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speech-in-noise

NPR: Music to Ease Hearing Loss

NPR: Music to Ease Hearing Loss

June 08, 2017 In the News

NPR featured a piece on  “All Things Considered,” considering how to improve speech understanding in noisy environments. The segment focused on an ongoing study by Frank Russo, the director of the Science of Music, Auditory Research, and Technology Lab (SMART Lab) at Ryerson University in Toronto.

Based on work of other researchers such as Nina Kraus, Russo and colleagues are recruiting subjects to join a choir to see if musical training, even short-term, can influence speech understanding in noise. The subjects in the choir group are being compared to two control groups, one with no musical intervention and a second not singing, but listening to music in a music appreciation course. The group plan to share their findings this summer at The Neurosciences and Music-VI.

Reference

Siegel R, Hsu A. (2017 “Like Brain Boot Camp:” Using Music to Ease Hearing Loss. ) National Public Radio, May 31.

A Proposed Protocol: Assessment for Patients with Single-Sided Deafness or Asymmetric Hearing Loss

A Proposed Protocol: Assessment for Patients with Single-Sided Deafness or Asymmetric Hearing Loss

April 21, 2017 In the News

Do you fit bone-conduction hearing aids, contralateral routing of signals (CROS) hearing aids, and/or cochlear implants to your adult patients with single-sided deafness or asymmetric hearing loss (with the four-frequency pure-tone average in the poorer ear being greater than or equal to 70 dB HL)? Curious which one is the best treatment? If so, you may be interested in a consensus paper by Van de Heyning et al (2016). 

These authors believe there is a need for the collection of uniform outcome measures with these treatment modalities in this patient population to help guide treatment recommendations in the future. They, therefore, present a protocol for clinical studies in this area. These recommendations came after two international consensus meetings. 

Using set subject inclusion/exclusion criteria, the authors propose using a randomization scheme in which the patient is given a three-week trial with either a bone-conduction hearing aid (using a headband) or a CROS hearing aid, and then treatment is switched. After both trials, the subject is given a choice to proceed with getting a cochlear implant, using the bone-conduction hearing aid, the CROS hearing aid, or not getting any treatment.

The authors go on to recommend auditory training in the case of a cochlear implant and the collection of the minimum set of outcome measures at suggested assessment time periods. Outcome measures include pure-tone hearing thresholds, sound localization, speech understanding in noise, hours of device use, and the subjective assessment of the hearing loss, tinnitus, and quality of life.

For specific details regarding the protocol proposed by Van de Heyning et al (2016), the reader is referred to the full article.

Reference

Van de Heyning P, Távora-Vieira D, Mertens G, Van Rompaey V, Rajan GP, Müller J, Hempel JM, Leander D, Polterauer D, Marx M, Usami SI, Kitoh R, Miyagawa M, Moteki H, Smilsky K, Baumgartner WD, Keintzel TG, Sprinzl GM, Wolf-Magele A, Arndt S, Wesarg T, Zirn S, Baumann U, Weissgerber T, Rader T, Hagen R, Kurz A, Rak K, Stokroos R, George E, Polo R, Medina M, Henkin Y, Hilly O, Ulanovski D, Rajeswaran R, Kameswaran M, Di Gregorio MF, Zernotti ME. (2016) Towards a unified testing framework for single-sided deafness studies: a consensus paper. Audiol Neurotol 21(6):391–398. 

Does Chronic Tinnitus Impact Listening Effort?

Does Chronic Tinnitus Impact Listening Effort?

April 20, 2017 In the News

Does chronic tinnitus have an impact on listening effort? Degeest et al (2017) completed a pilot investigation where this was the primary question. Subjects included 13 individuals with both normal hearing and constant, chronic tinnitus and 13 individuals who made up a matched control group without tinnitus. Both subject groups completed a dual-task paradigm and a subjective assessment of listening effort in three real-world conditions: (1) quiet with one talker, (2) quiet with multiple talkers, and (3) in background noise.

