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The aim of this article is to describe the audiological patterns of 71 adult patients presenting severe to profound sensorineural hearing loss, who were rehabilitated by cochlear implants (CIs) and hearing aids. This is a retrospective study in a university setting, where the clinical records of 71 adult patients were reviewed and processed. Speech intelligibility was evaluated at one aided ear (CI) or at both aided ears (double CI or a combination of CI and hearing aid [HA]). Patients with a bilateral CI or with a bimodal hearing setup (CI and HA) performed better than those with a single CI; data from the phonetic matrices test showed that there was a statistically significant difference among patients aided by a single CI versus binaural setup (double CI or CI + HA). In particular, patients aided by a bilateral CI, or by a CI and HA, showed an improvement in the functional results of the speech tests, compared to patients using a single CI. Binaural hearing (either with a bilateral CI or bimodal) allows an improvement in the functional results at the speech tests, compared to the use of a CI only.

Objectives: This study aimed to evaluate hearing outcomes and device safety in a large, single-surgeon experience with the totally implantable active middle-ear implants., Methods: This was a retrospective case series review of 116 patients with moderate-to-severe sensorineural hearing loss undergoing implantation of active middle-ear implants., Results: Mean baseline unaided pure tone average improved from 57.6 dB before surgery to 34.1 dB post-operatively, signifying a mean gain in pure tone average of 23.5 dB (p = 0.0002). Phonetically balanced maximum word recognition score improved slightly from 70.5 per cent to 75.8 per cent (p = 0.416), and word recognition score at a hearing level of 50 dB values increased substantially from 14.4 per cent to 70.4 per cent (p < 0.0001). Both revision and explant rates were low and dropped with increasing surgeon experience over time., Conclusion: This study showed excellent post-operative hearing results with active middle-ear implants with regard to pure tone average and word recognition score at a hearing level of 50 db. Complication rates in this case series were significantly lower with increasing experience of the surgeon. Active middle-ear implants should be considered in appropriate patients with moderate-to-severe sensorineural hearing loss who have struggled with conventional amplification and are good surgical candidates.

Objectives: To evaluate the effects of an adhesive adapter prosthesis (AAP) on memory function in pediatric subjects with single side hearing loss (SSHL)., Materials and Methods: Case-control study. 19 pediatric subjects with mild to moderate SSHL treated with AAP and 15 subjects with normal hearing (control group) were included in this study. Working and short-term memory functions were tested in all subjects, in silence and noise conditions. In SSHL subjects, tests were performed before the AAP was applied (T0) and at 1-month (T1) follow-up. The control group was tested once., Results: AAP significantly improved working memory function in noise as measured at T1 (p<0.01) compared with T0, but T1 scores in children with SSHL remained significantly different from the ones of the control group (p<0.01). AAP also significantly improved short- term memory function test scores at T1 compared with T0 (p<0.01), but despite being in the normal range for the subjects' age, the scores remained significantly different from those of the control group (p<0.01)., Conclusion: In pediatric subjects with mild, moderate, and moderate-severe SSHL, restoration of bilateral hearing through AAP improved short-term memory function and working memory function in noise, as measured at 1 month follow-up; however, AAP did not seem to lead to a full restoration of such functions as measured by a comparison with healthy controls. Further studies with longer follow-ups might help elucidate whether AAP can elicit further improvements in memory functions.

Objective: The purpose of the present study was to examine the effects of NLFC fitting in hearing aids and auditory acclimatisation on speech perception and sound-quality rating in hearing-impaired, native Mandarin-speaking adult listeners. Design: Mandarin consonant, vowel and tone recognition were tested in quiet and sentence recognition in noise (speech-shaped noise at a +5 dB signal-to-noise ratio) with NLFC-on and NLFC-off. Sound-quality ratings were collected on a 0-10 scale at each test session. A generalised linear model and correlational analyses were performed. Study sample: Thirty native Mandarin-speaking adults with moderate-to-severe sensorineural hearing loss were recruited. Results: The hearing-impaired listeners showed significantly higher accuracy with NLFC-on than with NLFC-off for consonant and sentence recognition and the recognition performance improved with both NLFC-on and off as a function of increased length of use. The satisfaction score of sound-quality ratings for different types of sounds significantly increased with NLFC-on than with NLFC-off. The speech recognition results showed moderate to strong correlation with the unaided hearing thresholds. Conclusion: For native Mandarin-speaking listeners with hearing loss, the NLFC technology provided modest but significant improvement in Mandarin fricative and sentence recognition. Subjectively, the naturalness and overall preference of sound-quality satisfaction judgement also improved with NLFC.

The use of hearing aid (HA) may improve the hearing performance and ease the perceived negative consequences of hearing difficulties in elderly individuals. The aim of this study was to determine the problems experienced by elderly individuals with HA and to investigate the factors that could increase the use of HA. A total of 122 female and 127 male patients with a mean age of 76.79 ± 6.91 years who were recommended HA were evaluated. The following details were taken from the patients: age, gender, duration of hearing complaint, whether or not they received HA, number of family members, number of hours they used HA in a day, type of device, number of ears with HA, educational status, whether they continued to work, whether they were tested before taking the device, the reasons for not taking HA, and the reasons that reduce their use of HA. A total of 18 patients did not receive HA for the following reasons: 9 considered HA too expensive, 8 thought it would be difficult to use HA, and 1 did not like it because of its appearance. No significant difference was found in the patients' daily HA use duration, age, sex, number of immediate family members, education level, type of device, test before taking the device, and use of HA in single ear or bilateral ears. There was a significant difference in the daily HA use duration and whether the patients continued to work. We need to help reduce the problems associated with the use of HA to help older individuals have a more active role in society and help them in their health problems.

Objective: For a group of bimodal subjects with moderate to severe hearing loss contralateral to the cochlear implant (CI), the bimodal benefit of the hearing aid (HA) gain prescriptions DSL v5.0, NAL-NL2 and the recipients' own gain setting were assessed. Design: Speech perception in quiet and in noise as well as self-reported ratings of benefit were determined for all three gain-settings. Speech tests were performed in the bimodal, the HA alone and the CI alone condition. The bimodal benefit was assessed for each prescription as the difference score of the bimodal condition and the better ear. Study Sample: Twenty adults with post-lingual hearing loss. Results: Speech perception with DSL v5.0 was significantly higher compared to NAL-NL2 and the own prescription in both quiet and noise. The median bimodal benefit was highest for DSL v5.0 with an average of 15 percentage points for both words in quiet and sentences in noise. Conclusions: DSL v5.0 and NAL-NL2 are both suitable for HA fitting in bimodal users. For subjects with moderate to severe hearing loss and HA experience contralateral to the implanted side, DSL v5.0 may provide better speech perception and bimodal benefit.

Objective: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia., Study Design: Cost-effectiveness analysis., Setting: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study., Subjects and Methods: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3., Results: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39)., Conclusion: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.

