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Objective: The aim of this study was to determine whether the differences in insertion gains from the first fit to generic prescriptions of hearing aids can predict the self-reported hearing aid (HA) outcomes for first-time and experienced HA users., Design: This was a prospective observational study., Study Sample: The study included 885 first-time and 330 experienced HA users with a valid real-ear measurement on both ears and answers to the abbreviated version of the Speech, Spatial, and Quality of Hearing (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaires., Results: K -means clustering of gain differences between individual real-ear insertion gain to three generic gain prescriptions (NAL-NL2, NAL-RP, and one-third gain rules) was performed. The gain difference at higher frequencies generally differentiated the clusters. The experienced users in the cluster with fittings closest to NAL-NL2 and NAL-RP prescription were found to exhibit a higher IOI-HA Factor 1 score (representing the overall benefit of the hearing aid use). The gain differences to generic prescription did not affect other self-reported outcomes for first-time and experienced HA users., Conclusion: The experienced HA users with minimal gain deviations from generic prescriptions reported better self-perceived benefits than users with larger deviations. However, this was not apparent in first-time users.

Objectives: The purpose of this study was to investigate differences in auditory environments and hearing aid feature activation between younger listeners with normal hearing and older listeners with hearing loss in an urban and rural location. We hypothesized that (1) urban dwellers and younger listeners would encounter more diverse and demanding auditory environments than rural dwellers and older listeners, respectively; (2) the advanced hearing aid features (noise reduction and directional microphone) of urban dwellers and younger listeners would be activated more frequently than rural dwellers and older listeners, respectively., Design: The design of this study was cross-sectional with repeated measures. A total of 12 older adults with hearing loss (OHL-U) and 11 younger adults with normal hearing (YNH-U) were recruited from an urban area (Berkeley, California) and 13 older adults with hearing loss (OHL-R) and 10 YNH-U were recruited from a rural area (Iowa City, Iowa). Participants wore hearing aids that recorded data about their listening environments and completed ecological momentary assessments for 1 week., Results: The YNH-U group experienced higher sound pressure levels and hearing aid features were activated more frequently than in the OHL groups. The OHL-R group experienced significantly less diverse sound pressure levels than the YNH-U group. The YNH-R group had sound levels between the YNH-U group and the OHL groups but without significant differences from any other group. The YNH groups showed a greater likelihood of hearing aid feature activation than the OHL-R group., Conclusions: Demographics affect auditory environments and the activation of hearing aid features. Younger urban dwellers have the most diverse or demanding auditory environments and hearing aid feature activation, and older, rural dwellers with hearing loss have the least diverse or demanding auditory environments and hearing aid feature activation. Future studies of real-world auditory environments and audiology intervention effectiveness should consider location in recruitment and interpretation of results., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To identify factors affecting hearing aid usage in children., Methods: This retrospective study examined 59 hearing-impaired children fitted with hearing aids for at least 6 months. Patients with moderate to profound sensorineural hearing loss with complete data-logging information stored in the hearing aid programming file from January 2020 until June 2021 were included. Children with concomitant disabilities were excluded. Data for audiological assessments included hearing assessment, aided hearing thresholds, and aided speech tests., Results: The children's age ranged from 6 months to 6 years. Average daily hearing aid usage was 5.5 hour (h) after 3 months, 7 h after 6 months; and 8.7± 4.7 h as reported by parents. Patient age was positively correlated with data logging at 3 months (r=0.414, p =0.01) and 6 months (r=0.406, p =0.01)., Conclusion: We found that children's age, gender, severity of hearing loss, residential location, and parents' educational level had a significant effect on daily hearing aid usage. Whereas, family size and a family history of hearing loss or use of amplification devices had no discernible influence., (Copyright: © Saudi Medical Journal.)

Purpose: Perceived sound quality was variously compared between either no aiding or aiding with three models of hearing aid that varied the microphone position around the pinna, depth of the receiver in the auditory meatus, degree of meatal occlusion, and processing sophistication. The hearing aids were modern designs and commercially available at the time of testing., Method: Binaural recordings of multichannel spatially separated speech and music excerpts were made in a manikin, either open ear or aided. Recordings were presented offline over wide-bandwidth, high-quality insert earphones. Participants listened to pairs of the recordings and made preference ratings both by clarity and externality (a proxy for "spaciousness"). Two separate groups of adults were tested, 20 with audiometrically normal hearing (NH) and 20 with mild-to-moderate sensorineural hearing loss (hearing impaired [HI])., Results: For ratings of speech clarity, the NH group expressed no preference between the open ear and a deeply inserted occluding aid, both of which were preferred to a low-pass filtered output of the same aid. For the music signal, a small preference emerged for the open-ear recording over that of the aid. For the HI group, clarity of the deeply inserted aid was similar to in-the-ear and behind-the-ear devices for speech, but worse for music. Ratings of spaciousness produced no clear result in either group, which can be attributed to study limitations and/or participant factors., Conclusion: Based on clarity, a wide bandwidth, particularly to beyond 5 kHz generally and below 300 Hz for music, is desirable, independent of hearing aid design.

Objectives: We analyzed the lateralization of the cortical auditory-evoked potential recorded previously from aided hearing-impaired listeners as part of a study on noise-mitigating hearing aid technologies. Specifically, we asked whether the degree of leftward lateralization in the magnitudes and latencies of these components was reduced by noise and, conversely, enhanced/restored by hearing aid technology. We further explored if individual differences in lateralization could predict speech-in-noise abilities in listeners when tested in the aided mode., Design: The study followed a double-blind within-subjects design. Nineteen older adults (8 females; mean age = 73.6 years, range = 56 to 86 years) with moderate to severe hearing loss participated. The cortical auditory-evoked potential was measured over 400 presentations of a synthetic /da/ stimulus which was delivered binaurally in a simulated aided mode using shielded ear-insert transducers. Sequences of the /da/ syllable were presented from the front at 75 dB SPL-C with continuous speech-shaped noise presented from the back at signal-to-noise ratios of 0, 5, and 10 dB. Four hearing aid conditions were tested: (1) omnidirectional microphone (OM) with noise reduction (NR) disabled, (2) OM with NR enabled, (3) directional microphone (DM) with NR disabled, and (4) DM with NR enabled. Lateralization of the P1 component and N1P2 complex was quantified across electrodes spanning the mid-coronal plane. Subsequently, listener speech-in-noise performance was assessed using the Repeat-Recall Test at the same signal-to-noise ratios and hearing aid conditions used to measure cortical activity., Results: As expected, both the P1 component and the N1P2 complex were of greater magnitude in electrodes over the left compared to the right hemisphere. In addition, N1 and P2 peaks tended to occur earlier over the left hemisphere, although the effect was mediated by an interaction of signal-to-noise ratio and hearing aid technology. At a group level, degrees of lateralization for the P1 component and the N1P2 complex were enhanced in the DM relative to the OM mode. Moreover, linear mixed-effects models suggested that the degree of leftward lateralization in the N1P2 complex, but not the P1 component, accounted for a significant portion of variability in speech-in-noise performance that was not related to age, hearing loss, hearing aid processing, or signal-to-noise ratio., Conclusions: A robust leftward lateralization of cortical potentials was observed in older listeners when tested in the aided mode. Moreover, the degree of lateralization was enhanced by hearing aid technologies that improve the signal-to-noise ratio for speech. Accounting for the effects of signal-to-noise ratio, hearing aid technology, semantic context, and audiometric thresholds, individual differences in left-lateralized speech-evoked cortical activity were found to predict listeners' speech-in-noise abilities. Quantifying cortical auditory-evoked potential component lateralization may then be useful for profiling listeners' likelihood of communication success following clinical amplification., Competing Interests: The authors have no other conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The signal-to-noise ratio (SNR) for speech presented in background noise may vary after being processed by digital hearing aids with nonlinear signal processing algorithms, such as wide dynamic range compression (WDRC). A phase inversion technique has been previously developed to assess the output SNR of hearing aids. However, systematic validations of this technique have not been conducted. This study aims to validate the phase inversion technique., Method: A simulated hearing aid with multichannel WDRC was implemented, from which the output SNRs, computed via shadow filtering, for connected speech in background noise were directly computed. The agreement between the shadow filter output SNRs and those estimated using the phase inversion technique for the same stimuli was utilized to validate the phase inversion technique. The background noise was 2- or 20-talker babble noise, and the speech stimuli were presented at SNRs of -10 to +10 dB at the input of the simulated hearing aid. The simulated hearing aid was configured to provide amplification for four representative audiograms, and the WDRC was set to be fast or slow acting. To investigate the effects of additive noise, independent of the presented noise stimulus, on the phase inversion estimated output SNR, the same simulated hearing aid was implemented with an additive Gaussian noise at its input (45 and 60 dB SPL)., Results: Results showed that the phase inversion technique could either overestimate or underestimate output SNR, depending on the test condition; the estimation errors tended to coincide with temporal landmarks, such as natural pauses between consecutive sentences or fricatives; and increasing the simulated noise led to poorer estimates of output SNR., Conclusions: Results imply that the accuracy of the phase inversion technique is dependent on the test conditions. Thus, the phase inversion technique should be used with caution, and its validity should be evaluated further.

