A comparison of speech intelligibility and subjective quality with hearing-aid processing in older adults with hearing loss.

OBJECTIVE: This study characterised the relationship between speech intelligibility and quality in listeners with hearing loss for a range of hearing-aid processing settings and acoustic conditions. DESIGN: Binaural speech intelligibility scores and quality ratings were measured for sentences presented in babble noise and processed through a hearing-aid simulation. The intelligibility-quality relationship was investigated by (1) assessing the effects of experimental conditions on each task; (2) directly comparing intelligibility scores and quality ratings for each participant across the range of conditions; and (3) comparing the association between signal envelope fidelity (represented by a cepstral correlation metric) and intelligibility and quality. STUDY SAMPLE: Participants were 15 adults (7 females; age range 59-81 years) with mild to moderately severe sensorineural hearing loss. RESULTS: Intelligibility and quality showed a positive association both with each other and with changes to signal fidelity introduced by the entire acoustic and signal-processing system including the additive noise and the hearing-aid output. As signal fidelity decreased, quality ratings changed at a slower rate than intelligibility scores. Individual psychometric functions were more variable for quality compared to intelligibility. CONCLUSIONS: Variability in the intelligibility-quality relationship reinforces the importance of measuring both intelligibility and quality in clinical hearing-aid fittings.

The Type of Noise Influences Quality Ratings for Noisy Speech in Hearing Aid Users.

Purpose The overall goal of the current study was to determine whether noise type plays a role in perceptual quality ratings. We compared quality ratings using various noise types and signal-to-noise ratio (SNR) ranges using hearing aid simulations to consider the effects of hearing aid processing features. Method Ten older adults with bilateral mild to moderately severe sensorineural hearing loss rated the sound quality of sentences processed through a hearing aid simulation and presented in the presence of five different noise types (six-talker babble, three-talker conversation, street traffic, kitchen, and fast-food restaurant) at four SNRs (3, 8, 12, and 20 dB). Results Everyday noise types differentially affected sound quality ratings even when presented at the same SNR: Kitchen and three-talker noises were rated significantly higher than restaurant, traffic, and multitalker babble, which were not different from each other. The effects of noise type were most pronounced at poorer SNRs. Conclusions The findings of this study showed that noise types differentially affected sound quality ratings. The differences we observed were consistent with the acoustic characteristics of the noise types. Noise types having lower envelope fluctuations yielded lower quality ratings than noise types characterized by sporadic high-intensity events at the same SNR.

Using Objective Metrics to Measure Hearing Aid Performance.

OBJECTIVES: The performance of hearing aids is generally characterized by a small set of standardized measurements. The primary goals of these procedures are to measure basic aspects of the hearing aid performance and to ascertain that the device is operating properly. A more general need exists for objective metrics that can predict hearing aid outcomes. Such metrics must consider the interaction of all the signal processing operating in the hearing aid and must do so while also accounting for the hearing loss for which the hearing aid has been prescribed. This article represents a first step in determining the clinical applicability of the hearing aid speech perception index (HASPI) intelligibility and hearing aid speech quality index (HASQI) speech quality metrics. The goals of this article are to demonstrate the feasibility of applying these metrics to commercial hearing aids and to illustrate the anticipated range of measured values and identify implementation concerns that may not be present for conventional measurements. DESIGN: This article uses the HASPI intelligibility and HASQI speech quality metrics to measure the performance of commercial hearing aids. These metrics measure several aspects of the processed signal, including envelope fidelity, modifications of the temporal fine structure, and changes in the long-term frequency response, all in the context of an auditory model that reproduces the salient aspects of the peripheral hearing loss. The metrics are used to measure the performance of basic and premium hearing aids from three different manufacturers. Test conditions include the environmental factors of signal to noise ratio and presentation level, and the fitting configurations were varied to provide different degrees of processing from linear to aggressive nonlinear processing for two different audiograms. RESULTS: The results show that the metrics are capable of measuring statistically significant differences across devices and processing settings. HASPI and HASQI measure both audibility and nonlinear distortion in the devices, and conditions are identified where predicted intelligibility is high but predicted speech quality is substantially reduced. The external signal properties of signal to noise ratio and presentation level are both statistically significant. Hearing loss is significant for HASPI but not for HASQI, and degree of processing is significant for both metrics. A quadratic model for manufacturer showed large effect sizes for HASPI and HASQI, but basic versus premium hearing aid model is not significant. CONCLUSIONS: The results presented in this article represent a first step in applying the HASPI and HASQI metrics to commercial hearing aids. Modern hearing aids often use several different processing strategies operating simultaneously. The proposed metrics provide a way to predict the total effect of this processing, including algorithm interactions that may be missed by conventional measurement procedures. The measurements in this article show significant differences between manufacturers, processing settings, and adjustment for different hearing losses. No significant differences were found between basic and premium hearing aid models. Further research will be needed to determine the clinical relevance of these measurements and to provide target values appropriate for successful fittings.

