Survey of selective electrode deactivation attitudes and practices by cochlear implant audiologists.

OBJECTIVES: The purpose of this study was to explore clinician attitudes regarding selective electrode deactivation and to investigate the primary methodology used to identify poorly encoded electrodes, deactivate identified electrodes, and measure outcomes. METHODS: An online survey consisting of 32 questions was administered to certified clinical and research cochlear implant (CI) audiologists. Questions asked participants about their demographic information, device programming patterns, and attitudes regarding selective electrode deactivation. RESULTS: Fifty-four audiologists completed the survey. When asked whether they believed selectively deactivating poorly encoded electrodes could improve speech perception outcomes, 43% of respondents selected 'Probably Yes,' 39% selected 'Definitely Yes,' and 18% selected 'Might or Might Not.' Of those who reported deactivating electrodes as part of CI programming, various methodology was reported to identify and deactivate poorly encoding electrodes and evaluate effectiveness of deactivation. General reasons against deactivation were also reported. DISCUSSION: CI audiologists generally believed selective electrode deactivation could be used to improve speech perception outcomes for patients; however, few reported implementing selective electrode deactivation in practice. Among those who do perform selective electrode deactivation, the reported methodology was highly variable. CONCLUSION: These findings support the need for clinical practice guidelines to assist audiologists in performing selective electrode deactivation.

The Effect of Speech Perception in Noise on Arabic and Spanish Bilingual Listeners.

PURPOSE: The purpose of this study was to compare speech perception performance in noise, as measured by signal-to-noise ratio for 50% correct scores (SNR-50) and SNR loss, between monolingual English speakers and two bilingual second-language learner populations with normal hearing sensitivity: Arabic-English and Spanish-English bilinguals. Additionally, this study observed how speech perception in noise varied as a function of language dominance for the Arabic-English bilinguals. METHOD: This study was a quasi-experimental, nonrandomized study. Adults with normal peripheral hearing sensitivity participated in this study: Group 1 (n = 16) bilingual Arabic-English speakers who learned English as a second language; Group 2 (n = 10) bilingual Spanish-English speakers from a previous study; Group 3 (n = 27) monolingual English speakers combined from this study and the study of Mendel and Widner (2016). Speech perception was assessed using standardized methods for the Quick Speech-in-Noise (QuickSIN), the Bamford-Kowal-Bench Speech-in-Noise, the Hearing in Noise Test (HINT), and the Words-in-Noise tests. RESULTS: The two bilingual groups had significantly higher SNR-50 scores and greater SNR loss as compared to their monolingual peers. SNR-50 negatively correlated with language dominance for the QuickSIN and HINT for the Arabic-English speakers. CONCLUSIONS: Despite having normal hearing and being proficient in the English language, bilingual Arabic-English and Spanish-English speakers exhibited a mild SNR loss. Speech perception abilities were affected by test difficulty as well as the individual's degree of language dominance.

Listening Effort and Speech Perception Performance Using Different Facemasks.

PURPOSE: The aim of this study was to assess the effect of eight different facemasks on speech perception and listening effort in listeners with normal hearing (NH) and hearing loss by manipulating both mask type and background noise levels. METHOD: Forty adults listened to Quick Speech-in-Noise Test sentences recorded by a female talker through eight different facemasks including a baseline condition with no mask. Listeners were tested in the sound field positioned 6 ft from the loudspeaker. Signal-to-noise ratio (SNR) loss and listening effort were measured. RESULTS: Listeners with NH exhibited a mild SNR loss, whereas those with hearing loss experienced a moderate SNR loss. Scores for the mild hearing loss group were significantly poorer (higher) than those with slight hearing loss. Speech perception performance was best in the no mask, KN95, and surgical mask conditions and poorest in the cloth mask and cloth mask plus face shield conditions for all groups. As listening effort decreased, speech perception increased for all groups. CONCLUSIONS: The impact of different types of facemasks on speech perception in noise was demonstrated in this study indicating that as the SNR was reduced, listening effort increased and speech perception performance decreased for listeners with NH and slight/mild hearing loss. No mask, KN95, and surgical masks had the least impact on performance, whereas cloth masks posed a significant detriment to communication. If communication is to occur in a background of noise while wearing masks, a KN95 mask and an SNR of at least +15 dB is recommended regardless of hearing status.