In cochlear implantation, current preoperative planning procedures allow for estimating how far a specific implant will reach into the inner ear of the patient, which is important to optimize hearing preservation and speech perception outcomes. Here we report on the development of a methodology that goes beyond current planning approaches: the proposed model does not only estimate specific outcome parameters but allows for entire, three-dimensional virtual implantations of patient-specific cochlear anatomies with different types of electrode arrays. The model was trained based on imaging datasets of 186 human cochleae, which contained 171 clinical computer tomographies (CTs) of actual cochlear implant patients as well as 15 high-resolution micro-CTs of cadaver cochleae to also reconstruct the refined intracochlear structures not visible in clinical imaging. The model was validated on an independent dataset of 141 preoperative and postoperative clinical CTs of cochlear implant recipients and outperformed all currently available planning approaches, not only in terms of accuracy but also regarding the amount of information that is available prior to the actual implantation., (Copyright © 2022. Published by Elsevier B.V.)

Objective: The present study aimed to investigate whether hearing aid use can induce improvement as acclimatization effect in unaided speech perception in patients with age-related hearing loss., Methods: Fifty ears in 41 patients (age range: 65-91 years) diagnosed as age-related hearing loss were enrolled in this study. They used hearing aids for more than 8 hours per day. Unaided speech audiometry using 67-S Japanese monosyllabic word list was performed one or two years after the commencement of hearing aid use. The changes in the unaided speech discrimination score before and after the commencement of hearing aid use were analyzed. To investigate factors for improvement, the patients' backgrounds in terms of age, sex, pure tone average, unaided maximum speech discrimination score, fitting period (one year/two years), fitting ear (bilateral/unilateral), audiogram type (flat-type/other-type), and the level of amplification were also analyzed., Results: Significant improvement in the unaided speech discrimination score after hearing aid use was seen only in the flat-type audiogram group. More than half of older patients in the flat-type audiogram group improved their unaided maximum speech discrimination score 10 % or more. The analysis of aided hearing thresholds revealed that the flat-type audiogram group had significantly lower thresholds of 3kHz and 4kHz than the other-type audiogram group. The age, sex, pure tone average, fitting period, fitting ear, functional gain were not influential factors for improvement. On the other hand, unaided maximum speech discrimination score before using hearing aid and aided hearing threshold at 4kHz had a negative correlation with improvement., Conclusion: The findings suggested that older patients with age-related hearing loss whose audiogram is a flat type can benefit from amplification as means of improving their unaided speech perception since flat-type audiogram can be more easily adjusted to sufficiently amplify speech sound at high frequencies. It should be considered that the potential for experience-dependent plasticity is retained even in older adults., Competing Interests: Disclosure statements The authors report no conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Objective: This study investigated the effects of different adjustment criteria and sound scenes on self-adjusted hearing-aid gain settings. Self-adjusted settings were evaluated for speech recognition in noise, perceived listening effort, and preference., Design: This study evaluated a semi-supervised self-adjustment fine-tuning procedure that presents realistic everyday sound scenes in a laboratory environment, using a two-dimensional user interface, and enabling simultaneous changes in amplitude and spectral slope. While exploring the two-dimensional space of parameter settings, the hearing-aid users were instructed to optimise either listening comfort or speech understanding., Study Sample: Twenty experienced hearing aid users (median age 69.5 years) were invited to participate in this study., Results: Adjustment criterion and sound scenes had a significant effect on preferred gain settings. No differences in signal-to-noise ratios required for 50% speech intelligibility or in the perceived listening effort were observed between the adjusted settings of the two adjustment criteria. There was a preference for the self-adjusted settings over the prescriptive first fit., Conclusions: Listeners could reliably select their preferred gains to the two adjustment criteria and for different speech stimuli.

Objectives: The primary aim of this study was to analyze the benefit of cochlear implants for patients with auditory neuropathy. The secondary aim was to identify risk factors for auditory neuropathy., Materials and Methods: Patients with cochlear implants (CIs) who were educated in hearing rehabilitation schools were included in the study. A total of 175 children were operated on for cochlear implantation between August 2019 and August 2021 in the department of otorhinolaryngology at different centers in Turkey, and while 16 (9.1%) of those patients had auditory neuropathy spectrum disorder (ANSD), 159 (90.9%) had sensorineural hearing loss (SNHL). Differences in auditory perception between the two groups were examined. Auditory perception tests were applied for these patients 6 months after CI surgery. The auditory perception performances of the patients were evaluated with the Evaluation of Auditory Responses to Speech (EARS) battery, including the Littlears, Lip, Bıs4, Bıs12, Cap, Sır, Mtp-3, Mtp-6, Mtp-12, Matrix A1, and Gasp tests., Results: All patients had profound bilateral SNHL. Four auditory perception tests (Littlears, Bıs-12, Sır, Matrix A1) showed similar results between patients with ANSD and SNHL, but seven auditory perception tests (Lıp, Bıs-4, Cap, Mtp-3, Mtp-6, Mtp-12, Gasp) showed significantly higher results among patients with SNHL. Hyperbilirubinemia, prematurity, consanguineous marriage, and family history of hearing loss were found to be common among patients with ANSD., Conclusions: ANSD patients who do not benefit from hearing aids benefit from CI surgery., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: To develop a model to predict individualized hearing aid benefit. To provide interpretations of model predictions on global and individual levels., Methods: We compiled a data set of patients with hearing loss who trialed hearing aids and completed the Client Oriented Scale of Improvement (COSI) questionnaire, a validated patient-reported outcome measure of hearing aid benefit. Features included demographic, medical, and audiological measures. The outcome was the COSI score for change in listening ability with hearing aids, scaled from 1 to 5. Model development was performed using fivefold cross-validation repeated three times with hyperparameter tuning. Model performance was assessed using the root mean squared error (RMSE) of the COSI scores. Model interpretation was performed using Shapley Additive Explanations., Results: The data set comprised 1,286 patients across 3,523 listening situations. The best performing model was random forest with an RMSE of 0.80, found to be significantly better than the next best model (eXtreme gradient boosting with RMSE of 0.85, p < 0.01). The most important features in predicting hearing aid benefit were shorter duration of hearing aid use, higher pure-tone average in the better hearing ear, and younger age., Conclusion: We have developed a predictive model for hearing aid benefit that can also provide individualized explanations of model predictions. Predictive modeling could be a useful tool in assessing a patient's candidacy and predicted benefit from hearing aids., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objectives: Many hearing aid (HA) users receive limited benefit from amplification, especially when trying to understand speech in noise, and they often report hearing-related residual activity limitations. Current HA fitting strategies are typically based on pure-tone hearing thresholds only, even though suprathreshold factors have been linked to aided outcomes. Furthermore, clinical measures of speech perception such as word recognition scores (WRSs) are performed without frequency-specific amplification, likely resulting in suboptimal speech audibility and thus inaccurate estimates of suprathreshold hearing abilities. Corresponding measures with frequency-specific amplification ("aided") would likely improve such estimates and enable more accurate aided outcome prediction. Here, we investigated potential links between either unaided WRSs or aided WRSs measured at several above-conversational levels and two established HA outcome measures: The Hearing-In-Noise Test (HINT) and the International Outcome Inventory for Hearing Aids (IOI-HA)., Design: Thirty-seven older individuals with bilateral hearing impairments participated. Two conditions were tested: unaided and aided, with all stimuli presented over headphones. In the unaided condition, the most comfortable level (MCL) for the presented speech stimuli, WRS at MCL+10 dB as well as uncomfortable levels (UCLs) for narrowband noise stimuli were measured. In the aided condition, all stimuli were individually amplified according to the "National Acoustic Laboratories-Revised, Profound" fitting rule. Aided WRSs were then measured using an Interacoustics Affinity system at three above-conversational levels, allowing for the maximum aided WRS as well as the presence of "rollover" in the performance-intensity function to be estimated. Multivariate data analyses were performed to examine the relations between the HINT (measured using a simulated HA with the NAL-RP amplification) or IOI-HA scores (for the participants' own HAs) and various potential predictors (age, pure-tone average hearing loss, unaided WRS, aided WRS, rollover presence [ROp], and UCL)., Results: Aided WRSs predicted the HINT scores better than any other predictor and were also the only significant predictor of the IOI-HA scores. In addition, UCL and ROp in the aided WRSs were significant predictors of the HINT scores and competed for variance in the statistical models. Neither age nor pure-tone average hearing loss could predict the two aided outcomes., Conclusions: Aided WRSs can predict HA outcome more effectively than unaided WRSs, age or pure-tone audiometry and could be relatively easily implemented in clinical settings. More research is necessary to better understand the relations between ROp, UCL and speech recognition at above-conversational levels., Competing Interests: This work was supported by Innovation Fund Denmark Grand Solutions 5164 00011B (“Better hEAring Rehabilitation” project) as well as GN Hearing, Oticon, and WS Audiology. There are no conflicts of interest, financial, or otherwise. The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Hearing aid verification with real-ear measurement (REM) is recommended in clinical practice. Improvements, over time, in accuracy of manufacturers' initial fit mean the benefit of routine REM for new adult users is unclear. This registered, double-blinded, randomized, mixed-methods clinical trial aimed to (i) determine whether new adult hearing aid users prefer initial or real-ear fit and (ii) investigate the reasons for preferences. New adult hearing aid users ( n  = 45) were each fitted with two programs: the initial fit and real-ear fit, both with adjustments based on immediate feedback from the patient. Participants were asked to complete daily paired-comparisons of the two programs with a magnitude estimation of the preference, one for each of clarity/comfort in quiet/noise as well as overall preference. The results revealed gain adjustment requests were low in number and small in magnitude. Deviation from NAL-NL2 targets (after adjustment for a 65 dB SPL input) was close to zero, except at high frequencies where real-ear fits were around 3 dB closer to target. There was no difference in clarity ratings between programs, but comfort ratings favored initial fit. Overall, 10 participants (22%) expressed a preference for real-ear fit. Reasons for preference were primarily based on comfort with the initial fit and clarity with real-ear fit. It may be acceptable to fit new adult users with mild-to-moderate hearing loss without the need for REMs, if the primary outcome of interest is user preference. It remains to be seen if the findings generalize to other fitting software, other outcome measures and more severe hearing loss., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Hearing aid fitting formulas intended for the pediatric population can differ by 6 to 25 dB in prescribed output across frequency leading to large variations in aided audibility. Children perceive these differences and have expressed preferences that favor more audibility for quiet speech and less audibility for noisy speech. In this study, the effect of variations in audibility consistent with hearing aid fittings for children was examined. Sixteen children and adolescents (9-17 years) with mild-to-moderate hearing loss participated. Hearing aids programed to National Acoustic Laboratories or Desired Sensation Level v5.0a targets were fitted to each participant. Also, separate programs with and without a low-level adaptive gain feature were provided with each prescription. Speech reception threshold (SRT) was measured as well as performance for four suprathreshold auditory tasks that increased in cognitive demand. These tasks were word recognition, nonword detection, multiword recall, and rapid word learning. A significant effect of fitting formula, but not low-level or adaptive gain, was observed for SRT. Significant effects of presentation level, fitting formula, and low-level gain were observed for word recognition. The effect of presentation level was significant for nonword detection, multiword recall, and rapid word learning but no other main effects or interactions were significant. Finally, word recognition and nonword detection increased significantly with audibility while multiword recall and word learning did not. The results suggest that audibility assists with the initial perception of auditory input but plays a smaller role in memory formation and learning.

