A clinical test for the assessment of binaural speech perception in noise

Study protocol for a randomised controlled trial evaluating the benefits from bimodal solution with cochlear implant and hearing aid versus bilateral hearing aids in patients with asymmetric speech identification scores

INTRODUCTION

Cochlear implant (CI) and hearing aid (HA) in a bimodal solution (CI+HA) is compared with bilateral HAs (HA+HA) to test if the bimodal solution results in better speech intelligibility and self-reported quality of life.

METHODS AND ANALYSIS

This randomised controlled trial is conducted in Odense University Hospital, Denmark. Sixty adult bilateral HA users referred for CI surgery are enrolled if eligible and undergo: audiometry, speech perception in noise (HINT: Hearing in Noise Test), Speech Identification Scores and video head impulse test. All participants will receive new replacement HAs. After 1 month they will be randomly assigned (1:1) to the intervention group (CI+HA) or to the delayed intervention control group (HA+HA). The intervention group (CI+HA) will receive a CI on the ear with a poorer speech recognition score and continue using the HA on the other ear. The control group (HA+HA) will receive a CI after a total of 4 months of bilateral HA use.The primary outcome measures are speech intelligibility measured objectively with HINT (sentences in noise) and DANTALE I (words) and subjectively with the Speech, Spatial and Qualities of Hearing scale questionnaire. Secondary outcomes are patient reported Health-Related Quality of Life scores assessed with the Nijmegen Cochlear Implant Questionnaire, the Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Third outcome is listening effort assessed with pupil dilation during HINT.In conclusion, the purpose is to improve the clinical decision-making for CI candidacy and optimise bimodal solutions.

ETHICS AND DISSEMINATION

This study protocol was approved by the Ethics Committee Southern Denmark project ID S-20200074G. All participants are required to sign an informed consent form.This study will be published on completion in peer-reviewed publications and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT04919928.

Auditory spatial analysis in reverberant multi-talker environments with congruent and incongruent audio-visual room information

In a multi-talker situation, listeners have the challenge of identifying a target speech source out of a mixture of interfering background noises. In the current study, it was investigated how listeners analyze audio-visual scenes with varying complexity in terms of number of talkers and reverberation. The visual information of the room was either congruent with the acoustic room or incongruent. The listeners' task was to locate an ongoing speech source in a mixture of other speech sources. The three-dimensional audio-visual scenarios were presented using a loudspeaker array and virtual reality glasses. It was shown that room reverberation, as well as the number of talkers in a scene, influence the ability to analyze an auditory scene in terms of accuracy and response time. Incongruent visual information of the room did not affect this ability. When few talkers were presented simultaneously, listeners were able to detect a target talker quickly and accurately even in adverse room acoustical conditions. Reverberation started to affect the response time when four or more talkers were presented. The number of talkers became a significant factor for five or more simultaneous talkers.

Modelling binaural unmasking and the intelligibility of speech in noise and reverberation for normal-hearing and hearing-impaired listeners

This study investigated the effect of hearing loss on binaural unmasking (BU) for the intelligibility of speech in noise. Speech reception thresholds (SRTs) were measured with normal-hearing (NH) listeners and older mildly hearing-impaired (HI) listeners while varying the presentation level of the stimuli, reverberation, modulation of the noise masker, and spatial separation of the speech and noise sources. On average across conditions, the NH listeners benefited more (by 0.6 dB) from BU than HI listeners. The binaural intelligibility model developed by Vicente, Lavandier, and Buchholz [J. Acoust. Soc. Am. 148, 3305-3317 (2020)] was used to describe the data, accurate predictions were obtained for the conditions considering moderate noise levels [50 and 60 dB sound pressure level (SPL)]. The interaural jitters that were involved in the prediction of BU had to be revised to describe the data measured at a lower level (40 dB SPL). Across all tested conditions, the correlation between the measured and predicted SRTs was 0.92, whereas the mean prediction error was 0.9 dB.

Effects of Simulated and Profound Unilateral Sensorineural Hearing Loss on Recognition of Speech in Competing Speech

OBJECTIVES

Unilateral hearing loss (UHL) is a condition as common as bilateral hearing loss in adults. Because of the unilaterally reduced audibility associated with UHL, binaural processing of sounds may be disrupted. As a consequence, daily tasks such as listening to speech in a background of spatially distinct competing sounds may be challenging. A growing body of subjective and objective data suggests that spatial hearing is negatively affected by UHL. However, the type and degree of UHL vary considerably in previous studies. The aim here was to determine the effect of a profound sensorineural UHL, and of a simulated UHL, on recognition of speech in competing speech, and the binaural and monaural contributions to spatial release from masking, in a demanding multisource listening environment.

DESIGN

Nine subjects (25 to 61 years) with profound sensorineural UHL [mean pure-tone average (PTA) across 0.5, 1, 2, and 4 kHz = 105 dB HL] and normal contralateral hearing (mean PTA = 7.2 dB HL) were included based on the criterion that the target and competing speech were inaudible in the ear with hearing loss. Thirteen subjects with normal hearing (19 to 60 years; mean left PTA = 4.1 dB HL; mean right PTA = 5.5 dB HL) contributed data in normal and simulated "mild-to-moderate" UHL conditions (PTA = 38.6 dB HL). The main outcome measure was the threshold for 40% correct speech recognition in colocated (0°) and spatially and symmetrically separated (±30° and ±150°) competing speech conditions. Spatial release from masking was quantified as the threshold difference between colocated and separated conditions.

RESULTS

Thresholds in profound UHL were higher (worse) than normal hearing in separated and colocated conditions, and comparable to simulated UHL. Monaural spatial release from masking, that is, the spatial release achieved by subjects with profound UHL, was significantly different from zero and 49% of the magnitude of the spatial release from masking achieved by subjects with normal hearing. There were subjects with profound UHL who showed negative spatial release, whereas subjects with normal hearing consistently showed positive spatial release from masking in the normal condition. The simulated UHL had a larger effect on the speech recognition threshold for separated than for colocated conditions, resulting in decreased spatial release from masking. The difference in spatial release between normal-hearing and simulated UHL conditions increased with age.

CONCLUSIONS

The results demonstrate that while recognition of speech in colocated and separated competing speech is impaired for profound sensorineural UHL, spatial release from masking may be possible when competing speech is symmetrically distributed around the listener. A "mild-to-moderate" simulated UHL decreases spatial release from masking compared with normal-hearing conditions and interacts with age, indicating that small amounts of residual hearing in the UHL ear may be more beneficial for separated than for colocated interferer conditions for young listeners.

Cochlear Implant and Hearing Aid: Objective Measures of Binaural Benefit

Cochlear implants (CI) improve hearing for the severely hearing impaired. With an extension of implantation candidacy, today many CI listeners use a hearing aid on their contralateral ear, referred to as bimodal listening. It is uncertain, however, whether the brains of bimodal listeners can combine the electrical and acoustical sound information and how much CI experience is needed to achieve an improved performance with bimodal listening. Patients with bilateral sensorineural hearing loss undergoing implant surgery were tested in their ability to understand speech in quiet and in noise, before and again 3 and 6 months after provision of a CI. Results of these bimodal listeners were compared to age-matched, normal hearing controls (NH). The benefit of adding a contralateral hearing aid was calculated in terms of head shadow, binaural summation, binaural squelch, and spatial release from masking from the results of a sentence recognition test. Beyond that, bimodal benefit was estimated from the difference in amplitudes and latencies of the N1, P2, and N2 potentials of the brains' auditory evoked response (AEP) toward speech. Data of fifteen participants contributed to the results. CI provision resulted in significant improvement of speech recognition with the CI ear, and in taking advantage of the head shadow effect for understanding speech in noise. Some amount of binaural processing was suggested by a positive binaural summation effect 6 month post-implantation that correlated significantly with symmetry of pure tone thresholds. Moreover, a significant negative correlation existed between binaural summation and latency of the P2 potential. With CI experience, morphology of the N1 and P2 potentials in the AEP response approximated that of NH, whereas, N2 remained different. Significant AEP differences between monaural and binaural processing were shown for NH and for bimodal listeners 6 month post-implantation. Although the grand-averaged difference in N1 amplitude between monaural and binaural listening was similar for NH and the bimodal group, source localization showed group-dependent differences in auditory and speech-relevant cortex, suggesting different processing in the bimodal listeners.

