considerations for survey design, a list of questionnaire items from previous studies is provided. For each item, an example and a list of references are given. EMA typically provides data sets that are rich but also challenging in that they are noisy, and there is often unequal amount of data between participants. After recommendations on how to check the data for compliance, reactivity, and careless responses, methods for statistical analysis on the individual level and on the group level are discussed including special methods for direct comparison of hearing device programs.

A language-independent hearing screening self-test at school-entry.

The usage of a tablet-based language-independent self-test involving the recognition of ecological sounds in background noise, the Sound Ear Check, was investigated. The results of 692 children, aged between 5 and 9 years and 4 months, recruited in seven different countries, were used to analyze the validity and the cultural independence of test. Three different test procedures, namely a monaural adaptive procedure, a procedure presenting the sounds dichotically in diotic noise, and a procedure presenting all the sounds with a fixed signal-to-noise ratio and a stopping rule were studied. Results showed high sensitivity and specificity of all three procedures to detect conductive, sensorineural and mixed hearing loss > 30 dB HL. Additionally, the data collected from different countries were consistent, and there were no clinically relevant differences observed between countries. Therefore, the Sound Ear Check can offer an international hearing screening test for young children at school entry, solving the current lack of hearing screening services on a global scale.

Bayesian analysis of Ecological Momentary Assessment (EMA) data collected in adults before and after hearing rehabilitation.

This paper presents a new Bayesian method for analyzing Ecological Momentary Assessment (EMA) data and applies this method in a re-analysis of data from a previous EMA study. The analysis method has been implemented as a freely available Python package EmaCalc, RRID:SCR 022943. The analysis model can use EMA input data including nominal categories in one or more situation dimensions, and ordinal ratings of several perceptual attributes. The analysis uses a variant of ordinal regression to estimate the statistical relation between these variables. The Bayesian method has no requirements related to the number of participants or the number of assessments by each participant. Instead, the method automatically includes measures of the statistical credibility of all analysis results, for the given amount of data. For the previously collected EMA data, the analysis results demonstrate how the new tool can handle heavily skewed, scarce, and clustered data that were collected on ordinal scales, and present results on interval scales. The new method revealed results for the population mean that were similar to those obtained in the previous analysis by an advanced regression model. The Bayesian approach automatically estimated the inter-individual variability in the population, based on the study sample, and could show some statistically credible intervention results also for an unseen random individual in the population. Such results may be interesting, for example, if the EMA methodology is used by a hearing-aid manufacturer in a study to predict the success of a new signal-processing method among future potential customers.

Speech Recognition and Listening Effort of Meaningful Sentences Using Synthetic Speech.

Speech-recognition tests are an important component of audiology. However, the development of such tests can be time consuming. The aim of this study was to investigate whether a Text-To-Speech (TTS) system can reduce the cost of development, and whether comparable results can be achieved in terms of speech recognition and listening effort. For this, the everyday sentences of the German Göttingen sentence test were synthesized for both a female and a male speaker using a TTS system. In a preliminary study, this system was rated as good, but worse than the natural reference. Due to the Covid-19 pandemic, the measurements took place online. Each set of speech material was presented at three fixed signal-to-noise ratios. The participants' responses were recorded and analyzed offline. Compared to the natural speech, the adjusted psychometric functions for the synthetic speech, independent of the speaker, resulted in an improvement of the speech-recognition threshold (SRT) by approximately 1.2 dB. The slopes, which were independent of the speaker, were about 15 percentage points per dB. The time periods between the end of the stimulus presentation and the beginning of the verbal response (verbal response time) were comparable for all speakers, suggesting no difference in listening effort. The SRT values obtained in the online measurement for the natural speech were comparable to published data. In summary, the time and effort for the development of speech-recognition tests may be significantly reduced by using a TTS system. This finding provides the opportunity to develop new speech tests with a large amount of speech material.

The Concurrent OLSA Test: A Method for Speech Recognition in Multi-talker Situations at Fixed SNR.