Alterations of the speech signal, including additive noise and nonlinear distortion, can reduce speech intelligibility and quality. Hearing aids present an especially complicated situation since these devices may implement nonlinear processing designed to compensate for the hearing loss. Hearing-aid processing is often realized as time-varying multichannel gain adjustments, and may also include frequency reassignment. The challenge in designing metrics for hearing aids and hearing-impaired listeners is to accurately model the perceptual trade-offs between speech audibility and the nonlinear distortion introduced by hearing-aid processing. This paper focuses on the Hearing Aid Speech Perception Index (HASPI) and the Hearing Aid Speech Quality Index (HASQI) as representative metrics for predicting intelligibility and quality. These indices start with a model of the auditory periphery that can be adjusted to represent hearing loss. The peripheral model, the speech features computed from the model outputs, and the procedures used to fit the features to subject data are described. Examples are then presented for using the metrics to measure the effects of additive noise, evaluate noise-suppression processing, and to measure the differences among commercial hearing aids. Open questions and considerations in using these and related metrics are then discussed., Competing Interests: Declaration of Competing Interest The authors have research grant support from hearing aid manufacturer GN ReSound., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: The objective of this study was to determine the prevalence, risk factors, and audiological characteristics of auditory neuropathy spectrum disorder (ANSD) in the pediatric population., Design: A retrospective review of medical charts was conducted for children visiting two hospitals in Saudi Arabia., Study Sample: Medical records of 1025 patients with sensorineural hearing loss (SNHL) were reviewed. We analyzed the databases for results of audiological examinations, risk factors, and outcomes of intervention including hearing aid (HA) and cochlear implantation (CI)., Results: Out of 1025 children with SNHL, 101 patients (9.85%) were identified to have ANSD. Audiological characteristics of the ANSD group revealed a severe-to-profound degree of hearing loss, all showed type A tympanogram and absent reflexes, absent auditory brainstem response (ABR) findings with present cochlear microphonic while otoacoustic emissions were absent in 54.5% of patients. The most prevalent risk factors for ANSD in this group were family history of hearing loss, consanguinity, hyperbilirubinemia, and low birth weight. Pure tone and speech detection thresholds improved significantly with CI compared to HA use in this sample of patients with ANSD., Conclusion: This study shows that ANSD is not extremely rare among Saudi children with severe to profound hearing loss, with a prevalence of 9.85%.

Objective: Whether hearing aid use in older adults modifies speech perception over time is not clear. To address this question, we systematically reviewed studies in which older first-time hearing aid users and controls were followed over time., Design: The review was pre-registered in PROSPERO and performed in accordance with the statement on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The question, inclusion and exclusion criteria were defined using the Population, Intervention, Control, Outcomes and Study design (PICOS) framework. Studies with no controls, studies in which participants and controls were tested at only one-time point, with no follow-up and no pre-fitting measures, or when outcome measures did not include speech measures, were excluded., Study Sample: 6113 studies were screened, out of which 12 studies, published between 1996 and 2021, met the inclusion and exclusion criteria and were included in the final review., Results: 9 of the 12 studies found evidence for amplification-induced auditory plasticity in older adults, expressed in improved speech perception., Conclusions: The results suggest amplification-induced improvements in speech perception over time, but findings should be interpreted with caution because overall improvements were small, and the studies' quality was moderate.

Objectives: To investigate the difference in outcome measures and drivers of user preference between premium and entry-level hearing aids using group concept mapping., Design: A single-blind crossover trial was conducted. Aided behavioural outcomes measured were loudness rating, speech/consonant recognition, and speech quality. Preference between hearing aids was measured with a 7-point Likert scale. Group concept mapping was utilised to investigate preference results. Participants generated statements based on what influenced their preferences. These were sorted into categories with underlying themes. Participants rated each statement on a 5-point Likert scale of importance., Study Sample: Twenty-three adult participants (mean: 62.4 years; range: 24-78) with mild to moderately severe bilateral SNHL (PTA 500-4000 Hz > 20 dB HL)., Results: A total of 83 unique statements and nine distinct clusters, with underlying themes driving preference, were generated. Clusters that differed significantly in importance between entry-level and premium hearing aid choosers were: Having access to smartphone application-based user-controlled settings, the ability to stream calls and music, and convenience features such as accessory compatibility., Conclusion: This study has identified non-signal-processing factors which significantly influenced preference for a premium hearing aid over an entry-level hearing aid, indicating the importance of these features as drivers of user preference.

