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Purpose: This report describes a hearing device and corresponding fitting protocol designed for use in a transitional intervention for debilitating loudnessbased hyperacusis. Method: The intervention goal is to transition patients with hyperacusis from their typical counterproductive sound avoidance behaviors (i.e., sound attenuation and limited exposure to healthy low-level sounds) into beneficial sound therapy treatment that can expand their dynamic range to the point where they can tolerate everyday sounds and experience an improved quality of life. This requires a combination of counseling and sound therapy, the latter of which is provided via the hearing device technology, signal processing, and precision fitting approach described in this report. The device combines a miniature behind-the-ear sound processor and a custom earpiece designed to maximize the attenuation of external sounds. Output-limiting loudness suppression is used to restrict exposure to offending high-level sounds while unity gain amplification maximizes exposure to healthy and tolerable lower level sounds. The fitting process includes measurement of the real-ear unaided response, the realear measurement (REM) system noise floor, the real-ear occluded response, real-ear insertion gain, and the output limit. With these measurements, the device can achieve the prescribed unity gain needed to provide transparent access to comfortable sound levels. It also supports individualized configuration of the therapeutic noise from an on-board sound generator and adaptive output limiting based on treatment-induced increases in dynamic range. Results and Conclusion: The utility of this device and fitting protocol, in combination with structured counseling, is highlighted in the outcomes of a successful 6-month trial of the transitional intervention described in a companion report in this issue. [ABSTRACT FROM AUTHOR]

Purpose: This report provides the experimental, clinical, theoretical, and historical background that motivated a patented transitional intervention and its implementation and evaluation in a field trial for mitigation of debilitating loudness based hyperacusis (LH). Background and Rationale: Barriers for ameliorating LH, which is differentiated here from other forms of hyperacusis, are delineated, including counterproductive management and treatment strategies that may exacerbate the condition. Evidence for hyper-gain central auditory processes as the bases for LH and the associated LH-induced distress and stress responses are presented. This presentation is followed by an overview of prior efforts to use counseling and therapeutic sound as interventional tools for recalibrating the hyper-gain LH response. We also consider previous efforts to use output-limiting sound protection devices in the management of LH. This historical background lays the foundation for our transitional intervention protocol and its implementation and evaluation in a field trial. Conclusions: The successful implementation and evaluation of a transitional intervention, which we document in the outcomes of a companion proof-of concept field trial in this issue, build on our prior efforts and those of others to understand, manage, and treat hyperacusis. These efforts to overcome significant barriers and vexing long-standing challenges in the management and treatment of LH, as reviewed here, are the pillars of the transitional intervention and its primary components, namely, counseling combined with protective sound management and therapeutic sound, which we detail in separate reports in this issue. [ABSTRACT FROM AUTHOR]

Purpose: We present results from a 6-month field trial of a transitional intervention for debilitating primary hyperacusis, including a combination of structured counseling; promotion of safe, comfortable, and healthy sound exposure; and therapeutic broadband sound from sound generators. This intervention is designed to overcome barriers to successful delivery of therapeutic sound as a tool to downregulate neural hyperactivity in the central auditory pathways (i.e., the maladaptive mechanism believed to account for primary hyperacusis) and, together with the counseling, reduce the associated negative emotional and physiological reactions to debilitating hyperacusis. Method: Twelve adults with normal or near-normal audiometric thresholds, complaints consistent with their pretreatment loudness discomfort levels ≤ 75 dB HL at multiple frequencies, and hearing questionnaire scores ≥ 24 completed the sound therapy–based intervention. The low-level broadband therapeutic sound was delivered by ear-level devices fitted bilaterally with either occluding earpieces and output-limiting loudness suppression (LS; to limit exposure to offensive sound levels) or open domes to maximize comfort and exposure to sound therapy. Thresholds for LS (primary outcome) were incrementally adjusted across six monthly visits based on treatment-driven change in loudness judgments for running speech in sound field. Secondary outcomes included categorical loudness judgments, speech understanding, and questionnaires to assess the hyperacusis problem, quality of life, and depression. An exit survey assessed satisfaction with and benefit from the intervention and the counseling, therapeutic sound, and LS components. Results: The mean change in LS (34.8 dB) was highly significant (effect size = 2.045). Eleven of 12 participants achieved ≥ 16-dB change in LS, consistent with highly significant change in sound-based questionnaire scores. Exit surveys indicated satisfaction with and benefit from the intervention. Conclusion: The transitional intervention was successful in improving the hyperacusis conditions of 11 of 12 study participants while reducing their sound avoidance behaviors and reliance on sound protection. [ABSTRACT FROM AUTHOR]

