The Association of Hearing Loss With Active Music Enjoyment in Hearing Aid Users.

OBJECTIVE: Hearing aids (HAs) are designed for speech rather than music listening. The impact of HAs on music enjoyment is poorly studied. We examine the effect of HAs on active music enjoyment in individuals with varying levels of hearing loss (HL). STUDY DESIGN: Cross-sectional study. SETTING: Tertiary medical center and community. METHODS: Adult (≥18 years) bilateral HA users and normal hearing (NH) controls actively listened to musical stimuli and rated their enjoyment across 3 measures (pleasantness, musicality, naturalness) with and without HAs using a visual analog scale. Multivariable linear regression was used to assess the association between HL (measured by a pure-tone average [PTA] and word recognition score [WRS] of the better ear) and music enjoyment with and without HAs, adjusting for covariates. Music enjoyment was compared between HA users and NH controls, and HA users with and without their HAs. RESULTS: One hundred bilateral HA users (mean age 66.0 years, 52% female, better ear mean [SD] PTA 50.2 [13.5] dBHL, mean WRS 84.5 [16.5]%) completed the study. Increasing severity of HL (PTA) was independently associated with decreased music enjoyment (pleasantness, musicality, naturalness) with and without HAs (p < .05). HA usage increased music enjoyment (musicality) in those with moderate to moderately severe HL. Music enjoyment in NH controls (n = 20) was significantly greater across all measures compared to HA users. CONCLUSION: Increased severity of HL is associated with decreased music enjoyment that can be enhanced with HA usage. Thus, HA usage can positively enhance both speech and music appreciation.

Hearing Aids Enhance Music Enjoyment in Individuals With Hearing Loss.

OBJECTIVE: To investigate music appreciation in hearing aid (HA) users with varying levels of hearing loss (HL). STUDY DESIGN: Cross-sectional, within-subjects design. SETTING: Tertiary medical center, community. PATIENTS: Adults (≥18 yr) bilateral HA users. INTERVENTIONS: HA usage. MAIN OUTCOME MEASURES: Outcome variables included self-reported music enjoyment measures (pleasantness, musicality, naturalness) with and without HAs assessed with visual analogue scales (10 indicates highest level of enjoyment, 0 the least). Exposure variables include HL (better ear pure-tone average) and speech discrimination (word recognition scores [WRS]). Demographic information was collected. RESULTS: One hundred nine bilateral HA users completed the study. Mean (standard deviation) age was 66.6 years (16.8 yr); 52.3% were female patients. Mean (standard deviation) better ear pure-tone average was 51.1 dB (16.3 dB) HL. Increased severity of HL and worse WRS were associated with decreased music enjoyment ( p < 0.05) across all measures without HAs, adjusting for sex, age, education, race, HA type, age of HL diagnosis, duration of HL, duration of HA use, musical preference, and musical experience. However, these associations were attenuated or no longer significant with HA usage. Moreover, among all subjects, HAs (vs. no HAs) provided increased music enjoyment in pleasantness (HA, 6.94, no HA, 5.74; p < 0.01), musicality (HA, 7.35; no HA, 6.13, p < 0.01), and naturalness (HA, 6.75; no HA, 6.02; p = 0.02). CONCLUSION: HA users report increased music enjoyment with HAs compared with without HAs. Increased severity of HL and worse WRS were independently associated with decreased unaided music enjoyment. HA usage seems to mitigate this effect, particularly for those with worse HL.

Novel Web-Based Music Re-Engineering Software for Enhancement of Music Enjoyment Among Cochlear Implantees.

OBJECTIVES: Cochlear implant (CI) listeners experience diminished music perception and enjoyment from a variety of patient-related and implant-related factors. We investigate the hypothesis that patient-directed music re-engineering may enhance music enjoyment with CI. STUDY DESIGN: Prospective cohort study. SETTING: Academic cochlear implant center. SUBJECTS AND METHODS: A multidisciplinary team of neurotologists, audiologists, and a sound/audio engineer collaborated with a web developer to create a music re-engineering application. Experienced adult CI listeners rated original excerpts from five major genres of music on enjoyment using a visual analog scale (VAS). Subjects were then allowed to re-engineer the original by adjusting treble frequencies, bass frequencies, percussion emphasis, and reverberation and again rated on enjoyment. RESULTS: Total of 46 subjects, with a mean age of 57.6 years (SD = 16; range, 18-90) participated in the study. User-mixed audio was rated higher across all measures of enjoyment than original recordings (mean difference +0.92; p < 0.05, CI [0.22, 1.62]), an effect that was seen across all genres except for country music. Subjects preferred louder bass frequencies (mean difference +7.1 dB; p < 0.01, CI [2.15, 24.3]) and more reverberation (mean difference +6.6 ms; p < 0.01, CI [2.85, 10.7]). Re-engineered music increased enjoyment in 57%, and 79% reported an interest in being able to mix music of their own choosing. CONCLUSION: User-directed music re-engineering increases music enjoyment for CI listeners. The cochlear implantee preferred heightened bass, reverberation, and treble across musical genres. These findings support the implementation of patient-directed music re-engineering to enhance music enjoyment with technology that is readily available today.