Objective: This study examined the accuracy of hearing aid output to DSL v5.0 Child targets in a group of children who wear hearing aids, and the impact on their auditory outcomes., Design: For each participant, the output of the initial hearing aid fitting was compared to DSL v5.0 Child prescriptive targets and again after the fitting was adjusted using coupler-based verification and RECD measures. Outcomes for initial and adjusted fittings were examined using the Speech Intelligibility Index (SII), Parent's Evaluation of Aural/Oral Performance of Children (PEACH) rating scale, and speech perception tests in quiet and noise., Study Sample: Sixty-eight children aged 3 months to 17 years with moderate to profound hearing loss participated in the study., Results: Fit-to-targets improved significantly after hearing aids were adjusted to match targets to within 5 dB RMSE. Adjusted hearing aids provided increased aided audibility compared to initial fittings and resulted in improved speech perception scores and parent-reported hearing performance. Fifty percent of the children aged 6 to 17 years preferred their adjusted fitting compared to 10% who preferred their initial fitting., Conclusions: Improvement in fit-to-target to a validated paediatric prescriptive formula using best practice procedures can result in improved auditory outcomes and possible self-reported satisfaction.

Objective: To objectively evaluate acoustic sensitivity of the implanted microphone, and maximum stable gain of a totally implantable active middle ear implant., Design: Prospective, single centre evaluation., Study Sample: Fourteen adult patients., Results: Microphone sensitivity is approx. 10 dB lower than an externally worn conventional hearing aid, at frequencies up to 4000 Hz, and substantially lower at higher frequencies. The masking level due to microphone noise, which determines the softest test tones that can be detected, is estimated at &lt;20 to &lt;30 dB HL up to 1000 Hz, and &lt;40 dB HL at higher frequencies. Maximum stable effective gain is the maximum amplification achievable without causing feedback whistling. In sensorineural hearing loss (SNHL) cases, it is 30-40 dB at frequencies up to 2000 Hz, allowing to compensate for even the maximum recommended hearing loss (60-70 dB HL). In both SNHL and mixed hearing loss (MHL) cases, maximum stable effective gain is lower (+20 to -30 dB) around 3000-6000 Hz., Conclusions: Microphone sensitivity is high enough to achieve aided thresholds of 20-40 dB HL. A strong correlation between actuator coupling efficiency and maximum stable effective gain implies that any effort to improve actuator efficiency should also increase the available gain.

Objective: This study investigated if individual preferences with respect to the trade-off between a good signal-to-noise ratio and a distortion-free speech target were stable across different masking conditions and if simple adjustment methods could be used to identify subjects as either "noise haters" or "distortions haters"., Design: In each masking condition, subjects could adjust the target speech level according to their preferences by employing (i) linear gain or gain at the cost of (ii) clipping distortions or (iii) compression distortions. The comparison of these processing conditions allowed investigating the preferred trade-off between distortions and noise disturbance., Study Sample: Thirty subjects differing widely in hearing status (normal-hearing to moderately impaired) and age (23-85 years)., Results: High test-retest stability of individual preferences was found for all modification schemes. The preference adjustments suggested that subjects could be consistently categorised along a scale from "noise haters" to "distortion haters", and this preference trait remained stable through all maskers, spatial conditions, and types of distortions., Conclusions: Employing quick self-adjustment to collect listening preferences in complex listening conditions revealed a stable preference trait along the "noise vs. distortions" tolerance dimension. This could potentially help in fitting modern hearing aid algorithms to the individual user.

Purpose: The study evaluated if there were differences between three types of hearing aids, Lyric extended wear (EW), receiver-in-the-ear canal (RITE), completely-in-the-canal (CIC) hearing aids in terms of audiological and psychosocial outcomes., Methods: Fifteen patients were selected., Inclusion Criteria: Pure-Tone Average (PTA) air conduction range of hearing threshold at 500, 1000, and 2000 Hz from 15 dB HL to 75 dB HL. Patients were assigned in three groups according to the hearing aid used: Extended wear, RITE, and CIC. Pure-tone audiometry, speech audiometry, free-field pure-tone and speech audiometry with hearing aids, and Matrix sentence test were performed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire were used to assess the psychosocial and audiological benefits provided by hearing aids., Results: No differences were demonstrated in the Matrix sentence test between the groups. A statistically significant difference was present between the "Personal image" of patients with EW and RITE with a p value of 0.01 (better outcome using EW). For the APHAB questionnaire, a significant difference was present in the "Aversiveness" of the patients with EW in comparison to CIC and RITE with a p value of 0.01 (higher aversiveness of sound using EW)., Conclusion: In terms of audiological advantage, extended ear hearing aids are similar to RITE and CIC as demonstrated from the Matrix speech reception threshold. The result was confirmed using the APHAB questionnaire. Extended wear devices are better than daily hearing aids concerning the "personal image"., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Hearing loss is an important health problem in children and cochlear implantation is used in its treatment. In addition, in children with hearing loss, accompanying renal, neurological, structural and cardiac conductive pathologies can often accompany. In this study, it was aimed to evaluate the electrocardiographic findings, especially QT duration in children who underwent cochlear implantation., Methods: The data were obtained from the medical records of our hospital, which is a tertiary referral cochlear implant center. All children who had cochlear implantation surgery due to sensorineural hearing loss and admitted to our hospital for speech therapy between 2019 and 2020 were evaluated with 12-channel ECG., Results: Sixty children (15 girls and 45 boys) with a mean age of 6.5 years were analyzed. Children with a history of heart disease were excluded. In cardiac examinations, five (8.3%) had systolic murmur, four (6.6%) had mid systolic click, and two (3.3%) had stiffening in the first heart sound. Abnormalities were detected in 25% (n = 15) of the electrocardiograms. The most common ECG abnormalities were prolonged QT in 4 cases, left ventricular hypertrophy in 3 cases, left axis deviation in 2 cases, and T wave changes in 2 cases. Long QT syndrome (3.3%) was diagnosed in 2 of the cases with long QT., Conclusion: This study demonstrates the need for electrocardiography and cardiac examinations in children undergoing cochlear implantation for hearing loss. These cases should be evaluated especially in terms of the presence of cardiac arrhythmias and potential for fatal ion channelopathy., Competing Interests: Declaration of competing interest None, (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: Vowels and consonants play different roles in language acquisition and speech recognition, yet standard clinical tests do not assess vowel and consonant perception separately. As a result, opportunities for targeted intervention may be lost. This study evaluated closed-set word recognition tests designed to rely predominantly on either vowel or consonant perception and compared results with sentence recognition scores., Method: Participants were children (5-17 years of age) and adults (18-38 years of age) with normal hearing and children with sensorineural hearing loss (7-17 years of age). Speech reception thresholds (SRTs) were measured in speech-shaped noise. Children with hearing loss were tested with their hearing aids. Word recognition was evaluated using a three-alternative forced-choice procedure, with a picture-pointing response; monosyllabic target words varied with respect to either consonant or vowel content. Sentence recognition was evaluated for low- and high-probability sentences. In a subset of conditions, stimuli were low-pass filtered to simulate a steeply sloping hearing loss in participants with normal hearing., Results: Children's SRTs improved with increasing age for words and sentences. Low-pass filtering had a larger effect for consonant-variable words than vowel-variable words for both children and adults with normal hearing, consistent with the greater high-frequency content of consonants. Children with hearing loss tested with hearing aids tended to perform more poorly than age-matched children with normal hearing, particularly for sentence recognition, but consonant- and vowel-variable word recognition did not appear to be differentially affected by the amount of high- and low-frequency hearing loss., Conclusions: Closed-set recognition of consonant- and vowel-variable words appeared to differentially evaluate vowel and consonant perception but did not vary by configuration of hearing loss in this group of pediatric hearing aid users. Word scores obtained in this manner do not fully characterize the auditory abilities necessary for open-set sentence recognition, but they do provide a general estimate.

The initial software fitting prescribed by the fitting formula largely depends on the patient's hearing loss, which may not be the optimal preference for a particular user. Certain criteria must also be readjusted by an audiologist to meet the user-specific requirements. Therefore, this study focuses on the novel application of a neural network (NN) technique to build a suitable fitting algorithm with prescribed hearing loss and the corresponding preferred gain to minimize the gap between optimized fittings. The algorithm intended to learn the hearing preferences of an individual user such that the initial fitting may be optimized. These findings demonstrate the efficiency of the algorithm, with and without additional features. Using the clinical fitting data, the average mean square error (MSE) for the simple NN algorithm was 5.4183%. By adding additional features to the data, the algorithm performed better, and the average MSE was as low as 5.2530%. However, the algorithm outperformed Company A fitting software, as the MSE was the highest at 5.4748%. As the company's automatic fitting has a noticeable discrepancy with clinical fitting records, the impeccable results from this study can lead to a better path towards fitting satisfaction, thus benefiting the hearing-impaired community to a larger extent., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 S. I. M. M. Raton Mondol et al.)