Objective: To assess the audiological and long-term medical and technical follow-up outcomes of an active middle ear implant., Methods: This was a retrospective medical chart analysis of all patients provided with an active middle ear implant in a tertiary academic medical referral center between September 1, 1998, and July 31, 2015. Main outcome measures were medical and technical complications, revisions, reimplantations, explantations, coupling approaches, mean time of use, pre- and postoperative hearing thresholds, functional hearing gain across frequencies (250-4,000 Hz), and Freiburg monosyllablic word test at 65 dB., Results: One hundred and three patients were identified. Fifteen were implanted bilaterally (n = 118 Vibrant Soundbridge devices [MED-EL, Innsbruck, Austria]). Seventy-seven devices were implanted for sensorineural and 41 for mixed and conductive hearing loss. Patients used the implant for 6.7 years (range 0.7 months-17.9 years) on average. Ninety-one patients (77.12%) were using the device at the end of the observation period. An overall complication rate of 16.1% was observed. The revision and explantation rates were higher for devices implanted between 2004 and 2006. The device failure rate was 3.4%. Audiological evaluation showed significant hearing gains for both hearing loss patient groups., Conclusion: This long-term follow-up reveals the reliability of the active middle ear implant in a single center. Overall complication rate and device failure rate are acceptable. The complication rate was higher during implementation of alternative coupling approaches. The audiological benefit was satisfactory in patients with all hearing loss types. The majority of implanted patients used the implant at the end of the observation period., Level of Evidence: 4 Laryngoscope, 129:477-481, 2019., (© 2018 The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Clinicians have long used self-report methods to assess hearing aid benefit. However, there are fewer data as to whether self-report instruments can be used to compare differences between signal processing settings. This study examined how self-perceived performance varied as a function of modifications in signal processing using two self-report measures. Data were collected as part of a double-blind randomised crossover clinical trial. Participants were fit with two fittings: mild processing (slow time constants, disabled frequency lowering) and strong processing (fast time constants, frequency lowering enabled). The speech, spatial, and qualities of hearing (SSQ) questionnaire and the Effectiveness of Auditory Rehabilitation (EAR) questionnaire were collected at multiple time points. Older adults with sensorineural hearing loss who had not used hearing aids within the previous year participated (49 older adults were consented; 40 were included in the final data analyses). Findings show that listeners report a difference in perceived performance when hearing aid features are modified. Both self-report measures were able to capture this change in perceived performance. Self-report measures provide a tool for capturing changes in perceived performance when hearing aid processing features are modified and may enhance provision of an evidence-based hearing aid fitting.

Recent studies have shown that activating the noise reduction scheme in hearing aids results in a smaller peak pupil dilation (PPD), indicating reduced listening effort, at 50% and 95% correct sentence recognition with a 4-talker masker. The objective of this study was to measure the effect of the noise reduction scheme (on or off) on PPD and sentence recognition across a wide range of signal-to-noise ratios (SNRs) from +16 dB to -12 dB and two masker types (4-talker and stationary noise). Relatively low PPDs were observed at very low (-12 dB) and very high (+16 dB to +8 dB) SNRs presumably due to 'giving up' and 'easy listening', respectively. The maximum PPD was observed with SNRs at approximately 50% correct sentence recognition. Sentence recognition with both masker types was significantly improved by the noise reduction scheme, which corresponds to the shift in performance from SNR function at approximately 5 dB toward a lower SNR. This intelligibility effect was accompanied by a corresponding effect on the PPD, shifting the peak by approximately 4 dB toward a lower SNR. In addition, with the 4-talker masker, when the noise reduction scheme was active, the PPD was smaller overall than that when the scheme was inactive. We conclude that with the 4-talker masker, noise reduction scheme processing provides a listening effort benefit in addition to any effect associated with improved intelligibility. Thus, the effect of the noise reduction scheme on listening effort incorporates more than can be explained by intelligibility alone, emphasizing the potential importance of measuring listening effort in addition to traditional speech reception measures., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Model-based hearing aid development considers the assessment of speech recognition using a master hearing aid (MHA). It is known that aided speech recognition in noise is related to cognitive factors such as working memory capacity (WMC). This relationship might be mediated by hearing aid experience (HAE). The aim of this study was to examine the relationship of WMC and speech recognition with a MHA for listeners with different HAE., Design: Using the MHA, unaided and aided 80% speech recognition thresholds in noise were determined. Individual WMC capacity was assed using the Verbal Learning and Memory Test (VLMT) and the Reading Span Test (RST)., Study Sample: Forty-nine hearing aid users with mild to moderate sensorineural hearing loss divided into three groups differing in HAE., Results: Whereas unaided speech recognition did not show a significant relationship with WMC, a significant correlation could be observed between WMC and aided speech recognition. However, this only applied to listeners with HAE of up to approximately three years, and a consistent weakening of the correlation could be observed with more experience., Conclusions: Speech recognition scores obtained in acute experiments with an MHA are less influenced by individual cognitive capacity when experienced HA users are taken into account.

Objective: Loudness perception of binaural broadband signals, e.g. speech shaped noise, shows large individual differences using frequency-dependent amplification which was adjusted to restore the loudness perception of monaural narrowband signals in hearing-impaired (HI) listeners. To better understand and quantify this highly individual effect, loudness perception of broadband stimuli consisting of a number of spectrally separated narrowband components which where individually adjusted to equal loudness is of interest., Design: Based on categorical loudness scaling, the loudness of an equal categorical loudness noise (ECLN) consisting of six third-octave noises was assessed. For loudness categories "medium" und "very loud" the required narrowband loudness was analysed., Study Sample: Nine normal-hearing (NH) and ten HI listeners., Results: HI listeners showed lower narrowband loudness values compared to NH listeners, indicating an increased spectral loudness summation. More than 50% of the HI listeners showed higher binaural spectral loudness summation compared to NH listeners. The amount of binaural spectral loudness summation was highly correlated (r 2  = 0.92) with the loudness level at "very loud" of aided speech shaped noise., Conclusions: The suggested ECLN measurement is suited to assess individual (binaural) broadband loudness in aided conditions, providing valuable information for hearing-aid fitting.

Objective: Binaural cues such as interaural level differences (ILDs) are used to organise auditory perception and to segregate sound sources in complex acoustical environments. In bilaterally fitted hearing aids, dynamic-range compression operating independently at each ear potentially alters these ILDs, thus distorting binaural perception and sound source segregation., Design: A binaurally-linked model-based fast-acting dynamic compression algorithm designed to approximate the normal-hearing basilar membrane (BM) input-output function in hearing-impaired listeners is suggested. A multi-center evaluation in comparison with an alternative binaural and two bilateral fittings was performed to assess the effect of binaural synchronisation on (a) speech intelligibility and (b) perceived quality in realistic conditions., Study Sample: 30 and 12 hearing impaired (HI) listeners were aided individually with the algorithms for both experimental parts, respectively., Results: A small preference towards the proposed model-based algorithm in the direct quality comparison was found. However, no benefit of binaural-synchronisation regarding speech intelligibility was found, suggesting a dominant role of the better ear in all experimental conditions., Conclusion: The suggested binaural synchronisation of compression algorithms showed a limited effect on the tested outcome measures, however, linking could be situationally beneficial to preserve a natural binaural perception of the acoustical environment.