A multi-talker paradigm is introduced that uses different attentional processes to adjust speech-recognition scores with the goal of conducting measurements at high signal-to-noise ratios (SNR). The basic idea is to simulate a group conversation with three talkers. Talkers alternately speak sentences of the German matrix test OLSA. Each time a sentence begins with the name "Kerstin" (call sign), the participant is addressed and instructed to repeat the last words of all sentences from that talker, until another talker begins a sentence with "Kerstin". The alternation of the talkers is implemented with an adjustable overlap time that causes an overlap between the call sign "Kerstin" and the target words to be repeated. Thus, the two tasks of detecting "Kerstin" and repeating target words are to be done at the same time. The paradigm was tested with 22 young normal-hearing participants (YNH) for three overlap times (0.6 s, 0.8 s, 1.0 s). Results for these overlap times show significant differences, with median target word recognition scores of 88%, 82%, and 77%, respectively (including call-sign and dual-task effects). A comparison of the dual task with the corresponding single tasks suggests that the observed effects reflect an increased cognitive load.

Individual Hearing Aid Benefit in Real Life Evaluated Using Ecological Momentary Assessment.

Ecological momentary assessment (EMA) was used in 24 adults with mild-to-moderate hearing loss who were seeking first hearing-aid (HA) fitting or HA renewal. At two stages in the aural rehabilitation process, just before HA fitting and after an average 3-month HA adjustment period, the participants used a smartphone-based EMA system for 3 to 4 days. A questionnaire app allowed for the description of the environmental context as well as assessments of various hearing-related dimensions and of well-being. In total, 2,042 surveys were collected. The main objectives of the analysis were threefold: First, describing the "auditory reality" of future and experienced HA users; second, examining the effects of HA fitting for individual participants, as well as for the subgroup of first-time HA-users; and third, reviewing whether the EMA data collected in the unaided condition predicted who ultimately decided for or against permanent HA use. The participants reported hearing-related disabilities across the full range of daily listening tasks, but communication events took the largest share. The effect of the HA intervention was small in experienced HA users. Generally, much larger changes and larger interindividual differences were observed in first-time compared with experienced HA users in all hearing-related dimensions. Changes were not correlated with hearing loss or with the duration of the HA adjustment period. EMA data collected in the unaided condition did not predict the cancelation of HA fitting. The study showed that EMA is feasible in a general population of HA candidates for establishing individual and multidimensional profiles of real-life hearing experiences.

Self-reported hearing handicap in adults aged 55 to 81 years is modulated by hearing abilities, frailty, mental health, and willingness to use hearing aids.

OBJECTIVE: The aim of this study was to predict outcomes of the HHI questionnaire (Hearing Handicap Inventory) using individual variables beyond pure-tone hearing thresholds. DESIGN: An extensive health-related test battery was applied including a general anamnesis, questionnaires, audiological measures, examination of visual acuity, balance, and cognition, as well as tactile- and motor skills. Based on the self-assessment of health variables and different sensory and cognitive performance measures, a frailty index was calculated to describe the health status of the participants. A stepwise linear regression analysis was conducted to predict HHI scores. STUDY SAMPLE: A mixed sample (N = 212) of 55- to 81-year-old, participants with different hearing and aiding status completed the test battery. RESULTS: The regression analysis showed statistically significant contributions of pure-tone hearing thresholds, speech recognition in noise, age, frailty, mental health, and the willingness to use hearing aids on HHIE outcomes. CONCLUSIONS: Self-reported hearing handicap assessed with the HHI questionnaire reflects various individual variables additionally to pure-tone hearing loss and speech recognition in noise. It is necessary to be aware of the influences of age and health-related variables on HHI scores when using it in research as well as in clinical settings.

The Quest for Ecological Validity in Hearing Science: What It Is, Why It Matters, and How to Advance It.