Impact of Underlying Diagnosis on Speech and Quality of Life Outcomes After Cochlear Implantation for Single-Sided Deafness.

OBJECTIVE: Our objective was to compare outcomes in speech and quality of life in those undergoing cochlear implantation for single-sided deafness (SSD), with the aim to characterize the clinical impact of underlying diagnosis in the affected ear and pre-operative hearing status. STUDY DESIGN: Prospective case series. SETTING: Academic Cochlear Implant Center. PATIENTS: 42 adult patients implanted with the diagnosis of SSD. INTERVENTIONS: Patients were evaluated at 3-, 6-, and 12-months post-operatively using AZBio sentence and speech, and consonant-nucleus-consonant (CNC) depending on appropriate testing level. Our previously validated Comprehensive Cochlear Implant Quality of Life (CCIQ) questionnaire was administered. MAIN OUTCOME MEASURES: Speech perception, quality of life. RESULTS: Subjects were stratified by the underlying diagnosis: Meniere's Disease (MD; n = 10), sudden sensorineural hearing loss (SSNHL; n = 13), and Other (eg TBI, acoustic neuroma, progressive, noise-induced; n = 19). Mean preoperative PTA of the implanted ear was 82dB ±â€Š17; that of the nonimplanted ear was 32dB ±â€Š17. SSNHL and MD demonstrated the highest speech perception score at 3 months (93 and 95%), and "Other" demonstrated the lowest scores at 88%. All 3 groups demonstrated nadir in speech scores at 6 months before improving at 12 months, but the "Other" diagnoses maintained the lowest speech testing across all time points. All 3 groups reported improved quality of life on CCIQ. CONCLUSIONS: Subjects with SSNHL and MD demonstrate excellent speech perception and quality of life outcomes after cochlear implantation for SSD. Subjects with "Other" diagnoses underlying their SSD demonstrated lower scores on speech testing but nonetheless reported improved quality of life.

Longitudinal Tracking of Sound Exposure and Hearing Aid Usage through Objective Data Logs.

Objective To use data-logging technology to objectively track and identify predictors of hearing aid (HA) usage and aided sound exposure. Study Design Case series with planned data collection. Setting Tertiary academic medical center. Subjects and Methods Individuals with HAs between 2007 and 2016 were included (N = 431; mean, 74.6 years; 95% CI, 73.1-76.0). Data-logging technology intrinsic to new-generation HAs was enabled to track usage and sound exposure. With multivariable linear regression, age, sex, number of audiology visits, duration of audiologic follow-up, pure tone average, and HA side were assessed as predictors of usage (hours/day) and aided sound exposure (dB-hours/day; ie, "dose" of sound per day). Results Mean follow-up was 319 days (95% CI, 277-360). Mean HA usage was 8.4 hours/day (95% CI, 8.0-8.8; N = 431). Mean aided sound exposure was 440 dB-hours/day (95% CI, 385-493; n = 110). HA use (ß < 0.001, P = .45) and aided sound exposure (ß = -0.006, P = .87) were both stable over time. HA usage was associated only with hearing loss level (pure tone average; ß = 0.030, P = .04). Aided sound exposure was associated only with duration of audiologic follow-up (ß = 0.100, P = .02). Conclusion While measurement of HA use has traditionally relied on subjective reporting, data logging offers an objective tool to longitudinally track HA use and sound exposure. We demonstrate the feasibility of using this potentially powerful research tool. Usage and sound exposure were stable among patients throughout the study period. Use was greater among subjects with greater hearing loss. Maximizing aided sound exposure might be possible through continued audiology follow-up visits.

The effect of brief subway station noise exposure on commuter hearing.

OBJECTIVE: To demonstrate that brief exposure to subway noise causes temporary threshold shift and is preventable with noise protection. METHODS: The study was conducted as a randomized crossover trial. Twenty subjects were randomly assigned to two groups, one with hearing protection and one without. Subjects were exposed to subway platform noise for 15 minutes. Pre- and post-exposure pure tone audiometry (PTA) and otoacoustic emissions were compared. After a washout period, subjects switched hearing protection groups and repeated the process. RESULTS: A statistically significant reduction in PTA thresholds after subway noise exposure was identified, for subjects with and without hearing protection (P < .001). For exposure without hearing protection, the mean threshold was 5.19 dB pre-exposure and 3.91 dB post-exposure (decrease of 1.28 dB; 95% confidence interval, 0.82-1.74). For exposure with hearing protection, the mean threshold was 4.81 dB pre-exposure and 3.47 dB post-exposure (decrease of 1.34 dB; 95% confidence interval, 0.89-1.79). CONCLUSION: Brief exposure to subway noise did not cause hearing loss with or without noise protection. Though clinically insignificant, the unexpected finding of reduction in PTA suggests that there are complex heterogeneous short- and long-term cochlear responses to noise exposure that should be further explored. LEVEL OF EVIDENCE: 1b.

