Toward parametric Bayesian adaptive procedures for multi-frequency categorical loudness scaling.

A series of Bayesian adaptive procedures to estimate loudness growth across a wide frequency range from individual listeners was developed, and these procedures were compared. Simulation experiments were conducted based on multinomial psychometric functions for categorical loudness scaling across ten test frequencies estimated from 61 listeners with normal hearing and 87 listeners with sensorineural hearing loss. Adaptive procedures that optimized the stimulus selection based on the interim estimates of two types of category-boundary models were tested. The first type of model was a phenomenological model of category boundaries adopted from previous research studies, while the other type was a data-driven model derived from a previously collected set of categorical loudness scaling data. An adaptive procedure without Bayesian active learning was also implemented. Results showed that all adaptive procedures provided convergent estimates of the loudness category boundaries and equal-loudness contours between 250 and 8000 Hz. Performing post hoc model fitting, using the data-driven model, on the collected data led to satisfactory accuracies, such that all adaptive procedures tested in the current study, independent of modeling approach and stimulus-selection rules, were able to provide estimates of the equal-loudness-level contours between 20 and 100 phons with root-mean-square errors typically under 6 dB after 100 trials.

Spectrally specific temporal analyses of spike-train responses to complex sounds: A unifying framework.

Significant scientific and translational questions remain in auditory neuroscience surrounding the neural correlates of perception. Relating perceptual and neural data collected from humans can be useful; however, human-based neural data are typically limited to evoked far-field responses, which lack anatomical and physiological specificity. Laboratory-controlled preclinical animal models offer the advantage of comparing single-unit and evoked responses from the same animals. This ability provides opportunities to develop invaluable insight into proper interpretations of evoked responses, which benefits both basic-science studies of neural mechanisms and translational applications, e.g., diagnostic development. However, these comparisons have been limited by a disconnect between the types of spectrotemporal analyses used with single-unit spike trains and evoked responses, which results because these response types are fundamentally different (point-process versus continuous-valued signals) even though the responses themselves are related. Here, we describe a unifying framework to study temporal coding of complex sounds that allows spike-train and evoked-response data to be analyzed and compared using the same advanced signal-processing techniques. The framework uses a set of peristimulus-time histograms computed from single-unit spike trains in response to polarity-alternating stimuli to allow advanced spectral analyses of both slow (envelope) and rapid (temporal fine structure) response components. Demonstrated benefits include: (1) novel spectrally specific temporal-coding measures that are less confounded by distortions due to hair-cell transduction, synaptic rectification, and neural stochasticity compared to previous metrics, e.g., the correlogram peak-height, (2) spectrally specific analyses of spike-train modulation coding (magnitude and phase), which can be directly compared to modern perceptually based models of speech intelligibility (e.g., that depend on modulation filter banks), and (3) superior spectral resolution in analyzing the neural representation of nonstationary sounds, such as speech and music. This unifying framework significantly expands the potential of preclinical animal models to advance our understanding of the physiological correlates of perceptual deficits in real-world listening following sensorineural hearing loss.

Effects of Sensorineural Hearing Loss on Cortical Synchronization to Competing Speech during Selective Attention.

