Comparison of Two Clinical Devices for the Measurement of Distortion Product Otoacoustic Emissions in Normal-Hearing Adults.

BACKGROUND AND OBJECTIVES: Otoacoustic emissions (OAEs) are low-intensity sounds generated by the cochlea and associated with the function of the outer hair cells. Since OAE measurements do not require active participation of a listener, OAEs are considered an objective measure of cochlear function. While distortion-product OAEs (DPOAEs) are commonly used in clinical practice, limited information is available on the performance of various clinical devices. This study compared two commercial clinical devices, Titan and Eclipse from Interacoustics, and collected normative data for DPOAEs in people with normal hearing. The data collection and analysis were focused on signal and noise amplitudes as well as signal-to-noise ratios (SNRs). SUBJECTS AND METHODS: Sixty-three participants with normal hearing (age 23.2±2.0 years) were included in the study. DPOAEs were measured at 31 frequencies ranging from 500 to 10,000 Hz. RESULTS: DPOAE amplitude differed across frequencies. Additionally, a high number of unreliable responses were observed at the edge frequencies (<828 Hz and >6,072 Hz). There were no significant differences between the two devices in terms of DPOAE amplitudes, but the recorded-noise levels (amplitude) differed significantly. SNRs of the recorded OAEs were frequency dependent (higher frequencies showed larger SNRs), and significant differences in terms of SNR were found between the two devices. CONCLUSIONS: Despite the above-mentioned differences, the OAEs recorded with both devices met the pass criteria for the SNR (≥6 dB) consistently across frequencies, and thus the differences do not compromise the test outcomes. The frequency dependence of the OAE amplitudes and the corresponding SNRs may be relevant for clinical practice.

Amplitude Compression for Preventing Rollover at Above-Conversational Speech Levels.

Hearing aids provide nonlinear amplification to improve speech audibility and loudness perception. While more audibility typically increases speech intelligibility at low levels, the same is not true for above-conversational levels, where decreases in intelligibility ("rollover") can occur. In a previous study, we found rollover in speech intelligibility measurements made in quiet for 35 out of 74 test ears with a hearing loss. Furthermore, we found rollover occurrence in quiet to be associated with poorer speech intelligibility in noise as measured with linear amplification. Here, we retested 16 participants with rollover with three amplitude-compression settings. Two were designed to prevent rollover by applying slow- or fast-acting compression with a 5:1 compression ratio around the "sweet spot," that is, the area in an individual performance-intensity function with high intelligibility and listening comfort. The third, reference setting used gains and compression ratios prescribed by the "National Acoustic Laboratories Non-Linear 1" rule. Speech intelligibility was assessed in quiet and in noise. Pairwise preference judgments were also collected. For speech levels of 70 dB SPL and above, slow-acting sweet-spot compression gave better intelligibility in quiet and noise than the reference setting. Additionally, the participants clearly preferred slow-acting sweet-spot compression over the other settings. At lower levels, the three settings gave comparable speech intelligibility, and the participants preferred the reference setting over both sweet-spot settings. Overall, these results suggest that, for listeners with rollover, slow-acting sweet-spot compression is beneficial at 70 dB SPL and above, while at lower levels clinically established gain targets are more suited.

Test-retest evaluation of a notched-noise test using consumer-grade mobile audio equipment.

OBJECTIVE: The aim of this study was to investigate whether consumer-grade mobile audio equipment can be reliably used as a platform for the notched-noise test, including when the test is conducted outside the laboratory. DESIGN: Two studies were conducted: Study 1 was a notched-noise masking experiment with three different setups: in a psychoacoustic test booth with a standard laboratory PC; in a psychoacoustic test booth with a mobile device; and in a quiet office room with a mobile device. Study 2 employed the same task as Study 1, but compared circumaural headphones to insert earphones. STUDY SAMPLE: Nine and ten young, normal-hearing participants completed studies 1 and 2, respectively. RESULTS: The test-retest accuracy of the notched-noise test on the mobile implementation did not differ from that for the laboratory setup. A possible effect of the earphone design was identified in Study 1, which was corroborated by Study 2, where test-retest variability was smallest when comparing results from experiments conducted using identical acoustic transducers. CONCLUSIONS: Results and test-retest repeatability comparable to standard laboratory settings for the notched-noise test can be obtained with mobile equipment outside the laboratory.