Validation of Male Talker Recordings of the Spanish Pediatric Speech Recognition Threshold Test and the Spanish Pediatric Picture Identification Test.

PURPOSE: The purpose of this study was to validate recordings of the Spanish Pediatric Speech Recognition Threshold (SPSRT) test and Spanish Pediatric Picture Identification Test (SPPIT) for Spanish-speaking children using a native, bilingual Spanish-English male talker of Castilian peninsular dialect from Spain. METHOD: Seventy native Spanish-speaking children from a variety of countries participated. Fifty-eight participants had normal hearing, and the remaining 12 had mild hearing loss in at least one ear. Male talker recordings of the SPSRT and SPPIT were administered to obtain baseline validation data. Participants listened to the stimuli and pointed to the appropriate item on the picture boards that represented the word they heard. RESULTS: Mean SRTs were within 5 dB of mean pure-tone averages resulting in a positive correlation. Performance-intensity functions for the SPPIT showed minimal significant differences across the three test lists, and performance increased as the sensation level increased. CONCLUSIONS: The male talker recordings of the SPSRT and SPPIT are valid speech perception picture-pointing assessments that can be used with Spanish-speaking children. The recordings present the Spanish target word while simultaneously presenting the English interpretation for ease of scoring.

Spanish Pediatric Picture Identification Test.

Purpose The purpose of this study was to construct and validate a recorded word recognition test for monolingual Spanish-speaking children utilizing a picture board and a picture-pointing task. Design The Spanish Pediatric Picture Identification Test was developed and validated in this study. Test construction steps included (a) producing new digital recordings of word lists created by Comstock and Martin (1984) using a bilingual Spanish-English female, (b) obtaining list equivalency, (c) creating digitally illustrated pictures representing the word lists, (d) validating the pictures using monolingual Spanish-speaking and bilingual Spanish-English children, and (e) re-establishing list equivalency and obtaining performance-intensity functions using a picture-pointing task with monolingual Spanish-speaking children and bilingual Spanish-English adults. Results Normative data for three Spanish word recognition lists were established. Performance-intensity functions at sensation levels from 0 to 40 dB SL in 8-dB steps were obtained, establishing list equivalency for Lists 1, 2, and 3. Conclusions The Spanish Pediatric Picture Identification Test was developed and validated as a picture-pointing task for word recognition with monolingual Spanish-speaking children. The two validated channel recordings include an English translation for ease of testing by clinicians lacking Spanish language skills. Future validation will be conducted with bilingual Spanish-English children with normal hearing and with hearing loss.

Semantic influences on the perception of degraded speech by individuals with cochlear implants.

This study investigated whether speech intelligibility in cochlear implant (CI) users is affected by semantic context. Three groups participated in two experiments: Two groups of listeners with normal hearing (NH) listened to either full spectrum speech or vocoded speech, and one CI group listened to full spectrum speech. Experiment 1 measured participants' sentence recognition as a function of target-to-masker ratio (four-talker babble masker), and experiment 2 measured perception of interrupted speech as a function of duty cycles (long/short uninterrupted speech). Listeners were presented with both semantic congruent/incongruent targets. Results from the two experiments suggested that NH listeners benefitted more from the semantic cues as the listening conditions became more challenging (lower signal-to-noise ratios and interrupted speech with longer silent intervals). However, the CI group received minimal benefit from context, and therefore performed poorly in such conditions. On the contrary, in the conditions that were less challenging, CI users benefitted greatly from the semantic context, and NH listeners did not rely on such cues. The results also confirmed that such differential use of semantic cues appears to originate from the spectro-temporal degradations experienced by CI users, which could be a contributing factor for their poor performance in suboptimal environments.