Objective: To validate the clinical use of Acoustic Change Complex (ACC) as an objective tool in children who use hearing Aids and explore how far ACC response parameters could be correlated to behavioral tests., Method: Sixty Arabic speaking children, using binaural Hearing Aids (H.As), participated in the present study. Their age ranged from 6 to 12 years. Evaluation of Hearing aid device performance was performed through questionnaire, speech in noise tests and aided/unaided ACC recordings. Two stimuli '' vowel/o/with SNR (0 &+8) ''were developed and standardized to elicit ACC response. The replicated ACC waveforms were collected and analyzed and the aided ACC responses were compared with unaided ACC and correlated to behavioral tests., Results: The ACC percent identification in children using H.As using vowel/o/with SNR (+8 & 0) stimuli was 75% and 45% respectively in aided condition, the percent decreased to 40% and 15% in unaided condition. Speech in noise stimuli showed significant difference of ACC-N1 latency between the aided and unaided groups being longer in the unaided condition. The correlations between behavioral tests and ACC response (latency and amplitude) were irrelevant., Conclusions: Hearing-impaired subjects can process speech stimulus at the level of the auditory cortex, and in a more effective manner when they used their H.As. ACC can be used as an objective measure for selective auditory attention ability using vowel-in-noise. However, it couldn't replace Behavioral measures., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: The U.S. Food and Drug Administration indications for cochlear implantation in children is currently 9 months of age and older for children with bilateral profound sensorineural hearing loss (SNHL). Studies have shown that earlier activation of a cochlear implant (CI) can lead to better spoken language outcomes. As auditory skills are a precursor to the development of spoken language, this study was developed to investigate the influence of age at CI activation on auditory skill acquisition in young children. A secondary aim was to describe the auditory skills of children implanted prior to 9 months of age as compared to children with older ages of activation., Method: Functional Listening Index (FLI) scores obtained during routine clinical visits were reviewed for 78 pediatric CI recipients with congenital bilateral profound hearing loss who were activated before 2 years of age. A linear mixed-effects model assessed the effect of age at CI activation on cumulative FLI scores over time., Results: There was a significant interaction between age at activation and chronological age at the time of evaluation, indicating that children with earlier access to sound achieved a greater number of auditory skills than those with later CI activations when measured at the same chronological age. Children activated before the age of 9 months approximated scores expected of children with typical hearing, whereas children activated between 9 and 24 months of age did not., Conclusions: Younger age at CI activation is associated with increased auditory skills over time. Children who undergo cochlear implantation and CI activation before 9 months achieve more auditory skills by 4 years of age than children who are activated at later ages. These data suggest that reducing the approved age at cochlear implantation for children with congenital bilateral profound SNHL may support optimal auditory skill acquisition.

Purpose: The purpose of this study was to determine the feasibility of a tablet-based remote data collection method for measuring preference for hearing aid signal processing features., Method: Participants were nine individuals with bilateral mild to moderately severe sensorineural hearing loss. Stimuli were spatialized low-context sentences mixed with six-talker babble at two realistic signal-to-noise ratios (3 and 8 dB) and processed through a hearing aid simulator. Preference for full factorial combinations of three common hearing aid processing features (two levels each) was elicited using a paired-comparison task. Participants completed two versions of the experiment: The lab version was completed in a sound-treated booth using a custom MATLAB application on a desktop computer; the remote version was completed in a quiet room in the participant's home, using a custom MATLAB executable application on a tablet. Both versions used the same calibrated headphones. Strict infection control protocols were followed., Results: McNemar's test showed no association between preference and data collection method for the majority of the conditions. Percentage agreement and kappa scores were moderate/fair across most conditions. The results indicated that the remote versus lab versions did not have a systematic effect on preference. However, the relatively low agreement and kappa scores suggested within-subject variability in the outcome (preference)., Conclusion: The tablet-based version of remote experimentation was comparable to the lab-based version for eliciting preference for hearing aid signal processing features.

Objectives: We completed a registered double-blind randomized control trial to compare acclimatization to two hearing aid fitting algorithms by experienced pediatric hearing aid users with mild to moderate hearing loss. We hypothesized that extended use (up to 13 months) of an adaptive algorithm with integrated directionality and noise reduction, OpenSound Navigator (OSN), would result in improved performance on auditory, cognitive, academic, and caregiver- or self-report measures compared with a control, omnidirectional algorithm (OMNI)., Design: Forty children aged 6 to 13 years with mild to moderate/severe symmetric sensorineural hearing loss completed this study. They were all experienced hearing aid users and were recruited through the Cincinnati Children's Hospital Medical Center Division of Audiology. The children were divided into 20 pairs based on similarity of age (within 1 year) and hearing loss (level and configuration). Individuals from each pair were randomly assigned to either an OSN (experimental) or OMNI (control) fitting algorithm group. Each child completed an audiology evaluation, hearing aid fitting using physically identical Oticon OPN hearing aids, follow-up audiological appointment, and 2 research visits up to 13 months apart. Research visit outcome measures covered speech perception (in quiet and in noise), novel grammar and word learning, cognition, academic ability, and caregiver report of listening behaviors. Analysis of outcome differences between visits, groups, ages, conditions and their interactions used linear mixed models. Between 22 and 39 children provided useable data for each task., Results: Children using the experimental (OSN) algorithm did not show any significant performance differences on the outcome measures compared with those using the control (OMNI) algorithm. Overall performance of all children in the study increased across the duration of the trial on word repetition in noise, sentence repetition in quiet, and caregivers' assessment of hearing ability. There was a significant negative relationship between age at first hearing aid use, final Reading and Mathematical ability, and caregiver rated speech hearing. A significant positive relationship was found between daily hearing aid use and study-long change in performance on the Flanker test of inhibitory control and attention. Logged daily use of hearing aids related to caregiver rated spatial hearing. All results controlled for age at testing/evaluation and false discovery rate., Conclusions: Use of the experimental (OSN) algorithm neither enhanced nor reduced performance on auditory, cognitive, academic or caregiver report measures compared with the control (OMNI) algorithm. However, prolonged hearing aid use led to benefits in hearing, academic skills, attention, and caregiver evaluation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to determine how multiple types of signal processing activated together influence listeners' preferences., Method: Participants were adults with mild to moderately severe sensorineural hearing loss. Stimuli were spatialized low-context sentences mixed with six-talker babble at 3 and 8 dB signal-to-noise ratios (SNRs). Stimuli were processed with three common hearing aid processing algorithms: wide dynamic range compression (WDRC), frequency compression (FC), and digital noise reduction (DNR). A full-factorial design with two levels for each algorithm (WDRC & DNR: mild versus strong; FC: ON versus OFF; clinically relevant ranges) was evaluated. Preference was measured using a paired-comparison task within a choice-based conjoint analysis framework. Remote data collection methods were used. A signal fidelity metric quantified the acoustic effects across conditions., Results: At 3 dB SNR, participants preferred a combination of Slow WDRC and Mild DNR, although the mean preference was small (odds ratio close to 1). At both SNRs when Strong DNR was used, Fast WDRC was preferred over Slow WDRC. This may be related to signal fidelity, which was lower for the combination of Fast WDRC and Mild DNR and higher for the combination of Slow WDRC and either Mild DNR or Strong DNR. There was no effect of FC on preference or signal fidelity., Conclusions: WDRC and DNR together influenced both listeners' preferences and signal fidelity in the investigated listening conditions. On average, the small effect sizes suggest that minor fine-tuning adjustments to hearing aid algorithms may not result in a substantial change in clinical outcomes.

Objective: Conventional directional hearing aid microphone technology may obstruct listening intentions when the talker and listener walk side by side. The purpose of the current study was to evaluate hearing aids that use a motion sensor to address listening needs during walking., Design: Each participant completed two walks in randomised order, one walk with each of two hearing aid programs: (1) conventional beamformer adaptation that activated an adaptive, multiband beamformer in loud environments and (2) motion-based beamformer adaptation that activated a pinna-mimicking microphone setting when walking was detected. Participants walked along a pre-defined track and completed tasks assessing speech understanding and environmental awareness., Study Sample: Participants were 22 older adults with moderate-to-severe hearing loss and experience using hearing aids., Results: More participants preferred the motion-based than conventional beamformer adaptation for speech understanding, environmental awareness, overall listening, and sound quality ( p <  0.05). Measures of speech understanding ( p  < 0.01) and localisation of sound stimuli ( p  < 0.05) were significantly better with motion-based than conventional beamformer adaptation., Conclusions: The results suggest that hearing aid users can benefit from beamforming that uses motion sensor input to adapt the signal processing according to the user's activity. The real-world setup of this study had limitations.

