Comparison of Different Hearing Aid Prescriptions for Children.

OBJECTIVES: To assess whether there are significant differences between speech scores for different hearing aid prescription methods, specifically DSL i/o, DSL V, and NAL-NL1, using age-appropriate closed- and open-set speech tests with young children, designed to avoid floor and ceiling effects. DESIGN: Participants were 44 children with moderate or severe bilateral hearing loss, 8 aged 2 to 3 years, 15 aged 4 to 5 years, and 21 aged 6 to 9 years. Children wore bilateral hearing aids fitted with each prescription method in turn in a balanced double-blind design. The speech tests used with each child (and for some tests the levels) were chosen so as to avoid floor and ceiling effects. For the closed-set tests, the level used was selected for each child based on their hearing loss. The tests used were: (1) The closed-set Consonant Confusion Test of word identification; (2) The closed-set Chear Auditory Perception Test (CAPT) of word identification. This has separate sections assessing discrimination of consonants and vowels and detection of consonants; (3) The open-set Cambridge Auditory Word Lists for testing word identification at levels of 50 and 65 dBA, utilizing 10 consonant-vowel-consonant real words that are likely to be familiar to children aged 3 years or older; (4) The open-set Common Phrases Test to measure the speech reception threshold in quiet; (5) Measurement of the levels required for identification of the Ling 5 sounds, using a recording of the sounds made at the University of Western Ontario. RESULTS: Scores for the Consonant Confusion Test and CAPT consonant discrimination and consonant detection were lower for the NAL-NL1 prescription than for the DSL prescriptions. Scores for the CAPT vowel-in-noise discrimination test were higher for DSL V than for either of the other prescriptions. Scores for the Cambridge Auditory Word Lists did not differ across prescriptions for the level of 65 dBA, but were lower for the NAL-NL1 prescription than for either of the DSL prescriptions for the level of 50 dBA. The speech reception threshold measured using the Common Phrases Test and the levels required for identification of the Ling 5 sounds were higher (worse) for the NAL-NL1 prescription than for the DSL prescriptions. CONCLUSIONS: The higher gains prescribed by the DSL i/o and DSL V prescription methods relative to NAL-NL1 led to significantly better detection and discrimination of low-level speech sounds.

Measurement and modeling of binaural loudness summation for hearing-impaired listeners.

The summation of loudness across ears is often studied by measuring the level difference required for equal loudness (LDEL) of monaural and diotic sounds. Typically, the LDEL is ∼5-6 dB, consistent with the idea that a diotic sound is ∼1.5 times as loud as the same sound presented monaurally at the same level, as predicted by the loudness model of Moore and Glasberg [J. Acoust. Soc. Am. 121, 1604-1612 (2007)]. One might expect that the LDEL would be <5-6 dB for hearing-impaired listeners, because loudness recruitment leads to a more rapid change of loudness for a given change in level. However, previous data sometimes showed similar LDEL values for normal-hearing and hearing-impaired listeners. Here, the LDEL was measured for hearing-impaired listeners using narrowband and broadband noises centered at 500 Hz, where audiometric thresholds were near-normal, and at 3000 or 4000 Hz, where audiometric thresholds were elevated. The mean LDEL was 5.6 dB at 500 Hz and 4.2 dB at the higher center frequencies. The results were predicted reasonably well by an extension of the loudness model of Moore and Glasberg.

Assessing the possible role of frequency-shift detectors in the ability to hear out partials in complex tones.

The possible role of frequency-shift detectors (FSDs) was assessed for a task measuring the ability to hear out individual "inner" partials in a chord with seven partials uniformly spaced on the ERBN-number (Cam) scale. In each of the two intervals in a trial, a pure-tone probe was followed by a chord. In one randomly selected interval, the frequency of the probe was the same as that of a partial in the chord. In the other interval, the probe was mistuned upwards or downwards from the "target" partial. The task was to indicate the interval in which the probe coincided with the target. In the "symmetric" condition, the frequency of the mistuned probe was midway in Cams between that of two partials in the chord. This should have led to approximately symmetric activation of the up-FSDs and down-FSDs, such that differential activation provided a minimal cue. In the "asymmetric" condition, the mistuned probe was much closer in frequency to one partial in the chord than to the next closest partial. This should have led to differential activation of the up-FSDs and down-FSDs, providing a strong discrimination cue. Performance was predicted to be better in the asymmetric than in the symmetric condition. The results were consistent with this prediction except when the probe was mistuned above the sixth (second highest) partial in the chord. To explain this, it is argued that activation of FSDs depends both on the size of the frequency shift between successive components and on the pitch strength of each component.

