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Background: Questionnaires, e. g. the APHAB, and speech-audiometry are the most used elements in measuring the success of hearing aid fitting (HAF). This study investigates the correlations between the results of the Freiburg monosyllabic word test without and with noise (FBE, FBE-S) and the results of the APHAB before and after HAF., Methods: Data of the FBE, the FBE-S, and the APHAB, generated within HAF of 156 subjects were analyzed. After exclusion of a normal distribution of the data, Spearman's correlation and Cohen's effect size were determined., Results: 73 (46.8 %) of the 156 subjects were females, and 83 (53.2 %) males. No significant correlation could be found between the EC-, the RV-, and the cumulative ECBNRV-subscale and the benefit of HAF in the FBE and FBE-S (EC: ease of communication, BN: background noise, RV: reverberation). Most of the remaining coefficients of correlation had a weak positive effect size. A middle positive effect size could only be demonstrated for 6 combinations, for the EC-subscale mostly., Conclusion: The not strong effect sizes could assume that the results in speech-audiometry and the APHAB are not independent and complementing each other as parameters of hearing loss and benefit in HAF. The effect size could be explained by individually different possibilities for the compensation of hearing loss., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Speech audiometry materials are widely available in many different languages. However, there are no known standardized materials for the assessment of speech recognition in Arabic-speaking children., Purpose: The aim of the study was to develop and validate phonetically balanced and psychometrically equivalent monosyllabic word recognition lists for children through a picture identification task., Research Design: A prospective repeated-measure design was used. Monosyllabic words were chosen from children's storybooks and were evaluated for familiarity. The selected words were then divided into four phonetically balanced word lists. The final lists were evaluated for homogeneity and equivalency., Study Sample: Ten adults and 32 children with normal hearing sensitivity were recruited., Data Collection and Analyses: Lists were presented to adult subjects in 5 dB increment from 0 to 60 dB hearing level. Individual data were then fitted using a sigmoid function from which the 50% threshold, slopes at the 50% points, and slopes at the 20 to 80% points were derived to determine list psychometric properties. Lists were next presented to children in two separate sessions to assess their equivalency, validity, and reliability. Data were subjected to a mixed design analysis of variance., Results: No statistically significant difference was found among the word lists., Conclusion: This study provided an evidence that the monosyllabic word lists had comparable psychometric characteristics and reliability. This supports that the constructed speech corpus is a valid tool that can be used in assessing speech recognition in Arabic-speaking children., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Background: Many of the Arabic monosyllabic word lists that are currently available in the literature have some limitations and drawbacks. Some of these available lists include word structures that are not consonant-nucleus-consonant (CNC) such as cluster and disyllabic word structures. Other lists have poor phonetic or phonemic distribution balance and do not represent some phoneme appropriately in each list., Purpose: The purpose of the present study is to create and validate eight digitally recorded lists of phonemically balanced CNC words that represent all Arabic phonemes, to be used in the evaluation of word recognition score (WRS) of Jordanian Arabic-speaking adults. These lists should be easily adapted by other Arab countries because of the simplicity of the words, and the balanced inclusion of all the Arabic phonemes., Research Design: The present study is a prospective cross-sectional study., Study Sample: Thirty-one (23 females, 8 males) normal hearing and healthy young adults (18-29 years old) participated in the present study. All participants were native speakers of Jordanian Arabic and had no history of ear disease or surgery., Lists: The authors created all possible combinations of Arabic CNC words, and then created eight phonemically balanced lists with 26 words in each list. Each consonant was presented only once at the beginning of a word and once at the end of a word in each list. The lists were recorded using a Jordanian male voice and the intensity of each word was digitally calibrated., Data Collection and Analysis: The pure tone average (PTA) of 0.5, 1, 2, 4 kHz was calculated for each participant, and the WRS was obtained for each intensity level in the range of -10 to 55 dB SL (ref. PTA) in 5 dB steps., Results: No significant difference between right and left ear WRS was found at any intensity level. The WRSs from both ears were averaged and used in the repeated measure analysis of variance. Performance-intensity functions for all the lists showed some small but statistically significant differences between lists. However, none of these differences were clinically significant (<4%). All the lists showed WRS exceeding 96% at 40 dB SL, and none of the lists showed statistically significant improvement in WRS beyond 40 dB SL., Conclusion: The present study provides eight lists of recorded and calibrated CNC word lists. The obtained PI functions showed that these lists are suitable for Jordanian Arabic speaking adults. These lists can be easily generalized to other Arab countries after conducting the required follow-up research., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Although hearing aids (HAs) and cochlear implants (CIs) can provide significant benefits to persons with hearing loss, users frequently report difficulty hearing in noisy environments, particularly when there are multiple talkers. Little is known about the benefits provided by currently available wireless microphones in multitalker situations., Purpose: The purpose of this study was to compare the benefits received in speech recognition in noise by adults with hearing loss when using two different wireless microphone types in a simulated group setting., Research Design: A quasi-experimental, repeated-measures design was used where performance in a control condition, HA/CI alone, was compared with performance in two wireless microphone intervention conditions., Study Sample: Participants included ten listeners, aged 20-92 years, with bilateral sensorineural hearing loss who were experienced HA or CI users., Intervention: The two wireless microphones by Phonak, Roger Pen, and Roger Select used the same digital modulation protocol to transmit the signal to compatible receivers. However, the Roger Pen operated in a fixed omnidirectional mode, whereas the Roger Select operated in an adaptive directional mode., Data Collection and Analysis: Participants were asked to repeat Hearing in Noise Test sentences presented in restaurant noise in three conditions: HA/CI alone, HA/CI with a Roger Pen, or HA/CI with a Roger Select microphone placed in the center of a round table. Sentences were presented from one of five loudspeakers equally spaced with the participant, while restaurant noise was presented on each side at four signal-to-noise ratios (SNRs), including +5, 0, -5, and -10 dB. A two-way, repeated-measures analysis of variance was performed with main effects of listening condition and noise level., Results: Significantly  greater speech recognition performance was achieved with the wireless microphones than with listening with just the HA or CI. Furthermore, at the -5- and -10-dB SNR conditions, the Roger Select resulted in significantly better performance than the Roger Pen microphone., Conclusions: The results suggest that the Roger Select microphone can provide significant benefits in speech recognition in noise over the use of HA/CI alone (61%) and also significant benefits over the use of a Roger Pen (16%) in a simulated group dining experience., Competing Interests: None declared., (American Academy of Audiology. All rights reserved.)

