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.

Toll-like receptor 2 and 4 antagonism for the treatment of experimental autoimmune encephalomyelitis (EAE)-related pain.

Neuropathic pain is a major symptom of multiple sclerosis (MS) with up to 92% of patients reporting bodily pain, and 85% reporting pain severe enough to cause functional disability. None of the available therapeutics target MS pain. Toll-like receptors 2 and 4 (TLR2/TLR4) have emerged as targets for treating a wide array of autoimmune disorders, including MS, as well as having demonstrated success at suppressing pain in diverse animal models. The current series of studies tested systemic TLR2/TLR4 antagonists in males and females in a low-dose Myelin oligodendrocyte glycoprotein (MOG) experimental autoimmune encephalomyelitis (EAE) model, with reduced motor dysfunction to allow unconfounded testing of allodynia through 50+ days post-MOG. The data demonstrated that blocking TLR2/TLR4 suppressed EAE-related pain, equally in males and females; upregulation of dorsal spinal cord proinflammatory gene expression for TLR2, TLR4, NLRP3, interleukin-1ß, IkBα, TNF-α and interleukin-17; and upregulation of dorsal spinal cord expression of glial immunoreactivity markers. In support of these results, intrathecal interleukin-1 receptor antagonist reversed EAE-induced allodynia, both early and late after EAE induction. In contrast, blocking TLR2/TLR4 did not suppress EAE-induced motor disturbances induced by a higher MOG dose. These data suggest that blocking TLR2/TLR4 prevents the production of proinflammatory factors involved in low dose EAE pathology. Moreover, in this EAE model, TLR2/TLR4 antagonists were highly effective in reducing pain, whereas motor impairment, as seen in high dose MOG EAE, is not affected.

Integrating a remote microphone with hearing-aid processing.

A remote microphone (RM) links a talker's microphone to a listener's hearing aids (HAs). The RM improves intelligibility in noise and reverberation, but the binaural cues necessary for externalization are lost. Augmenting the RM signal with synthesized binaural cues and early reflections enhances externalization, but interactions of the RM signal with the HA processing could reduce its effectiveness. These potential interactions were evaluated using RM plus HA processing in a realistic listening simulation. The HA input was the RM alone, the augmented RM signal, the acoustic inputs at the HA microphones, including reverberation measured using a dummy head, or a mixture of the augmented RM and acoustic input signals. The HA simulation implemented linear amplification or independent dynamic-range compression at the two ears and incorporated the acoustic effects of vented earmolds. Hearing-impaired listeners scored sentence stimuli for intelligibility and rated clarity, overall quality, externalization, and apparent source width. Using the RM improved intelligibility but reduced the spatial impression. Increasing the vent diameter reduced clarity and increased the spatial impression. Listener ratings reflect a trade-off between the attributes of clarity and overall quality and the attributes of externalization and source width that can be explained using the interaural cross correlation.

A single peri-sciatic nerve administration of the adenosine 2A receptor agonist ATL313 produces long-lasting anti-allodynia and anti-inflammatory effects in male rats.

Neuropathic pain is a widespread problem which remains poorly managed by currently available therapeutics. Peripheral nerve injury and inflammation leads to changes at the nerve injury site, including activation of resident and recruited peripheral immune cells, that lead to neuronal central sensitization and pain amplification. The present series of studies tested the effects of peri-sciatic nerve delivery of single doses of adenosine 2A receptor (A2aR) agonists on pain and neuroinflammation. The data provide converging lines of evidence supportive that A2aR agonism at the site of peripheral nerve injury and inflammation is effective in suppressing ongoing neuropathic pain. After A2aR agonism resolved neuropathic pain, a return of pain enhancement (allodynia) was observed in response to peri-sciatic injection of H-89, which can inhibit protein kinase A, and by peri-sciatic injection of neutralizing antibody against the potent anti-inflammatory cytokine interleukin-10. A2aR agonist actions at the nerve injury site suppress neuroinflammation, as reflected by decreased release of interleukin-1ß and nitric oxide, as well as decreased sciatic expression of markers of monocytes/macrophages and inducible nitric oxide synthase. Taken together, the data are supportive that A2aR agonists, acting at the level of peripheral nerve injury, may be of therapeutic value in treating chronic pain of neuroinflammatory origin.

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.

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.

Detecting malingerers by means of response-sequence analysis.

The feigning of sensory loss (malingering) poses a challenge for psychophysicists. To uncover malingerers by means of psychophysical testing, we combined measures of response-sequence randomness with the maximum-likelihood adaptive-staircase procedure used to measure sensory detection thresholds. The two-alternative, forced-choice maximum-likelihood adaptive-staircase procedure calculates an estimate of the threshold after each trial and also recommends the stimulus concentration for the next trial. Olfactory detection thresholds for butyl alcohol were measured in 7 normals, 6 anosmics, and 6 malingerers. Each participant was tested for 20 trials. A discriminant analysis, using threshold concentration and probability of being correct over the 20 trials, could correctly classify only 68% of the malingerers and anosmics. Correct classification of anosmics and malingerers rose to 100% when statistical measures of randomness in the response sequences were included in the discriminant analysis. We conclude that the maximum-likelihood adaptive-staircase procedure, combined with response-sequence analysis, is a powerful addition to the arsenal of techniques for detecting malingerers in the evaluation of sensory ability.