Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels

Two Tests for Quantifying Aided Hearing at Low- and High-Input Levels

Under- and overamplification of sound is a common problem in hearing aid fitting. This paper describes the implementation of two new variants of the hearing in noise test for quantifying aided hearing at the lower and upper ends of the range of everyday-life sound levels. We present results from experiments carried out with 30 adult hearing aid users to determine the respective test-retest reliabilities. Participants completed a test battery consisting of the standard Danish hearing in noise test, a variant targeting the lower threshold of audibility and a variant targeting the limit of loudness discomfort. The participants completed the test battery twice for reliability analysis. The results revealed a significant difference between test and retest for both the hearing in noise test and the two hearing in noise test variants. However, the effect sizes for the differences were all very small. A calculation of Pearson correlation coefficients showed that both the hearing in noise test and the two new hearing in noise test variants had significant and strong correlations between test and retest. The within-subject standard deviations were determined to be 0.8 dB for hearing in noise test, 0.9 dB for lower-end test, and 2.2 dB for upper-end test. The findings demonstrate that both the lower-end test and upper-end test have high test-retest reliabilities, and thus can provide consistent and reliable results.

Hyperacusis Diagnosis and Management in the United States: Clinical Audiology Practice Patterns

PURPOSE

Hyperacusis often leads to debilitating psychosocial consequences, but there is no standard protocol for its diagnosis and management in the United States. In this study, we surveyed U.S. clinical audiologists to understand their education and clinical practices surrounding the evaluation and treatment of hyperacusis.

METHOD

An online survey was distributed to clinical audiologists across the United States. Survey responses were quantified using descriptive statistics and inductive content analysis.

RESULTS

Hyperacusis definitions and clinical practice patterns varied widely across the 102 respondents. Respondents cited a lack of education and training as the primary barrier to effective audiological diagnosis and management of hyperacusis, with most respondents reporting ≤ 5 hr of hyperacusis education. Other primary barriers to effective audiological management of hyperacusis included time constraints, reimbursement, poor sensitivity and specificity of available diagnostic tools, and poor efficacy of available treatments and management strategies. Most respondents (82.5%) agreed that audiologists are the primary professionals who are responsible for implementing hyperacusis interventions. However, 63.3% of respondents reported that their clinic does not have a hyperacusis management protocol, and 80.0% routinely recommend treatment that is outside their scope of practice to implement (cognitive behavioral therapy).

CONCLUSIONS

Clinical audiologists in the United States do not receive uniform education on hyperacusis, and they report multiple barriers to its evidence-based diagnosis and management. Effective hyperacusis management necessitates a multidisciplinary approach. The information obtained via this survey will pave the way toward the refinement of interprofessional education programs and the development of systematic, evidence-based clinical protocols for hyperacusis.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24431188.

Acoustic deprivation modulates central gain in human auditory brainstem and cortex

Beyond reduced audibility, there is convincing evidence that the auditory system adapts according to the principles of homeostatic plasticity in response to a hearing loss. Such compensatory changes include modulation of central auditory gain mechanisms. Earplugging is a common experimental method that has been used to introduce a temporary, reversible hearing loss that induces changes consistent with central gain modulation. In the present study, young, normal-hearing adult participants wore a unilateral earplug for two weeks, during which we measured changes in the acoustic reflex threshold (ART), loudness perception, and cortically-evoked (40 Hz) auditory steady-state response (ASSR) to assess potential modulation in central gain with reduced peripheral input. The ART decreased on average by 8 to 10 dB during the treatment period, with modest increases in loudness perception after one week but not after two weeks of earplug use. Significant changes in both the magnitude and hemispheric laterality of source-localized cortical ASSR measures revealed asymmetrical changes in stimulus-driven cortical activity over time. The ART results following unilateral earplugging are consistent with the literature and suggest that homeostatic plasticity is evident in the brainstem. The novel findings from the cortical ASSR in the present study indicates that reduced peripheral input induces adaptive homeostatic plasticity reflected as both an increase in central gain in the auditory brainstem and reduced cortical activity ipsilateral to the deprived ear. Both the ART and the novel use of the 40-Hz ASSR provide sensitive measures of central gain modulation in the brainstem and cortex of young, normal hearing listeners, and thus may be useful in future studies with other clinical populations.

Predicting Hearing Aid Satisfaction in Adults: A Systematic Review of Speech-in-noise Tests and Other Behavioral Measures

OBJECTIVES

Adults with hearing loss report a wide range of hearing aid satisfaction that does not significantly correlate to degree of hearing loss. It is not clear which auditory behavioral factors do contribute to hearing aid satisfaction. While poor speech understanding in noise is known to contribute to dissatisfaction, there are many categories of this type of assessment. The purpose of this systematic review is to answer the question, "Are behavioral pre-fitting measures using speech and nonspeech materials related to hearing aid satisfaction among adults?"

DESIGN

Six electronic databases were searched to find peer-reviewed studies published before June 2020. The included studies reported on the relationship between auditory behavioral measures and hearing aid satisfaction alone or globally with other outcome domains among adults with hearing loss. Six types of behavioral prefitting measures were evaluated: speech recognition in quiet (% correct), speech recognition in noise (% correct), reception thresholds for speech-in-noise, speech-based subjective ratings, dichotic speech tests, and tests using nonspeech material. Each relevant study was independently reviewed by two reviewers. Methodological quality was evaluated in each included study using the American Speech-Language-Hearing Association's level of evidence ratings.