Background: The literature presents conflicting reports on the relationship between pure-tone threshold average and speech recognition in noise ability., Purpose: The purpose of this retrospective study and meta-analysis was to determine the effect of stimulus audibility on the relationship between speech recognition in noise ability and bilateral pure-tone average (BPTA)., Research Design: Pure-tone threshold and Hearing in Noise Test (HINT) data from two data sets were evaluated. The HINT data from both data sets were divided into groups with complete and partial audibility of the HINT stimuli delivered at 65 dBA., Study Sample: Normal and hearing-impaired participants were included in this retrospective study. For data set 1 (n = 215), a relatively weak relationship had been found between HINT thresholds and BPTA. For data set 2 (n = 55), a relatively strong relationship had been found between HINT thresholds and BPTA. For data set 1, only 10% of the participants had partial audibility of the HINT stimuli. For data set 2, 16% of the participants had partial audibility of the HINT stimuli., Data Collection and Analysis: Pure-tone thresholds and HINT data were obtained from published and unpublished studies. HINT data were collected in a simulated soundfield environment under headphones using the standard HINT protocol. Statistical analyses included descriptive statistics, correlations, and a two-way analysis of variance (ANOVA), and multiple regression., Results: A two-way ANOVA followed by post hoc analyses revealed a greater difference between the data sets for the Noise Front thresholds obtained with partial rather than complete audibility of the stimuli. A weak and nonsignificant relationship was found between BPTA (0.5, 1.0, 2.0, 3.0, 6.0 kHz) versus HINT Noise Front thresholds for complete audibility data (r = 0.060, p = 0.356) and a strong relationship was found for the partial audibility data (r = 0.863, p < 0.001)., Conclusions: The proportion of partial audibility data in a given data set may influence the relative strength of the relationship between BPTA and HINT Noise Front thresholds. This brings into question the convention of using pure-tone average as a predictor of speech recognition in noise ability., (American Academy of Audiology.)

Background: Sentence understanding scores for patients with cochlear implants (CIs) when tested in quiet are relatively high. However, sentence understanding scores for patients with CIs plummet with the addition of noise., Purpose: To assess, for patients with CIs (MED-EL), (1) the value to speech understanding of two new, noise-reducing microphone settings and (2) the effect of the microphone settings on sound source localization., Research Design: Single-subject, repeated measures design. For tests of speech understanding, repeated measures on (1) number of CIs (one, two), (2) microphone type (omni, natural, adaptive beamformer), and (3) type of noise (restaurant, cocktail party). For sound source localization, repeated measures on type of signal (low-pass [LP], high-pass [HP], broadband noise)., Study Sample: Ten listeners, ranging in age from 48 to 83 yr (mean = 57 yr), participated in this prospective study., Intervention: Speech understanding was assessed in two noise environments using monaural and bilateral CIs fit with three microphone types. Sound source localization was assessed using three microphone types., Data Collection and Analysis: In Experiment 1, sentence understanding scores (in terms of percent words correct) were obtained in quiet and in noise. For each patient, noise was first added to the signal to drive performance off of the ceiling in the bilateral CI-omni microphone condition. The other conditions were then administered at that signal-to-noise ratio in quasi-random order. In Experiment 2, sound source localization accuracy was assessed for three signal types using a 13-loudspeaker array over a 180° arc. The dependent measure was root-mean-score error., Results: Both the natural and adaptive microphone settings significantly improved speech understanding in the two noise environments. The magnitude of the improvement varied between 16 and 19 percentage points for tests conducted in the restaurant environment and between 19 and 36 percentage points for tests conducted in the cocktail party environment. In the restaurant and cocktail party environments, both the natural and adaptive settings, when implemented on a single CI, allowed scores that were as good as, or better, than scores in the bilateral omni test condition. Sound source localization accuracy was unaltered by either the natural or adaptive settings for LP, HP, or wideband noise stimuli., Conclusion: The data support the use of the natural microphone setting as a default setting. The natural setting (1) provides better speech understanding in noise than the omni setting, (2) does not impair sound source localization, and (3) retains low-frequency sensitivity to signals from the rear. Moreover, bilateral CIs equipped with adaptive beamforming technology can engender speech understanding scores in noise that fall only a little short of scores for a single CI in quiet., (American Academy of Audiology)

Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In single sided deafness, treatment with transcranial CROS makes pseudo stereophonic listening possible. This leads to improved speech understanding in noise. However, several reports show large variations between the individual results of the benefit by speech audiometry in noise. One possible factor is the duration and changes in the auditory pathway between the onset of deafness to CROS supply. 18 patients with single sided deafness have tested a transcranial CROS supply. The speech intelligibility thresholds were evaluated in 2 spatial hearing situations each with CROS and unaided. When speech was arriving at 45° from the deaf ear and noise at 45° from the hearing ear, a significant improvement of speech reception threshold for 50% intelligibility was detected by CROS supply compared the medians. Patients with longer duration of deafness showed higher benefit by an average of -4.0 dB, in contrast to patients with short duration of deafness. In the reversed situation, that speech on the hearing ear and noise on the deaf ear was a significant deterioration observed, an average of 3.1 dB at longer deafened patients. In addition, a highly significant correlation was found with the individual changes in the speech recognition threshold between the two situations. The duration of deafness is an essential factor in the individual benefit estimate for treatment with transcranial CROS supply. The time frame for audimetrically proven changes in the auditory pathway as a result of unilateral auditory deprivation can be estimated to about 1-3 years. Patients with short duration of deafness have low or no benefit from transcranial CROS supply., (© Georg Thieme Verlag KG Stuttgart · New York.)