Survey of Current Practice in the Fitting and Fine-Tuning of Common Signal-Processing Features in Hearing Aids for Adults.

BACKGROUND: Current guidelines for adult hearing aid fittings recommend the use of a prescriptive fitting rationale with real-ear verification that considers the audiogram for the determination of frequency-specific gain and ratios for wide dynamic range compression. However, the guidelines lack recommendations for how other common signal-processing features (e.g., noise reduction, frequency lowering, directional microphones) should be considered during the provision of hearing aid fittings and fine-tunings for adult patients. PURPOSE: The purpose of this survey was to identify how audiologists make clinical decisions regarding common signal-processing features for hearing aid provision in adults. RESEARCH DESIGN: An online survey was sent to audiologists across the United States. The 22 survey questions addressed four primary topics including demographics of the responding audiologists, factors affecting selection of hearing aid devices, the approaches used in the fitting of signal-processing features, and the strategies used in the fine-tuning of these features. STUDY SAMPLE: A total of 251 audiologists who provide hearing aid fittings to adults completed the electronically distributed survey. The respondents worked in a variety of settings including private practice, physician offices, university clinics, and hospitals/medical centers. DATA COLLECTION AND ANALYSIS: Data analysis was based on a qualitative analysis of the question responses. The survey results for each of the four topic areas (demographics, device selection, hearing aid fitting, and hearing aid fine-tuning) are summarized descriptively. RESULTS: Survey responses indicate that audiologists vary in the procedures they use in fitting and fine-tuning based on the specific feature, such that the approaches used for the fitting of frequency-specific gain differ from other types of features (i.e., compression time constants, frequency lowering parameters, noise reduction strength, directional microphones, feedback management). Audiologists commonly rely on prescriptive fitting formulas and probe microphone measures for the fitting of frequency-specific gain and rely on manufacturers' default settings and recommendations for both the initial fitting and the fine-tuning of signal-processing features other than frequency-specific gain. CONCLUSIONS: The survey results are consistent with a lack of published protocols and guidelines for fitting and adjusting signal-processing features beyond frequency-specific gain. To streamline current practice, a transparent evidence-based tool that enables clinicians to prescribe the setting of other features from individual patient characteristics would be desirable.

Using Cognitive Screening Tests in Audiology.

PURPOSE: The population of the United States is aging. Those older adults are living longer than ever and have an increased desire for social participation. As a result, audiologists are likely to see an increased demand for service by older clients whose communication difficulty is caused by a combination of hearing loss and cognitive impairment. For these individuals, early detection of mild cognitive impairment is critical for providing timely medical intervention and social support. METHOD: This tutorial provides information about cognition of older adults, mild cognitive impairment, and cognitive screening tests, with the purpose of assisting audiologists in identifying and appropriately referring potential cases of cognitive impairment. RESULTS: Topics addressed also include how to administer cognitive screening tests on individuals with hearing loss, how to use test results in audiology practice, and the potential of using cognitive screening tests for evaluating the benefit of clinical interventions. CONCLUSIONS: As health care professionals who serve the aging population, audiologists are likely to encounter cases of undiagnosed cognitive impairment. In order to provide timely referral for medical assistance as well as an optimized individual outcome of audiologic interventions, audiologists should be trained to recognize an abnormality in older clients' cognitive status.

Chosen Listening Levels for Music With and Without the Use of Hearing Aids.