A version of the TEN Test for use with ER-3A insert earphones.

OBJECTIVE: The aim of this study was to develop a version of the threshold-equalizing noise (TEN) test for the diagnosis of dead regions for use with Etymotic ER-3A insert earphones. The use of such earphones is helpful when testing clients with asymmetric hearing loss or clients whose ear canals tend to collapse under the pressure of supra-aural headphones. It can also be useful when ambient noise levels are problematic. DESIGN: The spectral shape of the noise required to give equal masked thresholds at all frequencies, when expressed in dB HL, was derived by empirical measurements of the electrical output of audiometers using ER-3A earphones. To reduce the loudness of the noise and to minimize distortion generated in the audiometer or earphone, the noise was band-limited between 354 and 6500 Hz. In addition, the noise was synthesized using a method that leads to a low crest factor (ratio of peak to root mean square value). This further reduced audiometer/earphone distortion, and allowed higher levels per ERBN; ERBN is the equivalent rectangular bandwidth of the auditory filter at 1 kHz, as determined using young normally hearing subjects. The test tone frequencies were limited to the range 500 to 4000 Hz. Subjects with normal or near-normal hearing were tested using a noise level of 60 dB HL/ERBN, to assess whether the noise did lead to equal masked thresholds in dB HL for all audiometric frequencies from 500 to 4000 Hz. Thresholds in the TEN were measured using manual audiometry with a 2 dB final step size. RESULTS: The mean-masked thresholds varied by 1.3 dB across frequency when expressed in dB HL, and were close to the noise level per ERBN. CONCLUSION: This version of the TEN test can be used with ER-3A insert earphones.

Effects of pulsing of a target tone on the ability to hear it out in different types of complex sounds.

Judgments of whether a sinusoidal probe is higher or lower in frequency than the closest partial ("target") in a multi-partial complex are improved when the target is pulsed on and off. These experiments explored the contribution of reduction in perceptual confusion and recovery from adaptation to this effect. In experiment 1, all partials except the target were replaced by noise to reduce perceptual confusion. Performance was much better than when the background was composed of multiple partials. When the level of the target was reduced to avoid ceiling effects, no effect of pulsing the target occurred. In experiment 2, the target and background partials were irregularly and independently amplitude modulated. This gave a large effect of pulsing the target, suggesting that if recovery from adaptation contributes to the effect, amplitude fluctuations do not prevent this. In experiment 3, the background was composed of multiple steady partials, but the target was irregularly amplitude modulated. This gave better performance than when the target was unmodulated and a moderate effect of pulsing the target. It is argued that when the target and background are steady tones, pulsing the target may result both in reduction of perceptual confusion and recovery from adaptation.

The influence of age and high-frequency hearing loss on sensitivity to temporal fine structure at low frequencies (L).

Sensitivity to temporal fine structure (TFS) at low frequencies may be adversely affected by hearing loss at high frequencies even when absolute thresholds at low frequencies are within the normal range. However, in several studies suggesting this, the effects of hearing loss and age were confounded. Here, interaural phase discrimination (IPD) thresholds for pure tones at 500 and 750 Hz were measured for 39 subjects with ages from 61 to 83 yr. All subjects had near-normal audiometric thresholds at low frequencies, but thresholds varied across subjects at high frequencies. IPD thresholds were correlated with age. IPD thresholds for the test frequency of 750 Hz were weakly correlated with absolute thresholds at high frequencies, but these correlations became non-significant when the effect of age was partialed out. The results do not confirm that sensitivity to TFS at low frequencies is influenced by hearing loss at high frequencies, independently of age.