This study gives an estimation of the long term outcome of a screening procedure for cochlear implant candidacy in hearing aid users.In a recent retrospective study, hearing aid performance and audiometric measures in 185 subjects (318 ears) were analyzed. In the context of 2 years follow-up, the outcome of the ipsilateral screening procedure was analyzed. For patients who did receive a cochlear implant, their audiometric outcome measures were viewed into relation to their preoperative results.From the 96 ears identified as cochlear implant candidates, 34 were provided with a cochlear implant. 222 ears were identified as hearing aid users. Only 4 of these 222 ears were provided with a cochlear implant. Cochlear implant recipients with a preoperative speech recognition score with hearing aids above zero showed a mean improvement of 65% points in Freiburg monosyllabics.The audiometry-based screening procedure enables an effective management of the referral process of cochlear implant candidates., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: In order for a diagnosis of Occupational Hearing Loss (BK-no. 2301) to be made certain criteria must be fulfilled to establish that the hearing loss is occupational in origin. This work compares 2 groups, those who fulfil the criteria (BKE) and those who do not (BKNE). Methods: A 100 consecutive reports ("Lärmgutachten BK-no. 2301") written by the authors were examined retrospectively. These recorded audiometric examination, an analysis of any tinnitus and noise exposure plus use of hearing protection. Pre- and post-noise exposure status together with an expert assessment of work limitations was made to produce a 7 point score. Results: 67% of the group fulfilled the conditions for occupational hearing loss (9% were entitled to compensation). In the BKE group 82% showed typical audiometric signs of noise damage with 75% of them fulfilling at least 6 criteria of occupational disease no. 2301. Tinnitus typical for noise exposure was found in 26%. Discussion: A 7 point score could be useful in the future as a method of helping distinguish hearing loss and tinnitus from occupational as opposed to other causes., (© Georg Thieme Verlag KG Stuttgart · New York.)

Hearing loss is one of the most dominant handicaps in modern societies, which additionally very often is not realized or not admitted. About one quarter of the general population suffers from inner ear hearing loss and is therefore restricted in communicational skills. Demographic factors like increasing age play an important role as well as environmental influences and an increasing sound and noise exposure especially in leisure activities. Thus borders between a "classical" presbyacusis - if it ever existed - and envirionmentally induced hearing loss disappear. Today restrictions in hearing ability develop earlier in age but at the same time they are detected and diagnosed earlier. This paper can eventually enlighten the wide field of inner ear hearing loss only fragmentarily; therefore mainly new research, findings and developments are reviewed. The first part discusses new aspects of diagnostics of inner ear hearing loss and different etiologies., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The bilateral contralateral routing of signals (BICROS) system has provided limited benefit for speech recognition in noise for patients with asymmetric sensorineural hearing loss, even when an automatic adaptive multichannel directional microphone (DM) is in the receiver (Rx) and an omnidirectional microphone (OM) is in the transmitter (Tx). A recent BICROS system was introduced that can be programmed with a DM in the Rx and an OM or a DM in the Tx., Purpose: To examine if significant differences in sentence recognition in noise and subjective preferences are present between an OM and an adaptive broadband DM programmed in the Tx of a BICROS system with an automatic adaptive multichannel DM programmed in the Rx., Research Design: A randomized crossover single-blind design was used to assess differences between the OM and DM programmed in the Tx., Study Sample: Eighteen adult experienced BICROS system users were recruited., Data Collection and Analysis: The BICROS system was fit using real-ear insertion gain measures. The Tx was programmed with an OM and a DM and the Rx was always programmed with an automatic adaptive multichannel DM. The order of microphone condition in the Tx was counterbalanced. Participants acclimatized to the BICROS system for 4 weeks and returned and completed the Abbreviated Profile of Hearing Aid Benefit (APHAB) for the respective microphone condition. The Tx was then programmed with the other microphone condition and participants acclimatized for another four weeks. At the final visit, the APHAB was completed for the respective microphone condition. After eight weeks of acclimatization, Hearing in Noise Test sentences were presented in the R-Space™ system with the Tx in either the OM or DM condition for three listening conditions: (1) speech from 90° to the Rx and noise from 0°, 90°, and 180° to the Tx (Sp Rx/N Tx), (2) speech from 90° to the Tx and noise from 0°, 90°, and 180° to the Rx (Sp Tx/N Rx), and (3) speech from 0° and noise from eight surrounding loudspeakers separated by 45° (diffuse)., Results: A two-factor repeated measures analysis of variance revealed no significant differences between the OM and DM microphone conditions for Sp Rx/N Tx listening condition. A significant mean disadvantage of 1.9 dB (p < 0.01) was revealed for the DM compared to the OM for Sp Tx/N Rx listening condition and a mean advantage of 2.6 dB (p < 0.001) for the DM compared to the OM in a diffuse listening condition. There were no significant differences in the APHAB aided problem and resulting benefit scores between the OM and DM for the following subscales: ease of communication, background noise, reverberation, and aversiveness of sounds., Conclusions: No significant differences were revealed between OM and DM for Sp Rx/N Tx. The DM performed significantly poorer than OM for the Sp Tx/N Rx listening condition. Results revealed significant benefit for the DM compared to OM for the diffuse listening condition. No significant differences were revealed between the OM and DM on the APHAB., (American Academy of Audiology.)