A significant effect of group was obtained in terms of performance on the secondary task of the dual-task paradigm, which is considered a metric of effort. This suggests that the individuals with tinnitus were expending more effort. No effect of condition, however, was obtained, suggesting there was no relationship between effort and the difficulty of the listening task. No significant differences were obtained between groups on the subjective assessment of effort either. It should be noted that the subjects with tinnitus reported little to no tinnitus handicap, nor was their tinnitus handicap score correlated with their test results.

These findings suggest that chronic tinnitus, therefore, may have an impact on listening effort regardless of the difficulty of the listening condition. The authors, however, do suggest that this finding may be impacted by the study design and suggest future work in this area. 

References

Degeest S, Keppler H, Corthals P. (2017) The effect of tinnitus on listening effort in normal-hearing young adults: a preliminary study. J Speech Lang Hear Res, 60:1036–1045.

The Cocktail Party Effect

The Cocktail Party Effect

January 03, 2017 In the News

2016 is over, and many of us attended celebrations of remembrance of the year's transpiration and resolutions for the year to come. Civilizations around the world have been celebrating the New Year for at least four millennia, but not always in December. Learn more about the history of New Year’s Eve (NYE).

Today, common traditions include attending parties, making resolutions, toasting with champagne, singing “Auld Lang Syne,” and enjoying food (in the United States, it is southern greens, black eyed peas, and cornbread…peas for pennies, greens for dollars, and cornbread for gold). The pop of the champagne cork, toasting to the new year, singing songs and making resolutions all together make a less than accommodating listening environment creating a situation that we commonly refer to as the “cocktail-party” effect.

The cocktail party effect refers to the ability to focus one’s attention a particular stimulus while filtering out a range of other stimuli (i.e., noise). But, how is the brain able to do this?  Recently, Holdgraf et al. (2016) have turned an ear to the neural plasticity of the brain that enables extraction of speech-like features from a degraded input. In brief, they found that the brain emphasizes anything that might be speech-like and that these tuning properties can be improved with experience. The study was performed in epilepsy patients who had electrodes placed on their brain’s surface to track seizures. Using these electrodes they were able to record changes in neuronal activity to speech stimuli. First, a garbled message was presented.  Next, the filtered clear version of the message was presented. Finally, the garbled message was presented again.

Not only, were the participants able to understand the garbled message post the clear message (a simulation often demonstrated in hearing and speech courses), but the neural recording showed nearly the same language-appropriate neural activity as observed with the filtered clear message suggesting a rapid and ongoing alteration of spectrotemporal feature detection and auditory tuning. Future work is needed to translate these findings to improved outcomes for normal hearing and individuals with hearing loss. Rapid tuning shifts in human auditory cortex enhance speech intelligibility.

Stay “tuned” for more in the New Year!

Reference

Sanders R (2016) How the brain extracts meaning from noise. UC Berkley. December 22.

Unilateral Hearing Loss: What to Do?

Unilateral Hearing Loss: What to Do?

October 27, 2016 In the News

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. The most common issues described in this population include difficulty understanding speech-in-noise, sound localization, awareness of sound located on the compromised side (even in quiet), and tinnitus.

Several options exist to address adult-onset severe-profound unilateral sensorineural hearing loss with normal contralateral hearing sensitivity. One approach is traditional amplification. This will be dependent on remaining function in the affected ear and ability to achieve audibility. A second approach is rerouting of the signal to the contralateral normal hearing ear. This may be accomplished by use of a contralateral routing of signal (CROS) hearing aid or through bone conduction. Bone conduction can be achieved in two ways, either a high-powered hearing aid or a bone-anchored hearing device. A third approach is to try to restore binaural hearing with the use of a cochlear implant.  The final approach is to do nothing. So what to do?

Recently, Kitterick et al. (2016) performed a systematic review and meta-analysis to determine the nature and quality of evidence for the use of hearing instruments in adults with unilateral severe to profound sensorineural hearing loss. The criteria for study inclusion required the following:

  • Hearing pure-tone average threshold ≤30 dBHL in the better hearing ear and >70 dBHL thresholds in the compromised ear
  • Evidence of a sensorineural hearing loss
  • Use of a hearing instrument
  • Use of a hearing instrument and placebo device (or no intervention)
  • Speech perception measures and/or other outcomes (e.g., localization)
  • Design consistent with a controlled trial or prospective observational study

The quality of the studies was assessed based on the level of evidence, use of randomization, blinding, use of control group, identification, and control of confounds, etc. A total of 778 articles were identified, of which only 30 articles reporting on 27 separate studies met the inclusion criteria.  The majority of the studies included were pre- and post-comparisons in which the patient acted as their control. All studies were judged to be of low-moderate quality; the reduced quality was most commonly related to lack of power analysis to determine sample size, the non-matched control group, and lack of control for confounding factors. 

