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Objective: Our primary purpose was evaluation of early benefits of lifestyle modification on symptoms of vestibular migraine. The secondary purpose was to determine if a patient's global sense of coping relates to outcomes with lifestyle modification., Design: Prospective observational cohort. Participants completed questionnaires related to dizziness handicap, headache disability, and adherence to lifestyle modifications at baseline and weekly over 30 d. Sense of coping was measured pre-intervention., Study Sample: Thirty-eight patients with vestibular migraine diagnosed in tertiary care setting between 2022 and 2023., Results: Symptoms were better at all four weeks post-intervention than pre-intervention ( p  < 0.01), with no difference across weeks two through four ( p  > 0.10) when symptoms were lowest and stable. By week two, 52% and 18.5% of participants had significant improvement in dizziness and headache compared to published critical difference scores, respectively. Sense of coping was inversely correlated with dizziness (R = -0.53, p  < 0.00001) and headache (R = -0.64, p  < 0.0001)., Conclusions: Lifestyle modification reduced dizziness and headache in many vestibular migraineurs in the first two weeks following intervention. Improvement in restful sleep was associated with improvement in symptoms. Sense of coping did not predict improvement but was inversely related to symptoms. Lifestyle modification could be considered as sole management or in addition to pharmacological intervention.

Spectral weighting functions for sound localization were measured in participants with bilateral mild sloping to moderately severe, high-frequency sensorineural hearing loss (SNHL) and compared to normal hearing (NH) participants with and without simulated SNHL. Each participant group localized three types of complex tones, comprised of seven frequency components spatially jittered and presented from the horizontal frontal field. A threshold-elevating noise masker was implemented in the free field to simulate SNHL for participants with NH. On average, participants with SNHL and NH (in quiet and simulated SNHL) placed the greatest perceptual weight on components within the interaural time difference "dominance region," found previously to peak around 800 Hz [Folkerts and Stecker, J. Acoust. Soc. Am. 151, 3409-3425 (2022)]. In addition to the peak at 800 Hz, both participant groups (including NH participants in quiet) placed near equal weight on 400 Hz, resulting in a broadened "peak" in the dominance region, most likely due to the reduction of audibility to higher frequency components. However, individual weighting strategies were more variable across participants with SNHL than participants with NH. Localization performance was reduced for participants with SNHL but not for NH participants with simulated hearing loss when compared to NH participants in quiet., (© 2024 Acoustical Society of America.)

Objectives: Adults with permanent hearing loss exhibit a reduced range of valence ratings in response to nonspeech sounds; however, the degree to which sound genre might affect such ratings is unclear. The purpose of this study was to determine if ratings of valence covary with sound genre (e.g., social communication, technology, music), or only expected valence (pleasant, neutral, unpleasant)., Design: As part of larger study protocols, participants rated valence and arousal in response to nonspeech sounds. For this study, data were reanalyzed by assigning sounds to unidimensional genres and evaluating relationships between hearing loss, age, and gender and ratings of valence. In total, results from 120 adults with normal hearing (M = 46.3 years, SD = 17.7, 33 males and 87 females) and 74 adults with hearing loss (M = 66.1 years, SD = 6.1, 46 males and 28 females) were included., Results: Principal component analysis confirmed valence ratings loaded onto eight unidimensional factors: positive and negative social communication, positive and negative technology, music, animal, activities, and human body noises. Regression analysis revealed listeners with hearing loss rated some genres as less extreme (less pleasant/less unpleasant) than peers with better hearing, with the relationship between hearing loss and valence ratings being similar across genres within an expected valence category. In terms of demographic factors, female gender was associated with less pleasant ratings of negative social communication, positive and negative technology, activities, and human body noises, while increasing age was related to a subtle rise in valence ratings across all genres., Conclusions: Taken together, these results confirm and extend previous findings that hearing loss is related to a reduced range of valence ratings and suggest that this effect is mediated by expected sound valence, rather than sound genre., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders., Design: All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders., Results: There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported., Conclusions: Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Active listening in everyday settings is challenging and requires substantial mental effort, particularly in noisy settings. In some cases, effortful listening can lead to significant listening-related fatigue and negatively affect quality of life. However, our understanding of factors that affect the severity of fatigue is limited. Hearing aids and cochlear implants (CIs) can improve speech understanding and thus, potentially, reduce listening effort and fatigue. Some research supports this idea for adult hearing aid users with mild-to-moderate hearing loss, but similar work in CI users is very limited. This study examined (1) longitudinal changes in listening-related fatigue in new and established CI users, and (2) relationships between demographic and audiologic factors and preimplantation and postimplantation listening-related fatigue., Design: Participants included an experimental group of 48 adult CI candidates receiving either a unilateral implant (n = 46) or simultaneous, bilateral implants (n = 2) and a control group of 96 experienced (>12 months experience) adult CI users (50 unilateral, 46 bilateral). Listening-related fatigue was evaluated using the 40-item version of the Vanderbilt Fatigue Scale for Adults. Experimental group ratings were obtained before implantation and again at 0.5-, 1-, 2-, 3-, 6-, and 12-month(s) postactivation. Control group participants completed the scale twice-upon study entry and approximately 3 months later. Additional measures, including a social isolation and disconnectedness questionnaire, hearing handicap inventory, and the Effort Assessment Scale, were also administered at multiple time points. The role of these measures and select demographic and audiologic factors on preimplant and postimplant fatigue ratings were examined., Results: Adult CI candidates reported significantly more fatigue, greater self-perceived hearing handicap, greater listening effort, and more social isolation than experienced adult CI users. However, significant reductions in fatigue and effort were observed within 2 weeks postimplantation. By 3 months, there were no significant differences in fatigue, effort, hearing handicap, or social isolation between new CI recipients and experienced CI users. Secondary analyses revealed that age at onset of hearing loss (before or after 2 years of age) and subjective hearing handicap contributed significantly to the variance of preimplantation fatigue ratings (those with higher handicap reported higher fatigue). In contrast, variance in postimplantation fatigue ratings was not affected by age of hearing loss onset but was affected by gender (females reported more fatigue than males) and subjective ratings of effort, handicap, and isolation (those reporting more effort, handicap, and isolation reported more fatigue)., Conclusions: Listening-related fatigue is a significant problem for many CI candidates, as well as for many experienced unilateral and bilateral CI users. Receipt of a CI significantly reduced listening-related fatigue (as well as listening effort, hearing handicap, and social isolation) as soon as 2 weeks post-CI activation. However, the magnitude of fatigue-related issues for both CI candidates and experienced CI users varies widely. Audiologic factors, such as hearing loss severity and aided speech recognition, were not predictive of individual differences in listening-related fatigue. In contrast, strong associations were observed between perceived hearing handicap and listening-related fatigue in all groups suggesting fatigue-related issues may be a component of perceived hearing handicap., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the potential contribution of limited English proficiency on daily hearing aid wear time for children with hearing loss., Method: A retrospective chart review was completed to evaluate hearing aid wear time based on data logging information available at the time of a follow-up visit following an initial hearing aid fitting. Children were included in the study if they had permanent bilateral hearing loss and were less than 60 months of age at the time of their first follow-up visit. Wear time was compared between children who attended an interpreter-mediated appointment and those who did not have an interpreter present. The presence of an interpreter at the appointment was the study indicator that the family had limited English proficiency., Results: Children from families with limited English proficiency exhibited significantly shorter daily wear time ( M = 1.3 hr) than their peers whose families were English-proficient speakers, thus, having a shared language with their audiologists ( M = 5.2 hr)., Conclusions: Results of this study suggest that family-clinician language discordance might put children at greater risk of shorter hearing aid wear time than children whose caregivers share a common language with their child's audiologist. There can be many linguistic, cultural, and educational factors that contribute to hearing aid wear time in children whose families have limited English proficiency as well as different approaches to improving that wear time. Efforts should ensure that hearing and hearing aid-related information is accessible to all families, especially those with clinician-family language discordance. Such efforts can include, among others, training that improves clinicians' cultural and linguistic responsiveness to the diverse families they serve.