RESULTS

There were 1342 articles identified in the systematic review process. After duplicates were removed and specific inclusion criteria were applied, 21 studies were included. All studies included had a 0 to 4 methodological quality rating indicating weak to moderate internal validity. The tests that showed potential for clinical application due to significant correlations with satisfaction were the QuickSIN, the synthetic sentence identification, the hearing in noise test, and the acceptable noise level test. Audibility, as measured by degree of hearing loss, was not significantly correlated to hearing aid satisfaction in the 13 studies that reported on this measure.

CONCLUSIONS

Based on this review, results indicated that speech-in-noise tests had the highest associations to hearing aid satisfaction, suggesting a greater role for assessment of speech-in-noise perception in auditory rehabilitation. This is an important finding for clinical practice, given that audibility was not a significant factor in predicting satisfaction. Overall, the results from this review show a need for well-designed, high-quality, prospective studies assessing the predictive value of prefitting measures on hearing aid satisfaction with current hearing aid models.

Uni- and bilateral spectral loudness summation and binaural loudness summation with loudness matching and categorical loudness scaling

OBJECTIVE

Current hearing aid prescription rules assume that spectral loudness summation decreases with hearing impairment and that binaural loudness summation is independent of hearing loss and signal bandwidth. Previous studies have shown that these assumptions might be incorrect. Spectral loudness summation was measured and compared for loudness scaling and loudness matching.

DESIGN

In this study, the effect of bandwidth on binaural summation was investigated by comparing loudness perception of low-pass filtered, high-pass filtered, and broadband pink noise at 35 Categorical Units for both unilateral and bilateral presentation.

STUDY SAMPLE

Sixteen hearing-impaired listeners.

RESULTS

The results show that loudness differences between the three signals are different for bilateral presentation than for unilateral presentation. In specific, binaural loudness summation is larger for the low-pass filtered pink noise than for the high-pass filtered pink noise. Finally, individual variability in loudness perception near loudness discomfort level was found to be very large.

CONCLUSIONS

Loudness matching is offered as a fast and reliable method to measure individual loudness perception. As discomfort with loud sounds is one of the major problems encountered by hearing aid users, measurement of individual loudness perception could improve hearing aid fitting substantially.

Potential Consequences of Spectral and Binaural Loudness Summation for Bilateral Hearing Aid Fitting

Aversiveness of loud sounds is a frequent complaint by hearing aid users, especially when fitted bilaterally. This study investigates whether loudness summation can be held responsible for this finding. Two aspects of loudness summation should be taken into account: spectral loudness summation for broadband signals and binaural loudness summation for signals that are presented binaurally. In this study, the effect of different symmetrical hearing losses was studied. Measurements were obtained with the widely used technique of Adaptive Categorical Loudness Scaling. For large bandwidths, spectral loudness summation for hearing-impaired listeners was found to be greater than that for normal-hearing listeners, both for monaurally and binaurally presented signals. For binaural loudness summation, the effect of hearing loss was not significant. In all cases, individual differences were substantial.

Group Means and Intersubject and Intrasubject Variability Estimates for Absolute and Relative (Categorical) Loudness Judgments of Typical Young Adult Listeners

Purpose This brief research note is motivated by an ever-increasing need for typical repeated-measures loudness judgments and variability estimates of the kind necessary to conduct evidence-based treatment studies and clinical trials. Method These judgments and variability data, originally collected but not reported by Formby, Payne, Yang, Wu, and Parton (2017) , are presented here for relative (categorical) and absolute loudness judgments for typical young adult listeners with normal auditory function. Results As shown in this research note, these data may differ appreciably between young and older adult listeners with audiometric pure-tone thresholds within the clinically normal range. Conclusion In general, these findings highlight the need for good age-based, repeated-measures data for planning and powering evidence-based treatment studies and, specifically, for clinical trials that rely on categorical loudness judgments (i.e., as measured with the Contour Test of loudness; Cox, Alexander, Taylor, & Gray, 1997 ) as primary and secondary outcome measures.

Intra- and Intersubject Variability in Audiometric Measures and Loudness Judgments in Older Listeners with Normal Hearing

This research was to document intra- and intersubject variability in measures of pure tone thresholds, loudness discomfort levels, and the Contour test of loudness for tonal and speech stimuli across 8 to 10 repeated test sessions over a period of almost 1 year in a group of 11 normal-hearing, older middle-aged adults (39 to 73 years, mean of 56 years). The measured pure tone thresholds and loudness discomfort levels were determined to be stable across sessions, with variability on the order of 5 dB. The categorical judgments for the Contour test for both warbled tones and spondaic speech stimuli decreased over time in level required for categories greater than comfortable. This result contrasts with reports of a slight increase over time when young, normal-hearing adults were tested in comparable measures. The intrasubject variability in the Contour test results was greatest for the 4,000-Hz tonal stimulus for which the largest time effects were observed. The intersubject variability was typically greater than the intrasubject variability and typically increased as the loudness category increased, with some exceptions. The results from this study can be used to aid in power and sample size analyses using these measures in future studies designed to compare effects of treatments based on changes in loudness judgments over time.