Modeling the Intelligibility Benefit of Active Noise Cancelation in Hearing Devices That Improve Signal-to-Noise Ratio.

The extent to which active noise cancelation (ANC), when combined with hearing assistance, can improve speech intelligibility in noise is not well understood. One possible source of benefit is ANC's ability to reduce the sound level of the direct (i.e., vent-transmitted) path. This reduction lowers the "floor" imposed by the direct path, thereby allowing any increases to the signal-to-noise ratio (SNR) created in the amplified path to be "realized" at the eardrum. Here we used a modeling approach to estimate this benefit. We compared pairs of simulated hearing aids that differ only in terms of their ability to provide ANC and computed intelligibility metrics on their outputs. The difference in metric scores between simulated devices is termed the "ANC Benefit." These simulations show that ANC Benefit increases as (1) the environmental sound level increases, (2) the ability of the hearing aid to improve SNR increases, (3) the strength of the ANC increases, and (4) the hearing loss severity decreases. The predicted size of the ANC Benefit can be substantial. For a moderate hearing loss, the model predicts improvement in intelligibility metrics of >30% when environments are moderately loud (>70 dB SPL) and devices are moderately capable of increasing SNR (by >4 dB). It appears that ANC can be a critical ingredient in hearing devices that attempt to improve SNR in loud environments. ANC will become more and more important as advanced SNR-improving algorithms (e.g., artificial intelligence speech enhancement) are included in hearing devices.

Frequency importance functions in simulated bimodal cochlear-implant users with spectral holes.

Frequency importance functions (FIFs) for simulated bimodal hearing were derived using sentence perception scores measured in quiet and noise. Acoustic hearing was simulated using low-pass filtering. Electric hearing was simulated using a six-channel vocoder with three input frequency ranges, resulting in overlap, meet, and gap maps, relative to the acoustic cutoff frequency. Spectral holes present in the speech spectra were created within electric stimulation by setting amplitude(s) of channels to zero. FIFs were significantly different between frequency maps. In quiet, the three FIFs were similar with gradually increasing weights with channels 5 and 6 compared to the first three channels. However, the most and least weighted channels slightly varied depending on the maps. In noise, the patterns of the three FIFs were similar to those in quiet, with steeper increasing weights with channels 5 and 6 compared to the first four channels. Thus, channels 5 and 6 contributed to speech perception the most, while channels 1 and 2 contributed the least, regardless of frequency maps. Results suggest that the contribution of cochlear implant frequency bands for bimodal speech perception depends on the degree of frequency overlap between acoustic and electric stimulation and if noise is absent or present.

In-situ Audiometry Compared to Conventional Audiometry for Hearing Aid Fitting.

The use of in-situ audiometry for hearing aid fitting is appealing due to its reduced resource and equipment requirements compared to standard approaches employing conventional audiometry alongside real-ear measures. However, its validity has been a subject of debate, as previous studies noted differences between hearing thresholds measured using conventional and in-situ audiometry. The differences were particularly notable for open-fit hearing aids, attributed to low-frequency leakage caused by the vent. Here, in-situ audiometry was investigated for six receiver-in-canal hearing aids from different manufacturers through three experiments. In Experiment I, the hearing aid gain was measured to investigate whether corrections were implemented to the prescribed target gain. In Experiment II, the in-situ stimuli were recorded to investigate if corrections were directly incorporated to the delivered in-situ stimulus. Finally, in Experiment III, hearing thresholds using in-situ and conventional audiometry were measured with real patients wearing open-fit hearing aids. Results indicated that (1) the hearing aid gain remained unaffected when measured with in-situ or conventional audiometry for all open-fit measurements, (2) the in-situ stimuli were adjusted for up to 30 dB at frequencies below 1000 Hz for all open-fit hearing aids except one, which also recommends the use of closed domes for all in-situ measurements, and (3) the mean interparticipant threshold difference fell within 5 dB for frequencies between 250 and 6000 Hz. The results clearly indicated that modern measured in-situ thresholds align (within 5 dB) with conventional thresholds measured, indicating the potential of in-situ audiometry for remote hearing care.

