A simple method to estimate noise levels in the workplace based on self-reported speech communication effort in noise.

Objective: To validate a method using self-reported speech communication effort in noise to estimate occupational noise levels by comparing with measured noise levels. Design: A comparative observational study. Reported vocal effort to communicate with a person at a distance of 1.2 m during workplace-related tasks was used to provide an estimate of noise levels in the workplace. These estimated noise levels were compared against noise level measurements obtained using personal noise dosimetry badges for corresponding tasks undertaken by participants. Study sample: Participants (n = 168) aged 16-25 years were recruited from companies where workplace noise levels were at least 85 dB(A). Results: Estimated noise levels using speech communication ability were evenly distributed above and below the measured noise levels (n = 134), indicating a lack of systematic bias in the method. For 91% of participants, estimates of noise levels using speech communication were within ±6 dB of the measured levels, whilst 56% were within ±3 dB. Conclusions: Report of speech communication effort required in noise by employees is an effective method of estimating noise levels within the workplace. This can be used for retrospective noise level assessment where there are no recorded noise level measurements, such as for retrospective research studies or in medicolegal work.

Repeatability of click-evoked otoacoustic emission-based medial olivocochlear efferent assay.

OBJECTIVES: Otoacoustic emissions-based efferent assays are evolving to become a part of auditory diagnostics. The wide range of clinical applications, such as assessment of auditory neuropathy, auditory processing disorders, learning disability, monitoring success in auditory intervention and others illustrate the significance of this measurement. Defining the procedure's test-retest repeatability is of critical importance, to allow for distinction between measurement deviations and true physiological or pathological changes. The purpose of this study was to assess the repeatability of a click-evoked otoacoustic emission-based (CEOAE) test of the medial olivocochlear (MOC) reflex in normal-hearing (NH) adults. DESIGN: Test-retest data were collected from 35 NH young adults in two distinct test sessions separated by 1 to 4 days. CEOAEs were recorded without and with contralateral acoustic stimulation (CAS; 35 dB SL). Three indices of the MOC reflex were computed: CAS-induced (a) absolute changes in CEOAE amplitude, (b) normalized changes in CEOAE amplitude, and (c) changes in CEOAE input-output functions. Repeatability of these indices was assessed by a three-layered approach, which consisted of Bland-Altman plots, coefficient of reliability (Cronbach's α), and analysis of variance. RESULTS: Analyses indicated good repeatability of three CEOAE-based MOC reflex indices. A two-way analysis of variance of the indices demonstrated no significant difference between test and retest. Normalized index showed similar repeatability as other indices. CEOAE signal to noise ratio did not seem to vary between test sessions. Notably, CAS caused a decrease in CEOAE input-output functions slope in a majority of participants (n = 29). CONCLUSIONS: The present study is the first to elucidate the intrasubject variability of absolute and normalized indices of the MOC inhibitory effect. Although the measurements were conducted under realistic conditions resembling the clinical setting, repeatability was generally good in NH adults. For MOC reflex test, the signal to noise ratio of 6 dB for recording CEOAEs seems to be a recommendable criterion when considering practicability and measurement quality in clinical conditions. The present findings exemplify the suitability of CEOAE-based MOC assay as a monitoring tool of medial efferent status over time. The data are intended to assist clinicians and scientists alike in the accurate interpretation of CAS-induced CEOAE changes in the test-retest situation.

Evaluation of the preliminary auditory profile test battery in an international multi-centre study.

OBJECTIVE: This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported disability and handicap, and cognition. Clinical applicability and comparability across different centres are investigated. DESIGN: Headphone tests were conducted in five centres divided over four countries. Effects of test-retest, ear, and centre were investigated. Results for normally-hearing (NH) and hearing-impaired (HI) listeners are presented. STUDY SAMPLE: Thirty NH listeners aged 19-39 years, and 72 HI listeners aged 22-91 years with a broad range of hearing losses were included. RESULTS: Test-retest reliability was generally good and there were very few right/left ear effects. Results of all tests were comparable across centres for NH listeners after baseline correction to account for necessary differences between test materials. For HI listeners, results were comparable across centres for the language-independent tests. CONCLUSIONS: The auditory profile forms a clinical test battery that is applicable in four different languages. Even after baseline correction, differences between test materials have to be taken into account when interpreting results of language-dependent tests in HI listeners.