PURPOSE: The objective of this study was to describe chosen listening levels (CLLs) for recorded music for listeners with hearing loss in aided and unaided conditions. METHOD: The study used a within-subject, repeated-measures design with 13 adult hearing-aid users. The music included rock and classical samples with different amounts of audio-industry compression limiting. CLL measurements were taken at ear level (i.e., at input to the hearing aid) and at the tympanic membrane. RESULTS: For aided listening, average CLLs were 69.3 dBA at the input to the hearing aid and 80.3 dBA at the tympanic membrane. For unaided listening, average CLLs were 76.9 dBA at the entrance to the ear canal and 77.1 dBA at the tympanic membrane. Although wide intersubject variability was observed, CLLs were not associated with audiometric thresholds. CLLs for rock music were higher than for classical music at the tympanic membrane, but no differences were observed between genres for ear-level CLLs. The amount of audio-industry compression had no significant effect on CLLs. CONCLUSION: By describing the levels of recorded music chosen by hearing-aid users, this study provides a basis for ecologically valid testing conditions in clinical and laboratory settings.

Long-Term Outcome Data in Patients following One Year's Use of a Fully Implantable Active Middle Ear Implant.

This study examined the safety and efficacy of a fully implantable active middle ear (AMEI) system. Outcome measures assessed AMEI performance compared with an optimally fitted conventional hearing aid (CHA). Fifty adults with stable, symmetric moderate-to-severe sensorineural hearing loss were implanted at 9 ambulatory settings. Consonant-Nucleus-Consonant (CNC) words, Bamford-Kowel-Bench Speech in Noise test (BKB-SIN), Abbreviated Profile of Hearing Aid Benefit (APHAB), and unaided hearing thresholds in the implanted ear were compared to baseline measures obtained using a personal CHA. Changes in thresholds were observed from pre- to 12-month postoperative assessments. CNC word scores decreased (within 10%), and the BKB-SIN showed no change from pre- to 12-month postoperative time points. The APHAB revealed improvement. Findings suggest no difference in performance between an appropriately fit CHA and the AMEI at 12 months. This study indicates AMEIs have the potential to help individuals who choose not to use CHAs.

The effects of noise vocoding on speech quality perception.

Speech perception depends on access to spectral and temporal acoustic cues. Temporal cues include slowly varying amplitude changes (i.e. temporal envelope, TE) and quickly varying amplitude changes associated with the center frequency of the auditory filter (i.e. temporal fine structure, TFS). This study quantifies the effects of TFS randomization through noise vocoding on the perception of speech quality by parametrically varying the amount of original TFS available above 1500Hz. The two research aims were: 1) to establish the role of TFS in quality perception, and 2) to determine if the role of TFS in quality perception differs between subjects with normal hearing and subjects with sensorineural hearing loss. Ratings were obtained from 20 subjects (10 with normal hearing and 10 with hearing loss) using an 11-point quality scale. Stimuli were processed in three different ways: 1) A 32-channel noise-excited vocoder with random envelope fluctuations in the noise carrier, 2) a 32-channel noise-excited vocoder with the noise-carrier envelope smoothed, and 3) removal of high-frequency bands. Stimuli were presented in quiet and in babble noise at 18dB and 12dB signal-to-noise ratios. TFS randomization had a measurable detrimental effect on quality ratings for speech in quiet and a smaller effect for speech in background babble. Subjects with normal hearing and subjects with sensorineural hearing loss provided similar quality ratings for noise-vocoded speech.

Effects of noise, nonlinear processing, and linear filtering on perceived music quality.

OBJECTIVE: The purpose of this study was to determine the relative impact of different forms of hearing aid signal processing on quality ratings of music. DESIGN: Music quality was assessed using a rating scale for three types of music: orchestral classical music, jazz instrumental, and a female vocalist. The music stimuli were subjected to a wide range of simulated hearing aid processing conditions including, (1) noise and nonlinear processing, (2) linear filtering, and (3) combinations of noise, nonlinear, and linear filtering. STUDY SAMPLE: Quality ratings were measured in a group of 19 listeners with normal hearing and a group of 15 listeners with sensorineural hearing impairment. RESULTS: Quality ratings in both groups were generally comparable, were reliable across test sessions, were impacted more by noise and nonlinear signal processing than by linear filtering, and were significantly affected by the genre of music. CONCLUSIONS: The average quality ratings for music were reasonably well predicted by the hearing aid speech quality index (HASQI), but additional work is needed to optimize the index to the wide range of music genres and processing conditions included in this study.

Determining perceived sound quality in a simulated hearing aid using the international speech test signal.