Ecological validity is a relatively new concept in hearing science. It has been cited as relevant with increasing frequency in publications over the past 20 years, but without any formal conceptual basis or clear motive. The sixth Eriksholm Workshop was convened to develop a deeper understanding of the concept for the purpose of applying it in hearing research in a consistent and productive manner. Inspired by relevant debate within the field of psychology, and taking into account the World Health Organization's International Classification of Functioning, Disability, and Health framework, the attendees at the workshop reached a consensus on the following definition: "In hearing science, ecological validity refers to the degree to which research findings reflect real-life hearing-related function, activity, or participation." Four broad purposes for striving for greater ecological validity in hearing research were determined: A (Understanding) better understanding the role of hearing in everyday life; B (Development) supporting the development of improved procedures and interventions; C (Assessment) facilitating improved methods for assessing and predicting ability to accomplish real-world tasks; and D (Integration and Individualization) enabling more integrated and individualized care. Discussions considered the effects of variables and phenomena commonly present in hearing-related research on the level of ecological validity of outcomes, supported by examples from a few selected outcome domains and for different types of studies. Illustrated with examples, potential strategies were offered for promoting a high level of ecological validity in a study and for how to evaluate the level of ecological validity of a study. Areas in particular that could benefit from more research to advance ecological validity in hearing science include: (1) understanding the processes of hearing and communication in everyday listening situations, and specifically the factors that make listening difficult in everyday situations; (2) developing new test paradigms that include more than one person (e.g., to encompass the interactive nature of everyday communication) and that are integrative of other factors that interact with hearing in real-life function; (3) integrating new and emerging technologies (e.g., virtual reality) with established test methods; and (4) identifying the key variables and phenomena affecting the level of ecological validity to develop verifiable ways to increase ecological validity and derive a set of benchmarks to strive for.

Ecological Momentary Assessment in Hearing Research: Current State, Challenges, and Future Directions.

Common methods to assess hearing deficits and the benefit of hearing devices include retrospective questionnaires and speech tests under controlled conditions. As typically applied, both approaches suffer from serious limitations regarding their ecological validity. An alternative approach rapidly gaining widespread use is ecological momentary assessment (EMA), which employs repeated assessments of individual everyday situations. Smartphones facilitate the implementation of questionnaires and rating schemes to be administered in the real life of study participants or customers, during or shortly after an experience. In addition, objective acoustical parameters extracted from head- or body-worn microphones and/or settings from the hearing aid's signal processing unit can be stored alongside the questionnaire data. The advantages of using EMA include participant-specific, context-sensitive information on activities, experienced challenges, and preferences. However, to preserve the privacy of all communication partners and bystanders, the law in many countries does not allow audio recordings, limiting the information about environmental acoustics to statistical data such as, for example, levels and averaged spectra. Other challenges for EMA are, for example, the unsupervised handling of the equipment, the trade-off between the accuracy of description and the number of similar listening situations when performing comparisons (e.g., with and without hearing aids), the trade-off between the duration of recording intervals and the amount of data collected and analyzed, the random or target-oriented reminder for subjective responses, as well as the willingness and ability of the participants to respond while doing specific tasks. This contribution reviews EMA in hearing research, its purpose, current applications, and possible future directions.

The perception of the stereo effect in bilateral and bimodal cochlear implant users and its contribution to music enjoyment.

OBJECTIVES: In this clinical study, stereo perception of music samples and its contribution to music enjoyment in CI users is investigated. It is studied in free field as well as direct audio presentation. METHODS: 20 bilateral and 9 bimodal CI users performed stereo detection tests and music enjoyment ratings. Music was presented either in mono or in stereo in free field or with direct audio presentation. Stereo detection was assessed with a 3-AFC paradigm. Music enjoyment was studied with scale ratings. RESULTS: For bilateral CI users, stereo detection increased from 52% correct in free field to 86% with direct audio presentation. Increased music enjoyment with improved stereo detection was obtained. Bimodal CI users could not identify stereo sounds. Music enjoyment did not increase for stereo presentations in bimodal subjects. DISCUSSION: For bilateral CI users, improved stereo detection might increase music enjoyment with direct audio presentation, which is likely due to bypassing the room acoustics. In bimodal CI users, no clear improvement was found, which is likely attributed due to the different hearing losses and therefore individually different interaural frequency overlaps between the hearing aid and the cochlear implant. CONCLUSION: Direct audio presentation is an efficient method to improve music enjoyment in bilateral CI users.

Gender-specific hearing loss in German adults aged 18 to 84 years compared to US-American and current European studies.