Objectives: The purposes of this study were to compare (a) listening-in-noise (accuracy and effort) and (b) remote microphone (RM) system benefits between autistic and non-autistic youth., Design: Groups of autistic and non-autistic youth that were matched on chronological age and biological sex completed listening-in-noise testing when wearing and not wearing an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in type (syllables, words, sentences, and passages). Several putative moderators of RM system effects on outcomes of interest were also evaluated., Results: Autistic youth outperformed non-autistic youth in some conditions on listening-in-noise accuracy; listening effort between the two groups was not significantly different. RM system use resulted in listening-in-noise accuracy improvements that were nonsignificantly different across groups. Benefits of listening-in-noise accuracy were all large in magnitude. RM system use did not have an effect on listening effort for either group. None of the putative moderators yielded effects of the RM system on listening-in-noise accuracy or effort for non-autistic youth that were significant and interpretable, indicating that RM system benefits did not vary according to any of the participant characteristics assessed., Conclusions: Contrary to expectations, autistic youth did not demonstrate listening-in-noise deficits compared to non-autistic youth. Both autistic and non-autistic youth appear to experience RM system benefits marked by large gains in listening-in-noise performance. Thus, the use of this technology in educational and other noisy settings where speech perception needs enhancement might be beneficial for both groups of children.

Objectives: Recognizing speech through telecommunication can be challenging in unfavorable listening conditions. Text supplementation or provision of facial cues can facilitate speech recognition under some circumstances. However, our understanding of the combined benefit of text and facial cues in telecommunication is limited. The purpose of this study was to investigate the potential benefit of text supplementation for sentence recognition scores and subjective ratings of spoken speech with and without facial cues available., Design: Twenty adult females (M = 24 years, range 21 to 29 years) with normal hearing performed a sentence recognition task and also completed a subjective rating questionnaire in 24 conditions. The conditions varied by integrity of the available facial cues (clear facial cues, slight distortion facial cues, great distortion facial cues, no facial cues), signal-to-noise ratio (quiet, +1 dB, -3 dB), and text availability (with text, without text). When present, the text was an 86 to 88% accurate transcription of the auditory signal presented at a 500 ms delay relative to the auditory signal., Results: The benefits of text supplementation were largest when facial cues were not available and when the signal-to-noise ratio was unfavorable. Although no recognition score benefit was present in quiet, recognition benefit was significant in all levels of background noise for all levels of facial cue integrity. Moreover, participant subjective ratings of text benefit were robust and present even in the absence of recognition benefit. Consistent with previous literature, facial cues were beneficial for sentence recognition scores in the most unfavorable signal-to-noise ratio, even when greatly distorted. It is interesting that, although all levels of facial cues were beneficial for recognition scores, participants rated a significant benefit only with clear facial cues., Conclusions: The benefit of text for auditory-only and auditory-visual speech recognition is evident in recognition scores and subjective ratings; the benefit is larger and more robust for subjective ratings than for scores. Therefore, text supplementation might provide benefit that extends beyond speech recognition scores. Combined, these findings support the use of text supplementation in telecommunication, even when facial cues are concurrently present, such as during teleconferencing or watching television., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Spectral weighting of sound localization cues was measured in the presence of three levels of competing noise presented in the free field. Target stimuli were complex tones containing seven tonal components, presented from an ∼120° range of frontal azimuths. Competitors were two independent Gaussian noises presented from 90° left and right azimuth at one of three levels yielding +9, 0, and -6 dB signal-to-noise ratio. Results revealed the greatest perceptual weight for components within the interaural time difference (ITD) "dominance region," which was found previously to peak around the 800-Hz component in quiet [Folkerts and Stecker (2022) J. Acoust. Soc. Am. 151, 3409-3425]. Here, peak weights were shifted toward lower-frequency components (i.e., 400 Hz) in all competing noise conditions. These results contradict the hypothesis of a shift in the peak weights toward higher frequencies based on previous behavioral localization performance in competing noise but are consistent with binaural cue sensitivity, availability, and reliability; measured low-frequency ITD cues within the dominance region were least disrupted by the presence of competing noise., (© 2023 Acoustical Society of America.)

Objective: To assess the suitability of newborn hearing screening brochures by evaluating current state-level brochures and pregnant people's understanding of screening result terminology., Design: In Study 1, state-level brochures were evaluated based on readability, design, picture appropriateness, and use of the word "refer." In Study 2, pregnant people completed a questionnaire that queried their understanding of and expected anxiety about three newborn hearing screening outcomes ("refer," "did not pass," and "pass")., Study Sample: In Study 1, 59 newborn hearing screening brochures were analysed. In Study 2, 43 pregnant people completed surveys during a prenatal appointment., Results: Most of the brochures were found deficient on at least one element. Thirty percent of brochures used the word "refer" to indicate a hearing screening failure; yet, fewer than half of participants understood its meaning. Ratings of expected anxiety were highest in response to the term "did not pass.", Conclusions: Based on four study criteria of brochure suitability, 88% of available state-level newborn hearing screening brochures should be modified to make them readily understandable by a broad educational demographic. Discretion in use of the term "refer" should be made when indicating screening results, because the term is not readily understood.

Purpose: There is unexplained variability in self-reported hearing aid outcomes. The aim of this study was to evaluate determinants of hearing aid benefit and satisfaction ratings using a large-scale customer survey and to analyze the relation between demographic variables, hearing aid attributes, benefit, and satisfaction., Method: The study used a retrospective design wherein 2,109 hearing aid users, recruited by Hearing Tracker and Hearing Loss Association of America, completed an online survey. The survey included questions about demographics, perceived hearing loss, devices, service delivery, cost, benefit, and satisfaction. The analytic approach included descriptive summaries and regression models to evaluate potential determinants of hearing aid benefit and satisfaction ratings., Results: Hearing aid sound quality, fit and comfort, and battery life were related to both benefit and satisfaction. Respondents who rated these outcomes favorably were also likely to benefit from, and be satisfied with, their hearing aids. Benefit was also related to degree of hearing loss, hearing aid experience, and cost. Hearing aid users with greater self-perceived hearing loss, more hearing aid experience, and more expensive hearing aids reported more benefit. Satisfaction was also related to age, employment status, and brand. Younger respondents, those who were students, and those using certain brands reported more satisfaction., Conclusions: The results highlight importance of good hearing aid outcomes (quality, fit/comfort, and battery life) for benefit and satisfaction ratings. Professionals who fit hearing aids should strive to focus on achieving these outcomes and researchers should strive to explain the remaining variability in ratings of benefit and satisfaction., Supplemental Material: https://doi.org/10.23641/asha.22280854.

Competing Interests: Conflict of Interest None declared.

Response time-based dual-task paradigms are commonly adopted to measure behavioral listening effort. Most extant studies used an all-response approach that included secondary task responses under both correct and incorrect primary task responses during analysis. However, evidence supporting this strategy is limited. Therefore, the current study investigated the potential differences between including all responses versus only including correct responses. Data from two previous studies were reanalyzed. Experiment 1 included 16 listeners and used a dual-task paradigm to examine the effect of introducing background noise on listening effort. Experiment 2 included 19 participants and used a different dual-task paradigm to examine the effect of reverberation and loudspeaker-to-listener distance on listening effort. ANOVA results obtained using both analysis approaches were compared. The all-response and correct-only approaches revealed similar results. However, larger effect sizes and an additional main effect were found with the all-response approach. The current study supports the use of an all-response approach due to its greater sensitivity to changes in behavioral listening effort. However, a correct-only approach could be utilized to suit specific study purposes., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Purpose: Mixed historical data on how listening effort is affected by reverberation and listener-to-speaker distance challenge existing models of listening effort. This study investigated the effects of reverberation and listener-to-speaker distance on behavioral and subjective measures of listening effort: (a) when listening at a fixed signal-to-noise ratio (SNR) and (b) at SNRs that were manipulated so that word recognition would be comparable across different reverberation times and listening distances. It was expected that increased reverberation would increase listening effort but only when listening outside critical distance., Method: Nineteen adults (21-40 years) with no hearing loss completed a dual-task paradigm. The primary task was word recognition and the secondary task was timed word categorization; response times indexed behavioral listening effort. Additionally, participants provided subjective ratings in each condition. Testing was completed at two reverberation levels (moderate and high, RT 30 = 469 and 1,223 ms, respectively) and at two listener-to-speaker distances (inside and outside critical distance for the test room, 1.25 and 4 m, respectively)., Results: Increased reverberation and listening distances worsened word recognition performance and both behavioral and subjective listening effort. The effect of reverberation was exacerbated when listeners were outside critical distance. Subjective experience of listening effort persisted even when word recognition was comparable across conditions., Conclusions: Longer reverberation times or listening outside the room's critical distance negatively affected behavioral and subjective listening effort. This study extends understanding of listening effort in reverberant rooms by highlighting the effect of listener's position relative to the room's critical distance.

