scholarly journals Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss

2017 ◽  
Vol 28 (09) ◽  
pp. 823-837 ◽  
Author(s):  
Marc A. Brennan ◽  
Dawna Lewis ◽  
Ryan McCreery ◽  
Judy Kopun ◽  
Joshua M. Alexander
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
High Frequency ◽  
Hearing Aid ◽  
Nonsense Word ◽  
Spectral Distortion ◽  
Listening Effort ◽  
Frequency Compression ◽  
Low Pass ◽  
Adults And Children

AbstractNonlinear frequency compression (NFC) can improve the audibility of high-frequency sounds by lowering them to a frequency where audibility is better; however, this lowering results in spectral distortion. Consequently, performance is a combination of the effects of increased access to high-frequency sounds and the detrimental effects of spectral distortion. Previous work has demonstrated positive benefits of NFC on speech recognition when NFC is set to improve audibility while minimizing distortion. However, the extent to which NFC impacts listening effort is not well understood, especially for children with sensorineural hearing loss (SNHL).To examine the impact of NFC on recognition and listening effort for speech in adults and children with SNHL.Within-subject, quasi-experimental study. Participants listened to amplified nonsense words that were (1) frequency-lowered using NFC, (2) low-pass filtered at 5 kHz to simulate the restricted bandwidth (RBW) of conventional hearing aid processing, or (3) low-pass filtered at 10 kHz to simulate extended bandwidth (EBW) amplification.Fourteen children (8–16 yr) and 14 adults (19–65 yr) with mild-to-severe SNHL.Participants listened to speech processed by a hearing aid simulator that amplified input signals to fit a prescriptive target fitting procedure.Participants were blinded to the type of processing. Participants' responses to each nonsense word were analyzed for accuracy and verbal-response time (VRT; listening effort). A multivariate analysis of variance and linear mixed model were used to determine the effect of hearing-aid signal processing on nonsense word recognition and VRT.Both children and adults identified the nonsense words and initial consonants better with EBW and NFC than with RBW. The type of processing did not affect the identification of the vowels or final consonants. There was no effect of age on recognition of the nonsense words, initial consonants, medial vowels, or final consonants. VRT did not change significantly with the type of processing or age.Both adults and children demonstrated improved speech recognition with access to the high-frequency sounds in speech. Listening effort as measured by VRT was not affected by access to high-frequency sounds.

scholarly journals Paired Comparisons of Nonlinear Frequency Compression, Extended Bandwidth, and Restricted Bandwidth Hearing Aid Processing for Children and Adults with Hearing Loss

2014 ◽  
Vol 25 (10) ◽  
pp. 983-998 ◽  
Author(s):  
Marc A. Brennan ◽  
Ryan McCreery ◽  
Judy Kopun ◽  
Brenda Hoover ◽  
Joshua Alexander ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Hearing Aid ◽  
Age Groups ◽  
Nonlinear Frequency ◽  
Frequency Compression ◽  
Low Pass ◽  
Quasi Experimental ◽  
Adults And Children ◽  
Forced Choice Task ◽  
Children With Hearing Loss

Background: Preference for speech and music processed with nonlinear frequency compression (NFC) and two controls (restricted bandwidth [RBW] and extended bandwidth [EBW] hearing aid processing) was examined in adults and children with hearing loss. Purpose: The purpose of this study was to determine if stimulus type (music, sentences), age (children, adults), and degree of hearing loss influence listener preference for NFC, RBW, and EBW. Research Design: Design was a within-participant, quasi-experimental study. Using a round-robin procedure, participants listened to amplified stimuli that were (1) frequency lowered using NFC, (2) low-pass filtered at 5 kHz to simulate the RBW of conventional hearing aid processing, or (3) low-pass filtered at 11 kHz to simulate EBW amplification. The examiner and participants were blinded to the type of processing. Using a two-alternative forced-choice task, participants selected the preferred music or sentence passage. Study Sample: Participants included 16 children (ages 8–16 yr) and 16 adults (ages 19–65 yr) with mild to severe sensorineural hearing loss. Intervention: All participants listened to speech and music processed using a hearing aid simulator fit to the Desired Sensation Level algorithm v5.0a. Results: Children and adults did not differ in their preferences. For speech, participants preferred EBW to both NFC and RBW. Participants also preferred NFC to RBW. Preference was not related to the degree of hearing loss. For music, listeners did not show a preference. However, participants with greater hearing loss preferred NFC to RBW more than participants with less hearing loss. Conversely, participants with greater hearing loss were less likely to prefer EBW to RBW. Conclusions: Both age groups preferred access to high-frequency sounds, as demonstrated by their preference for either the EBW or NFC conditions over the RBW condition. Preference for EBW can be limited for those with greater degrees of hearing loss, but participants with greater hearing loss may be more likely to prefer NFC. Further investigation using participants with more severe hearing loss may be warranted.

