Clinical Assessment of Functional Hearing Deficits: Speech-in-Noise Performance.

OBJECTIVE: The clinical evaluation of hearing loss, using a pure-tone audiogram, is not adequate to assess the functional hearing capabilities (or handicap) of a patient, especially the speech-in-noise communication difficulties. The primary objective of this study was to measure the effect of elevated hearing thresholds on the recognition performance in various functional speech-in-noise tests that cover acoustic scenes of different complexities and to identify the subset of tests that (a) were sensitive to individual differences in hearing thresholds and (b) provide complementary information to the audiogram. A secondary goal was to compare the performance on this test battery with the self-assessed performance level of functional hearing abilities. DESIGN: In this study, speech-in-noise performance of normal-hearing listeners and listeners with hearing loss (audiometric configuration ranging from near-normal hearing to moderate-severe hearing loss) was measured on a battery of 12 different tests designed to evaluate speech recognition in a variety of speech and masker conditions, and listening tasks. The listening conditions were designed to measure the ability to localize and monitor multiple speakers or to take advantage of masker modulation, spatial separation between the target and the masker, and a restricted vocabulary. RESULTS: Listeners with hearing loss had significantly worse performance than the normal-hearing control group when speech was presented in the presence of a multitalker babble or in the presence of a single competing talker. In particular, the ability to take advantage of modulation benefit and spatial release from masking was significantly affected even with a mild audiometric loss. Elevated thresholds did not have a significant effect on the performance in the spatial awareness task. A composite score of all 12 tests was considered as a global metric of the overall speech-in-noise performance. Perceived hearing difficulties of subjects were better correlated with the composite score than with the performance on a standardized clinical speech-in-noise test. Regression analysis showed that scores from a subset of these tests, which could potentially take less than 10 min to administer, when combined with the better-ear pure-tone average and the subject's age, accounted for as much as 93.2% of the variance in the composite score. CONCLUSIONS: A test that measures speech recognition in the presence of a spatially separated competing talker would be useful in measuring suprathreshold speech-in-noise deficits that cannot be readily predicted from standard audiometric evaluation. Including such a test can likely reduce the gap between patient complaints and their clinical evaluation.

Development of a Test Battery for Evaluating Speech Perception in Complex Listening Environments: Effects of Sensorineural Hearing Loss.

OBJECTIVE: To evaluate the speech-in-noise performance of listeners with different levels of hearing loss in a variety of complex listening environments. DESIGN: The quick speech-in-noise (QuickSIN)-based test battery was used to measure the speech recognition performance of listeners with different levels of hearing loss. Subjective estimates of speech reception thresholds (SRTs) corresponding to 100% and 0% speech intelligibility, respectively, were obtained using a method of adjustment before objective measurement of the actual SRT corresponding to 50% speech intelligibility in every listening condition. RESULTS: Of the seven alternative listening conditions, two conditions, one involving time-compressed, reverberant speech (TC+Rev), and the other (N0Sπ) having in-phase noise masker (N0) and out-of-phase target (Sπ), were found to be substantially more sensitive to the effect of hearing loss than the standard QuickSIN test. The performance in these two conditions also correlated with self-reported difficulties in attention/concentration during speech communication and in localizing the sound source, respectively. Hearing thresholds could account for about 50% or less variance in SRTs in any listening condition. Subjectively estimated SRTs (SRTs corresponding to 0% and 100% speech intelligibility) were highly correlated with the objective SRT measurements (SRT corresponding to 50% speech intelligibility). CONCLUSIONS: A test battery that includes the TC+Rev and the N0Sπ conditions would be useful in identifying individuals with hearing loss with speech-in-noise deficits in everyday communication.

The localization of non-individualized virtual sounds by hearing impaired listeners.

Although many studies have evaluated the performance of virtual audio displays with normal hearing listeners, very little information is available on the effect that hearing loss has on the localization of virtual sounds. In this study, normal hearing (NH) and hearing impaired (HI) listeners were asked to localize noise stimuli with short (250 ms), medium (1000 ms), and long (4000 ms) durations both in the free field and with a non-individualized head-tracked virtual audio display. The results show that the HI listeners localized sounds less accurately than the NH listeners, and that both groups consistently localized virtual sounds less accurately than free-field sounds. These results indicate that HI listeners are sensitive to individual differences in head related transfer functions (HRTFs), which means that they might have difficulty using auditory display systems that rely on generic HRTFs to control the apparent locations of virtual sounds. However, the results also reveal a high correlation between free-field and virtual localization performance in the HI listeners. This suggests that it may be feasible to use non-individualized virtual audio display systems to predict the auditory localization performance of HI listeners in clinical environments where free-field speaker arrays are not available.