Spanish Pediatric Speech Recognition Threshold Test.

Purpose The purpose of this study was to construct a recorded speech recognition threshold (SRT) test for Spanish-speaking children utilizing a picture board and a picture-pointing task. Design The Spanish Pediatric Speech Recognition Threshold (SPSRT) test was developed and validated in this study. Test construction steps included (a) stimulus selection, (b) assessment of familiarity, (c) digital recording, (d) creation of pictures that accurately depicted the target word from the stimulus set, and (e) validation of the test and recordings. SRTs were obtained from 24 Spanish-speaking children whose 1st language was Spanish. Results Normative data are presented that validate the SPSRT and establish the baseline relationship between the pure-tone average and the SRT obtained with the SPSRT. Results indicated that the SPSRT obtained using this test should be within 2-12 dB of an individual's pure-tone average for Spanish-speaking children with normal hearing and minimal hearing loss. Conclusions The SPSRT was developed and validated as a picture-pointing Spanish SRT test to be used with Spanish-speaking children. The 2-channel recording contains an English translation track, making this test easy to administer and interpret for clinicians without knowledge of Spanish.

Predicting Speech Recognition Using the Speech Intelligibility Index and Other Variables for Cochlear Implant Users.

Purpose Although the speech intelligibility index (SII) has been widely applied in the field of audiology and other related areas, application of this metric to cochlear implants (CIs) has yet to be investigated. In this study, SIIs for CI users were calculated to investigate whether the SII could be an effective tool for predicting speech perception performance in a population with CI. Method Fifteen pre- and postlingually deafened adults with CI participated. Speech recognition scores were measured using the AzBio sentence lists. CI users also completed questionnaires and performed psychoacoustic (spectral and temporal resolution) and cognitive function (digit span) tests. Obtained SIIs were compared with predicted SIIs using a transfer function curve. Correlation and regression analyses were conducted on perceptual and demographic predictor variables to investigate the association between these factors and speech perception performance. Result Because of the considerably poor hearing and large individual variability in performance, the SII did not predict speech performance for this CI group using the traditional calculation. However, new SII models were developed incorporating predictive factors, which improved the accuracy of SII predictions in listeners with CI. Conclusion Conventional SII models are not appropriate for predicting speech perception scores for CI users. Demographic variables (aided audibility and duration of deafness) and perceptual-cognitive skills (gap detection and auditory digit span outcomes) are needed to improve the use of the SII for listeners with CI. Future studies are needed to improve our CI-corrected SII model by considering additional predictive factors. Supplemental Material https://doi.org/10.23641/asha.8057003.

Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma.

PURPOSE: Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma. METHOD: Conventional frequency (CF = 0.25-8.0 kHz) audiometry, extended high-frequency (EHF = 9.0-16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1-5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores. RESULTS: At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463). CONCLUSION: At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.

Gated Word Recognition by Postlingually Deafened Adults With Cochlear Implants: Influence of Semantic Context.

Purpose: The main goal of this study was to investigate the minimum amount of sensory information required to recognize spoken words (isolation points [IPs]) in listeners with cochlear implants (CIs) and investigate facilitative effects of semantic contexts on the IPs. Method: Listeners with CIs as well as those with normal hearing (NH) participated in the study. In Experiment 1, the CI users listened to unprocessed (full-spectrum) stimuli and individuals with NH listened to full-spectrum or vocoder processed speech. IPs were determined for both groups who listened to gated consonant-nucleus-consonant words that were selected based on lexical properties. In Experiment 2, the role of semantic context on IPs was evaluated. Target stimuli were chosen from the Revised Speech Perception in Noise corpus based on the lexical properties of the final words. Results: The results indicated that spectrotemporal degradations impacted IPs for gated words adversely, and CI users as well as participants with NH listening to vocoded speech had longer IPs than participants with NH who listened to full-spectrum speech. In addition, there was a clear disadvantage due to lack of semantic context in all groups regardless of the spectral composition of the target speech (full spectrum or vocoded). Finally, we showed that CI users (and users with NH with vocoded speech) can overcome such word processing difficulties with the help of semantic context and perform as well as listeners with NH. Conclusion: Word recognition occurs even before the entire word is heard because listeners with NH associate an acoustic input with its mental representation to understand speech. The results of this study provide insight into the role of spectral degradation on the processing of spoken words in isolation and the potential benefits of semantic context. These results may also explain why CI users rely substantially on semantic context.