Relationship between speech recognition in noise and sparseness.

OBJECTIVE: Established methods for predicting speech recognition in noise require knowledge of clean speech signals, placing limitations on their application. The study evaluates an alternative approach based on characteristics of noisy speech, specifically its sparseness as represented by the statistic kurtosis. DESIGN: Experiments 1 and 2 involved acoustic analysis of vowel-consonant-vowel (VCV) syllables in babble noise, comparing kurtosis, glimpsing areas, and extended speech intelligibility index (ESII) of noisy speech signals with one another and with pre-existing speech recognition scores. Experiment 3 manipulated kurtosis of VCV syllables and investigated effects on speech recognition scores in normal-hearing listeners. STUDY SAMPLE: Pre-existing speech recognition data for Experiments 1 and 2; seven normal-hearing participants for Experiment 3. RESULTS: Experiments 1 and 2 demonstrated that kurtosis calculated in the time-domain from noisy speech is highly correlated (r > 0.98) with established prediction models: glimpsing and ESII. All three measures predicted speech recognition scores well. The final experiment showed a clear monotonic relationship between speech recognition scores and kurtosis. CONCLUSIONS: Speech recognition performance in noise is closely related to the sparseness (kurtosis) of the noisy speech signal, at least for the types of speech and noise used here and for listeners with normal hearing.

Measuring real-ear signal-to-noise ratio: application to directional hearing aids.

Due to individual characteristics such as head size, earmould type, and earmould venting, the directional benefit that an individual will obtain from a hearing aid cannot be predicted from average data. It is therefore desirable to measure real ear directional benefit. This paper demonstrates a method to measure real ear hearing aid directivity based on a general approach to measure the broadband output signal-to-noise ratio of a hearing aid. Errors arising from non-linearity were tested in simulation and found to be low for typical hearing aid compression ratios. Next, the efficacy of the method to estimate directional benefit was demonstrated on KEMAR. Finally the variability of directional benefit was explored in real-ears. Significant differences in signal-to-noise ratio between directional and omnidirectional microphone settings were demonstrated at most azimuths. Articulation-Index-weighted directional benefit varied by more than 7 dB across ears at some azimuths. Such individual variation in directional benefit has implications when fitting hearing aids: it should not be assumed that all users will receive similar directional benefit from the same hearing aid.

Effects of UMTS cellular phones on human hearing: results of the European project EMFnEAR.

Abstract The European project EMFnEAR was undertaken to assess potential changes in human auditory function after a short-term exposure to radiofrequency (RF) radiation produced by UMTS (Universal Mobile Telecommunication System) mobile phones. Participants were healthy young adults with no hearing or ear disorders. Auditory function was assessed immediately before and after exposure to radiofrequency radiation, and only the exposed ear was tested. Tests for the assessment of auditory function were hearing threshold level (HTL), distortion product otoacoustic emissions (DPOAE), contralateral suppression of transiently evoked otoacoustic emission (CAS effect on TEOAE), and auditory evoked potentials (AEP). The exposure consisted of speech at a typical conversational level delivered via an earphone to one ear, plus genuine or sham RF-radiation exposure produced by a commercial phone controlled by a personal computer. Results from 134 participants did not show any consistent pattern of effects on the auditory system after a 20-min UMTS exposure at the maximum output of the phone with 69 mW/kg SAR in the cochlea region in a double blind comparison of genuine and sham exposure. An isolated effect on the hearing threshold at high frequencies was identified, but this was statistically nonsignificant after correction for multiple comparisons. It is concluded that UMTS short-term exposure at the maximum output of consumer mobile phones does not cause measurable immediate effects on the human auditory system.

Measuring outcome from vestibular rehabilitation, part II: refinement and validation of a new self-report measure.