Semantic Context Can Mask Intelligibility Declines at Above-Conversational Speech Levels in Normal-Hearing Listeners.

PURPOSE: While speech audibility generally improves with increasing level, declines in intelligibility are inconsistently observed at above-conversational levels, even in listeners with normal audiograms (NAs). The inconsistent findings could be due to different types of speech materials, ranging from monosyllabic words to everyday sentences, used across studies. Here, we hypothesized that semantic context can "mask" intelligibility declines at high levels by constraining plausible response options. METHOD: Intelligibility was assessed in speech-shaped noise with monosyllabic words, sentences without semantic context, and sentences with semantic context. Two presentation levels were used: 80 and 95 dB SPL broadband. Bandpass filtering was applied to minimize upward spread of masking. Twenty-two young adults with NAs were tested. RESULTS: Poorer performance at the higher level was found with the monosyllabic words and context-free sentences but not with the context-rich sentences. The scores obtained at the higher level with the two context-free materials were strongly correlated. The correlation was independent of the lower-level scores, suggesting that the high-level performance declines reflect "normal" auditory functioning. CONCLUSIONS: Young adults with NAs show intelligibility decreases at above-conversational levels when tested with speech materials without semantic context. Top-down processing as facilitated by context information can mask such declines.

Predicting Aided Outcome With Aided Word Recognition Scores Measured With Linear Amplification at Above-conversational Levels.

OBJECTIVES: Many hearing aid (HA) users receive limited benefit from amplification, especially when trying to understand speech in noise, and they often report hearing-related residual activity limitations. Current HA fitting strategies are typically based on pure-tone hearing thresholds only, even though suprathreshold factors have been linked to aided outcomes. Furthermore, clinical measures of speech perception such as word recognition scores (WRSs) are performed without frequency-specific amplification, likely resulting in suboptimal speech audibility and thus inaccurate estimates of suprathreshold hearing abilities. Corresponding measures with frequency-specific amplification ("aided") would likely improve such estimates and enable more accurate aided outcome prediction. Here, we investigated potential links between either unaided WRSs or aided WRSs measured at several above-conversational levels and two established HA outcome measures: The Hearing-In-Noise Test (HINT) and the International Outcome Inventory for Hearing Aids (IOI-HA). DESIGN: Thirty-seven older individuals with bilateral hearing impairments participated. Two conditions were tested: unaided and aided, with all stimuli presented over headphones. In the unaided condition, the most comfortable level (MCL) for the presented speech stimuli, WRS at MCL+10 dB as well as uncomfortable levels (UCLs) for narrowband noise stimuli were measured. In the aided condition, all stimuli were individually amplified according to the "National Acoustic Laboratories-Revised, Profound" fitting rule. Aided WRSs were then measured using an Interacoustics Affinity system at three above-conversational levels, allowing for the maximum aided WRS as well as the presence of "rollover" in the performance-intensity function to be estimated. Multivariate data analyses were performed to examine the relations between the HINT (measured using a simulated HA with the NAL-RP amplification) or IOI-HA scores (for the participants' own HAs) and various potential predictors (age, pure-tone average hearing loss, unaided WRS, aided WRS, rollover presence [ROp], and UCL). RESULTS: Aided WRSs predicted the HINT scores better than any other predictor and were also the only significant predictor of the IOI-HA scores. In addition, UCL and ROp in the aided WRSs were significant predictors of the HINT scores and competed for variance in the statistical models. Neither age nor pure-tone average hearing loss could predict the two aided outcomes. CONCLUSIONS: Aided WRSs can predict HA outcome more effectively than unaided WRSs, age or pure-tone audiometry and could be relatively easily implemented in clinical settings. More research is necessary to better understand the relations between ROp, UCL and speech recognition at above-conversational levels.

Towards Auditory Profile-Based Hearing-Aid Fittings: BEAR Rationale and Clinical Implementation.

