Modified Multiple Stimulus With Hidden Reference and Anchors-Gabrielsson Total Impression Sound Quality Rating Comparisons for Speech in Quiet, Noise, and Reverberation.

PURPOSE: The purpose of the study was to obtain, analyze, and compare subjective sound quality data for the same test stimuli using modified multistimulus MUSHRA (Multiple Stimulus with Hidden Reference and Anchors) based procedures (viz., MUSHRA with custom anchors and MUSHRA without anchor) and the single-stimulus Gabrielsson's total impression rating procedure. METHOD: Twenty normally hearing young adults were recruited in this study. Participants completed sound quality ratings on two different hearing aid recording data sets-Data Set A contained speech recordings from four different hearing aids under a variety of noisy and processing conditions, and Data Set B contained speech recordings from a single hearing aid under a combination of different noisy, reverberant, and signal processing conditions. Recordings in both data sets were rated for their quality using the total impression rating procedure. In addition, quality ratings of Data Set A recordings were obtained using a MUSHRA with custom anchors, while the ratings of Data Set B recordings were collected using a MUSHRA without anchor. RESULTS: Statistical analyses revealed a high test-retest reliability of quality ratings for the same stimuli that were rated multiple times. In addition, high-interrater reliability was observed with all three rating procedures. Further analyses indicated (a) a high correlation between the total impression rating and the two modified MUSHRA ratings and (b) a similar relationship between the average and standard deviation of the subjective rating data obtained by the total impression rating and MUSHRA with custom anchors on Data Set A, and the total impression rating and the MUSHRA without anchor on Data Set B. CONCLUSION: Both sound quality procedures, namely, the MUSHRA-based procedures and the total impression rating scale, obtained similar quality ratings of varied hearing aid speech recordings with high reliability.

Auditory-Perceptual and Pupillometric Evaluation of Vocal Roughness and Listening Effort in Tracheoesophageal Speech.

OBJECTIVES: This study evaluated auditory-perceptual judgments of perceived vocal roughness (VR) and listening effort (LE) along with pupillometric responses in response to speech samples produced by tracheoesophageal (TE) talkers. METHODS: Twenty normal-hearing, naive young adults (eight men and twelve women) served as listeners. Listeners were divided into two groups: (1) a with-anchor (WA) group (four men and six women) and (2) a no-anchor (NA) group (four men and six women). All were presented with speech samples produced by twenty TE talkers; listeners evaluated two auditory-perceptual dimensions-VR and LE-using visual analog scales. Anchors were provided to the WA group as an external referent for their ratings. In addition, during the auditory-perceptual task, each listener's pupil reactions also were recorded with peak pupil dilation (PPD) measures extracted as a physiologic indicator associated with the listening task. RESULTS: High interrater reliability was obtained for both the WA and NA groups. High correlations also were observed between auditory-perceptual ratings of roughness and LE, and between PPD values and ratings of both dimensions for the WA group. The inclusion of an anchor during the auditory-perceptual task improved interrater reliability ratings, but it also imposed an increased demand on listeners. CONCLUSIONS: Data obtained offer insights into the relationship between subjective indices of voice quality (ie, auditory-perceptual evaluation) and physiologic responses (PPD) to the abnormal voice quality that characterizes TE talkers. Furthermore, these data provide information on the inclusion/exclusion of audio anchors and potential increases in listener demand in response to abnormal voice quality.

Verification of a Mobile Psychoacoustic Test System.

Many hearing difficulties can be explained as a loss of audibility, a problem easily detected and treated using standard audiological procedures. Yet, hearing can be much poorer (or more impaired) than audibility predicts because of deficits in the suprathreshold mechanisms that encode the rapidly changing, spectral, temporal, and binaural aspects of the sound. The ability to evaluate these mechanisms requires well-defined stimuli and strict adherence to rigorous psychometric principles. This project reports on the comparison between a laboratory-based and a mobile system's results for psychoacoustic assessment in adult listeners with normal hearing. A description of both systems employed is provided. Psychoacoustic tests include frequency discrimination, amplitude modulation detection, binaural encoding, and temporal gap detection. Results reported by the mobile system were not significantly different from those collected with the laboratory-based system for most of the tests and were consistent with those reported in the literature. The mobile system has the potential to be a feasible option for the assessment of suprathreshold auditory encoding abilities.