An exploratory investigation of speech recognition thresholds in noise with auralisations of two reverberant rooms

OBJECTIVE

Speech-in-noise tests are widely used in hearing diagnostics but typically without reverberation, although reverberation is an inextricable part of everyday listening conditions. To support the development of more real-life-like test paradigms, the objective of this study was to explore how spatially reproduced reverberation affects speech recognition thresholds in normal-hearing and hearing-impaired listeners.

DESIGN

Thresholds were measured with a Finnish speech-in-noise test without reverberation and with two test conditions with reverberation times of ∼0.9 and 1.8 s. Reverberant conditions were produced with a multichannel auralisation technique not used before in this context.

STUDY SAMPLE

Thirty-four normal-hearing and 14 hearing-impaired listeners participated in this study. Five people were tested with and without hearing aids.

RESULTS

No significant differences between test conditions were found for the normal-hearing listeners. Results for the hearing-impaired listeners indicated better performance for the 0.9 s reverberation time compared to the reference and the 1.8 s conditions. Benefit from hearing aid use varied between individuals; for one person, an advantage was observed only with reverberation.

CONCLUSIONS

Auralisations may offer information on speech recognition performance that is not obtained with a test without reverberation. However, more complex stimuli and/or higher signal-to-noise ratios should be used in the future.

Development and validation of a digits-in-noise hearing test in Persian

OBJECTIVE

The prevalence of unrecognised and late-diagnosed hearing loss is higher in low- and middle-income than in high-income countries, due in part to lack of access to hearing services. Because hearing screening is important for early identification of hearing loss, development of an accessible, self-screening test that can detect hearing loss reliably and quickly would provide significant benefits, especially for underserved populations. This study aimed to develop and validate a new version of the digits-in-noise (DIN) test for Persian speaking countries.

DESIGN

Recordings of Persian digits 0-9 were binaurally presented in broadband speech-shaped noise. Using fitted speech intelligibility functions, digits were homogenised to achieve equal perceptual difficulty across stimuli. The evaluation was established by reference to existing English DIN tests.

STUDY SAMPLE

Thirty Persian speaking young adults with normal hearing thresholds (≤20 dB HL, 0.25-8 kHz).

RESULTS

Speech intelligibility functions produced a mean speech reception threshold (SRT) of -7.7 dB, corresponding closely to previously developed DIN tests. There was no significant difference between test and retest SRTs, indicating high reliability of the test. Our findings suggest that language-specific factors need to be considered for cross-language comparison of DIN-SRTs.

CONCLUSION

This study introduces a convenient tool for future hearing screening in Persian speaking countries with limited access to audiology services.

A convergent validity study: Listening in Spatialized Noise-Sentences (LiSN-S) test and the Hearing in Noise Test (HINT)

OBJECTIVES

The primary purpose of this study was to compare Listening in Spatialized Noise - Sentence (LiSN-S) test and the Hearing in Noise Test (HINT) thresholds in order to determine if the two tests measure the same construct (convergent validity). The secondary purpose was to determine performance differences between the two test protocols. The third purpose was to determine the relationships between quiet measures (pure-tone average [PTA] and HINT Quiet thresholds) vs. speech-in-noise performances.

DESIGN

Statistical analyses included descriptive statistics, Spearman rho statistic, repeated measures analysis of variance (ANOVA) and linear mixed model analyses. Study sample: Fifty-six young adults with normal PTAs (≤15 dB HL for 0.5-4.0 kHz) participated in this study.

RESULTS

No statistically significant relationships were found between LiSN-S and HINT measures (poor convergent validity). However, statistically significant relationships were found between the quiet measures (HINT Quiet thresholds and average PTA_{(0.5-4.0 kHz)}) vs. the LiSN-S (same and different voices) ±90° performances.

CONCLUSION

LiSN-S performances in two-talker babble cannot be generalized to the ability to recognise HINT sentences in steady-state speech-shaped noise, and vice versa. The results imply that LiSN-S ± 90° thresholds were influenced by hearing sensitivity or by supra-threshold distortions that co-vary with hearing sensitivity.

The effect of room acoustical parameters on speech reception thresholds and spatial release from masking

In daily life, speech intelligibility is affected by masking caused by interferers and by reverberation. For a frontal target speaker and two interfering sources symmetrically placed to either side, spatial release from masking (SRM) is observed in comparison to frontal interferers. In this case, the auditory system can make use of temporally fluctuating interaural time/phase and level differences promoting binaural unmasking (BU) and better-ear glimpsing (BEG). Reverberation affects the waveforms of the target and maskers, and the interaural differences, depending on the spatial configuration and on the room acoustical properties. In this study, the effect of room acoustics, temporal structure of the interferers, and target-masker positions on speech reception thresholds and SRM was assessed. The results were compared to an optimal better-ear glimpsing strategy to help disentangle energetic masking including effects of BU and BEG as well as informational masking (IM). In anechoic and moderate reverberant conditions, BU and BEG contributed to SRM of fluctuating speech-like maskers, while BU did not contribute in highly reverberant conditions. In highly reverberant rooms a SRM of up to 3 dB was observed for speech maskers, including effects of release from IM based on binaural cues.

Spatial Release From Masking Under Different Reverberant Conditions in Young and Elderly Subjects: Effect of Moving or Stationary Maskers at Circular and Radial Conditions

Purpose Normal-hearing and hard-of-hearing listeners suffer from reduced speech intelligibility in noisy and reverberant environments. Although daily listening environments are in constant motion, most researchers have only studied speech-in-noise perception for stationary masker locations. The aim of this study was to investigate the spatial release from masking (SRM) of circularly and radially moving maskers under different room acoustic conditions for young and elderly subjects. Method Twelve young subjects with normal hearing and 12 elderly subjects with normal hearing or mild hearing loss were tested. Several different room acoustic conditions were simulated and reproduced via headphones using binaural synthesis. The target speech stream consisted of German digit triplets, and masker stream consisted of quasistationary noise with matched long-term averaged speech spectra. During the experiment, the position of the masker was changed to be in different stationary positions, or varied continuously. In the latter case, it was moved either on a circular trajectory spanning a 90° azimuth angle or on a radial trajectory linearly increasing the distance to the receiver from 0.5 m to 1.8 m. Absorption characteristics of the virtual room's surfaces were changed, recreating an anechoic room, a treated room with mean reverberation times (RT60) = 0.48 s, and an untreated room with mean RT60 = 1.26 s. Results For the circular condition, a significant difference was found between moving and stationary maskers, F(4, 44) = 20.91, p < .001, with a bigger SRM for stationary maskers than moving masker conditions. Also, both age groups displayed a significant decrease in SRM over the reverberation conditions: F(2, 22) = 12.24, p < .001. For the radial condition, both age groups showed a significant decrease in SRM over the reverberation conditions, F(2, 22) = 13.62, p < .001, as well as the moving and stationary masker conditions, F(8, 88) = 29.23, p < .001. In general, the SRM of a moving masker decreased when the reverberation increased, especially for elderly subjects. Conclusions A radially moving masker led to improved SRM in an anechoic environment for both age groups, whereas a circularly moving masker caused degraded SRM, especially for elderly subjects in the highly reverberant environment. Supplemental Material https://doi.org/10.23641/asha.9795371.