Corpus of deaf speech for acoustic and speech production research.

A corpus of recordings of deaf speech is introduced. Adults who were pre- or post-lingually deafened as well as those with normal hearing read standardized speech passages totaling 11 h of .wav recordings. Preliminary acoustic analyses are included to provide a glimpse of the kinds of analyses that can be conducted with this corpus of recordings. Long term average speech spectra as well as spectral moment analyses provide considerable insight into differences observed in the speech of talkers judged to have low, medium, or high speech intelligibility.

The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss.

BACKGROUND: It is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent ("see-through") surgical mask may help to overcome this issue. PURPOSE: To compare the effect of noise and various visual input conditions on speech understanding for listeners with normal hearing (NH) and hearing impairment using different surgical masks. RESEARCH DESIGN: Participants were assigned to one of three groups based on hearing sensitivity in this quasi-experimental, cross-sectional study. STUDY SAMPLE: A total of 31 adults participated in this study: one talker, ten listeners with NH, ten listeners with moderate sensorineural hearing loss, and ten listeners with severe-to-profound hearing loss. DATA COLLECTION AND ANALYSIS: Selected lists from the Connected Speech Test were digitally recorded with and without surgical masks and then presented to the listeners at 65 dB HL in five conditions against a background of four-talker babble (+10 dB SNR): without a mask (auditory only), without a mask (auditory and visual), with a transparent mask (auditory only), with a transparent mask (auditory and visual), and with a paper mask (auditory only). RESULTS: A significant difference was found in the spectral analyses of the speech stimuli with and without the masks; however, no more than ∼2 dB root mean square. Listeners with NH performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask. The magnitude of improvement in speech perception in noise was greatest for the severe-to-profound group. CONCLUSIONS: Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

Derivation of frequency importance functions for the AzBio sentences.

Although the AzBio test is well validated, has effective standardization data available, and is highly recommended for Cochlear Implant (CI) evaluation, no attempt has been made to derive a Frequency Importance Function (FIF) for its stimuli. This study derived FIFs for the AzBio sentence lists using listeners with normal hearing. Traditional procedures described in studies by Studebaker and Sherbecoe [(1991). J. Speech. Lang. Hear. Res. 34, 427-438] were applied for this purpose. Participants with normal hearing listened to a large number of AzBio sentences that were high- and low-pass filtered under speech-spectrum shaped noise at various signal-to-noise ratios. Frequency weights for the AzBio sentences were greatest in the 1.5 to 2 kHz frequency regions as is the case with other speech materials. A cross-procedure comparison was conducted between the traditional procedure [Studebaker and Sherbecoe (1991). J. Speech. Lang. Hear. Res. 34, 427-438] and the nonlinear optimization procedure [Kates (2013). J. Acoust. Soc. Am. 134, EL459-EL464]. Consecutive data analyses provided speech recognition scores for the AzBio sentences in relation to the Speech Intelligibility Index (SII). The findings of the authors provide empirically derived FIFs for the AzBio test that can be used for future studies. It is anticipated that the accuracy of predicting SIIs for CI patients will be improved when using these derived FIFs for the AzBio test.

Role of contextual cues on the perception of spectrally reduced interrupted speech.