When selectively attending to a speech stream in multi-talker scenarios, low-frequency cortical activity is known to synchronize selectively to fluctuations in the attended speech signal. Older listeners with age-related sensorineural hearing loss (presbycusis) often struggle to understand speech in such situations, even when wearing a hearing aid. Yet, it is unclear whether a peripheral hearing loss degrades the attentional modulation of cortical speech tracking. Here, we used psychoacoustics and electroencephalography (EEG) in male and female human listeners to examine potential effects of hearing loss on EEG correlates of speech envelope synchronization in cortex. Behaviorally, older hearing-impaired (HI) listeners showed degraded speech-in-noise recognition and reduced temporal acuity compared with age-matched normal-hearing (NH) controls. During EEG recordings, we used a selective attention task with two spatially separated simultaneous speech streams where NH and HI listeners both showed high speech recognition performance. Low-frequency (<10 Hz) envelope-entrained EEG responses were enhanced in the HI listeners, both for the attended speech, but also for tone sequences modulated at slow rates (4 Hz) during passive listening. Compared with the attended speech, responses to the ignored stream were found to be reduced in both HI and NH listeners, allowing for the attended target to be classified from single-trial EEG data with similar high accuracy in the two groups. However, despite robust attention-modulated speech entrainment, the HI listeners rated the competing speech task to be more difficult. These results suggest that speech-in-noise problems experienced by older HI listeners are not necessarily associated with degraded attentional selection.SIGNIFICANCE STATEMENT People with age-related sensorineural hearing loss often struggle to follow speech in the presence of competing talkers. It is currently unclear whether hearing impairment may impair the ability to use selective attention to suppress distracting speech in situations when the distractor is well segregated from the target. Here, we report amplified envelope-entrained cortical EEG responses to attended speech and to simple tones modulated at speech rates (4 Hz) in listeners with age-related hearing loss. Critically, despite increased self-reported listening difficulties, cortical synchronization to speech mixtures was robustly modulated by selective attention in listeners with hearing loss. This allowed the attended talker to be classified from single-trial EEG responses with high accuracy in both older hearing-impaired listeners and age-matched normal-hearing controls.

Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults.

Cochlear implants (CI) have increasingly been adopted in older adults with severe to profound sensorineural hearing loss as a result of the growing and aging world population. Consequently, researchers have recently shown great interest in the cost-effectiveness of cochlear implantation and its effect on quality of life (QoL) in older CI users. Therefore, a systematic review and critical evaluation of the available literature on QoL in older adult CI users was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching MEDLINE (PubMed) and the Cochrane Library and by checking the reference lists of relevant articles. Inclusion criteria were as follows: (1) the study sample were adults aged 50 years and older with postlingual onset of bilateral severe to profound hearing loss, (2) all subjects received a multi-electrode CI, and (3) QoL was assessed before and after implantation. Out of 1,093 records, 18 articles were accepted for review. Several studies demonstrated significant positive effects of cochlear implantation on QoL in older adults, but high-level evidence-based medicine is lacking. An improvement of QoL was generally reported when using disease-specific instruments, which are designed to detect treatment-specific changes, whereas the outcomes of generic QoL questionnaires, assessing general health states, were rather ambiguous. However, only generic questionnaires would be able to provide calculations of the cost-effectiveness of CI and comparisons across patient populations, diseases, or interventions. Hence, generic and disease-specific QoL instruments are complementary rather than contradictory. In general, older CI users' QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. There is a need for a standardized, multidimensional, and comprehensive QoL study protocol including all relevant generic and disease-specific instruments to measure and compare QoL, utility, and/or daily life performance in CI users.

Can Cochlear Implantation in Older Adults Reverse Cognitive Decline Due to Hearing Loss?

INTRODUCTION: Older adults with late-onset hearing loss are at risk for cognitive decline. Our study addresses the question of whether cochlear implantation (CI) can counteract this potential influence. We investigated whether cognitive performance in older adults with severe and profound hearing loss improves 12 months after CI to a level comparable to controls with normal hearing, matched for age, sex, and education level. DESIGN: This cohort study was performed at two tertiary referral centers. The study included 29 patients, of age between 60 and 80 years, with adult-onset, severe to profound bilateral sensorineural hearing loss and indication for CI (study group), as well as 29 volunteers with age-adjusted hearing abilities, according to the norm curves of ISO-702 9:2000-01, (control group). Before CI and 12 months after CI, participants completed a neurocognitive test battery including tests of global cognition, verbal and figural episodic memory, and executive functions (attentional control, inhibition, and cognitive flexibility). RESULTS: Twelve months after CI, the performance of the study group improved significantly in global cognition, compared to the situation before CI. Differences in verbal episodic memory, figural episodic memory, and executive function were not significant. Moreover, the improvement of the study group was significantly larger only in global cognition compared to the control group. Noninferiority tests on the cognitive performances of the study group after CI revealed that comparable levels to normal hearing controls were reached only in global cognition, figural episodic memory (immediate recall), and attentional control. The improvement in global cognition was significantly associated with speech recognition 3 months after CI, but not with speech recognition 12 months after CI. CONCLUSION: One year after CI, cognitive deficits in older individuals with adult-onset hearing loss, compared to normal-hearing peers, could only improve some cognitive skills.