INTRODUCTION: From an epidemiological point of view, the increase of pure-tone hearing thresholds as one aspect of biological ageing is moderated by societal factors. Since health policies refer to empirical findings, it is reasonable to replicate population-based hearing surveys and to compare estimates for different birth cohorts from the same regions or, conversely, for the same birth cohorts from different regions. METHODS: We pooled data from two independent cross-sectional German studies conducted between 2008 and 2012 and including 3105 adults. The increase of thresholds, the prevalence and risk of hearing impairment (HI) by age and gender were compared to results reported for European and US-American studies that were carried out at about the same time. Since these studies differed with regard to the age limits, the statistical approaches and, importantly, their definitions of HI, data adjustments were performed to enable the comparison. RESULTS: Overall, 15.5% of the participants in the German studies showed a pure-tone average at 0.5, 1, 2, and 4 kHz in the better ear (PTA) greater than 25 dB HL and 8.6% had a PTA of at least 35 dB HL. Based on one-to-one comparisons, the German estimates demonstrated a good agreement to a large Dutch study and with some reservations to a Swedish study, but considerable differences to US-American results. Comprehensive comparisons of the within-study gender differences showed that age-related HI was less and the gender gap was markedly smaller in Europe compared to the US due to the lower HI in males found in the European studies. CONCLUSION: Discrepancies in measurement procedures, conditions, and equipment that complicate the comparison of absolute HI estimates across studies play no or only a marginal role when comparing relative estimates. Hence, the gender gap differences reviewed in this analysis possibly stem from societal conditions that distinguish societies commonly labeled modern industrialized western countries.

Impact of Lexical Parameters and Audibility on the Recognition of the Freiburg Monosyllabic Speech Test.

OBJECTIVE: Correct word recognition is generally determined by audibility, but lexical parameters also play a role. The focus of this study was to examine both the impact of audibility and lexical parameters on speech recognition of test words of the clinical German Freiburg monosyllabic speech test, and subsequently on the perceptual imbalance of test lists observed in the literature. DESIGN: For 160 participants with normal hearing that were divided into three groups with different simulated hearing thresholds, monaural speech recognition for the Freiburg monosyllabic speech test was obtained via headphones in quiet at different presentation levels. A software manipulated the original speech material to simulate two different hearing thresholds. All monosyllables were classified according to their frequency of occurrence in contemporary language and the number of lexical neighbors using the Cross-Linguistic Easy-Access Resource for Phonological and Orthographic Neighborhood Density database. Generalized linear mixed-effects regression models were used to evaluate the influences of audibility in terms of the Speech Intelligibility Index and lexical properties of the monosyllables in terms of word frequency (WF) and neighborhood density (ND) on the observed speech recognition per word and per test list, respectively. RESULTS: Audibility and interactions of audibility with WF and ND correctly predicted identification of the individual monosyllables. Test list recognition was predicted by test list choice, audibility, and ND, as well as by interactions of WF and test list, audibility and ND, ND and test list, and audibility per test list. CONCLUSIONS: Observed differences in speech recognition of the Freiburg monosyllabic speech test, which are well reported in the literature, depend not only on audibility but also on WF, neighborhood density, and test list choice and their interactions. The authors conclude that future creations of speech test material should take these lexical parameters into account.

Measuring Speech Recognition With a Matrix Test Using Synthetic Speech.

Speech audiometry is an essential part of audiological diagnostics and clinical measurements. Development times of speech recognition tests are rather long, depending on the size of speech corpus and optimization necessity. The aim of this study was to examine whether this development effort could be reduced by using synthetic speech in speech audiometry, especially in a matrix test for speech recognition. For this purpose, the speech material of the German matrix test was replicated using a preselected commercial system to generate the synthetic speech files. In contrast to the conventional matrix test, no level adjustments or optimization tests were performed while producing the synthetic speech material. Evaluation measurements were conducted by presenting both versions of the German matrix test (with natural or synthetic speech), alternately and at three different signal-to-noise ratios, to 48 young, normal-hearing participants. Psychometric functions were fitted to the empirical data. Speech recognition thresholds were 0.5 dB signal-to-noise ratio higher (worse) for the synthetic speech, while slopes were equal for both speech types. Nevertheless, speech recognition scores were comparable with the literature and the threshold difference lay within the same range as recordings of two different natural speakers. Although no optimization was applied, the synthetic-speech signals led to equivalent recognition of the different test lists and word categories. The outcomes of this study indicate that the application of synthetic speech in speech recognition tests could considerably reduce the development costs and evaluation time. This offers the opportunity to increase the speech corpus for speech recognition tests with acceptable effort.