Evidence was then described for speech perception in quiet, speech perception in noise, sound lateralization/localization, hearing health-related quality of life and complications/adverse events. In each of these areas, there was a comparison of re-routing vs. unaided, bone-conduction device vs. air-conduction device, cochlear implant vs. unaided, and cochlear implant vs. rerouting. Brief summaries of these findings are provided. 

Speech Perception in Quiet
No overall evidence of benefit was indicated with speech presented directly in front of patients in aided vs. unaided performance. One study showed compromised speech perception accuracy in individuals with an air conduction routing device. Also, no overall evidence of benefit was indicated for bone conduction vs. air conduction device for re-routing of the signal. Cochlear implant studies only examined pre and post-perception in the implanted ear only; therefore, no evidence of benefit for improved binaural performance was demonstrated. A condition that seems to be missing in the literature is the presentation of soft speech to the compromised ear in quiet, consistent with someone talking softly on the compromised side.

Speech Perception in Noise
The benefit was indicated when the compromised ear had a more favorable signal-to-noise ratio (SNR). Conversely, deficits were reported when the compromised ear had less favorable SNR. When noise was comparable for both ears, patients performed better with a bone-conduction device compared to air-conduction re-routing. A similar dependency on SNR was reported with cochlear implant studies. Overall, the evidence suggests benefit and detriment depending on SNR at each ear.

Sound Lateralization/Localization
No overall evidence was indicated for sound lateralization/localization. Some studies reported no effect, some improvement, and others deficits.

Hearing Health-Related Quality of Life
Overall, evidence suggested perceived benefit on hearing health and reduced listening difficulty for re-routing signal. However, limited evidence exists for the quality of life or hearing health for application of cochlear implants to unilateral loss. Also, there was no description of the control for general inclusion/placebo effect.

The most common complaints of individuals with individuals with an adult-onset severe-to-profound sensorineural hearing loss with normal contralateral hearing function include difficulty with speech in noise and localization/lateralization. Overall, the evidence suggests benefit under specific noise conditions and detriment in other noise conditions. Also, no evidence is proposed for localization. Despite limited evidence for common complaints, in general, patients report perceived benefit. This may be in particular in situations with minimal background noise, and the speaker of interest is positioned on their compromised side. However, this situation, or condition, was either not reported or discussed in the studies reviewed. Furthermore, there was a minimal discussion of fatigue and listening effort during signal rerouting, where now the patient needs to deal with bilateral input with one functioning side. Finally, none of these studies report on having the patient simply turn their head. 

Reference

Kitterick PT, Smith SN, Lucas L (2016). Hearing Instruments for Unilateral Severe-Profound Sensorineural Hearing Loss in Adults: A Systematic Review and Meta-Analysis, Ear and Hearing 37(5):495–507.

The Importance of Frequency Regions for Cochlear Implant Patients

The Importance of Frequency Regions for Cochlear Implant Patients

November 12, 2015 In the News

Sladen and Ricketts (2015) report that given current cochlear implant (CI) technology, the majority of post-lingually deafened adults achieve 80 percent word recognition (in quiet) after only six months experience with a CI. In their study, CI users were presented with monaural information and the NH listeners had binaural input. The noisy condition was a 10 dB SNR with six-talker babble. Of note, “the average decrease in performance between quiet and noisy conditions was 13% for the NH group and 20 percent for the CI group.”  

The authors report that in their study of 9 adults with normal hearing (NH) and 9 adults with cochlear implants (CIs), in quiet, the adults with NH appear to place greater listening emphasis on particular bands of spectral information, whereas adults using CIs apply equal listening emphasis across all bands. In noise, “the shape of the frequency importance function remained the same….” That is, for people with NH and people with CIs, the spectral information that was important “for speech understanding in quiet were the same bands that were important for speech understanding in noise.” 

