Ecological Momentary Assessment: A Field Evaluation of Subjective Ratings of Speech in Noise.

PURPOSE: As hearing rehabilitation research evolves to include both retrospective and momentary assessment outcome measures, it is important to understand how in-the-moment contextual factors influence subjective ratings. We aimed to determine, over a 4-week period of participants responding to ecological momentary assessments (EMAs) in their own environments, whether: (1) participants will complete surveys in speech-in-noise listening situations; (2) ratings of speech in noise change in a predictable manner as the acoustic conditions change; and (3) EMAs provide patient insights beyond those provided from retrospective ratings. DESIGN: Fourteen adults aged 26 to 86 years with at least 6 months of hearing aid experience were recruited for an 8-week crossover field trial (4 weeks wearing hearing aids with no EMA; 4 weeks wearing hearing aids with EMA). Participants were fitted with hearing aids and provided with a streamer and a smartphone with an app that analyzed the acoustic signal from the hearing aids and alerted the participant to respond to a survey when predetermined acoustic conditions were detected. Participants were prompted to complete brief surveys up to 9 times/day that contained establishing questions, quality ratings, and items assessing perceived benefit, residual activity limitation, and satisfaction. Participants also completed retrospective questionnaires at intake and after each 4-week field trial. RESULTS: Participants completed an average of 4.4 surveys per day. The quality ratings changed as the acoustics changed: Ratings of intelligibility were lower for 10 dB signal-to-noise ratio (SNR) than 20 dB SNR (p = 0.006); ratings of noisiness were higher for 10 dB SNR than 20 dB SNR (p = 0.001) and higher for 65 dB SPL than 50 dB SPL (p < 0.001); ratings of effort were higher for 65 dB SPL than 50 dB SPL (p = 0.004); ratings of loudness were higher for 65 dB SPL than 50 dB SPL (p = 0.001). Descriptive analysis of satisfaction, benefit, and residual activity limitation responses showed that the momentary surveys provided more detail about individual variability across acoustic conditions than the retrospective questions. CONCLUSIONS: Participants completed more than 99% of the triggered surveys, demonstrating high compliance. Because the quality ratings generally changed in the hypothesized direction, it is concluded that the participants provided valid responses. The greater variability in responses with EMA than retrospective questionnaires demonstrates its potential utility as a clinical tool for exploring hearing aid outcomes in real-world environments.

A Laboratory Evaluation of Contextual Factors Affecting Ratings of Speech in Noise: Implications for Ecological Momentary Assessment.

OBJECTIVES: As hearing aid outcome measures move from retrospective to momentary assessments, it is important to understand how contextual factors influence subjective ratings. Under laboratory-controlled conditions, we examined whether subjective ratings changed as a function of acoustics, response timing, and task variables. DESIGN: Eighteen adults (age 21 to 85 years; M = 51.4) with sensorineural hearing loss were fitted with hearing aids. Sentences in noise were presented at 3 overall levels (50, 65, and 80 dB SPL) and 3 signal to noise ratios (0, +5, and +10 dB signal to noise ratio [SNR]). Listeners rated three sound quality dimensions (intelligibility, noisiness, and loudness) under four experimental conditions that manipulated timing and task focus. RESULTS: The quality ratings changed as the acoustics changed: intelligibility ratings increased with input level (p < 0.05); noisiness ratings increased at poorer SNRs (p < 0.05); and loudness ratings increased as input level increased (p < 0.05). Timing of rating was significant at the highest presentation level (80 dB SPL): Participants gave higher noise ratings while listening to the signal than afterward (p < 0.05). Presence of a secondary task had no significant effect on ratings (p > 0.1). CONCLUSIONS: The findings of this laboratory study provide evidence to support the conclusion that group-mean listener ratings of loudness, noisiness, and intelligibility change in predictable ways as level and SNR of the speech in noise stimulus are altered. They also provide weak evidence to support the conclusion that timing of the ratings (during or immediately after sound exposure) can affect noisiness ratings under certain conditions, but no evidence to support the conclusion that timing affects other quality ratings. There is also no evidence to support the conclusion that quality ratings are influenced by the presence of, or focus on, a secondary nonauditory task of the type used here.

Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses.

OBJECTIVE: Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS: Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA: systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS: The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION: Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS: Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.

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

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

Communication with face masks during the COVID-19 pandemic for adults with hearing loss.

Face masks have become common protective measures in community and workplace environments to help reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Face masks can make it difficult to hear and understand speech, particularly for people with hearing loss. An aim of our cross-sectional survey was to investigate the extent that face masks as a health and safety protective measure against SARS-CoV-2 have affected understanding speech in the day-to-day lives of adults with deafness or hearing loss, and identify possible strategies to improve communication accessibility. We analyzed closed- and open-ended survey responses of 656 adults who self-identified as D/deaf or hard of hearing. Over 80% of respondents reported difficulty with understanding others who wore face masks. The proportion of those experiencing difficulty increased with increasing hearing loss severity. Recommended practical supports to facilitate communication and social interaction included more widespread use of clear face masks to aid lip-reading; improved clarity in policy guidance on face masks; and greater public awareness and understanding about ways to more clearly communicate with adults with hearing loss while wearing face masks.

Counseling During Real Ear Measurements: The Clients' Perspective.

BACKGROUND: When dispensing hearing aids, audiologists must follow validated fitting and verification procedures to ensure that the hearing aids are properly fitted to the client's hearing. Real ear measurements (REMs) are best practice for verifying hearing aids. Prior literature regarding REMs has mainly focused on the clinicians' perspective. PURPOSE: This study investigated informational counseling throughout REMs by gathering perspectives of first-time hearing aid users regarding the content and format of counseling. RESEARCH DESIGN: The study used an interpretive description approach with focus groups. STUDY SAMPLE: There were 16 adult participants (4 males, 12 females) who were first-time hearing aid users and who all had memory of REMs occurring during their own hearing aid verification. INTERVENTION: We investigated the addition of informational counseling during REM verification. DATA COLLECTION AND ANALYSIS: Four focus groups were conducted to elicit feedback on a demonstration of informational counseling during REM hearing aid verification. The data from the focus groups were transcribed verbatim and analyzed using qualitative content analysis. RESULTS: Analysis revealed positive aspects, negative aspects, and suggested changes in relation to the verbal and visual information presented during the REM verification demonstration. These data fell into two broad categories: the interaction and transaction of informational counseling. CONCLUSION: Most clients were interested in learning more about REMs if the information was accessible. Results provide recommendations for clinical audiologists and REM system manufacturers to make the information presented during informational counseling more client-friendly and individualized for client-centered care. To continue exploring this new inquiry, further experimental research is required to determine if there is any added value of incorporating informational counseling during REMs.

Longitudinal changes in real-ear to coupler difference measurements in infants.

BACKGROUND: The real-ear-to-coupler difference (RECD) measurement is a commonly used clinical procedure that quantifies the difference in sound pressure level between a 2 cc coupler and an individual's ear canal. The SPL levels in infant ears are highly variable and significantly higher than the SPL levels present in average adult ears, making the quantification of SPL levels in infant ears extremely important for threshold determination and fitting of amplification. It is unknown how much the RECD changes in an individual infant over time, whether that change is within test-retest reliability of the RECD measure, and whether RECD values are predictable from other outer and middle ear measures. PURPOSE: The purposes of this study were to examine longitudinal changes in RECD values in newborn infants to determine whether a significant change in RECD values takes place over a one-month period, how the change in RECD relates to test-retest variability of the measure, and whether RECD values are predictable from the infant's corrected age, or measures of static admittance and equivalent ear canal volume (EECV). STUDY SAMPLE: Fourteen infants (seven females, seven males) aged 7 to 25 days were recruited through community prenatal classes, physicians, hospital nurseries, and word of mouth. All infants had normal middle ear status. DATA COLLECTION AND ANALYSIS: Infants were tested on two separate visits, first when the infant was approximately two to three weeks old and then approximately one month later. Each visit lasted one to two hours, during which time otoacoustic emissions, 226 Hz and 1000 Hz probe-tone tympanometry, and two RECD measures were made for each ear. RESULTS: A multivariate analysis of variance revealed a significant change in RECD values over a one-month interval. Regression analyses revealed that final RECD values were partially predictable from age, initial RECD value, static admittance; and EECV. RECD test-retest variability was not large but larger than longitudinal RECD changes over a one-month period. CONCLUSIONS: It may be unnecessary to remeasure an RECD to account for changes in ear canal acoustics for repeated assessments, no more than one month apart, when the same test transducer is used. The RECD should, however, be measured at one of these assessments because RECD values are not predictable from an infant's age or measures of static admittance and ear canal volume.