Amount of Frequency Compression in Bimodal Cochlear Implant Users Is a Poor Predictor for Audibility and Spatial Hearing

2021 ◽  
pp. 1-14
Author(s):  
Snandan Sharma ◽  
Waldo Nogueira ◽  
A. John van Opstal ◽  
Josef Chalupper ◽  
Lucas H. M. Mens ◽  
...  
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Sound Localization ◽  
High Frequency ◽  
Hearing Aid ◽  
Spatial Hearing ◽  
Meaningful Improvement ◽  
Frequency Compression ◽  
Knee Point ◽  
Localization Performance

Purpose Speech understanding in noise and horizontal sound localization is poor in most cochlear implant (CI) users with a hearing aid (bimodal stimulation). This study investigated the effect of static and less-extreme adaptive frequency compression in hearing aids on spatial hearing. By means of frequency compression, we aimed to restore high-frequency audibility, and thus improve sound localization and spatial speech recognition. Method Sound-detection thresholds, sound localization, and spatial speech recognition were measured in eight bimodal CI users, with and without frequency compression. We tested two compression algorithms: a static algorithm, which compressed frequencies beyond the compression knee point (160 or 480 Hz), and an adaptive algorithm, which aimed to compress only consonants leaving vowels unaffected (adaptive knee-point frequencies from 736 to 2946 Hz). Results Compression yielded a strong audibility benefit (high-frequency thresholds improved by 40 and 24 dB for static and adaptive compression, respectively), no meaningful improvement in localization performance (errors remained > 30 deg), and spatial speech recognition across all participants. Localization biases without compression (toward the hearing-aid and implant side for low- and high-frequency sounds, respectively) disappeared or reversed with compression. The audibility benefits provided to each bimodal user partially explained any individual improvements in localization performance; shifts in bias; and, for six out of eight participants, benefits in spatial speech recognition. Conclusions We speculate that limiting factors such as a persistent hearing asymmetry and mismatch in spectral overlap prevent compression in bimodal users from improving sound localization. Therefore, the benefit in spatial release from masking by compression is likely due to a shift of attention to the ear with the better signal-to-noise ratio facilitated by compression, rather than an improved spatial selectivity. Supplemental Material https://doi.org/10.23641/asha.16869485

scholarly journals Listener Performance with a Novel Hearing Aid Frequency Lowering Technique

2017 ◽  
Vol 28 (09) ◽  
pp. 810-822 ◽  
Author(s):  
Benjamin J. Kirby ◽  
Judy G. Kopun ◽  
Meredith Spratford ◽  
Clairissa M. Mollak ◽  
Marc A. Brennan ◽  
...  
Keyword(s):  
Signal Processing ◽  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Aids ◽  
High Frequency ◽  
Hearing Aid ◽  
Sound Quality ◽  
Processing Strategy ◽  
Listening Effort ◽  
At Home