Pitch perception of concurrent harmonic tones with overlapping spectra.

Fundamental frequency difference limens (F0DLs) were measured for a target harmonic complex tone with nominal fundamental frequency (F0) of 200 Hz, in the presence and absence of a harmonic masker with overlapping spectrum. The F0 of the masker was 0, ± 3, or ± 6 semitones relative to 200 Hz. The stimuli were bandpass filtered into three regions: 0-1000 Hz (low, L), 1600-2400 Hz (medium, M), and 2800-3600 Hz (high, H), and a background noise was used to mask combination tones and to limit the audibility of components falling on the filter skirts. The components of the target or masker started either in cosine or random phase. Generally, the effect of F0 difference between target and masker was small. For the target alone, F0DLs were larger for random than cosine phase for region H. For the target plus masker, F0DLs were larger when the target had random phase than cosine phase for regions M and H. F0DLs increased with increasing center frequency of the bandpass filter. Modeling using excitation patterns and "summary autocorrelation" and "stabilized auditory image" models suggested that use of temporal fine structure information can account for the small F0DLs obtained when harmonics are barely, if at all, resolved.

The effect of hearing loss on the resolution of partials and fundamental frequency discrimination.

The relationship between the ability to hear out partials in complex tones, discrimination of the fundamental frequency (F0) of complex tones, and frequency selectivity was examined for subjects with mild-to-moderate cochlear hearing loss. The ability to hear out partials was measured using a two-interval task. Each interval included a sinusoid followed by a complex tone; one complex contained a partial with the same frequency as the sinusoid, whereas in the other complex that partial was missing. Subjects had to indicate the interval in which the partial was present in the complex. The components in the complex were uniformly spaced on the ERB(N)-number scale. Performance was generally good for the two "edge" partials, but poorer for the inner partials. Performance for the latter improved with increasing spacing. F0 discrimination was measured for a bandpass-filtered complex tone containing low harmonics. The equivalent rectangular bandwidth (ERB) of the auditory filter was estimated using the notched-noise method for center frequencies of 0.5, 1, and 2 kHz. Significant correlations were found between the ability to hear out inner partials, F0 discrimination, and the ERB. The results support the idea that F0 discrimination of tones with low harmonics depends on the ability to resolve the harmonics.

The role of temporal fine structure in harmonic segregation through mistuning.

Bernstein and Oxenham [(2008). J. Acoust. Soc. Am. 124, 1653-1667] measured thresholds for discriminating the fundamental frequency, F0, of a complex tone that was passed through a fixed bandpass filter. They found that performance worsened when the F0 was decreased so that only harmonics above the tenth were audible. However, performance in this case was improved by mistuning the odd harmonics by 3%. Bernstein and Oxenham considered whether the results could be explained in terms of temporal fine structure information available at the output of a single auditory filter and concluded that their results did not appear to be consistent with such an explanation. Here, it is argued that such cues could have led to the improvement in performance produced by mistuning the odd harmonics.

The loudness of sounds whose spectra differ at the two ears.

Moore and Glasberg [(2007). J. Acoust. Soc. Am. 121, 1604-1612] developed a model for predicting the loudness of dichotic sounds. The model gave accurate predictions of data in the literature, except for an experiment of Zwicker and Zwicker [(1991). J. Acoust. Soc. Am. 89, 756-764], in which sounds with non-overlapping spectra were presented to the two ears. The input signal was noise with the same intensity in each critical band (bark). This noise was filtered into 24 bands each 1 bark wide. The bands were then grouped into wider composite bands (consisting of 1, 2, 4, or 12 successive sub-bands) and each composite band was presented either to one ear or the other. Loudness estimates obtained using a scaling procedure decreased somewhat as the number of composite bands increased (and their width decreased), but the predictions of the model showed the opposite pattern. This experiment was similar to that of Zwicker and Zwicker, except that the widths of the bands were based on the ERB(N)-number scale, and a loudness-matching procedure was used. The pattern of the results was consistent with the predictions of the model, showing an increase in loudness as the number of composite bands increased and their spacing decreased.