A review about technical and perceptual factors in hearing aid technology, research and development is provided, covering current commercial solutions, underlying models of hearing loss for usage in hearing devices and emerging future technical solutions for hearing aid functionalities. A chain of techniques has provided incremental, but steady increases in user benefit, e.g. in the fields of hearing aid amplification, feedback suppression, dynamic compression, noise reduction and situation adaptation. The models describing the perceptual consequences of sensorineural hearing impairment describe the effects on the acoustical level, the neurosensory level and the cognitive level and provide the framework for compensatory (or even substitutional) functions of hearing aids in terms of the attenuation component, the distortion component and the neural component of the hearing loss. A major factor is the requirement of a strong individualisation of hearing aid solutions calling for an appropriate assessment of the different sensorineural components of a hearing loss, especially with respect to bilateral and binaural hearing aid solutions.

Objective: Single-channel noise reduction (SCNR) and dynamic range compression (DRC) are important elements in hearing aids. Only relatively few studies have addressed interaction effects and typically used real hearing aids with limited knowledge about the integrated algorithms. Here the potential benefit of different combinations and integration of SCNR and DRC was systematically assessed., Design: Ten different systems combining SCNR and DRC were implemented, including five serial arrangements, a parallel and two multiplicative approaches. In an instrumental evaluation, signal-to-noise ratio (SNR) improvement and spectral contrast enhancement (SCE) were assessed. Quality ratings at 0 and +6 dB SNR, and speech reception thresholds (SRTs) in noise were measured using stationary and babble noise., Study Sample: Thirteen young normal-hearing (NH) listeners and 12 hearing-impaired (HI) listeners participated., Results: In line with an increased segmental SNR and spectral contrast compared to a serial concatenation, the parallel approach significantly reduced the perceived noise annoyance for both subject groups. The proposed multiplicative approaches could partly counteract increased speech distortions introduced by DRC and achieved the best overall quality for the HI listeners., Conclusions: For high SNRs well above the individual SRT, the specific combination of SCNR and DRC is perceptually relevant and the integrative approaches were preferred.

Objective: To investigate the influence of an algorithm designed to enhance or magnify interaural difference cues on speech signals in noisy, spatially complex conditions using both technical and perceptual measurements. To also investigate the combination of interaural magnification (IM), monaural microphone directionality (DIR), and binaural coherence-based noise reduction (BC)., Design: Speech-in-noise stimuli were generated using virtual acoustics. A computational model of binaural hearing was used to analyse the spatial effects of IM. Predicted speech quality changes and signal-to-noise-ratio (SNR) improvements were also considered. Additionally, a listening test was carried out to assess speech intelligibility and quality., Study Sample: Listeners aged 65-79 years with and without sensorineural hearing loss (N = 10 each)., Results: IM increased the horizontal separation of concurrent directional sound sources without introducing any major artefacts. In situations with diffuse noise, however, the interaural difference cues were distorted. Preprocessing the binaural input signals with DIR reduced distortion. IM influenced neither speech intelligibility nor speech quality., Conclusions: The IM algorithm tested here failed to improve speech perception in noise, probably because of the dispersion and inconsistent magnification of interaural difference cues in complex environments.

Objectives: Previous studies show that intracochlear electrical stimulation independent of environmental sounds appears to suppress tinnitus, even long-term. In order to assess the viability of this potential treatment option it is essential to study the effects of this tinnitus specific electrical stimulation on speech perception., Design: A randomised, prospective crossover design., Study Sample: Ten patients with unilateral or asymmetric hearing loss and severe tinnitus complaints., Results: The audiological effects of standard clinical CI, formal auditory training and tinnitus specific electrical stimulation were investigated. Results show that standard clinical CI in unilateral or asymmetric hearing loss is shown to be beneficial for speech perception in quiet, speech perception in noise and subjective hearing ability. Formal auditory training does not appear to improve speech perception performance. However, CI-related discomfort reduces significantly more rapidly during CI rehabilitation in subjects receiving formal auditory training. Furthermore, tinnitus specific electrical stimulation has neither positive nor negative effects on speech perception., Conclusions: In combination with the findings from previous studies on tinnitus suppression using intracochlear electrical stimulation independent of environmental sounds, the results of this study contribute to the viability of cochlear implantation based on tinnitus complaints.

Objective: To compare preference for and performance of manually selected programmes to an automatic sound classifier, the Phonak AutoSense OS., Design: A single blind repeated measures study. Participants were fit with Phonak Virto V90 ITE aids; preferences for different listening programmes were compared across four different sound scenarios (speech in: quiet, noise, loud noise and a car). Following a 4-week trial preferences were reassessed and the users preferred programme was compared to the automatic classifier for sound quality and hearing in noise (HINT test) using a 12 loudspeaker array., Study Sample: Twenty-five participants with symmetrical moderate-severe sensorineural hearing loss., Results: Participant preferences of manual programme for scenarios varied considerably between and within sessions. A HINT Speech Reception Threshold (SRT) advantage was observed for the automatic classifier over participant's manual selection for speech in quiet, loud noise and car noise. Sound quality ratings were similar for both manual and automatic selections., Conclusions: The use of a sound classifier is a viable alternative to manual programme selection.

The relevance of the problem of a sensorineural hearing loss (ASNL) arises from the necessity of the special approaches to the diagnostics of this condition, the complications accompanying this pathology, and the difficulties encountered in the implementation of the methods designed for hearing rehabilitation of such patients. The objective of the present study was to estimate the prevalence of ASHL among the adult population. The sensorineural impairment of hearing was diagnosed in a total of 2456 (72%) examined patients presenting with hearing loss. To determine the presence of asymmetry of sensorineural hearing loss, we employed three counting techniques allowing (1) to calculate the difference between the average hearing thresholds at four frequencies within the range from 0.5 to 4 kHz (the difference was found to be 15 dB or more in 17% of the patients), (2) to calculate the difference between the degrees of hearing loss in the right and left ears (the difference was documented in 47% of the patients), (3) to calculate the difference between the hearing thresholds at least at a single frequency within the range from 0.125 to 8 kHz (he difference was found to be 15 dB or more in 71% of the patients). When using the third method to characterize asymmetry of hearing impairment, it was identified in most patients (53%) at one or two frequencies. Moreover, there was a large number of the patients (13%) with asymmetry apparent over the entire frequency range. A high degree of threshold asymmetry (in excess of 40 dB) was more often noted in the mid-frequency range. In the majority of the patients, the asymmetry manifested itself as the different degree of bilateral sensorineural hearing impairment (51%) or unilateral sensorineural hearing loss with the normal hearing ability preserved in the contralateral ear (35%). The results of the present study give evidence of the necessity of developing a reliable method for the identification of clinically significant ACNL.