The hearing aid market is rapidly evolving with advancements in features and potential changes in service delivery models, including the new over-the-counter device category. Data from the MarkeTrak 2022 survey indicate most hearing aid owners report regular quality-of-life benefits from hearing aids, even more than in previous surveys. The increased likelihood of hearing aid benefits might be attributable to modern hearing aid features advancements, such as wireless connectivity and rechargeable batteries. Hearing aid satisfaction rates have been relatively stable over the years, indicating that more than 80% of hearing aid owners are satisfied with their devices. Hearing aid satisfaction rates do not appreciably vary by fitting channel; hearing aid owners fitted in person, fitted remotely, or self-fit are similarly likely to report high satisfaction with their device. However, only respondents in the in-person channel gave establishment ratings (reflecting their willingness to recommend) that resulted and reflected a positive net promoter score. Given the potential for net promoter scores to be related to brand growth and customer loyalty, this finding has implications for the development of over-the-counter hearing aid service-delivery models. Additional work is warranted to explore the factors that negatively affect hearing aid owners' satisfaction with the companies delivering limited services., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Cochlear duct length (CDL) is subject to significant individual variation. In the context of cochlear implantation, adapting the electrode array length to the CDL is of potential interest, as it has been associated with improvements in both speech recognition and sound quality. Using a tablet-based software package, it is possible to measure CDL at the level of the organ of Corti (CDL OC ) to select appropriate electrode array lengths based on individual cochlear anatomy., Objective: To identify effects of imaging modality and rater background on CDL estimates., Methods: Magnetic resonance imaging (MRI) and flat-panel volume CT (fpVCT) scans of 10 patients (20 cochleae) were analyzed using the OTOPLAN software package (MED-EL, Innsbruck, Austria). Raters were an otorhinolaryngology (ORL) specialist, an ORL resident, and an audiologist. To analyze effects of rater background and imaging modality on CDL measurements, linear mixed models were constructed., Results: Measurements showed mean CDL OC (fpVCT) = 36.69 ± 1.78 mm and CDL OC (MRI) = 36.81 ± 1.87 mm. Analyses indicated no significant effect of rater background (F(2, 105) = 0.84; p = 0.437) on CDL estimates. Imaging modality, on the other hand, significantly affected CDL (F (1, 105) = 20.70; p < 0.001), whereby estimates obtained using MRI were 0.89 mm larger than those obtained using fpVCT., Conclusion: No effect of rater background on CDL estimates could be identified, suggesting that comparable measurements could be obtained by personnel other than specially trained neurootologists. While imaging modality (fpVCT vs. MRI) did impact CDL results, the difference was small and of questionable clinical significance., (© 2022. The Author(s).)

Objective: To evaluate remote testing as a tool for measuring emotional responses to non-speech sounds., Design: Participants self-reported their hearing status and rated valence and arousal in response to non-speech sounds on an Internet crowdsourcing platform. These ratings were compared to data obtained in a laboratory setting with participants who had confirmed normal or impaired hearing., Study Sample: Adults with normal and impaired hearing., Results: In both settings, participants with hearing loss rated pleasant sounds as less pleasant than did their peers with normal hearing. The difference in valence ratings between groups was generally smaller when measured in the remote setting than in the laboratory setting. This difference was the result of participants with normal hearing rating sounds as less extreme (less pleasant, less unpleasant) in the remote setting than did their peers in the laboratory setting, whereas no such difference was noted for participants with hearing loss. Ratings of arousal were similar from participants with normal and impaired hearing; the similarity persisted in both settings., Conclusions: In both test settings, participants with hearing loss rated pleasant sounds as less pleasant than did their normal hearing counterparts. Future work is warranted to explain the ratings of participants with normal hearing.

The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus on the selection of unilateral/bilateral hearing aids, hearing aid style, and coupling, in addition to feature selection. The standard emphasizes that decisions around these three aspects should be recommended for a patient in an individualized manner, based on their needs assessment. For these decisions, the needs assessment might include measures of speech-in-noise ability, social network size, patient preference, and a trial period. Additional elements could include assessments of manual dexterity, binaural interference, and attitude toward hearing aids. However, there are a multitude of ways to practice clinically and still meet the items outlined in the standard. As long as the selection decisions consider individualized patient factors and are capable of meeting validated prescriptive targets, a clinician would be meeting the adult hearing aid fitting minimum standard guidance. In addition, despite the large number of past studies supporting these standards, additional, high-quality research including randomized, controlled, clinical trials are still needed to further support appropriate minimum standard recommendations., Competing Interests: CONFLICT OF INTEREST None declared., (Thieme. All rights reserved.)

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.

Objectives: This study examined whether remote microphone (RM) systems improved listening-in-noise performance in youth with autism. We explored effects of RM system use on both listening-in-noise accuracy and listening effort in a well-characterized sample of participants with autism. We hypothesized that listening-in-noise accuracy would be enhanced and listening effort reduced, on average, when participants used the RM system. Furthermore, we predicted that effects of RM system use on listening-in-noise accuracy and listening effort would vary according to participant characteristics. Specifically, we hypothesized that participants who were chronologically older, had greater nonverbal cognitive and language ability, displayed fewer features of autism, and presented with more typical sensory and multisensory profiles might exhibit greater benefits of RM system use than participants who were younger, had less nonverbal cognitive or language ability, displayed more features of autism, and presented with greater sensory and multisensory disruptions., Design: We implemented a within-subjects design to investigate our hypotheses, wherein 32 youth with autism completed listening-in-noise testing with and without an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in complexity (i.e., syllable-, word-, sentence-, and passage-level). In addition, several putative moderators of RM system effects (i.e., sensory and multisensory function, language, nonverbal cognition, and broader features of autism) on outcomes of interest were evaluated., Results: Overall, RM system use resulted in higher listening-in-noise accuracy in youth with autism compared with no RM system use. The observed benefits were all large in magnitude, although the benefits on average were greater for more complex stimuli (e.g., key words embedded in sentences) and relatively smaller for less complex stimuli (e.g., syllables). Notably, none of the putative moderators significantly influenced the effects of the RM system on listening-in-noise accuracy, indicating that RM system benefits did not vary according to any of the participant characteristics assessed. On average, RM system use did not have an effect on listening effort across all youth with autism compared with no RM system use but instead yielded effects that varied according to participant profile. Specifically, moderated effects indicated that RM system use was associated with increased listening effort for youth who had (a) average to below-average nonverbal cognitive ability, (b) below-average language ability, and (c) reduced audiovisual integration. RM system use was also associated with decreased listening effort for youth with very high nonverbal cognitive ability., Conclusions: This study extends prior work by showing that RM systems have the potential to boost listening-in-noise accuracy for youth with autism. However, this boost in accuracy was coupled with increased listening effort, as indexed by longer reaction times while using an RM system, for some youth with autism, perhaps suggesting greater engagement in the listening-in-noise tasks when using the RM system for youth who had lower cognitive abilities, were less linguistically able, and/or have difficulty integrating seen and heard speech. These findings have important implications for clinical practice, suggesting RM system use in classrooms could potentially improve listening-in-noise performance for some youth with autism., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Up to 80% of audiograms could be automated which would allow more time for provision of specialty services. Ideally, automated audiometers would provide accurate results for listeners with impaired hearing as well as normal hearing. Additionally, accurate results should be provided both in controlled environments like a sound-attenuating room but also in test environments that may support greater application when sound-attenuating rooms are unavailable. Otokiosk is an iOS-based system that has been available for clinical use, but there are not yet any published validation studies using this product., Purpose: The purpose of this project was to complete a validation study on the OtoKiosk automated audiometry system in quiet and in low-level noise, for listeners with normal hearing and for listeners with impaired hearing., Research Design: Pure tone air conduction thresholds were obtained for each participant for three randomized conditions: standard audiometry, automated testing in quiet, and automated testing in noise. Noise, when present, was 35 dBA overall and was designed to emulate an empty medical exam room., Study Sample: Participants consisted of 11 adults with hearing loss and 15 adults with normal hearing recruited from the local area., Data Collection and Analysis: Thresholds were measured at 500, 1,000, 2,000, and 4,000 Hz using the Otokiosk system that incorporates a modified Hughson-Westlake method. Results were analyzed using descriptive statistics and also by a linear mixed-effects model to compare thresholds obtained in each condition., Results: Across condition and participant group 73.6% of thresholds measured with OtoKiosk were within ± 5 dB of the conventionally measured thresholds; 92.8% were within ± 10 dB. On average, differences between tests were small. Pairwise comparisons revealed thresholds were ∼3.5-4 dB better with conventional audiometry than with the mobile application in quiet and in noise. Noise did not affect thresholds measured with OtoKiosk., Conclusions: The OtoKiosk automated hearing test measured pure tone air conduction thresholds from 500 to 4,000 Hz at slightly higher thresholds than conventional audiometry, but less than the smallest typical 5 dB clinical step-size. Our results suggest OtoKiosk is a reasonable solution for sound booths and exam rooms with low-level background noise., Competing Interests: Equipment and funding that supported this research project was provided by Otohub, SRL., (American Academy of Audiology. This article is published by Thieme.)