Improved Estimation of Parkinsonian Vowel Quality through Acoustic Feature Assimilation.

This paper investigated the performance of a number of acoustic measures, both individually and in combination, in predicting the perceived quality of sustained vowels produced by people impaired with Parkinson's disease (PD). Sustained vowel recordings were collected from 51 PD patients before and after the administration of the Levodopa medication. Subjective ratings of the overall vowel quality were garnered using a visual analog scale. These ratings served to benchmark the effectiveness of the acoustic measures. Acoustic predictors of the perceived vowel quality included the harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPP), recurrence period density entropy (RPDE), Gammatone frequency cepstral coefficients (GFCCs), linear prediction (LP) coefficients and their variants, and modulation spectrogram features. Linear regression (LR) and support vector regression (SVR) models were employed to assimilate multiple features. Different feature dimensionality reduction methods were investigated to avoid model overfitting and enhance the prediction capabilities for the test dataset. Results showed that the RPDE measure performed the best among all individual features, while a regression model incorporating a subset of features produced the best overall correlation of 0.80 between the predicted and actual vowel quality ratings. This model may therefore serve as a surrogate for auditory-perceptual assessment of Parkinsonian vowel quality. Furthermore, the model may offer the clinician a tool to predict who may benefit from Levodopa medication in terms of enhanced voice quality.

Evaluation of Acoustic Analyses of Voice in Nonoptimized Conditions.

Objectives This study aimed to evaluate the fidelity and accuracy of a smartphone microphone and recording environment on acoustic measurements of voice. Method A prospective cohort proof-of-concept study. Two sets of prerecorded samples (a) sustained vowels (/a/) and (b) Rainbow Passage sentence were played for recording via the internal iPhone microphone and the Blue Yeti USB microphone in two recording environments: a sound-treated booth and quiet office setting. Recordings were presented using a calibrated mannequin speaker with a fixed signal intensity (69 dBA), at a fixed distance (15 in.). Each set of recordings (iPhone-audio booth, Blue Yeti-audio booth, iPhone-office, and Blue Yeti-office), was time-windowed to ensure the same signal was evaluated for each condition. Acoustic measures of voice including fundamental frequency (fo), jitter, shimmer, harmonic-to-noise ratio (HNR), and cepstral peak prominence (CPP), were generated using a widely used analysis program (Praat Version 6.0.50). The data gathered were compared using a repeated measures analysis of variance. Two separate data sets were used. The set of vowel samples included both pathologic (n = 10) and normal (n = 10), male (n = 5) and female (n = 15) speakers. The set of sentence stimuli ranged in perceived voice quality from normal to severely disordered with an equal number of male (n = 12) and female (n = 12) speakers evaluated. Results The vowel analyses indicated that the jitter, shimmer, HNR, and CPP were significantly different based on microphone choice and shimmer, HNR, and CPP were significantly different based on the recording environment. Analysis of sentences revealed a statistically significant impact of recording environment and microphone type on HNR and CPP. While statistically significant, the differences across the experimental conditions for a subset of the acoustic measures (viz., jitter and CPP) have shown differences that fell within their respective normative ranges. Conclusions Both microphone and recording setting resulted in significant differences across several acoustic measurements. However, a subset of the acoustic measures that were statistically significant across the recording conditions showed small overall differences that are unlikely to have clinical significance in interpretation. For these acoustic measures, the present data suggest that, although a sound-treated setting is ideal for voice sample collection, a smartphone microphone can capture acceptable recordings for acoustic signal analysis.

Using visual feedback to enhance intonation control with a variable pitch electrolarynx.