The objective of this study was to assess the effectiveness of rehabilitation of hearing impaired elderly patients using hearing aids with frequency lowering technology called Frequency Composition ™. 23 hearing aid users (mean age 64 years) with moderate to severe sensorineural hearing loss were tested. All participants were divided into two groups according to configuration of audiogram: 11 people with averaged slope of 27,9 dB per an octave within frequency range of 1-2 kHz (the 1st group) and 12 people with slope of 24,1 dB at 2-4 kHz (the 2nd group). Average speech tests scores of the 1st group were significantly worse than for the 2nd group (p<0,05 in quiet; p<0,01 in noise). It has been seen that the 1st group had significant better improvement of speech understanding using of Frequency Composition™ than the 2nd group. It has been shown that frequency lowering can improve perception of high frequency sounds and enhance speech intelligibility especially in patients with audiogram slope within frequency range of 1-2 kHz. To effective use of frequency lowering technology a careful selection of patients and adaptation to the new algorithm of amplification are required.

Objective: The purpose of this study was to evaluate the effects of directional microphone use on laboratory measures of sentence recognition, listening effort and localisation. An additional purpose of this study was to evaluate the effects of asymmetric directional microphone use on the same laboratory measures., Design: Three hearing aid conditions were evaluated: (1) bilateral omnidirectional microphones, (2) bilateral directional microphones and (3) asymmetric microphones (directional microphone for only one hearing aid). Sentence recognition performance was evaluated using a connected speech test. Listening effort was evaluated using a dual-task paradigm with a response time-based secondary task requiring word categorisation. Localisation was examined using a complex task requiring localisation and recall of speech originating from one of four loudspeakers in the horizontal plane (-60°, -45°, +45°, +60°)., Study Sample: Eighteen adults (M = 61.8 years) with symmetrical, moderate-to-severe hearing loss participated., Results: Performance on each task was analysed separately using a repeated measures analysis of variance. Results revealed directional benefits for sentence recognition and listening effort, but microphone setting did not affect localisation. Performance was equivalent with symmetric and asymmetric directional configurations., Conclusions: Bilateral and asymmetric directional microphone configurations equally improved sentence recognition and listening effort; neither affected localisation or recall.

A hearing-aid strategy that combines a beamforming microphone array in the high frequencies with natural binaural signals in the low frequencies was examined. This strategy attempts to balance the benefits of beamforming (improved signal-to-noise ratio) with the benefits of binaural listening (spatial awareness and location-based segregation). The crossover frequency was varied from 200 to 1200 Hz, and performance was compared to full-spectrum binaural and beamformer conditions. Speech intelligibility in the presence of noise or competing speech was measured in listeners with and without hearing loss. Results showed that the optimal crossover frequency depended on the listener and the nature of the interference.

Individuals with hearing impairment have particular difficulty perceptually segregating concurrent voices and understanding a talker in the presence of a competing voice. In contrast, individuals with normal hearing perform this task quite well. This listening situation represents a very different problem for both the human and machine listener, when compared to perceiving speech in other types of background noise. A machine learning algorithm is introduced here to address this listening situation. A deep neural network was trained to estimate the ideal ratio mask for a male target talker in the presence of a female competing talker. The monaural algorithm was found to produce sentence-intelligibility increases for hearing-impaired (HI) and normal-hearing (NH) listeners at various signal-to-noise ratios (SNRs). This benefit was largest for the HI listeners and averaged 59%-points at the least-favorable SNR, with a maximum of 87%-points. The mean intelligibility achieved by the HI listeners using the algorithm was equivalent to that of young NH listeners without processing, under conditions of identical interference. Possible reasons for the limited ability of HI listeners to perceptually segregate concurrent voices are reviewed as are possible implementation considerations for algorithms like the current one.

The masking release (i.e., better speech recognition in fluctuating compared to continuous noise backgrounds) observed for normal-hearing (NH) listeners is generally reduced or absent in hearing-impaired (HI) listeners. One explanation for this lies in the effects of reduced audibility: elevated thresholds may prevent HI listeners from taking advantage of signals available to NH listeners during the dips of temporally fluctuating noise where the interference is relatively weak. This hypothesis was addressed through the development of a signal-processing technique designed to increase the audibility of speech during dips in interrupted noise. This technique acts to (i) compare short-term and long-term estimates of energy, (ii) increase the level of short-term segments whose energy is below the average energy, and (iii) normalize the overall energy of the processed signal to be equivalent to that of the original long-term estimate. Evaluations of this energy-equalizing (EEQ) technique included consonant identification and sentence reception in backgrounds of continuous and regularly interrupted noise. For HI listeners, performance was generally similar for processed and unprocessed signals in continuous noise; however, superior performance for EEQ processing was observed in certain regularly interrupted noise backgrounds.

Old, hearing-impaired listeners generally benefit little from lateral separation of multiple talkers when listening to one of them. This study aimed to determine how spatial release from masking (SRM) in such listeners is affected when the interaural time differences (ITDs) in the temporal fine structure (TFS) are manipulated by tone-vocoding (TVC) at the ears by a master hearing aid system. Word recall was compared, with and without TVC, when target and masker sentences from a closed set were played simultaneously from the front loudspeaker (co-located) and when the maskers were played 45° to the left and right of the listener (separated). For 20 hearing-impaired listeners aged 64 to 86, SRM was 3.7 dB smaller with TVC than without TVC. This difference in SRM correlated with mean audiometric thresholds below 1.5 kHz, even when monaural TFS sensitivity (discrimination of frequency-shifts in identically filtered complexes) was partialed out, suggesting that low-frequency audiometric thresholds may be a good indicator of candidacy for hearing aids that preserve ITDs. The TVC difference in SRM was not correlated with age, pure-tone ITD thresholds, nor fundamental frequency difference limens, and only with monaural TFS sensitivity before control for low-frequency audiometric thresholds.

This study investigated the effects of fast-acting hearing-aid compression on normal-hearing and hearing-impaired listeners' spatial perception in a reverberant environment. Three compression schemes-independent compression at each ear, linked compression between the two ears, and "spatially ideal" compression operating solely on the dry source signal-were considered using virtualized speech and noise bursts. Listeners indicated the location and extent of their perceived sound images on the horizontal plane. Linear processing was considered as the reference condition. The results showed that both independent and linked compression resulted in more diffuse and broader sound images as well as internalization and image splits, whereby more image splits were reported for the noise bursts than for speech. Only the spatially ideal compression provided the listeners with a spatial percept similar to that obtained with linear processing. The same general pattern was observed for both listener groups. An analysis of the interaural coherence and direct-to-reverberant ratio suggested that the spatial distortions associated with independent and linked compression resulted from enhanced reverberant energy. Thus, modifications of the relation between the direct and the reverberant sound should be avoided in amplification strategies that attempt to preserve the natural sound scene while restoring loudness cues.

