Hearing From You: Design Thinking in Audiological Research.

PURPOSE: The purpose of this article is to describe the emerging use of design thinking methodologies in hearing health care research using a participatory action approach with a consumer and community involvement panel, audiologists, and adults with hearing loss. METHOD: Two connected hearing health care projects that adopted design thinking principles are presented here as case studies. Case 1 investigated the applicability and acceptability of smart voice assistant technology as post-hearing aid fitting support. Case 2 investigated the feasibility of providing support for new adult patients with hearing loss before they attend their hearing assessment appointment. DISCUSSION: The design thinking process provided a flexible structure in which researchers were able to empathize with stakeholders, define their unmet needs, and ideate potential connected hearing health care solutions to develop and evaluate prototypes in clinical and home settings. CONCLUSION: Utilizing a needs-based, collaborative design thinking approach to conduct development in hearing health care research is a viable and novel option to produce innovative, relevant, and translational hearing health solutions that address stakeholder needs.

Understanding patient empowerment along the hearing health journey.

OBJECTIVE: Related to the hearing health journey, this study aimed to: (i) explore how empowerment manifests itself from individuals' first awareness of hearing loss through to hearing aid fitting and then to becoming an active hearing aid user, (ii) identify points when the different dimensions of empowerment are most relevant, and (iii) conceptualise empowerment. DESIGN: A semi-structured interview study was conducted, followed by a template analysis of the data. STUDY SAMPLE: Adult hearing aid users from Sweden (n = 8) and Australia (n = 10) who had worn hearing aids for between 6 and 36 months. RESULTS: The themes that emerged from the transcripts were knowledge, skills and strategies, participation, self-efficacy, and control. CONCLUSIONS: This study conceptualises empowerment along the hearing health journey as the process through which individuals with hearing-related challenges acquire and use knowledge, skills, and strategies, and increase self-efficacy, participation, and the feeling of control of their hearing health care, hearing solutions, and everyday lives. There are not specific points along the hearing health journey where any dimension is uniquely relevant, instead, each dimension is a dynamic component at all stages.

Determining unilateral or bilateral hearing aid preference in adults: a prospective study.

OBJECTIVE: Despite high rates of bilateral hearing aid fitting globally, a number of adults continue to reject one hearing aid. The current study aimed to identify a clinically suitable tool for determining, pre-fitting, which clients might prefer one hearing aid.Study Sample: Ninety-five new adult hearing aid candidates, aged 49-87 years, were assessed prior to a first hearing aid fitting. Sixty-eight participants adhered to the prescribed protocol for both bilateral and unilateral hearing aid use. DESIGN: Performance was assessed on a modified version of the Listening in Spatialised Noise - Sentences test (LiSN-S), the Dichotic Digits difference Test, the Experiential Hearing Aid simulator, and the Grooved Pegboard Test. All participants were fitted bilaterally, but were instructed to alternate between unilateral and bilateral hearing aid use over fourteen weeks post-fitting. Participants' wearing preferences were assessed via a short questionnaire. RESULTS: 78% of participants expressed an overall preference for bilateral hearing aid use. Only the LiSN-S bilateral advantage test outcomes significantly correlated with overall wearing preference. CONCLUSIONS: Although the LiSN-S bilateral advantage score related to overall wearing preference, the accuracy of the predictor was too low to warrant implementation of this test prior to hearing aid fitting. The current practice of recommending bilateral hearing aid use continues to be the best option for clinicians.

Listening in Spatialized Noise - Universal Test (LiSN-U) test-retest reliability study.

OBJECTIVE: To assess test-retest reliability of the Listening in Spatialised Noise - Universal test (LiSN-U). DESIGN: Test-retest reliability study. Participants completed the LiSN-U twice, four to eight weeks apart. Study sample: Test-retest reliability was analysed for 23 adults and 109 children. RESULTS: ANOVA showed significant group average score improvement on LiSN-U spatially-separated and co-located conditions on retest (by 1.3 and 0.9 dB, respectively), but not on the difference between them (spatial advantage). Critical difference scores for children were -3.6 dB for the spatially-separated condition, -5.8 dB for the co-located condition, and 5.5 dB for spatial advantage. Critical difference scores for adults were -2.0 dB for the spatially-separated condition, -4.9 dB for the co-located condition, and 5.4 dB for spatial advantage. A correlation analysis was run to determine the relationship between test and retest speech reception thresholds. The correlation was r = 0.63, p < 0.001 for the spatially-separated condition, r = 0.50, p < 0.001 for the co-located condition, and r = 0.37, p < 0.001 for the spatial advantage measure. CONCLUSIONS: The LiSN-U, which is potentially useable for speakers of any language, shows mean test-retest difference and test-retest reliability comparable to other tests that have proven useful in clinical practice.