This study evaluated the effectiveness of using visual feedback to facilitate pitch control by a speaker using a pressure sensitive onset controlled electrolarynx (EL). This proof-of-concept study was conducted with one healthy adult. The participant-speaker was provided with computer generated visual feedback over five sessions within a consecutive period of three weeks. Changes in force control accuracy were gathered and analyzed. An improvement in finger (thumb) force control accuracy from the first to the last training session was documented. The results of this study provide data toward the development of a clinical training protocol for the use of a pressure sensitive onset controlled EL by laryngectomized speakers. Further, these results highlight the importance of developing a relevant multimodality training protocol for the improvement of postlaryngectomy EL speech production.

Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features.

Objective: To assess the performance of an active transcutaneous implantable-bone conduction device (TI-BCD), and to evaluate the benefit of device digital signal processing (DSP) features in challenging listening environments.Design: Participants were tested at 1- and 3-month post-activation of the TI-BCD. At each session, aided and unaided phoneme perception was assessed using the Ling-6 test. Speech reception thresholds (SRTs) and quality ratings of speech and music samples were collected in noisy and reverberant environments, with and without the DSP features. Self-assessment of the device performance was obtained using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire.Study sample: Six adults with conductive or mixed hearing loss.Results: Average SRTs were 2.9 and 12.3 dB in low and high reverberation environments, respectively, which improved to -1.7 and 8.7 dB, respectively with the DSP features. In addition, speech quality ratings improved by 23 points with the DSP features when averaged across all environmental conditions. Improvement scores on APHAB scales revealed a statistically significant aided benefit.Conclusions: Noise and reverberation significantly impacted speech recognition performance and perceived sound quality. DSP features (directional microphone processing and adaptive noise reduction) significantly enhanced subjects' performance in these challenging listening environments.

Perceptual and Objective Assessment of Envelope Enhancement for Children With Auditory Processing Disorder.

This paper evaluated the performance of an envelope enhancement (EE) algorithm subjectively by children with auditory processing disorder (APD), and objectively through computational models. Speech intelligibility data was collected from children with APD, for unprocessed and envelope-enhanced speech in the presence of stationary and non-stationary background noise at different signal to noise ratios (SNRs), both with and without noise reduction (NR) algorithms as a front-end to the EE algorithm. Furthermore, intrusive and non-intrusive objective speech intelligibility metrics were derived to predict the perceptual impact of this EE algorithm. Subjective data for stationary noise conditions revealed that the combination of NR and EE algorithms significantly improved the speech intelligibility scores at poor SNRs. In contrast, the same combination was ineffective in improving speech intelligibility in non-stationary noise conditions. Taken together, subjective results suggest that exaggerating the envelope cues improves speech identification scores for children with APD. However, the benefit obtained varies depending upon the type and level of the background noise. Both intrusive and non-intrusive objective speech intelligibility estimators exhibited good correlation with the subjective data, with the intrusive metric demonstrating better generalization capabilities. Implications of these results for hearing aid applications for children with APD is discussed.

Effects of Bimodal and Bilateral Cochlear Implant Use on a Nonauditory Working Memory Task: Reading Span Tests Over 2 Years Following Cochlear Implantation.

Purpose A growing body of evidence indicates that treatment of hearing loss by provision of hearing aids leads to improvements in auditory and visual working memory. The purpose of this study was to assess whether similar working memory benefits are observed following provision of cochlear implants (CIs). Method Fifteen adults with postlingually acquired severe bilateral sensorineural hearing loss completed the prospective longitudinal study. Participants were candidates for bilateral cochlear implantation with some aidable hearing in each ear. Implantation surgeries were carried out sequentially, approximately 1 year apart. Working memory was measured with the visual Reading Span Test (Daneman & Carpenter, 1980) at 5 time points: pre-operatively following a 6-month bilateral hearing aid trial, after 6 and 12 months of bimodal (CI plus contralateral hearing aid) listening experience following the 1st CI surgery and activation, and again after 6 and 12 months of bilateral CI listening experience following the 2nd CI surgery and activation. Results Compared to the preoperative baseline, CI listening experience yielded significant improvements in participants' ability to recall test words in the correct serial order after 12 months in the bimodal condition. Individual performance outcomes were variable, but almost all participants showed increases in task performance over the course of the study. Conclusions These results suggest that, similar to appropriate interventions with hearing aids, treatment of hearing loss with CIs can yield working memory benefits. A likely mechanism is the freeing of cognitive resources previously devoted to effortful listening.

