Effect of Digital Noise Reduction in Hearing Aids on Speech Intelligibility in Both Quiet and Noisy Environments.

AIMS: Digital noise reduction (DNR) minimizes the effect of noise on speech signals by continuously monitoring frequency bands in the presence of noise. In the present study, we explored the effect of DNR technology on speech intelligibility in individuals using hearing aids (HAs) and investigated implications for daily use. METHODS AND MATERIAL: Eighteen participants with bilateral moderate sensorineural hearing loss (aged 16-45 years) were included. Bilateral receiver-in-the-ear HAs were fitted in the participants. The adaptive and nonadaptive (with a signal-to-noise ratio (SNR) of +5 and -5 dB, respectively) Turkish matrix sentence test (TURMatrix) in noise and free-field hearing assessments, including hearing thresholds with hearing aids, speech recognition thresholds (SRT), and speech discrimination scores, were conducted in two different conditions: HA in the DNR-on and DNR-off conditions. RESULTS: No significant difference was observed between free-field hearing assessments with the HA in the DNR-off and DNR-on conditions (P > 0.05). Furthermore, the adaptive and nonadaptive TURMatrix revealed significant differences between the scores under the DNR-on and DNR-off conditions (P < 0.05). Nevertheless, under the DNR-on condition, there was no correlation between free-field hearing assessments with HA and TURMatrix results (P > 0.05). However, a significant correlation was observed between SRT scores with HA and TURMatrix scores (adaptive and nonadaptive, +5 and -5 dB SNR, respectively) under the DNR-off condition (P < 0.05). CONCLUSION: Our study findings suggest that DNR can improve speech intelligibility in noisy environments. Therefore, DNR can enhance an individual's auditory comfort by improving their capacity to grasp speech in background noise.

Reduced Tolerance for Risky Play in Primary Caregivers of Children With Hearing Loss.

PURPOSE: It is known that taking appropriate risks during play is crucial for the development of a child's creativity, problem-solving abilities, resilience, self-confidence, and skills in evaluating risky situations. However, communication problems resulting from hearing loss (HL) can affect a child's ability to hear danger and warning signals during play, potentially leading to injury. This study investigates the attitudes of parents or caregivers with children with HL toward risky play. METHOD: The study included 170 caregivers of children with normal hearing (NH; n = 103) and cochlear implant and/or hearing aids users (n = 67) aged 3-13 years. The primary caregiver completed the Tolerance for Risk in Play Scale (TRIPS), and the caregivers of children with HL also completed the Auditory Behavior in Everyday Life (ABEL) questionnaire. RESULTS: TRIPS total scores were significantly higher in the NH group (p < .05). Mothers of children with HL had lower TRIPS scores than mothers of children with NH (p < .05). Similarly, lower TRIPS scores were found in the lower income group with HL (p < .05). A weak positive correlation was observed between TRIPS and both the ABEL total score (p < .05, r = .207) and ABEL auditory awareness score (p < .05, r = .204) in the hard of hearing group. CONCLUSIONS: The study found that caregivers of children with HL have less tolerance for risky play. Additionally, caregivers of children with better auditory skills were more tolerant of risky play. Therefore, it is suggested that caregivers of children using appropriate hearing devices should be informed that they do not need to be overly restrictive during play, and these children should be encouraged to engage in risky play.

Loudness Balancing Optimization for Better Speech Intelligibility, Music Perception, and Spectral Temporal Resolution in Cochlear Implant Users.

HYPOTHESIS: The behaviorally based programming with loudness balancing (LB) would result in better speech understanding, spectral-temporal resolution, and music perception scores, and there would be a relationship between these scores. BACKGROUND: Loudness imbalances at upper stimulation levels may cause sounds to be perceived as irregular, gravelly, or overly echoed and may negatively affect the listening performance of the cochlear implant (CI) user. LB should be performed after fitting to overcome these problems. METHODS: The study included 26 unilateral Med-EL CI users. Two different CI programs based on the objective electrically evoked stapedial reflex threshold (P1) and the behaviorally program with LB (P2) were recorded for each participant. The Turkish Matrix Sentence Test (TMS) was applied to evaluate speech perception; the Random Gap Detection Test (RGDT) and Spectral-Temporally Modulated Ripple Test (SMRT) were applied to evaluate spectral temporal resolution skills; the Mini Profile of Music Perception Skills (mini-PROMS) and Melodic Contour Identification (MCI) tests were applied to evaluate music perception, and the results were compared. RESULTS: Significantly better scores were obtained with P2 in TMS tests performed in noise and quiet. SMRT scores were significantly correlated with TMS in quiet and noise, and mini-PROMS sound perception results. Although better scores were obtained with P2 in the mini-PROMS total score and MCI, a significant difference was found only for MCI. CONCLUSION: The data from the current study showed that equalization of loudness across CI electrodes leads to better perceptual acuity. It also revealed the relationship between speech perception, spectral-temporal resolution, and music perception.