Impact of Hearing Aids on Language Outcomes in Preschool Children With Mild Bilateral Hearing Loss.

This study aimed to investigate the role of hearing aid (HA) usage in language outcomes among preschool children aged 3-5 years with mild bilateral hearing loss (MBHL). The data were retrieved from a total of 52 children with MBHL and 30 children with normal hearing (NH). The association between demographical, audiological factors and language outcomes was examined. Analyses of variance were conducted to compare the language abilities of HA users, non-HA users, and their NH peers. Furthermore, regression analyses were performed to identify significant predictors of language outcomes. Aided better ear pure-tone average (BEPTA) was significantly correlated with language comprehension scores. Among children with MBHL, those who used HA outperformed the ones who did not use HA across all linguistic domains. The language skills of children with MBHL were comparable to those of their peers with NH. The degree of improvement in audibility in terms of aided BEPTA was a significant predictor of language comprehension. It is noteworthy that 50% of the parents expressed reluctance regarding HA use for their children with MBHL. The findings highlight the positive impact of HA usage on language development in this population. Professionals may therefore consider HAs as a viable treatment option for children with MBHL, especially when there is a potential risk of language delay due to hearing loss. It was observed that 25% of the children with MBHL had late-onset hearing loss. Consequently, the implementation of preschool screening or a listening performance checklist is recommended to facilitate early detection.

An Alternative Method of Assessing d/DHH Secondary-School Students' L2 Language Development.

Little information is available on d/Deaf and hard of hearing (d/DHH) learners' L2 development. Their limited auditory access may discourage them from taking standardized tests, highlighting the need for alternative ways of assessing their L2 development and proficiency. Therefore, this study suggests adopting processability theory, which demonstrates a universal order of L2 development. Interviews with d/DHH learners and their teachers were conducted to explore their current difficulties in regard to understanding their L2 development. Also, we conducted brief speaking tasks to suggest alternatives to testing the L2 development of learners who are d/DHH in comparison to typical literacy learners. The result showed d/DHH students' L2 developmental patterns are similar to those of typical hearing peers, suggesting that d/DHH students and hearing learners share difficulties in similar areas when learning English. Teachers highlighted the lack of appropriate English tests to determine the d/DHH students' L2 development.

Examining the Language and Communication Factors of a Deaf Child with Autism Spectrum Disorder from an Immigrant Korean Family.

Extant research on learners who are d/Deaf or hard of hearing with disabilities who come from Asian immigrant families is extremely sparse. The authors conducted an intrinsic case study of a deaf student with autism who comes from a Korean immigrant family. To acquire a comprehensive understanding of language and communication characteristics, they analyzed (a) interview data of three administrators who worked with the student and family and (b) school documents/reports issued to the parents. Themes are reported across the three components of the tri-focus framework (Siegel-Causey & Bashinski, 1997): the learner, partner, and environment. Implications for practitioners who work with these learners and their families are discussed, including (a) compiling an individualized language and communication profile that encompasses the framework; (b) utilizing culturally and linguistically responsive practices with the family; (c) practicing interprofessional collaboration; and (d) modifying physical and social environments to increase accessibility.

Teaching Literacy to Filipino Deaf Students in Multilingual Classrooms Amid a Pandemic.

This article describes the current landscape of teaching literacy to Filipino Deaf students in a multilingual, multi-cultural classroom amid the pandemic. The article highlights the uniqueness of Filipino Deaf students as multilingual learners in a multi-cultural classroom and the lack of literature and research on Deaf multilingualism both locally and globally. Moreover, the article focuses on the role of Deaf teachers in teaching Filipino Deaf students, especially in their literacy development. The steps being done to ensure that the curriculum is inclusive of Deaf learners who use Filipino Sign Language (FSL), teacher preparation and materials development, and the challenges in the shift to distance learning amid the COVID-19 pandemic are also discussed. Future directions and recommendations include review of curriculum and adaptation, enhancement of teacher preparation, promotion of collaborative teaching and research efforts, and the production of more appropriate and accessible instructional materials for Deaf students.