The abilities of 59 adult hearing-aid users to hear phonetic details were assessed by measuring their abilities to identify syllable constituents in quiet and in differing levels of noise (12-talker babble) while wearing their aids. The set of sounds consisted of 109 frequently occurring syllable constituents (45 onsets, 28 nuclei, and 36 codas) spoken in varied phonetic contexts by eight talkers. In nominal quiet, a speech-to-noise ratio (SNR) of 40 dB, scores of individual listeners ranged from about 23% to 85% correct. Averaged over the range of SNRs commonly encountered in noisy situations, scores of individual listeners ranged from about 10% to 71% correct. The scores in quiet and in noise were very strongly correlated, R = 0.96. This high correlation implies that common factors play primary roles in the perception of phonetic details in quiet and in noise. Otherwise said, hearing-aid users' problems perceiving phonetic details in noise appear to be tied to their problems perceiving phonetic details in quiet and vice versa.

We conducted a retrospective study to determine the success rate of initial fittings in digital hearing aid (DHA) users. We also addressed the implications of national health systems' continuing to provide access to these devices. We identified 1,597 consecutively presenting adults who had undergone a first fitting or a new fitting (i.e., an upgrade from an analogue hearing aid in the first or second ear) of a behind-the-ear DHA during the previous year. We further sought to identify all nominal reprogram appointments that had taken place within 6 months after the first or new fitting; we found 460 such appointments (28.8%). Of these, 419 appointments had been for typical reasons other than patient dissatisfaction with the fitting itself-for example, poor hearing, a further hearing loss, an uncomfortably loud hearing aid level, difficulty with speech in noise, an imbalance between bilateral hearing aids, and a faulty or lost hearing aid. Only 41 of the 1,597 first or new fittings (2.6%) were considered unsatisfactory by patients and necessitated a follow-up reprogramming appointment. Overall, DHA fittings were generally successful, as most patients (1,137/1,597 [71.2%]) did not require any follow-up appointment during the study period. Principles of cost-effectiveness demand the maximum practicable efficiency in the utilization of resources to ensure the continuous delivery of high-quality audiologic services through national health systems. This can be achieved by scheduling group appointments to reduce costs and to increase the time allocated to fitting and training patients.

Objective: The objective was to assess the degradation of speech sound quality produced by frequency compression for listeners with extensive high-frequency dead regions (DRs)., Design: Quality ratings were obtained using values of the starting frequency (Sf) of the frequency compression both below and above the estimated edge frequency, f e , of each DR. Thus, the value of Sf often fell below the lowest value currently used in clinical practice. Several compression ratios were used for each value of Sf. Stimuli were sentences processed via a prototype hearing aid based on Phonak Exélia Art P., Study Sample: Five participants (eight ears) with extensive high-frequency DRs were tested., Results: Reductions of sound-quality produced by frequency compression were small to moderate. Ratings decreased significantly with decreasing Sf and increasing CR. The mean ratings were lowest for the lowest Sf and highest CR. Ratings varied across participants, with one participant rating frequency compression lower than no frequency compression even when Sf was above f e ., Conclusions: Frequency compression degraded sound quality somewhat for this small group of participants with extensive high-frequency DRs. The degradation was greater for lower values of Sf relative to f e , and for greater values of CR. Results varied across participants.

Objective: To compare loudness and tone-quality ratings for sounds processed via a simulated five-channel compression hearing aid fitted using NAL-NL2 or using a modification of the fitting designed to be appropriate for the type of listening situation: speech in quiet, speech in noise, music, and noise alone., Design: Ratings of loudness and tone quality were obtained for stimuli presented via a loudspeaker in front of the participant. For normal-hearing participants, levels of 50, 65, and 80 dB SPL were used. For hearing-impaired participants, the stimuli were processed via a simulated hearing aid with five-channel fast-acting compression fitted using NAL-NL2 or using a modified fitting. Input levels to the simulated hearing aid were 50, 65, and 80 dB SPL. All participants listened with one ear plugged. For speech in quiet, the modified fitting was based on the CAM2B method. For speech in noise, the modified fitting used slightly (0 to 2 dB) decreased gains at low frequencies. For music, the modified fitting used increased gains (by 5 to 14 dB) at low frequencies. For noise alone, the modified fitting used decreased gains at all frequencies (by a mean of 1 dB at low frequencies increasing to 8 dB at high frequencies)., Results: For speech in quiet, ratings of loudness with the NAL-NL2 fitting were slightly lower than the mean ratings for normal-hearing participants for all levels, while ratings with CAM2B were close to normal for the two lower levels, and slightly greater than normal for the highest level. Ratings of tone quality were close to the optimum value ("just right") for both fittings, except that the CAM2B fitting was rated as very slightly boomy for the 80-dB SPL level. For speech in noise, the ratings of loudness were very close to the normal values and the ratings of tone quality were close to the optimal value for both fittings and for all levels. For music, the ratings of loudness were close to the normal values for NAL-NL2 and slightly above normal for the modified fitting. The tone quality was rated as very slightly tinny for NAL-NL2 and very slightly boomy for the modified fitting. For noise alone, the NAL-NL2 fitting was rated as slightly louder than normal for all levels, while the modified fitting was rated as close to normal. Tone quality was rated as slightly sharper for the NAL-NL2 fitting than for the modified fitting., Conclusions: Loudness and tone quality can sometimes be made slightly closer to "normal" by modifying gains for different listening situations. The modification for music required to achieve "normal" tone quality appears to be less than used in this study.

Increasingly, children are considered for a unilateral CI, even if the contralateral ear falls outside current audiological guidelines, especially if they are not considered to be reaching their educational potential. The primary aim was to investigate the benefit of unilateral CI in children currently outside UK [National Institute for Health and Care Excellence Technology Appraisal Guidance. 2009. Cochlear implants for children and adults with severe to profound deafness. NICE technology appraisal guidance [TAG166]. Available January 29, 2016 from http://www.nice.org.uk/ta166 ] audiological guidelines in the contralateral ear. The secondary aim was to measure compliance. A retrospective case review with standard demographic data was performed. Forty-seven children were identified as having received a unilateral CI with the contralateral ear falling outside of current UK audiological criteria. These children were allocated to two groups; with hearing between 50 and 70 dB, and 70 and 90 dB at 2 and 4 kHz in the contralateral ear, respectively. Categories of auditory performance (CAP) were assessed. Pre- and post-operative CAP scores demonstrated a statistically significant improvement in auditory perception. We would suggest that assessing candidacy in individual ears and subsequent unilateral CI, has given these children a benefit they may not otherwise have acquired if they only had bilateral hearing aid.

Children who have partial hearing (PH) in the low frequencies and profound sensorineural hearing loss in the high frequencies can present a challenge to cochlear implant (CI) teams in terms of referral, assessment, and candidacy. Neither clinical criteria nor optimal timing for implantation has been explored in the literature. Data from both the Hearing Implant Centres of Birmingham Children's Hospital and St Thomas' Hospital indicate that it is clinically appropriate to implant children with PH; they perform better with CIs than with hearing aids, even if their hearing is not fully preserved. We have also found that children need early access to high frequency sound in order to reach their full potential.