Sensorineural hearing loss degrades behavioral and physiological measures of human spatial selective auditory attention.

Listeners with sensorineural hearing loss often have trouble understanding speech amid other voices. While poor spatial hearing is often implicated, direct evidence is weak; moreover, studies suggest that reduced audibility and degraded spectrotemporal coding may explain such problems. We hypothesized that poor spatial acuity leads to difficulty deploying selective attention, which normally filters out distracting sounds. In listeners with normal hearing, selective attention causes changes in the neural responses evoked by competing sounds, which can be used to quantify the effectiveness of attentional control. Here, we used behavior and electroencephalography to explore whether control of selective auditory attention is degraded in hearing-impaired (HI) listeners. Normal-hearing (NH) and HI listeners identified a simple melody presented simultaneously with two competing melodies, each simulated from different lateral angles. We quantified performance and attentional modulation of cortical responses evoked by these competing streams. Compared with NH listeners, HI listeners had poorer sensitivity to spatial cues, performed more poorly on the selective attention task, and showed less robust attentional modulation of cortical responses. Moreover, across NH and HI individuals, these measures were correlated. While both groups showed cortical suppression of distracting streams, this modulation was weaker in HI listeners, especially when attending to a target at midline, surrounded by competing streams. These findings suggest that hearing loss interferes with the ability to filter out sound sources based on location, contributing to communication difficulties in social situations. These findings also have implications for technologies aiming to use neural signals to guide hearing aid processing.

Cochlear implantation in patients with Pendred syndrome.

OBJECTIVE: To examine the outcomes of cochlear implantation in children with Pendred Syndrome. MATERIAL AND METHODS: A retrospective case series of nine pediatric patients with Pendred syndrome undergoing cochlear implantation at a tertiary academic medical center from 2003 to 2017. RESULTS: All patients were diagnosed with bilateral mild-to-profound to severe-to-profound sensorineural hearing loss and used hearing aids prior to implantation. Preoperative imaging results revealed that all patients exhibited bilateral enlarged vestibular aqueducts and 8 of 9 had cochlear dysplasia equivalent to Incomplete Partition II. Despite inner ear malformations, all electrodes were successfully implanted with minimal complications and favorable post-operative audiological outcomes. CONCLUSIONS: Cochlear implantation is an effective and successful treatment for severe-to-profound hearing loss in children with Pendred syndrome and for whom traditional amplification aids provide limited benefit. With early intervention, cochlear implantation allows speech and cognitive development in Pendred children comparable to that of normal hearing individuals, allowing patients to learn in a mainstream educational setting.

The effect of induction loop system use training on adults with hearing aids

Background/aim: The study aimed to investigate the effect of training on hearing aid users to benefit from induction loop systems. Materials and methods: A five-question scale was developed to evaluate whether individuals using hearing aids could use the induction loop system effectively. In the first step, validity-reliability studies were performed with 264 individuals using hearing aids. In the second step, 30 individuals using hearing aids were given verbal and hands-on training on the induction loop system. Before and after training with hearing aids (noiseless, noise, noise + induction system active) in three different environments, questions on the scale were asked twice in total from the beginning to the end of the study. Results: The significance of the differences between the values obtained as a result of the application of word lists in three different test settings was examined by repeating the measurements variance analysis. As a result of the post hoc analysis, P = 0.002 between test 3 (10.7, 1.53) and test 1 (11.7, 0.7) was calculated. There appears to be a statistically significant difference with the present situation (P < 0.01). The average scores of the scale between pre and posttraining applications as a preliminary and final test were analysed with a t-test. The final test average was statistically significantly greater than the preliminary test (P < 0.01). Conclusion: This study shows how important it is for hearing aid users to be informed and to receive the necessary training in order to gain the expected benefit from induction loop systems developed to improve speech intelligibility in noisy environments.