Objective and Subjective Speech Quality Assessment of Amplification Devices for Patients With Parkinson's Disease.

This paper investigated subjective and objective assessment of Parkinsonian speech quality. Speech stimuli were recorded from 11 Parkinsonian and 10 age-matched normal control participants under different amplification and environmental conditions. Quality ratings of the recorded stimuli were obtained from naïve listeners. For objective assessment, feature vectors were derived from the speech recordings based on temporal, spectral, and/or cepstral parametrization. These feature vectors were subsequently mapped to the predicted quality scores through several regression methods, including support vector regression, Gaussian process regression, and deep learning. Analyses of subjective speech quality ratings showed that Parkinsonian speech quality was significantly poorer than control subjects' speech quality, and that the amplification devices differentially affected perceived quality of Parkinsonian speech. Objective analyses revealed disparity in performance among feature vectors and mappers, with some feature vector and mapper combinations exhibiting statistically similar correlations with subjective ratings. A set consisting of cepstral, spectral, and modulation domain speech features when combined with Gaussian process regression or deep learning resulted in the highest correlation of 0.85 with the subjective data.

An evaluation of the Sennheiser HDA 280-CL circumaural headphone for use in audiometric testing.

Objective: Evaluation of the Sennheiser HDA 280-CL circumaural headphone for the determination of (1) equivalent threshold sound pressure levels (ETSPL) for 125-18,000 Hz.; (2) real ear attenuation (250-8000 Hz); (3) insertion loss (63-18,000 Hz); (4) frequency response (125-18,000 Hz); (5) total harmonic distortion (THD) (125-10,000 Hz); and, (6) linearity (11,200-18,000 Hz).Study Sample: Twenty-five normal hearing adults aged 18-25 participated in (1) and (2).Design: (1) Hearing thresholds were measured using the Sennheiser HDA 280-CL. Frequency specific ETSPL values were calculated in an artificial ear. (2) Sound field thresholds were measured with the ears open and covered with the headphone to obtain the real ear attenuation thresholds (REAT). These values were used to determine the maximum permissible ambient noise levels (MPANL). (3) A B&K HATS mannequin recorded the output levels of a broadband pink noise with the ears open and covered with the headphones. (4, 5) The frequency response, THD and linearity were measured in an artificial ear.Results: Values for ETSPL, REAT, MPANL, insertion loss, as well as measures of frequency response, THD and linearity are presented.Conclusions: The Sennheiser HDA 280-CL meets the requirements for audiometric testing and the values presented can be used for calibration.

Sound Quality Effects of an Adaptive Nonlinear Frequency Compression Processor with Normal-Hearing and Hearing-Impaired Listeners.