Turn an Ear to Hear: How Hearing-Impaired Listeners Can Exploit Head Orientation to Enhance Their Speech Intelligibility in Noisy Social Settings

Turning an ear toward the talker can enhance spatial release from masking. Here, with their head free, listeners attended to speech at a gradually diminishing signal-to-noise ratio and with the noise source azimuthally separated from the speech source by 180° or 90°. Young normal-hearing adult listeners spontaneously turned an ear toward the speech source in 64% of audio-only trials, but a visible talker’s face or cochlear implant (CI) use significantly reduced this head-turn behavior. All listener groups made more head movements once instructed to explore the potential benefit of head turns and followed the speech to lower signal-to-noise ratios. Unilateral CI users improved the most. In a virtual restaurant simulation with nine interfering noises or voices, hearing-impaired listeners and simulated bilateral CI users typically obtained a 1 to 3 dB head-orientation benefit from a 30° head turn away from the talker. In diffuse interference environments, the advice to U.K. CI users from many CI professionals and the communication guidance available on the Internet most often advise the CI user to face the talker head on. However, CI users would benefit from guidelines that recommend they look sidelong at the talker with their better hearing or implanted ear oriented toward the talker.

Perspectives of Dutch health professionals regarding auditory processing disorders; a focus group study

OBJECTIVE

This study investigated the perspectives of professionals from the Dutch audiological centres on the definition and care pathways of children with suspected auditory processing disorders (susAPD).

DESIGN

focus group interviews.

STUDY SAMPLE

In total, 45 professionals from 6 disciplines, representing 22 different audiological centres and one ambulatory service, participated in five parallel focus group interviews. Participants had a variety of experience in diagnosing and advising children with suspected APD.

RESULTS

Qualitative analysis (open and thematic) identified four themes ("Definition", "Causes", "Diagnostic Procedures" and "Clinical Reasoning") expressing a variety of perspectives. Differences in perspectives were mainly affected by two debates: (1) whether or not APD exists as a pure (auditory) disorder and (2) whether or not current AP-tests are suitable in diagnosing children with listening difficulties. They also expressed a need for more guidance from the literature in their clinical decision making process.

CONCLUSIONS

Professionals from the Dutch audiological centres share a broad perspective on children with APD. The ICF framework supports this perspective, thereby diminishing the need for a clear definition. The use of AP-tests should be limited to children where broader developmental disorders are first ruled out; a possible "pure" APD could then be diagnosed in a limited number of children.

Hearing in Noise Test, HINT-Brazil, in normal-hearing children

Introduction

The auditory processing is related to certain skills such as speech recognition in noise. The HINT-Brazil test allows the measurement of the Speech/Noise ratio however there are no studies in the national literature that establish parameters for the child population.

Objective

To analyze the performance of normal-hearing subjects aged 8–10 years old in tasks for speech recognition in noise using HINT test.

Methods

Sixty schoolchildren were evaluated. They were between 8 and 10 years of age, of both genders, and had no auditory and school complaints, with results ranking within normality for the Basic Audiological Assessment and the Dichotic Digits Test. HINT-Brazil test was applied with headphones, with the Speech/Noise ratio in conditions of frontal noise, noise to the right, and noise to the left being investigated. The software calculated the Composite Noise, which corresponds to the weighted mean of the tested conditions.

Results

There was no statistically significant difference between the ears, nor between the genders. There was a statistically significant difference for age ranges of 8 and 10 years, in situations with noise, and for Composite Noise. The age group of 10 years showed better performance than the age group of 8; the age group of 9 years did not show statistically significant difference regarding the other age ranges. We suggest the values of mean and standard deviation of the Speech/Noise ratio, considering the age ranges of: 8 years – Frontal Noise: −2.09 (±1.09); Right Noise: −7.64 (±1.72); Left Noise: −7.53 (±2.80); Composite Noise: −4.86 (±1.31); 9 years – Frontal Noise: −2.82 (±0.74); Right Noise: −8.49 (±2.24); Left Noise: −8.41 (±1.75); Composite Noise: −5.63 (±1.02); 10 years – Frontal Noise: −3.01 (±0.95); Right Noise: −9.47 (±1.43); Left Noise: −9.16 (±1.65); Composite Noise: −6.16 (±0.91).

Conclusion

HINT-Brazil test is a simple and fast test, and is not difficult to performed with normal-hearing children. The results confirm that it is an efficient test to be used with the age range evaluated.

Selection of test-setup parameters to target specific signal-to-noise regions in speech-on-speech intelligibility testing

OBJECTIVE

To investigate the magnitude of the change in speech-reception threshold (SRT) provided by altering four different test-setup parameters. Furthermore, to determine whether these changes in SRT are of a sufficient magnitude, such that they can be used to design a test-setup in future experiments that target a predefined signal-to-noise ratio (SNR) region. This could be particularly important if the test contrast investigated is confounded with test SNR.

DESIGN

The investigated test-setup parameters were: Spatial separation between target (0°) and maskers (±15°, ±30°, ±45°, or ±75°), number of maskers (two, four or six), scoring method (scoring percent-correct words or sentences) and masker gender (same or opposite to target). Twenty SRTs were measured per test subject.

STUDY SAMPLE

Twenty hearing-impaired test subjects participated over two visits.

RESULTS

Alteration of masker gender, spatial separation between target and masker (±15°, ±30°, ± 45°), and scoring method was shown to offer SRT changes of a sufficient magnitude. The different test setups resulted in average SRTs ranging from -4.0 to 3.3 dB.

CONCLUSION

Deliberately selecting test setup parameters can change the overall difficulty of the test by up to 7.3 dB SRT. Thus, a future experiment can, to this extent, be designed to target a specific SNR region.

Towards measuring the Speech Transmission Index in fluctuating noise: Accuracy and limitations

In the field of room acoustics, the modulation transfer function (MTF) can be used to predict speech intelligibility in stationary noise and reverberation and can be expressed in one single value: the Speech Transmission Index (STI). One drawback of the classical STI measurement method is that it is not validated for fluctuating background noise. As opposed to the classical measurement method, the MTF due to reverberation can also be calculated using an impulse response measurement. This indirect method presents an opportunity for STI measurements in fluctuating noise, and a first prerequisite is a reliable impulse response measurement. The conditions under which the impulse response can be measured with sufficient precision were investigated in the current study. Impulse response measurements were conducted using a sweep stimulus. Two experiments are discussed with variable absorption, different levels of stationary and fluctuating background noise, and different sweep levels. Additionally, simulations with different types of fluctuating noise were conducted in an attempt to extrapolate the experimental findings to other acoustical conditions. The experiments and simulations showed that a minimum impulse-to-noise ratio of +25 dB in fluctuating noise was needed.

Head orientation benefit to speech intelligibility in noise for cochlear implant users and in realistic listening conditions

Cochlear implant (CI) users suffer from elevated speech-reception thresholds and may rely on lip reading. Traditional measures of spatial release from masking quantify speech-reception-threshold improvement with azimuthal separation of target speaker and interferers and with the listener facing the target speaker. Substantial benefits of orienting the head away from the target speaker were predicted by a model of spatial release from masking. Audio-only and audio-visual speech-reception thresholds in normal-hearing (NH) listeners and bilateral and unilateral CI users confirmed model predictions of this head-orientation benefit. The benefit ranged 2-5 dB for a modest 30° orientation that did not affect the lip-reading benefit. NH listeners' and CI users' lip-reading benefit measured 3 and 5 dB, respectively. A head-orientation benefit of ∼2 dB was also both predicted and observed in NH listeners in realistic simulations of a restaurant listening environment. Exploiting the benefit of head orientation is thus a robust hearing tactic that would benefit both NH listeners and CI users in noisy listening conditions.

Early outcomes after cochlear implantation for adults and children with unilateral hearing loss

OBJECTIVES/HYPOTHESIS

This study was designed to examine speech recognition and self-perceived health-related quality of life (HRQoL) received from cochlear implantation among a cohort of adults and children with a short duration of unilateral hearing loss greater than 6 months, but less than 2 years.

