Trends in Hearing最新文献

Hearing loss is common among Veterans, and extensive hearing care resources are prioritized within the Veterans Administration (VA). Severe hearing loss poses unique communication challenges with speech understanding that may not be overcome with amplification. We analyzed data from the VA Audiometric Repository between 2005 and 2017 and the relationship between hearing loss severity with speech recognition scores. We hypothesized that a significant subset of Veterans with severe or worse hearing loss would have poor unaided speech perception outcomes even with adequate audibility. Sociodemographic characteristics and comorbidities were compiled using electronic medical records as was self-report measures of hearing disability. We identified a cohort of 137,500 unique Veterans with 232,789 audiograms demonstrating bilateral severe or worse hearing loss (four-frequency PTA > 70 dB HL). The median (IQR; range) age of Veterans at their first audiogram with severe or worse hearing loss was 81 years (74 to 87; 21-90+), and a majority were male (136,087 [99%]) and non-Hispanic white (107,798 [78.4%]). Among those with bilateral severe or worse hearing loss, 41,901 (30.5%) also had poor speech recognition scores (<50% words), with greater hearing loss severity correlating with worse speech perception. We observed variability in speech perception abilities in those with moderate-severe and greater levels of hearing loss who may derive limited benefit from amplification. Veterans with communication challenges may warrant alternative approaches and treatment strategies such as cochlear implants to support communication needs.

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

A cochlear implant (CI) is a prosthesis that allows people with severe to profound hearing loss to understand speech in quiet settings. However, listening to music presents a challenge to most CI users; they often do not enjoy music or avoid it altogether. The Musi-CI training course was developed for CI users with the goal of reducing music aversion and improving music enjoyment. A consortium was established consisting of a professional musician with CI, CI rehabilitation professionals and researchers. Participatory action research (PAR) was applied to develop and evaluate the training experiences, collaborating with 37 CI users during three cycles of eight training sessions, each held over a period of 3 months. Input and feedback were collected after each training session using questionnaires, observations and focus group interviews. Almost all participants (86%) completed the training. After completing the training a large majority of participants reported increased music appreciation, increased social participation in musical settings and a positive impact on general auditory perception. The resulting Musi-CI training programme focuses on music listening skills, self-efficacy, and self-motivation. It consists of exercises intended to strengthen attention and working memory, to improve beat and rhythm perception (with online rhythm exercises) and exercises to distinguish timbre of instruments and emotion in music. A Melody Game was developed to improve pitch and melodic contour discrimination.

There are large interindividual variations in preference for strength of noise-reduction (NR). It is hypothesized that each individual's tolerance for background noise on one hand and signal distortions on the other hand form this preference. We aim to visualize and analyze this so-called trade-off between noise attenuation and signal quality. Dutch sentences in stationary background noise were processed with different NR strengths. We used an NR algorithm that allows us to separate the positive effects of NR (noise attenuation) from the negative effects (signal distortion). Stimuli consisted of speech in noise with different degrees of (1) background noise, (2) signal distortions, or (3) both (i.e., realistic NR at different NR strengths). With pairwise comparisons, participants chose which stimulus they preferred for prolonged listening. Twelve listeners with mild to moderate hearing loss participated in the study. For all participants, a trade-off between noise attenuation and signal quality was found and visualized. The strength of preference was estimated with the Bradley-Terry-Luce choice model and was different for all individuals but in the same order of magnitude for distortion effects and noise effects. Strength of preference of realistic NR was smaller by a factor of ten. This study used a unique setup to capture the individual trade-off between noise attenuation and signal quality in NR. Disturbance from signal distortions is as important as disturbance from background noise for determining preference for NR strength. Individual listeners differ in their sensitivity to both factors and as a consequence in their preferred NR strength.

The objective to preserve residual hearing during cochlear implantation has recently led to the use of intracochlear electrocochleography (ECochG) as an intraoperative monitoring tool. Currently, a decrease in the amplitude of the difference between responses to alternating-polarity stimuli (DIF response), predominantly reflecting the hair cell response, is used for providing feedback. Including other ECochG response components, such as phase changes and harmonic distortions, could improve the accuracy of surgical feedback. The objectives of the present study were (1) to compare simultaneously recorded stepwise intracochlear and extracochlear ECochG responses to 500 Hz tone bursts, (2) to explore patterns in features extracted from the intracochlear ECochG recordings relating to hearing preservation or hearing loss, and (3) to design support vector machine (SVM) and random forest (RF) classifiers of acoustic hearing preservation that treat each subject as a sample and use all intracochlear ECochG recordings made during electrode array insertion for classification. Forty subjects undergoing cochlear implant (CI) surgery at the Oslo University Hospital, St. Thomas' Hearing Implant Centre, or the University Hospital of Zurich were prospectively enrolled. In this cohort, DIF response amplitude decreases did not relate to postoperative acoustic hearing preservation. Exploratory analysis of the feature set extracted from the ECochG responses and preoperative audiogram showed that the features were not discriminative between outcome classes. The SVM and RF classifiers that were trained on these features could not distinguish cases with hearing loss and hearing preservation. These findings suggest that hearing loss following CI surgery is not always reflected in intraoperative ECochG recordings.