BACKGROUND: Frequency lowering (FL) technology offers a means of improving audibility of high-frequency sounds. For some listeners, the benefit of such technology can be accompanied by a perceived degradation in sound quality, depending on the strength of the FL setting. PURPOSE: The studies presented in this article investigate the effect of a new type of FL signal processing for hearing aids, adaptive nonlinear frequency compression (ANFC), on subjective speech quality. RESEARCH DESIGN: Listener ratings of sound quality were collected for speech stimuli processed with systematically varied fitting parameters. STUDY SAMPLE: Study 1 included 40 normal-hearing (NH) adult and child listeners. Study 2 included 11 hearing-impaired (HI) adult and child listeners. HI listeners were fitted with laboratory-worn hearing aids for use during listening tasks. INTERVENTION: Speech quality ratings were assessed across test conditions consisting of various strengths of static nonlinear frequency compression (NFC) and ANFC speech. Test conditions included those that were fine-tuned on an individual basis per hearing aid fitting and conditions that were modified to intentionally alter the sound quality of the signal. DATA COLLECTION AND ANALYSIS: Listeners rated speech quality using the MUlti Stimulus test with Hidden Reference and Anchor (MUSHRA) test paradigm. Ratings were analyzed for reliability and to compare results across conditions. RESULTS: Results show that interrater reliability is high for both studies, indicating that NH and HI listeners from both adult and child age groups can reliably complete the MUSHRA task. Results comparing sound quality ratings across experimental conditions suggest that both the NH and HI listener groups rate the stimuli intended to have poor sound quality (e.g., anchors and the strongest available parameter settings) as having below-average sound quality ratings. A different trend in the results is reported when considering the other experimental conditions across the listener groups in the studies. Speech quality ratings measured with NH listeners improve as the strength of ANFC decreases, with a range of bad to good ratings reported, on average. Speech quality ratings measured with HI listeners are similar and above-average for many of the experimental stimuli, including those with fine-tuned NFC and ANFC parameters. CONCLUSIONS: Overall, HI listeners provide similar sound quality ratings when comparing static and adaptive forms of frequency compression, especially when considering the individualized parameter settings. These findings suggest that a range in settings may result in above-average sound quality for adults and children with hearing impairment. Furthermore, the fitter should fine-tune FL parameters for each individual listener, regardless of type of FL technology.

Objective and Subjective Assessment of Amplified Parkinsonian Speech Quality.

Hypophonia is a common speech impairment associated with Parkinson's disease (PD). Voice amplifiers are typically used to increase voice loudness, but little is known about their impact on perceived speech quality. In this paper, speech recordings were obtained from 11 PD subjects with and without the use of seven different amplification devices, and in the absence or presence of background noise. The recorded speech samples were rated for their sound quality by 10 naive listeners. The same speech recordings were analyzed objectively, where in linear prediction, mel-frequency cepstral coefficients (MFCCs), and gammatone cepstral coefficients (GFCCs) were extracted and mapped to predicted quality scores using linear regression and Support Vector Regression (SVR). Results showed that amplification devices differentially affect the perceived quality of PD speech, that objective and subjective quality scores correlated well, and that a reduced set of GFCC features mapped with SVR produced the best correlation with the subjective scores.

Electroacoustic assessment of wireless remote microphone systems.

Wireless remote microphones (RMs) transmit the desired acoustic signal to the hearing aid (HA) and facilitate enhanced listening in challenging environments. Fitting and verification of RMs, and benchmarking the relative performance of different RM devices in varied acoustic environments are of significant interest to Audiologists and RM developers. This paper investigates the application of instrumental speech intelligibility and quality metrics for characterizing the RM performance in two acoustic environments with varying amounts of background noise and reverberation. In both environments, two head and torso simulators (HATS) were placed 2 m apart, where one HATS served as the talker and the other served as the listener. Four RM systems were interfaced separately with a HA programmed to match the prescriptive targets for the N4 standard audiogram and placed on the listener HATS. The HA output in varied acoustic conditions was recorded and analyzed offline through computational models predicting speech intelligibility and quality. Results showed performance differences among the four RMs in the presence of noise and/or reverberation, with one RM exhibiting significantly better performance. Clinical implications and applications of these results are discussed.

Predicting the quality of enhanced wideband speech with a cochlear model.

Objective measures are commonly used in the development of speech coding algorithms as an adjunct to human subjective evaluation. Predictors of speech quality based on models of physiological or perceptual processing tend to perform better than measures based on simple acoustical properties. Here, a modeling method based on a detailed physiological model and a neurogram similarity measure is developed and optimized to predict the quality of an enhanced wideband speech dataset. A model capturing temporal modulations in neural activity up to 267 Hz was found to perform as well as or better than several existing objective quality measures.