STUDY DESIGN

Single-subject repeated measures prospective study.

METHODS

This study assessed changes in speech recognition and self-perceived quality of life by prospectively analyzing data at the preoperative evaluation and at the 3-month and 6-month postactivation intervals. Measurement tools included Medical Outcomes Study Questionnaire Short Form 36, Nijmegen Cochlear Implant Questionnaire, Speech Spatial and Qualities of Hearing-Comparative, and speech recognition measures in quiet and in noise.

RESULTS

Results indicated significant improvement in speech recognition, both in quiet and noise. Quality-of-life measures showed a significant increase in self-perceived benefit with disease-specific instruments, but remained constant with a generic HRQoL instrument.

CONCLUSIONS

Cochlear implantation was a successful intervention for improved hearing in quiet and noise, and a self-perceived benefit for this group of adults and children with a short duration of unilateral hearing loss.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:1683-1688, 2017.

Reverberation limits the release from informational masking obtained in the harmonic and binaural domains

A difference in fundamental frequency (ΔF0) and a difference in spatial location (ΔSL) are two cues known to provide masking releases when multiple speakers talk at once in a room. We examined situations in which reverberation should have no effect on the mechanisms underlying the releases from energetic masking produced by these two cues. Speech reception thresholds using both unpredictable target sentences and the coordinate response measure followed a similar pattern. Both ΔF0s and ΔSLs provided masking releases in the presence of nonspeech maskers (matched in excitation pattern and temporal envelope to the speech maskers) that, as intended, were robust to reverberation. Larger masking releases were obtained for speech maskers, but critically, they were affected by reverberation. These results suggest that reverberation either limits the amount of informational masking that is present to begin with or affects its release by ΔF0s or ΔSLs.

The benefit of head orientation to speech intelligibility in noise

Spatial release from masking is traditionally measured with speech in front. The effect of head-orientation with respect to the speech direction has rarely been studied. Speech-reception thresholds (SRTs) were measured for eight head orientations and four spatial configurations. Benefits of head orientation away from the speech source of up to 8 dB were measured. These correlated with predictions of a model based on better-ear listening and binaural unmasking (r = 0.96). Use of spontaneous head orientations was measured when listeners attended to long speech clips of gradually diminishing speech-to-noise ratio in a sound-deadened room. Speech was presented from the loudspeaker that initially faced the listener and noise from one of four other locations. In an undirected paradigm, listeners spontaneously turned their heads away from the speech in 56% of trials. When instructed to rotate their heads in the diminishing speech-to-noise ratio, all listeners turned away from the speech and reached head orientations associated with lower SRTs. Head orientation may prove valuable for hearing-impaired listeners.

The effect of spatial separation in distance on the intelligibility of speech in rooms

The influence of spatial separation in source distance on speech reception thresholds (SRTs) is investigated. In one scenario, the target was presented at 0.5 m distance, and the masker varied from 0.5 m distance up to 10 m. In a second scenario, the masker was presented at 0.5 m distance and the target distance varied. The stimuli were synthesized using convolution with binaural room impulse responses (BRIRs) measured on a dummy head in a reverberant auditorium, and were equalized to compensate for distance-dependent spectral and intensity changes. All sources were simulated directly in front of the listener. SRTs decreased monotonically when the target was at 0.5 m and the speech-masker was moved further away, resulting in a SRT improvement of up to 10 dB. When the speech masker was at 0.5 m and the target was moved away, a large variation across subjects was observed. Neither short-term signal-to-noise ratio (SNR) improvements nor cross-ear glimpsing could account for the observed improvement in intelligibility. However, the effect might be explained by an improvement in the SNR in the modulation domain and a decrease in informational masking. This study demonstrates that distance-related cues can play a significant role when listening in complex environments.

Reverberation impairs brainstem temporal representations of voiced vowel sounds: challenging "periodicity-tagged" segregation of competing speech in rooms

The auditory system typically processes information from concurrently active sound sources (e.g., two voices speaking at once), in the presence of multiple delayed, attenuated and distorted sound-wave reflections (reverberation). Brainstem circuits help segregate these complex acoustic mixtures into “auditory objects.” Psychophysical studies demonstrate a strong interaction between reverberation and fundamental-frequency (F0) modulation, leading to impaired segregation of competing vowels when segregation is on the basis of F0 differences. Neurophysiological studies of complex-sound segregation have concentrated on sounds with steady F0s, in anechoic environments. However, F0 modulation and reverberation are quasi-ubiquitous. We examine the ability of 129 single units in the ventral cochlear nucleus (VCN) of the anesthetized guinea pig to segregate the concurrent synthetic vowel sounds /a/ and /i/, based on temporal discharge patterns under closed-field conditions. We address the effects of added real-room reverberation, F0 modulation, and the interaction of these two factors, on brainstem neural segregation of voiced speech sounds. A firing-rate representation of single-vowels' spectral envelopes is robust to the combination of F0 modulation and reverberation: local firing-rate maxima and minima across the tonotopic array code vowel-formant structure. However, single-vowel F0-related periodicity information in shuffled inter-spike interval distributions is significantly degraded in the combined presence of reverberation and F0 modulation. Hence, segregation of double-vowels' spectral energy into two streams (corresponding to the two vowels), on the basis of temporal discharge patterns, is impaired by reverberation; specifically when F0 is modulated. All unit types (primary-like, chopper, onset) are similarly affected. These results offer neurophysiological insights to perceptual organization of complex acoustic scenes under realistically challenging listening conditions.

Head shadow, squelch, and summation effects with an energetic or informational masker in bilateral and bimodal CI users

PURPOSE

The objective of the study was to investigate the influence of noise (energetic) and speech (energetic plus informational) maskers on the head shadow (HS), squelch (SQ), and binaural summation (SU) effect in bilateral and bimodal cochlear implant (CI) users.

METHOD

Speech recognition was measured in the presence of either a competing talker or modulated speech-shaped noise in 10 bimodal and 10 bilateral adult CI users. HS, SQ, and SU effects were calculated. The interfering signals were manipulated with respect to F0 to consider the influence of different speaker voices.

RESULTS

The effects HS, SQ, and SU differed depending on the type of masker. A detailed analysis of errors was used to dissociate energetic and informational masking effects. The analysis showed a release from energetic than from informational masking.

CONCLUSION

Noise interferers are not sufficient to reflect difficulties experienced with speech understanding in noise for bilateral and bimodal CI users.

A model that predicts the binaural advantage to speech intelligibility from the mixed target and interferer signals

A model is presented that predicts the binaural advantage to speech intelligibility by analyzing the right and left recordings at the two ears containing mixed target and interferer signals. This auditory-inspired model implements an equalization-cancellation stage to predict the binaural unmasking (BU) component, in conjunction with a modulation-frequency estimation block to estimate the "better ear" effect (BE) component of the binaural advantage. The model's performance was compared to experimental data obtained under anechoic and reverberant conditions using a single speech-shaped noise interferer paradigm. The internal BU and BE components were compared to those of the speech intelligibility model recently proposed by Lavandier et al. [J. Acoust. Soc. Am. 131, 218-231 (2012)], which requires separate inputs for target and interferer. The data indicate that the proposed model provides comparably good predictions from a mixed-signals input under both anechoic and reverberant conditions.