A prototype self-report measure of vestibular rehabilitation outcome is described in a previous paper. The objectives of the present work were to identify the most useful items and assess their psychometric properties. Stage 1: One hundred fifty-five participants completed a prototype 36-item Vestibular Rehabilitation Benefit Questionnaire (VRBQ). Statistical analysis demonstrated its subscale structure and identified redundant items. Stage 2: One hundred twenty-four participants completed a refined 22-item VRBQ and three established questionnaires (Dizziness Handicap Inventory, DHI; Vertigo Symptom Scale short form, VSS-sf; Medical Outcomes Study short form 36, SF-36) in a longitudinal study. Statistical analysis revealed four internally consistent subscales of the VRBQ: Dizziness, Anxiety, Motion-Provoked Dizziness, and Quality of Life. Correlations with the DHI, VSS-sf, and SF-36 support the validity of the VRBQ, and effect size estimates suggest that the VRBQ is more responsive than comparable questionnaires. Twenty participants completed the VRBQ twice in a 24-hour period, indicating excellent test-retest reliability. The VRBQ appears to be a concise and psychometrically robust questionnaire that addresses the main aspects of dizziness impact.

Measuring outcome from Vestibular Rehabilitation, Part I: Qualitative development of a new self-report measure.

Research suggests that Vestibular Rehabilitation (VR) is an effective treatment for dizziness, but there is currently no measure specifically designed to assess treatment outcome. A review of existing self-report measures of dizziness indicates that no measure has been designed for longitudinal application and all suffer from limitations which restrict their usefulness in measuring VR outcome. A need for a psychometrically robust patient-oriented measure of quality of life benefit from VR is identified. The aim of the present study was to explore dimensions relevant to VR with a view to developing a measure of outcome. Eighteen adults receiving VR participated in interviews about the quality of life impact of dizziness. Qualitative analysis revealed 64 themes describing self-perceived quality of life impact. Themes were developed into potential questionnaire items and 35 were selected to represent the quality of life impact of dizziness in a prototype questionnaire. A quarter of items in the prototype questionnaire refer to issues not addressed by existing measures; the remaining items draw together issues covered by the range of questionnaires currently in use.

Effects of GSM cellular phones on human hearing: the European project "GUARD".

The European multicenter project named GUARD involved nine centers and aimed to assess potential changes in auditory function as a consequence of exposure to low-intensity electromagnetic fields (EMFs) produced by GSM cellular phones. Participants were healthy young adults without any evidence of hearing or ear disorders. Auditory function was assessed immediately before and after exposure to EMFs, and only the exposed ear was tested. The procedure was conducted twice in a double blinded design, once with a genuine EMF exposure and once with a sham exposure (at least 24 h apart). Tests for assessment of auditory function were hearing threshold level (HTL), transient otoacoustic emissions (TEOAE), distortion product otoacoustic emissions (DPOAE), and auditory brainstem response (ABR). The exposure consisted of speech at a typical conversational level delivered via an earphone to one ear, plus genuine or sham EMF exposure. The EMF exposure used the output of a software-controlled consumer cellular phone at full power for 10 min. A system of phone positioning that allowed participants to freely move their heads without affecting exposure was used. Analysis of the data showed there were no effects of exposure to GSM mobile phone signals on the main measures of the status of the auditory system.

Effects of mobile phone exposure on time frequency fine structure of transiently evoked otoacoustic emissions.

Mobile phones have become very commonly used worldwide within a short period of time. To date there is only limited knowledge about interaction between electromagnetic fields (EMFs) emitted by mobile phones and the auditory function. Moreover, there is widespread concern that there may be potential for harm. The aim of this study was to assess potential subtle changes in cochlear function by measuring the temporal and spectral fine structure of transiently evoked otoacoustic emissions (TEOAE) in normal hearing subjects after exposure to EMFs emitted by Global System for Mobile Communication (GSM) mobile phones. TEOAEs were recorded in 27 healthy young adults before and after 10 min of real or sham exposure in a double-blind design. TEOAE data were analyzed both globally (broadband analysis) and using the Wavelet Transform (analysis of the time-frequency fine structure). The broadband analysis revealed no significant effect on TEOAEs related to exposure, confirming results of previous studies; in addition, no significant change was detected in the analysis of the elementary wavelet components, suggesting that the temporal and spectral fine structure of TEOAEs is not affected by 10 min exposure to low-intensity EMFs emitted by GSM mobile phones.