Development and validation of the Speech Reception in Noise (SPRINT) Test.

Since 1992, the Speech Recognition in Noise Test, or SPRINT, has been the standard speech-in-noise test for assessing auditory fitness-for-duty of US Army Soldiers with hearing loss. The original SPRINT test consisted of 200 monosyllabic words presented at a Signal-to-Noise Ratio (SNR) of +9 dB in the presence of a six-talker babble noise. Normative data for the test was collected on 319 hearing impaired Soldiers, and a procedure for making recommendations about the disposition of military personnel on the basis of their SPRINT score and their years of experience was developed and implemented as part of US Army policy. In 2013, a new 100-word version of the test was developed that eliminated words that were either too easy or too hard to make meaningful distinctions among hearing impaired listeners. This paper describes the development of the original 200-word SPRINT test, along with a description of the procedure used to reduce the 200-word test to 100 words and the results of a validation study conducted to evaluate how well the shortened 100-word test is able to capture the results from the full 200-word version of the SPRINT.

The effects of elevated hearing thresholds on performance in a paintball simulation of individual dismounted combat.

OBJECTIVE: To examine the relationship between hearing acuity and operational performance in simulated dismounted combat. DESIGN: Individuals wearing hearing loss simulation systems competed in a paintball-based exercise where the objective was to be the last player remaining. Four hearing loss profiles were tested in each round (no hearing loss, mild, moderate and severe) and four rounds were played to make up a match. This allowed counterbalancing of simulated hearing loss across participants. STUDY SAMPLE: Forty-three participants across two data collection sites (Fort Detrick, Maryland and the United States Military Academy, New York). All participants self-reported normal hearing except for two who reported mild hearing loss. RESULTS: Impaired hearing had a greater impact on the offensive capabilities of participants than it did on their "survival", likely due to the tendency for individuals with simulated impairment to adopt a more conservative behavioural strategy than those with normal hearing. CONCLUSIONS: These preliminary results provide valuable insights into the impact of impaired hearing on combat effectiveness, with implications for the development of improved auditory fitness-for-duty standards, the establishment of performance requirements for hearing protection technologies, and the refinement of strategies to train military personnel on how to use hearing protection in combat environments.

Performance in noise: Impact of reduced speech intelligibility on Sailor performance in a Navy command and control environment.

Noise, hearing loss, and electronic signal distortion, which are common problems in military environments, can impair speech intelligibility and thereby jeopardize mission success. The current study investigated the impact that impaired communication has on operational performance in a command and control environment by parametrically degrading speech intelligibility in a simulated shipborne Combat Information Center. Experienced U.S. Navy personnel served as the study participants and were required to monitor information from multiple sources and respond appropriately to communications initiated by investigators playing the roles of other personnel involved in a realistic Naval scenario. In each block of the scenario, an adaptive intelligibility modification system employing automatic gain control was used to adjust the signal-to-noise ratio to achieve one of four speech intelligibility levels on a Modified Rhyme Test: No Loss, 80%, 60%, or 40%. Objective and subjective measures of operational performance suggested that performance systematically degraded with decreasing speech intelligibility, with the largest drop occurring between 80% and 60%. These results confirm the importance of noise reduction, good communication design, and effective hearing conservation programs to maximize the operational effectiveness of military personnel.

Enhancing listener strategies using a payoff matrix in speech-on-speech masking experiments.

Speech recognition was measured as a function of the target-to-masker ratio (TMR) with syntactically similar speech maskers. In the first experiment, listeners were instructed to report keywords from the target sentence. Data averaged across listeners showed a plateau in performance below 0 dB TMR when masker and target sentences were from the same talker. In this experiment, some listeners tended to report the target words at all TMRs in accordance with the instructions, while others reported keywords from the louder of the sentences, contrary to the instructions. In the second experiment, stimuli were the same as in the first experiment, but listeners were also instructed to avoid reporting the masker keywords, and a payoff matrix penalizing masker keywords and rewarding target keywords was used. In this experiment, listeners reduced the number of reported masker keywords, and increased the number of reported target keywords overall, and the average data showed a local minimum at 0 dB TMR with same-talker maskers. The best overall performance with a same-talker masker was obtained with a level difference of 9 dB, where listeners achieved near perfect performance when the target was louder, and at least 80% correct performance when the target was the quieter of the two sentences.

