The Hannover Coupler V2: Audiological outcomes of a round window coupler for the Vibrant Soundbridge.

Introduction: The Hannover Coupler version 2 (HC2) was designed to (1) adapt the coupler geometry to the round window (RW) niche (2) to stabilize the floating mass transducer, and (3) to control static coupling forces to the RW. First audiological outcomes with a custom-made HC2 are reported here. Material and Methods: Ten patients were enrolled in our site-initiated, prospective study. To assess audiological outcomes up to 6 months, preoperative and postoperative hearing thresholds, word recognition score (WRS) at 65 dB SPL and the speech recognition threshold in quiet and noise were performed. The effective gain (EG) and the coupling efficiency were calculated. Results: One revision surgery had to be performed during the study period and a significant, but clinically not relevant bone conduction thresholds change was observed at 4 and 6 kHz at 6-month follow-up. At 6 months, the median WRS (n = 10) improved significantly from 0% to 80%. The median speech reception threshold in noise improved significantly from 11.6 to -2.4 dB SNR, and in quiet significantly from 79.6 to 44.4 dB SPL. The average EG of -1.3 dB indicated a closure of the air bone gap. The determined average coupling efficiency of 23.3 dB was within the acceptance range suggested by the manufacturer. Conclusion: For patients with mixed hearing loss and multiple ear surgeries, the HC2 provided good and stable speech recognition results exceeding published results of RW coupling without a coupler or coupling with the RW soft coupler.

Inference of the distortion component of hearing impairment from speech recognition by predicting the effect of the attenuation component.

OBJECTIVE: A model-based determination of the average supra-threshold ("distortion") component of hearing impairment which limits the benefit of hearing aid amplification. DESIGN: Published speech recognition thresholds (SRTs) were predicted with the framework for auditory discrimination experiments (FADE), which simulates recognition processes, the speech intelligibility index (SII), which exploits frequency-dependent signal-to-noise ratios (SNR), and a modified SII with a hearing-loss-dependent band importance function (PAV). Their attenuation-component-based prediction errors were interpreted as estimates of the distortion component. STUDY SAMPLE: Unaided SRTs of 315 hearing-impaired ears measured with the German matrix sentence test in stationary noise. RESULTS: Overall, the models showed root-mean-square errors (RMSEs) of 7 dB, but for steeply sloping hearing loss FADE and PAV were more accurate (RMSE = 9 dB) than the SII (RMSE = 23 dB). Prediction errors of FADE and PAV increased linearly with the average hearing loss. The consideration of the distortion component estimate significantly improved the accuracy of FADE's and PAV's predictions. CONCLUSIONS: The supra-threshold distortion component-estimated by prediction errors of FADE and PAV-seems to increase with the average hearing loss. Accounting for a distortion component improves the model predictions and implies a need for effective compensation strategies for supra-threshold processing deficits with increasing audibility loss.

Hearing Aid Treatment for Patients with Mixed Hearing Loss. Part II: Speech Recognition in Comparison to Direct Acoustic Cochlear Stimulation.

BACKGROUND: The conventional therapy for severe mixed hearing loss is middle ear surgery combined with a power hearing aid. However, a substantial group of patients with severe mixed hearing loss cannot be treated adequately with today's state-of-the-art (SOTA) power hearing aids, as predicted by the accompanying part I of this publication, where we compared the available maximum power output (MPO) and gain from technical specifications to requirements for optimum benefit using a common fitting rule. Here, we intended to validate the theoretical assumptions from part I experimentally in a mixed hearing loss cohort fitted with SOTA power hearing aids. Additionally, we compared the results with an implantable hearing device that circumvents the impaired middle ear, directly stimulating the cochlea, as this might be a better option. OBJECTIVES: Speech recognition outcomes obtained from patients with severe mixed hearing loss supplied acutely with a SOTA hearing aid were studied to validate the outcome predictions as described in part I. Further, the results obtained with hearing aids were compared to those in direct acoustic cochlear implant (DACI) users. MATERIALS AND METHODS: Twenty patients (37 ears with mixed hearing loss) were provided and fitted with a SOTA power hearing aid. Before and after an acclimatization period of at least 4 weeks, word recognition scores (WRS) in quiet and in noise were studied, as well as the speech reception threshold in noise (SRT). The outcomes were compared retrospectively to a second group of 45 patients (47 ears) using the DACI device. Based on the severity of the mixed hearing loss and the available gain and MPO of the SOTA hearing aid, the hearing aid and DACI users were subdivided into groups with prediction of sufficient, partially insufficient, or very insufficient hearing aid performance. RESULTS: The patients with predicted adequate SOTA hearing aid performance indeed showed the best WRS in quiet and in noise when compared to patients with predicted inferior outcomes. Insufficient hearing aid performance at one or more frequencies led to a gradual decrease in hearing aid benefit, validating the criteria used here and in the accompanying paper. All DACI patients showed outcomes at the same level as the adequate hearing aid performance group, being significantly better than those of the groups with inadequate hearing aid performance. Whereas WRS in quiet and noise were sensitive to insufficient gain or output, showing significant differences between the SOTA hearing aid and DACI groups, the SRT in noise was less sensitive. CONCLUSIONS: Limitations of outcomes in mixed hearing loss individuals due to insufficient hearing aid performance can be accurately predicted by applying a commonly used fitting rule and the 35-dB dynamic range rule on the hearing aid specifications. Evidently, when outcomes in patients with mixed hearing loss using the most powerful hearing aids are insufficient, bypassing the middle ear with a powerful active middle ear implant or direct acoustic implant can be a promising alternative treatment.