Adjusting Expectations: Hearing Abilities in a Population-Based Sample Using an SSQ Short Form.

The German short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) was administered in a cross-sectional study based on stratified random samples complemented by audiometric tests and a general interview. Data from 1,711 unaided adults aged 18 to 97 years were analyzed in order to determine a distribution of hearing abilities considered as normal and the main factors that impact self-assessments. An innovative mathematical approach was used to overcome the constraints of statistics based on the mean. Quantile regression analysis yielded a benchmark distribution of SSQ scores that might support audiologists in setting realistic SSQ score targets and estimated how the effect of auditory and nonauditory factors changes across the distribution of SSQ scores. Regression models showed significant effects for nonauditory factors on SSQ ratings when controlled for pure-tone hearing and interaural asymmetry. Self-reporting of hearing difficulties, when asked in general terms, was substantially related to SSQ ratings. This effect was observed in both high and low scoring participants and led to a considerable score decrease in all SSQ subscales. Gender, educational level, and self-reporting of health issues also were significantly related to SSQ ratings, but the corresponding effects were regularly unbalanced across the score distribution and particularly large at lower quantiles. The estimated effects of age, however, were mostly small in size, inconsistent regarding the direction, and failed significance for all SSQ items. Overall, the results suggest that nonauditory factors and cumulative effects must be considered when evaluating rehabilitative interventions against an ideal outcome.

Exploring the Link Between Cognitive Abilities and Speech Recognition in the Elderly Under Different Listening Conditions.

Elderly listeners are known to differ considerably in their ability to understand speech in noise. Several studies have addressed the underlying factors that contribute to these differences. These factors include audibility, and age-related changes in supra-threshold auditory processing abilities, and it has been suggested that differences in cognitive abilities may also be important. The objective of this study was to investigate associations between performance in cognitive tasks and speech recognition under different listening conditions in older adults with either age appropriate hearing or hearing-impairment. To that end, speech recognition threshold (SRT) measurements were performed under several masking conditions that varied along the perceptual dimensions of dip listening, spatial separation, and informational masking. In addition, a neuropsychological test battery was administered, which included measures of verbal working and short-term memory, executive functioning, selective and divided attention, and lexical and semantic abilities. Age-matched groups of older adults with either age-appropriate hearing (ENH, n = 20) or aided hearing impairment (EHI, n = 21) participated. In repeated linear regression analyses, composite scores of cognitive test outcomes (evaluated using PCA) were included to predict SRTs. These associations were different for the two groups. When hearing thresholds were controlled for, composed cognitive factors were significantly associated with the SRTs for the ENH listeners. Whereas better lexical and semantic abilities were associated with lower (better) SRTs in this group, there was a negative association between attentional abilities and speech recognition in the presence of spatially separated speech-like maskers. For the EHI group, the pure-tone thresholds (averaged across 0.5, 1, 2, and 4 kHz) were significantly associated with the SRTs, despite the fact that all signals were amplified and therefore in principle audible.

[Hearing test results of 18- to 20-year old men preceding military conscription from 2008-2010]. / Hörtestergebnisse bei 18- bis 20-jährigen Männern aus Kreiswehrersatzämtern von 2008­2010.

OBJECTIVE: High-frequency hearing loss is known to increase with age, whereas the amount and rate of increase of hearing loss in younger people is still unclear. A large proportion of young age groups is expected to preserve normal hearing. Therefore, the requirements for screening methods are particularly high and the motivation to participate is low. The obligatory examinations preceding military conscription include a pure-tone audiogram and thus allow the analysis of the hearing status of young male adults. MATERIAL AND METHODS: The prevalence of hearing impairment was determined using air-conduction thresholds of 18- to 20-year old men, from 54 German registration offices (KWEA), measured in 2008 to 2010. The criterion was based on candidates exceeding a threshold of 20 dB HL for one of the frequencies 3, 4, or 6 kHz in at least one ear. This very strict criterion was compared to other definitions of hearing impairment. RESULTS: The prevalence of hearing impairment was, on average, 15.3 % and thus in the same range as in other studies. However, the results of single KWEA differed by up to a factor of 10. CONCLUSIONS: Due to high fluctuations in measurement quality in the KWEA, regional differences in hearing thresholds of young men are not resolvable and it remains unclear whether the hearing loss has increased in comparison to earlier studies. The high variability of measurements near thresholds requires permanent quality inspections. However, hearing thresholds derived from screening cannot be evaluated applying the same criteria as for hearing tests in audiological centers or studies.