Visualizing a Framework in Teaching Literacy to Filipino Deaf Students in Multimodal Learning Spaces.

In this article, we visualize a framework of the intersectionality of literacy, spatial justice, and multimodality in teaching literacy to Filipino Deaf students. We propose a metaphor-based framework and discuss how it can be used in teaching literacy to Filipino Deaf students through classroom examples as well as suggestions and recommendations for teachers. We do this mainly through redefining the term literacy, allowing students access to different modalities, and restructuring learning spaces. We also explore the relationship between spatial justice and the concept of Deaf Space and how this applies in the "new normal" of online learning due to the pandemic. We also address the issue of how classroom and education structure may inadvertently produce spatial injustice, especially for Deaf students. Implications and additional questions in teaching Filipino Deaf students are also discussed.

Deaf on the Prairie: Combining Traditional and Contemporary Learning Theories.

This single case study concerns an 11-year-old girl, Agata, who recently moved to a rural community in the United States from the Philippines. Agata is profoundly deaf, has had no access to amplification, and has had very limited access to language and formal school. The journey through the next year, including the COVID-19 pandemic, saw Agata's language and literacy skills blossom at an unexpected rate. The study examines the how and why of Agata's progress by using multiple sources of both quantitative and qualitative data. A conceptual framework of both direct instruction theory (Engelmann & Carnine, 1982) and resilience theory (Garmezy, 1993) was used to systematically analyze the factors that contributed to Agata's growth and offer a more thorough understanding of the complex challenges and potential successes in supporting students from Asian communities who are d/Deaf or hard of hearing (d/DHH).

An Exploration of the Memory Performance in Older Adult Hearing Aid Users on the Integrated Digit-in-Noise Test.

This study aimed to preliminarily investigate the associations between performance on the integrated Digit-in-Noise Test (iDIN) and performance on measures of general cognition and working memory (WM). The study recruited 81 older adult hearing aid users between 60 and 95 years of age with bilateral moderate to severe hearing loss. The Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) was used to screen older adults for mild cognitive impairment. Speech reception thresholds (SRTs) were measured using 2- to 5-digit sequences of the Mandarin iDIN. The differences in SRT between five-digit and two-digit sequences (SRT5-2), and between five-digit and three-digit sequences (SRT5-3), were used as indicators of memory performance. The results were compared to those from the Digit Span Test and Corsi Blocks Tapping Test, which evaluate WM and attention capacity. SRT5-2 and SRT5-3 demonstrated significant correlations with the three cognitive function tests (rs ranging from -.705 to -.528). Furthermore, SRT5-2 and SRT5-3 were significantly higher in participants who failed the MoCA-BC screening compared to those who passed. The findings show associations between performance on the iDIN and performance on memory tests. However, further validation and exploration are needed to fully establish its effectiveness and efficacy.

Intracochlear Recording of Electrocochleography During and After Cochlear Implant Insertion Dependent on the Location in the Cochlea.

To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.

Changes in visually and auditory attended audiovisual speech processing in cochlear implant users: A longitudinal ERP study.