(1) Background: To improve hearing-aid rehabilitation, the Danish 'Better hEAring Rehabilitation' (BEAR) project recently developed methods for individual hearing loss characterization and hearing-aid fitting. Four auditory profiles differing in terms of audiometric hearing loss and supra-threshold hearing abilities were identified. To enable auditory profile-based hearing-aid treatment, a fitting rationale leveraging differences in gain prescription and signal-to-noise (SNR) improvement was developed. This report describes the translation of this rationale to clinical devices supplied by three industrial partners. (2) Methods: Regarding the SNR improvement, advanced feature settings were proposed and verified based on free-field measurements made with an acoustic mannikin fitted with the different hearing aids. Regarding the gain prescription, a clinically feasible fitting tool and procedure based on real-ear gain adjustments were developed. (3) Results: Analyses of the collected real-ear gain and SNR improvement data confirmed the feasibility of the clinical implementation. Differences between the auditory profile-based fitting strategy and a current 'best practice' procedure based on the NAL-NL2 fitting rule were verified and are discussed in terms of limitations and future perspectives. (4) Conclusion: Based on a joint effort from academic and industrial partners, the BEAR fitting rationale was transferred to commercially available hearing aids.

Revisiting Auditory Profiling: Can Cognitive Factors Improve the Prediction of Aided Speech-in-Noise Outcome?

Hearing aids (HA) are the most common type of rehabilitation treatment for age-related hearing loss. However, HA users often obtain limited benefit from their devices, particularly in noisy environments, and thus many HA candidates do not use them at all. A possible reason for this could be that current HA fittings are audiogram-based, that is, they neglect supra-threshold factors. In an earlier study, an auditory-profiling method was proposed as a basis for more personalized HA fittings. This method classifies HA users into four profiles that differ in terms of hearing sensitivity and supra-threshold hearing abilities. Previously, HA users belonging to these profiles showed significant differences in terms of speech recognition in noise but not subjective assessments of speech-in-noise (SIN) outcome. Moreover, large individual differences within some profiles were observed. The current study therefore explored if cognitive factors can help explain these differences and improve aided outcome prediction. Thirty-nine older HA users completed sets of auditory and SIN tests as well as two tablet-based cognitive measures (the Corsi block-tapping and trail-making tests). Principal component analyses were applied to extract the dominant sources of variance both within individual tests producing many variables and within the three types of tests. Multiple linear regression analyses performed on the extracted components showed that auditory factors were related to aided speech recognition in noise but not to subjective SIN outcome. Cognitive factors were unrelated to aided SIN outcome. Overall, these findings provide limited support for adding those two cognitive tests to the profiling of HA users.

Corrigendum: Auditory tests for characterizing hearing deficits in listeners with various hearing abilities: The BEAR test battery.

[This corrects the article DOI: 10.3389/fnins.2021.724007.].

Auditory Tests for Characterizing Hearing Deficits in Listeners With Various Hearing Abilities: The BEAR Test Battery.

The Better hEAring Rehabilitation (BEAR) project aims to provide a new clinical profiling tool-a test battery-for hearing loss characterization. Although the loss of sensitivity can be efficiently measured using pure-tone audiometry, the assessment of supra-threshold hearing deficits remains a challenge. In contrast to the classical "attenuation-distortion" model, the proposed BEAR approach is based on the hypothesis that the hearing abilities of a given listener can be characterized along two dimensions, reflecting independent types of perceptual deficits (distortions). A data-driven approach provided evidence for the existence of different auditory profiles with different degrees of distortions. Ten tests were included in a test battery, based on their clinical feasibility, time efficiency, and related evidence from the literature. The tests were divided into six categories: audibility, speech perception, binaural processing abilities, loudness perception, spectro-temporal modulation sensitivity, and spectro-temporal resolution. Seventy-five listeners with symmetric, mild-to-severe sensorineural hearing loss were selected from a clinical population. The analysis of the results showed interrelations among outcomes related to high-frequency processing and outcome measures related to low-frequency processing abilities. The results showed the ability of the tests to reveal differences among individuals and their potential use in clinical settings.

Effects of Noise and Second Language on Conversational Dynamics in Task Dialogue.