Binaural speech intelligibility in rooms with variations in spatial location of sources and modulation depth of noise interferers

Four experiments investigated the effects on speech intelligibility of reverberation, sound source locations, and amplitude modulation of the interferers. Speech reception thresholds (SRTs) were measured using headphones and stimuli that simulated real-room listening, considering one or two interferers which were stationary or speech-modulated noises. In experiment 1, SRTs for modulated noises showed little variation with increasing interferer reverberation. Reverberation might have increased masking by filling in the modulated noise gaps, but simultaneously changed the noise spectra making them less effective maskers. In experiment 2, SRTs were lower when measured using a unique one-voice modulated interferer rather than a different interferer for each target sentence, suggesting that listeners could take advantage of the predictability of the interferer gaps. In experiment 3, increasing speech reverberation did not significantly affect the difference of SRTs measured with stationary and modulated noises, indicating that the ability to exploit noise modulations was still useful for temporally smeared speech. In experiment 4, spatial unmasking remained constant when applying modulations to the interferers, suggesting an independence of the abilities to exploit these modulations and the spatial separation of sources. Finally, a model predicting binaural intelligibility for modulated noises was developed and provided a good fit to the experimental data.

Effects of reverberation and masker fluctuations on binaural unmasking of speech

In daily life, listeners use two ears to understand speech in situations which typically include reverberation and non-stationary noise. In headphone experiments, the binaural benefit for speech in noise is often expressed as the difference in speech reception threshold between diotic (N(0)S(0)) and dichotic (N(0)S(π)) conditions. This binaural advantage (BA), arising from the use of inter-aural phase differences, is about 5-6 dB in stationary noise, but may be lower in everyday conditions. In the current study, BA was measured in various combinations of noise and artificially created diotic reverberation, for normal-hearing and hearing-impaired listeners. Speech-intelligibility models were applied to quantify the combined effects. Results showed that in stationary noise, diotic reverberation did not affect BA. BA was reduced in conditions where the masker fluctuated. With additional reverberation, however, it was restored. Results for both normal-hearing and hearing-impaired listeners were accounted for by assuming that binaural unmasking is only effectively realized at low instantaneous speech-to-noise ratios (SNRs). The observed BA was related to the distribution of SNRs resulting from fluctuations, reverberation, and peripheral processing. It appears that masker fluctuations and reverberation, both relevant for everyday communication, interact in their effects on binaural unmasking and need to be considered together.

Binaural prediction of speech intelligibility in reverberant rooms with multiple noise sources

When speech is in competition with interfering sources in rooms, monaural indicators of intelligibility fail to take account of the listener's abilities to separate target speech from interfering sounds using the binaural system. In order to incorporate these segregation abilities and their susceptibility to reverberation, Lavandier and Culling [J. Acoust. Soc. Am. 127, 387-399 (2010)] proposed a model which combines effects of better-ear listening and binaural unmasking. A computationally efficient version of this model is evaluated here under more realistic conditions that include head shadow, multiple stationary noise sources, and real-room acoustics. Three experiments are presented in which speech reception thresholds were measured in the presence of one to three interferers using real-room listening over headphones, simulated by convolving anechoic stimuli with binaural room impulse-responses measured with dummy-head transducers in five rooms. Without fitting any parameter of the model, there was close correspondence between measured and predicted differences in threshold across all tested conditions. The model's components of better-ear listening and binaural unmasking were validated both in isolation and in combination. The computational efficiency of this prediction method allows the generation of complex "intelligibility maps" from room designs.

The binaural intelligibility level difference in hearing-impaired listeners: the role of supra-threshold deficits

Reduced binaural performance of hearing-impaired listeners may not only be caused by raised hearing thresholds (reduced audibility), but also by supra-threshold coding deficits in signal cues. This question was investigated in the present study using binaural intelligibility level difference (BILD) comparisons: the improvement of speech-reception threshold scores for N(0)S(π) relative to N(0)S(0) presentation conditions. Investigated was what types of supra-threshold deficits play a role in reducing BILDs in hearing-impaired subjects. BILDs were investigated for 25 mild to moderate sensorineural hearing-impaired listeners, under conditions where optimal audibility was assured. All stimuli were bandpass filtered (250-4000 Hz). A distortion-sensitivity approach was used to investigate the sensitivity of subjects BILDs to external stimulus perturbations in the phase, frequency, time, and intensity domains. The underlying assumption of this approach was that an auditory coding deficit occurring in a signal cue in a particular domain will result in a low sensitivity to external perturbations applied in that domain. Compared to reference data for listeners with normal BILDs, distortion-sensitivity data for a subgroup of eight listeners with reduced BILDs suggests that these reductions in BILD were caused by coding deficits in the phase and time domains.

Curvas logoaudiométricas utilizando sentenças como estímulo

OBJETIVO: determinar curvas logoaudiométricas, utilizando o teste Listas de Sentenças em Português (LSP), em um grupo de indivíduos normo-ouvintes e um grupo de indivíduos com perda auditiva neurossensorial, e comparar os resultados obtidos nestes grupos. MÉTODOS: utilizou-se o teste Listas de Sentenças em Português (LSP) para determinar os Limiares de Detecção de Voz (LDV), Limiares de Reconhecimento de Sentenças no Silêncio (LRSS), e os Índices Percentuais Máximos de Reconhecimento de Sentenças no Silêncio (IPMRSS), em um grupo de indivíduos normo-ouvintes (grupo A) e um grupo de indivíduos com perda auditiva neurossensorial (grupo B). RESULTADOS: o grupo A foi composto por 19 indivíduos do sexo feminino e 11 do sexo masculino, com idades entre 18 e 40 anos. No grupo B, 15 indivíduos eram do sexo feminino e 14 eram do sexo masculino, com idades variando entre 23 e 81 anos. Para o grupo A, encontraram-se valores médios de 16,47 dB para o LDV; 23,77 dB para o LRSS e de 31,23 dB para o IPMRSS. Já no grupo B, os valores encontrados foram de 38,38 dB para o LDV; 50,35 dB para o LRSS e 59,65 dB para o IPMRSS. Na análise estatística, encontrou-se diferença estatisticamente significante entre os grupos. CONCLUSÃO: foram traçadas as curvas logoaudiométricas para os grupos estudados. Os dados permitem inferir que a cada 1 dB de variação, na intensidade de apresentação das sentenças, ocasionou uma mudança de 6,77% no reconhecimento de fala para os indivíduos normo-ouvintes e de 4,70% e no grupo de indivíduos com perda auditiva.

Prediction of binaural speech intelligibility against noise in rooms

In the presence of competing speech or noise, reverberation degrades speech intelligibility not only by its direct effect on the target but also by affecting the interferer. Two experiments were designed to validate a method for predicting the loss of intelligibility associated with this latter effect. Speech reception thresholds were measured under headphones, using spatially separated target sentences and speech-shaped noise interferers simulated in virtual rooms. To investigate the effect of reverberation on the interferer unambiguously, the target was always anechoic. The interferer was placed in rooms with different sizes and absorptions, and at different distances and azimuths from the listener. The interaural coherence of the interferer did not fully predict the effect of reverberation. The azimuth separation of the sources and the coloration introduced by the room also had to be taken into account. The binaural effects were modeled by computing the binaural masking level differences in the studied configurations, the monaural effects were predicted from the excitation pattern of the noises, and speech intelligibility index weightings were applied to both. These parameters were all calculated from the room impulse responses convolved with noise. A 0.95-0.97 correlation was obtained between the speech reception thresholds and their predicted value.

Candidacy for bilateral hearing aids: a retrospective multicenter study

PURPOSE

The goal of this study was to find factors for refining candidacy criteria for bilateral hearing aid fittings. Clinical files of 1,000 consecutive hearing aid fittings were analyzed.

METHOD

Case history, audiometric, and rehabilitation data were collected from clinical files, and an extensive questionnaire on long-term outcome measures was conducted. After at least 2 years of hearing aid use, 505 questionnaires were returned. In order to compare differences in benefits between unilateral and bilateral fittings, two subgroups were composed in which most relevant variables (age, degree of hearing loss, and audiometric asymmetry) were matched for unilateral fittings (n=212) and bilateral fittings (n=477).

RESULTS

The bilateral group had significantly higher benefit scores than the unilateral group for detection, speech intelligibility in reverberation, and localization, but poorer scores for comfort of loud sounds. The benefit of bilateral hearing aids was not significantly related to the level of technology of the hearing aids.