Limited auditory input, whether caused by hearing loss or by electrical stimulation through a cochlear implant (CI), can be compensated by the remaining senses. Specifically for CI users, previous studies reported not only improved visual skills, but also altered cortical processing of unisensory visual and auditory stimuli. However, in multisensory scenarios, it is still unclear how auditory deprivation (before implantation) and electrical hearing experience (after implantation) affect cortical audiovisual speech processing. Here, we present a prospective longitudinal electroencephalography (EEG) study which systematically examined the deprivation- and CI-induced alterations of cortical processing of audiovisual words by comparing event-related potentials (ERPs) in postlingually deafened CI users before and after implantation (five weeks and six months of CI use). A group of matched normal-hearing (NH) listeners served as controls. The participants performed a word-identification task with congruent and incongruent audiovisual words, focusing their attention on either the visual (lip movement) or the auditory speech signal. This allowed us to study the (top-down) attention effect on the (bottom-up) sensory cortical processing of audiovisual speech. When compared to the NH listeners, the CI candidates (before implantation) and the CI users (after implantation) exhibited enhanced lipreading abilities and an altered cortical response at the N1 latency range (90-150 ms) that was characterized by a decreased theta oscillation power (4-8 Hz) and a smaller amplitude in the auditory cortex. After implantation, however, the auditory-cortex response gradually increased and developed a stronger intra-modal connectivity. Nevertheless, task efficiency and activation in the visual cortex was significantly modulated in both groups by focusing attention on the visual as compared to the auditory speech signal, with the NH listeners additionally showing an attention-dependent decrease in beta oscillation power (13-30 Hz). In sum, these results suggest remarkable deprivation effects on audiovisual speech processing in the auditory cortex, which partially reverse after implantation. Although even experienced CI users still show distinct audiovisual speech processing compared to NH listeners, pronounced effects of (top-down) direction of attention on (bottom-up) audiovisual processing can be observed in both groups. However, NH listeners but not CI users appear to show enhanced allocation of cognitive resources in visually as compared to auditory attended audiovisual speech conditions, which supports our behavioural observations of poorer lipreading abilities and reduced visual influence on audition in NH listeners as compared to CI users.

Effects of hearing acuity on psychophysiological responses to effortful speech perception.

In recent studies, psychophysiological measures have been used as markers of listening effort, but there is limited research on the effect of hearing loss on such measures. The aim of the current study was to investigate the effect of hearing acuity on physiological responses and subjective measures acquired during different levels of listening demand, and to investigate the relationship between these measures. A total of 125 participants (37 males and 88 females, age range 37-72 years, pure-tone average hearing thresholds at the best ear between -5.0 to 68.8 dB HL and asymmetry between ears between 0.0 and 87.5 dB) completed a listening task. A speech reception threshold (SRT) test was used with target sentences spoken by a female voice masked by male speech. Listening demand was manipulated using three levels of intelligibility: 20 % correct speech recognition, 50 %, and 80 % (IL20 %/IL50 %/IL80 %, respectively). During the task, peak pupil dilation (PPD), heart rate (HR), pre-ejection period (PEP), respiratory sinus arrhythmia (RSA), and skin conductance level (SCL) were measured. For each condition, subjective ratings of effort, performance, difficulty, and tendency to give up were also collected. Linear mixed effects models tested the effect of intelligibility level, hearing acuity, hearing asymmetry, and tinnitus complaints on the physiological reactivity (compared to baseline) and subjective measures. PPD and PEP reactivity showed a non-monotonic relationship with intelligibility level, but no such effects were found for HR, RSA, or SCL reactivity. Participants with worse hearing acuity had lower PPD at all intelligibility levels and showed lower PEP baseline levels. Additionally, PPD and SCL reactivity were lower for participants who reported suffering from tinnitus complaints. For IL80 %, but not IL50 % or IL20 %, participants with worse hearing acuity rated their listening effort to be relatively high compared to participants with better hearing. The reactivity of the different physiological measures were not or only weakly correlated with each other. Together, the results suggest that hearing acuity may be associated with altered sympathetic nervous system (re)activity. Research using psychophysiological measures as markers of listening effort to study the effect of hearing acuity on such measures are best served by the use of the PPD and PEP.

Objective measure of binaural processing: Acoustic change complex in response to interaural phase differences.