Objective: Telecommunication can be difficult in the presence of noise or hearing loss. The purpose of this study was to systematically review evidence regarding the effects of text supplementation (e.g. captions, subtitles) of auditory or auditory-visual signals on speech intelligibility for listeners with normal or impaired hearing., Design: Three databases were searched. Articles were evaluated for inclusion based on the Population Intervention Comparison Outcome framework. The Effective Public Health Practice Project instrument was used to evaluate the quality of the identified articles., Study Sample: After duplicates were removed, the titles and abstracts of 2019 articles were screened. Forty-six full texts were reviewed; ten met inclusion criteria., Results: The quality of all ten articles was moderate or strong. The articles demonstrated that text added to auditory (or auditory-visual) signals improved speech intelligibility and that the benefits were largest when auditory signal integrity was low, accuracy of the text was high, and the auditory signal and text were synchronous. Age and hearing loss did not affect benefits from the addition of text., Conclusions: Although only based on ten studies, these data support the use of text as a supplement during telecommunication, such as while watching television or during telehealth appointments.

The purpose of this project was to evaluate differences between groups and device configurations for emotional responses to non-speech sounds. Three groups of adults participated: 1) listeners with normal hearing with no history of device use, 2) hearing aid candidates with or without hearing aid experience, and 3) bimodal cochlear-implant listeners with at least 6 months of implant use. Participants ( n  = 18 in each group) rated valence and arousal of pleasant, neutral, and unpleasant non-speech sounds. Listeners with normal hearing rated sounds without hearing devices. Hearing aid candidates rated sounds while using one or two hearing aids. Bimodal cochlear-implant listeners rated sounds while using a hearing aid alone, a cochlear implant alone, or the hearing aid and cochlear implant simultaneously. Analysis revealed significant differences between groups in ratings of pleasant and unpleasant stimuli; ratings from hearing aid candidates and bimodal cochlear-implant listeners were less extreme (less pleasant and less unpleasant) than were ratings from listeners with normal hearing. Hearing aid candidates' ratings were similar with one and two hearing aids. Bimodal cochlear-implant listeners' ratings of valence were higher (more pleasant) in the configuration without a hearing aid (implant only) than in the two configurations with a hearing aid (alone or with an implant). These data support the need for further investigation into hearing device optimization to improve emotional responses to non-speech sounds for adults with hearing loss.

Objective: To evaluate effects of lifestyle modification on symptoms of dizziness and headache in patients diagnosed with definite vestibular migraine., Study Design: Prospective within-participants repeated-measures study., Setting: Otolaryngology tertiary care., Participants: Twenty-eight adults with definite vestibular migraine who were willing to be treated without pharmacological intervention., Interventions: Information and instructions were provided on lifestyle modification; participants were instructed to improve restful sleep, exercise, eat at regulated mealtimes, and avoid dietary triggers. Participants were asked to maintain the modifications for at least 60 days., Main Outcome Measures: Two self-report inventories were used pre- and post-intervention to evaluate participants' perceived dizziness handicap and headache disability using the Dizziness Handicap Inventory and Headache Disability Inventory, respectively. Questions were also used to evaluate the extent to which participants reported compliance with lifestyle factors pre- and post-intervention., Results: Significant improvement was observed after the lifestyle intervention with mean improvements in Dizziness Handicap Inventory and Headache Disability Inventory of 14.3 points. As a group, improvement in restful sleep was related to improvement in both dizziness and headache symptoms. At the individual participant level, 39% and 18% of participants reported significant reduction in dizziness handicap and headache disability, respectively., Conclusions: Lifestyle modifications are an effective intervention for symptoms of dizziness and headache in participants with definite vestibular migraine. Participants who reported a larger increase in restful sleep were more likely to also report larger improvements in dizziness handicap and headache disability. Effect sizes using the current intervention were comparable or better than some reported pharmacological interventions but less than others. Our lifestyle modification intervention produced significant improvement in dizziness for a larger percentage of individual participants and in headache for a similar percentage of participants compared to data reported with other lifestyle modification interventions. Lifestyle modifications, especially restful sleep, have the potential to reduce the impact of vestibular migraine on patients' lives, with limited risk.Clinical Trials Registration: NCT03979677., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Background: Modern hearing aids have various features and functionalities, such as digital wireless streaming, bilateral connectivity, rechargeability, and specialized programs, which allow for a multitude of hearing aid attributes (e.g., comfort, reliability, and clarity). Consumers likely vary greatly in their preferences for these hearing aid attributes. Their preferences might be related to various demographic and hearing loss characteristics., Purpose: The purposes of this study were to describe which hearing aid attributes consumers find desirable when choosing their hearing aids and to explore factors that might predict preferences., Research Design: Cross-sectional., Study Sample: 14,993., Intervention: Not applicable., Data Collection and Analysis: In this retrospective study, hearing aid attribute preferences were evaluated from consumers who answered questions in the Help Me Choose tool on the HearingTracker.com Web site. Chi-squared tests and correlation analyses were used to identify potential relationships between attribute preference and respondent characteristics. Cluster analysis with Partitioning Around Medoids (PAM) was used to identify patterns of attribute preferences., Results: Of the 21 hearing aid attributes queried, the four most favorably rated were improved ability to hear friends and family in quiet and in noisy settings, physical comfort, and reliability, with 75 to 88% of respondents rating these attributes as very or extremely important. Type of hearing loss, technology level preference, and mobile phone brand were significantly associated with preferences for all 21 hearing aid attributes. PAM cluster analysis unveiled two unique user groups based on their preference to hearing aid attributes. One-third of the respondents preferred high-end technology and favored all types of advanced attributes. The other two-thirds of users predominantly preferred either advanced or best match and were more selective about which attributes were most important to them., Conclusion: Patterns in preferences to hearing aid attributes help identify unique subgroups of consumers. Patient preferences for specific hearing aid attributes, in addition to audiologic characteristics, could help audiologists in recommending hearing aids for their patients., Competing Interests: Abram Bailey is the CEO of HearingTracker.com. No conflicts were declared by the other authors., (American Academy of Audiology. This article is published by Thieme.)