The development and validation of the speech quality instrument.

OBJECTIVE: Although speech perception tests are available to evaluate hearing, there is no standardized validated tool to quantify speech quality. The objective of this study is to develop a validated tool to measure quality of speech heard. STUDY DESIGN: Prospective instrument validation study of 35 normal hearing adults recruited at a tertiary referral center. METHODS: Participants listened to 44 speech clips of male/female voices reciting the Rainbow Passage. Speech clips included original and manipulated excerpts capturing goal qualities such as mechanical and garbled. Listeners rated clips on a 10-point visual analog scale (VAS) of 18 characteristics (e.g. cartoonish, garbled). RESULTS: Skewed distribution analysis identified mean ratings in the upper and lower 2-point limits of the VAS (ratings of 8-10, 0-2, respectively); items with inconsistent responses were eliminated. The test was pruned to a final instrument of nine speech clips that clearly define qualities of interest: speech-like, male/female, cartoonish, echo-y, garbled, tinny, mechanical, rough, breathy, soothing, hoarse, like, pleasant, natural. Mean ratings were highest for original female clips (8.8) and lowest for not-speech manipulation (2.1). Factor analysis identified two subsets of characteristics: internal consistency demonstrated Cronbach's alpha of 0.95 and 0.82 per subset. Test-retest reliability of total scores was high, with an intraclass correlation coefficient of 0.76. CONCLUSION: The Speech Quality Instrument (SQI) is a concise, valid tool for assessing speech quality as an indicator for hearing performance. SQI may be a valuable outcome measure for cochlear implant recipients who, despite achieving excellent speech perception, often experience poor speech quality. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:1622-1627, 2018.

The influence of subway station design on noise levels.

OBJECTIVES/HYPOTHESIS: To investigate the impact of subway station design on platform noise levels. STUDY DESIGN: Observational. METHODS: Continuous A-weighted decibel (dBA) sound levels were recorded in 20 New York City subway stations, where trains entered on either a straight track or curved track in 10 stations each. Equivalent continuous noise levels (Leq ) at various locations on the boarding platform (inbound end, midplatform, and outbound end) during train entry and exit were compared between the straight and curved stations in broadband as well as narrow one-third octave bands. RESULTS: Overall, curved stations trended louder than straight stations, although the difference in broadband Leq did not reach statistical significance (curve, 83.4 dBA; straight, 82.6 dBA; P = .054). Noise levels were significantly louder at the inbound end of the platform during train entry (inbound, 89.7 dBA; mid, 85.5 dBA; outbound, 78.7 dBA; P < .001) and at the outbound end during train exit (inbound, 79.7 dBA; mid, 85.3 dBA; outbound, 89.1 dBA; P < .001). Narrow band analysis showed that curved stations were significantly louder than straight stations at 100 Hz and high frequencies from 8 to 20 kHz. Peak impact levels ranged from 104 to 121 dBA. CONCLUSIONS: Curved stations have a different noise profile compared to straight stations and are significantly louder than straight stations at high frequencies. Designing stations with straight tracks within the platform can help reduce commuter noise exposure. LEVEL OF EVIDENCE: NA Laryngoscope, 127:1169-1174, 2017.

Stability of audiometric measures and challenges in long-term management of the elderly cochlear implant patient.

OBJECTIVE: To determine the long-term audiometric stability and the types and frequency of management challenges encountered when working with elderly cochlear implant users. STUDY DESIGN: Retrospective chart review. SETTING: University hospital. PATIENTS: The final sample is 23 cochlear implantees over the age of 60, followed an average of 8.4 years. INTERVENTION: Rehabilitative (cochlear implantation for clinical purposes, audiologic management). MAIN CLINICAL OUTCOME MEASURES: Warble tone thresholds, spondee thresholds, speech recognition scores, and frequency counts of management problems. RESULTS: Warble tone thresholds were stable over the study period. Speech recognition performance was not significantly changed statistically over the study period, but examination of individual results showed that 26% improved in performance, 17% participants decreased, and 17% remained the same. Thirteen percent of the sample had noteworthy thinning of the flap, including one individual whose flap deteriorated and required explantation.Management challenges relating to failing health, broken and lost equipment, thinning of the skin flap, critical judgment and emotional difficulties during programming sessions, and the need for repeated instructions on device use were noted with varying frequencies. CONCLUSION: Cochlear implantation is beneficial for elderly patients with severe-profound sensorineural hearing loss as demonstrated by long-term stability of function, with the caveat that some individuals may experience significant decreases in speech recognition over time. However, unique management challenges resulting from age-related cognitive decline, health problems, and/or reduced dexterity may present themselves. Audiologists must keep these issues in mind during preoperative counseling and when structuring postoperative follow-up sessions.