AbstractSloping hearing loss imposes limits on audibility for high-frequency sounds in many hearing aid users. Signal processing algorithms that shift high-frequency sounds to lower frequencies have been introduced in hearing aids to address this challenge by improving audibility of high-frequency sounds.This study examined speech perception performance, listening effort, and subjective sound quality ratings with conventional hearing aid processing and a new frequency-lowering signal processing strategy called frequency composition (FC) in adults and children.Participants wore the study hearing aids in two signal processing conditions (conventional processing versus FC) at an initial laboratory visit and subsequently at home during two approximately six-week long trials, with the order of conditions counterbalanced across individuals in a double-blind paradigm.Children (N = 12, 7 females, mean age in years = 12.0, SD = 3.0) and adults (N = 12, 6 females, mean age in years = 56.2, SD = 17.6) with bilateral sensorineural hearing loss who were full-time hearing aid users.Individual performance with each type of processing was assessed using speech perception tasks, a measure of listening effort, and subjective sound quality surveys at an initial visit. At the conclusion of each subsequent at-home trial, participants were retested in the laboratory. Linear mixed effects analyses were completed for each outcome measure with signal processing condition, age group, visit (prehome versus posthome trial), and measures of aided audibility as predictors.Overall, there were few significant differences in speech perception, listening effort, or subjective sound quality between FC and conventional processing, effects of listener age, or longitudinal changes in performance. Listeners preferred FC to conventional processing on one of six subjective sound quality metrics. Better speech perception performance was consistently related to higher aided audibility.These results indicate that when high-frequency speech sounds are made audible with conventional processing, speech recognition ability and listening effort are similar between conventional processing and FC. Despite the lack of benefit to speech perception, some listeners still preferred FC, suggesting that qualitative measures should be considered when evaluating candidacy for this signal processing strategy.

Preferred Low- and High-Frequency Compression Ratios among Hearing Aid Users with Moderately Severe to Profound Hearing Loss

2007 ◽  
Vol 18 (01) ◽  
pp. 017-033 ◽  
Author(s):  
Gitte Keidser ◽  
Harvey Dillon ◽  
Ole Dyrlund ◽  
Lyndal Carter ◽  
David Hartley
Keyword(s):  
Hearing Loss ◽  
High Frequency ◽  
Hearing Aid ◽  
Low Frequency ◽  
Fine Tuning ◽  
Adaptive Procedure ◽  
Profound Hearing Loss ◽  
Low Frequencies ◽  
Frequency Compression ◽  
Fast Acting

This study aimed to determine the low- and high-frequency compression ratios of a fast-acting device that were preferred by people with moderately severe to profound hearing loss. Three compression ratios (1:1, 1.8:1, and 3:1) were combined in the low and high frequencies to produce nine schemes that were evaluated pair-wise for three weeks in the field using an adaptive procedure. The evaluation was performed by 21 experienced hearing aid users with a moderately severe to profound hearing loss. Diaries and an exit interview were used to monitor preferences. Generally, the subjects preferred lower compression ratios than are typically prescribed, especially in the low frequencies. Specifically, 11 subjects preferred linear amplification in the low frequencies, and 14 subjects preferred more compression in the high than in the low frequencies. Preferences could not be predicted from audiometric data, onset of loss, or past experience with amplification. The data suggest that clients with moderately severe to profound hearing loss should be fitted with low-frequency compression ratios in the range 1:1 to 2:1 and that fine-tuning is essential. Este estudio trató de determinar las tasas de compresión de alta y baja frecuencia de un dispositivo de acción rápida, que resultara preferido por personas con hipoacusias moderadamente severas a profundas. Se combinaron tres tasas de compresión (1:1, 1.8:1, y 3:1) en las frecuencias graves y agudas para producir nueve esquemas que fueron evaluados en el campo, en pares, durante tres semanas, utilizando un procedimiento de adaptación. La evaluación fue realizada por 21 usuarios experimentados de audífono con hipoacusias moderadamente severas a profundas. Se usaron diarios y un cuestionario final para monitorear las preferencias. Generalmente, los sujetos prefirieron menores tasas de compresión de lo que típicamente se prescribe, especialmente en las bajas frecuencias. Específicamente, 11 sujetos prefirieron la amplificación lineal en las frecuencias graves y 14 sujetos prefirieron más compresión en las frecuencias altas. Las preferencias no podían predecirse a partir de los datos audiométricos, del inicio de la pérdida, o por experiencias anteriores con amplificación. Los datos sugieren que los clientes con hipoacusias moderadamente severas a profundas, deberían adaptarse con tasas de compresión en las frecuencias graves en el rango de 1:1 a 2:1, y que un ajuste fino es esencial.