For More Information, References, and Recommendations

Sladen DP, Ricketts TA. (2015) Frequency Importance Functions in Quiet and Noise for Adults With Cochlear Implants. American Journal of Audiology. September.

Predicting When Dementia Starts

Predicting When Dementia Starts

November 02, 2015 In the News

Murman (2015) reviews cognitive changes associated with normal aging.  He states that “there is emerging evidence that healthy lifestyles may decrease the rate of cognitive decline….” Murman notes that in 1910 the average lifespan for a male was 48 years and for female it was 52. In 2010, the lifespan averages are 76 years for men and 81 years for women. Murman divides cognitive ability into multiple domains—attention, memory, executive cognitive function, language and visuo-spatial ability. Each domain “has measureable declines with age…” and of note, “speech comprehension in the setting of background noise and ambiguous speech content declines with age….”

With regard to age-related changes in brain structure and function, he reports that gray matter loss is most prominent in the pre-frontal cortex and the temporal lobes also show moderate declines in gray matter with aging. Of significance, he notes that neuronal synapses can now be measured quite accurately through immunohistochemistry. It has been suggested that when there is a loss of 40 percent or more of cortical synapses, symptomatic dementia may occur.

Murman reports that “Terry and Katzman predicted that dementia due to aging (senility) would occur at approximately age 130 without requiring the development of a disease state such as Alzheimer’s Disease (AD)…” and AD would be expected to accelerate the rate of synaptic loss. Murman states that when “synaptic density declines to 60 percent of maximal density symptoms of dementia would be expected…” and “someone with normal (cognitive) reserve and normal rate of synaptic loss with age (i.e., normal aging) would cross the dementia threshold line around age 130….” However, if one starts with lesser synaptic density, say perhaps 30 percent less than normal at age 25 years, that individual would potentially reach the dementia threshold by age 62 years.

For More Information, References, and Recommendations

Beck DL (2015) The State of the Art: Hearing Impairment, Cognitive Decline, and Amplification. Hearing Review.

Beck DL, Clark JL. (2009) Audition Matters More as Cognition Declines, and Cognition Matters More as Audition Declines. www.audiology.org (March).

Murman DL. (2015) The Impact of Age on Cognition. Seminars in Hearing 36(3).

Change the Game, Change the Focus

Change the Game, Change the Focus

October 27, 2015 In the News

Beck (2015) notes that hearing care professionals (HCPs) should consider a philosophical change from simply correcting hearing loss to maximal hearing and listening. He reports that hearing is the perception of sound, whereas listening is applying meaning to sound. Beck advocates that for the brain to listen maximally, technology must preserve the natural acoustic information the brain needs to make sense of sound.

Specifically, he notes preservation of natural acoustic information includes the maintenance and delivery of interaural loudness differences (ILDs) and interaural timing differences (ITDs)—as these cues help the brain orient, separate, focus and recognize sounds. Beck reports listening requires unique personal cognitive abilities and processes working in tandem and in real time, such as working memory, processing speed, attention and the ability to integrate multiple sensory systems and most importantly (for speech-in-noise), the ability to compare and contrast sounds from the left and right ears—to know where to attend, and to better appreciate spatial information, so the brain has key information from which it can de-code the acoustic information and so the brain knows where (in space) to focus listening effort.

Beck reports that “adaptive compression” is a new concept (Pittman, 2014), which provides variable fast or slow compression release times based on the demands of the specific acoustic environment, at a given moment in time.

He concludes, as we move beyond correcting hearing loss to an approach that emphasizes the preservation and delivery of maximal acoustic information, to support maximal listening, it is likely our patients will better appreciate the world of natural sounds.

For More Information, References, and Recommendations

Beck DL. (2015) Brain hearing: maximizing hearing and listening. Hear Rev March 2015.

Pittman AL, Pederson AJ, Rash MA. (2014) Effects of fast, slow, and adaptive amplitude compression on children’s and adults’ perception of meaningful acoustic information. J Am Acad Audiol 25:834-847.