The development of the listening in spatialised noise - universal test (LiSN-U) and preliminary evaluation in English-speaking listeners.

Objective: To create a language independent version of the Listening in Spatialised Noise - Sentences test (LiSN-S) and evaluate it in an English-speaking population.Design: Test development and normative data collection. LiSN-Universal (LiSN-U) targets consisted of CVCV pseudo-words (e.g. /mupa/). Two looped distracter tracks consisted of CVCVCVCV pseudo-words. The listener's task was to repeat back the target pseudo-words. Stimuli were presented over headphones using an iPad. Speech reception thresholds were measured adaptively. In the co-located condition all stimuli came from directly in front. In the spatially-separated condition the distracters emanated from +90° and -90° azimuth. Perceived location was manipulated using head-related transfer functions. Spatial advantage was calculated as the difference in dB between the co-located and spatially separated conditions.Study samples: Stimulus intelligibility data were collected from 20 adults. Normative data were collected from native English speakers (23 adults and 127 children).Results: Children's spatially separated, co-located, and spatial advantage results improved significantly with age. Spatial advantage was 4-6 dB larger in the LiSN-U than LiSN-S depending on age group.Conclusion: Whereas additional research in non-native English populations is required, the LiSN-U appears to be an effective tool for measuring spatial processing ability.

The Phoneme Identification Test for Assessment of Spectral and Temporal Discrimination Skills in Children: Development, Normative Data, and Test-Retest Reliability Studies.

BACKGROUND: Previous research suggests that a proportion of children experiencing reading and listening difficulties may have an underlying primary deficit in the way that the central auditory nervous system analyses the perceptually important, rapidly varying, formant frequency components of speech. PURPOSE: The Phoneme Identification Test (PIT) was developed to investigate the ability of children to use spectro-temporal cues to perceptually categorize speech sounds based on their rapidly changing formant frequencies. The PIT uses an adaptive two-alternative forced-choice procedure whereby the participant identifies a synthesized consonant-vowel (CV) (/ba/ or /da/) syllable. CV syllables differed only in the second formant (F2) frequency along an 11-step continuum (between 0% and 100%-representing an ideal /ba/ and /da/, respectively). The CV syllables were presented in either quiet (PIT Q) or noise at a 0 dB signal-to-noise ratio (PIT N). RESEARCH DESIGN: Development of the PIT stimuli and test protocols, and collection of normative and test-retest reliability data. STUDY SAMPLE: Twelve adults (aged 23 yr 10 mo to 50 yr 9 mo, mean 32 yr 5 mo) and 137 typically developing, primary-school children (aged 6 yr 0 mo to 12 yr 4 mo, mean 9 yr 3 mo). There were 73 males and 76 females. DATA COLLECTION AND ANALYSIS: Data were collected using a touchscreen computer. Psychometric functions were automatically fit to individual data by the PIT software. Performance was determined by the width of the continuum for which responses were neither clearly /ba/ nor /da/ (referred to as the uncertainty region [UR]). A shallower psychometric function slope reflected greater uncertainty. Age effects were determined based on raw scores. Z scores were calculated to account for the effect of age on performance. Outliers, and individual data for which the confidence interval of the UR exceeded a maximum allowable value, were removed. Nonparametric tests were used as the data were skewed toward negative performance. RESULTS: Across participants, the median value of the F2 range that resulted in uncertain responses was 33% in quiet and 40% in noise. There was a significant effect of age on the width of this UR (p < 0.00001) in both quiet and noise, with performance becoming adult like by age 9 on the PIT Q and age 10 on the PIT N. A skewed distribution toward negative performance occurred in both quiet (p = 0.01) and noise (p = 0.006). Median UR scores were significantly wider in noise than in quiet (T = 2041, p < 0.0000001). Performance (z scores) across the two tests was significantly correlated (r = 0.36, p = 0.000009). Test-retest z scores were significantly correlated in both quiet and noise (r = 0.4 and 0.37, respectively, p < 0.0001). CONCLUSIONS: The PIT normative data show that the ability to identify phonemes based on changes in formant transitions improves with age, and that some children in the general population have performance much worse than their age peers. In children, uncertainty increases when the stimuli are presented in noise. The test is suitable for use in planned studies in a clinical population.