Combining cochlear implants with binaural acoustic hearing via preserved hearing in the implanted ear(s) is commonly referred to as combined electric and acoustic stimulation (EAS). EAS fittings can provide patients with significant benefit for speech recognition in complex noise, perceived listening difficulty, and horizontal-plane localization as compared to traditional bimodal hearing conditions with contralateral and monaural acoustic hearing. However, EAS benefit varies across patients and the degree of benefit is not reliably related to the underlying audiogram. Previous research has indicated that EAS benefit for speech recognition in complex listening scenarios and localization is significantly correlated with the patients' binaural cue sensitivity, namely interaural time differences (ITD). In the context of pure tones, interaural phase differences (IPD) and ITD can be understood as two perspectives on the same phenomenon. Through simple mathematical conversion, one can be transformed into the other, illustrating their inherent interrelation for spatial hearing abilities. However, assessing binaural cue sensitivity is not part of a clinical assessment battery as psychophysical tasks are time consuming, require training to achieve performance asymptote, and specialized programming and software all of which render this clinically unfeasible. In this study, we investigated the possibility of using an objective measure of binaural cue sensitivity by the acoustic change complex (ACC) via imposition of an IPD of varying degrees at stimulus midpoint. Ten adult listeners with normal hearing were assessed on tasks of behavioral and objective binaural cue sensitivity for carrier frequencies of 250 and 1000 Hz. Results suggest that 1) ACC amplitude increases with IPD; 2) ACC-based IPD sensitivity for 250 Hz is significantly correlated with behavioral ITD sensitivity; 3) Participants were more sensitive to IPDs at 250 Hz as compared to 1000 Hz. Thus, this objective measure of IPD sensitivity may hold clinical application for pre- and post-operative assessment for individuals meeting candidacy indications for cochlear implantation with low-frequency acoustic hearing preservation as this relatively quick and objective measure may provide clinicians with information identifying patients most likely to derive benefit from EAS technology.

Characterizing the relationship between modulation sensitivity and pitch resolution in cochlear implant users.

Cochlear implants are medical devices that have restored hearing to approximately one million people around the world. Outcomes are impressive and most recipients attain excellent speech comprehension in quiet without relying on lip-reading cues, but pitch resolution is poor compared to normal hearing. Amplitude modulation of electrical stimulation is a primary cue for pitch perception in cochlear implant users. The experiments described in this article focus on the relationship between sensitivity to amplitude modulations and pitch resolution based on changes in the frequency of amplitude modulations. In the first experiment, modulation sensitivity and pitch resolution were measured in adults with no known hearing loss and in cochlear implant users with sounds presented to and processed by their clinical devices. Stimuli were amplitude-modulated sinusoids and amplitude-modulated narrow-band noises. Modulation detection and modulation frequency discrimination were measured for modulation frequencies centered on 110, 220, and 440 Hz. Pitch resolution based on changes in modulation frequency was measured for modulation depths of 25 %, 50 %, 100 %, and for a half-waved rectified modulator. Results revealed a strong linear relationship between modulation sensitivity and pitch resolution for cochlear implant users and peers with no known hearing loss. In the second experiment, cochlear implant users took part in analogous procedures of modulation sensitivity and pitch resolution but bypassing clinical sound processing using single-electrode stimulation. Results indicated that modulation sensitivity and pitch resolution was better conveyed by single-electrode stimulation than by clinical processors. Results at 440 Hz were worse, but also not well conveyed by clinical sound processing, so it remains unclear whether the 300 Hz perceptual limit described in the literature is a technological or biological limitation. These results highlight modulation depth and sensitivity as critical factors for pitch resolution in cochlear implant users and characterize the relationship that should inform the design of modulation enhancement algorithms for cochlear implants.

Deaf/hard of hearing students' experiences with higher education's real-time captioning services.