Objective: In contrast to the moderate presentation levels most commonly used in clinical practice, speech encountered in everyday life often occurs at low levels, such as when a conversational partner whispers or speaks from another room. In addition, even when the overall signal level is moderate, levels for particular words or speech sounds, such as voiceless consonants, can be considerably lower. Existing techniques for improving recognition of low-level speech for cochlear implant users include using a wider input dynamic range and elevating electrode threshold levels (T-levels). While these techniques tend to positively impact recognition of soft speech, each has also been associated with drawbacks. Recently, a noise-gating (NG) algorithm was reported, which works by eliminating input to an electrode when signal level in the associated frequency channel is at or below a predetermined threshold. Available evidence suggests that activation of this algorithm can improve recognition of sentences presented at low levels (35 to 50 dB SPL), though it remains unclear whether the benefits will be equally evident with both manufacturer default and individually optimized T-levels. The primary aim of this study was therefore to evaluate the independent and combined effects of NG activation and T-level personalization., Methods: Twenty adults between the ages of 25 and 77 years (M = 54.9 years, SD = 17.56) with postlingually acquired profound hearing loss completed testing for this study. Participants were fit with an Advanced Bionics Naida CI Q90 speech processor, which contained four programs based on each participant's existing everyday program. The programs varied by the NG algorithm setting (on, off) and T-level method (default 10% of M-level, personalized based on subjective ratings of "very quiet"). All participants completed speech sound detection threshold testing (/m/, /u/, /a/, /i/, /s/, and /∫/), as well as tests of monosyllabic word recognition in quiet (45 and 60 dB SPL), sentence recognition in quiet (45 and 60 dB SPL), and sentence recognition in noise (45-dB SPL speech, +10 dB SNR)., Results: Findings demonstrated that both activating NG and personalizing T-levels in isolation significantly improved detection (speech sounds) and recognition (monosyllables, sentences in quiet, and sentences in noise) of soft speech, with their respective individual effects being comparable. However, the lowest speech sound detection thresholds and the highest speech recognition performance were identified when NG was activated in conjunction with personalized T-levels. Importantly, neither T-level personalization nor NG activation affected recognition of speech presented at 60 dB SPL, which suggests the strategies should not be expected to interfere with recognition of average conversational speech., Conclusions: Taken together, these data support the clinical recommendation of personalizing T-levels and activating NG to improve the detection and recognition of soft speech. However, future work is needed to evaluate potential limitations of these techniques. Specifically, speech recognition testing should be performed in the presence of diverse noise backgrounds and home-trials should be conducted to determine processing effects on sound quality in realistic environments., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design Two groups of school-age children (aged 7-12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (-12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of "task difficulty" and "hard to think" were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.

Hearing loss can disrupt emotional responses to sound. However, the impact of stimulus modality (multisensory versus unisensory) on this disruption, and the underlying mechanisms responsible, are unclear. The purposes of this project were to evaluate the effects of stimulus modality and filtering on emotional responses to non-speech stimuli. It was hypothesized that low- and high-pass filtering would result in less extreme ratings, but only for unisensory stimuli. Twenty-four adults (22- 34 years old; 12 male) with normal hearing participated. Participants made ratings of valence and arousal in response to pleasant, neutral, and unpleasant non-speech sounds and/or pictures. Each participant completed ratings of five stimulus modalities: auditory-only, visual-only, auditory-visual, filtered auditory-only, and filtered auditory-visual. Half of the participants rated low-pass filtered stimuli (800 Hz cutoff), and half of the participants rated high-pass filtered stimuli (2000 Hz cutoff). Combining auditory and visual modalities resulted in more extreme (more pleasant and more unpleasant) ratings of valence in response to pleasant and unpleasant stimuli. In addition, low- and high-pass filtering of sounds resulted in less extreme ratings of valence (less pleasant and less unpleasant) and arousal (less exciting) in response to both auditory-only and auditory-visual stimuli. These results suggest that changes in audible spectral information are partially responsible for the noted changes in emotional responses to sound that accompany hearing loss. The findings also suggest the effects of hearing loss will generalize to multisensory stimuli if the stimuli include sound, although further work is warranted to confirm this in listeners with hearing loss., (Copyright © 2020. Published by Elsevier B.V.)

Objective: To evaluate two real-time methods for reducing distortion product otoacoustic emission (DPOAE) fine structure in terms of DPOAE amplitude and fine structure depth., Design: A prospective, repeated-measures design was used to assess DPOAE characteristics in response to a conventional stimulation method (Conv.), as well as for methods implementing either a generic suppressor tone (Supp.) or frequency modulation of the f 2 primary tone (FM)., Study Sample: Eighty-three young adults (58 females) between the ages of 20 and 34 years with normal hearing completed testing for this study., Results: Use of the Conv. and FM methods resulted in consistently higher DPOAE levels relative to the Supp. method, with average advantages of 6 and 5 dB, respectively. For all methods, increased fine structure depth was observed for stimulation with lower level (25-45 dB SPL) and lower frequency (1000-3000 Hz) primary tones. Finally, use of the Supp. and FM methods resulted in significantly decreased fine structure depth relative to the Conv. method., Conclusion: Through frequency modulation of the f 2 primary tone, it was possible to reduce the depth of fine structure across a clinically meaningful range of stimulation levels and frequencies without concomitant reduction in DPOAE amplitude.

Purpose This study sought to evaluate the effects of common hearing aid microphone technologies on speech recognition and listening effort, and to evaluate potential predictive factors related to microphone benefits for school-age children with hearing loss in a realistic listening situation. Method Children ( n = 17, ages 10-17 years) with bilateral, sensorineural hearing loss were fitted with hearing aids set to include three programs: omnidirectional, adaptive directional, and omnidirectional + remote microphone. Children completed a dual-task paradigm in a moderately reverberant room. The primary task included monosyllabic word recognition, with target speech presented at 60 dB A from 0° (front) or 180° (back) azimuth. The secondary task was a "go/no-go," visual shape-recognition task. Multitalker babble noise created a +5 dB SNR. Children were evaluated in two speaker conditions (front, back) using all three hearing aid programs. The remote microphone transmitter remained at the front speaker throughout testing. Speech recognition performance was calculated from the primary task while listening effort was measured as response time during the secondary task. Results Speech presented from the back significantly increased listening effort and caused a reduction in speech perception when directional and remote microphones were used. Considerable variability was found in pattern of benefit across microphones and source location. Clinical measures did not predict benefit patterns with directional or remote microphones; however, child age and performance with omnidirectional microphones did. Conclusions When compared to a traditional omnidirectional setting, the directional and remote microphone configurations evaluated in this study have the potential to provide benefit for some children and increase difficulty for others when used in dynamic environments. A child's performance with omnidirectional hearing aids could be used to better inform clinical recommendations for these technologies.

Technology options for children with limited hearing unilaterally that improve the signal-to-noise ratio are expected to improve speech recognition and also reduce listening effort in challenging listening situations, although previous studies have not confirmed this. Employing behavioral and subjective indices of listening effort, this study aimed to evaluate the effects of two intervention options, remote microphone system (RMS) and contralateral routing of signal (CROS) system, in school-aged children with limited hearing unilaterally. Nineteen children (aged 7-12 years) with limited hearing unilaterally completed a digit triplet recognition task in three loudspeaker conditions: midline, monaural direct, and monaural indirect with three intervention options: unaided, RMS, and CROS system. Verbal response times were interpreted as a behavioral measure of listening effort. Participants provided subjective ratings immediately following behavioral measures. The RMS significantly improved digit triplet recognition across loudspeaker conditions and reduced verbal response times in the midline and indirect conditions. The CROS system improved speech recognition and listening effort only in the indirect condition. Subjective ratings analyses revealed that significantly more participants indicated that the remote microphone made it easier for them to listen and to stay motivated. Behavioral and subjective indices of listening effort indicated that an RMS provided the most consistent benefit for speech recognition and listening effort for children with limited unilateral hearing. RMSs could therefore be a beneficial technology option in classrooms for children with limited hearing unilaterally.