This study provides a framework for measuring conversational dynamics between conversational partners (interlocutors). Conversations from 20 pairs of young, normal-hearing, native-Danish talkers were recorded when speaking in both quiet and noise (70 dBA sound pressure level [SPL]) and in Danish and English. Previous studies investigating the intervals from when one talker stops talking to when the next one starts, termed floor-transfer offsets (FTOs), suggest that typical turn-taking requires interlocutors to predict when the current talker will finish their turn. We hypothesized that adding noise and/or speaking in a second language (L2) would increase the communication difficulty and result in longer and more variable FTOs. The median and interquartile range of FTOs increased slightly in noise, and in L2, there was a small increase in interquartile range but a small decrease in the median of FTO durations. It took the participants longer to complete the task in both L2 and noise, indicating increased communication difficulty. The average duration of interpausal units, that is, units of connected speech surrounded by silences of 180 ms or more, increased by 18% in noise and 8% in L2. These findings suggest that talkers held their turn for longer, allowing more time for speech understanding and planning. In L2, participants spoke slower, and in both L2 and noise, they took fewer turns. These changes in behavior may have offset some of the increased difficulty when communicating in noise or L2. We speculate that talkers prioritize the maintenance of turn-taking timing over other speech measures.

Influence of Three Auditory Profiles on Aided Speech Perception in Different Noise Scenarios.

Hearing aid (HA) users differ greatly in their speech-in-noise (SIN) outcomes. This could be because the degree to which current HA fittings can address individual listening needs differs across users and listening situations. In two earlier studies, an auditory test battery and a data-driven method were developed for classifying HA candidates into four distinct auditory profiles differing in audiometric hearing loss and suprathreshold hearing abilities. This study explored aided SIN outcome for three of these profiles in different noise scenarios. Thirty-one older habitual HA users and six young normal-hearing listeners participated. Two SIN tasks were administered: a speech recognition task and a "just follow conversation" task requiring the participants to self-adjust the target-speech level. Three noise conditions were tested: stationary speech-shaped noise, speech-shaped babble noise, and speech-shaped babble noise with competing dialogues. Each HA user was fitted with three HAs from different manufacturers using their recommended procedures. Real-ear measurements were performed to document the final gain settings. The results showed that HA users with mild hearing deficits performed better than HA users with pronounced hearing deficits on the speech recognition task but not the just follow conversation task. Moreover, participants with pronounced hearing deficits obtained different SIN outcomes with the tested HAs, which appeared to be related to differences in HA gain. Overall, these findings imply that current proprietary fitting strategies are limited in their ability to ensure good SIN outcomes, especially for users with pronounced hearing deficits, for whom the choice of device seems most consequential.

Comparison of Behavioral and Physiological Measures of the Status of the Cochlear Nonlinearity.

While an audiogram is a useful method of characterizing hearing loss, it has been suggested that including a complementary, suprathreshold measure, for example, a measure of the status of the cochlear active mechanism, could lead to improved diagnostics and improved hearing-aid fitting in individual listeners. While several behavioral and physiological methods have been proposed to measure the cochlear-nonlinearity characteristics, evidence of a good correspondence between them is lacking, at least in the case of hearing-impaired listeners. If this lack of correspondence is due to, for example, limited reliability of one of such measures, it might be a reason for limited evidence of the benefit of measuring peripheral compression. The aim of this study was to investigate the relation between measures of the peripheral-nonlinearity status estimated using two psychoacoustical methods (based on the notched-noise and temporal-masking curve methods) and otoacoustic emissions, on a large sample of hearing-impaired listeners. While the relation between the estimates from the notched-noise and the otoacoustic emissions experiments was found to be stronger than predicted by the audiogram alone, the relations between the two measures and the temporal-masking based measure did not show the same pattern, that is, the variance shared by any of the two measures with the temporal-masking curve-based measure was also shared with the audiogram.

Towards Auditory Profile-Based Hearing-Aid Fitting: Fitting Rationale and Pilot Evaluation.

Background-The clinical characterization of hearing deficits for hearing-aid fitting purposes is typically based on the pure-tone audiogram only. In a previous study, a group of hearing-impaired listeners completed a comprehensive test battery that was designed to tap into different dimensions of hearing abilities. A data-driven analysis of the data yielded four clinically relevant patient sub-populations or "auditory profiles". The purpose of the current study was to propose and pilot-test profile-based hearing-aid settings in order to explore their potential for providing more targeted hearing-aid treatment. Methods-Four candidate hearing-aid settings were developed and evaluated by a subset of the participants tested previously. The evaluation consisted of multi-comparison preference ratings that were carried out in realistic sound scenarios. Results-Listeners belonging to the different auditory profiles showed different patterns of preference for the tested hearing-aid settings that were largely consistent with the expectations. Conclusions-The results of this pilot evaluation support further investigations into stratified, profile-based hearing-aid fitting with wearable hearing aids.