Real-time captions appear to be an effective tool in assisting deaf and hard of hearing (DHH) college students' access information and communication in certain classroom settings. However, there is limited knowledge of DHH students' direct experiences with real-time captioning services. In this study, we gathered narratives from 15 DHH college students across the United States about their experiences with real-time captioning services in college. We analyzed the stories using thematic narrative analysis and uncovered 4 types that students told about their experiences. The story types were (a) stories of overcoming obstacles, (b) stories of resignation, (c) pragmatic stories, and (d) stories of personal connection. These story types reveal that although many students eventually experience effective communication access through real-time captioning services, they can initially struggle to overcome barriers to using the services successfully. Making time and space to listen to DHH students' narratives can teach educators and professionals how to support these students and resolve barriers before they arise.

On the Feasibility of Using Behavioral Listening Effort Test Methods to Evaluate Auditory Performance in Cochlear Implant Users.

Realistic outcome measures that reflect everyday hearing challenges are needed to assess hearing aid and cochlear implant (CI) fitting. Literature suggests that listening effort measures may be more sensitive to differences between hearing-device settings than established speech intelligibility measures when speech intelligibility is near maximum. Which method provides the most effective measurement of listening effort for this purpose is currently unclear. This study aimed to investigate the feasibility of two tests for measuring changes in listening effort in CI users due to signal-to-noise ratio (SNR) differences, as would arise from different hearing-device settings. By comparing the effect size of SNR differences on listening effort measures with test-retest differences, the study evaluated the suitability of these tests for clinical use. Nineteen CI users underwent two listening effort tests at two SNRs (+4 and +8 dB relative to individuals' 50% speech perception threshold). We employed dual-task paradigms-a sentence-final word identification and recall test (SWIRT) and a sentence verification test (SVT)-to assess listening effort at these two SNRs. Our results show a significant difference in listening effort between the SNRs for both test methods, although the effect size was comparable to the test-retest difference, and the sensitivity was not superior to speech intelligibility measures. Thus, the implementations of SVT and SWIRT used in this study are not suitable for clinical use to measure listening effort differences of this magnitude in individual CI users. However, they can be used in research involving CI users to analyze group data.

Assessing parent-child interaction with deaf and hard of hearing infants aged 0-3 years: An international multi-professional e-Delphi.

INTRODUCTION: Most deaf babies are born to hearing families who do not yet have the skills to communicate effectively with their child. Adaptations to communication are important because the quality of parent-child interaction (PCI) predicts how a deaf child develops language. Teachers of Deaf children and Speech and Language Therapists support families with communication in the home. Currently, there are no assessments that appraise how a parent interacts with their deaf baby. Previous research has identified which parent behaviours and approaches are used in PCI assessments in research and practice. The current paper forms consensus on the core content and best practices of a new PCI tool for deaf children aged 0-3 years. METHODS: An international sample of expert academics and practitioners (n = 83) were recruited to take part in a two-round modified electronic Delphi study. Participants were presented with 69 statements focusing on (i) which parent behaviours were important in assessment (ii) the methods to be used in PCI assessment. Participants rated the extent to which they agreed or disagreed with each statement on a five-point Likert scale and gave comments to support their response. Consensus was defined as >80% of participants rating the statement as a (4) 'highly important' or a (5) 'essential'. If consensus was not reached, participant comments were used to generate new statements which were rated in the second round. This project involved a patient and public involvement (PPI) group of hearing and deaf parents and professionals to design and guide the study. RESULTS: Consensus was achieved on 52 statements and ranged from 80-99%. A further six statements were additionally included. Within the 58 statements included, 36 were parent behaviours which centred on the parent's observation of, and response to, their child's behaviour and/or language. The remaining 22 statements focused on methods used in the assessment such as parents having their PCI filmed, parents having the opportunity to review the video and assess themselves alongside a professional, and parents being involved in subsequent goal setting. CONCLUSIONS: This e-Delphi presented the parent behaviours and methods of assessment to be included in a new PCI tool for deaf children. Future co-production work and acceptability and feasibility testing are discussed.