The auditory middle latency response, evoked using maximum length sequences and chirps, as an indicator of adequacy of anesthesia.

The auditory evoked potential known as the middle latency response (MLR), evoked with regular click stimulation at around 5 Hz, has been suggested as an indicator of adequacy of anesthesia. The MLR is a very small signal embedded in high levels of background noise, so it can take a long time to acquire. However, using a stimulus paradigm of chirps presented in a maximum length sequence, the acquisition of the MLR can be improved compared to using conventional click stimulation. In this pilot study, we investigated this new technique in a clinical environment. Significant changes in MLR amplitude, but not latency, were measured for six of seven subjects in association with changes in responsiveness to command using the isolated forearm technique. The absence of any latency shift differs from other studies of the MLR during anesthesia and highlights the limited understanding of the relationship between anesthesia and the MLR.

Dynamic nonlinear cochlear model predictions of click-evoked otoacoustic emission suppression.

A comprehensive set of results from 2-click suppression experiments on otoacoustic emissions (OAEs) have been presented by Kapadia and Lutman [Kapadia, S., Lutman, M.E., 2000a. Nonlinear temporal interactions in click-evoked otoacoustic emissions. I. Assumed model and polarity-symmetry. Hear. Res. 146, 89-100]. They found that the degree of suppression of an OAE evoked by a test click varied systematically with the timing and the level of a suppressor click, being greatest for suppressor clicks occurring some time before the test click, particularly at lower levels of suppression. Kapadia and Lutman also showed that although the general shape of the graph of suppression against suppressor click timing could be predicted by a static power law model, this did not predict the asymmetry with respect to the timing of the suppressor click. A generalised automatic gain control (AGC) is presented as a simple example of a dynamic nonlinear system. Its steady state nonlinear behaviour, as quantified by its level curve, and its dynamic behaviour, as quantified by its transient response, can be independently set by the feedback gain law and detector time constant, respectively. The previously reported suppression results, with the asymmetry in the timing, are found to be predicted better by such an AGC having a level curve with a slope of about 0.5 dB/dB, and a detector time constant of about twice the period at the characteristic frequency. Although this gives adequate predictions for high suppression levels, it under predicts the suppression and the asymmetry for lower levels. Further research is required to establish whether simple peripheral feedback models can explain OAE suppression of this type.

Auditory localization abilities in bilateral cochlear implant recipients.

OBJECTIVE: To quantify binaural advantage for auditory localization in the horizontal plane by bilateral cochlear implant (CI) recipients. Also, to determine whether the use of dual microphones with one implant improves localization. METHODS: Twenty subjects from the UK multicenter trial of bilateral cochlear implantation with Nucleus 24 K/M device were recruited. Sound localization was assessed in an anechoic room with an 11-loudspeaker array under four test conditions: right CI, left CI, binaural CI, and dual microphone. Two runs were undertaken for each of five stimuli (speech, tones, noise, transients, and reverberant speech). Order of conditions was counterbalanced across subjects. RESULTS: Mean localization error with bilateral implants was 24 degrees compared with 67 degrees for monaural implant and dual microphone conditions (chance performance is 65 degrees). Normal controls average 2 to 3 degrees in similar conditions. Binaural performance was significantly better than monaural performance for all subjects, for all stimulus types, and for different sound sources. Only small differences in performance with different stimuli were observed. CONCLUSIONS: Bilateral cochlear implantation with the Nucleus 24 device provides marked improvement in horizontal plane localization abilities compared with unilateral CI use for a range of stimuli having different spectral and temporal characteristics. Benefit was obtained by all subjects, for all stimulus types, and for all sound directions. However, binaural performance was still worse than that obtained by normal hearing listeners and hearing aid users with the same methodology. Monaural localization performance was at chance. There is no benefit for localization with dual microphones.

Further tests of the local nonlinear interaction-based mechanism for simultaneous suppression of tone burst-evoked otoacoustic emissions.