The Parsing Syllable Envelopes Test for Assessment of Amplitude Modulation Discrimination Skills in Children: Development, Normative Data, and Test-Retest Reliability Studies.

BACKGROUND: Intensity peaks and valleys in the acoustic signal are salient cues to syllable structure, which is accepted to be a crucial early step in phonological processing. As such, the ability to detect low-rate (envelope) modulations in signal amplitude is essential to parse an incoming speech signal into smaller phonological units. PURPOSE: The Parsing Syllable Envelopes (ParSE) test was developed to quantify the ability of children to recognize syllable boundaries using an amplitude modulation detection paradigm. The envelope of a 750-msec steady-state /a/ vowel is modulated into two or three pseudo-syllables using notches with modulation depths varying between 0% and 100% along an 11-step continuum. In an adaptive three-alternative forced-choice procedure, the participant identified whether one, two, or three pseudo-syllables were heard. RESEARCH DESIGN: Development of the ParSE stimuli and test protocols, and collection of normative and test-retest reliability data. STUDY SAMPLE: Eleven adults (aged 23 yr 10 mo to 50 yr 9 mo, mean 32 yr 10 mo) and 134 typically developing, primary-school children (aged 6 yr 0 mo to 12 yr 4 mo, mean 9 yr 3 mo). There were 73 males and 72 females. DATA COLLECTION AND ANALYSIS: Data were collected using a touchscreen computer. Psychometric functions (PFs) were automatically fit to individual data by the ParSE software. Performance was related to the modulation depth at which syllables can be detected with 88% accuracy (referred to as the upper boundary of the uncertainty region [UBUR]). A shallower PF slope reflected a greater level of uncertainty. Age effects were determined based on raw scores. z Scores were calculated to account for the effect of age on performance. Outliers, and individual data for which the confidence interval of the UBUR exceeded a maximum allowable value, were removed. Nonparametric tests were used as the data were skewed toward negative performance. RESULTS: Across participants, the performance criterion (UBUR) was met with a median modulation depth of 42%. The effect of age on the UBUR was significant (p < 0.00001). The UBUR ranged from 50% modulation depth for 6-yr-olds to 25% for adults. Children aged 6-10 had significantly higher uncertainty region boundaries than adults. A skewed distribution toward negative performance occurred (p = 0.00007). There was no significant difference in performance on the ParSE between males and females (p = 0.60). Test-retest z scores were strongly correlated (r = 0.68, p < 0.0000001). CONCLUSIONS: The ParSE normative data show that the ability to identify syllable boundaries based on changes in amplitude modulation improves with age, and that some children in the general population have performance much worse than their age peers. The test is suitable for use in planned studies in a clinical population.

A Method for Assessing Auditory Spatial Analysis in Reverberant Multitalker Environments.

BACKGROUND: Deficits in spatial hearing can have a negative impact on listeners' ability to orient in their environment and follow conversations in noisy backgrounds and may exacerbate the experience of hearing loss as a handicap. However, there are no good tools available for reliably capturing the spatial hearing abilities of listeners in complex acoustic environments containing multiple sounds of interest. PURPOSE: The purpose of this study was to explore a new method to measure auditory spatial analysis in a reverberant multitalker scenario. RESEARCH DESIGN: This study was a descriptive case control study. STUDY SAMPLE: Ten listeners with normal hearing (NH) aged 20-31 yr and 16 listeners with hearing impairment (HI) aged 52-85 yr participated in the study. The latter group had symmetrical sensorineural hearing losses with a four-frequency average hearing loss of 29.7 dB HL. DATA COLLECTION AND ANALYSIS: A large reverberant room was simulated using a loudspeaker array in an anechoic chamber. In this simulated room, 96 scenes comprising between one and six concurrent talkers at different locations were generated. Listeners were presented with 45-sec samples of each scene, and were required to count, locate, and identify the gender of all talkers, using a graphical user interface on an iPad. Performance was evaluated in terms of correctly counting the sources and accuracy in localizing their direction. RESULTS: Listeners with NH were able to reliably analyze scenes with up to four simultaneous talkers, while most listeners with hearing loss demonstrated errors even with two talkers at a time. Localization performance decreased in both groups with increasing number of talkers and was significantly poorer in listeners with HI. Overall performance was significantly correlated with hearing loss. CONCLUSIONS: This new method appears to be useful for estimating spatial abilities in realistic multitalker scenes. The method is sensitive to the number of sources in the scene, and to effects of sensorineural hearing loss. Further work will be needed to compare this method to more traditional single-source localization tests.