Understanding speech within an auditory scene is constantly challenged by interfering noise in suboptimal listening environments when noise hinders the continuity of the speech stream. In such instances, a typical auditory-cognitive system perceptually integrates available speech information and "fills in" missing information in the light of semantic context. However, individuals with cochlear implants (CIs) find it difficult and effortful to understand interrupted speech compared to their normal hearing counterparts. This inefficiency in perceptual integration of speech could be attributed to further degradations in the spectral-temporal domain imposed by CIs making it difficult to utilize the contextual evidence effectively. To address these issues, 20 normal hearing adults listened to speech that was spectrally reduced and spectrally reduced interrupted in a manner similar to CI processing. The Revised Speech Perception in Noise test, which includes contextually rich and contextually poor sentences, was used to evaluate the influence of semantic context on speech perception. Results indicated that listeners benefited more from semantic context when they listened to spectrally reduced speech alone. For the spectrally reduced interrupted speech, contextual information was not as helpful under significant spectral reductions, but became beneficial as the spectral resolution improved. These results suggest top-down processing facilitates speech perception up to a point, and it fails to facilitate speech understanding when the speech signals are significantly degraded.

Normative data for the Maryland CNC Test.

BACKGROUND: The Maryland consonant-vowel nucleus-consonant (CNC) Test is routinely used in Veterans Administration medical centers, yet there is a paucity of published normative data for this test. PURPOSE: The purpose of this study was to provide information on the means and distribution of word-recognition scores on the Maryland CNC Test as a function of degree of hearing loss for a veteran population. RESEARCH DESIGN: A retrospective, descriptive design was conducted. STUDY SAMPLE: The sample consisted of records from veterans who had Compensation and Pension (C&P) examinations at a Veterans Administration medical center (N = 1,760 ears). DATA COLLECTION AND ANALYSIS: Audiometric records of veterans who had C&P examinations during a 10 yr period were reviewed, and the pure-tone averages (PTA4) at four frequencies (1000, 2000, 3000, and 4000 Hz) were documented. The maximum word-recognition score (PBmax) was determined from the performance-intensity functions obtained using the Maryland CNC Test. Correlations were made between PBmax and PTA4. RESULTS: A wide range of word-recognition scores were obtained at all levels of PTA4 for this population. In addition, a strong negative correlation between the PBmax and the PTA4 was observed, indicating that as PTA4 increased, PBmax decreased. Word-recognition scores decreased significantly as hearing loss increased beyond a mild hearing loss. Although threshold was influenced by age, no statistically significant relationship was found between word-recognition score and the age of the participants. CONCLUSIONS: RESULTS from this study provide normative data in table and figure format to assist audiologists in interpreting patient results on the Maryland CNC test for a veteran population. These results provide a quantitative method for audiologists to use to interpret word-recognition scores based on pure-tone hearing loss.

A study of recorded versus live voice word recognition.

OBJECTIVE: To determine administration times for word recognition presented via monitored live voice (MLV) and compact disc (CD) recordings. DESIGN: A quasi-experimental design was used. Fifty-word NU-6 lists were presented in three conditions: (1) MLV, (2) short ISI CD recording, and (3) long ISI CD recording. STUDY SAMPLE: Listeners with normal hearing (NH) and hearing impairment (HI) participated in this study. RESULTS: Average administration time using MLV was significantly shorter than using recorded word lists for both groups of listeners. MLV presentation to the NH listeners was significantly faster than the MLV presentation to the HI listeners. There were no significant differences between groups in the administration times for any of the recorded lists (long or short ISI). Considerably more variability in administration time was observed for MLV presentation compared to recorded presentations. CONCLUSIONS: MLV presentation was about one minute faster than the shortest CD recording of the NU-6 fifty-item word lists, but it was only 49 seconds quicker when administering tests to individuals with hearing loss. Because the majority of our patients are hearing impaired, the difference of 49 seconds is not clinically significant. This difference is even less when 25-item word lists are used.

Current considerations in pediatric speech audiometry.