Introduction: This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. Description of Counseling Components: The counseling protocol includes five components. First, the patient’s audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. Results and Conclusion: The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention. [ABSTRACT FROM AUTHOR]

Purpose: Most people with dysphonia present with voices that vary along more than one voice quality (VQ) dimension. This study sought to examine the effect of covariance between breathy and rough VQ in natural voices. Method: A two-dimensional matrix of 16 /a/ vowels was selected such that two VQ dimensions (breathiness and roughness) were sampled on a 4-point severity scale (none, mild, moderate, and severe). Ten listeners evaluated 480 stimuli (16 stimuli x 10 repetitions x 3 blocks) on one-dimensional magnitude estimation (1DME) tasks and a novel two-dimensional magnitude estimation (2DME) task that allowed for simultaneous measurement of breathiness and roughness. Results: Data indicated high intra- and interrater reliabilities for both breathiness and roughness in the 2DME and 1DME tasks. Correlation analyses revealed a strong correlation between 2DME and 1DME judgments for breathiness and roughness (r > .95). There was also a minimal correlation between breathy and rough VQ in the 2DME task (r < .10). Conclusions: Covarying roughness or breathiness had less impact on the perception of the other VQ in natural dysphonic voices in 2DME compared to 1DME. An understanding and quantification of the perceptual interactions among the dimensions will aid in the refinement of computational models and in the establishment of the validity of clinical scales for VQ perception. [ABSTRACT FROM AUTHOR]

Purpose: Acoustic and perceptual quantification of vocal strain has been a vexing problem for years. To increase measurement rigor, a suitable single-variable matching stimulus for strain was developed and validated, based on the matching stimulus used previously for breathy and rough voice qualities. Method: A set of 21 comparison stimuli for a single-variable matching task (SVMT) was synthesized based on a speech-shaped sawtooth waveform mixed with speech-shaped noise. Variable bandpass filter gain in mid-to-high frequencies achieved a wide range of computed sharpness (in constant sharpness steps) and served as the independent variable for the SVMT. Ten natural /ɑ/ stimuli with a wide range of the primary voice quality of strain and a minimum of breathiness or roughness were selected and assessed using the SVMT. Natural voice samples and synthetic comparison stimuli were also assessed using a perceptual magnitude estimation (ME) task. Results: ME data validated the correspondence of the set of comparison stimuli to varying perceived strain. Perceived strain magnitudes of the comparison stimuli increased significantly and linearly with computed sharpness (r² = .99). A linear regression revealed that strain matching values were significantly predicted by computed sharpness (r² = .96) and perceived strain magnitudes (r² = .95) of the natural voice stimuli. Conclusion: The perception of vocal strain is strongly associated with computed sharpness and is captured accurately and precisely using an SVMT, in which the independent variable is the bandpass filter gain (in steps of equal sharpness) applied to the comparison stimuli. [ABSTRACT FROM AUTHOR]