CONCLUSION

The analysis of the relation between objective parameters and the subjective outcome measures showed that candidacy for a successful bilateral fitting could not be predicted from age, maximum speech intelligibility, employment, exposure to background noise, or social activities.

An objective measure for selecting microphone modes in OMNI/DIR hearing aid circuits

OBJECTIVES

Studies have shown that listener preferences for omnidirectional (OMNI) or directional (DIR) processing in hearing aids depend largely on the characteristics of the listening environment, including the relative locations of the listener, signal sources, and noise sources; and whether reverberation is present. Many modern hearing aids incorporate algorithms to switch automatically between microphone modes based on an analysis of the acoustic environment. Little work has been done, however, to evaluate these devices with respect to user preferences, or to compare the outputs of different signal processing algorithms directly to make informed choices between the different microphone modes. This study describes a strategy for automatically switching between DIR and OMNI microphone modes based on a direct comparison between acoustic speech signals processed by DIR and OMNI algorithms in the same listening environment. In addition, data are shown regarding how a decision to choose one microphone mode over another might change as a function of speech to noise ratio (SNR) and spatial orientation of the listener.

DESIGN

Speech and noise signals were presented at a variety of SNR's and in different spatial orientations relative to a listener's head. Monaural recordings, made in both OMNI and DIR microphone processing modes, were analyzed using a model of auditory processing that highlights the spectral and temporal dynamics of speech. Differences between OMNI and DIR processing were expressed in terms of a modified spectrotemporal modulation index (mSTMI) developed specifically for this hearing aid application. Differences in mSTMI values were compared with intelligibility measures and user preference judgments made under the same listening conditions.

RESULTS

A comparison between the results of the mSTMI analyses and behavioral data (intelligibility and preference judgments) showed excellent agreement, especially in stationary noise backgrounds. In addition, the mSTMI was found to be sensitive to changes in SNR as well as spatial orientation of the listener relative to signal and noise sources. Subsequent mSTMI analyses on hearing aid recordings obtained from real-life environments with more than one talker and modulated noise backgrounds also showed promise for predicting the preferred microphone setting in varied and complex listening environments.

Binaural intelligibility prediction based on the speech transmission index

Although the speech transmission index (STI) is a well-accepted and standardized method for objective prediction of speech intelligibility in a wide range of environments and applications, it is essentially a monaural model. Advantages of binaural hearing in speech intelligibility are disregarded. In specific conditions, this leads to considerable mismatches between subjective intelligibility and the STI. A binaural version of the STI was developed based on interaural cross correlograms, which shows a considerably improved correspondence with subjective intelligibility in dichotic listening conditions. The new binaural STI is designed to be a relatively simple model, which adds only few parameters to the original standardized STI and changes none of the existing model parameters. For monaural conditions, the outcome is identical to the standardized STI. The new model was validated on a set of 39 dichotic listening conditions, featuring anechoic, classroom, listening room, and strongly echoic environments. For these 39 conditions, speech intelligibility [consonant-vowel-consonant (CVC) word score] and binaural STI were measured. On the basis of these conditions, the relation between binaural STI and CVC word scores closely matches the STI reference curve (standardized relation between STI and CVC word score) for monaural listening. A better-ear STI appears to perform quite well in relation to the binaural STI model; the monaural STI performs poorly in these cases.

Medial olivocochlear functioning and speech perception in noise in older adults

The purposes of this study were to: (1) compare medial olivocochlear system (MOCS) functioning and speech perception in noise in young and older adults and (2) to quantify the correlation between MOCS functioning and speech perception in noise. Measurements were taken in 20 young (mean 26.3 +/- 2.1 years) and 20 older adults (mean 55.2 +/- 2.8 years). Contralateral distortion product otoacoustic emission (DPOAE) suppression was measured to assess MOCS functioning. Speech perception in noise was evaluated using the Hearing in Noise Test in noise-ipsilateral, noise-front and noise-contralateral test conditions. The results revealed that the older group had a significantly lower high-frequency (3-8 kHz) contralateral DPOAE suppression, and performed more poorly in the noise-ipsilateral condition than the younger group. However, there was no correlation between contralateral DPOAE suppression and speech perception in noise. This study suggests that poor speech perception performance in noise experienced by older adults might be due to a decline in medial olivocochlear functioning, among other factors.

Speech segregation in rooms: monaural, binaural, and interacting effects of reverberation on target and interferer

Speech reception thresholds were measured in virtual rooms to investigate the influence of reverberation on speech intelligibility for spatially separated targets and interferers. The measurements were realized under headphones, using target sentences and noise or two-voice interferers. The room simulation allowed variation of the absorption coefficient of the room surfaces independently for target and interferer. The direct-to-reverberant ratio and interaural coherence of sources were also varied independently by considering binaural and diotic listening. The main effect of reverberation on the interferer was binaural and mediated by the coherence, in agreement with binaural unmasking theories. It appeared at lower reverberation levels than the effect of reverberation on the target, which was mainly monaural and associated with the direct-to-reverberant ratio, and could be explained by the loss of amplitude modulation in the reverberant speech signals. This effect was slightly smaller when listening binaurally. Reverberation might also be responsible for a disruption of the mechanism by which the auditory system exploits fundamental frequency differences to segregate competing voices, and a disruption of the "listening in the gaps" associated with speech interferers. These disruptions may explain an interaction observed between the effects of reverberation on the targets and two-voice interferers.

Speech recognition thresholds in noisy areas: Reference values for normal hearing adults

In audiology clinics, complaints about difficulties in speech recognition in noise environments are frequent, even for normal-hearing individuals. Thus, the audiologist must not only identify a hearing loss, but also analyze speech recognition, under noisy conditions similar to those found in our daily lives.

Aim

Determine the reference value for the recognition of phrases under noisy conditions, in the free field, for adult normal hearing patients.

Materials and Methods

This study was carried out in 2005 and 2006. We had 150 adult normal hearing individuals participating, with ages between 18 and 64 years, assessed in a soundproof booth. We evaluation was based on lists of phrases in Portuguese. The phrases lists were presented in the free field, in the presence of a competitive noise, at the fixed intensity of 65 dB H. The incidence angle of both stimuli was 0°- 0° azimuth.

Results and Conclusion

The phrases recognition thresholds in the free fields were obtained in the signal to noise ratio of −8.14 dB H, which is the reference value for normal hearing individuals.

Speech segregation in rooms: effects of reverberation on both target and interferer

Speech reception thresholds were measured to investigate the influence of a room on speech segregation between a spatially separated target and interferer. The listening tests were realized under headphones. A room simulation allowed selected positioning of the interferer and target, as well as varying the absorption coefficient of the room internal surfaces. The measurements involved target sentences and speech-shaped noise or 2-voice interferers. Four experiments revealed that speech segregation in rooms was not only dependent on the azimuth separation of sound sources, but also on their direct-to-reverberant energy ratio at the listening position. This parameter was varied for interferer and target independently. Speech intelligibility decreased as the direct-to-reverberant ratio of sources was degraded by sound reflections in the room. The influence of the direct-to-reverberant ratio of the interferer was in agreement with binaural unmasking theories, through its effect on interaural coherence. The effect on the target occurred at higher levels of reverberation and was explained by the intrinsic degradation of speech intelligibility in reverberation.

Auditory Evoked Potentials in the Detection of Interaural Intensity Differences in Children and Adults

OBJECTIVE

The goal of the current study was to identify neurophysiological indices of binaural processing in children with no history of hearing loss or listening problems. The results will guide our efforts to diagnose children for whom impaired binaural processing may contribute to difficulty understanding speech in adverse listening environments. Our main aim was to document the cortical auditory evoked potentials (AEPs) in response to interaural intensity differences (IIDs) in children. It is well known, however, that the morphology of AEPs is substantially different in children and adults. Comparison of AEPs in response to IIDs between children and adults allowed us to evaluate age-related differences in the AEP waveform of binaural processing.