Adults' cochlear implant journeys through care: a qualitative study.

BACKGROUND: Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices. METHOD: Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed. RESULTS: One hundred forty-three data-capture events disclosed 2 themes: 1) "The burden of hearing loss and the impact of Cochlear Implants", and 2) "Professional Support and Practice, and HCPs Roles and Responsibilities". CONCLUSIONS: Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.

Hearing Phenotypes of Patients with Hearing Loss Homozygous for the GJB2 c.235delc Mutation.

Hereditary hearing loss is characterized by remarkable phenotypic heterogeneity. Patients with the same pathogenic mutations may exhibit various hearing loss phenotypes. In the Chinese population, the c.235delC mutation is the most common pathogenic mutation of GJB2 and is closely related to hereditary recessive hearing loss. Here, we investigated the hearing phenotypes of patients with hearing loss associated with the homozygous c.235delC mutation, paying special attention to asymmetric interaural hearing loss. A total of 244 patients with the GJB2 c.235delC homozygous mutation encountered from 2007 to 2015 were enrolled. The severity of hearing loss was scaled with the American Speech-Language-Hearing Association (ASHA). Auditory phenotypes were analyzed, and three types of interaural asymmetry were defined based on audiograms: Type A (asymmetry of hearing loss severity), Type B (asymmetry of audiogram shape), and Type C (Type A plus Type B). Of the 488 ears (244 cases) examined, 71.93% (351) presented with profound hearing loss, 14.34% (70) with severe hearing loss, and 9.43% (46) with moderate to severe hearing loss. The most common audiogram shapes were descending (31.15%) and flat (24.18%). A total of 156 (63.93%) of the 244 patients exhibited asymmetric interaural hearing loss in terms of severity and/or audiogram shape. Type A was evident in 14 of these cases, Type B in 106, and Type C in 36. In addition, 211 of 312 ears (67.63%) in the interaural hearing asymmetry group showed profound hearing loss, and 59 (18.91%) exhibited severe hearing loss, with the most common audiogram shapes being flat (27.88%) and descending (22.12%). By contrast, in the interaural hearing symmetry group, profound hearing loss was observed in 140 ears (79.55%), and the most common audiograms were descending (46.59%) and residual (21.59%). Hearing loss associated with the GJB2 c.235delC homozygous mutation shows diverse phenotypes, and a considerable proportion of patients show bilateral hearing loss asymmetry.

The development of auditory performance and speech perception in CI children after long-period follow up.

PURPOSE: The main purpose of the current study was to assess the development of auditory and speech perception and the effects of the age at implantation in CI children after long-period follow up. MATERIALS AND METHODS: Five hundred and forty-four young children participated in this study (339 males and 205 females). The age at implantation ranged from 6 months to 36 months. All subjects were prelingually bilateral profound sensorineural hearing loss. They were divided into 3 groups according to the implant ages: group 1 (age at implantation < 12 months, n = 109); group 2 (12 months < age at implantation < 24 months, n = 284); and group 3 (24 months < age at implantation < 36 months, n = 151). The categorical auditory performance (CAP) was used to assess auditory abilities and the speech intelligibility rating (SIR) was used to assess the speech intelligibility of these CI children. The tests were administered at pre-surgery and 1, 3, 6, 12, 24, 36, 48- and 60-months post-surgery. RESULTS: All the subjects demonstrated improvements of auditory abilities and speech intelligibility after CI surgery. The auditory ability developed quickly in 12 months after implantation. However, the speech intelligibility scores show rapid improvement within 24 months post implantation. Significant difference was found between group 1 and group 3, group 2 and group 3 before 12 months post-implantation for CAP and SIR. The three groups of children showed similar development pattern for their auditory abilities and speech intelligibility. CONCLUSION: The results of this study suggested dramatic and continuous improvement of the auditory and speech abilities post implantation in these CI children. Furthermore, the age at implantation played a considerably smaller role in the improvement of hearing and speech abilities. However, earlier implantation still benefits the language development.

Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation.

