Influence of Compression Thresholds and Maximum Power Output on Speech Understanding with Bone-Anchored Hearing Systems.

Bone-anchored hearing systems (BAHS) transmit sound via osseointegrated implants behind the ear. They are used to treat patients with conductive or mixed hearing loss, but speech understanding may be limited especially in users with substantial additional cochlear hearing losses. In recent years, BAHS with higher maximum power output (MPO) and more advanced digital processing including loudness compression have become available. These features may be useful to increase speech understanding in users with mixed hearing loss. We have tested the effect of 4 combinations of two different MPO levels (highest level available and level reduced by 12 dB) and two different compression thresholds (CT) levels (50 dB and 65 dB sound pressure level) in 12 adult BAHS users on speech understanding in quiet and in noise. We have found that speech understanding in quiet was not influenced significantly by any of the changes in these two fitting parameters. In contrast, in users with average bone-conduction (BC) threshold of 25 dB or more, speech understanding in noise was improved by +0.8 dB to +1.1 dB (p < 0.03) when using the higher MPO level. In this user group, there may be an additional, but very small benefit of +0.1 dB to +0.4 dB when using the lower rather than the higher CT value, but the difference was not statistically significant (p > 0.27). In users with better average BC thresholds than 25 dB, none of the improvement was statistically significant. Higher MPOs and possibly, to a lesser degree, lower CTs seem to be able to improve speech understanding in noise in users with higher BC thresholds, but even their combined effect seems to be limited.

Using attribution theory to explore the reasons adults with hearing loss do not use their hearing aids.

Hearing aids are an effective treatment for individuals with hearing loss that have been shown to dampen (and sometime ameliorate) the negative effects of hearing loss. Despite the devices' efficacy, many reject hearing aids as a form of treatment. In the present qualitative study, we explored the reasons for hearing aid non-use in the United States that emerged from the stories of adults with hearing loss who do not to utilize hearing aids. We specifically used thematic analysis in concert with an attribution theory framework to identify and analyze recurring themes and reasons throughout these individuals' narratives. A total of nine themes describing reasons of hearing aid non-use emerged. Four reasons were internally motivated: (1) non-necessity, (2) stigmatization, (3) lack of integration into daily living, and (4) unreadiness due to lack of education; five reasons were externally motivated: (5) discomfort, (6) financial setback, (7) burden, (8) professional distrust, and (9) priority setting. These findings contribute to the field of hearing healthcare by providing professionals with insight into reasons that people across the provided when recounting their experiences following the diagnosis of hearing loss, prescription for hearing aids, and their hearing aid non-use. These findings are an important step toward the development of more effective, person-centered hearing healthcare that can best address these individuals' concerns and expectations surrounding hearing loss and hearing aids.

Trends in hearing rehabilitation use among vestibular schwannoma patients.

OBJECTIVE: Most patients with vestibular schwannoma (VS) have significant hearing loss in the affected ear as a result of either their tumor or treatment. There is a paucity of data on which hearing rehabilitation options, if any, are preferred by patients with VS. Our study analyzed the use of hearing rehabilitation devices among VS patients. METHODS: Patients with unilateral VS treated at our institution from January 2008 to August 2018 were identified. Those with bilateral VS, profound hearing loss in the contralateral ear, neurofibromatosis type 2, or inadequate follow-up were excluded. Patients who met inclusion criteria were given two online questionnaires: an 8-item instrument that assesses use of hearing rehabilitation devices and the Abbreviated Profile of Hearing Aid Benefit. RESULTS: Of 212 eligible patients, 61 completed both surveys. The majority (88%) were able to hear "poorly" or "not at all" in the affected ear, but less than one-third had ever used a hearing rehabilitation device. Most had used conventional hearing aids (30%) or contralateral routing of signal/bilateral contralateral routing of signal (30%), whereas only a handful had used bone-anchored hearing devices or cochlear implant. Patients who did not pursue hearing rehabilitation were either not bothered by their deficit or were unaware of their options. Most had good functionality despite their deficit. CONCLUSION: Whereas 88% of patients treated for VS had a significant hearing loss, the majority did not pursue hearing rehabilitation but maintained good functional performance. Many did not remember being counseled about hearing rehabilitation options, indicating that regular and repeated counseling may be needed to increase patient utilization of hearing rehabilitation after VS treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1558-1564, 2020.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions.

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight (N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23-48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Effects of auditory and socio-demographic variables on discontinuation of hearing aid use among older adults with hearing loss fitted in the Chilean public health sector.