Background: Bone-anchored hearing aids represent a valid alternative for patients with conductive/mixed hearing loss who cannot use hear- ing aids. To date, these devices have given good audiological results, thanks to various fitting prescription programs (i.e., National Acoustic Laboratories and Desired Sensation Level). The aim of this study is to compare 2 types of fitting algorithms (National Acoustic Laboratories and Desired Sensation Level) implemented for bone-anchored hearing devices., Methods: We retrospectively enrolled 10 patients followed at our operative unit, suffering from bilateral symmetrical mixed hearing loss and who underwent bone-anchored hearing aid implantation. All patients experienced each prescriptive procedure, National Acoustic Laboratories and Desired Sensation Level, for 7 months (on average), and they were subjected to audiological tests and questionnaires to evaluate the best program., Results: National Acoustic Laboratories and Desired Sensation Level prescriptions yielded similar results. Desired Sensation Level allowed less amplification of the low frequencies than the National Acoustic Laboratories prescription, and these differences were the only statistically sig- nificant. Desired Sensation Level allowed better disyllabic word and sentence recognition scores only in quiet and not in noisy conditions. The subjective questionnaires showed similar results. At the end of the trial sessions, more patients (60%) definitively chose the Desired Sensation Level program for their device. These patients were those with a worse hearing threshold., Conclusion: The 2 prescriptive programs allowed similar results although patients with a worse threshold seem to prefer the DSL program. This is the first evaluation of the 2 prescriptive programs, National Acoustic Laboratories versus Desired Sensation Level, for bone conduction devices available in the literature. Further studies are needed to confirm this initial finding.

Objective: To study the Influence of Auditory Training on acceptable noise level (ANL) scores in elderly persons with hearing impairment., Design: Quasi-experimental study design., Study Sample: A total of 20 bilateral mild to moderately severe sensorineural hearing loss participants with "high" ANL scores were taken into the study and randomly allocated to experimental and control groups. In the time frame, the experimental group provided 12 sessions of speech in noise training with a hearing aid and the baseline measures were repeated in both groups., Results: The Acceptable noise level and Speech in Noise scores significantly improved post-training only in the experimental group. They also showed a significant difference "Client Oriented Scale of Improvement (COSI)" scale in the domain "Conversation in Noise"., Conclusions: Acceptable noise level is susceptible to training similar to that of speech in noise score. It provides hope to the individuals who are poor candidates to the hearing aids., Competing Interests: None

Background and Objective: In practice, the unilateral monosyllabic speech recognition score with hearing aid (WRS 65 (HA)) is often below the maximum word recognition score with headphones (WRS max ), in particular for subjects with severe hearing loss. The aim of this study was to evaluate the efficiency factor Q of hearing aid provision, the ratio WRS 65 (HA)/WRS max , in patients with severe to profound hearing loss., Materials and Methods: Data from real-ear measurements (REM), pure tone and speech audiogram, and speech recognition with and without hearing aid of 93 ears in 64 patients were examined. The patients visited the authors' hearing center for hearing aid evaluation in 2019. Deviations of the real-ear measured frequency-dependent output level values from the prescription targets NAL-NL2 and DSL v5.0 were analyzed. Spearman correlation coefficients for the speech intelligibility index (SII) were calculated for the parameters WRS 65 (HA) and Q., Results: In more than 67% of the hearing aid fittings, output level values matched the target curves of NAL-NL2 or DSL v5.0 in the range of ±5 dB for frequencies from 0.5 to 4 kHz at 65 dB SPL. Nevertheless, WRS max was not achieved with hearing aid at conversational speech levels of 65 dB SPL (mean deviations: 34.4%). However, WRS 65 (HA) and Q were best when target values for DSL v5.0 were achieved at 65 dB SPL, which is associated with a higher SII., Conclusion: For patients with severe to profound hearing loss, the prescription targets of NAL-NL2 and DSL v5.0 do not provide sufficient amplification for WRS max to be achieved at a normal speech level of 65 dB SPL. It remains to be investigated whether alternative prescriptions with better audibility for input levels of 50 and 65 dB SPL might improve the effectiveness of hearing aid provision., (© 2022. The Author(s).)

Objectives: The goal of the study was to investigate prelinguistic consonant production and the influence of vocalizations that co-occurred with object mouthing on consonant production in infants with profound sensorineural hearing loss before and after cochlear implantation to advance knowledge of early speech development in infants with profound hearing loss., Design: Participants were 43 infants, 16 infants with profound sensorineural hearing loss and 27 hearing infants. In the mixed longitudinal and cross-sectional design, infants with profound hearing loss and age-matched hearing infants participated before cochlear implantation, at an average age of 9.9 mo, and/or after cochlear implantation, at an average age of 17.8 mo. Mean age at cochlear implantation for infants with profound hearing loss was 12.4 mo; mean duration of cochlear implant use at time of testing was 4.2 mo., Results: Before and after cochlear implantation, infants with profound hearing loss produced significantly fewer supraglottal consonants per consonant-vowel vocalization than hearing peers and had smaller overall consonant inventories. Before, but not after cochlear implantation, infants with profound hearing loss produced proportionally more vocalizations, supraglottal consonant-vowel vocalizations, and different supraglottal consonants in vocalizations during mouthing than did hearing infants., Conclusions: The results document consonant production before cochlear implantation in a larger group of infants with profound hearing loss than previously examined. The results also extend evidence of early delays in consonant production to infants who received cochlear implants at 12 mo of age, and show that they likely miss the potential benefits of auditory-motor feedback in vocalization-mouthing combinations that occur before they have access to sound through cochlear implants., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The purpose of this study was to compare the speech perception abilities in adult cochlear implant recipients implanted for bilateral sensorineural hearing loss (BSNHL) with those implanted for single-sided deafness (SSD)., Design: A total of 12 adults with BSNHL and 12 adults with SSD participated. Each participant completed a battery of speech perception measures including monosyllabic words, sentences, and consonant recognition., Results: Cochlear implant users with BSNHL performed higher on word and sentence recognition. Consonant recognition scores showed higher performance for CI listeners with BSNHL for voicing and manner, but not for place or articulation., Conclusions: Results of this study suggest that adults with SSD may have lower speech perception abilities with their cochlear implant when compared to adults implanted for BSNHL.

Purpose: Self-adjustment of hearing aid amplification enables wearers to customize the hearing aid output to match their preferences and could become an important tool for programming direct-to-consumer devices for people with mild-to-moderate hearing loss. One risk is that user-selected settings may provide inadequate audibility. This study assessed that risk by quantifying relationships between self-adjusted settings, subjective preferences, and speech recognition performance using speech at low levels in quiet, where achieving high speech audibility requires sufficient amplification., Method: Fifteen people with symmetric, mild-to-moderate sensorineural hearing loss self-adjusted hearing aid amplification while listening to speech in quiet at 45, 55, and 65 dBA. After self-adjustment, 11 participants made blinded ratings of their self-adjusted fit, their NAL-NL2 prescriptive fit, and experimenter-created fits with reduced gain. Participants completed blinded paired comparisons and sentence recognition assessments using these settings., Results: The gain of self-adjusted fits showed a large range of variability between participants. On average, self-adjusted gain was similar to NAL-NL2 prescribed gain for input signals of 55 dBA and slightly greater than prescribed gain for 45-dBA signals. Speech recognition scores for NAL-NL2 fits were consistently high, and differences in speech recognition results were strongly correlated with the overall preferences obtained from paired comparisons., Conclusions: Self-adjusted fits are highly variable between individuals for low-audibility conditions. Nonetheless, self-adjusted fits are at least as satisfactory as NAL-NL2 fits, and listeners tend to disfavor settings that result in poorer speech recognition. The findings argue against concerns that self-adjustment will result in inadequate audibility compared to prescribed settings.