OBJECTIVES: Based on speech segments from female talkers of different languages, the International Speech Test Signal (ISTS) has speech-like acoustic properties but is not intelligible. This study investigated whether sound quality ratings for the ISTS are similar to ratings obtained for linguistically meaningful speech. DESIGN: A simulated hearing aid was used to process the ISTS for a variety of noise, nonlinear, linear, and combined nonlinear and linear processing conditions. The sound quality of the test conditions was rated by both normal-hearing and hearing-impaired (HI) listeners. Listeners' ratings were then modeled using the Hearing Aid Sound Quality Index (HASQI). RESULTS: The HASQI predictions indicated how closely the ISTS sound quality ratings were to listener ratings of American English. In the normal-hearing group, correlations between HASQI predictions and listener ratings were 0.90 for nonlinear processing, 0.78 for linear processing, and 0.88 for combined processing. In the HI group, correlations between HASQI predictions and listener ratings were 0.96 for nonlinear processing, 0.94 for linear processing, and 0.96 for combined processing. CONCLUSIONS: Since the ISTS is intended for use with hearing aids, the accuracy of the HASQI predictions for the HI listeners reinforces the validity of using this signal for hearing aid sound quality ratings and predictions.

Effects of noise, nonlinear processing, and linear filtering on perceived speech quality.

OBJECTIVES: The purpose of this study was to measure subjective quality ratings in listeners with normal hearing and listeners with hearing loss for speech subjected to a wide range of processing conditions that are representative of real hearing aids. DESIGN: Speech quality was assessed using a rating scale in a group of 14 listeners with normal hearing and 15 listeners with mild to moderately severe sensorineural hearing loss. Controlled simulations of hearing aid processing were used to process speech that included speech subjected to (1) noise and nonlinear processing, (2) linear filtering, and (3) combinations of noise, nonlinear processing, and linear filtering. The 32 conditions of noise and nonlinear processing included stationary speech-shaped nose, multitalker babble, peak clipping, quantization noise, spectral subtraction, and dynamic range compression (in quiet, with babble, and with spectral subtraction). The 32 linear filtering conditions included high-pass filtering, low-pass filtering, band-pass filtering, positive and negative spectral tilt, and resonance peaks. Subsets of these conditions were used for the 36 conditions that combined noise and nonlinear processing with linear processing. RESULTS: Both listeners with normal hearing and listeners with hearing loss gave consistent (reliable) ratings. In both listener groups, sound quality was significantly affected by the noise, nonlinear processing, and linear filtering conditions. Compared with the listeners with normal hearing, the listeners with hearing loss showed significantly lower ratings of sound quality in nearly all of the processing conditions. For the conditions included in the current hearing aid simulation, noise and nonlinear conditions had a greater effect on quality judgments than did the linear filtering conditions. CONCLUSIONS: The data reported here provide a comprehensive dataset of speech quality ratings for simulated hearing aid processing conditions. The results indicate that quality ratings by listeners with hearing loss are significantly lower than quality ratings by listeners with normal hearing. In addition, quality ratings by listeners with hearing loss are impacted by signal processing at least as much as, and often more than, the quality ratings by listeners with normal hearing. Finally, quality ratings for speech processed with a simulated hearing aid are impacted more by noise and nonlinear signal processing than by linear filtering.

Effects of noise and distortion on speech quality judgments in normal-hearing and hearing-impaired listeners.

Noise and distortion reduce speech intelligibility and quality in audio devices such as hearing aids. This study investigates the perception and prediction of sound quality by both normal-hearing and hearing-impaired subjects for conditions of noise and distortion related to those found in hearing aids. Stimuli were sentences subjected to three kinds of distortion (additive noise, peak clipping, and center clipping), with eight levels of degradation for each distortion type. The subjects performed paired comparisons for all possible pairs of 24 conditions. A one-dimensional coherence-based metric was used to analyze the quality judgments. This metric was an extension of a speech intelligibility metric presented in Kates and Arehart (2005) [J. Acoust. Soc. Am. 117, 2224-2237] and is based on dividing the speech signal into three amplitude regions, computing the coherence for each region, and then combining the three coherence values across frequency in a calculation based on the speech intelligibility index. The one-dimensional metric accurately predicted the quality judgments of normal-hearing listeners and listeners with mild-to-moderate hearing loss, although some systematic errors were present. A multidimensional analysis indicates that several dimensions are needed to describe the factors used by subjects to judge the effects of the three distortion types.