Hearing threshold levels (HTLs) at 500-8,000 Hz from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2015-2016, and 2017-2020 were analyzed for males and females ranging in age from 20 to 80-plus years (N = 8,795). HTLs for the 10th, 25th, 50th, 75th, and 90th percentiles are provided for males and females. Equations were generated to describe median HTLs as a function of age at each frequency. The medians generated for this unscreened dataset of U.S. adults were compared to those in Table B.3 of ISO 1999 (2013), which came from analyses of the NHANES 1999-2006 datasets. The ISO 1999 values were found to be slightly higher (worse) at several frequencies. The ISO 1999 (2013) median HTLs were 2 to 5 dB worse at 500 Hz for males and females and 2 to 8 dB worse at 4,000 and 6,000 Hz for males than the updated NHANES estimates. As in prior analyses of NHANES data, HTLs worsened with age, were better for females than males, and were better for Non-Hispanic Blacks than for Non-Hispanic Whites. The latter difference was observed for both males and females, was confined to frequencies above 2,000 Hz, and widened with increasing age.

Dynamic focusing cochlear implant strategies aim to emulate normal cochlear excitation patterns by varying the degree of current focusing as a function of input level. Results on the speech perception benefits of these strategies have been mixed. In previous studies, channel interaction coefficients (K), which mediate the relationship between current level and degree of focusing, were fixed across channels and participants. Fixing K without accounting for channel interaction and the current required to accurately stimulate target neurons may elicit suboptimal loudness growth and speech perception. This study tested whether individualizing K improved speech perception relative to fixed-K and monopolar strategies. Fourteen ears of implanted adults were programmed with 14-channel strategies matched on pulse duration, pulse rate, filtering, and loudness. Sentence recognition and vowel identification was measured at 60 dB SPL equivalent in quiet and four-talker babble. On the group level, speech recognition in quiet and noise was similar between strategies. On the individual level, there were participants who benefitted with dynamic focusing strategies for speech perception in noise. Patterns of benefit were generally unclear, beyond associations between focused thresholds, duration of hearing loss, and individual-K benefit. Participants rated dynamic focusing like monopolar in clarity and ease of listening. Almost all participants expressed their willingness to use the strategies in a take-home trial. These results suggest that while individualizing K does not benefit all, there are individuals who benefit, for which the electrode-neuron interface may play a role. Future studies will evaluate acclimatization of dynamic focusing strategies using take-home trials.

This study was aimed at assessing listening effort (LE) in quiet and in noisy daily life situations, in 481 adults with hearing aids (HAs) and 62 adults with normal hearing, using an Extended version of the Effort Assessment Scale (EEAS). Participants were invited to self-assess their LE in daily life, on a visual analog scale graded from 0 (no effort) to 10. The EEAS's internal structure identified two separate constructs pertaining to LE in quiet and LE in noise, each with good consistency (Cronbach's α > 0.83). A three-factor model explained 12% of the variance of the EEAS scores, with HA experience the most important one, and better ear hearing threshold (averaged across 0.5-4 kHz) and ear asymmetry as the other two factors. The EEAS subscales differed in behavior, with the LE in noise being the most dependent on HA experience, whereas LE in quiet depended more on better ear hearing threshold. In a subgroup of people with 6 months to less than 24 months HA experience, a significant decrease in LE in noise was observed with increasing HA experience (0.26 points decrease per year of HA experience), whereas in a group of people with at least 24 months of HA experience, a small increase in LE in noise was observed. This effect was not mediated by age, nor hearing threshold. The extended Effort Assessment Scale is therefore offering an assessment of both LE in quiet and LE in noise, with different dependence on HA experience and hearing thresholds.

Electroencephalography could serve as an objective tool to evaluate hearing aid benefit in infants who are developmentally unable to participate in hearing tests. We investigated whether speech-evoked envelope following responses (EFRs), a type of electroencephalography-based measure, could predict improved audibility with the use of a hearing aid in children with mild-to-severe permanent, mainly sensorineural, hearing loss. In 18 children, EFRs were elicited by six male-spoken band-limited phonemic stimuli--the first formants of /u/ and /i/, the second and higher formants of /u/ and /i/, and the fricatives /s/ and /∫/--presented together as /su∫i/. EFRs were recorded between the vertex and nape, when /su∫i/ was presented at 55, 65, and 75 dB SPL using insert earphones in unaided conditions and individually fit hearing aids in aided conditions. EFR amplitude and detectability improved with the use of a hearing aid, and the degree of improvement in EFR amplitude was dependent on the extent of change in behavioral thresholds between unaided and aided conditions. EFR detectability was primarily influenced by audibility; higher sensation level stimuli had an increased probability of detection. Overall EFR sensitivity in predicting audibility was significantly higher in aided (82.1%) than unaided conditions (66.5%) and did not vary as a function of stimulus or frequency. EFR specificity in ascertaining inaudibility was 90.8%. Aided improvement in EFR detectability was a significant predictor of hearing aid-facilitated change in speech discrimination accuracy. Results suggest that speech-evoked EFRs could be a useful objective tool in predicting hearing aid benefit in children with hearing loss.