Descriptions of Hearing Aids Influence the Experience of Listening to Hearing Aids.

OBJECTIVES: Experiences can be strongly influenced by expectations. In hearing healthcare, previous studies have shown that descriptions of hearing aids or contextual factors during the hearing aid fitting process can change subjective and even objective outcomes with hearing aids via the placebo effect. Personality factors have also been shown to affect susceptibility to placebo effects. The purposes of the present study were to (a) investigate the effects of communicating narratives designed to foster positive, negative, or neutral expectations about hearing aids on short-term patient outcomes, and (b) to determine if the degree to which the narratives affected end-user outcomes could be predicted by personality factors. DESIGN: Nineteen adults between the ages of 54 and 81 (mean age = 68.5, SD = 8.9) had 3 separate research appointments, each exposing them to a different narrative condition: positive, negative, or neutral. the appointment was designed to look and feel like a "traditional" hearing aid fitting appointment, during which the experimenter introduced (i.e., the narrative condition) and fit a pair of hearing aids, the participant was asked to provide their initial feedback about the hearing aids, and the participant performed speech-in-noise testing. Unbeknownst to the research participant, the hearing aids fitted at all three appointments were the same, and the only difference between the three appointments was the way the hearing aids were described to the participants. RESULTS: The results of this study showed that communication of a positive narrative about hearing aids before a hearing aid fitting led to better speech-in-noise performance on the QuickSIN as compared with performance following the negative or neutral narrative conditions. Also, the positive narrative led to the perception that acclimatization to the hearing aids would occur faster than the negative or neutral narrative conditions. Notably, the effect of communication of a positive narrative was stronger for individuals who scored higher on agreeableness, and susceptibility to positive and negative messaging was stronger for individuals low in neuroticism. CONCLUSIONS: The study suggests that short-term evaluations of hearing aids can be strongly influenced by narratives as provided by the hearing healthcare provider at the time of a hearing aid fitting.

Evaluation of Potential Benefits and Limitations of Noise-Management Technologies for Children with Hearing Aids.

BACKGROUND: Children with hearing loss frequently experience difficulty understanding speech in the presence of noise. Although remote microphone systems are likely to be the most effective solution to improve speech recognition in noise, the focus of this study centers on the evaluation of hearing aid noise management technologies including directional microphones, adaptive noise reduction (ANR), and frequency-gain shaping. These technologies can improve children's speech recognition, listening comfort, and/or sound quality in noise. However, individual contributions of these technologies as well as the effect of hearing aid microphone mode on localization abilities in children is unknown. PURPOSE: The objectives of this study were to (1) compare children's speech recognition and subjective perceptions across five hearing aid noise management technology conditions and (2) compare localization abilities across three hearing aid microphone modes. RESEARCH DESIGN: A single-group, repeated measures design was used to evaluate performance differences and subjective ratings. STUDY SAMPLE: Fourteen children with mild to moderately severe hearing loss. DATA COLLECTION AND ANALYSIS: Children's sentence recognition, listening comfort, sound quality, and localization were assessed in a room with an eight-loudspeaker array. RESULTS AND CONCLUSION: The use of adaptive directional microphone technology improves children's speech recognition in noise when the signal of interest arrives from the front and is spatially separated from the competing noise. In contrast, the use of adaptive directional microphone technology may result in a decrease in speech recognition in noise when the signal of interest arrives from behind. The use of a microphone mode that mimics the natural directivity of the unaided auricle provides a slight improvement in speech recognition in noise compared with omnidirectional use with limited decrement in speech recognition in noise when the signal of interest arrives from behind. The use of ANR and frequency-gain shaping provide no change in children's speech recognition in noise. The use of adaptive directional microphone technology, ANR, and frequency-gain shaping improve children's listening comfort, perceived ability to understand speech in noise, and overall listening experience. Children prefer to use each of these noise management technologies regardless of whether the signal of interest arrives from the front or from behind. The use of adaptive directional microphone technology does not result in a decrease in children's localization abilities when compared with the omnidirectional condition. The best localization performance occurred with use of the microphone mode that mimicked the directivity of the unaided auricle.

Low-Level Speech Recognition of Children with Hearing Aids.