PURPOSE: To comprehensively assess and describe functional auditory performance in a group of adults with bilateral, moderate sloping to profound sensorineural hearing loss who were dissatisfied users of well-fit bilateral hearing aids and presented for Cochlear implant evaluation. Participants were evaluated with bilateral hearing aids and after six months of bimodal (Cochlear implant and a contralateral hearing aid) hearing experience with a Cochlear implant and contralateral hearing aid. METHODS: Study participants were assessed using pure tone audiometry, aided speech understanding in quiet (CNC words) and in noise (AzBio sentences at +10 and +5 dB SNR) in the sound field with unilateral and bilateral hearing aids fit to target. Participants completed subjective scales of quality of life, (Health Utilities Index Mark 3), hearing disability, (Speech, Spatial and Qualities of Hearing Scale) and a device use satisfaction scale. Participants ≥55 years were administered the Montreal Cognitive Assessment screening tool. One-hundred enrolled individuals completed baseline evaluations. RESULTS: Aided bilateral mean speech understanding scores were 28% for CNC words and 31%, and 17% for AzBio sentences at a +10 dB, and +5 dB SNR, respectively. Mean scale ratings were 0.46 for overall quality of life and 3.19 for functional hearing ability. Ninety percent of participants reported dissatisfaction with overall hearing performance. CONCLUSIONS: Evaluation results, including functional performance metrics quantifying the deleterious effects of hearing loss for overall wellbeing, underscore that bilateral hearing aids are not an effective treatment for individuals with bilateral, moderate sloping to profound sensorineural hearing loss. Individuals with this degree of hearing impairment, who demonstrate poor aided speech understanding and dissatisfaction with hearing abilities in everyday life, require timely referral to a Cochlear implant clinic for further evaluation.

Effect of video-assisted information prior to intratympanic steroid injection on patient anxiety.

OBJECTIVE: Patients may be afraid when they receive knowledge that medications are injected into the middle ear through the tympanic membrane using a fine needle during intratympanic treatment. The aim of this study was to evaluate the effect of video-assisted information prior to intratympanic steroid injection on patient anxiety. STUDY DESIGN: Prospective, Non-randomized, controlled trial. SETTING: Tertiary academic medical center. METHODS: A total of 85 patients who had an indication for intratympanic treatment due to idiopathic sudden sensorineural hearing loss and tinnitus were included in this prospective study. 40 cases received video-assisted information before intratympanic steroid injection in the study group, while 45 cases were verbally informed face-to-face in the control group. Then, patient anxiety was measured using the Visual Analog Scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI). RESULTS: The mean VAS score was 3.58 ± 3.37 (mean rank = 42.09) in the study group and 3.87 ± 3.56 (mean rank = 43.81) in the control group. The mean STAI-S score was 37.03 ± 10.637 in the study group and 39.11 ± 11.783 in the control group. The mean STAI-T score was 40.18 ± 9.151 in the study group and 38.73 ± 11.438 in the control group. It was found that there were no statistically significant differences in the mean VAS, STAI-S and STAI-T scores between the two groups (p > 0.05). CONCLUSION: We revealed that video-assisted information prior to intratympanic steroid injection had no superiority in reducing anxiety over face-to-face verbal information.

Hearing aid experience and background noise affect the robust relationship between working memory and speech recognition in noise.

Objective: The aim of this study was to examine how background noise and hearing aid experience affect the robust relationship between working memory and speech recognition.Design: Matrix sentences were used to measure speech recognition in noise. Three measures of working memory were administered. Study sample: 148 participants with at least 2 years of hearing aid experience.Results: A stronger overall correlation between working memory and speech recognition performance was found in a four-talker babble than in a stationary noise background. This correlation was significantly weaker in participants with most hearing aid experience than those with least experience when background noise was stationary. In the four-talker babble, however, no significant difference was found between the strength of correlations between users with different experience.Conclusion: In general, more explicit processing of working memory is invoked when listening in a multi-talker babble. The matching processes (cf. Ease of Language Understanding model, ELU) were more efficient for experienced than for less experienced users when perceiving speech. This study extends the existing ELU model that mismatch may also lead to the establishment of new phonological representations in the long-term memory.