[Hearing Loss and Speech Recognition in the Elderly]. / Hörverlust und Sprachverstehen im Alter.

Elderly people often complain about poor speech understanding in noisy environments. In clinical practice, speech tests under noise conditions are used to examine hearing ability. The HÖRSTAT study, conducted on a population-based random sample consisting of 1903 adults, used the Goettingen Sentence Test (GÖSA) under noise conditions along with pure-tone audiometry. Hearing impairment was defined as pure-tone average at 0.5, 1, 2 and 4 kHz (PTA-4) greater than 25 dB HL in the better ear (WHO criterion). As expected, pure-tone thresholds and speech recognition thresholds (SRT) in GÖSA worsened steadily with age. For a comparison of PTA-4, SRTGÖSA and self-reported hearing, analysis was limited to 553 adults aged 60-85 years with PTA-4 below 50 dB HL and SRTs measured with a constant 65 dB SPL noise level. The percentage of hearing-impaired increased from 13 % in the 60-65 year-old people to 60 % in those aged 80-85 years. Overall, 68 % of the 60-85 years adults showed normal hearing in terms of unimpaired hearing according to the WHO criterion. The SRTGÖSA of 66 % of the elderly adults with normal hearing, however, did not lie within the reference range established with young normal hearing subjects in the HÖRSTAT study (4.8 ± 1.8 dB SNR, mean±2 * standard deviation). Among the 553 elderly, only 24 % reached this reference range. PTA-4 and SRTGÖSA results showed moderate to good correlations (Pearson r = 0.562, within 5-years bands: 0.372-0.514). From PTA-4 ≥ 30 dB HL and SRTGÖSA ≥- 2 dB SNR, respectively, more than half of the subjects reported hearing difficulties. Despite the continuous decline of PTA-4 and SRTGÖSA with age, the proportion of self-reported hearing difficulties as well as the self-rated hearing ability score stagnated. From the age of 70 years onwards, the elderly in the HÖRSTAT sample tend to overestimate their hearing abilities and to underestimate their difficulties.

Relation Between Listening Effort and Speech Intelligibility in Noise.

PURPOSE: Subjective ratings of listening effort might be applicable to estimate hearing difficulties at positive signal-to-noise ratios (SNRs) at which speech intelligibility scores are near 100%. Hence, ratings of listening effort were compared with speech intelligibility scores at different SNRs, and the benefit of hearing aids was evaluated. METHOD: Two groups of listeners, 1 with normal hearing and 1 with hearing impairment, performed adaptive speech intelligibility and adaptive listening effort tests (Adaptive Categorical Listening Effort Scaling; Krueger, Schulte, Brand, & Holube, 2017) with sentences of the Oldenburg Sentence Test (Wagener, Brand, & Kollmeier, 1999a, 1999b; Wagener, Kühnel, & Kollmeier, 1999) in 4 different maskers. Model functions were fitted to the data to estimate the speech reception threshold and listening effort ratings for extreme effort and no effort. RESULTS: Listeners with hearing impairment showed higher rated listening effort compared with listeners with normal hearing. For listeners with hearing impairment, the rating extreme effort, which corresponds to negative SNRs, was more correlated to the speech reception threshold than the rating no effort, which corresponds to positive SNRs. A benefit of hearing aids on speech intelligibility was only verifiable at negative SNRs, whereas the effect on listening effort showed high individual differences mainly at positive SNRs. CONCLUSION: The adaptive procedure for rating subjective listening effort yields information beyond using speech intelligibility to estimate hearing difficulties and to evaluate hearing aids.