Background: Frequency-lowering (FL) algorithms are an alternative method of providing access to high-frequency speech cues. There is currently a lack of independent research addressing: (1) what functional, measureable benefits FL provides; (2) which, if any, FL algorithm provides the maximum benefit, (3) how to clinically program algorithms, and (4) how to verify algorithm settings., Purpose: Two experiments were included in this study. The purpose of Experiment 1 was to (1) determine if a commercially available nonlinear frequency compression (NLFC) algorithm provides benefit as measured by improved speech recognition in noise when fit and verified using standard clinical procedures; and (2) evaluate the impact of acclimatization. The purpose of Experiment 2 was to (1) evaluate the benefit of using enhanced verification procedures to systematically determine the optimal application of a prototype NLFC algorithm, and (2) determine if the optimized prototype NLFC settings provide benefit as measured by improved speech recognition in quiet and in noise., Research Design: A single-blind, within-participant repeated measures design in which participants served as their own controls., Study Sample: Experiment 1 included 26 participants with a mean age of 68.3 yr and Experiment 2 included 37 participants with a mean age of 68.8 yr. Participants were recruited from the Audiology and Speech Pathology Center at Walter Reed National Military Medical Center in Bethesda, MD., Intervention: Participants in Experiment 1 wore bilateral commercially available hearing aids fit using standard clinical procedures and clinician expertise. Participants in Experiment 2 wore a single prototype hearing aid for which FL settings were systematically examined to determine the optimum application. In each experiment, FL-On versus FL-Off settings were examined in a variety of listening situations to determine benefit and possible implications., Data Collection and Analysis: In Experiment 1, speech recognition measures using the QuickSIN and Modified Rhyme Test stimuli were obtained at initial bilateral fitting and 3-5 weeks later during a follow-up visit. In Experiment 2, Modified Rhyme Test, /sə/, /∫ə/ consonant discrimination task, and dual-task cognitive load speech recognition performance measures were conducted. Participants in Experiment 2 received four different systematic hearing aid programs during an initial visit and speech recognition data were collected over 2-3 follow-up sessions., Results: Some adults with hearing loss obtained small-to-moderate benefits from implementation of FL, while others maintained performance without detriment in both experiments. There was no significant difference among FL-On settings systematically obtained in Experiment 2. There was a modest but significant age effect in listeners of both experiments that indicated older listeners (>65 yr) might benefit more on average from FL than younger listeners. In addition, there were reliable improvements in the intelligibility of the phonemes /ŋ/ and /b/ for both groups, and /ð/ for older listeners from the FL in both experiments., Conclusions: Although the optimum settings, application, and benefits of FL remain unclear at this time, there does not seem to be degradation in listener performance when FL is activated. The benefits of FL should be explored in older adult (>65 yr) listeners, as they tended to benefit more from FL applications., (American Academy of Audiology.)

Background: Many studies have reported the speech recognition benefits of a personal remote microphone system when used by adult listeners with hearing loss. The advance of wireless technology has allowed for many wireless audio transmission protocols. Some of these protocols interface with commercially available hearing aids. As a result, commercial remote microphone systems use a variety of different protocols for wireless audio transmission. It is not known how these systems compare, with regard to adult speech recognition in noise., Purpose: The primary goal of this investigation was to determine the speech recognition benefits of four different commercially available remote microphone systems, each with a different wireless audio transmission protocol., Research Design: A repeated-measures design was used in this study., Study Sample: Sixteen adults, ages 52 to 81 yr, with mild to severe sensorineural hearing loss participated in this study., Intervention: Participants were fit with three different sets of bilateral hearing aids and four commercially available remote microphone systems (FM, 900 MHz, 2.4 GHz, and Bluetooth(®) paired with near-field magnetic induction)., Data Collection and Analysis: Speech recognition scores were measured by an adaptive version of the Hearing in Noise Test (HINT). The participants were seated both 6 and 12' away from the talker loudspeaker. Participants repeated HINT sentences with and without hearing aids and with four commercially available remote microphone systems in both seated positions with and without contributions from the hearing aid or environmental microphone (24 total conditions). The HINT SNR-50, or the signal-to-noise ratio required for correct repetition of 50% of the sentences, was recorded for all conditions. A one-way repeated measures analysis of variance was used to determine statistical significance of microphone condition., Results: The results of this study revealed that use of the remote microphone systems statistically improved speech recognition in noise relative to unaided and hearing aid-only conditions across all four wireless transmission protocols at 6 and 12' away from the talker., Conclusions: Participants showed a significant improvement in speech recognition in noise when comparing four remote microphone systems with different wireless transmission methods to hearing aids alone., (American Academy of Audiology.)

Background: In 1940, a cooperative effort by the radio networks and Bell Telephone produced the volume unit (vu) meter that has been the mainstay instrument for monitoring the level of speech signals in commercial broadcasting and research laboratories. With the use of computers, today the amplitude of signals can be quantified easily using the root mean square (rms) algorithm. Researchers had previously reported that amplitude estimates of sentences and running speech were 4.8 dB higher when measured with a vu meter than when calculated with rms. This study addresses the vu-rms relation as applied to the carrier phrase and target word paradigm used to assess word-recognition abilities, the premise being that by definition the word-recognition paradigm is a special and different case from that described previously., Purpose: The purpose was to evaluate the vu and rms amplitude relations for the carrier phrases and target words commonly used to assess word-recognition abilities. In addition, the relations with the target words between rms level and recognition performance were examined., Research Design: Descriptive and correlational., Study Sample: Two recoded versions of the Northwestern University Auditory Test No. 6 were evaluated, the Auditec of St. Louis (Auditec) male speaker and the Department of Veterans Affairs (VA) female speaker., Data Collection and Analysis: Using both visual and auditory cues from a waveform editor, the temporal onsets and offsets were defined for each carrier phrase and each target word. The rms amplitudes for those segments then were computed and expressed in decibels with reference to the maximum digitization range. The data were maintained for each of the four Northwestern University Auditory Test No. 6 word lists. Descriptive analyses were used with linear regressions used to evaluate the reliability of the measurement technique and the relation between the rms levels of the target words and recognition performances., Results: Although there was a 1.3 dB difference between the calibration tones, the mean levels of the carrier phrases for the two recordings were -14.8 dB (Auditec) and -14.1 dB (VA) with standard deviations <1 dB. For the target words, the mean amplitudes were -19.9 dB (Auditec) and -18.3 dB (VA) with standard deviations ranging from 1.3 to 2.4 dB. The mean durations for the carrier phrases of both recordings were 593-594 msec, with the mean durations of the target words a little different, 509 msec (Auditec) and 528 msec (VA). Random relations were observed between the recognition performances and rms levels of the target words. Amplitude and temporal data for the individual words are provided., Conclusions: The rms levels of the carrier phrases closely approximated (±1 dB) the rms levels of the calibration tones, both of which were set to 0 vu (dB). The rms levels of the target words were 5-6 dB below the levels of the carrier phrases and were substantially more variable than the levels of the carrier phrases. The relation between the rms levels of the target words and recognition performances on the words was random., (American Academy of Audiology.)