Effects of Reducing Low-Frequency Amplification on Consonant Perception in Quiet and Noise

1984 ◽  
Vol 27 (4) ◽  
pp. 483-493 ◽  
Author(s):  
Sandra Gordon-Salant
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Hearing Aids ◽  
High Frequency ◽  
Hearing Aid ◽  
Recognition Performance ◽  
Low Frequency ◽  
Identification Performance ◽  
Phonetic Feature ◽  
Consonant Recognition

The aim of this study was to assess the effect of low-frequency amplification on speech recognition performance by hearing-impaired listeners. Consonant identification performance by subjects with flat hearing losses and high-frequency hearing losses was assessed in three different hearing aid conditions, in quiet and noise. The experimental hearing aids all provided extra high-frequency amplification but differed in the amount of low-frequency amplification. The results showed that listeners with flat hearing losses benefited by low-frequency amplification, whereas subjects with high-frequency hearing losses exhibited deteriorating scores in conditions with greatest low-frequency amplification. Analyses of phonetic feature perception and individual consonant recognition scores revealed subtle interactions between hearing loss configuration and amplification contour.

Individual Differences Offer Insight Into Clinical Recommendations for Directional and Remote Microphone Technology Use in Children

2021 ◽  
Vol 64 (2) ◽  
pp. 635-650
Author(s):  
Samantha J. Gustafson ◽  
Todd A. Ricketts ◽  
Erin M. Picou
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Hearing Aids ◽  
Technology Use ◽  
Secondary Task ◽  
Hearing Aid ◽  
Recognition Task ◽  
Primary Task ◽  
Listening Effort ◽  
Clinical Recommendations

Purpose This study sought to evaluate the effects of common hearing aid microphone technologies on speech recognition and listening effort, and to evaluate potential predictive factors related to microphone benefits for school-age children with hearing loss in a realistic listening situation. Method Children ( n = 17, ages 10–17 years) with bilateral, sensorineural hearing loss were fitted with hearing aids set to include three programs: omnidirectional, adaptive directional, and omnidirectional + remote microphone. Children completed a dual-task paradigm in a moderately reverberant room. The primary task included monosyllabic word recognition, with target speech presented at 60 dB A from 0° (front) or 180° (back) azimuth. The secondary task was a “go/no-go,” visual shape-recognition task. Multitalker babble noise created a +5 dB SNR. Children were evaluated in two speaker conditions (front, back) using all three hearing aid programs. The remote microphone transmitter remained at the front speaker throughout testing. Speech recognition performance was calculated from the primary task while listening effort was measured as response time during the secondary task. Results Speech presented from the back significantly increased listening effort and caused a reduction in speech perception when directional and remote microphones were used. Considerable variability was found in pattern of benefit across microphones and source location. Clinical measures did not predict benefit patterns with directional or remote microphones; however, child age and performance with omnidirectional microphones did. Conclusions When compared to a traditional omnidirectional setting, the directional and remote microphone configurations evaluated in this study have the potential to provide benefit for some children and increase difficulty for others when used in dynamic environments. A child's performance with omnidirectional hearing aids could be used to better inform clinical recommendations for these technologies.

Evaluation of Nonlinear Frequency Compression for School-Age Children with Moderate to Moderately Severe Hearing Loss

2010 ◽  
Vol 21 (10) ◽  
pp. 618-628 ◽  
Author(s):  
Jace Wolfe ◽  
Andrew John ◽  
Erin Schafer ◽  
Myriel Nyffeler ◽  
Michael Boretzki ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Hearing Aids ◽  
High Frequency ◽  
Nonlinear Frequency ◽  
Speech Sounds ◽  
Severe Hearing Loss ◽  
Frequency Compression ◽  
Digital Hearing Aids ◽  
Significant Difference