Perceptual learning of fundamental frequency discrimination: effects of fundamental frequency, harmonic number, and component phase.

Thresholds (F0DLs) were measured for discrimination of the fundamental frequency (F0) of a group of harmonics (group B) embedded in harmonics with a fixed F0. Miyazono and Moore [(2009). Acoust. Sci. & Tech. 30, 383386] found a large training effect for tones with high harmonics in group B, when the harmonics were added in cosine phase. It is shown here that this effect was due to use of a cue related to pitch pulse asynchrony (PPA). When PPA cues were disrupted by introducing a temporal offset between the envelope peaks of the harmonics in group B and the remaining harmonics, F0DLs increased markedly. Perceptual learning was examined using a training stimulus with cosine-phase harmonics, F0 = 50 Hz, and high harmonics in group B, under conditions where PPA was not useful. Learning occurred, and it transferred to other cosine-phase tones, but not to random-phase tones. A similar experiment with F0 = 100 Hz showed a learning effect which transferred to a cosine-phase tone with mainly high unresolved harmonics, but not to cosine-phase tones with low harmonics, and not to random-phase tones. The learning found here appears to be specific to tones for which F0 discrimination is based on distinct peaks in the temporal envelope.

The origin of binaural interaction in the modulation domain.

The purpose of these experiments was to assess whether the detection of diotic 5 Hz "probe" modulation of a 4000 Hz sinusoidal carrier was influenced by binaural interaction of "masker" modulators presented separately to each ear and applied to the same carrier. A 50 Hz masker modulator was applied to one ear and the masker modulator applied to the other ear had a frequency of 55 or 27.5 Hz. The starting phase of the masker modulators was fixed, and the starting phase of the probe modulator was varied. For both pairs of masker modulators, the threshold for detecting the probe modulation varied slightly but significantly with probe starting phase. Further experiments measuring probe detectability as a function of probe modulation depth did not provide clear evidence to support the idea that the internal representations of the masker modulators interacted binaurally to produce a weak distortion component in the internal representation of the modulation at a 5 Hz frequency. Also, the obtained phase effects were not correctly predicted using a model based on short-term loudness fluctuations.

Development of a new method for deriving initial fittings for hearing aids with multi-channel compression: CAMEQ2-HF.

Moore et al (1999b) described a procedure, CAMEQ, for the initial fitting of multi-channel compression hearing aids. The procedure was derived using a model of loudness perception for impaired hearing. We describe here the development of a new fitting method, CAMEQ2-HF, which differs from CAMEQ in the following ways: (1) CAMEQ2-HF gives recommended gains for centre frequencies up to 10 kHz, whereas the upper limit for CAMEQ is 6 kHz; (2) CAMEQ is based on the assumption that the hearing aid user faces the person they wish to hear and uses a free-field-to-eardrum transfer function for frontal incidence. CAMEQ2-HF is based on the assumption that the user may wish to hear sounds from many directions, and uses a diffuse-field-to-eardrum transfer function; (3) CAMEQ2-HF is based on an improved loudness model for impaired hearing; (4) CAMEQ2-HF is based on recent wideband measurements of the average spectrum of speech.

AMTAS: automated method for testing auditory sensitivity: validation studies.

Three studies are reported assessing the validity of AMTAS, an automated method for obtaining an audiogram, including air- and bone-conduction thresholds (stimuli delivered by a forehead-placed transducer) with masking noise presented to the non-test ear. In Study 1, six subjects at each of three sites were tested using manual audiometry by two audiologists at each site. The mean differences between the audiograms for the paired audiologists provided a measure of the reliability of traditional audiometry. In Study 2, thirty subjects (5 normal hearing, 25 hearing impaired) were tested using AMTAS and manual audiometry. For air-conduction thresholds, AMTAS-manual differences were similar to inter-tester differences in Study 1, but for bone-conduction thresholds, the former were larger. Two possible sources of the greater differences were identified, (1) incorrect reference-equivalent threshold force levels for forehead bone conduction, and (2) a differential effect of middle-ear disease on forehead and mastoid bone-conduction thresholds. In Study 3, intersubject variability was studied for forehead and mastoid bone-conduction thresholds. The results indicate similar variability for the two placement sites.