Background: Since 1974, the recommendation for assessment of hearing impairment caused by noise - formerly known as "Königsteiner Merkblatt" (now: "Königsteiner Empfehlung") - has been representing the state of the art for the assessment of the occupational disease BK-No. 2301. It was updated several times, the last time in 2012. It provides a summary of the current medical knowledge. A new measurement for the entire working life - the Effective Noise Dose by Liedtke - was introduced. Otoacoustic emissions (OAE) are now the crucial tests in order to detect a hair cell dysfunction. As from now the tinnitus has to be put under a more comprehensive examination. On the strength of post experience the previous speech audiometry (Freiburger Test) is reliable, it was retrained. In future the indication for hearing aids will be oriented towards the aid guidelines of the legal health insurance. The questionnaire for the expert opinion was revised and the fee was adapted., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: There is a need for objective pediatric hearing aid outcome measurement and thus a need for the evaluation of outcome measures. We explored a commercially available pediatric sentence-in-noise measure adapted for use as an aided outcome measure., Purpose: The purposes of the current study were (1) to administer an adapted BKB-SIN (Bamford-Kowal-Bench Speech-in-Noise test) to adults and children who have normal hearing and children who use hearing aids and (2) to evaluate the utility of this adapted BKB-SIN as an aided, within-subjects outcome measure for amplification strategies., Research Design: We used a mixed within and between groups design to evaluate speech recognition in noise for the three groups of participants. The children who use hearing aids were tested under the omnidirectional, directional, and digital noise reduction (DNR) conditions. Results from each group were compared to each other, and we compared results of each aided condition for the children who use hearing aids to evaluate the test utility as an aided outcome measure., Study Sample: The study sample consisted of 14 adults with normal hearing (aged 22-28 yr) and 15 children with normal hearing (aged 6-18 yr), recruited through word of mouth, and 14 children who use hearing aids (aged 9-16 yr) recruited from local audiology clinics., Data Collection and Analysis: List pairs of the BKB-SIN test were presented at 50 dB HL as follows: four list pairs to each participant with normal hearing, four list pairs in the omnidirectional condition, and two list pairs in the directional and DNR conditions. Children who use hearing aids were fitted bilaterally with laboratory devices and completed the BKB-SIN test aided. Data were plotted as mean percent of key words correct at each signal-to-noise ratio (SNR). Further, we conducted an analysis of variance for group differences and within-groups for the three aided conditions., Results: Adult participants outperformed children with normal hearing, who outperformed the children who use hearing aids. SNR-50 (signal-to-noise ratio at which listener can obtain a speech recognition score of 50% correct) scores demonstrated reliability of the adapted test implementation. The BKB-SIN test measured significant differences in performance for omnidirectional versus directional microphone conditions but not between omnidirectional and DNR conditions., Conclusions: We conclude that the adapted implementation of the BKB-SIN test can be administered reliably and feasibly. Further study is warranted to develop norms for the adapted implementation as well as to determine if an adapted implementation can be sensitive to age effects. Until such norms are developed, clinicians should refrain from comparing results from the adapted test to the test manual norms and should instead use the adapted implementation as a within-subject measure., (American Academy of Audiology.)

Background: Use of personal frequency-modulated (FM) systems significantly improves speech recognition in noise for users of cochlear implants (CIs). Previous studies have shown that the most appropriate gain setting on the FM receiver may vary based on the listening situation and the manufacturer of the CI system. Unlike traditional FM systems with fixed-gain settings, Dynamic FM automatically varies the gain of the FM receiver with changes in the ambient noise level. There are no published reports describing the benefits of Dynamic FM use for CI recipients or how Dynamic FM performance varies as a function of CI manufacturer., Purpose: To evaluate speech recognition of Advanced Bionics Corporation or Cochlear Corporation CI recipients using Dynamic FM vs. a traditional FM system and to examine the effects of Autosensitivity on the FM performance of Cochlear Corporation recipients., Research Design: A two-group repeated-measures design. Participants were assigned to a group according to their type of CI., Study Sample: Twenty-five subjects, ranging in age from 8 to 82 years, met the inclusion criteria for one or more of the experiments. Thirteen subjects used Advanced Bionics Corporation, and 12 used Cochlear Corporation implants., Intervention: Speech recognition was assessed while subjects used traditional, fixed-gain FM systems and Dynamic FM systems., Data Collection and Analysis: In Experiments 1 and 2, speech recognition was evaluated with a traditional, fixed-gain FM system and a Dynamic FM system using the Hearing in Noise Test sentences in quiet and in classroom noise. A repeated-measures analysis of variance (ANOVA) was used to evaluate effects of CI manufacturer (Advanced Bionics and Cochlear Corporation), type of FM system (traditional and dynamic), noise level, and use of Autosensitivity for users of Cochlear Corporation implants. Experiment 3 determined the effects of Autosensitivity on speech recognition of Cochlear Corporation implant recipients when listening through the speech processor microphone with the FM system muted. A repeated-measures ANOVA was used to examine the effects of signal-to-noise ratio and Autosensitivity., Results: In Experiment 1, use of Dynamic FM resulted in better speech recognition in noise for Advanced Bionics recipients relative to traditional FM at noise levels of 65, 70, and 75 dB SPL. Advanced Bionics recipients obtained better speech recognition in noise with FM use when compared to Cochlear Corporation recipients. When Autosensitivity was enabled in Experiment 2, the performance of Cochlear Corporation recipients was equivalent to that of Advanced Bionics recipients, and Dynamic FM was significantly better than traditional FM. Results of Experiment 3 indicate that use of Autosensitivity improves speech recognition in noise of signals directed to the speech processor relative to no Autosensitivity., Conclusions: Dynamic FM should be considered for use with persons with CIs to improve speech recognition in noise. At default CI settings, FM performance is better for Advanced Bionics recipients when compared to Cochlear Corporation recipients, but use of Autosensitivity by Cochlear Corporation users results in equivalent group performance.

