Computer-based auditory training approaches have existed for decades. A major limitation of these platforms has been the transferability to real-world communication challenges. An almost universal complaint of individuals with any level of hearing loss is difficulty understanding speech in background noise. The challenge of background noise remains even with an appropriate fitting of amplification; coupling with remote microphone technologies are currently the best method for improving the signal-to-noise ratio, but also has its own inherent limitations.
Patients with unilateral hearing loss can present with variable issues. Much is dependent on the severity of the hearing loss (threshold and speech understanding), age of onset, hearing status of contralateral ear, and presence of comorbidities (e.g., vertigo, cognitive status, central auditory processing, hyperacusis, tinnitus, disease/pathology/disorder, etc.). Adult-onset severe-to-profound unilateral sensorineural hearing loss with normal hearing sensitivity in the contralateral ear presents a unique dilemma.
Brons et al (2015) examined whether dynamic range compression and noise reduction work in tandem or in opposition to each other. They report that the literature on the interaction of these two strategies is scarce. The role of noise reduction is to “reduce hearing aid gain for background noises, while preserving gain for speech…” and the role of dynamic compression is to alter the hearing aid gain, based on the input level so as to fit sound levels into the dynamic range of the wearer.
Digital Noise Reduction and Just Noticeable Differences: 2015
Pittman (2011) reported modern digital noise reduction (DNR) circuits do not have a negative impact on speech perception, and for older children, DNR significantly improved word learning rates in noise. Dillon (2012) reported that directional microphones and modern DNR circuits are beneficial and should be used all the time for children and adults. Pittman (2013) reported that modern DNR circuits can improve the signal-to-noise ratio (SNR) up to 6 dB.
Wireless Mics Improve Word Recognition for Hearing Aids and Cochlear Implants
Beck and Holmberg (2011) reported that there are significant benefits to wireless microphones (WM), such as (1) reduction of background noise, (2) reduction of reverberation, and (3) maintenance of the signal-to-noise ratio (SNR) as measured at the sound source (i.e., the person talking).
Comparing CROS Hearing Aids and Bone-Anchored Hearing Devices
Finbow et al (2015) evaluated 8 adults with single-sided deafness (SSD) with regard to contralateral routing of signal (CROS) and bone-anchored hearing devices (BHADs). The authors report CROS and BAHDs are the two main interventions used to treat SSD, although they also report cochlear implants (CIs) have also been used to treat SSD.
Private Practice, Bundling/Unbundling, and CPT Codes: Interview with Elizabeth Protti-Patterson, AuD
Douglas L. Academy, AuD, spoke with Dr. Protti-Patterson about private practice, bundling/unbundling, CPT codes, speech-in-noise tests, professional multi-tiered service packages, and more.
Academy: Good morning, Liz. Thanks for sharing your time with me!
Patterson: Hi, Doug. Always a joy to speak with you.
Academy: How long have you been in practice, Liz?
Patterson: Well, it's been about 30 years. Seems hard to believe!
Hearing Aid Noise-Reduction Programs and Listening Effort
Desjardins and Doherty (2014) evaluated listening effort, with and without a noise reduction algorithm, across 12 adult experienced hearing aid wearers (age range 50 to 74 years, mean=66 years). A dual-task paradigm was used. The primary task was a sentence-in-noise task, presented at two loudness levels. The first level was a moderate listening condition with a performance level of 76 percent and the second was a difficult listening condition” with a 50 percent performance level. To achieve these scores in quiet required various levels to meet the needs and abilities of the individuals.