Fitting Frequency-Lowering Signal Processing Applying the American Academy of Audiology Pediatric Amplification Guideline: Updates and Protocols.

BACKGROUND: Although guidelines for fitting hearing aids for children are well developed and have strong basis in evidence, specific protocols for fitting and verifying technologies can supplement such guidelines. One such technology is frequency-lowering signal processing. Children require access to a broad bandwidth of speech to detect and use all phonemes including female /s/. When access through conventional amplification is not possible, the use of frequency-lowering signal processing may be considered as a means to overcome limitations. Fitting and verification protocols are needed to better define candidacy determination and options for assessing and fine tuning frequency-lowering signal processing for individuals. PURPOSE: This work aims to (1) describe a set of calibrated phonemes that can be used to characterize the variation in different brands of frequency-lowering processors in hearing aids and the verification with these signals and (2) determine whether verification with these signal are predictive of perceptual changes associated with changes in the strength of frequency-lowering signal processing. Finally, we aimed to develop a fitting protocol for use in pediatric clinical practice. STUDY SAMPLE: Study 1 used a sample of six hearing aids spanning four types of frequency lowering algorithms for an electroacoustic evaluation. Study 2 included 21 adults who had hearing loss (mean age 66 yr). DATA COLLECTION AND ANALYSIS: Simulated fricatives were designed to mimic the level and frequency shape of female fricatives extracted from two sources of speech. These signals were used to verify the frequency-lowering effects of four distinct types of frequency-lowering signal processors available in commercial hearing aids, and verification measures were compared to extracted fricatives made in a reference system. In a second study, the simulated fricatives were used within a probe microphone measurement system to verify a wide range of frequency compression settings in a commercial hearing aid, and 27 adult listeners were tested at each setting. The relation between the hearing aid verification measures and the listener's ability to detect and discriminate between fricatives was examined. RESULTS: Verification measures made with the simulated fricatives agreed to within 4 dB, on average, and tended to mimic the frequency response shape of fricatives presented in a running speech context. Some processors showed a greater aided response level for fricatives in running speech than fricatives presented in isolation. Results with listeners indicated that verified settings that provided a positive sensation level of /s/ and that maximized the frequency difference between /s/ and /∫/ tended to have the best performance. CONCLUSIONS: Frequency-lowering signal processors have measureable effects on the high-frequency fricative content of speech, particularly female /s/. It is possible to measure these effects either with a simple strategy that presents an isolated simulated fricative and measures the aided frequency response or with a more complex system that extracts fricatives from running speech. For some processors, a more accurate result may be achieved with a running speech system. In listeners, the aided frequency location and sensation level of fricatives may be helpful in predicting whether a specific hearing aid fitting, with or without frequency-lowering, will support access to the fricatives of speech.

Fitting Noise Management Signal Processing Applying the American Academy of Audiology Pediatric Amplification Guideline: Verification Protocols.

BACKGROUND: Although guidelines for fitting hearing aids for children are well developed and have strong basis in evidence, specific protocols for fitting and verifying some technologies are not always available. One such technology is noise management in children's hearing aids. Children are frequently in high-level and/or noisy environments, and many options for noise management exist in modern hearing aids. Verification protocols are needed to define specific test signals and levels for use in clinical practice. PURPOSE: This work aims to (1) describe the variation in different brands of noise reduction processors in hearing aids and the verification of these processors and (2) determine whether these differences are perceived by 13 children who have hearing loss. Finally, we aimed to develop a verification protocol for use in pediatric clinical practice. STUDY SAMPLE: A set of hearing aids was tested using both clinically available test systems and a reference system, so that the impacts of noise reduction signal processing in hearing aids could be characterized for speech in a variety of background noises. A second set of hearing aids was tested across a range of audiograms and across two clinical verification systems to characterize the variance in clinical verification measurements. Finally, a set of hearing aid recordings that varied by type of noise reduction was rated for sound quality by children with hearing loss. RESULTS: Significant variation across makes and models of hearing aids was observed in both the speed of noise reduction activation and the magnitude of noise reduction. Reference measures indicate that noise-only testing may overestimate noise reduction magnitude compared to speech-in-noise testing. Variation across clinical test signals was also observed, indicating that some test signals may be more successful than others for characterization of hearing aid noise reduction. Children provided different sound quality ratings across hearing aids, and for one hearing aid rated the sound quality as higher with the noise reduction system activated. CONCLUSIONS: Implications for clinical verification systems may be that greater standardization and the use of speech-in-noise test signals may improve the quality and consistency of noise reduction verification cross clinics. A suggested clinical protocol for verification of noise management in children's hearing aids is suggested.