Cochlear Implant Satisfaction and Psychological Profiles

Cochlear Implant Satisfaction and Psychological Profiles

October 19, 2015 In the News

Kobosko et al (2015) report that when post-lingually deafened adults acquire a cochlear implant, the benefits extend beyond hearing. That is, quality of life improves, as does psychological well-being and social interactions. The authors studied the relationship between cochlear implant (CI) satisfaction and level of psychological distress, stress coping strategies, and global self-esteem. The authors report that CI satisfaction “…reflects the overall feeling of benefit…attributed to their CI, including quality of life and general psychological well-being.”

Ninety eight adult patients ( aged 19 to 85 years) with unilateral CIs participated in the mail-based, multiple-questionnaire study. Kobosko et al state that, “CI satisfaction was not related to speech perception scores, duration of deafness, length of CI use, or other socio-demographic factors.”  For the younger adults, CI satisfaction was more highly correlated with “lower severity of depressive symptoms,” and for the older adults, CI satisfaction was more highly correlated with “less severe social dysfunction symptoms.”

Kobosko et al report that average levels of satisfaction of CI users (in their study) was determined to be 82 percent. Of note, 31 percent of their subjects reported a satisfaction rate of 100 percent and 47 percent reported satisfaction above 90 percent. Further, speech perception in quiet averaged 66 percent and of interest, the authors report “no statistically significant differences between younger and older subjects or between those with shorter and longer experience….” They added that “satisfaction with CIs showed no connection with speech perception in quiet and noise,” thereby underscoring the important finding that non-audiological factors are very important with respect to CI satisfaction. Indeed, they state that higher levels of self-esteem correlate with higher levels of CI satisfaction, humor is often an advantage to satisfied CI users, and “satisfaction with a CI appears to be a phenomenon linked most strongly to the human psyche and how it deals psychologically with hearing loss….” Likewise, factors that work against CI satisfaction include depression and denial.

For More Information, References, and Recommendations

Kobosko J, Jedrzejczak WW, Pilka E, Pankowska A, Skarzynski H. (2015) Satisfaction With Cochlear Implants in Post-Lingually Deaf Adults and Its Nonaudiological Predictors: Psychological Distress, Coping Strategies, and Self-Esteem. Ear & Hearing 36(5):605-618.

Noise Reduction and Compression Combined?

Noise Reduction and Compression Combined?

September 13, 2015 In the News

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. Brons et al report that the literature describing compression is reasonably well known and relatively easy to find, yet the literature on noise reduction is often limited and “is commonly presented as a black box….” 

Recordings of four different hearing aid (Starkey, ReSound, Widex, and Phonak) outputs, based on an input of speech in babble at +4 dB signal-to-noise ratio (SBR) were obtained across three experiments—(1)acoustical measurements, (2) perceptual measurements from 16 people with hearing loss to determine “detectability” of processing differences, and (3) perceptual effects from the participants to determine the effect of processing (with regard to speech intelligibility, annoyance of noise, the naturalness of speech and overall preference).

The authors reported processing strategies for noise reduction and compression varied across hearing aids. The strongest effect of combining compression and noise reduction was reduced noise and speech levels. Detectability of the combined processing strategies was different across different hearing aids. The authors state that “…there are relatively large differences between the test hearing aids in terms of gain changes due to noise reduction, compression, and their combined processing….” However, noise reduction and compression did not cancel each other out (in the hearing aids tested), yet speech and noise levels were both reduced. They report compression protocols by themselves were not detectably different, the combined strategies “did not influence speech intelligibility” and they report preference for combined strategies “was lower than previously observed for noise reduction without compression.” 

Brons et al state that combined processing (noise-reduction and dynamic-range compression) reduced noise annoyance and did not impact speech intelligibility. They concluded that “conditions with combined processing are not significantly preferred over unprocessed conditions, most probably because compression reduces SNR for input signals with positive SNR. The influence of compression should therefore be considered for the development and evaluation of noise reduction algorithms for hearing aid applications.”

For More Information, References, and Recommendations

Brons I, Houben R, Dreschler AW. (2015) Acoustical and Perceptual Comparison of Noise Reduction and Compression in Hearing Aids. Journal of Speech, Language, and Hearing Research 58(8):1363-1376.