Release from informational masking in a monaural competing-speech task with vocoded copies of the maskers presented contralaterally.

Single-sided deafness prevents access to the binaural cues that help normal-hearing listeners extract target speech from competing voices. Little is known about how listeners with one normal-hearing ear might benefit from access to severely degraded audio signals that preserve only envelope information in the second ear. This study investigated whether vocoded masker-envelope information presented to one ear could improve performance for normal-hearing listeners in a multi-talker speech-identification task presented to the other ear. Target speech and speech or non-speech maskers were presented unprocessed to the left ear. The right ear received no signal, or either an unprocessed or eight-channel noise-vocoded copy of the maskers. Presenting the vocoded maskers contralaterally yielded significant masking release from same-gender speech maskers, albeit less than in the unprocessed case, but not from opposite-gender speech, stationary-noise, or modulated-noise maskers. Unmasking also occurred with as few as two vocoder channels and when an attenuated copy of the target signal was added to the maskers before vocoding. These data show that delivering masker-envelope information contralaterally generates masking release in situations where target-masker similarity impedes monaural speech-identification performance. By delivering speech-envelope information to a deaf ear, cochlear implants for single-sided deafness have the potential to produce a similar effect.

Better-ear glimpsing in hearing-impaired listeners.

When competing speech sounds are spatially separated, listeners can make use of the ear with the better target-to-masker ratio. Recent studies showed that listeners with normal hearing are able to efficiently make use of this "better-ear," even when it alternates between left and right ears at different times in different frequency bands, which may contribute to the ability to listen in spatialized speech mixtures. In the present study, better-ear glimpsing in listeners with bilateral sensorineural hearing impairment, who perform poorly in spatialized speech mixtures, was investigated. The results suggest that this deficit is not related to better-ear glimpsing.

Assessment of auditory spatial awareness in complex listening environments.

In the real world, listeners often need to track multiple simultaneous sources in order to maintain awareness of the relevant sounds in their environments. Thus, there is reason to believe that simple single source sound localization tasks may not accurately capture the impact that a listening device such as a hearing aid might have on a listener's level of auditory awareness. In this experiment, 10 normal hearing listeners and 20 hearing impaired listeners were tested in a task that required them to identify and localize sound sources in three different listening tasks of increasing complexity: a single-source localization task, where listeners identified and localized a single sound source presented in isolation; an added source task, where listeners identified and localized a source that was added to an existing auditory scene, and a remove source task, where listeners identified and localized a source that was removed from an existing auditory scene. Hearing impaired listeners completed these tasks with and without the use of their previously fit hearing aids. As expected, the results show that performance decreased both with increasing task complexity and with the number of competing sound sources in the acoustic scene. The results also show that the added source task was as sensitive to differences in performance across listening conditions as the standard localization task, but that it correlated with a different pattern of subjective and objective performance measures across listeners. This result suggests that a measure of complex auditory situation awareness such as the one tested here may be a useful tool for evaluating differences in performance across different types of listening devices, such as hearing aids or hearing protection devices.

Development of a test battery for evaluating speech perception in complex listening environments.

In the real world, spoken communication occurs in complex environments that involve audiovisual speech cues, spatially separated sound sources, reverberant listening spaces, and other complicating factors that influence speech understanding. However, most clinical tools for assessing speech perception are based on simplified listening environments that do not reflect the complexities of real-world listening. In this study, speech materials from the QuickSIN speech-in-noise test by Killion, Niquette, Gudmundsen, Revit, and Banerjee [J. Acoust. Soc. Am. 116, 2395-2405 (2004)] were modified to simulate eight listening conditions spanning the range of auditory environments listeners encounter in everyday life. The standard QuickSIN test method was used to estimate 50% speech reception thresholds (SRT50) in each condition. A method of adjustment procedure was also used to obtain subjective estimates of the lowest signal-to-noise ratio (SNR) where the listeners were able to understand 100% of the speech (SRT100) and the highest SNR where they could detect the speech but could not understand any of the words (SRT0). The results show that the modified materials maintained most of the efficiency of the QuickSIN test procedure while capturing performance differences across listening conditions comparable to those reported in previous studies that have examined the effects of audiovisual cues, binaural cues, room reverberation, and time compression on the intelligibility of speech.

Better-ear glimpsing efficiency with symmetrically-placed interfering talkers.