Purpose: Dysphonic voices typically present multiple voice quality dimensions. This study investigated potential interactions between perceived breathiness and roughness and their contributions to overall dysphonia severity. Method: Synthetic stimuli based on four talkers were created to systematically map out potential interactions. For each talker, a stimulus matrix composed of 49 stimuli (seven breathiness steps x seven roughness steps) was created by varying aspiration noise and open quotient to manipulate breathiness and super-imposing amplitude modulation of varying depths to simulate roughness. One-dimensional matching (1DMA) and magnitude estimation (1DME) tasks were used to measure perceived breathiness, roughness, their potential interactions, and overall dysphonia severity. Additional 1DME tasks were used to assess a set of natural stimuli that varied along both breathiness and roughness. Results: For the synthetic stimuli, the 1DMA task indicated little interaction between the two voice qualities. For the 1DME task, breathiness magnitude was influenced by roughness step to a greater extent than roughness magnitude was influenced by breathiness step. The additive contributions of breathiness and roughness to overall severity gradually diminished with increasing breathiness and roughness steps, possibly reflecting a ceiling effect in the 1DME task. For the natural stimuli, little consistent interaction was observed between breathiness and roughness. Conclusions: The matching task revealed minimal interaction between perceived breathiness and roughness, whereas the magnitude estimation task revealed some interaction between the two qualities and their cumulative contributions to overall dysphonia severity. Task differences are discussed in terms of differences in response bias and the role of perceptual anchors. [ABSTRACT FROM AUTHOR]

Purpose: Vocal roughness is often present in many voice disorders but the assessment of roughness mainly depends on the subjective auditory-perceptual evaluation and lacks acoustic correlates. This study aimed to apply the concept of roughness in general sound quality perception to vocal roughness assessment and to characterize the relationship between vocal roughness and temporal envelop fluctuation measures obtained from an auditory model. Method: Ten/?/recordings with a wide range of roughness were selected from an existing database. Ten listeners rated the roughness of the recordings in a single-variable matching task. Temporal envelope fluctuations of the recordings were analyzed with an auditory processing model of amplitude modulation that utilizes a modulation filterbank of different modulation frequencies. Pitch strength and the smoothed cepstral peak prominence were also obtained for comparison. Results: Individual simple regression models yielded envelope standard deviation from a modulation filter with a low center frequency (64.3 Hz) as a statistically significant predictor of vocal roughness with a strong coefficient of determination (r2 = .80). Pitch strength and CPPS were not significant predictors of roughness. Conclusion: This result supports the possible utility of envelope fluctuation measures from an auditory model as objective correlates of vocal roughness. [ABSTRACT FROM AUTHOR]

Purpose: Listeners shift their listening strategies between lower level acoustic information and higher level semantic information to prioritize maximum speech intelligibility in challenging listening conditions. Although increasing task demands via acoustic degradation modulates lexicalsemantic processing, the neural mechanisms underlying different listening strategies are unclear. The current study examined the extent to which encoding of lower level acoustic cues is modulated by task demand and associations with lexical-semantic processes. Method: Electroencephalography was acquired while participants listened to sentences in the presence of fourtalker babble that contained either higher or lower probability final words. Task difficulty was modulated by time available to process responses. Cortical tracking of speech--neural correlates of acoustic temporal envelope processing--were estimated using temporal response functions. Results: Task difficulty did not affect cortical tracking of temporal envelope of speech under challenging listening conditions. Neural indices of lexical-semantic processing (N400 amplitudes) were larger with increased task difficulty. No correlations were observed between the cortical tracking of temporal envelope of speech and lexical-semantic processes, even after controlling for the effect of individualized signal-to-noise ratios. Conclusions: Cortical tracking of the temporal envelope of speech and semantic processing are differentially influenced by task difficulty. While increased task demands modulated higher level semantic processing, cortical tracking of the temporal envelope of speech may be influenced by task difficulty primarily when the demand is manipulated in terms of acoustic properties of the stimulus, consistent with an emerging perspective in speech perception. [ABSTRACT FROM AUTHOR]