Effects of pulsing of the target tone on the audibility of partials in inharmonic complex tones.

The audibility of partials was measured for complex tones with partials uniformly spaced on an ERB(N)-number scale. On each trial, subjects heard a sinusoidal "probe" followed by a complex tone. The probe was mistuned downwards or upwards (at random) by 3% or 4.5% from the frequency of one randomly selected partial in the complex (the "target"). The subject indicated whether the target was higher or lower in frequency than the probe. The probe and the target were pulsed on and off and the ramp times and inter-pulse intervals were systematically varied. Performance was better for longer ramp times and longer inter-pulse intervals. In a second experiment, the ability to detect which of two complex tones contained a pulsed partial was measured. The pattern of results was similar to that for experiment 1. A model of auditory processing including an adaptation stage was able to account for the general pattern of the results of experiment 2. The results suggest that the improvement in ability to hear out a partial in a complex tone produced by pulsing that partial is partly mediated by a release from adaptation produced by the pulsing, and does not result solely from reduction of perceptual confusion.

Effects of the build-up and resetting of auditory stream segregation on temporal discrimination.

The tendency to hear a tone sequence as 2 or more streams (segregated) builds up, but a sudden change in properties can reset the percept to 1 stream (integrated). This effect has not hitherto been explored using an objective measure of streaming. Stimuli comprised a 2.0-s fixed-frequency inducer followed by a 0.6-s test sequence of alternating pure tones (3 low [L]-high [H] cycles). Listeners compared intervals for which the test sequence was either isochronous or the H tones were slightly delayed. Resetting of segregation should make identifying the anisochronous interval easier. The HL frequency separation was varied (0-12 semitones), and properties of the inducer and test sequence were set to the same or different values. Inducer properties manipulated were frequency, number of onsets (several short bursts vs. one continuous tone), tone:silence ratio (short vs. extended bursts), level, and lateralization. All differences between the inducer and the L tones reduced temporal discrimination thresholds toward those for the no-inducer case, including properties shown previously not to affect segregation greatly. Overall, it is concluded that abrupt changes in a sequence cause resetting and improve subsequent temporal discrimination.

Spectro-temporal characteristics of speech at high frequencies, and the potential for restoration of audibility to people with mild-to-moderate hearing loss.

OBJECTIVES: It is possible for auditory prostheses to provide amplification for frequencies above 6 kHz. However, most current hearing-aid fitting procedures do not give recommended gains for such high frequencies. This study was intended to provide information that could be useful in quantifying appropriate high-frequency gains, and in establishing the population of hearing-impaired people who might benefit from such amplification. DESIGN: The study had two parts. In the first part, wide-bandwidth recordings of normal conversational speech were obtained from a sample of male and female talkers. The recordings were used to determine the mean spectral shape over a wide frequency range, and to determine the distribution of levels (the speech dynamic range) as a function of center frequency. In the second part, audiometric thresholds were measured for frequencies of 0.125, 0.25, 0.5, 1, 2, 3, 4, 6, 8, 10, and 12.5 kHz for both ears of 31 people selected to have mild or moderate cochlear hearing loss. The hearing loss was never greater than 70 dB for any frequency up to 4 kHz. RESULTS: The mean spectrum level of the speech fell progressively with increasing center frequency above about 0.5 kHz. For speech with an overall level of 65 dB SPL, the mean 1/3-octave level was 49 and 37 dB SPL for center frequencies of 1 and 10 kHz, respectively. The dynamic range of the speech was similar for center frequencies of 1 and 10 kHz. The part of the dynamic range below the root-mean-square level was larger than reported in previous studies. The mean audiometric thresholds at high frequencies (10 and 12.5 kHz) were relatively high (69 and 77 dB HL, respectively), even though the mean thresholds for frequencies below 4 kHz were 41 dB HL or better. CONCLUSIONS: To partially restore audibility for a hearing loss of 65 dB at 10 kHz would require an effective insertion gain of about 36 dB at 10 kHz. With this gain, audibility could be (partly) restored for 25 of the 62 ears assessed.