DESIGN

Nine children (ages 7 yr 0 mo to 9 yr 4 mo) and 11 adults (23 to 34 yr) with normal hearing and no known or suspected neurological or academic problems listened to click stimuli under earphones. Click trains consisted of broadband noise of 1-msec duration with a click rate of 100 Hz. In the experimental condition (IID-present) 50-msec intervals containing an interaural intensity difference of 20 dB were introduced periodically in the continuous stream of otherwise diotic click trains. The diotic trains alternated in intensity between 50 and 70 dB peSPL. In the baseline condition (IID-absent), the same continuous diotic click stream utilized in the IID-present condition was presented with no IID. Finally, for comparison with existing literature on AEPs in children and adults, we presented monaural click trains of 50-msec duration, like those used in the IID stimulus (but with no continuous stream) to the left ear at 70 dB peSPL, with an interstimulus interval of 750 msec. Stimuli were presented in separate blocks for each stimulus type and AEPs were recorded in a passive listening condition.

RESULTS

A prominent AEP activation was present in both age groups for the IID-present condition; the IID-absent condition did not evoke substantial AEPs. Adult waveform characteristics of the AEPs to monaural clicks and IID-present around 100 and 200 msec were comparable to previous reports. The children demonstrated the expected AEP activation patterns in response to monaural clicks (i.e., positivity around 100 msec, followed by prominent negativity around 250 msec); however their AEP waveforms to IIDs were mainly comprised of a prolonged positivity around 200 to 250 msec after stimulus onset. A two-step temporal-spatial Principal Component Analysis (PCA) was used to evaluate the temporal (time) and spatial (electrode location) composition of the AEP waveforms in children and adults in response to IID-present and IID-absent conditions. Separate repeated-measures ANOVAs with factor scores as the dependent variable were conducted for each temporal factor (TF) representing the waveform deflections around 100, 200 and 250 msec (i.e., TF110, TF200, and TF255) at the frontocentral spatial factor (SF1). Significantly greater negative activation was observed in adults than in children in response to IID-present for TF110. The IID-present condition evoked a significantly greater waveform inflection for TF200 in both age groups than IID-absent. A positive going activation for TF255 was observed in the IID-present condition in children but not in adults.

CONCLUSIONS

This study compared obligatory AEPs in response to binaural processing of IIDs in children and adults with normal hearing. The morphology of the AEP waveform in children was different for monaural clicks and IID-present stimuli. The difference between AEPs for monaural clicks and IID-present did not occur in adults. It is likely that polarity reversal of the AEPs in response to the IID accounts for the observed AEP morphology in children.

Evaluation of Bilaterally Implanted Adult Subjects with the Nucleus 24 Cochlear Implant System

OBJECTIVE

To evaluate the speech perception benefits of bilateral implantation for subjects who already have one implant.

STUDY DESIGN

Repeated measures.

PATIENTS

Thirty adult cochlear implant users who received their second implant from 1 to 7 years with a mean of 3 years after their first device. Ages ranged from 29 to 82 years with a mean of 57 years.

SETTING

Tertiary referral centers across the United Kingdom.

MAIN OUTCOME MEASURES

Monosyllabic consonant-nucleus-consonant words and City University of New York sentences in quiet with coincident speech and noise and with the noise spatially separated from the speech by +/-90 degrees .

RESULTS

At 9 months, results showed the second ear in noise was 13.9 +/- 5.9% worse than the first ear (p < 0.001); a significant binaural advantage of 12.6 +/- 5.4% (p < 0.001) over the first ear alone for speech and noise from the front; a 21 +/- 6% (p < 0.001) binaural advantage over the first ear alone when noise was ipsilateral to the first ear; no binaural advantage when noise was contralateral to the first ear.

CONCLUSIONS

There is a significant bilateral advantage of adding a second ear for this group. We were unable to predict when the second ear would be the better performing ear, and by implanting both ears, we guarantee implanting the better ear. Sequential implantation with long delays between ears has resulted in poor second ear performance for some subjects and has limited the degree of bilateral benefit that can be obtained by these users. The dual microphone does not provide equivalent benefit to bilateral implants.

Reliability of recognition thresholds of sentences in quiet and in noise

A larger number of research studies has been performed with different people and objectives and have shown that the sentence recognition test in noise is the best instrument to evaluate individuals’ daily communication. However, we believe these tests are not applied so frequently because they require a lot of research to establish the parameters and variables related to their application and interpretation of the results. Aim: To check the reliability of the recognition threshold of the sentences in quiet and in noise for a group of young normal listeners. Study design: transversal cohort. Material and Method: The group comprised 40 subjects, 20 males and 20 females, with ages between 18 and 28 and all of them with normal hearing threshold. First, we applied the Basic Audiological Evaluation and after this, the Sentence Recognition Threshold test in quiet (LRSS) and in noise (LRSR). The sentences and the noise (fixed in 65 dB HL) were presented monoaurally, by earphones through “ascending-descending” strategy. The test and retest were done in different evaluation sessions, with an interval of seven days between them, respecting the same hour of evaluation. Results: The results showed strong positive statistically significant correlation between the test and retest of LRSS, both for right ear (r = 0.6107) and left ear (r = 0.5853), as S/N ratio, for right ear (r = 0.5711) and for left ear (r = 0.5867) for the assessed individuals. Conclusion: In the end of this study, we concluded that LRSS and S/N ratio obtained from the Portuguese Sentence List Test showed to be highly reliable, with strong positive correlation when compared to the results obtained in different sessions of evaluation in a group of young normal listeners.

The effect of spatial separation on informational masking of speech in normal-hearing and hearing-impaired listeners

The ability to understand speech in a multi-source environment containing informational masking may depend on the perceptual arrangement of signal and masker objects in space. In normal-hearing listeners, Arbogast et al. [J. Acoust. Soc. Am. 112, 2086-2098 (2002)] found an 18-dB spatial release from a primarily informational masker, compared to 7 dB for a primarily energetic masker. This article extends the earlier work to include the study of listeners with sensorineural hearing loss. Listeners performed closed-set speech recognition in two spatial conditions: 0 degrees and 90 degrees separation between signal and masker. Three maskers were tested: (1) the different-band sentence masker was designed to be primarily informational; (2) the different-band noise masker was a control for the different-band sentence; and (3) the same-band noise masker was designed to be primarily energetic. The spatial release from the different-band sentence was larger than for the other maskers, but was smaller (10 dB) for the hearing-impaired group than for the normal-hearing group (15 dB). The smaller benefit for the hearing-impaired listeners can be partially explained by masker sensation level. However, the results suggest that hearing-impaired listeners can use the perceptual effect of spatial separation to improve speech recognition in the presence of a primarily informational masker.

The effect of spatial separation on informational and energetic masking of speech

The effect of spatial separation of sources on the masking of a speech signal was investigated for three types of maskers, ranging from energetic to informational. Normal-hearing listeners performed a closed-set speech identification task in the presence of a masker at various signal-to-noise ratios. Stimuli were presented in a quiet sound field. The signal was played from 0 degrees azimuth and a masker was played either from the same location or from 90 degrees to the right. Signals and maskers were derived from sentences that were preprocessed by a modified cochlear-implant simulation program that filtered each sentence into 15 frequency bands, extracted the envelopes from each band, and used these envelopes to modulate pure tones at the center frequencies of the bands. In each trial, the signal was generated by summing together eight randomly selected frequency bands from the preprocessed signal sentence. Three maskers were derived from the preprocessed masker sentences: (1) different-band sentence, which was generated by summing together six randomly selected frequency bands out of the seven bands not present in the signal (resulting in primarily informational masking); (2) different-band noise, which was generated by convolving the different-band sentence with Gaussian noise; and (3) same-band noise, which was generated by summing the same eight bands from the preprocessed masker sentence that were used in the signal sentence and convolving the result with Gaussian noise (resulting in primarily energetic masking). Results revealed that in the different-band sentence masker, the effect of spatial separation averaged 18 dB (at 51% correct), while in the different-band and same-band noise maskers the effect was less than 10 dB. These results suggest that, in these conditions, the advantage due to spatial separation of sources is greater for informational masking than for energetic masking.