Objective: To use a computer model of impaired hearing to explore the effects of a physiologically-inspired hearing-aid algorithm on a range of psychoacoustic measures., Design: A computer model of a hypothetical impaired listener's hearing was constructed by adjusting parameters of a computer model of normal hearing. Absolute thresholds, estimates of compression, and frequency selectivity (summarized to a hearing profile) were assessed using this model with and without pre-processing the stimuli by a hearing-aid algorithm. The influence of different settings of the algorithm on the impaired profile was investigated. To validate the model predictions, the effect of the algorithm on hearing profiles of human impaired listeners was measured., Study Sample: A computer model simulating impaired hearing (total absence of basilar membrane compression) was used, and three hearing-impaired listeners participated., Results: The hearing profiles of the model and the listeners showed substantial changes when the test stimuli were pre-processed by the hearing-aid algorithm. These changes consisted of lower absolute thresholds, steeper temporal masking curves, and sharper psychophysical tuning curves., Conclusion: The hearing-aid algorithm affected the impaired hearing profile of the model to approximate a normal hearing profile. Qualitatively similar results were found with the impaired listeners' hearing profiles.

Objectives: There is strong evidence from other fields of health, and growing evidence in audiology, that characteristics of the process of intervention as perceived by the client (embodied narratives) can have significant effects on treatment outcomes, independent of the technical properties of the intervention itself. This phenomenon deserves examination because studies of technical interventions that fail to take account of it may reach erroneous conclusions and because clinical practice can put such effects to therapeutic use. The aim of this study was to test the idea that embodied narratives might affect outcomes in hearing aid fitting. This was achieved by carrying out experiments in which technical (acoustic) differences between alternative hearing aid fittings were absent, while providing test subjects with a strong contrast between the processes apparently applied to derive the fittings being compared. Thus, any effects of contrasting narratives could be observed, free of acoustical confounds. The hypothesis was that narrative effects would be observed., Design: A balanced crossover design was used, in which subjects received and evaluated two bilateral hearing aid fittings in succession. Subjects were deceived as to the true identical content of the hearing aid fittings being compared, but encouraged to believe that one fitting process was "interactive" and the other was "diagnostic" in character. Two almost identical experiments were undertaken: one with 24 experienced adult hearing aid users and another with 16 adult first-time users. Each hearing aid fitting was worn at home for 2 weeks, after which self-report outcome measures (Hearing Aid Performance Questionnaire, Hearing Handicap Inventory for the Elderly, and International Outcome Inventory for Hearing Aids) were administered. After the second test period, a short preference questionnaire was also completed., Results: Twenty of the 24 experienced users showed a clear preference for one or the other fitting, and their self-report scores reflected these preferences. Effect sizes were comparable with those typically observed for true acoustical contrasts. No order effect was seen in this group. In contrast, 13 of the 16 first-time users preferred the second fitting. Trends in the self-report measures were similar for this group but weaker than for the experienced users. In both groups, the reasons given for subjects' preference were predominantly related to sound, despite there being no acoustical differences., Conclusions: This study suggests that the narrative embodied in a given fitting process can have a substantial effect on the perceived benefit of the treatment, independent of any acoustical differences, at least for experienced users. For first-time users, acclimatization seems to overshadow the purely narrative effect of any fitting process. In the future, research study designs should include steps to avoid narrative effects when technical parameters of hearing aids are the intended object of study. In clinical practice, the narrative is part of the therapeutic context, and one may design it for maximum beneficial effect.

Purpose: The aims of this study were to determine if a remotely delivered, Internet-based auditory training (AT) program improved speech-in-noise understanding and if the number of hours spent engaged in the program influenced postintervention speech-in-noise understanding., Method: Twenty-nine first-time hearing aid users were randomized into an AT group (hearing aids + 3 week remotely delivered, Internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (Nilsson, Soli, & Sullivan, 1994) and the Words-in-Noise test (Wilson, 2003) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training., Results: Speech-in-noise understanding improved for both groups at the completion of the study; however, there was not a statistically significant difference in postintervention improvement between the AT and control groups. Although the number of hours the participants engaged in the AT program was far fewer than prescribed, time on task influenced the postintervention Words-in-Noise but not Hearing in Noise Test scores., Conclusion: Although remotely delivered, Internet-based AT programs represent an attractive alternative to resource-intensive, clinic-based interventions, their demonstrated efficacy continues to remain a challenge due in part to issues associated with compliance.

Objective: Sensorineural hearing loss (SNHL) is identified at a rate of 1-3 per 1,000 newborns in the United States. Timely referral to Early Intervention (EI) services is critical, as early EI referral has been shown to improve outcomes, including speech and language development, social and emotional development, and academic performance. The objective of this study was to determine the rate at which children diagnosed with SNHL at a large tertiary referral center were referred to EI, and, if so, by whom. In addition, we sought to determine the time from the diagnosis of SNHL to the completion of the referral, and what services were received., Design: Prospective observational study, Methods: Data were collected by telephone survey and review of the electronic medical record, Results: Children with SNHL were referred to and participated in EI at a high rate. All children in this study (100%) were referred to EI. Most (92%) of the children were referred by 6 months of age, and almost all (98%) participated in EI., Conclusion: At our institution, children with SNHL are being consistently referred to EI, meeting the goals of the Early Hearing Detection and Intervention program. Future outcomes research can now be designed to determine whether achieving these benchmark goals improves children's academic performance, expressive and receptive language skills, and development as compared to age-matched, normal hearing peers.

Objectives: This study aimed to report the bone-anchored hearing aid uptake and the reasons for their rejection by unilateral sensorineural deafness patients., Methods: A retrospective review of 90 consecutive unilateral sensorineural deafness patients referred to the Greater Manchester Bone-Anchored Hearing Aid Programme between September 2008 and August 2011 was performed., Results: In all, 79 (87.8 per cent) were deemed audiologically suitable: 24 (30.3 per cent) eventually had a bone-anchored hearing aid implanted and 55 (69.6 per cent) patients declined. Of those who declined, 26 (47.3 per cent) cited perceived limited benefits, 18 (32.7 per cent) cited reservations regarding surgery, 13 (23.6 per cent) preferred a wireless contralateral routing of sound device and 12 (21.8 per cent) cited cosmetic reasons. In all, 32 (40.5 per cent) suitable patients eventually chose the wireless contralateral routing of sound device., Conclusion: The uptake rate was 30 per cent for audiologically suitable patients. Almost half of suitable patients did not perceive a sufficient benefit to proceed to device implantation and a significant proportion rejected it. It is therefore important that clinicians do not to rush to implant all unilateral sensorineural hearing loss patients with a bone-anchored hearing aid.

Objective: While potentially improving audibility for listeners with considerable high frequency hearing loss, the effects of implementing nonlinear frequency compression (NFC) for listeners with moderate high frequency hearing loss are unclear. The purpose of this study was to investigate the effects of activating NFC for listeners who are not traditionally considered candidates for this technology., Design: Participants wore study hearing aids with NFC activated for a 3-4 week trial period. After the trial period, they were tested with NFC and with conventional processing on measures of consonant discrimination threshold in quiet, consonant recognition in quiet, sentence recognition in noise, and acceptableness of sound quality of speech and music., Study Sample: Seventeen adult listeners with symmetrical, mild to moderate sensorineural hearing loss participated. Better ear, high frequency pure-tone averages (4, 6, and 8 kHz) were 60 dB HL or better., Results: Activating NFC resulted in lower (better) thresholds for discrimination of /s/, whose spectral center was 9 kHz. There were no other significant effects of NFC compared to conventional processing., Conclusion: These data suggest that the benefits, and detriments, of activating NFC may be limited for this population.