In listening tasks where a target speech signal is spatially separated from a masking voice, listeners can often gain a substantial advantage in performance by attending to the ear with the better signal-to-noise ratio (SNR). However, this better-ear strategy becomes much more complicated when a target talker located in front of the listener is masked by interfering talkers positioned at symmetric locations to the left and right of the target. When this happens, there are no long-term SNR advantages at either ear and the only binaural SNR advantages available are the result of complicated better-ear glimpses that vary as a function of frequency and rapidly switch back and forth between the two ears according to the natural fluctuations in the relative levels of the two masking voices. In this study, a signal processing technique was used to take the better-ear glimpses that would ordinarily be randomly distributed across the two ears in a binaural speech signal and move them all into the same ear. This resulted in a monaural signal that contained all the information available to an ideal listener using an optimal binaural glimpsing strategy. Speech intelligibility was measured with these optimized monaural stimuli and compared to performance with unprocessed binaural speech stimuli. Performance was similar in these two conditions, suggesting that listeners with normal hearing are able to efficiently extract information from better-ear glimpses that fluctuate rapidly across frequency and across the two ears.

Set-size procedures for controlling variations in speech-reception performance with a fluctuating masker.

Adaptive signal-to-noise ratio (SNR) tracking is often used to measure speech reception in noise. Because SNR varies with performance using this method, data interpretation can be confounded when measuring an SNR-dependent effect such as the fluctuating-masker benefit (FMB) (the intelligibility improvement afforded by brief dips in the masker level). One way to overcome this confound, and allow FMB comparisons across listener groups with different stationary-noise performance, is to adjust the response set size to equalize performance across groups at a fixed SNR. However, this technique is only valid under the assumption that changes in set size have the same effect on percentage-correct performance for different masker types. This assumption was tested by measuring nonsense-syllable identification for normal-hearing listeners as a function of SNR, set size and masker (stationary noise, 4- and 32-Hz modulated noise and an interfering talker). Set-size adjustment had the same impact on performance scores for all maskers, confirming the independence of FMB (at matched SNRs) and set size. These results, along with those of a second experiment evaluating an adaptive set-size algorithm to adjust performance levels, establish set size as an efficient and effective tool to adjust baseline performance when comparing effects of masker fluctuations between listener groups.

Effects of spectral smearing and temporal fine-structure distortion on the fluctuating-masker benefit for speech at a fixed signal-to-noise ratio.

Normal-hearing listeners receive less benefit from momentary dips in the level of a fluctuating masker for speech processed to degrade spectral detail or temporal fine structure (TFS) than for unprocessed speech. This has been interpreted as evidence that the magnitude of the fluctuating-masker benefit (FMB) reflects the ability to resolve spectral detail and TFS. However, the FMB for degraded speech is typically measured at a higher signal-to-noise ratio (SNR) to yield performance similar to normal speech for the baseline (stationary-noise) condition. Because the FMB decreases with increasing SNR, this SNR difference might account for the reduction in FMB for degraded speech. In this study, the FMB for unprocessed and processed (TFS-removed or spectrally smeared) speech was measured in a paradigm that adjusts word-set size, rather than SNR, to equate stationary-noise performance across processing conditions. Compared at the same SNR and percent-correct level (but with different set sizes), processed and unprocessed stimuli yielded a similar FMB for four different fluctuating maskers (speech-modulated noise, one opposite-gender interfering talker, two same-gender interfering talkers, and 16-Hz interrupted noise). These results suggest that, for these maskers, spectral or TFS distortions do not directly impair the ability to benefit from momentary dips in masker level.

Effects of target-masker contextual similarity on the multimasker penalty in a three-talker diotic listening task.

In many multitalker listening tasks, the degradation in performance that occurs when the number of interfering talkers increases from one to two is much larger than would be predicted from the corresponding decrease in the signal-to-noise ratio (SNR). In this experiment, a variety of contextually-relevant speech maskers, contextually-irrelevant speech maskers and non-speech maskers were used to examine the impact that the characteristics of the interfering sound sources have on the magnitude of this "multimasker penalty." The results show that a significant multimasker penalty only occurred in cases where two specific conditions were met: 1) the stimulus contained at least one contextually-relevant masker that could be confused with the target; and 2) the signal-to-noise ratio of the target relative to the combined masker stimulus was less than 0 dB. Remarkably, in cases where one masker was contextually relevant, the specific characteristics of the second masker had virtually no impact on the size of the multimasker penalty. Indeed, when the results were corrected for random guessing, there was essentially no difference in performance between conditions with three contextually-relevant talkers and those with two contextually-relevant talkers and one irrelevant talker. The results of a second experiment suggest that the listeners are generally able to hear keywords spoken by all three talkers even in situations where the multimasker penalty occurs, implying that the primary cause of the penalty is a degradation in the listener's ability to use prosodic cues and voice characteristics to link together words spoken at different points in the target phrase.