Cognition in older adults with severe to profound sensorineural hearing loss compared to peers with normal hearing for age.

Objective: Cognitive performance of older adults with severe to profound sensorineural hearing loss and indication for cochlear implantation was evaluated compared to peers with age appropriate hearing.Design: Prospective matched case control study.Study sample: Study group consisted of n = 30 patients aged between 60 and 80 years, with adult onset, severe to profound sensorineural hearing loss on both sides and indication for cochlear implantation. Matched control group consisted of n = 30 peers with age-adjusted hearing abilities, based on age- appropriate norms.Results: Differences in Constructional Praxis and Recall, Trail Making Test A and Stroop were not significant between both groups. However, the differences in Clock Drawing Test, Word Lists and Trail Making Test B were significant. The impairment in TMT B (cognitive flexibility) was mediated via the severity of depressive problems. Cognitive performance was not related to word recognition, the percentage and duration of hearing loss and hearing aid use.Conclusion: Severely hearing-impaired older adults show widespread impairments in cognitive performance.

Effects of Reverberation on the Relation Between Compression Speed and Working Memory for Speech-in-Noise Perception.

OBJECTIVES: Previous study has suggested that when listening in modulated noise, individuals benefit from different wide dynamic range compression (WDRC) speeds depending on their working memory ability. Reverberation reduces the modulation depth of signals and may impact the relation between WDRC speed and working memory. The purpose of this study was to examine this relation across a range of reverberant conditions. DESIGN: Twenty-eight older listeners with mild-to-moderate sensorineural hearing impairment were recruited in the present study. Individual working memory was measured using a Reading Span test. Sentences were combined with noise at two signal to noise ratios (2 and 5 dB SNR), and reverberation was simulated at a range of reverberation times (0.00, 0.75, 1.50, and 3.00 sec). Speech intelligibility was measured in listeners when listening to the sentences processed with simulated fast-acting and slow-acting WDRC conditions. RESULTS: There was a significant relation between WDRC speed and working memory with minimal or no reverberation. Consistent with previous research, this relation was such that individuals with high working memory had higher speech intelligibility with fast-acting WDRC, and individuals with low working memory performed better with slow-acting WDRC. However, at longer reverberation times, there was no relation between WDRC speed and working memory. CONCLUSIONS: Consistent with previous studies, results suggest that there is an advantage of tailoring WDRC speed based on an individual's working memory under anechoic conditions. However, the present results further suggest that there may not be such a benefit in reverberant listening environments due to reduction in signal modulation.

Childhood sensorineural hearing loss and adult mental health up to 43 years later: results from the HUNT study.

BACKGROUND: Hearing loss is a global public health problem putting millions of people at risk of experiencing impediments in communication and potentially impaired mental health. Many studies in this field are based on small, cross sectional samples using self-report measures. The present study aims to investigate the association between childhood sensorineural hearing loss and mental health in adult men and women longitudinally in a large cohort with a matched control group, and hearing is measured by pure-tone audiometry. Studies of this kind are virtually non-existing. METHODS: The present study combines data from two large studies; the School Hearing Investigation in Nord-Trøndelag (SHINT) carried out yearly from 1954 to 1986, and the second wave of the Nord-Trøndelag Health Study (HUNT 2) conducted from 1995 to 1997. The participants were 7, 10 or 13 years during the SHINT, and between 20 and 56 years old during HUNT 2. The total sample consisted of 32,456 participants (of which 32,104 in the reference group). Participants with a sensorineural hearing loss in SHINT of 41 dB or more were classified with moderate-severe hearing loss (N = 66), 26-40 dB as mild (N = 66) and 16-25 dB as slight (N = 220). Mental health in adulthood was measured in HUNT 2 by symptoms of anxiety and depression, subjective well-being, and self-esteem. The association between childhood sensorineural hearing loss and adult mental health was tested by means of ANOVA. RESULTS: There was a significant relation between slight childhood sensorineural hearing loss and lowered subjective well-being in women (B = -.25, p = 0.038). Further investigation of the results revealed a significant association between slight hearing loss and symptoms of anxiety and depression (B = .30, p = 0.054) and between mild hearing loss and lowered self-esteem (B = .63, p = 0.024) among women aged 20-39 years. There were no significant relations between childhood sensorineural hearing loss and any of the three mental health outcomes among men. CONCLUSIONS: This study suggests that women with slight or mild sensorineural hearing loss from childhood experience elevated levels of symptoms of anxiety and depression, lowered subjective well-being and lowered self-esteem. However, the results should be interpreted with caution due to a lack of power in some analyses.