Current considerations in pediatric speech perception assessment are highlighted in this article with a focus on specific test principles and variables that must be addressed when evaluating speech perception performance in children. Existing test materials are reviewed with an emphasis on the level of sensitivity and standardization that they have for accurate assessment of a child's speech perception performance. A test battery approach is advocated because speech perception is an abstract construct, and in order to provide a comprehensive assessment of a child's capabilities, information is needed from several sources of concrete data. The importance of ongoing speech perception assessment in children is also emphasized because a child's progress over time must be monitored to determine if improvements need to be made with amplification and intervention efforts. Results from pediatric speech perception assessments can provide practical information regarding the prognosis of speech, language, reading, and cognitive abilities of children as well as steps that need to be taken in the intervention process.

Speech understanding using surgical masks: a problem in health care?

BACKGROUND: Successful communication is necessary in health-care environments. Yet the presence of noise in hospitals, operating rooms, and dental offices may have a deleterious effect on health-care personnel and patients understanding messages accurately. The presence of a surgical mask and hearing loss may further affect speech perception. PURPOSE: To evaluate whether a surgical mask had an effect on speech understanding for listeners with normal hearing and hearing impairment when speech stimuli were administered in the presence or absence of dental office noise. RESEARCH DESIGN: Participants were assigned to one of two groups based on hearing sensitivity in this quasi-experimental, cross-sectional study. STUDY SAMPLE: A total of 31 adults participated in this study (1 talker, 15 listeners with normal hearing, and 15 with hearing impairment). The normal hearing group had thresholds of 25 dB HL or better at the octave frequencies from 250 through 8000 Hz while the hearing loss group had varying degrees and configurations of hearing loss with thresholds equal to or poorer than 25 dB HL for the same octave frequencies. DATA COLLECTION AND ANALYSIS: Selected lists from the Connected Speech Test (CST) were digitally recorded with and without a surgical mask present and then presented to the listeners in four conditions: without a mask in quiet, without a mask in noise, with a mask in quiet, and with a mask in noise. RESULTS: A significant difference was found in the spectral analyses of the speech stimuli with and without the mask. The presence of a surgical mask, however, did not have a detrimental effect on speech understanding in either the normal-hearing or hearing-impaired groups. The dental office noise did have a significant effect on speech understanding for both groups. CONCLUSIONS: These findings suggest that the presence of a surgical mask did not negatively affect speech understanding. However, the presence of noise did have a deleterious effect on speech perception and warrants further attention in health-care environments.

Objective and subjective hearing aid assessment outcomes.

PURPOSE: To determine whether specific sentence recognition assessments were sensitive enough to serve as objective outcome measurements that document subjective improvements in speech understanding with hearing aids. METHOD: The Revised Speech Perception in Noise test (R-SPIN; R. C. Bilger, J. M. Nuetzel, W. M. Rabinowitz, & C. Rzeczkowski, 1984), the Hearing in Noise Test (HINT; M. Nilsson, S. D. Soli, & J. A. Sullivan, 1994), and the Quick Speech-in-Noise test (QuickSIN; Etymotic Research, 2001; M. C. Killion, P. A. Niquette, G. I. Gudmundsen, L. J. Revit, & S. Banerjee, 2004) were administered to 21 hearing aid users to determine whether the tests could adequately document improvements in speech understanding with hearing aids compared with the research participants' self-assessments of their own performance. Comparisons were made between unaided and aided performance on these sentence tests and on the Hearing Aid Performance Inventory (HAPI; B. E. Walden, M. Demorest, & E. Hepler, 1984). RESULTS: The R-SPIN, the HINT Quiet threshold, and the QuickSIN signal-to-noise ratio (SNR) loss were the most sensitive of the sentence recognition tests to objectively assess improvements in speech perception performance with hearing aids. Comparisons among the subjective and objective outcome measures documented that HAPI ratings improved as performance on the R-SPIN, the HINT Quiet threshold, and the QuickSIN SNR loss improved. CONCLUSIONS: Objective documentation of subjective impressions is essential for determining the efficacy of treatment outcomes in hearing aid fitting. The findings reported here more clearly define the relationship between objective and subjective outcome measures in an attempt to better define true hearing aid benefit.