Background: The use of bilateral amplification is now common clinical practice for hearing aid users but not for cochlear implant recipients. In the past, most cochlear implant recipients were implanted in one ear and wore only a monaural cochlear implant processor. There has been recent interest in benefits arising from bilateral stimulation that may be present for cochlear implant recipients. One option for bilateral stimulation is the use of a cochlear implant in one ear and a hearing aid in the opposite nonimplanted ear (bimodal hearing)., Purpose: This study evaluated the effect of wearing a cochlear implant in one ear and a digital hearing aid in the opposite ear on speech recognition and localization., Research Design: A repeated-measures correlational study was completed., Study Sample: Nineteen adult Cochlear Nucleus 24 implant recipients participated in the study., Intervention: The participants were fit with a Widex Senso Vita 38 hearing aid to achieve maximum audibility and comfort within their dynamic range., Data Collection and Analysis: Soundfield thresholds, loudness growth, speech recognition, localization, and subjective questionnaires were obtained six-eight weeks after the hearing aid fitting. Testing was completed in three conditions: hearing aid only, cochlear implant only, and cochlear implant and hearing aid (bimodal). All tests were repeated four weeks after the first test session. Repeated-measures analysis of variance was used to analyze the data. Significant effects were further examined using pairwise comparison of means or in the case of continuous moderators, regression analyses. The speech-recognition and localization tasks were unique, in that a speech stimulus presented from a variety of roaming azimuths (140 degree loudspeaker array) was used., Results: Performance in the bimodal condition was significantly better for speech recognition and localization compared to the cochlear implant-only and hearing aid-only conditions. Performance was also different between these conditions when the location (i.e., side of the loudspeaker array that presented the word) was analyzed. In the bimodal condition, the speech-recognition and localization tasks were equal regardless of which side of the loudspeaker array presented the word, while performance was significantly poorer for the monaural conditions (hearing aid only and cochlear implant only) when the words were presented on the side with no stimulation. Binaural loudness summation of 1-3 dB was seen in soundfield thresholds and loudness growth in the bimodal condition. Measures of the audibility of sound with the hearing aid, including unaided thresholds, soundfield thresholds, and the Speech Intelligibility Index, were significant moderators of speech recognition and localization. Based on the questionnaire responses, participants showed a strong preference for bimodal stimulation., Conclusions: These findings suggest that a well-fit digital hearing aid worn in conjunction with a cochlear implant is beneficial to speech recognition and localization. The dynamic test procedures used in this study illustrate the importance of bilateral hearing for locating, identifying, and switching attention between multiple speakers. It is recommended that unilateral cochlear implant recipients, with measurable unaided hearing thresholds, be fit with a hearing aid.

Background: While testing suprathreshold word recognition at multiple levels is considered best practice, studies on practice patterns do not suggest that this is common practice. Audiologists often test at a presentation level intended to maximize recognition scores, but methods for selecting this level are not well established for a wide range of hearing losses., Purpose: To determine the presentation level methods that resulted in maximum suprathreshold phoneme-recognition scores while avoiding loudness discomfort., Research Design: Performance-intensity functions were obtained for 40 participants with sensorineural hearing loss using the Computer-Assisted Speech Perception Assessment. Participants had either gradually sloping (mild, moderate, moderately severe/severe) or steeply sloping losses. Performance-intensity functions were obtained at presentation levels ranging from 10 dB above the SRT to 5 dB below the UCL (uncomfortable level). In addition, categorical loudness ratings were obtained across a range of intensities using speech stimuli. Scores obtained at UCL - 5 dB (maximum level below loudness discomfort) were compared to four alternative presentation-level methods. The alternative presentation-level methods included sensation level (SL; 2 kHz reference, SRT reference), a fixed-level (95 dB SPL) method, and the most comfortable loudness level (MCL). For the SL methods, scores used in the analysis were selected separately for the SRT and 2 kHz references based on several criteria. The general goal was to choose levels that represented asymptotic performance while avoiding loudness discomfort. The selection of SLs varied across the range of hearing losses., Results: Scores obtained using the different presentation-level methods were compared to scores obtained using UCL - 5 dB. For the mild hearing loss group, the mean phoneme scores were similar for all presentation levels. For the moderately severe/severe group, the highest mean score was obtained using UCL - 5 dB. For the moderate and steeply sloping groups, the mean scores obtained using 2 kHz SL were equivalent to UCL - 5 dB, whereas scores obtained using the SRT SL were significantly lower than those obtained using UCL - 5 dB. The mean scores corresponding to MCL and 95 dB SPL were significantly lower than scores for UCL - 5 dB for the moderate and the moderately severe/severe group., Conclusions: For participants with mild to moderate gradually sloping losses and for those with steeply sloping losses, the UCL - 5 dB and the 2 kHz SL methods resulted in the highest scores without exceeding listeners' UCLs. For participants with moderately severe/severe losses, the UCL - 5 dB method resulted in the highest phoneme recognition scores.

Purpose: To measure the subjective and objective improvement of speech intelligibility in noise offered by a commercial hearing aid that uses a fully adaptive directional microphone and a noise reduction algorithm that optimizes the Speech Intelligibility Index (SII)., Research Design: Comparison of results on the Hearing in Noise Test (HINT) and the Acceptable Noise Level task (ANL)., Study Sample: Eighteen participants with varying configurations of sensorineural hearing loss., Results: Both the directional microphone and the noise reduction algorithm improved the speech-in-noise performance of the participants. The benefits reported were higher for the directional microphone than the noise reduction algorithm. A moderate correlation was noted between the benefits measured on the HINT and the ANL for the directional microphone condition, the noise reduction condition, and the directional microphone plus noise reduction conditions., Conclusions: These results suggest that the directional microphone and the SII-based noise reduction algorithm may improve the SNR of the listening environments, and both the HINT and the ANL may be used to study their benefits.