Cochlear implantation under local anesthesia: a possible alternative for elderly patients.

INTRODUCTION: As average life-expectancy increases, a sufficient hearing rehabilitation for elderly patients with severe-to-profound sensorineural hearing loss becomes more important. Cochlear implantation is a relatively safe surgical procedure also for elderly patients, the higher risk is caused by general anesthesia. We report on four patients who underwent cochlear implantation under local anesthesia. METHODS: After detailed preoperative examinations (audiological tests, imaging, genetic tests, evaluation of motivation and compliance of the patient), four patient with severe-to-profound hearing loss were selected for cochlear implantation under local anesthesia. For the electrode insertion, we used the posterior suprameatal approach technique. Pre- and postoperative pure tone audiometry and speech-perception tests were conducted to prove the success of the procedure. RESULTS: The mentioned technique was applied; the average length of the operation was 52 min. The intraoperative measurements showed normal impedance and normal neuronal response telemetry, all the patients had sound experience during the intraoperative examination of the engineer. No complications were observed. The postoperative audiological tests showed a significant increase in the hearing perception. CONCLUSION: Cochlear implantation under local anesthesia is a safe and fast procedure for elderly patients. The intraoperative sound experience can give an extra motivation in the postoperative rehabilitation. Our results prove that by carefully selected elderly patients cochlear implantation can assure a significant increase in speech perception. We can establish that the new posterior suprameatal approach technique combined with local anesthesia presents a viable future option for those patients who were inoperable beforehand because of high risks of general anesthesia.

Determining the energetic and informational components of speech-on-speech masking in listeners with sensorineural hearing loss.

The ability to identify the words spoken by one talker masked by two or four competing talkers was tested in young-adult listeners with sensorineural hearing loss (SNHL). In a reference/baseline condition, masking speech was colocated with target speech, target and masker talkers were female, and the masker was intelligible. Three comparison conditions included replacing female masker talkers with males, time-reversal of masker speech, and spatial separation of sources. All three variables produced significant release from masking. To emulate energetic masking (EM), stimuli were subjected to ideal time-frequency segregation retaining only the time-frequency units where target energy exceeded masker energy. Subjects were then tested with these resynthesized "glimpsed stimuli." For either two or four maskers, thresholds only varied about 3 dB across conditions suggesting that EM was roughly equal. Compared to normal-hearing listeners from an earlier study [Kidd, Mason, Swaminathan, Roverud, Clayton, and Best, J. Acoust. Soc. Am. 140, 132-144 (2016)], SNHL listeners demonstrated both greater energetic and informational masking as well as higher glimpsed thresholds. Individual differences were correlated across masking release conditions suggesting that listeners could be categorized according to their general ability to solve the task. Overall, both peripheral and central factors appear to contribute to the higher thresholds for SNHL listeners.

Wireless binaural hearing aid technology for telephone use and listening in wind noise.

OBJECTIVE: To assess the speech perception benefits of binaural streaming technology for bilateral hearing aid users in two difficult listening conditions. DESIGN: Two studies were conducted to compare hearing aid processing features relating to telephone use and wind noise. Speech perception testing was conducted in four different experimental conditions in each study. STUDY SAMPLE: Ten bilaterally-aided children in each study. RESULTS: Significant improvements in speech perception were obtained with a wireless feature for telephone use. Significant speech perception benefits were also obtained with wireless hearing aid features when listening to speech in simulated wind noise. CONCLUSIONS: Binaural signal processing algorithms can significantly improve speech perception for bilateral hearing aid users in challenging listening situations.