Robust Data-Driven Auditory Profiling Towards Precision Audiology.

The sources and consequences of a sensorineural hearing loss are diverse. While several approaches have aimed at disentangling the physiological and perceptual consequences of different etiologies, hearing deficit characterization and rehabilitation have been dominated by the results from pure-tone audiometry. Here, we present a novel approach based on data-driven profiling of perceptual auditory deficits that attempts to represent auditory phenomena that are usually hidden by, or entangled with, audibility loss. We hypothesize that the hearing deficits of a given listener, both at hearing threshold and at suprathreshold sound levels, result from two independent types of "auditory distortions." In this two-dimensional space, four distinct "auditory profiles" can be identified. To test this hypothesis, we gathered a data set consisting of a heterogeneous group of listeners that were evaluated using measures of speech intelligibility, loudness perception, binaural processing abilities, and spectrotemporal resolution. The subsequent analysis revealed that distortion type-I was associated with elevated hearing thresholds at high frequencies and reduced temporal masking release and was significantly correlated with elevated speech reception thresholds in noise. Distortion type-II was associated with low-frequency hearing loss and abnormally steep loudness functions. The auditory profiles represent four robust subpopulations of hearing-impaired listeners that exhibit different degrees of perceptual distortions. The four auditory profiles may provide a valuable basis for improved hearing rehabilitation, for example, through profile-based hearing-aid fitting.

Investigating the Effects of Four Auditory Profiles on Speech Recognition, Overall Quality, and Noise Annoyance With Simulated Hearing-Aid Processing Strategies.

Effective hearing aid (HA) rehabilitation requires personalization of the HA fitting parameters, but in current clinical practice only the gain prescription is typically individualized. To optimize the fitting process, advanced HA settings such as noise reduction and microphone directionality can also be tailored to individual hearing deficits. In two earlier studies, an auditory test battery and a data-driven approach that allow classifying hearing-impaired listeners into four auditory profiles were developed. Because these profiles were found to be characterized by markedly different hearing abilities, it was hypothesized that more tailored HA fittings would lead to better outcomes for such listeners. Here, we explored potential interactions between the four auditory profiles and HA outcome as assessed with three different measures (speech recognition, overall quality, and noise annoyance) and six HA processing strategies with various noise reduction, directionality, and compression settings. Using virtual acoustics, a realistic speech-in-noise environment was simulated. The stimuli were generated using a HA simulator and presented to 49 habitual HA users who had previously been profiled. The four auditory profiles differed clearly in terms of their mean aided speech reception thresholds, thereby implying different needs in terms of signal-to-noise ratio improvement. However, no clear interactions with the tested HA processing strategies were found. Overall, these findings suggest that the auditory profiles can capture some of the individual differences in HA processing needs and that further research is required to identify suitable HA solutions for them.

Data-Driven Approach for Auditory Profiling and Characterization of Individual Hearing Loss.

Pure-tone audiometry still represents the main measure to characterize individual hearing loss and the basis for hearing-aid fitting. However, the perceptual consequences of hearing loss are typically associated not only with a loss of sensitivity but also with a loss of clarity that is not captured by the audiogram. A detailed characterization of a hearing loss may be complex and needs to be simplified to efficiently explore the specific compensation needs of the individual listener. Here, it is hypothesized that any listener's hearing profile can be characterized along two dimensions of distortion: Type I and Type II. While Type I can be linked to factors affecting audibility, Type II reflects non-audibility-related distortions. To test this hypothesis, the individual performance data from two previous studies were reanalyzed using an unsupervised-learning technique to identify extreme patterns in the data, thus forming the basis for different auditory profiles. Next, a decision tree was determined to classify the listeners into one of the profiles. The analysis provides evidence for the existence of four profiles in the data. The most significant predictors for profile identification were related to binaural processing, auditory nonlinearity, and speech-in-noise perception. This approach could be valuable for analyzing other data sets to select the most relevant tests for auditory profiling and propose more efficient hearing-deficit compensation strategies.