Purpose: The aim of the study was to compare the user-rated benefit of two categories of hearing aids, mainly the basic and premium categories of hearing aids., Methods: A questionnaire was administered on 102 hearing aids users (47 basic and 55 premium category users) with severity of hearing loss ranging from mild to moderately severe sensorineural hearing loss. The questionnaire administered was divided into mainly seven subscales which included speech intelligibility in quiet and in noise, ease of communication, the efficiency of noise reduction, localization, quality of music perception and cost effectiveness. The effect of duration of daily usage of hearing aids on performance among these different subscales was also assessed., Results: Ease of communication was rated better by premium hearing aid users, whereas the cost effectiveness was rated to be better by basic users. There was no significant difference observed between performances of basic versus premium category of hearing aids in other listening domains assessed. There was no significant difference in any of the listening domains with daily usage duration for both categories of hearing aid users., Conclusion: The users of premium category devices revealed better ease of communication in daily environments, whereas performance of these devices on other listening domains remains questionable. Cost effectiveness was reported to be better by the users of basic hearing aids. A prospective and controlled paired series comparison of hearing aid performance needs to be performed to confirm these findings., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Experiences can be strongly influenced by expectations. In hearing healthcare, previous studies have shown that descriptions of hearing aids or contextual factors during the hearing aid fitting process can change subjective and even objective outcomes with hearing aids via the placebo effect. Personality factors have also been shown to affect susceptibility to placebo effects. The purposes of the present study were to (a) investigate the effects of communicating narratives designed to foster positive, negative, or neutral expectations about hearing aids on short-term patient outcomes, and (b) to determine if the degree to which the narratives affected end-user outcomes could be predicted by personality factors., Design: Nineteen adults between the ages of 54 and 81 (mean age = 68.5, SD = 8.9) had 3 separate research appointments, each exposing them to a different narrative condition: positive, negative, or neutral. the appointment was designed to look and feel like a "traditional" hearing aid fitting appointment, during which the experimenter introduced (i.e., the narrative condition) and fit a pair of hearing aids, the participant was asked to provide their initial feedback about the hearing aids, and the participant performed speech-in-noise testing. Unbeknownst to the research participant, the hearing aids fitted at all three appointments were the same, and the only difference between the three appointments was the way the hearing aids were described to the participants., Results: The results of this study showed that communication of a positive narrative about hearing aids before a hearing aid fitting led to better speech-in-noise performance on the QuickSIN as compared with performance following the negative or neutral narrative conditions. Also, the positive narrative led to the perception that acclimatization to the hearing aids would occur faster than the negative or neutral narrative conditions. Notably, the effect of communication of a positive narrative was stronger for individuals who scored higher on agreeableness, and susceptibility to positive and negative messaging was stronger for individuals low in neuroticism., Conclusions: The study suggests that short-term evaluations of hearing aids can be strongly influenced by narratives as provided by the hearing healthcare provider at the time of a hearing aid fitting., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Identifying and understanding speech is difficult for individuals with sensorineural hearing loss, especially in noisy environments. Possible causes include less audibility of the signal, impaired temporal resolution, and low selectivity of frequency. The hearing aid is the most common option used to minimize the problems faced by individuals with sensorineural hearing loss., Purpose: This article investigates the effects of multichannel and channel-free hearing aid signal processing techniques on spectral-temporal resolution and speech understanding in noise., Research Design: An experimental study was used in which the determined tests were applied to the participants., Study Sample: Thirty-four individuals with bilateral symmetrical sensorineural hearing loss between the ages of 18 and 70 were included in our study., Data Collection and Analysis: Spectral-temporally modulated ripple test, random gap detection test (RGDT), and Turkish matrix test were applied to the participants using multichannel and channel-free hearing aids. All the data obtained were compared statistically in terms of the performances of the hearing aids., Results: There was no significant difference between multichannel and channel-free hearing aids for spectral resolution and speech understanding in noise tests ( p  > 0.05). While there was no significant difference between the two hearing aids for 500 and 4,000 Hz RGDT in temporal resolution measurement ( p  > 0.05), for 1,000 Hz ( p  = 0.045), 2,000 Hz ( p  = 0.046), and composite RGDT ( p  = 0.001), statistically significant better performances were obtained with the channel-free hearing aids., Conclusion: It is thought that faster processing of the incoming signal in the channel-free hearing aids improves the temporal resolution performance. It is predicted that our study findings might help to determine the signal processing technique that will maximize the communication skills of the patients in various conditions., Competing Interests: The authors report no declarations of interest. The authors do not have any personal or financial relationships with participants and with the organizations in the research., (American Academy of Audiology. This article is published by Thieme.)

Objectives: This study was a continuation of work on an explore-and-select approach to the self-adjustment of amplification. Goals were to determine (i) the effect of changing the number of adjustment controls from three to two, (ii) the effect of changing the initial adjustment from overall output to high-frequency output, (iii) individual repeatability, (iv) the effect on phoneme recognition of increasing and decreasing overall output relative to the starting and adjusted conditions, and (v) listener reactions to, and opinions of, the self-adjustment procedure., Design: Twenty-two adults with hearing loss, 10 of whom were hearing aid users, adjusted level and spectrum of connected speech to preference, using three configurations of number and order of adjustment parameters. The three adjustments were replicated to give a total of six. Presentation was monaural, in quiet, using the ear with the better threshold at 2 kHz. The starting condition was a generic prescription for a typical mild-to-moderate hearing loss. Real ear output spectra were measured for the 6 self-adjustments, the generic starting condition, and the individual NAL-NL2 prescriptions for speech at 65 dB SPL. Monaural phoneme recognition in monosyllables was assessed, in quiet, at levels of -14, -7, 0 and +7 dB relative to both the starting and the self-adjusted conditions. Participants completed a questionnaire and their comments on each question were transcribed., Results: Changing the number of listener controls from 3 to 2 reduced mean adjustment time by around 50% but had negligible effect on group-mean output response. Starting adjustment with high-frequency output rather than overall output resulted in a 2 to 3 dB reduction of group-mean self-adjusted output below 1 kHz. Individual self-adjustments were within ±5 dB of NAL-NL2 prescription (for a 65 dB SPL speech input) for two-thirds of the participants in the high frequencies and for just over half in the low frequencies. In six self-adjustments, individuals self-adjusted, on average, to within ±4 dB of their own mean in both high and low frequencies. There was no evidence that these findings differed for hearing aid users and nonusers. Changes of overall output by ±7 dB after self-adjustment did not significantly affect group mean phoneme recognition. Preference for number and order of self-adjustment differed among participants, as did opinions on self-fitting of hearing aids., Conclusions: These findings support the conclusion that, for many adults with hearing loss, an explore-and-select procedure for self-adjustment of amplification leads to output values that are repeatable within a few dB, are relatively immune to the number and order of adjustment parameters, and place the average listener well along the plateau of a phoneme recognition versus amplitude function., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This paper presents an assistive hearing smartphone app mimicking the two main functions of hearing aids, consisting of compression and noise reduction. The app is designed to run in real time on smartphones or tablets. Appropriate levels of amplification or gain are activated by selecting a filter from a filter bank for six audio environment situations covering three sound pressure levels of speech and two sound pressure levels of noise. The results of this smartphone app for real-world audio environments are provided, indicating its effectiveness as a real-time platform for studying compression and noise reduction algorithms in the field or in realistic audio environments.