Evaluation of Speech-Evoked Envelope Following Responses as an Objective Aided Outcome Measure: Effect of Stimulus Level, Bandwidth, and Amplification in Adults With Hearing Loss.

OBJECTIVES: The present study evaluated a novel test paradigm based on speech-evoked envelope following responses (EFRs) as an objective aided outcome measure for individuals fitted with hearing aids. Although intended for use in infants with hearing loss, this study evaluated the paradigm in adults with hearing loss, as a precursor to further evaluation in infants. The test stimulus was a naturally male-spoken token /susa∫i/, modified to enable recording of eight individual EFRs, two from each vowel for different formants and one from each fricative. In experiment I, sensitivity of the paradigm to changes in audibility due to varying stimulus level and use of hearing aids was tested. In experiment II, sensitivity of the paradigm to changes in aided audible bandwidth was evaluated. As well, experiment II aimed to test convergent validity of the EFR paradigm by comparing the effect of bandwidth on EFRs and behavioral outcome measures of hearing aid fitting. DESIGN: Twenty-one adult hearing aid users with mild to moderately severe sensorineural hearing loss participated in the study. To evaluate the effects of level and amplification in experiment I, the stimulus was presented at 50 and 65 dB SPL through an ER-2 insert earphone in unaided conditions and through individually verified hearing aids in aided conditions. Behavioral thresholds of EFR carriers were obtained using an ER-2 insert earphone to estimate sensation level of EFR carriers. To evaluate the effect of aided audible bandwidth in experiment II, EFRs were elicited by /susa∫i/ low-pass filtered at 1, 2, and 4 kHz and presented through the programmed hearing aid. EFRs recorded in the 65 dB SPL aided condition in experiment I represented the full bandwidth condition. EEG was recorded from the vertex to the nape of the neck over 300 sweeps. Speech discrimination using the University of Western Ontario Distinctive Feature Differences test and sound quality rating using the Multiple-Stimulus Hidden Reference and Anchor paradigm were measured in the same bandwidth conditions. RESULTS: In experiment I, an increase in stimulus level above threshold and the use of amplification resulted in a significant increase in the number of EFRs detected per condition. At positive sensation levels, an increase in level demonstrated a significant increase in response amplitude in unaided and aided conditions. At 50 and 65 dB SPL, the use of amplification led to a significant increase in response amplitude for the majority of carriers. In experiment II, the number of EFR detections and the combined response amplitude of all eight EFRs improved with an increase in bandwidth up to 4 kHz. In contrast, behavioral measures continued to improve at wider bandwidths. Further change in EFR parameters was possibly limited by the hearing aid bandwidth. Significant positive correlations were found between EFR parameters and behavioral test scores in experiment II. CONCLUSIONS: The EFR paradigm demonstrates sensitivity to changes in audibility due to a change in stimulus level, bandwidth, and use of amplification in clinically feasible test times. The paradigm may thus have potential applications as an objective aided outcome measure. Further investigations exploring stimulus-response relationships in aided conditions and validation studies in children are warranted.

Effect of Stimulus Level and Bandwidth on Speech-Evoked Envelope Following Responses in Adults With Normal Hearing.