BACKGROUND: For children with hearing loss, the primary goal of hearing aids is to provide improved access to the auditory environment within the limits of hearing aid technology and the child's auditory abilities. However, there are limited data examining aided speech recognition at very low (40 decibels A [dBA]) and low (50 dBA) presentation levels. PURPOSE: Due to the paucity of studies exploring aided speech recognition at low presentation levels for children with hearing loss, the present study aimed to (1) compare aided speech recognition at different presentation levels between groups of children with "normal" hearing and hearing loss, (2) explore the effects of aided pure tone average and aided Speech Intelligibility Index (SII) on aided speech recognition at low presentation levels for children with hearing loss ranging in degree from mild to severe, and (3) evaluate the effect of increasing low-level gain on aided speech recognition of children with hearing loss. RESEARCH DESIGN: In phase 1 of this study, a two-group, repeated-measures design was used to evaluate differences in speech recognition. In phase 2 of this study, a single-group, repeated-measures design was used to evaluate the potential benefit of additional low-level hearing aid gain for low-level aided speech recognition of children with hearing loss. STUDY SAMPLE: The first phase of the study included 27 school-age children with mild to severe sensorineural hearing loss and 12 school-age children with "normal" hearing. The second phase included eight children with mild to moderate sensorineural hearing loss. INTERVENTION: Prior to the study, children with hearing loss were fitted binaurally with digital hearing aids. Children in the second phase were fitted binaurally with digital study hearing aids and completed a trial period with two different gain settings: (1) gain required to match hearing aid output to prescriptive targets (i.e., primary program), and (2) a 6-dB increase in overall gain for low-level inputs relative to the primary program. In both phases of this study, real-ear verification measures were completed to ensure the hearing aid output matched prescriptive targets. DATA COLLECTION AND ANALYSIS: Phase 1 included monosyllabic word recognition and syllable-final plural recognition at three presentation levels (40, 50, and 60 dBA). Phase 2 compared speech recognition performance for the same test measures and presentation levels with two differing gain prescriptions. CONCLUSION: In phase 1 of the study, aided speech recognition was significantly poorer in children with hearing loss at all presentation levels. Higher aided SII in the better ear (55 dB sound pressure level input) was associated with higher Consonant-Nucleus-Consonant word recognition at a 40 dBA presentation level. In phase 2, increasing the hearing aid gain for low-level inputs provided a significant improvement in syllable-final plural recognition at very low-level inputs and resulted in a nonsignificant trend toward better monosyllabic word recognition at very low presentation levels. Additional research is needed to document the speech recognition difficulties children with hearing aids may experience with low-level speech in the real world as well as the potential benefit or detriment of providing additional low-level hearing aid gain.

Effects of Increasing the Overall Level or Fitting Hearing Aids on Emotional Responses to Sounds.

Adults with hearing loss demonstrate a reduced range of emotional responses to nonspeech sounds compared to their peers with normal hearing. The purpose of this study was to evaluate two possible strategies for addressing the effects of hearing loss on emotional responses: (a) increasing overall level and (b) hearing aid use (with and without nonlinear frequency compression, NFC). Twenty-three adults (mean age = 65.5 years) with mild-to-severe sensorineural hearing loss and 17 adults (mean age = 56.2 years) with normal hearing participated. All adults provided ratings of valence and arousal without hearing aids in response to nonspeech sounds presented at a moderate and at a high level. Adults with hearing loss also provided ratings while using individually fitted study hearing aids with two settings (NFC-OFF or NFC-ON). Hearing loss and hearing aid use impacted ratings of valence but not arousal. Listeners with hearing loss rated pleasant sounds as less pleasant than their peers, confirming findings in the extant literature. For both groups, increasing the overall level resulted in lower ratings of valence. For listeners with hearing loss, the use of hearing aids (NFC-OFF) also resulted in lower ratings of valence but to a lesser extent than increasing the overall level. Activating NFC resulted in ratings that were similar to ratings without hearing aids (with a moderate presentation level) but did not improve ratings to match those from the listeners with normal hearing. These findings suggest that current interventions do not ameliorate the effects of hearing loss on emotional responses to sound.

Evaluation of a Remote Microphone System with Tri-Microphone Beamformer.