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

Introduction: Conventional hearing aids are commonly recommended for the treatment of tinnitus, though results of studies investigating the efficacy of hearing aid-based tinnitus treatments have been mixed. Recently, it has been suggested that the addition of a notch filter around the tinnitus frequency might enhance lateral inhibitory mechanisms and thereby improve tinnitus severity relative to traditional processing. The primary aim of this study was to compare the effects of conventional versus notch filter amplification strategies on subjective tinnitus severity in adults with mild-to-moderate hearing loss and no previous hearing aid experience., Methods: Thirty-nine adults (mean age=53.6 years; SD=9.7 years) with bilateral, mild to moderate sensorineural hearing loss and an established clinical history of stable, tonal tinnitus participated in this double-blinded study. Each participant was randomly assigned to complete a 12-week hearing aid trial using either a conventional amplification strategy or a strategy which applied a notch filter at the given participant's tinnitus pitch match frequency. Tinnitus-related handicap and distress were assessed before and after the hearing aid trial via the Tinnitus Handicap Inventory (Newman et al., 1996) and the Tinnitus Questionnaire (Hallam et al., 1988)., Results: Average tinnitus severity did not differ significantly between the conventional and notch filter amplification groups following treatment. Moreover, average pre- to post-intervention change scores were relatively low for both groups, indicating minimal effect of either treatment on tinnitus symptoms. Participant age, high-frequency pure-tone average hearing threshold, average daily hearing aid usage, and pre-intervention tinnitus severity ratings were not predictive of treatment success or failure., Discussion: Results of the present study suggest no significant effect of either conventional or notch filter amplification on average ratings of tinnitus severity following a 12-week hearing aid trial. However, as clinically meaningful changes in tinnitus severity were identified for some participants, future work is needed to better identify those individuals most likely to benefit, as well as optimal amplification characteristics., Competing Interests: Conflicts of interest and source of funding This project was funded in part by Sivantos GmbH., (© 2021 Elsevier B.V. All rights reserved.)

A classic paradigm used to quantify the perceptual weighting of binaural spatial cues requires a listener to adjust the value of one cue, while the complementary cue is held constant. Adjustments are made until the auditory percept appears centered in the head, and the values of both cues are recorded as a trading relation (TR), most commonly in μs interaural time difference per dB interaural level difference. Interestingly, existing literature has shown that TRs differ according to the cue being adjusted. The current study investigated whether cue-specific adaptation, which might arise due to the continuous, alternating presentation of signals during adjustment tasks, could account for this poorly understood phenomenon. Three experiments measured TRs via adjustment and via lateralization of single targets in virtual reality (VR). Targets were 500 Hz pure tones preceded by silence or by adapting trains that held one of the cues constant. VR removed visual anchors and provided an intuitive response technique during lateralization. The pattern of results suggests that adaptation can account for cue-dependent TRs. In addition, VR seems to be a viable tool for psychophysical tasks.

Objective The purpose of this study was to evaluate the effects of hearing aid-based rerouting systems (remote microphone [RM] and contralateral routing of signals [CROS]) on speech recognition and comprehension for children with limited usable hearing unilaterally. A secondary purpose was to evaluate students' perceptions of CROS benefits in classrooms. Method Twenty children aged 10-16 years with limited useable hearing in one ear completed tasks of sentence recognition and comprehension in a laboratory. For both tasks, speech was presented from one of four loudspeakers in an interleaved fashion. Speech loudspeakers were either midline, monaural direct, or monaural indirect, and noise loudspeakers surrounded the participant. Throughout testing, the RM was always near the midline loudspeaker. Six established users of CROS systems completed a newly developed questionnaire that queried experiences in diverse listening situations. Results There were no effects of RM or CROS use on performance for speech presented from front or monaural direct loudspeakers. However, for monaural indirect loudspeakers, CROS improved sentence recognition and RM impaired recognition. In the comprehension task, CROS improved comprehension by 11 rationalized arcsine units, but RM did not affect comprehension. Questionnaire results demonstrated that students report CROS benefits for talkers in the front and from the side, but not for situations requiring localization. Conclusions The results support CROS benefits without CROS disadvantages in a laboratory environment that reflects a dynamic classroom. Thus, CROS systems have the potential to improve hearing in contemporary classrooms for students, especially if there is only a single microphone.

Objectives: Unilateral hearing loss increases the risk of academic and behavioral challenges for school-aged children. Previous research suggests that remote microphone (RM) systems offer the most consistent benefits for children with unilateral hearing loss in classroom environments relative to other nonsurgical interventions. However, generalizability of previous laboratory work is limited because of the specific listening situations evaluated, which often included speech and noise signals originating from the side. In addition, early studies focused on speech recognition tasks requiring limited cognitive engagement. However, those laboratory conditions do not reflect characteristics of contemporary classrooms, which are cognitively demanding and typically include multiple talkers of interest in relatively diffuse background noise. The purpose of this study was to evaluate the potential effects of rerouting amplification systems, specifically a RM system and a contralateral routing of signal (CROS) system, on speech recognition and comprehension of school-age children in a laboratory environment designed to emulate the dynamic characteristics of contemporary classrooms. It was expected that listeners would benefit from the CROS system when the head shadow limits audibility (e.g., monaural indirect listening). It was also expected that listeners would benefit from the RM system only when the RM was near the talker of interest., Design: Twenty-one children (10 to 14 years, M = 11.86) with normal hearing participated in laboratory tests of speech recognition and comprehension. Unilateral hearing loss was simulated by presenting speech-shaped masking noise to one ear via an insert earphone. Speech stimuli were presented from 1 of 4 loudspeakers located at either 0°, +45°, -90°, and -135° or 0°, -45°, +90°, and +135°. Cafeteria noise was presented from separate loudspeakers surrounding the listener. Participants repeated sentences (sentence recognition) and also answered questions after listening to an unfamiliar story (comprehension). They were tested unaided, with a RM system (microphone near the front loudspeaker), and with a CROS system (ear-level microphone on the ear with simulated hearing loss)., Results: Relative to unaided listening, both rerouting systems reduced sentence recognition performance for most signals originating near the ear with normal hearing (monaural direct loudspeakers). Only the RM system improved speech recognition for midline signals, which were near the RM. Only the CROS system significantly improved speech recognition for signals originating near the ear with simulated hearing loss (monaural indirect loudspeakers). Although the benefits were generally small (approximately 6.5 percentage points), the CROS system also improved comprehension scores, which reflect overall listening across all four loudspeakers. Conversely, the RM system did not improve comprehension scores relative to unaided listening., Conclusions: Benefits of the CROS system in this study were small, specific to situations where speech is directed toward the ear with hearing loss, and relative only to a RM system utilizing one microphone. Although future study is warranted to evaluate the generalizability of the findings, the data demonstrate both CROS and RM systems are nonsurgical interventions that have the potential to improve speech recognition and comprehension for children with limited useable unilateral hearing in dynamic, noisy classroom situations.

Purpose It is not clear if behavioral indices of listening effort are sensitive to changes in signal-to-noise ratio (SNR) for young children (7-12 years old) from multilingual backgrounds. The purpose of this study was to explore the effects of SNR on listening effort in multilingual school-aged children (native English, nonnative English) as measured with a single- and a dual-task paradigm with low-linguistic speech stimuli (digits). The study also aimed to explore age effects on digit triplet recognition and response times (RTs). Method Sixty children with normal hearing participated, 30 per language group. Participants completed single and dual tasks in three SNRs (quiet, -10 dB, and -15 dB). Speech stimuli for both tasks were digit triplets. Verbal RTs were the listening effort measure during the single-task paradigm. A visual monitoring task was the secondary task during the dual-task paradigm. Results Significant effects of SNR on RTs were evident during both single- and dual-task paradigms. As expected, language background did not affect the pattern of RTs. The data also demonstrate a maturation effect for triplet recognition during both tasks and for RTs during the dual-task only. Conclusions Both single- and dual-task paradigms were sensitive to changes in SNR for school-aged children between 7 and 12 years of age. Language background (English as native language vs. English as nonnative language) had no significant effect on triplet recognition or RTs, demonstrating practical utility of low-linguistic stimuli for testing children from multilingual backgrounds.