Tone burst-evoked otoacoustic emission (TBOAE) components measured in response to a 1 kHz tone burst (TB1) are suppressed by the simultaneous presence of an additional tone burst (TB2). This "simultaneous suppression of TBOAEs" has been explained in terms of a mechanism based on local nonlinear interactions between the basilar membrane (BM) travelling waves caused by TB1 and TB2. A test of this local nonlinear interaction (LNI)-based mechanism, as a function of the frequency separation (Δf, expressed in kHz) between TB1 and TB2, has previously been reported by Killan et al. (2012) using a simple mathematical model [Killan et al., Hear. Res. 285, 58-64 (2012)]. The two experiments described in this paper add additional data on the extent to which the LNI-based mechanism can account for simultaneous suppression, by testing two further hypotheses derived from the model predictions. Experiment I tested the hypothesis that TBOAE suppression is directly linked to TBOAE amplitude nonlinearity where ears that exhibit a higher degree of amplitude nonlinearity yield greater suppression than more linear ears, and this relationship varies systematically as a function of Δf. In order to test this hypothesis simultaneous suppression at a range of values of Δf at 60 dB peak-equivalent sound pressure level (p.e. SPL) and TBOAE amplitude nonlinearity from normal human ears was measured. In Experiment II the hypothesis that suppression will also increase progressively as a function of increasing tone burst level was tested by measuring suppression for a range of Δf and tone burst levels at 40, 50, 60 and 70 dB p.e. SPL. The majority of the findings from both experiments provide support for the LNI-based mechanism being primarily responsible for simultaneous suppression. However, some data were inconsistent with this view. Specifically, a breakdown in the relationship between suppression and TBOAE amplitude nonlinearity at Δf = 1 (i.e. when TB2 was reasonably well separated from, and had a higher frequency than TB1) and unexpected level-dependence, most notably at Δf = 1, but also where Δf = -0.5, was observed. Either the LNI model is too simple or an alternative explanation, involving response components generated at basal regions of the basilar membrane, is required to account for these findings.

Simultaneous suppression of tone burst-evoked otoacoustic emissions: Two and three-tone burst combinations.

Previous investigations have shown that components of a tone burst-evoked otoacoustic emission (TBOAE) evoked by a 1 kHz tone burst (TB1) can be suppressed by the simultaneous presence of a 2 kHz tone burst (TB2) or a pair of tone bursts at 2 and 3 kHz (TB2 and TB3 respectively). No previous study has measured this "simultaneous suppression of TBOAEs" for both TB2 alone and TB2 and TB3 from the same ears, so that the effect of the additional presence of TB3 on suppression caused by TB2 is not known. In simple terms, three outcomes are possible; suppression increases, suppression is reduced or suppression is not affected. Comparison of previously reported simultaneous suppression data suggests TB3 causes a reduction in suppression, though it is not clear if this is a genuine effect or simply reflects methodological and ear differences between studies. This issue has implications for previously proposed mechanisms of simultaneous suppression of TBOAEs and the interpretation of clinical data, and is clarified by the present study. Simultaneous suppression of TBOAEs was measured for TB1 and TB2 as well as TB1, TB2 and TB3 at 50, 60 and 70 dB p.e. SPL from nine normal human ears. Results showed no significant difference between mean suppression obtained for the two and three-tone burst combinations, indicating the reduction of suppression inferred from comparison of previous data is likely a result of methodological and ear differences rather than a genuine effect.

Sparse Nonnegative Matrix Factorization Strategy for Cochlear Implants.

Current cochlear implant (CI) strategies carry speech information via the waveform envelope in frequency subbands. CIs require efficient speech processing to maximize information transfer to the brain, especially in background noise, where the speech envelope is not robust to noise interference. In such conditions, the envelope, after decomposition into frequency bands, may be enhanced by sparse transformations, such as nonnegative matrix factorization (NMF). Here, a novel CI processing algorithm is described, which works by applying NMF to the envelope matrix (envelopogram) of 22 frequency channels in order to improve performance in noisy environments. It is evaluated for speech in eight-talker babble noise. The critical sparsity constraint parameter was first tuned using objective measures and then evaluated with subjective speech perception experiments for both normal hearing and CI subjects. Results from vocoder simulations with 10 normal hearing subjects showed that the algorithm significantly enhances speech intelligibility with the selected sparsity constraints. Results from eight CI subjects showed no significant overall improvement compared with the standard advanced combination encoder algorithm, but a trend toward improvement of word identification of about 10 percentage points at +15 dB signal-to-noise ratio (SNR) was observed in the eight CI subjects. Additionally, a considerable reduction of the spread of speech perception performance from 40% to 93% for advanced combination encoder to 80% to 100% for the suggested NMF coding strategy was observed.