A critical review of hearing-aid single-microphone noise-reduction studies in adults and children.

PURPOSE: Single-microphone noise reduction (SMNR) is implemented in hearing aids to suppress background noise. The purpose of this article was to provide a critical review of peer-reviewed studies in adults and children with sensorineural hearing loss who were fitted with hearing aids incorporating SMNR. METHOD: Articles published between 2000 and 2016 were searched in PUBMED and EBSCO databases. RESULTS: Thirty-two articles were included in the final review. Most studies with adult participants showed that SMNR has no effect on speech intelligibility. Positive results were reported for acceptance of background noise, preference, and listening effort. Studies of school-aged children were consistent with the findings of adult studies. No study with infants or young children of under 5 years old was found. Recent studies on noise-reduction systems not yet available in wearable hearing aids have documented benefits of noise reduction on memory for speech processing for older adults. CONCLUSIONS: This evidence supports the use of SMNR for adults and school-aged children when the aim is to improve listening comfort or reduce listening effort. Future research should test SMNR with infants and children who are younger than 5 years of age. Further development, testing, and clinical trials should be carried out on algorithms not yet available in wearable hearing aids. Testing higher cognitive level for speech processing and learning of novel sounds or words could show benefits of advanced signal processing features. These approaches should be expanded to other populations such as children and younger adults. Implications for rehabilitation The review provides a quick reference for students and clinicians regarding the efficacy and effectiveness of SMNR in wearable hearing aids. This information is useful during counseling session to build a realistic expectation among hearing aid users. Most studies in the adult population suggest that SMNR may provide some benefits to adult listeners in terms of listening comfort, acceptance of background noise, and release of cognitive load in a complex listening condition. However, it does not improve speech intelligibility. Studies that examined SMNR in the paediatric population suggest that SMNR may benefit older school-aged children, aged between 10 and 12 years old. The evidence supports the use of SMNR for adults and school-aged children when the aim is to improve listening comfort or reduce listening effort.

Implications and attitudes of audiologists towards smartphone integration in hearing healthcare.

In a relatively short period of time, modern societies have been transformed by the ubiquitous uptake of advanced and portable mobile communication, computation, and sensors available on smartphones. Looking forward, it is anticipated that smartphones will have an increasingly important role in health management including the delivery of hearing healthcare and operation of hearing instruments. OBJECTIVE: This paper provides a brief overview of the role of smartphones in audiologic rehabilitation and hearing research and reports on the findings of a survey assessing attitudes of audiologists towards smartphone integration in hearing healthcare. DESIGN: A total of 258 audiologists working in the United States completed the 10-item survey. RESULTS: The key finding from the survey is that practitioners generally expressed a high willingness to integrate smartphone technology in patient care. Counterintuitively, it was observed that clinicians with the least number of years of experience had relatively more negative attitudes toward smartphone integration in hearing healthcare than clinicians with comparatively more years of experience. CONCLUSIONS: The findings suggest that the attitudes of audiologists likely do not represent a barrier regarding smartphone integration in audiologic rehabilitation.

Temporal envelope changes of compression and speech rate: combined effects on recognition for older adults.