BACKGROUND: The percentage of older adults with hearing loss who stop using their hearing aids and the variables associated with this phenomenon have not been systematically investigated in South America. This problem is relevant to the region since countries such as Colombia, Brazil and Chile have public programmes that provide hearing aids to older adults. The aims of this study were to determine the percentage of older adults fitted with a hearing aid at a public hospital in Chile who subsequently stop using it and the auditory and socio-demographic variables associated with the hazard of discontinuing hearing aid use. METHODS: A group that included 355 older adults who had been fitted with a hearing aid was studied retrospectively. In a structured interview, participants were asked about socio-demographic variables and answered part of the Chilean National Survey on Health, evaluating self-perceived hearing loss and responding to questions about discontinuation of hearing aid use and their satisfaction with the device. Survival models were applied to determine the hazard of stopping hearing aid use in relation to the variables of interest. RESULTS: The rate of discontinuation of hearing aid use reached 21.7%. Older adults stopped using their hearing aids mainly during the first 5-6 months post-fitting, and then this number steadily increased. The income fifth quintile was 2.56 times less likely to stop using the hearing aid compared to the first. Those who self-reported that they could not hear correctly without the hearing aid were 2.62 times less likely to stop using it compared to those who reported normal hearing. The group that was very dissatisfied with the hearing aid was 20.86 times more likely to discontinue use than those who reported satisfaction with the device. CONCLUSIONS: Socio-demographic variables such as economic income and auditory factors such as self-perceived hearing loss and satisfaction with the device were significantly associated with the hazard of stopping hearing aid use. Self-perceived hearing loss should be considered part of the candidacy criteria for hearing aids in older adults in Chile and other (developing) countries.

Comparison of Two-Talker Attention Decoding from EEG with Nonlinear Neural Networks and Linear Methods.

Auditory attention decoding (AAD) through a brain-computer interface has had a flowering of developments since it was first introduced by Mesgarani and Chang (2012) using electrocorticograph recordings. AAD has been pursued for its potential application to hearing-aid design in which an attention-guided algorithm selects, from multiple competing acoustic sources, which should be enhanced for the listener and which should be suppressed. Traditionally, researchers have separated the AAD problem into two stages: reconstruction of a representation of the attended audio from neural signals, followed by determining the similarity between the candidate audio streams and the reconstruction. Here, we compare the traditional two-stage approach with a novel neural-network architecture that subsumes the explicit similarity step. We compare this new architecture against linear and non-linear (neural-network) baselines using both wet and dry electroencephalogram (EEG) systems. Our results indicate that the new architecture outperforms the baseline linear stimulus-reconstruction method, improving decoding accuracy from 66% to 81% using wet EEG and from 59% to 87% for dry EEG. Also of note was the finding that the dry EEG system can deliver comparable or even better results than the wet, despite the latter having one third as many EEG channels as the former. The 11-subject, wet-electrode AAD dataset for two competing, co-located talkers, the 11-subject, dry-electrode AAD dataset, and our software are available for further validation, experimentation, and modification.

Hearing Protection, Restoration, and Regeneration: An Overview of Emerging Therapeutics for Inner Ear and Central Hearing Disorders.

OBJECTIVE: To provide an overview of biotechnology and pharmaceutical companies active in the field of inner ear and central hearing disorders and their therapeutic approaches. METHODS: Scientific and grey literature was searched using broad search terms to identify companies and their hearing-related therapeutic approaches. For each approach its lead indication, product, therapeutic modality, target, mechanism of action and current phase of clinical development was collated. RESULTS: A total of 43 biotechnology and pharmaceutical companies have been identified that are developing therapeutics for inner ear and central hearing disorders. Their therapeutics include drug-, cell- and gene-based approaches to prevent hearing loss or its progression, restore hearing, and regenerate the inner ear. Their therapeutic targets and specific mechanisms of action are wide-ranging, reflecting the complexity of the hearing pathways and the diversity of mechanisms underlying inner ear disorders. While none of the novel products under investigation have yet made it to the clinical market, and a large proportion are still at preclinical phase, many therapeutics have already entered clinical testing with more expected to do so in the next few years. CONCLUSION: A wide range of novel therapeutics targeting different hearing, balance and tinnitus pathways, and patient populations are approaching the clinical domain. It is important that clinicians involved in the care of patients with hearing loss prepare for what may become a radically different approach to the management of hearing disorders, and develop a true understanding of the new therapies' mechanisms of action, applications, and indications.

A new bone conduction hearing aid to predict hearing outcome with an active implanted device.