Binaural cochlear implants placed during the same operation

OBJECTIVE

To evaluate the binaural listening advantages for speech in quiet and in noise and to localize sound when independently programmed binaural cochlear implants are used, and to determine whether ears with different hearing ability and duration of profound deafness perform differently with cochlear implants as well as to what extent preimplant psychophysical and physiologic assessment could be predictive of performance.

STUDY DESIGN

Prospective study in which patients were prospectively selected to undergo bilateral implantation during a single surgical procedure at a tertiary referral center. All testing was performed with patients using their right, left, or both cochlear implants. Preimplant and intraoperative measures used electrical stimulation at the round window and stimulation through the cochlear implant.

RESULTS

Bilateral implantation during the same operation did not cause any postoperative problems such as severe vertigo or ataxia. At 1 year, results of speech testing in quiet demonstrated a binaural advantage for 2 of 10 subjects. Speech-in-noise testing demonstrated that two implants were beneficial for two individuals. All subjects benefited from a head shadow effect when an ear with a better signal-to-noise ratio was available. The ability to localize sound was improved with binaural implants in all subjects. Preimplant psychophysical or physiologic measures were not predictive of eventual speech perception performance.

CONCLUSION

Binaural cochlear implants can assist in the localization of sounds and have the potential in some individuals to improve speech understanding in quiet and in noise.

Three-month results with bilateral cochlear implants

OBJECTIVES

To evaluate possible binaural listening advantages for speech in quiet, speech in noise, and for localization in a group of postlingually deafened adults with two cochlear implants functioning independently after 3 mo experience.

DESIGN

Nine postlingually deafened subjects who had received a Cochlear Corporation CI24M implant in each ear were evaluated on a number of tasks. The subjects all had audiometric or biographical (e.g., duration of deafness) differences between the ears. Word and sentence materials were presented to the subjects in quiet and in noise with the signal always in the front and the noise from the front or either side. Results are reported for each ear and for both ears with the noise on either side. This allowed evaluation of head shadow and squelch effects. Additionally, localization ability was assessed for broadband noise presented either to the right or left of center at 45 degrees azimuth. Localization was assessed for each ear and for both ears.

RESULTS

Results of speech testing in quiet showed a significant advantage for the binaural condition over the better ear in four subjects. In noise, with both signal and noise in front of the subject, a significant advantage of two ears over the better ear was found for four subjects. For noise to one side of the head, when the ear opposite the noise source was added to the ear ipsilateral to the noise, a significant advantage was demonstrated for seven of seven tested subjects. When the ear ipsilateral to the noise was added to the ear contralateral to the noise, a significant advantage was shown for only one of seven (noise on right) and three of seven (noise on left) tested subjects. The localization task showed that all seven tested subjects could discriminate 45 degrees left from 45 degrees right above chance with bilateral stimulation. Three subjects could perform the discrimination above chance with only one ear. However, performance with both ears was significantly better than performance with one ear for two of these latter subjects.

CONCLUSIONS

We conclude that bilateral cochlear implants can provide real advantages, particularly when it is possible to utilize the ear that is away from a noise source, thus taking advantage of the head shadow effect. In addition, localization ability was generally better with two implants than with one.

Intelligibility of speech in a virtual 3-D environment

In a simulated air traffic control task, improvement in the detection of auditory warnings when using virtual 3-D audio depended on the spatial configuration of the sounds. Performance improved substantially when two of four sources were placed to the left and the remaining two were placed to the right of the participant. Surprisingly, little or no benefits were observed for configurations involving the elevation or transverse (front/back) dimensions of virtual space, suggesting that position on the interaural (left/right) axis is the crucial factor to consider in auditory display design. The relative importance of interaural spacing effects was corroborated in a second, free-field (real space) experiment. Two additional experiments showed that (a) positioning signals to the side of the listener is superior to placing them in front even when two sounds are presented in the same location, and (b) the optimal distance on the interaural axis varies with the amplitude of the sounds. These results are well predicted by the behavior of an ideal observer under the different display conditions. This suggests that guidelines for auditory display design that allow for effective perception of speech information can be developed from an analysis of the physical sound patterns.

Spatial unmasking of nearby speech sources in a simulated anechoic environment

Spatial unmasking of speech has traditionally been studied with target and masker at the same, relatively large distance. The present study investigated spatial unmasking for configurations in which the simulated sources varied in azimuth and could be either near or far from the head. Target sentences and speech-shaped noise maskers were simulated over headphones using head-related transfer functions derived from a spherical-head model. Speech reception thresholds were measured adaptively, varying target level while keeping the masker level constant at the "better" ear. Results demonstrate that small positional changes can result in very large changes in speech intelligibility when sources are near the listener as a result of large changes in the overall level of the stimuli reaching the ears. In addition, the difference in the target-to-masker ratios at the two ears can be substantially larger for nearby sources than for relatively distant sources. Predictions from an existing model of binaural speech intelligibility are in good agreement with results from all conditions comparable to those that have been tested previously. However, small but important deviations between the measured and predicted results are observed for other spatial configurations, suggesting that current theories do not accurately account for speech intelligibility for some of the novel spatial configurations tested.

Speech intelligibility and localization in a multi-source environment

Natural environments typically contain sound sources other than the source of interest that may interfere with the ability of listeners to extract information about the primary source. Studies of speech intelligibility and localization by normal-hearing listeners in the presence of competing speech are reported on in this work. One, two or three competing sentences [IEEE Trans. Audio Electroacoust. 17(3), 225-246 (1969)] were presented from various locations in the horizontal plane in several spatial configurations relative to a target sentence. Target and competing sentences were spoken by the same male talker and at the same level. All experiments were conducted both in an actual sound field and in a virtual sound field. In the virtual sound field, both binaural and monaural conditions were tested. In the speech intelligibility experiment, there were significant improvements in performance when the target and competing sentences were spatially separated. Performance was similar in the actual sound-field and virtual sound-field binaural listening conditions for speech intelligibility. Although most of these improvements are evident monaurally when using the better ear, binaural listening was necessary for large improvements in some situations. In the localization experiment, target source identification was measured in a seven-alternative absolute identification paradigm with the same competing sentence configurations as for the speech study. Performance in the localization experiment was significantly better in the actual sound-field than in the virtual sound-field binaural listening conditions. Under binaural conditions, localization performance was very good, even in the presence of three competing sentences. Under monaural conditions, performance was much worse. For the localization experiment, there was no significant effect of the number or configuration of the competing sentences tested. For these experiments, the performance in the speech intelligibility experiment was not limited by localization ability.

Audiometric results of bilateral bone-anchored hearing aid application in patients with bilateral congenital aural atresia

The effect of bilateral application of bone-anchored hearing aids (BAHAs) was examined in terms of directional hearing and speech recognition in quiet and in noise in four patients with bilateral congenital atresia who, out of pure necessity, had been using a unilateral bone-conduction hearing aid since early life. This study comprised a prospective clinical evaluation in a single subject design; four patients with bilateral congenital atresia originating from the Nijmegen BAHA series participated. Three patients had Treacher Collins syndrome. All four patients had conductive, most probably, symmetrical, hearing loss. Recently these patients had applied for a second BAHA and were subsequently fitted bilaterally. With two BAHAs, all four patients showed significant improvement in sound localization. Also, speech perception in quiet showed significant improvement with bilateral application, and a significant improvement was found in speech perception in noise in three patients. These results suggest that patients with congenital conductive, symmetrical hearing loss will benefit from bilateral BAHAs.