Background: The surgical therapy of acoustic neuromas has been seen critically lately. Alternative methods like the gamma-knife treatment open a wide field of discussion., Patients: The results of 392 patients are presented operated on via a middle fossa approach between 1989 and 2004., Results: Hearing preservation according to the 50:50 rule (hearing loss less than 50 dB in pure tone audiogram 500-1000-2000 Hz, speech discrimination>50%) was possible in 59.7% of patients. A hearing impression up to 90 dB was recognized in 83.1%, 16.9% of cases were deaf. There was no difference between tumors confined to the inner ear canal and tumors extending into the cerebello pontine angle. There was also no difference between tumors up to a volume of 100 mm3 and tumors between 100 mm3 and 500 mm3., Conclusion: Acoustic neuroma confined to the internal meatus or with little extend into the cerebello pontine angle (i. e. no contact to structures of the brain stem or vessels of the posterior fossa) are feasible for resection via the middle fossa approach. The possibility of hearing preservation and low morbidity makes it the treatment of choice for this group of tumors.

Background: Auditory processing disorders involve deficits in the processing of information in the auditory domain that are not due to higher order language, cognitive or other related factors., Purpose: To evaluate the possibility of structural brain abnormalities in preterm children manifesting as auditory processing disorders., Research Design: A case report of a young girl, preterm at birth, with language difficulties, learning problems at school, and additional listening problems., Results: A diagnosis of a central auditory processing disorder was made on the basis of severe deficits in three nonspeech temporal tests (the frequency and duration pattern and the random gap detection tests). Her brain MRI revealed large porencephalic cysts and thinning of the corpus callosum., Conclusions: The observed auditory deficits would be compatible with a pressure effect of the cysts at a brainstem or higher level for the random gap detection test, and with the thinning of the corpus callosum for the pattern tests, the latter requiring interhemispheric transfer of information. The case highlights that preterm children with learning difficulties may suffer from an auditory processing disorder, in the presence of structural brain abnormalities that are due to birth and neonatal complications.

Larson et al (2000) reported the findings of a multicenter, NIDCDNA clinical trial that compared hearing aid performance for three output limiting circuits in 360 adults with symmetrical sensorineural hearing loss. The current study was undertaken to examine long-term hearing aid benefit in this same group of participants following five to six years of hearing aid use. The speech-recognition portion of the follow-up study enrolled 108 participants from the original study, 85% of whom were current hearing aid users and 15% of whom had not worn hearing aids during the past month (nonusers). Recognition performance in sound field on the NU-6 (quiet at 62 dB SPL) and the CST (quiet at 74 dB SPL and with -3 and 3 dB signal-to-babble ratios [S/B] at 62 and 74 dB SPL) was measured unaided and aided whenever possible. Speech-recognition abilities decreased significantly since the original study. Speech-recognition decrements were observed regardless of the speech materials (NU-6 and CST), test condition (quiet and noise), S/B (-3 and 3 dB), or stimulus level (62 and 74 dB SPL). Despite decreases in speech recognition, hearing aid benefit remained largely unchanged since the original study; aided performance exceeded unaided performance regardless of presentation level or noise condition. As in the original study, the relations among stimulus level, S/B, and speech-recognition performance were complex.

The advent of bone-anchored hearing aids with titanium implants has markedly improved patient management. There are two systems on the market for performing the requisite osseointegration. The aim of our study was to evaluate the Ti-Epiplating system, since no data have been published on this in the literature thus far. Between November 2002 and March 2005, we anchored the BAHA snap coupling via the Ti-Epiplating system in 8 patients in a single session. The patients were followed-up at regular intervals to assess clinical and audiometric results and subjective satisfaction. The postoperative hearing threshold with the BAHA was in the former bone conduction range. In the Freiburg speech test, a significant improvement was found for monosyllables (free-field), and the hearing loss for numbers showed a mean reduction from 75 to 30 dB. There has been no implant loss in our collective thus far. Good to very good results were evaluated for the quality of life in the "International Inventory of evaluation of hearing aids" (IIEH). Clinics that use Medicon's osteosynthesis system can safely and reliably achieve inexpensive and audiometrically successful BAHA management by a comparatively simple surgical procedure.

Background: Auditory neuropathy is a disorder characterised by preservation of outer hair cells function with normal otoacoustic emissions (OAEs), but with absent auditory brainstem responses (ABR). Perisynaptic synchronisation disorder is one of the possible pathogenesis underlying auditory neuropathy. In this paper we describe the clinical presentation and audiological findings in pediatric auditory neuropathy and its management., Patients and Methods: 9 children with auditory neuropathy could be included in the study. An audiological evaluation was performed in all children including behavioural audiometry, measurement of the OAEs as well as electrocochleography (ECoG) and ABR recordings. Children who failed to get any benefit from conventional amplification received a cochlear implant. Prior to implantation the responses to electrical stimuli were examined with the promontory test and with the electrically evoked ABR., Results: One child showed auditory neuropathy only on one side with normal hearing thresholds on the contralateral ear. Another child had normal hearing thresholds after the follow up period. Four children received a hearing aid. But variable hearing reactions were observed. Thus in three cases a CI is planned. In three children cochlea implantation was done. Following implantation a remarkable improvement in hearing/speech capabilities with the CI compared to conventional hearing aids were observed in all three cases. Beside, these three children developed open set speech discrimination and are using now oral language for communication., Conclusions: Auditory neuropathy is a disorder which presents with different clinical and audiological findings. Thus the management of this disorder must be an individual one. In light of our findings we support the use of cochlear implants as an option for children with auditory neuropathy in cases where conventional amplification does not work sufficiently.