Speech quality evaluation of a sparse coding shrinkage noise reduction algorithm with normal hearing and hearing impaired listeners.

Although there are numerous papers describing single-channel noise reduction strategies to improve speech perception in a noisy environment, few studies have comprehensively evaluated the effects of noise reduction algorithms on speech quality for hearing impaired (HI). A model-based sparse coding shrinkage (SCS) algorithm has been developed, and has shown previously (Sang et al., 2014) that it is as competitive as a state-of-the-art Wiener filter approach in speech intelligibility. Here, the analysis is extended to include subjective quality ratings and a method called Interpolated Paired Comparison Rating (IPCR) is adopted to quantitatively link the benefit of speech intelligibility and speech quality. The subjective quality tests are performed through IPCR to efficiently quantify noise reduction effects on speech quality. Objective measures including frequency-weighted segmental signal-to-noise ratio (fwsegSNR), perceptual evaluation of speech quality (PESQ) and hearing aid speech quality index (HASQI) are adopted to predict the noise reduction effects. Results show little difference in speech quality between the SCS and the Wiener filter algorithm but a difference in quality rating between the HI and NH listeners. HI listeners generally gave better quality ratings of noise reduction algorithms than NH listeners. However, SCS reduced the noise more efficiently at the cost of higher distortions that were detected by NH but not by the HI. SCS is a promising candidate for noise reduction algorithms for HI. In general, care needs to be taken when adopting algorithms that were originally developed for NH participants into hearing aid applications. An algorithm that is evaluated negatively with NH might still bring benefits for HI participants.

Parents and their cochlear implanted child: questionnaire development to assess parental views and experiences.

OBJECTIVES: To test the reliability of a validated closed-format questionnaire assessing parental views following cochlear implantation of their child. DESIGN: Parents were surveyed using a closed-format questionnaire developed in earlier work. The same parents were surveyed 1 month later and responses compared. Test-retest reliability was thereby assessed. SETTING: Tertiary referral Pediatric Cochlear Implant Centre in the UK. SUBJECTS AND METHODS: The parents of 20 children who had been born deaf or were deafened by age 3 years and who had been implanted for at least 2 years were drawn at random from patient lists. Parents were surveyed using a closed-format questionnaire whose validity had been previously assessed and re-surveyed 1 month later. Responses over time were compared. RESULTS: For the majority of items in the questionnaire, the replication of the item would lead to the same response on at least 95% of occasions. The text of the closed-format questionnaire is reproduced in full. CONCLUSION: This validated closed-format questionnaire appears to be unique in respect of cochlear implantation, being based explicitly on issues thought important by the parents. The high test-retest reliability indicates that it is capable of eliciting parental views in a meaningful manner. This information that is not currently available by other means can then be used as part of an overall assessment of outcomes, to inform efforts aimed at quality improvement as well as demonstrating accountability to purchasers and policymakers. Moreover, a wider use of this instrument can result in valid comparisons of outcomes among different cochlear implant centres.

Does static ear canal pressure influence pure tone pitch perception?

OBJECTIVE: That static ear canal air pressure (ECP) influences the frequency of spontaneous otoacoustic emissions (SOAEs) suggests that it may influence intracochlear, in addition to middle ear, processes. A previous study suggested that ECP influences pure tone pitch perception at 1,000 Hz, which was interpreted as indicating an effect on the cochlear place-frequency map. The present study extended investigations of this effect to 500 and 4,000 Hz. MATERIAL AND METHODS: Nine normal-hearing listeners performed interaural pitch matching with monaural ECPs of 0 and -300 daPa. RESULTS: Some indications of a small downward pitch shift (mean 0.2%) at 500 Hz were observed, which were marginally statistically significant at the 5% level. No pitch shifts were observed at 4,000 Hz. CONCLUSIONS: ECP does not influence pitch to the extent suggested previously or by SOAE frequency shifts. No evidence was found to support the notion that ECP influences the place-frequency map.