PURPOSE: When understanding speech in complex listening situations, older adults with hearing loss face the double challenge of cochlear hearing loss and deficits of the aging auditory system. Wide-dynamic range compression (WDRC) is used in hearing aids as remediation for the loss of audibility associated with hearing loss. WDRC processing has the additional effect of altering the acoustics of the speech signal, particularly the temporal envelope. Older listeners are negatively affected by other types of temporal distortions, but this has not been found for the distortion of WDRC processing for simple signals. The purpose of this research was to determine the circumstances under which older adults might be negatively affected by WDRC processing and what compensatory mechanisms those listeners might be using for the listening conditions when speech recognition performance is not affected. METHOD: Two groups of adults with mild to moderate hearing loss were tested: (a) young-old (62-74 years, n=11) and (b) old-old (75-88 years, n=14). The groups did not differ in hearing loss, cognition, working memory, or self-reported health status. Participants heard low-predictability sentences compressed at each of 4 compression settings. The effect of compression on the temporal envelope was quantified by the envelope difference index (EDI; T. W. Fortune, B. D. Woodruff, & D. A. Preves, 1994). The sentences were presented at three rates: (a) normal rate, (b) 50% time compressed, and (c) time restored. RESULTS: There was no difference in performance between age groups, or any interactions involving age. There was a significant interaction between speech rate and EDI value; as the EDI value increased, representing higher amounts of temporal envelope distortion, speech recognition was significantly reduced. At the highest EDI value, this reduction was greater for the time-compressed than the normal rate condition. When time was restored to the time-compressed signals, speech recognition did not improve. CONCLUSION: Temporal envelope changes were detrimental to recognition of low-context speech for older listeners once a certain threshold of distortion was reached, particularly for rapid rate speech. For this sample tested, the effect was not age related within the age range tested here. The results of the time-restored condition suggested that listeners were using acoustic redundancy to compensate for the negative effects of WDRC distortion in the normal rate condition.

Quantifying the effect of compression hearing aid release time on speech acoustics and intelligibility.

Compression hearing aids have the inherent, and often adjustable, feature of release time from compression. Research to date does not provide a consensus on how to choose or set release time. The current study had 2 purposes: (a) a comprehensive evaluation of the acoustic effects of release time for a single-channel compression system in quiet and (b) an evaluation of the relation between the acoustic changes and speech recognition. The release times under study were 12, 100, and 800 ms. All of the stimuli were VC syllables from the Nonsense Syllable Task spoken by a female talker. The stimuli were processed through a hearing aid simulator at 3 input levels. Two acoustic measures were made on individual syllables: the envelope-difference index and CV ratio. These measurements allowed for quantification of the short-term amplitude characteristics of the speech signal and the changes to these amplitude characteristics caused by compression. The acoustic analyses revealed statistically significant effects among the 3 release times. The size of the effect was dependent on characteristics of the phoneme. Twelve listeners with moderate sensorineural hearing loss were tested for their speech recognition for the same stimuli. Although release time for this single-channel, 3:1 compression ratio system did not directly predict overall intelligibility for these nonsense syllables in quiet, the acoustic measurements reflecting the changes due to release time were significant predictors of phoneme recognition. Increased temporal-envelope distortion was predictive of reduced recognition for some individual phonemes, which is consistent with previous research on the importance of relative amplitude as a cue to syllable recognition for some phonemes.

Hearing care for elders: a personal reflection on participatory action learning with primary care providers.

PURPOSE: This report is a reflective critical narrative of the authors' experience with an interdisciplinary collaboration of primary care providers (PCPs) and hearing health care providers (HHCPs) that followed the principles of participatory action research/learning. The goal for this report is to describe the 1st author's observed barriers to PCPs' willingness to learn about hearing health care and the subsequent facilitators to learning. METHOD: A team of PCPs and HHCPs created the "Communication: Hearing Loss in Elders" educational module. The module included (a) prereading developed from a combination of literature reviews and contextual factors and (b) a case study. RESULTS: The authors present the list of topics included in the module, and they reflect on why and how these topics were deemed important by the team. In particular, 2 topics were identified for motivating PCPs' behavior regarding hearing health care: (a) the overlap in symptoms and possible causation among depression, dementia, and hearing loss and (b) how hearing can affect efficiency of care regarding other health issues. CONCLUSIONS: This personal reflective narrative gives the authors' opinions about what can make for a successful collaboration and presents some hypotheses regarding information that may motivate behavior change with regard to hearing care.