Background: APDs at infancy has become a common reason of introduction at phoniatric/pedaudiologic departments. The question arises whether this neurocognitive construct can be accounted with the standard clinical diagnostics., Methods: The children with suspicion of APD referred to the Department of Phoniatrics/Pedaudiology at the University Hospital Goettingen/Germany were clinically examined., Patients: Of 107 children 8 % demonstrated abnormal hearing acuity, 7 % learning and intelligence disorders, 7 % developmental dyslexia, 6 % language impairments, and 5 % attention deficit/hyperactivity. So, 59 children remained for evaluating for an APD (mean age: 85.3; SD 16.3 months)., Results: Their auditory performances were normdeviant from 7 % (speech audiometry) to 86 % (auditory sequential short-term memory for non-words). 55 % of the children exhibited a reduced dichotic word discrimination, 59 % a performance below norm level in auditory sequential memory for digits, and 86 % for non-words. Next step, the children of the study group were distributed according to their therapy situations at the time of examination: without; speech therapy; occupational therapy; speech therapy + occupational therapy. No significant group effects were found in the mean performances of the audiometric and psychometric tests, even though the results considerably differed. No auditory dimension made a contribution to separate the groups in a stepwise discriminant analysis., Conclusions: There was a notably inherent heterogeneity of the population presenting with auditory processing problems. The overall objective of the APD evaluation must be to assess processing skills apart from complex stimuli like language skills (e. g. parameter of tones, memory of tone pitch).

Acceptable noise level (ANL) measures a listener's reaction to background noise while listening to speech. Relations among hearing aid use and ANL, speech in noise (SPIN) scores, and listener characteristics (age, gender, pure-tone average) were investigated in 191 listeners with hearing impairment. Listeners were assigned to one of three groups based on patterns of hearing aid use: full-time use (whenever hearing aids are needed), part-time use (occasional use), or nonuse. Results showed that SPIN scores and listener characteristics were not related to ANL or hearing aid use. However, ANLs were related to hearing aid use. Specifically, full-time hearing aid users accepted more background noise than part-time users or nonusers, yet part-time users and nonusers could not be differentiated. Thus, a prediction of hearing aid use was examined by comparing part-time users and nonusers (unsuccessful hearing aid users) with full-time users (successful hearing aid users). Regression analysis determined that unaided ANLs could predict a listener's success of hearing aids with 85% accuracy.

Almost half of the population with multiple sclerosis (MS) complains of difficulty hearing, despite having essentially normal pure-tone thresholds. The purpose of the present investigation was to evaluate the effects of frequency-modulation (FM) technology utilization on speech perception in noise for adults with and without MS. Sentence material was presented at a constant level of 65 dBA Leq from a loudspeaker located at 0 degrees azimuth. The microphone of the FM transmitter was placed 7.5 cm from this loudspeaker. Multitalker babble was presented from four loudspeakers positioned at 45 degrees, 135 degrees, 225 degrees, and 315 degrees azimuths. The starting presentation level for the babble was 55 dBA Leq, The level of the noise was increased systematically in 1 dB steps until the subject obtained 0% key words correct on the IEEE (Institute for Electrical and Electronic Engineers) sentences. Test results revealed significant differences between the unaided and aided conditions at several signal-to-noise ratios.

A 46-year-old white male diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) was seen for audiological testing 15 minutes following a sudden onset hearing loss in the right ear. The test battery included pure-tone audiometry, word-recognition testing, speech-recognition threshold (SRT) testing, immittance testing, and distortion-product otoacoustic emissions (DPOAE) testing. Testing revealed a sensorineural hearing loss in the right ear. Shortly after testing, the patient indicated that his condition had improved. Testing was repeated, and the second round of tests revealed normal hearing in both ears. Four days later, a follow-up test again indicated normal hearing in both ears. Possible connections of this brief occurrence of idiopathic hearing loss with the patient's medical conditions are discussed. Specifically, symptoms were consistent with a transient ischemic attack (TIA) affecting his right cochlea in the stria vascularis region, resulting in a temporary, sensorineural hearing loss. No residual effects were observed clinically.

The goal of this study was to identify specific neurocognitive deficits that are associated with older listeners' difficulty understanding rapid speech. Older listeners performed speech recognition tests comprised of time-compressed sentences with and without context, and on a neurocognitive battery aimed specifically at testing working memory, processing speed, and attention. A principle component analysis identified three main cognitive components as follows: a sequencing working memory (WM-S) component, a nonsequencing working memory (WM-NS) component, and a processing speed (PS) component. Each of the cognitive component scores was divided into high, mid, and low categories. Sentence performance of the cognitive subgroups was compared within each component. The results showed that, with hearing loss and age accounted for, the cognitive score groups differed similarly on the sentence condition scores also at 50 and 60% time compression, particularly on the subgroups of the WM-S component. The results suggest that deficits in a separate working memory function identified as sequencing were associated with differences in ability to understand time-compressed speech in this study.

This clinical trial was undertaken to evaluate the subjective benefit obtained from hearing aids employing automatic switching second-order adaptive directional microphone technology, used in conjunction with digital noise reduction, as compared to a fixed directional microphone or omnidirectional microphone response with the same digital noise reduction. Data were collected for 49 participants across two sites. Both new and experienced hearing aid users were fit bilaterally with behind-the-ear hearing aids using the NAL-NL1 (National Acoustics Laboratory-Nonlinear version 1) prescriptive method with manufacturer default settings for various signal processing (e.g., noise reduction, compression parameters, etc.). During ten days of hearing aid use, participants responded to daily journal questions. Subjective ratings for each of the three hearing aid responses (omnidirectional, automatic-adaptive directional, and automatic-fixed directional) were similar. Overall preference for a microphone condition was equally distributed between no preference, omnidirectional, and automatic adaptive and/or fixed directional.

The present study examined auditory event-related potential (ERP) responses to sentence-embedded syntactic (phrase structure) and semantic violations. Syntactic violations were found to elicit a centroparietal negativity peaking at around 350 msec, followed by a P600. Semantic anomalies elicited an N400 as well as a late centroparietally distributed positivity. The shorter latency and different morphology of the negativity observed in response to phrase structure violations compared to semantic anomalies indicate that the observed negativities are to some extent functionally different, suggesting that phrase structure information is processed prior to lexical-semantic information. The finding of a P600 in response to semantic anomalies suggests that the latter component reflects processes of reprocessing that are based on syntactic and semantic aspects of the sentence.