Effects of Slow- and Fast-Acting Compression on Hearing-Impaired Listeners' Consonant-Vowel Identification in Interrupted Noise.

There is conflicting evidence about the relative benefit of slow- and fast-acting compression for speech intelligibility. It has been hypothesized that fast-acting compression improves audibility at low signal-to-noise ratios (SNRs) but may distort the speech envelope at higher SNRs. The present study investigated the effects of compression with a nearly instantaneous attack time but either fast (10 ms) or slow (500 ms) release times on consonant identification in hearing-impaired listeners. Consonant-vowel speech tokens were presented at a range of presentation levels in two conditions: in the presence of interrupted noise and in quiet (with the compressor "shadow-controlled" by the corresponding mixture of speech and noise). These conditions were chosen to disentangle the effects of consonant audibility and noise-induced forward masking on speech intelligibility. A small but systematic intelligibility benefit of fast-acting compression was found in both the quiet and the noisy conditions for the lower speech levels. No detrimental effects of fast-acting compression were observed when the speech level exceeded the level of the noise. These findings suggest that fast-acting compression provides an audibility benefit in fluctuating interferers when compared with slow-acting compression while not substantially affecting the perception of consonants at higher SNRs.

Investigating time-efficiency of forward masking paradigms for estimating basilar membrane input-output characteristics.

It is well known that pure-tone audiometry does not sufficiently describe individual hearing loss (HL) and that additional measures beyond pure-tone sensitivity might improve the diagnostics of hearing deficits. Specifically, forward masking experiments to estimate basilar-membrane (BM) input-output (I/O) function have been proposed. However, such measures are very time consuming. The present study investigated possible modifications of the temporal masking curve (TMC) paradigm to improve time and measurement efficiency. In experiment 1, estimates of knee point (KP) and compression ratio (CR) of individual BM I/Os were derived without considering the corresponding individual "off-frequency" TMC. While accurate estimation of KPs was possible, it is difficult to ensure that the tested dynamic range is sufficient. Therefore, in experiment 2, a TMC-based paradigm, referred to as the "gap method", was tested. In contrast to the standard TMC paradigm, the maker level was kept fixed and the "gap threshold" was obtained, such that the masker just masks a low-level (12 dB sensation level) signal. It is argued that this modification allows for better control of the tested stimulus level range, which appears to be the main drawback of the conventional TMC method. The results from the present study were consistent with the literature when estimating KP levels, but showed some limitations regarding the estimation of the CR values. Perspectives and limitations of both approaches are discussed.

Complex-Tone Pitch Discrimination in Listeners With Sensorineural Hearing Loss.

Physiological studies have shown that noise-induced sensorineural hearing loss (SNHL) enhances the amplitude of envelope coding in auditory-nerve fibers. As pitch coding of unresolved complex tones is assumed to rely on temporal envelope coding mechanisms, this study investigated pitch-discrimination performance in listeners with SNHL. Pitch-discrimination thresholds were obtained for 14 normal-hearing (NH) and 10 hearing-impaired (HI) listeners for sine-phase (SP) and random-phase (RP) complex tones. When all harmonics were unresolved, the HI listeners performed, on average, worse than NH listeners in the RP condition but similarly to NH listeners in the SP condition. The increase in pitch-discrimination performance for the SP relative to the RP condition (F0DL ratio) was significantly larger in the HI as compared with the NH listeners. Cochlear compression and auditory-filter bandwidths were estimated in the same listeners. The estimated reduction of cochlear compression was significantly correlated with the increase in the F0DL ratio, while no correlation was found with filter bandwidth. The effects of degraded frequency selectivity and loss of compression were considered in a simplified peripheral model as potential factors in envelope enhancement. The model revealed that reducing cochlear compression significantly enhanced the envelope of an unresolved SP complex tone, while not affecting the envelope of a RP complex tone. This envelope enhancement in the SP condition was significantly correlated with the increased pitch-discrimination performance for the SP relative to the RP condition in the HI listeners.