Purpose: Spectral modulation detection is an increasingly common assay of suprathreshold auditory perception and has been correlated with speech perception performance. Here, the potential effects of stimulus duration and stimulus presentation level on spectral modulation detection were investigated. Method: Spectral modulation detection thresholds were measured as a function of modulation frequency in young, normal-hearing listeners. The standard stimulus was a bandpass noise, and signal stimuli were created by superimposing sinusoidal spectral modulation on the bandpass noise carrier. The modulation was sinusoidal on a log2 frequency axis and a log10 (dB) amplitude scale with a random starting phase (0–2π radians). In 1 experiment, stimulus durations were 50, 100, 200, or 400 ms (at fixed level 81 dB SPL). In a 2nd experiment, stimuli were presented at sensation levels of 10, 20, 30, 40, and 60 dB SL (fixed at a duration of 400 ms). Results: Spectral modulation detection thresholds were similarly low for the 400- and 200-ms durations, increased slightly for the 100-ms duration, and increased markedly for the 50-ms duration. Thresholds were lowest for 40 dB SL; increased slightly for 20, 30, and 60 dB SL; and markedly higher for the 10–dB SL condition. Conclusions: The increase in thresholds for the shortest durations and lowest sensational levels is consistent with previous investigations of auditory spectral profile analysis. The effects of presentation level and stimulus duration are important considerations in the context of understanding potential relationships between the perception of spectral cues and speech perception, when designing investigations and interpreting data related to spectral envelope perception, and in the context of models of auditory perception. As examples, 2 simple models based on auditory nerve output that have been used to explain spectrotemporal modulation in previous investigations produced an output inconsistent with the present results. Plain language summary: Intensity variations across audio frequency lead to spectral shapes that are essential and sometimes signature features of various sounds in the environment, including speech. Here, we show how laboratory measures of spectral shape perception depend on presentation level and stimulus duration. [ABSTRACT FROM AUTHOR]

Purpose: Growing evidence supports the inclusion of perceptual tests that quantify the processing of temporal fine structure (TFS) in clinical hearing assessment. Many tasks have been used to evaluate TFS in the laboratory that vary greatly in the stimuli used and whether the judgments require monaural or binaural comparisons of TFS. The purpose of this study was to compare laboratory measures of TFS for inclusion in a battery of suprathreshold auditory tests. A subset of available TFS tasks were selected on the basis of potential clinical utility and were evaluated using metrics that focus on characteristics important for clinical use. Method: TFS measures were implemented in replication of studies that demonstrated clinical utility. Monaural, diotic, and dichotic measures were evaluated in 11 young listeners with normal hearing. Measures included frequency modulation (FM) tasks, harmonic frequency shift detection, interaural phase difference (TFS-low frequency), interaural time difference (ITD), monaural gap duration discrimination, and Purpose: Growing evidence supports the inclusion of perceptual tests that quantify the processing of temporal fine structure (TFS) in clinical hearing assessment. Many tasks have been used to evaluate TFS in the laboratory that vary greatly in the stimuli used and whether the judgments require monaural or binaural comparisons of TFS. The purpose of this study was to compare laboratory measures of TFS for inclusion in a battery of suprathreshold auditory tests. A subset of available TFS tasks were selected on the basis of potential clinical utility and were evaluated using metrics that focus on characteristics important for clinical use. Method: TFS measures were implemented in replication of studies that demonstrated clinical utility. Monaural, diotic, and dichotic measures were evaluated in 11 young listeners with normal hearing. Measures included frequency modulation (FM) tasks, harmonic frequency shift detection, interaural phase difference (TFS-low frequency), interaural time difference (ITD), monaural gap duration discrimination, and [ABSTRACT FROM AUTHOR]

Purpose: Improving the ability to listen efficiently in noisy environments is a critical goal for hearing rehabilitation. However, understanding of the impact of difficult listening conditions on language processing is limited. The current study evaluated the neural processes underlying semantics in challenging listening conditions. Method: Thirty adults with normal hearing completed an auditory sentence processing task in 4-talker babble. Eventrelated brain potentials were elicited by the final word in highor low-context sentences, where the final word was either highly expected or not expected, followed by a 4-alternative forced-choice response with either longer (1,000 ms), middle (700 ms), or shorter (400 ms) response time deadlines (RTDs). Results: Behavioral accuracy was reduced, and reactions times were faster for shorter RTDs. N400 amplitudes, reflecting ease of lexical access, were larger when elicited by target words in low-context sentences followed by shorter compared with longer RTDs. Conclusions: These results reveal that more neural resources are allocated for semantic processing/lexical access when listening difficulty increases. Differences between RTDs may reflect increased attentional allocation for shorter RTDs. These findings suggest that situational listening demands can impact the demands for cognitive resources engaged in language processing, which could significantly impact listener experiences across environments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this introduction is to briefly describe the nature of the conference, Aging and Speech Communication: An International and Interdisciplinary Research Conference, and to introduce the articles featured in this forum that represent the nature of the biennial conference. [ABSTRACT FROM AUTHOR]