The purpose of this article is threefold. First, it is to evaluate current rates of hearing aid satisfaction, in addition to the examination of factors that influence satisfaction rates. A second purpose is to evaluate the effects of hearing aid use on mental health and quality of life, from the consumer perspective. The third purpose of this article is to review the current status of the market in terms of usage and ownership. The usage statistics from MarkeTrak 10 answer questions such as what is the most common type of hearing aid style. And what types of hearing aid features are popular? The results of the usage statistics provide not only insight into the satisfaction and quality-of-life metrics but also information about marketplace trends. By fulfilling these purposes, strengths and weaknesses of the current hearing aid marketplace can be determined, guiding future technological and clinical practice developments. Survey results demonstrate the continued dominance of mini-BTE (behind the ear) hearing aids and high popularity of features, including wireless capabilities. Overall satisfaction rates are encouragingly high, driven by satisfaction with BTE instruments, especially those acquired in the past 5 years. Noted areas for improvement continue to be related to listening in noise and patient understanding of their hearing aids. Given the high levels of noted satisfaction, it is not surprising that the sample revealed significant hearing aid benefits, notably in a lower risk for depression, higher satisfaction listening in almost all environments, and improved quality of life on a regular basis. Together, these data provide insights into the factors that drive satisfaction, encourage industrial and scientific advancements in the identified areas of weakness, and paint a bright picture of the hearing aid market from the consumer perspective., (© Thieme Medical Publishers.)

Purpose Current recommendations for clinical management of school-aged children with limited useable hearing unilaterally primarily focus on remote microphone systems and preferential seating. The purpose of this narrative review is to examine the existing evidence supporting these recommendations. Method A narrative review was conducted, focused on nonsurgical interventions for children with limited useable hearing unilaterally. Results Six articles were identified. Three survey studies suggest high use rates and improved academic performance with contralateral routing of signal systems. One laboratory study suggests students with hearing loss need to sit closer to the desired signal (e.g., teacher) than their peers with normal hearing to achieve similar speech recognition. Two laboratory studies suggest remote microphone systems provide consistent benefits when the microphone is located near the talker of interest, whereas contralateral routing of signal systems impairs performance in noise. Conclusions The discrepancy between survey studies and laboratory studies could be explained partly due to the difference between listening situations in the laboratory and in classrooms. Everyone in the classroom is a potential talker of interest, and the listening environments are often dynamic. Thus, contralateral routing of signal systems might have more potential to improve classroom communication than was suggested by the laboratory studies. Recommendations for microphone technologies should be based on the extent to which a student is struggling, where the student sits in the classroom, and where the important talkers are located. There is not one optimal recommendation for all students, but a combination of remote microphone and contralateral routing of signal systems could work for most students. Supplemental Material https://doi.org/10.23641/asha.9956663.

Purpose Previous evidence supports benefits of bilateral hearing aids, relative to unilateral hearing aid use, in laboratory environments using audio-only (AO) stimuli and relatively simple tasks. The purpose of this study was to evaluate bilateral hearing aid benefits in ecologically relevant laboratory settings, with and without visual cues. In addition, we evaluated the relationship between bilateral benefit and clinically viable predictive variables. Method Participants included 32 adult listeners with hearing loss ranging from mild-moderate to severe-profound. Test conditions varied by hearing aid fitting type (unilateral, bilateral) and modality (AO, audiovisual). We tested participants in complex environments that evaluated the following domains: sentence recognition, word recognition, behavioral listening effort, gross localization, and subjective ratings of spatialization. Signal-to-noise ratio was adjusted to provide similar unilateral speech recognition performance in both modalities and across procedures. Results Significant and similar bilateral benefits were measured for both modalities on all tasks except listening effort, where bilateral benefits were not identified in either modality. Predictive variables were related to bilateral benefits in some conditions. With audiovisual stimuli, increasing hearing loss, unaided speech recognition in noise, and unaided subjective spatial ability were significantly correlated with increased benefits for many outcomes. With AO stimuli, these same predictive variables were not significantly correlated with outcomes. No predictive variables were correlated with bilateral benefits for sentence recognition in either modality. Conclusions Hearing aid users can expect significant bilateral hearing aid advantages for ecologically relevant, complex laboratory tests. Although future confirmatory work is necessary, these data indicate the presence of vision strengthens the relationship between bilateral benefits and degree of hearing loss.

Background noise and reverberation levels in typical classrooms have negative effects on speech recognition, but their effects on listening effort and fatigue are less well understood. Based on the Framework for Understanding Effortful Listening, noise and reverberation would be expected to increase both listening effort and fatigue. However, previous investigations of the effects of reverberation for adults have resulted in mixed findings. Some discrepancies in the literature might be accounted for by methodological differences; behavioral and subjective indices of listening effort do not often align in adults. The effects of sustained listening on self-reported fatigue in school-aged children are also not well understood. The purposes of this project were to (1) evaluate the effects of noise and reverberation on listening effort in school-aged children using behavioral and subjective measures, (2) compare subjective and behavioral indices of listening effort, and (3) evaluate the effects of reverberation on self-reported fatigue. Twenty typically developing children (10-17 years old) participated. Participants completed dual-task testing in two rooms that varied in terms of reverberation, an audiometric sound booth and a moderately reverberant room. In each room, testing was completed in quiet and in two levels of background noise. Participants provided subjective ratings of listening effort after completing the dual-task in each listening condition. Subjective ratings of fatigue were completed before and after testing in each level of reverberation. Results revealed background noise, not reverberation, increased behavioral and subjective listening effort. Subjective ratings of perceived performance, ease of listening, and desire to control the listening situation revealed a similar pattern of results as word recognition performance, making them poor candidates for providing an indication of behavioral listening effort. However, ratings of time perception were moderately correlated with behavioral listening effort. Finally, sustained listening for approximately 25 min increased self-reported fatigue, although changes in fatigue were comparable in low and moderately reverberant environments. In total, these data offer no evidence that a moderate level of reverberation increases listening effort or fatigue, but the data do support the reduction of background noise in classrooms.