Simplified form of tinnitus retraining therapy in adults: a retrospective study.

BACKGROUND: Since the first description of tinnitus retraining therapy (TRT), clinicians have modified and customised the method of TRT in order to suit their practice and their patients. A simplified form of TRT is used at Ealing Primary Care Trust Audiology Department. Simplified TRT is different from TRT in the type and (shorter) duration of the counseling but is similar to TRT in the application of sound therapy except for patients exhibiting tinnitus with no hearing loss and no decreased sound tolerance (wearable sound generators were not mandatory or recommended here, whereas they are for TRT). The main goal of this retrospective study was to assess the efficacy of simplified TRT. METHODS: Data were collected from a series of 42 consecutive patients who underwent simplified TRT for a period of 3 to 23 months. Perceived tinnitus handicap was measured by the Tinnitus Handicap Inventory (THI) and perceived tinnitus loudness, annoyance and the effect of tinnitus on life were assessed through the Visual Analog Scale (VAS). RESULTS: The mean THI and VAS scores were significantly decreased after 3 to 23 months of treatment. The mean decline of the THI score was 45 (SD = 22) and the difference between pre- and post-treatment scores was statistically significant. The mean decline of the VAS scores was 1.6 (SD = 2.1) for tinnitus loudness, 3.6 (SD = 2.6) for annoyance, and 3.9 (SD = 2.3) for effect on life. The differences between pre- and post-treatment VAS scores were statistically significant for tinnitus loudness, annoyance, and effect on life. The decline of THI scores was not significantly correlated with age and duration of tinnitus. CONCLUSION: The results suggest that benefit may be obtained from a substantially simplified form of TRT.

Frequency discrimination of complex tones by hearing-impaired subjects: Evidence for loss of ability to use temporal fine structure.

For normally hearing subjects, thresholds for discriminating the fundamental frequency (F0) of a complex tone, F0DLs, increase when the number of the lowest harmonic, N, is above eight. A previous study showed that F0DLs were affected by component phase for N above 7, and it was argued that the increase in F0DLs with increasing N reflects a loss of temporal fine structure information. Here, subjects with moderate hearing loss were tested in a similar experiment. F0DLs were measured for tones with three successive harmonics, added in cosine or alternating phase. The center frequency was 2000 Hz. N was varied by changing the mean F0. A background noise was used to mask combination tones. F0 was roved across trials and N was roved by +/-1, to reduce use of excitation pattern cues. F0DLs were smaller for cosine than for alternating phase for four out of six subjects, and this occurred once N exceeded 5. In contrast to the result for normally hearing subjects, F0DLs decreased with increasing N. Performance was much worse than obtained for normally hearing subjects at the same center frequency, suggesting that most of the hearing-impaired subjects had a poor ability to use temporal fine structure information.

A Loudness Model for Time-Varying Sounds Incorporating Binaural Inhibition.

This article describes a model of loudness for time-varying sounds that incorporates the concept of binaural inhibition, namely, that the signal applied to one ear can reduce the internal response to a signal at the other ear. For each ear, the model includes the following: a filter to allow for the effects of transfer of sound through the outer and middle ear; a short-term spectral analysis with greater frequency resolution at low than at high frequencies; calculation of an excitation pattern, representing the magnitudes of the outputs of the auditory filters as a function of center frequency; application of a compressive nonlinearity to the output of each auditory filter; and smoothing over time of the resulting instantaneous specific loudness pattern using an averaging process resembling an automatic gain control. The resulting short-term specific loudness patterns are used to calculate broadly tuned binaural inhibition functions, the amount of inhibition depending on the relative short-term specific loudness at the two ears. The inhibited specific loudness patterns are summed across frequency to give an estimate of the short-term loudness for each ear. The overall short-term loudness is calculated as the sum of the short-term loudness values for the two ears. The long-term loudness for each ear is calculated by smoothing the short-term loudness for that ear, again by a process resembling automatic gain control, and the overall loudness impression is obtained by summing the long-term loudness across ears. The predictions of the model are more accurate than those of an earlier model that did not incorporate binaural inhibition.