Purpose: The goal was to evaluate the potential effects of increasing hearing loss and advancing age on spectral envelope perception. Method: Spectral modulation detection was measured as a function of spectral modulation frequency from 0.5 to 8.0 cycles/octave. The spectral modulation task involved discrimination of a noise carrier (3 octaves wide from 400 to 3200 Hz) with a flat spectral envelope from a noise having a sinusoidal spectral envelope across a logarithmic audio frequency scale. Spectral modulation transfer functions (SMTFs; modulation threshold vs. modulation frequency) were computed and compared 4 listener groups: young normal hearing, older normal hearing, older with mild hearing loss, and older with moderate hearing loss. Estimates of the internal spectral contrast were obtained by computing excitation patterns. Results: SMTFs for young listeners with normal hearing were bandpass with a minimum modulation detection threshold at 2 cycles/octave, and older listeners with normal hearing were remarkably similar to those of the young listeners. SMTFs for older listeners with mild and moderate hearing loss had a low-pass rather than a bandpass shape. Excitation patterns revealed that limited spectral resolution dictated modulation detection thresholds at high but not low spectral modulation frequencies. Even when factoring out (presumed) differences in frequency resolution among groups, the spectral envelope perception was worse for the group with moderate hearing loss than the other 3 groups. Conclusions: The spectral envelope perception as measured by spectral modulation detection thresholds is compromised by hearing loss at higher spectral modulation frequencies, consistent with predictions of reduced spectral resolution known to accompany sensorineural hearing loss. Spectral envelope perception is not negatively impacted by advancing age at any spectral modulation frequency between 0.5 and 8.0 cycles/octave. [ABSTRACT FROM AUTHOR]

Purpose: Perceptual estimates of voice quality obtained using rating scales are subject to contextual biases that influence how individuals assign numbers to estimate the magnitude of vocal quality. Because rating scales are commonly used in clinical settings, assessments of voice quality are also subject to the limitations of these scales. Instead, a matching task can be used to obtain objective measures of voice quality, thereby facilitating model development and tools for clinical use. Method: Twenty-seven individuals participated in a rating task or at least 1 of 3 matching tests (named after their modulation functions: SINE, SQUARE, POWER) to quantify the degree of roughness in dysphonic voice stimuli. Participants evaluated the roughness of 34 voice samples using an amplitude-modulated complex carrier. Results: The matching thresholds were highly correlated with the ratings estimates. Reliability of thresholds did not significantly differ across tasks, but linear regressions showed that the POWER test resulted in larger perceptual distances. Conclusions: A matching task can be used to obtain reliable estimates of roughness in dysphonic voices. The POWER comparison is recommended because the variability in matching thresholds across the range of roughness was evenly distributed, and the perceptual distances between stimuli were maximized. [ABSTRACT FROM AUTHOR]

Purpose: In this experiment, a single comparison stimulus was developed as a reference in a perceptual matching task for the quantification of breathy voice quality. Perceptual judgments of a set of synthetic voice samples were compared to previous data obtained using multiple comparison stimuli "customized" for different voices (Patel, Shrivastav, & Eddins, 2010). Method: Five male and 5 female samples of the vowel /a/ were selected from the Kay Elemetrics Disordered Voice Database and resynthesized using a Klatt synthesizer. Eleven samples were created for each base voice by manipulating the aspiration noise level. Five samples from each continuum were evaluated in a perceptual matching task in which a single sawtooth and noise comparison stimulus was used to obtain breathiness judgments. Linear regression was used to compare measurements obtained using the new comparison stimulus against the customized comparison stimuli. Results: Results indicated that the noncustomized sawtooth comparison provides reliability and perceptual distances between stimuli similar to those obtained using customized comparison stimuli. Conclusion: A single-variable matching task using a single comparison stimulus can be used to obtain perceptual estimates of breathiness across voices and experiments in a laboratory setting. This technique will help develop models of voice-quality perception. [ABSTRACT FROM AUTHOR]