BACKGROUND: Children with hearing loss often experience difficulty understanding speech in noisy and reverberant classrooms. Traditional remote microphone use, in which the teacher wears a remote microphone that captures her speech and wirelessly delivers it to radio receivers coupled to a child's hearing aids, is often ineffective for small-group listening and learning activities. A potential solution is to place a remote microphone in the middle of the desk used for small-group learning situations to capture the speech of the peers around the desk and wirelessly deliver the speech to the child's hearing aids. PURPOSE: The objective of this study was to compare speech recognition of children using hearing aids across three conditions: (1) hearing aid in an omnidirectional microphone mode (HA-O), (2) hearing aid with automatic activation of a directional microphone (HA-ADM) (i.e., the hearing aid automatically switches in noisy environments from omnidirectional mode to a directional mode with a cardioid polar plot pattern), and (3) HA-ADM with simultaneous use of a remote microphone (RM) in a "Small Group" mode (HA-ADM-RM). The Small Group mode is designed to pick up multiple near-field talkers. An additional objective of this study was to compare the subjective listening preferences of children between the HA-ADM and HA-ADM-RM conditions. RESEARCH DESIGN: A single-group, repeated measures design was used to evaluate performance differences obtained in the three technology conditions. Sentence recognition in noise was assessed in a classroom setting with each technology, while sentences were presented at a fixed level from three different loudspeakers surrounding a desk (0, 90, and 270° azimuth) at which the participant was seated. This arrangement was intended to simulate a small-group classroom learning activity. STUDY SAMPLE: Fifteen children with moderate to moderately severe hearing loss. DATA COLLECTION AND ANALYSIS: Speech recognition was evaluated in the three hearing technology conditions, and subjective auditory preference was evaluated in the HA-ADM and HA-ADM-RM conditions. RESULTS: The use of the remote microphone system in the Small Group mode resulted in a statistically significant improvement in sentence recognition in noise of 24 and 21 percentage points compared with the HA-O and HA-ADM conditions, respectively (individual benefit ranged from -8.6 to 61.1 and 3.4 to 44 percentage points, respectively). There was not a significant difference in sentence recognition in noise between the HA-O and HA-ADM conditions when the remote microphone system was not in use. Eleven of the 14 participants who completed the subjective rating scale reported at least a slight preference for the use of the remote microphone system in the Small Group mode. CONCLUSIONS: Objective and subjective measures of sentence recognition indicated that use of remote microphone technology with the Small Group mode may improve hearing performance in small-group learning activities. Sentence recognition in noise improved by 24 percentage points compared to the HA-O condition, and children expressed a preference for the use of the remote microphone Small Group technology regarding listening comfort, sound quality, speech intelligibility, background noise reduction, and overall listening experience.

Evaluation of Adaptive Noise Management Technologies for School-Age Children with Hearing Loss.

BACKGROUND: Children with hearing loss experience significant difficulty understanding speech in noisy and reverberant situations. Adaptive noise management technologies, such as fully adaptive directional microphones and digital noise reduction, have the potential to improve communication in noise for children with hearing aids. However, there are no published studies evaluating the potential benefits children receive from the use of adaptive noise management technologies in simulated real-world environments as well as in daily situations. PURPOSE: The objective of this study was to compare speech recognition, speech intelligibility ratings (SIRs), and sound preferences of children using hearing aids equipped with and without adaptive noise management technologies. RESEARCH DESIGN: A single-group, repeated measures design was used to evaluate performance differences obtained in four simulated environments. In each simulated environment, participants were tested in a basic listening program with minimal noise management features, a manual program designed for that scene, and the hearing instruments' adaptive operating system that steered hearing instrument parameterization based on the characteristics of the environment. STUDY SAMPLE: Twelve children with mild to moderately severe sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: Speech recognition and SIRs were evaluated in three hearing aid programs with and without noise management technologies across two different test sessions and various listening environments. Also, the participants' perceptual hearing performance in daily real-world listening situations with two of the hearing aid programs was evaluated during a four- to six-week field trial that took place between the two laboratory sessions. RESULTS: On average, the use of adaptive noise management technology improved sentence recognition in noise for speech presented in front of the participant but resulted in a decrement in performance for signals arriving from behind when the participant was facing forward. However, the improvement with adaptive noise management exceeded the decrement obtained when the signal arrived from behind. Most participants reported better subjective SIRs when using adaptive noise management technologies, particularly when the signal of interest arrived from in front of the listener. In addition, most participants reported a preference for the technology with an automatically switching, adaptive directional microphone and adaptive noise reduction in real-world listening situations when compared to conventional, omnidirectional microphone use with minimal noise reduction processing. CONCLUSIONS: Use of the adaptive noise management technologies evaluated in this study improves school-age children's speech recognition in noise for signals arriving from the front. Although a small decrement in speech recognition in noise was observed for signals arriving from behind the listener, most participants reported a preference for use of noise management technology both when the signal arrived from in front and from behind the child. The results of this study suggest that adaptive noise management technologies should be considered for use with school-age children when listening in academic and social situations.