Hearing Aid Treatment in Patients with Mixed Hearing Loss. Part I: Expected Benefit and Limitations after Stapes Surgery.

OBJECTIVE: The purpose of the present study was to determine the fraction of patients with mixed hearing loss who can or cannot expect benefit from power hearing aids (HAs) after stapes surgery. DESIGN: The audiological outcome of 374 stapes surgeries was used to calculate the patients' individual postoperative requirements in terms of gain and output of HAs. These requirements were compared to the available gain and output provided by state-of-the-art power HAs at 0.5, 1.0, 2.0, and 4.0 kHz. According to these comparisons, ears were divided into three groups. For G0, required gain and output lay within the corresponding technical limits of the HAs at all frequencies. In G1, one or both requirements could not be fulfilled at 1 frequency. G2 combined all ears where the requirements lay beyond the HA's technical limitations at 2 or more frequencies. RESULTS: Stapes surgery resulted in an improvement of air-bone gap (ABG) in 84.5% of the cases by 15.7 dB on average. Based on pure-tone average (0.5, 1.0, 2.0, 4.0 kHz), 40.6% of all cases showed an ABG ≤10 dB. 44.9% of all cases did no longer need a HA after stapes surgery. A power HA would fulfill both audiological criteria at all 4 frequencies in 81.6% of cases that needed a HA postoperatively. However, 18.4% would not be sufficiently treatable at 1 or more frequencies (15.0% in G1, 3.4% in G2). CONCLUSIONS: The present study identified a subset of patients with mixed hearing loss after stapes surgery that cannot be treated sufficiently with available power HAs. As the residual ABG is an important reason for this lack of treatment success, the advancement of alternative hearing devices that circumvent the middle ear, such as powerful active middle ear implants, is indicated.

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

OBJECTIVE: The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA). DESIGN: After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility. STUDY SAMPLE: Data was obtained from 315 ears of 177 subjects with hearing losses ranging from -5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz). RESULTS: Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs. CONCLUSION: The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ∼47 dB HL, and above it is determined by listening in quiet.

Development of the Russian matrix sentence test.

OBJECTIVE: To develop the Russian matrix sentence test for speech intelligibility measurements in noise. DESIGN: Test development included recordings, optimization of speech material, and evaluation to investigate the equivalency of the test lists and training. For each of the 500 test items, the speech intelligibility function, speech reception threshold (SRT: signal-to-noise ratio, SNR, that provides 50% speech intelligibility), and slope was obtained. The speech material was homogenized by applying level corrections. In evaluation measurements, speech intelligibility was measured at two fixed SNRs to compare list-specific intelligibility functions. To investigate the training effect and establish reference data, speech intelligibility was measured adaptively. STUDY SAMPLE: Overall, 77 normal-hearing native Russian listeners. RESULTS: The optimization procedure decreased the spread in SRTs across words from 2.8 to 0.6 dB. Evaluation measurements confirmed that the 16 test lists were equivalent, with a mean SRT of -9.5 ± 0.2 dB and a slope of 13.8 ± 1.6%/dB. The reference SRT, -8.8 ± 0.8 dB for the open-set and -9.4 ± 0.8 dB for the closed-set format, increased slightly for noise levels above 75 dB SPL. CONCLUSIONS: The Russian matrix sentence test is suitable for accurate and reliable speech intelligibility measurements in noise.

A Spanish matrix sentence test for assessing speech reception thresholds in noise.

OBJECTIVE: To develop, optimize, and evaluate a new Spanish sentence test in noise. DESIGN: The test comprises a basic matrix of ten names, verbs, numerals, nouns, and adjectives. From this matrix, test lists of ten sentences with an equal syntactical structure can be formed at random, with each list containing the whole speech material. The speech material represents the phoneme distribution of the Spanish language. The test was optimized for measuring speech reception thresholds (SRTs) in noise by adjusting the presentation levels of the individual words. Subsequently, the test was evaluated by independent measurements investigating the training effects, the comparability of test lists, open-set vs. closed-set test format, and performance of listeners of different Spanish varieties. STUDY SAMPLE: In total, 68 normal-hearing native Spanish-speaking listeners. RESULTS: SRTs measured using an adaptive procedure were 6.2 ± 0.8 dB SNR for the open-set and 7.2 ± 0.7 dB SNR for the closed-set test format. The residual training effect was less than 1 dB after using two double-lists before data collection. CONCLUSIONS: No significant differences were found for listeners of different Spanish varieties indicating that the test is applicable to Spanish as well as Latin American listeners. Test lists can be used interchangeably.