Direct Health Expenditure Analysis Related to Hearing Loss in Individuals Using Hearing Aids and Cochlear Implants.

Objective: This study aimed to investigate the expenditures related to hearing devices and compare the differences in expenditures in child and adult users. Methods: A preliminary questionnaire was developed and conducted amongst hearing aid and cochlear implant users. A total of 178 patients (57.3% were hearing aid users, 42.7% were cochlear implant users) were included in the study and grouped as adults (first group, 50 patients), and children 1< (second group, 123 patients). Results: The results of the study showed that individuals used approximately 4.5% of their annual income as health expenditure related to hearing loss. This rate was over 5% for child users, and about 2.7% for adult users. Moreover, the expenditure made by adult users was below the amount of expenditure made for children in all health expenditure indicators. Conclusion: Supporting the family budget for hearing loss expenditures not covered by the public health insurance will minimize the financial problems caused by the disability.

Electrically Evoked Auditory Late Responses as a Novel Method for Cochlear Implant Programming.

HYPOTHESIS: Electrically evoked auditory late responses (eALR) are useful as an objective cochlear implant (CI) fitting method. BACKGROUND: Different objective and behavioral methods are used for CI fitting. However, there is no objective method that indicates that the electrical signal reaches the auditory cortex. eALR is an indicator that electrical signals reach the auditory cortex, so our aim was to investigate the use of eALR as an objective method for CI programming. METHODS: Two different programs were created for 21 unilateral Med-El CI users. In the first program, the most comfortable level (MCL) was adjusted with the electrical stapes reflex threshold (eSRT), and the threshold levels (THR) were behaviorally adjusted according to the user's feedback. In the second program, the MCL level was adjusted to a level where all the components of the eALR were clearly seen, and the user did not feel uncomfortable; the THR levels were adjusted to the lowest level where the eALR P1 wave could be seen. The results of the MCL and THR levels of the two programs and the free field tests conducted with both programs were compared. RESULTS: While MCL levels did not differ significantly between the two programs, a significant difference was observed between THR levels. In addition, no significant difference was found between hearing and speech tests with CI in the free field. CONCLUSION: The results revealed no significant performance difference between the two programs and that eALR could be preferred as an objective method for MCL determination.

Changes in electrically evoked auditory brainstem responses in children with sequential bilateral cochlear implants.

OBJECTIVES: The primary aim of this study is to investigate whether the electrical stimulation of the second ear causes a difference in electrically evoked auditory brainstem responses (eABR) between two ears over time. METHODS: The study included thirteen subjects under the age of five who used cochlear implants for at least six months in the first ear prior to the sequential cochlear implantation. Postoperative eABRs were conducted on the 1st (first fitting of the second speech processor), 3rd, and 6th months of the second implantation in the basal, medial, and apical electrode positions. The recording was started with the second cochlear implant (CI2), and then the first cochlear implant (CI1) was tested. Sound field audiometry and receptive/expressive language assessments were also performed at 1 and 6 months after the second cochlear implantation. RESULTS: eABR results indicate that when eV wave latencies are examined for all electrodes, CI2 is significantly longer than CI1 (p < 0.05). When eV wave amplitudes are examined for all electrodes, CI1 is significantly higher than the CI2 (p < 0.05). eV latency and amplitude changes between both implants were examined up to six months after implantation. Statistically significant changes were observed in the basal, medial, apical electrode for eV wave latencies, and only in the medial electrode for eV wave amplitudes (p < 0.05). Average sound field thresholds and receptive/expressive language scores improved statistically significantly for all subjects at the end of the study (p < 0.05). CONCLUSION: The postoperative eABR test is a valuable test battery that provides the clinician with important ideas about the estimated threshold, comfortable and audible sound level, CI performance, and auditory pathways up to the brainstem. Since the maturation is still ongoing, an extended period longer than six months is needed to evaluate interaural differences.