PURPOSE: We compared our historical medium-term data obtained with an active semi-implanted bone conduction device and the hearing results of a new passive bone conduction hearing device to determine its predictive value for the hearing results with the semi-implanted device. METHODS: The study sample was 15 patients with an active bone conduction implant (mean follow-up 26 months). Pure tone audiometry was performed with headphones, sound field speech audiometry was conducted unaided, and free-field speech audiometry was carried out with both the active bone conduction system and the passive device switched off. RESULTS: As compared with the unaided condition, speech reception was significantly improved with both devices. Comparison of speech reception threshold at 100% of word recognition showed no difference between the active and the passive device. At lower intensity the difference in speech perception was significant in the patients with monaural fitting (group A) and was non-statistically significant in those with binaural fitting (group B); the speech reception threshold at 50% of word recognition was 26.00 dB (± 10.22) with the active implant and 30.50 dB (± 7.98) with the passive device in group A (p = 0.047) and 24.00 dB (± 5.48) and 29.00 dB (± 2.24) in group B (p = 0.052), respectively. CONCLUSIONS: The hearing outcome after active bone conduction implant was comparable to published data. Compared with the unaided condition, speech recognition was significantly improved with the passive device. The device may also provide value to predict the hearing outcome with the implanted device, especially at higher intensities. LEVEL OF EVIDENCE: IV.

Implantes activos de oído medio / Active middle ear implants

Los implantes activos de oído medio son prótesis implantadas quirúrgicamente, que estimulan la cadena osicular o los fluidos del oído interno a través de la ventana oval o redonda. Estos implantes pueden ser útiles para el tratamiento de determinados pacientes con pérdida auditiva neurosensorial, así como para pérdida auditiva conductiva o mixta. Esta guía clínica pretende resumir los conocimientos actuales sobre las características básicas y las indicaciones de los implantes de oído medio más utilizados, como Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia) y CodacsTM. (Cochlear, Australia)

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia)

Efficient characterization of individual differences in compression ratio preference.

While wide dynamic range compression (WDRC) is a standard feature of modern hearing aids, it can be difficult to fit compression settings to individual hearing aid users. The goal of the current study was to develop a practical test to learn the preference of individual listeners for different compression ratio (CR) settings in different listening conditions (speech-in-quiet and speech-in-noise). While it is possible to exhaustively test different CR settings, such methods can take many hours to complete, making them impractical. Bayesian optimization methods were used to find CR preferences in individual listeners in a relatively short amount of time. Using this practical preference learning test, individual differences in CR preference were examined across a relatively wide range of CR settings in different listening conditions. In experiment 1, the accuracy of the preference learning test in normal hearing listeners was verified. In experiment 2, it is shown that individual hearing impaired listeners differ in their CR preferences, and listeners tended to prefer the CR setting identified by the preference learning test over both linear gain or the National Acoustics Lab--Nonlinear 2 CR prescription based on their audiograms.

An Extended Binaural Real-Time Auralization System With an Interface to Research Hearing Aids for Experiments on Subjects With Hearing Loss.

Theory and implementation of acoustic virtual reality have matured and become a powerful tool for the simulation of entirely controllable virtual acoustic environments. Such virtual acoustic environments are relevant for various types of auditory experiments on subjects with normal hearing, facilitating flexible virtual scene generation and manipulation. When it comes to expanding the investigation group to subjects with hearing loss, choosing a reproduction system which offers a proper integration of hearing aids into the virtual acoustic scene is crucial. Current loudspeaker-based spatial audio reproduction systems rely on different techniques to synthesize a surrounding sound field, providing various possibilities for adaptation and extension to allow applications in the field of hearing aid-related research. Representing one option, the concept and implementation of an extended binaural real-time auralization system is presented here. This system is capable of generating complex virtual acoustic environments, including room acoustic simulations, which are reproduced as combined via loudspeakers and research hearing aids. An objective evaluation covers the investigation of different system components, a simulation benchmark analysis for assessing the processing performance, and end-to-end latency measurements.

Neural decoding of attentional selection in multi-speaker environments without access to clean sources.