Background: Previous research has indicated that children with moderate hearing loss experience difficulty with recognition of high-frequency speech sounds, such as fricatives and affricates. Conventional behind-the-ear (BTE) amplification typically does not provide ample output in the high frequencies (4000 Hz and beyond) to ensure optimal audibility for these sounds. Purpose: To evaluate nonlinear frequency compression (NLFC) as a means to improve speech recognition for children with moderate to moderately severe hearing loss. Research Design: Within subject, crossover design with repeated measures across test conditions. Study Sample: Fifteen children, aged 5–13 yr, with moderate to moderately severe high-frequency sensorineural hearing loss were fitted with Phonak Nios, microsized, BTE hearing aids. These children were previous users of digital hearing aids and communicated via spoken language. Their speech and language abilities were age-appropriate. Data Collection and Analysis: Aided thresholds and speech recognition in quiet and in noise were assessed after 6 wk of use with NLFC and 6 wk of use without NLFC. Participants were randomly assigned to counter-balanced groups so that eight participants began the first 6 wk trial with NLFC enabled and the other seven participants started with NLFC disabled. Then, the provision of NLFC was switched for the second 6 wk trial. Speech recognition in quiet was assessed via word recognition assessments with the University of Western Ontario (UWO) Plural Test and recognition of vowel-consonant-vowel nonsense syllables with the Phonak Logatome test. Speech recognition in noise was assessed by evaluating the signal-to-noise ratio in dB for 50% correct performance on the Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test, an adaptive test of speech perception in a multitalker babble background. Results: Aided thresholds for high-frequency stimuli were significantly better when NLFC was enabled, and use of NLFC resulted in significantly better speech recognition in quiet for the UWO Plural Test and for the phonemes /d/ and /s/ on the Phonak Logatome test. There was not a statistically significant difference in performance on the BKB-SIN test between the NLFC enabled and disabled conditions. Conclusions: These results indicate that NLFC improves audibility for and recognition of high-frequency speech sounds for children with moderate to moderately severe hearing loss in quiet listening situations.

Evaluation of Wideband Frequency Responses and Nonlinear Frequency Compression for Children with Cookie-Bite Audiometric Configurations

2014 ◽  
Vol 25 (10) ◽  
pp. 1022-1033 ◽  
Author(s):  
Andrew John ◽  
Jace Wolfe ◽  
Susan Scollie ◽  
Erin Schafer ◽  
Mary Hudson ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Hearing Aids ◽  
High Frequency ◽  
Repeated Measures ◽  
Nonsense Syllable ◽  
Nonlinear Frequency ◽  
Frequency Compression ◽  
Sentence Recognition ◽  
Phoneme Perception

Background: Previous research has suggested that use of nonlinear frequency compression (NLFC) can improve audibility for high-frequency sounds and speech recognition of children with moderate to profound high-frequency hearing loss. Furthermore, previous studies have generally found no detriment associated with the use of NLFC. However, there have been no published studies examining the effect of NLFC on the performance of children with cookie-bite audiometric configurations. For this configuration of hearing loss, frequency-lowering processing will likely move high-frequency sounds to a lower frequency range at which a greater degree of hearing loss exists. Purpose: The purpose of this study was to evaluate and compare the effects of wideband amplification and NLFC on high-frequency audibility and speech recognition of children with cookie-bite audiometric configurations. Research Design: This study consisted of a within-participant design with repeated measures across test conditions. Study Sample: Seven children, ages 6–13 yr, with cookie-bite audiometric configurations and normal hearing or mild hearing loss at 6000 and 8000 Hz, were recruited. Intervention: Participants were fitted with Phonak Nios S H2O III behind-the-ear hearing aids and Oticon Safari 300 behind-the-ear hearing aids. Data Collection: The participants were evaluated after three 4-to 6-wk intervals: (1) Phonak Nios S H2O III without NLFC, (2) Phonak Nios S H2O III with NLFC, and (3) Oticon Safari 300 with wideband frequency response extending to 8000 Hz. The order in which each technology was used was counterbalanced across participants. High-frequency audibility was evaluated by assessing aided thresholds (dB SPL) for warble tones and the high-frequency phonemes /sh/ and /s/. Speech recognition in quiet was measured with the University of Western Ontario (UWO) Plurals Test, the UWO Distinctive Features Difference (DFD) Test, and the Phoneme Perception Test vowel-consonant-vowel nonsense syllable test. Sentence recognition in noise was evaluated with the Bamford-Kowal-Bench Speech-In-Noise (BKB-SIN) Test. Analysis: Repeated-measures analyses of variance were used to analyze the data collected in this study. The results across the three different conditions were compared. Results: No difference in performance across conditions was observed for detection of high-frequency warble tones and the speech sounds /sh/ and /s/. No significant difference was seen across conditions for speech recognition in quiet when measured with the UWO Plurals Test, the UWO-DFD Test, and the Phoneme Perception Test vowel-consonant-vowel nonsense syllable test. Finally, there were also no differences across conditions on the BKB-SIN Test. Conclusions: These results suggest that NLFC does not degrade or improve audibility for and recognition of high-frequency speech sounds as well as sentence recognition in noise when compared with wideband amplification for children with cookie-bite audiometric configurations.