Objective: This clinical trial investigated the ability of concurrent speech segregation in hearing impaired children. The auditory behavioral responses and auditory late responses (ALRs) were compared between test and control groups prior to vowel auditory training and after 3 and 6 months of vowel auditory training to find the effects of bottom-up training on concurrent speech segregation in hearing impaired children., Methods: Auditory behavioral responses for 5 vowels and ALRs for double synthetic vowels, with special physical properties, were recorded in a timetable in 30 hearing impaired children (test group = 15 and control group = 15)., Results: Identification score and reaction time data showed that the test group was approximately proficient for some vowels (P < .05 for vowels /æ/, /e/, and /u:/) and took less time to process after 6 months of training. N1-P2 amplitude indexing of the vowel change detection and reflecting central auditory speech representation without active client participation has been increased in the test group (P < .05)., Conclusion: The present study showed training-related improvements in concurrent speech segregation. This information provided evidence for bottom-up training based on F0, its differences in auditory scene analysis, and neural underpinnings., (© The Author(s) 2014.)

The present study aimed to investigate the changing relationship between aided speech recognition and cognitive function during the first 6 months of hearing aid use. Twenty-seven first-time hearing aid users with symmetrical mild to moderate sensorineural hearing loss were recruited. Aided speech recognition thresholds in noise were obtained in the hearing aid fitting session as well as at 3 and 6 months postfitting. Cognitive abilities were assessed using a reading span test, which is a measure of working memory capacity, and a cognitive test battery. Results showed a significant correlation between reading span and speech reception threshold during the hearing aid fitting session. This relation was significantly weakened over the first 6 months of hearing aid use. Multiple regression analysis showed that reading span was the main predictor of speech recognition thresholds in noise when hearing aids were first fitted, but that the pure-tone average hearing threshold was the main predictor 6 months later. One way of explaining the results is that working memory capacity plays a more important role in speech recognition in noise initially rather than after 6 months of use. We propose that new hearing aid users engage working memory capacity to recognize unfamiliar processed speech signals because the phonological form of these signals cannot be automatically matched to phonological representations in long-term memory. As familiarization proceeds, the mismatch effect is alleviated, and the engagement of working memory capacity is reduced., (© The Author(s) 2014.)

This study explored a range of training dosages and durations for a word-based auditory-training procedure for older adults with hearing impairment. Three groups received a different "dose": 2x/week; 3x/week; no training. Fifteen training sessions comprised a "cycle" which was repeated three times for each dosage. Groups that completed training performed significantly better than controls for speech-in-noise materials included in the training regimen, with no significant difference observed between the 2x or 3x/week training groups. Based on these results, as well as prior literature on learning theory, training 2x or 3x/week for 5-15 weeks appears to be sufficient to yield training benefits with this training regimen.

Purpose: The purpose of this study was to evaluate the contribution of a contralateral hearing aid to the perception of consonants, in terms of voicing, manner, and place-of-articulation cues in reverberation and noise by adult cochlear implantees aided by bimodal fittings., Method: Eight postlingually deafened adult cochlear implant (CI) listeners with a fully inserted CI in 1 ear and low-frequency hearing in the other ear were tested on consonant perception. They were presented with consonant stimuli processed in the following experimental conditions: 1 quiet condition, 2 different reverberation times (0.3 s and 1.0 s), and the combination of 2 reverberation times with a single signal-to-noise ratio (5 dB)., Results: Consonant perception improved significantly when listening in combination with a contralateral hearing aid as opposed to listening with a CI alone in 0.3 s and 1.0 s of reverberation. Significantly higher scores were also noted when noise was added to 0.3 s of reverberation., Conclusions: A considerable benefit was noted from the additional acoustic information in conditions of reverberation and reverberation plus noise. The bimodal benefit observed was more pronounced for voicing and manner of articulation than for place of articulation.

This study compared elderly hearing aid (EHA) users and elderly normal-hearing (ENH) individuals on identification of auditory speech stimuli (consonants, words, and final word in sentences) that were different when considering their linguistic properties. We measured the accuracy with which the target speech stimuli were identified, as well as the isolation points (IPs: the shortest duration, from onset, required to correctly identify the speech target). The relationships between working memory capacity, the IPs, and speech accuracy were also measured. Twenty-four EHA users (with mild to moderate hearing impairment) and 24 ENH individuals participated in the present study. Despite the use of their regular hearing aids, the EHA users had delayed IPs and were less accurate in identifying consonants and words compared with the ENH individuals. The EHA users also had delayed IPs for final word identification in sentences with lower predictability; however, no significant between-group difference in accuracy was observed. Finally, there were no significant between-group differences in terms of IPs or accuracy for final word identification in highly predictable sentences. Our results also showed that, among EHA users, greater working memory capacity was associated with earlier IPs and improved accuracy in consonant and word identification. Together, our findings demonstrate that the gated speech perception ability of EHA users was not at the level of ENH individuals, in terms of IPs and accuracy. In addition, gated speech perception was more cognitively demanding for EHA users than for ENH individuals in the absence of semantic context., (© The Author(s) 2014.)

Background: Outcome measures can be used to improve the quality of the rehabilitation by identifying and understanding which variables influence the outcome. This information can be used to improve outcomes for clients. In clinical practice, pure-tone audiometry, speech reception thresholds (SRTs), and speech discrimination scores (SDSs) in quiet or in noise are common assessments made prior to hearing aid (HA) fittings. It is not known whether SRT and SDS in quiet relate to HA outcome measured with the International Outcome Inventory for Hearing Aids (IOI-HA)., Purpose: The aim of the present study was to investigate the relationship between pure-tone average (PTA), SRT, and SDS in quiet and IOI-HA in both first-time and experienced HA users., Research Design: SRT and SDS were measured in a sample of HA users who also responded to the IOI-HA., Study Sample: Fifty-eight Danish-speaking adult HA users., Data Collection and Analysis: The psychometric properties were evaluated and compared to previous studies using the IOI-HA. The associations and differences between the outcome scores and a number of descriptive variables (age, gender, fitted monaurally/binaurally with HA, first-time/experienced HA users, years of HA use, time since last HA fitting, best ear PTA, best ear SRT, or best ear SDS) were examined. A multiple forward stepwise regression analysis was conducted using scores on the separate IOI-HA items, the global score, and scores on the introspection and interaction subscales as dependent variables to examine whether the descriptive variables could predict these outcome measures., Results: Scores on single IOI-HA items, the global score, and scores on the introspection (items 1, 2, 4, and 7) and interaction (items 3, 5, and 6) subscales closely resemble those previously reported. Multiple regression analysis showed that the best ear SDS predicts about 18-19% of the outcome on items 3 and 5 separately, and about 16% on the interaction subscale (sum of items 3, 5, and 6) CONCLUSIONS: The best ears SDS explains some of the variance displayed in the IOI-HA global score and the interaction subscale. The relation between SDS and IOI-HA suggests that a poor unaided SDS might in itself be a limiting factor for the HA rehabilitation efficacy and hence the IOI-HA outcome. The clinician could use this information to align the user's HA expectations to what is within possible reach., (American Academy of Audiology.)