"You Can Lead a Horse to Water ": Focus Group Perspectives on Initiating and Supporting Hearing Health Change in Older Adults.

PURPOSE: The aim of this study was to use focus group discussions to (a) evaluate the use of an educational presentation as an impetus for hearing health change and (b) investigate hearing health from the perspective of older adults. METHOD: Twenty-seven (4 men, 23 women) community-dwelling older adults attended 4 data collection events. Participants attended a presentation titled Hearing Health in Older Adults, which was delivered by a trained presenter in a peer-teaching-peer format. Following each presentation, a focus group discussion took place. Digital audio recordings, field notes, and memos of the discussions were used to create verbatim transcripts. Data were analyzed using qualitative description and thematic analysis techniques. RESULTS: Five central themes emerged when older adult focus groups discussed the presentation and hearing health change: recognizing and admitting, understanding the options, sharing stories and experiences, barriers and facilitators, and the presentation. CONCLUSION: Facilitators to hearing health change identified by participants include widespread education about hearing health; clarification about roles, professional motivation, and cost in hearing care; and opportunities to learn from and share personal stories with peers.

Hearing aid troubleshooting based on patients' descriptions.

Clinical audiologists were surveyed to determine the terms that their patients use to describe their reaction to hearing aid fitting problems. From this survey, a vocabulary of 40 frequently reported terms was developed. A second survey of hearing aid fitting experts was conducted to determine their methods of troubleshooting a hearing aid fitting when the patient reports one of the frequently reported terms. There was a high degree of agreement among the 24 experts. Principal components analysis resulted in ten components that explained 90.8% of the variance in the experts' responses. These results can be applied as an expert system for fine-tuning hearing aid fittings.

Slow Cortical Potentials and Amplification-Part II: Acoustic Measures.

In a previous study, we investigated slow cortical potential (SCP) N1-P2 amplitudes and N1 latencies in aided and unaided conditions, with the finding that despite being set to provide 20 or 40 dB of gain, none of the hearing aids resulted in a reliable increase in SCP response amplitude relative to the unaided (Marynewich et al., in press). The current study investigates the effects of hearing-aid processing on acoustic measures for two 1000-Hz tonal stimuli: short (60 ms) and long (757 ms), presented at three intensities (30, 50, 70 dB SPL) in aided and unaided conditions using three hearing aids (Analog, DigitalA, DigitalB) with two gain settings (20, 40 dB). Acoustic results indicate that gain achieved by the hearing aids, measured at 30 ms after stimulus onset, for both the short and long stimuli, was less than real-ear insertion gain measured with standard hearing aid test signals. Additionally, the digital hearing aids altered the rise time of the stimuli such that maximum gain was reached well past 30 ms after stimulus onset; rise times differed between the digital aids. These results indicate that aided SCP results must be cautiously interpreted and that further research is required for clinical application.

Slow cortical potentials and amplification-part I: n1-p2 measures.

Slow cortical potentials (SCPs) are currently of great interest in the hearing aid fitting process for infants; however, there is conflicting evidence in the literature concerning the use of SCPs for this purpose. The current study investigated SCP amplitudes and latencies in young normal-hearing listeners in response to a 60 ms duration tonal stimulus (1000 Hz) presented at three intensities (30, 50, and 70 dB SPL) in aided and unaided conditions using three hearing aids (Analog, DigitalA, and DigitalB) with two gain settings (20 and 40 dB). Results showed that SCP amplitudes were smaller for the digital hearing aids compared with the analog hearing aid, and none of the hearing aids resulted in a reliable increase in response amplitude relative to the unaided across conditions. SCP latencies in analog conditions were not significantly different from latencies in the unaided conditions; however, both digital hearing aids resulted in significantly delayed SCP latencies. The results of the current study (as well as several previous studies) indicate that the SCP may not accurately reflect the amplified stimulus expected from the prescribed hearing aids. Thus, "aided-SCP" results must be interpreted with caution, and more research is required concerning possible clinical use of this technique.