Auditory acuity for aircraft in real-world ambient environments.

Although many psychoacoustic studies have been conducted to examine the detection of masked target sounds, the vast majority of these studies have been conducted in carefully controlled laboratory listening environments, and their results may not apply to the detection of real-world sounds in the presence of naturalistic ambient sound fields. Those studies that have examined the detection of realistic naturally-occurring sounds have been conducted in uncontrolled listening environments (i.e., outdoor listening tests) where the experimenters were unable to precisely control, or even measure, the specific characteristics of the target and masker at the time of the detection judgment. This study represents an attempt to bridge the gap between unrealistic laboratory listening studies and uncontrolled outdoor listening studies through the use of pseudorandomly-presented real world recordings of target and masking sounds. Subjects were asked to detect helicopter signals in the context of an ongoing ambient recording in a two interval detection task. The results show that the signal-to-noise ratio required to detect an aircraft sound varies across different types of ambient environments (i.e., rural, suburban, or urban).

Effects of bandwidth on auditory localization with a noise masker.

Although high-frequency content is known to be critically important for the accurate location of isolated sounds, relatively little is known about the importance of high-frequency spectral content for the localization of sounds in the presence of a masker. In this experiment, listeners were asked to identify the location of a pulsed-noise target in the presence of a randomly located continuous noise masker. Both the target and masker were low-pass filtered at one of eight cutoff frequencies ranging from 1 to 16 kHz, and the signal-to-noise ratio was varied from -12 to +12 dB. The results confirm the importance of high frequencies for the localization of isolated sounds, and show that high-frequency content remains critical in cases where the target sound is masked by a spatially separated masker. In fact, when two sources of the same level are randomly located in space, these results show that a decrease in stimulus bandwidth from 16 to 12 kHz might result in a 30% increase in overall localization error.

Multitalker speech perception with ideal time-frequency segregation: effects of voice characteristics and number of talkers.

When a target voice is masked by an increasingly similar masker voice, increases in energetic masking are likely to occur due to increased spectro-temporal overlap in the competing speech waveforms. However, the impact of this increase may be obscured by informational masking effects related to the increased confusability of the target and masking utterances. In this study, the effects of target-masker similarity and the number of competing talkers on the energetic component of speech-on-speech masking were measured with an ideal time-frequency segregation (ITFS) technique that retained all the target-dominated time-frequency regions of a multitalker mixture but eliminated all the time-frequency regions dominated by the maskers. The results show that target-masker similarity has a small but systematic impact on energetic masking, with roughly a 1 dB release from masking for same-sex maskers versus same-talker maskers and roughly an additional 1 dB release from masking for different-sex masking voices. The results of a second experiment measuring ITFS performance with up to 18 interfering talkers indicate that energetic masking increased systematically with the number of competing talkers. These results suggest that energetic masking differences related to target-masker similarity have a much smaller impact on multitalker listening performance than energetic masking effects related to the number of competing talkers in the stimulus and non-energetic masking effects related to the confusability of the target and masking voices.

Effects of periodic masker interruption on the intelligibility of interrupted speech.

When listeners hear a target signal in the presence of competing sounds, they are quite good at extracting information at instances when the local signal-to-noise ratio of the target is most favorable. Previous research suggests that listeners can easily understand a periodically interrupted target when it is interleaved with noise. It is not clear if this ability extends to the case where an interrupted target is alternated with a speech masker rather than noise. This study examined speech intelligibility in the presence of noise or speech maskers, which were either continuous or interrupted at one of six rates between 4 and 128 Hz. Results indicated that with noise maskers, listeners performed significantly better with interrupted, rather than continuous maskers. With speech maskers, however, performance was better in continuous, rather than interrupted masker conditions. Presumably the listeners used continuity as a cue to distinguish the continuous masker from the interrupted target. Intelligibility in the interrupted masker condition was improved by introducing a pitch difference between the target and speech masker. These results highlight the role that target-masker differences in continuity and pitch play in the segregation of competing speech signals.