OBJECTIVE: People who suffer from hearing impairments can find it difficult to follow a conversation in a multi-speaker environment. Current hearing aids can suppress background noise; however, there is little that can be done to help a user attend to a single conversation amongst many without knowing which speaker the user is attending to. Cognitively controlled hearing aids that use auditory attention decoding (AAD) methods are the next step in offering help. Translating the successes in AAD research to real-world applications poses a number of challenges, including the lack of access to the clean sound sources in the environment with which to compare with the neural signals. We propose a novel framework that combines single-channel speech separation algorithms with AAD. APPROACH: We present an end-to-end system that (1) receives a single audio channel containing a mixture of speakers that is heard by a listener along with the listener's neural signals, (2) automatically separates the individual speakers in the mixture, (3) determines the attended speaker, and (4) amplifies the attended speaker's voice to assist the listener. MAIN RESULTS: Using invasive electrophysiology recordings, we identified the regions of the auditory cortex that contribute to AAD. Given appropriate electrode locations, our system is able to decode the attention of subjects and amplify the attended speaker using only the mixed audio. Our quality assessment of the modified audio demonstrates a significant improvement in both subjective and objective speech quality measures. SIGNIFICANCE: Our novel framework for AAD bridges the gap between the most recent advancements in speech processing technologies and speech prosthesis research and moves us closer to the development of cognitively controlled hearable devices for the hearing impaired.

Hearing Aid Technology for the 21st Century: A Proposal for Universal Wireless Connectivity and Improved Sound Quality.

Approximately 360 million people in the world live with a debilitating hearing loss. The most common conditions-age-related and noise-induced sensorineural hearing loss-are both progressive and, for the foreseeable future, neither curable nor reversible.

Barriers to early cochlear implantation.

OBJECTIVE: Identify variables associated with paediatric access to cochlear implants (CIs). DESIGN: Part 1. Trends over time for age at CI surgery (N = 802) and age at hearing aid (HA) fitting (n = 487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. RESULTS: Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. CONCLUSION: NHS implementation was associated with reductions in age at device intervention in this cohort.

Hearing Loss Health Care for Older Adults.

Hearing deficits are highly prevalent among older adults and are associated with declines in cognitive, physical, and mental health. However, hearing loss in the geriatric population often goes untreated and generally receives little clinical emphasis in primary care practice. This article reviews hearing health care for older adults, focusing on what is most relevant for family physicians. The objective of hearing loss treatment is to ensure that a patient can communicate effectively in all settings. We present the 5 major obstacles to obtaining effective hearing and rehabilitative care: awareness, access, treatment options, cost, and device effectiveness. Hearing technologies are discussed, along with recommendations on when it is appropriate to screen, refer, or counsel a patient. The purpose of this article is to provide pragmatic recommendations for the clinical management of the older adult with hearing loss that can be conducted in family medicine practices.

Tecnologías auditivas actuales y desarrollo gramatical infantil / Current auditory technologies and childhood gramatical development

Las nuevas tecnologías audioprotésicas proporcionan a los niños sordos una discriminación de la palabra impensable hace unos años. El objetivo de este estudio es analizar el desarrollo gramatical de niños sordos que emplean dichas tecnologías y comprobar qué variables inciden en las diferencias interindividuales. Se ha evaluado a 32 niños de entre 3 y 7 años con pérdidas auditivas prelocutivas bilaterales superiores a 70 dB, que emplean audífono de programación digital o implante coclear unilateral o bilateral. A cada participante se le administró la prueba Escalas de Desarrollo del Lenguaje de Reynell III, que incluye una escala de comprensión verbal y otra de lenguaje expresivo. Los resultados muestran que solo un 30% de los participantes alcanza un desarrollo lingüístico normalizado. En la escala de comprensión, la dificultad comienza en oraciones que relacionan más de 2 elementos, y se hace muy patente en pasivas y subordinadas. En expresión, la gramática que resulta más compleja a la mayoría es la correspondiente a la edad de 3 años. Y también se detectan dificultades importantes en la flexión de verbos en pasado, tercera persona y plural de sustantivos. La edad de colocación de la prótesis o el implante resulta ser la variable más explicativa, y a ella se suma el nivel sociocultural familiar (AU)

The new auditory technologies provide deaf children with auditory speech discrimination that was unthinkable a few years ago. The aim of this study was to analyze grammatical development in deaf children using new auditory technologies, and to confirm which variables account for intersubject differences. We evaluated 32 children (aged 3-7 years) with bilateral and congenital or pre-speech deafness and hearing loss greater than 70 dB, who used digital hearing aids or cochlear implants. The Reynell Developmental Language Scales III was administered in each child. The results showed that only 30% of the participants demonstrated age-appropriate language skills. In language comprehension, sentences connecting more than 2 elements caused difficulties, which were greater when these sentences were passive and subordinate. In expressive language, a grammatical level equivalent to that in 3-year-olds caused the most difficulty for most of the participants. Expressive language related to inflections of past tense and third person verbs, and plural noun construction also caused difficulties. The most explanatory variable was age at implantation and at prosthesis fitting in deaf children. The family's sociocultural level was also important (AU)