Early-identified severe/profound hearing loss (HL) following universal newborn hearing screening (UNHS) has been associated with improved speech and language outcomes. However, speech outcome reports have typically been based on broad measures of speech intelligibility and/or singleton consonant accuracy, with little known about production of consonant clusters. Using a prospective design, the range and accuracy of consonant clusters produced by a homogenous cohort of 12 children early-identified with severe/profound HL aged 3- and 4-years were examined. All children demonstrated bilateral aided thresholds within a range of 15-25 dB HL across all frequencies, were optimally amplified with cochlear implants (11/12) or hearing aids (1/12), and attended auditory-verbal (AV) early intervention. Standardized speech and language assessments were administered. Consonant clusters were strategically sampled in single-word and conversational speech contexts. All standard scores for speech, receptive, and expressive language were within normal limits. All children produced consonant clusters commensurate with expectations for typically-developing hearing peers at 3- and 4- years-of-age. Children's production of phonetically complex morphophonemes (final consonant clusters marking grammatical morphemes) was also in keeping with developmental expectations. Factors which contributed to these encouraging outcomes require further investigation.

Objectives: To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life., Design: Prospective, with sequential enrolment and within-subject comparisons. Post-operative performance using a Freedom Hybrid sound processor was compared with that of pre-operative hearing aids., Study Sample: Sixty-six adult hearing-impaired subjects with bilateral severe-to-profound high frequency hearing loss., Results: Group median increase in air-conduction thresholds in the implanted ear for test frequencies 125-1000 Hz was < 15 dB across the population; both immediately and one year post-operatively. Eighty-eight percent of subjects used the Hybrid processor at one year post-op. Sixty-five percent of subjects had significant gain in speech recognition in quiet, and 73% in noise (≥ 20 percentage points/2 dB SNR). Mean SSQ subscale scores were significantly improved (+ 1.2, + 1.3, + 1.8 points, p < 0.001), as was mean HUI3 score (+ 0.117, p < 0.01). Combining residual hearing with CI gave 22-26 %age points mean benefit in speech recognition scores over CI alone (p < 0.01)., Conclusions: Useful residual hearing was conserved in 88% of subjects. Speech perception was significantly improved over preoperative hearing aids, as was sound quality and quality of life.

Objective: Backward-facing directional processing (Back-DIR) is an algorithm that employs an anti-cardioid directivity pattern to enhance speech arriving from behind the listener. An experiment that was originally designed to evaluate Back-DIR, together with its follow-up experiment, are reported to illustrate how hearing-aid users' voices could affect directional benefit., Design: Speech recognition performance was measured in a speech-180°/noise-0° configuration, with aids programmed to Back-DIR enabled or omnidirectional processing. In the original experiment, the conventional hearing-in-noise test (HINT) was used, wherein listeners repeated heard sentences. In the follow-up experiment, a modified HINT was used, wherein a carrier phrase was presented before each sentence., Study Sample: Fifteen adults with sensorineural hearing loss participated in both experiments., Results: Significant Back-DIR benefit (relative to omnidirectional processing) was observed in the follow-up experiment, while not in the original experiment., Conclusions: In the original experiment, hearing aids were affected by listeners' voices such that Back-DIR was not always activated when the target speech was presented. In the follow-up experiment, listeners' voice effects were eliminated by the carrier phrase activating Back-DIR before the sentences were presented. The results suggest that the effect of hearing-aid technologies is highly dependent on the characteristics of listening conditions.

Background: Today's compression hearing aids with noise reduction systems may not manage transient noises effectively because of the short duration of these sounds compared to the onset times of the compressors and/or noise reduction algorithms., Purpose: The current study was designed to evaluate the effect of a transient noise reduction (TNR) algorithm on listening comfort, speech intelligibility in quiet, and preferred wearer gain in the presence of transients., Research Design: A single-blinded, repeated-measures design was used., Study Sample: Thirteen experienced hearing aid users with bilaterally symmetrical (≤7.5 dB) sensorineural hearing loss participated in the study., Results: Speech identification in quiet (no transient noise) was identical between the TNR On and the TNR Off conditions. The participants showed subjective preference for the TNR algorithm when "comfortable listening" was used as the criterion. Participants preferred less gain than the default prescription in the presence of transient noise sounds. However, the preferred gain was 2.9 dB higher when the TNR was activated than when it was deactivated. This translated to 12.1% improvement in phoneme identification over the TNR Off condition for soft speech., Conclusions: This study demonstrated that the use of the TNR algorithm would not negatively affect speech identification. The results also suggested that this algorithm may improve listening comfort in the presence of transient noise sounds and ensure consistent use of prescribed gain. Such an algorithm may ensure more consistent audibility across listening environments., (American Academy of Audiology.)

Despite considerable effort, monaural (single-microphone) algorithms capable of increasing the intelligibility of speech in noise have remained elusive. Successful development of such an algorithm is especially important for hearing-impaired (HI) listeners, given their particular difficulty in noisy backgrounds. In the current study, an algorithm based on binary masking was developed to separate speech from noise. Unlike the ideal binary mask, which requires prior knowledge of the premixed signals, the masks used to segregate speech from noise in the current study were estimated by training the algorithm on speech not used during testing. Sentences were mixed with speech-shaped noise and with babble at various signal-to-noise ratios (SNRs). Testing using normal-hearing and HI listeners indicated that intelligibility increased following processing in all conditions. These increases were larger for HI listeners, for the modulated background, and for the least-favorable SNRs. They were also often substantial, allowing several HI listeners to improve intelligibility from scores near zero to values above 70%.

Objective: Tinnitus is a perceived sound that cannot be attributed to an external source. This study attempts to identify a prescription of amplification that is optimized as a first-fit setting for tinnitus relief., Design: Participants compared the effect of high frequency amplification on their tinnitus. Stimuli were 13 speech files with different amounts of high frequency amplification (three cut-off frequencies and four gain settings) to simulate the effects of a change in DSL(I/O) v5.0 prescription in the high frequencies., Study Sample: Twenty-five participants with chronic tinnitus participated in the study., Results: A 6-dB reduction to prescribed gain at 2 kHz emerged as the most preferred output (26.47% participants) to interfere with participants' tinnitus. Overall, 70.58% of the participants' preferred a 3 to 6 dB reduction in output while 29.42% preferred a similar increase across all cut-off frequencies. A trend was observed in which the higher the tinnitus pitch the more similar the preferred output to DSL(I/O) v5.0., Conclusion: DSL(I/O) v5.0 appears to be a good starting point for prescription of hearing-aid output for tinnitus management. Long-term benefits of different prescriptions for tinnitus still need to be ascertained.