Evaluation of the desired sensation level [input/output] algorithm for adults with hearing loss: the acceptable range for amplified conversational speech.

OBJECTIVES: This study had two related purposes: first, to define the range of optimal ear canal levels of aided speech in both high frequency and low frequency regions for adults, using both subjective and objective definitions of optimal; and second, to determine whether a prescribed frequency response, such as that given by Desired Sensation Level [Input/Output], falls within the adult listener's optimal range. DESIGN: Twenty-three adult listeners with mild to moderately severe sensorineural hearing loss were selected from a pool of research volunteers. They were fitted in the laboratory with the Siemens Signia hearing instrument and tested with 20 nominally different frequency responses. All advanced processing options of the hearing instrument were disabled. Subjective ratings of loudness and quality and objective measures of consonant identification were obtained for every frequency response. RESULTS: These adult listeners had, on average, a 10 dB range of measured responses in both the low and the high frequencies that resulted in optimal performance on all the measurements. The range did not vary with degree or configuration of hearing loss, or previous hearing aid experience. Desired-Sensation-Level Input/Output targets were within the optimal range for the low frequencies, and 3 dB above the optimal range for the high frequencies. CONCLUSIONS: A range of aided ear canal frequency responses was determined within which adults with mild to moderately severe hearing loss performed optimally on both objective and subjective outcomes. Clinical implications of this finding include the following: prescriptive methods providing different targets may all result in optimal fittings; and a range of targets may be more appropriate than a single target when setting the frequency-gain characteristics of the hearing instrument.

Measuring the acoustic effects of compression amplification on speech in noise.

This letter contains a description of an inversion technique that allows for separation of speech and noise and its application to quantifying the acoustic effects of wide-dynamic-range compression (WDRC) on speech in background noise. Three main findings are reported: that fast-acting WDRC further degrades signal-to-noise ratio; that the effective compression ratio is lower for speech in noise than speech in quiet; and that in contrast to speech in quiet, the amplitude envelope of speech is mostly unaffected when compressed in background noise.

Using multichannel wide-dynamic range compression in severely hearing-impaired listeners: effects on speech recognition and quality.

OBJECTIVE: The objective of this study was to compare speech recognition across a sampling of amplification choices available for listeners with severe loss. This includes conventional options (linear with peak clipping and linear with compression limiting) and newer strategies (multichannel wide-dynamic range compression [WDRC]) theorized to better accommodate reduced dynamic range. A second objective was to compare speech quality across the same conditions using a paired-comparison test. DESIGN: Participants were 13 adults with severe sensorineural hearing loss and a control group of seven adults with normal hearing. Test materials included consonant-vowel syllables (speech recognition) and sentences (speech quality). Four amplification conditions were included: peak clipping; compression limiting; two-channel WDRC; and three-channel WDRC, with overall audibility similar across conditions. In the WDRC conditions, the compression ratio was fixed at 3:1 in each channel. Consonant recognition was measured using a closed-set task, and speech quality was measured using a paired-comparison test. RESULTS: For the listeners with severe loss, recognition and preference were lower for a three-channel WDRC system than for a compression limiting system. Specific errors were consistent with poorer transmission of amplitude envelope information by the multichannel WDRC systems. CONCLUSIONS: Under some conditions, the benefit of fast-acting, multichannel WDRC systems relative to more linear amplification strategies may be reduced in listeners with severe loss. Performance decrements with these systems are consistent with consequences of broader auditory filters.