Background: For children with hearing loss, the primary goal of hearing aids is to provide improved access to the auditory environment within the limits of hearing aid technology and the child's auditory abilities. However, there are limited data examining aided speech recognition at very low (40 decibels A [dBA]) and low (50 dBA) presentation levels., Purpose: Due to the paucity of studies exploring aided speech recognition at low presentation levels for children with hearing loss, the present study aimed to (1) compare aided speech recognition at different presentation levels between groups of children with "normal" hearing and hearing loss, (2) explore the effects of aided pure tone average and aided Speech Intelligibility Index (SII) on aided speech recognition at low presentation levels for children with hearing loss ranging in degree from mild to severe, and (3) evaluate the effect of increasing low-level gain on aided speech recognition of children with hearing loss., Research Design: In phase 1 of this study, a two-group, repeated-measures design was used to evaluate differences in speech recognition. In phase 2 of this study, a single-group, repeated-measures design was used to evaluate the potential benefit of additional low-level hearing aid gain for low-level aided speech recognition of children with hearing loss., Study Sample: The first phase of the study included 27 school-age children with mild to severe sensorineural hearing loss and 12 school-age children with "normal" hearing. The second phase included eight children with mild to moderate sensorineural hearing loss., Intervention: Prior to the study, children with hearing loss were fitted binaurally with digital hearing aids. Children in the second phase were fitted binaurally with digital study hearing aids and completed a trial period with two different gain settings: (1) gain required to match hearing aid output to prescriptive targets (i.e., primary program), and (2) a 6-dB increase in overall gain for low-level inputs relative to the primary program. In both phases of this study, real-ear verification measures were completed to ensure the hearing aid output matched prescriptive targets., Data Collection and Analysis: Phase 1 included monosyllabic word recognition and syllable-final plural recognition at three presentation levels (40, 50, and 60 dBA). Phase 2 compared speech recognition performance for the same test measures and presentation levels with two differing gain prescriptions., Conclusion: In phase 1 of the study, aided speech recognition was significantly poorer in children with hearing loss at all presentation levels. Higher aided SII in the better ear (55 dB sound pressure level input) was associated with higher Consonant-Nucleus-Consonant word recognition at a 40 dBA presentation level. In phase 2, increasing the hearing aid gain for low-level inputs provided a significant improvement in syllable-final plural recognition at very low-level inputs and resulted in a nonsignificant trend toward better monosyllabic word recognition at very low presentation levels. Additional research is needed to document the speech recognition difficulties children with hearing aids may experience with low-level speech in the real world as well as the potential benefit or detriment of providing additional low-level hearing aid gain., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Background: In our study, we aimed to evaluate the hearing aid benefit and speech intelligibility with hearing aids using objective and subjective measurements, according to the type of hearing loss in elderly individuals who used different types of hearing aids., Methods: The objective and subjective findings from a total of 47 elderly individuals between the ages of 60 and 84, who used regular hearing aids for at least six months, and who were diagnosed with different types and degrees of hearing loss were evaluated by scanning them retrospectively., Results: : In our study, the Adaptive Turkish matrix sentence test (ATMST) was carried out with binaural headphones, and a statistically significant difference was observed between the ATMST scores of individuals with symmetrical hearing loss. A significant difference was found between the ATMST score averages for individuals with symmetrical hearing loss (S0 N90 and S0 N270) and asymmetric hearing loss (S0 N0 and S0 N270) in the free area. A significant difference was found between abbreviated profile of hearing aid benefit satisfaction questionnaires before and after hearing aid use in all groups., Discussion: The Turkish matrix sentence test (TMST) in noise can be used routinely in clinics in order to evaluate the possible hearing loss from the daily environment and the hearing aid effectiveness.

Objective: To analyse hearing attention and quality of listening in a cohort of children affected by moderate to severe unilateral hearing loss, comparing a group of hearing aid users to children with no hearing aid., Methods: Twenty-four children (12 hearing aid users, and 12 without hearing rehabilitation) underwent audiological evaluation with speech audiometry in quiet and noise, hearing attention tests, and the speech, spatial and quality of hearing questionnaire in the version for parents., Results: Concerning speech audiometry in noise, in the most difficult condition no one in the unaided group achieved a normal speech recognition threshold score (0% vs 11.6 ± 2.7% in the aided group). The selective hearing attention and shifting tests showed fewer errors in the aided group vs. the non-aided group. The questionnaire showed a significant difference between the quality of listening perceived by the parents of the two groups. The mean total scores were 152.8 ± 2.7 in the aided group and 116.1 ± 2.6 in the non-aided group (p > 0.001)., Conclusions: Children with unilateral hearing loss without hearing rehabilitation show a lower quality of hearing, especially with regards to divided auditory attention. Hearing rehabilitation should be proposed as soon as possible in children with moderate to severe unilateral hearing loss., (Copyright © 2022 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Purpose: Hearing aids are the primary method to manage hearing loss. However, there are limited recommendations for when and how to set advanced hearing aid features. The purpose of this study is to describe how hearing aid features are utilized in clinically fit devices and to evaluate the relationship between the fitted hearing aid feature and the Quick Speech-in-Noise Test (QuickSIN)., Method: Data from two laboratories were evaluated retrospectively, resulting in 107 bilateral hearing aid participants who obtained their hearing aids at clinics in their communities. Ages ranged from 60 to 93 years. Degree of speech-in-noise difficulty was evaluated using the QuickSIN (mild, moderate, or severe). Settings for directionality, digital noise reduction (DNR), and hearing assistive technology (HAT) use were documented. Directionality was categorized as omnidirectional, fixed (full-time directional), or adaptive (adjusts automatically based on noise source). DNR was recorded as either on or off. HAT use was recorded as either yes or no., Results: QuickSIN scores ranged from -1.5 to 25 dB SNR loss ( M = 7). A moderate correlation was determined for QuickSIN scores and pure-tone averages. Adaptive directionality was used most often, most participants had DNR turned on, and HAT use was low. The biggest contributions to the Chi-square test for directionality and degrees of speech-in-noise difficulty together were fixed/severe, fixed/moderate, and adaptive/mild., Conclusions: In this clinical sample, there was limited HAT use and advanced features are not set in a way that is consistent with speech-in-noise abilities. It is likely that patients fit with noise management that is not suited to their listening abilities are experiencing increased difficulties in challenging listening environments that could potentially be mitigated with alternative management. Evidence-based research on prefitting measures of speech in noise to help inform patient-centered clinical decisions is needed.

Background: Hearing aid manufacturers offer several different levels of technology that vary in sophistication and cost. It would stand to reason that higher technology hearing aids would provide greater benefit in the daily life of the user; however, research does not support this assumption for all users. Recent research in experienced hearing aid users indicated noise acceptance and satisfaction for speech in a large group were significantly improved when using the premium devices and suggested noise acceptance may be useful when comparing hearing aid technology levels., Purpose: The purpose of this study was to determine the effect of hearing aid technology level on listener outcome measures for new hearing aid users., Research Design: A repeated measures, single-blinded research design was utilized., Study Sample: Twenty-four adults with no previous hearing aid experience were recruited using flyers posted at the University of Tennessee Audiology Clinic and on social media (19 males, 5 females). The average age of the participants was 61 years (48-81 years)., Data Collection and Analysis: Participants completed two, 4-week trial periods using Unitron T Moxi Fit FLEX:TRIAL devices programmed with basic or premium technology. Following each trial, laboratory evaluations were conducted using the QuickSIN, Hearing in Noise Test (HINT), and the Acceptable Noise Level (ANL). Subjective data was obtained using the Speech, Spatial, and Qualities of Hearing Short Form, satisfaction ratings, and preference. Data was analyzed using one-way repeated-measures analysis of variance., Results: Speech perception results did not reveal significant differences between technology level on the HINT or QuickSIN; however, ANL was significantly improved for the premium devices. Subjective results revealed significantly improved satisfaction for speech in a large group and overall preference when using premium technology., Conclusion: Group data revealed similar outcomes between technology levels on most measures; however, noise acceptance, satisfaction for speech in a large group, and overall preference were significantly improved when using the premium devices. Individual characteristics such as noise acceptance, age, and degree of hearing loss may be useful when comparing hearing aid technology levels for new hearing aid users., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

Objective: The purpose of the study was to examine the effects of symmetrical and asymmetrical directional microphone settings on speech recognition, localisation and microphone preference in listening conditions with on- and off-axis talkers., Design: A within-subjects repeated-measure evaluation of three hearing aid microphone settings (bilateral omnidirectional, bilateral directional, asymmetrical directional) was completed in a moderately reverberant laboratory. An exploratory analysis of the potential relationship between microphone preference and unaided measures was also completed., Study Sample: Twenty adult listeners with mild to moderately severe bilateral hearing loss participated., Results: The directional and asymmetric microphone settings resulted in equivalent benefits for sentence recognition in noise, word recall, and localisation speed regardless of the speech loudspeaker location (on- or off-axis). However, localisation accuracy was significantly worse with the asymmetric fitting than the directional setting when speech was presented from the rear hemisphere. Listeners who always preferred directional microphones had significantly poorer unaided speech recognition than those who preferred the omnidirectional setting for one or more listening condition., Conclusions: Benefits from directional and asymmetric processing were small in the current study, but generally similar to each other. Unaided speech recognition in noise performance may have utility as a clinical predictor of preference for directional processing.

Background: Sensorineural hearing loss in child has a profound impact on their neurodevelopment and on language acquisition. Thus, the diagnosis and early intervention are critical, namely in unilateral or bilateral asymmetric hearing losses, which are diagnosed later than symmetric bilateral hearing losses., Objectives: This study aims to examine the progression of asymmetric SNHL in children, and the link between hearing thresholds and the technological level of the hearing aid fitted., Material and Methods: Eighteen children with asymmetric SNHL were submitted to a pure tone audiogram at the age of 5 years (T0) and reassessed at the age of 10 years (T1). Children were divided according to the technological level of the hearing aid fitted: basic, medium, and advanced., Results: A positive correlation was established between the hearing thresholds at T0 and T1, revealing an accelerated progression of hearing thresholds in the better ear after a 5-year period., Conclusions: Hearing thresholds in the worse ear influence the progression of the SNHL. Moreover, technologically advanced hearing aids led to a slower progression of the hearing thresholds over time.