Objectives: Distortion product otoacoustic emissions (DPOAEs) are a time-efficient, non-invasive means of assessing the integrity of active inner ear mechanics. Unfortunately, the presence of even relatively minor conductive hearing loss (CHL) has been suggested to reduce the clinical utility of DPOAEs significantly. The primary aims of this study were to systematically evaluate the impact of CHL on DPOAE amplitude and to determine if ear-specific primary tone level manipulations can be used to mitigate CHL impact and recover DPOAE measurability., Methods: For 30 young adults (57 ears) with normal hearing, DPOAEs were obtained for f 2  = 1-6 kHz. Observed DPOAE amplitudes were used to generate ear- and frequency-specific models with the primary tone levels, L 1 and L 2, as inputs and predicted DPOAE amplitude, L DP , as output. These models were then used to simulate the effect of CHL (0-15 dB), as well as L 1 manipulations (0-15 dB), on DPOAE measurability., Results: Mean L DP for every CHL condition was significantly different from that for all other conditions (p = <.001), with a mean L DP attenuation of 8.7 dB for every 5 dB increase in CHL. Mean DPOAE measurability in response to a standard clinical stimulation paradigm of L 1 /L 2  = 65/55 (dB SPL) was determined to be 99%, 84%, 37%, and 9% in the presence of 0, 5, 10, and 15 dB CHL, respectively. In the presence of 10 dB CHL, altering L 1 resulted in an approximately 25% increase in DPOAE responses., Conclusion: Subclinical CHL loss is sufficient to significantly impair DPOAE measurability in a meaningful proportion of otherwise healthy ears. However, through strategic alteration of primary tone levels, the clinician can mitigate CHL impact and at least partially recover DPOAE measurability., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: People with hearing loss experience difficulty understanding speech in noisy environments. Beamforming microphone arrays in hearing aids can improve the signal-to-noise ratio (SNR) and thus also speech recognition and subjective ratings. Unilateral beamformer arrays, also known as directional microphones, accomplish this improvement using two microphones in one hearing aid. Bilateral beamformer arrays, which combine information across four microphones in a bilateral fitting, further improve the SNR. Early bilateral beamformers were static with fixed attenuation patterns. Recently adaptive, bilateral beamformers have been introduced in commercial hearing aids., Purpose: The purpose of this article was to evaluate the potential benefits of adaptive unilateral and bilateral beamformers for improving sentence recognition and subjective ratings in a laboratory setting. A secondary purpose was to identify potential participant factors that explain some of the variability in beamformer benefit., Research Design: Participants were fitted with study hearing aids equipped with commercially available adaptive unilateral and bilateral beamformers. Participants completed sentence recognition testing in background noise using three hearing aid settings (omnidirectional, unilateral beamformer, bilateral beamformer) and two noise source configurations (surround, side). After each condition, participants made subjective ratings of their perceived work, desire to control the situation, willingness to give up, and tiredness., Study Sample: Eighteen adults (50-80 yr, M = 66.2, σ = 8.6) with symmetrical mild sloping to severe hearing loss participated., Data Collection and Analysis: Sentence recognition scores and subjective ratings were analyzed separately using generalized linear models with two within-subject factors (hearing aid microphone and noise configuration). Two benefit scores were calculated: (1) unilateral beamformer benefit (relative to performance with omnidirectional) and (2) additional bilateral beamformer benefit (relative to performance with unilateral beamformer). Hierarchical multiple linear regression was used to determine if beamformer benefit was associated with participant factors (age, degree of hearing loss, unaided speech in noise ability, spatial release from masking, and performance in omnidirectional)., Results: Sentence recognition and subjective ratings of work, control, and tiredness were better with both types of beamformers relative to the omnidirectional conditions. In addition, the bilateral beamformer offered small additional improvements relative to the unilateral beamformer in terms of sentence recognition and subjective ratings of tiredness. Speech recognition performance and subjective ratings were generally independent of noise configuration. Performance in the omnidirectional setting and pure-tone average were independently related to unilateral beamformer benefits. Those with the lowest performance or the largest degree of hearing loss benefited the most. No factors were significantly related to additional bilateral beamformer benefit., Conclusions: Adaptive bilateral beamformers offer additional advantages over adaptive unilateral beamformers in hearing aids. The small additional advantages with the adaptive beamformer are comparable to those reported in the literature with static beamformers. Although the additional benefits are small, they positively affected subjective ratings of tiredness. These data suggest that adaptive bilateral beamformers have the potential to improve listening in difficult situations for hearing aid users. In addition, patients who struggle the most without beamforming microphones may also benefit the most from the technology., (American Academy of Audiology.)

Objective: The primary purpose of this study was to update existing data on additional gain before feedback and maximum stable gain in commercially available, open-fit hearing instruments. A secondary purpose was to evaluate ratings of sound quality with feedback reduction systems active., Design: Additional gain before feedback, maximum stable gain and subjective sound quality ratings were obtained for six commercially available hearing instruments utilising modern feedback reduction systems., Study Sample: Twenty adults (22-46 years) with normal hearing participated in gain measurement testing. Thirty adults (22-39 years) with normal hearing provided ratings of sound quality., Results: Mean additional gain before feedback for 2000-4000 Hz ranged from 5 to 16 dB across manufacturers. Mean maximum stable gain in the same frequency region ranged from 25 to 35 dB across manufacturers. However, meaningful performance differences between participants within each given manufacturer were also identified. Sound quality ratings were not related to the type of feedback reduction algorithm., Conclusions: AGBF and MSG continue to vary significantly both across manufacturers as well as individual ears within a given manufacturer. User satisfaction and performance with hearing aids might be improved by identifying the feedback reduction system optimal for the individual patient.

Purpose: Subjective reports of listening effort are frequently inconsistent with behavioral and physiological findings. A potential explanation is that participants unwittingly substitute an easier question when faced with a judgment that requires computationally expensive analysis (i.e., heuristic response strategies). The purpose of this study was to investigate whether participants substitute the question "How did I perform?" when asked "How much effort did that take?"., Method: Participants completed 2 sets of online surveys containing a text-based, multiple-choice synonym task. Expected performance and mental effort were manipulated across sets in 4 experiments, using a visual masking technique shown to correlate with speech-reception-testing in noise. Experiment 1 was designed to yield stable accuracy and differing effort across sets. Experiment 2 elicited differing accuracy and stable effort. Experiments 3 and 4 manipulated accuracy and performance in opposite directions. Participants included 273 adults (aged 19-68 years, M = 38.4 years)., Results: Experiment 1 revealed no influence of perceived performance on ratings of effort when accuracy was stable. Experiment 2 showed that ratings of effort differed inversely with ratings of performance (lower performance and increased effort). Experiments 3 and 4 also demonstrated that participants rated effort in a manner inversely related to performance, regardless of the effort inherent in the condition., Conclusions: Participants likely substitute an easier question when asked to rate the multidimensional construct of mental effort. The results presented here suggest that perceived performance can serve as a ready heuristic and may explain the dissociation between subjective measures of listening effort and behavioral and physiological measures.

Objective: The purpose of this study was to evaluate the reliability and validity of four subjective questions related to listening effort. A secondary purpose of this study was to evaluate the effects of hearing aid beamforming microphone arrays on word recognition and listening effort., Design: Participants answered subjective questions immediately following testing in a dual-task paradigm with three microphone settings in a moderately reverberant laboratory environment in two noise configurations. Participants rated their: (1) mental work, (2) desire to improve the situation, (3) tiredness, and (4) desire to give up. Data were analysed using repeated measures and reliability analyses., Study Sample: Eighteen adults with symmetrical sensorineural hearing loss participated., Results: Beamforming differentially affected word recognition and listening effort. Analysis revealed the same pattern of results for behavioural listening effort and subjective ratings of desire to improve the situation. Conversely, ratings of work revealed the same pattern of results as word recognition performance. Ratings of tiredness and desire to give up were unaffected by hearing aid microphone or noise configuration., Conclusions: Participant ratings of their desire to control the listening situation appear to reliable subjective indicators of listening effort that align with results from a behavioural measure of listening effort.

The question of how hearing loss and hearing rehabilitation affect patients' momentary emotional experiences is one that has received little attention but has considerable potential to affect patients' psychosocial function. This article is a product from the Hearing, Emotion, Amplification, Research, and Training workshop, which was convened to develop a consensus document describing research on emotion perception relevant for hearing research. This article outlines conceptual frameworks for the investigation of emotion in hearing research; available subjective, objective, neurophysiologic, and peripheral physiologic data acquisition research methods; the effects of age and hearing loss on emotion perception; potential rehabilitation strategies; priorities for future research; and implications for clinical audiologic rehabilitation. More broadly, this article aims to increase awareness about emotion perception research in audiology and to stimulate additional research on the topic.

The purpose of this study was to evaluate the relationship between emotional responses to sounds, hearing acuity, and isolation, specifically objective isolation (social disconnectedness) and subjective isolation (loneliness). It was predicted that ratings of valence in response to pleasant and unpleasant stimuli would influence the relationship between hearing loss and isolation. Participants included 83 adults, without depression, who were categorized into three groups (young with normal hearing, older with normal hearing, and adults with mild-to-moderately severe hearing loss). Participants made ratings of valence in response to pleasant and unpleasant nonspeech sounds, presented at a moderate overall level in the laboratory. Participants also completed questionnaires related to social disconnectedness and loneliness. Data were analyzed using multiple regression with questionnaire scores as dependent variables. Independent variables were age, gender, degree of hearing loss, perceived hearing handicap, number of depressive symptoms, mean valence rating in response to unpleasant sounds, and mean valence rating in response to pleasant sounds. Emotional responses to pleasant sounds explained significant variability in scores of both social disconnectedness and loneliness. Depressive symptoms also explained variability in loneliness scores. Hearing loss was not significantly related to social disconnectedness or loneliness, although it was the only variable significantly related to ratings of valence in response to pleasant sounds. Emotional responses to pleasant sounds are related to disconnectedness and loneliness. Although not related to isolation in this study, hearing loss was related to emotional responses. Thus, emotional responses should be considered in future models of isolation and hearing loss.