OBJECTIVE: The use of auditory evoked potentials as an objective outcome measure in infants fitted with hearing aids has gained interest in recent years. This article proposes a test paradigm using speech-evoked envelope following responses (EFRs) for use as an objective-aided outcome measure. The method uses a running speech-like, naturally spoken stimulus token /susa∫i/ (fundamental frequency [f0] = 98 Hz; duration 2.05 sec), to elicit EFRs by eight carriers representing low, mid, and high frequencies. Each vowel elicited two EFRs simultaneously, one from the region of formant one (F1) and one from the higher formants region (F2+). The simultaneous recording of two EFRs was enabled by lowering f0 in the region of F1 alone. Fricatives were amplitude modulated to enable recording of EFRs from high-frequency spectral regions. The present study aimed to evaluate the effect of level and bandwidth on speech-evoked EFRs in adults with normal hearing. As well, the study aimed to test convergent validity of the EFR paradigm by comparing it with changes in behavioral tasks due to bandwidth. DESIGN: Single-channel electroencephalogram was recorded from the vertex to the nape of the neck over 300 sweeps in two polarities from 20 young adults with normal hearing. To evaluate the effects of level in experiment I, EFRs were recorded at test levels of 50 and 65 dB SPL. To evaluate the effects of bandwidth in experiment II, EFRs were elicited by /susa∫i/ low-pass filtered at 1, 2, and 4 kHz, presented at 65 dB SPL. The 65 dB SPL condition from experiment I represented the full bandwidth condition. EFRs were averaged across the two polarities and estimated using a Fourier analyzer. An F test was used to determine whether an EFR was detected. Speech discrimination using the University of Western Ontario Distinctive Feature Differences test and sound quality rating using the Multiple Stimulus Hidden Reference and Anchors paradigm were measured in identical bandwidth conditions. RESULTS: In experiment I, the increase in level resulted in a significant increase in response amplitudes for all eight carriers (mean increase of 14 to 50 nV) and the number of detections (mean increase of 1.4 detections). In experiment II, an increase in bandwidth resulted in a significant increase in the number of EFRs detected until the low-pass filtered 4 kHz condition and carrier-specific changes in response amplitude until the full bandwidth condition. Scores in both behavioral tasks increased with bandwidth up to the full bandwidth condition. The number of detections and composite amplitude (sum of all eight EFR amplitudes) significantly correlated with changes in behavioral test scores. CONCLUSIONS: Results suggest that the EFR paradigm is sensitive to changes in level and audible bandwidth. This may be a useful tool as an objective-aided outcome measure considering its running speech-like stimulus, representation of spectral regions important for speech understanding, level and bandwidth sensitivity, and clinically feasible test times. This paradigm requires further validation in individuals with hearing loss, with and without hearing aids.

Objective Quality and Intelligibility Prediction for Users of Assistive Listening Devices.

This article presents an overview of twelve existing objective speech quality and intelligibility prediction tools. Two classes of algorithms are presented, namely intrusive and non-intrusive, with the former requiring the use of a reference signal, while the latter does not. Investigated metrics include both those developed for normal hearing listeners, as well as those tailored particularly for hearing impaired (HI) listeners who are users of assistive listening devices (i.e., hearing aids, HAs, and cochlear implants, CIs). Representative examples of those optimized for HI listeners include the speech-to-reverberation modulation energy ratio, tailored to hearing aids (SRMR-HA) and to cochlear implants (SRMR-CI); the modulation spectrum area (ModA); the hearing aid speech quality (HASQI) and perception indices (HASPI); and the PErception MOdel - hearing impairment quality (PEMO-Q-HI). The objective metrics are tested on three subjectively-rated speech datasets covering reverberation-alone, noise-alone, and reverberation-plus-noise degradation conditions, as well as degradations resultant from nonlinear frequency compression and different speech enhancement strategies. The advantages and limitations of each measure are highlighted and recommendations are given for suggested uses of the different tools under specific environmental and processing conditions.