Influence of audibility and distortion on the recognition of reverberant speech for children and adults with hearing aid amplification

2021 ◽  
Author(s):  
Marc Brennan ◽  
Ryan Mccreery ◽  
John Massey
Keyword(s):  
Speech Recognition ◽  
Hearing Aids ◽  
Nonsense Syllable ◽  
Hearing Aid ◽  
Release Time ◽  
Spectral Distortion ◽  
Release Times ◽  
Negative Effect ◽  
Amplitude Compression ◽  
Adults And Children

Background: Adults and children with sensorineural hearing loss (SNHL) have trouble understanding speech in rooms with reverberation when using hearing aid amplification. While the use of amplitude compression signal processing in hearing aids may contribute to this difficulty, there is conflicting evidence on the effects of amplitude compression settings on speech recognition. Less clear is the effect of a fast release time for adults and children with SNHL when using compression ratios derived from a prescriptive procedure. Purpose: To determine whether release time impacts speech recognition in reverberation for children and adults with SNHL and to determine if these effects of release time and reverberation can be predicted using indices of audibility or temporal and spectral distortion. Research Design: A quasi-experimental cohort study. Participants used a hearing aid simulator set to the Desired Sensation Level algorithm m[i/o] for three different amplitude compression release times. Reverberation was simulated using three different reverberation times. Participants: Participants were 20 children and 16 adults with SNHL. Data Collection and Analyses: Participants were seated in a sound-attenuating booth and then nonsense syllable recognition was measured. Predictions of speech recognition were made using indices of audibility, temporal distortion, and spectral distortion and the effects of release time and reverberation were analyzed using linear mixed models. Results: While nonsense syllable recognition decreased in reverberation; release time did not significantly affect nonsense syllable recognition. Participants with lower audibility were more susceptible to the negative effect of reverberation on nonsense syllable recognition. Conclusions: We have extended previous work on the effects of reverberation on aided speech recognition to children with SNHL. Variations in release time did not impact the understanding of speech. An index of audibility best predicted nonsense syllable recognition in reverberation and, clinically, these results suggest that patients with less audibility are more susceptible to nonsense syllable recognition in reverberation.

scholarly journals Degree of Hearing Loss Affects Bilateral Hearing Aid Benefits in Ecologically Relevant Laboratory Conditions

2019 ◽  
Vol 62 (10) ◽  
pp. 3834-3850 ◽  
Author(s):  
Todd A. Ricketts ◽  
Erin M. Picou ◽  
James Shehorn ◽  
Andrew B. Dittberner
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Hearing Aids ◽  
Visual Cues ◽  
Hearing Aid ◽  
Recognition Performance ◽  
Listening Effort ◽  
Sentence Recognition ◽  
Predictive Variables ◽  
The Relationship

Purpose Previous evidence supports benefits of bilateral hearing aids, relative to unilateral hearing aid use, in laboratory environments using audio-only (AO) stimuli and relatively simple tasks. The purpose of this study was to evaluate bilateral hearing aid benefits in ecologically relevant laboratory settings, with and without visual cues. In addition, we evaluated the relationship between bilateral benefit and clinically viable predictive variables. Method Participants included 32 adult listeners with hearing loss ranging from mild–moderate to severe–profound. Test conditions varied by hearing aid fitting type (unilateral, bilateral) and modality (AO, audiovisual). We tested participants in complex environments that evaluated the following domains: sentence recognition, word recognition, behavioral listening effort, gross localization, and subjective ratings of spatialization. Signal-to-noise ratio was adjusted to provide similar unilateral speech recognition performance in both modalities and across procedures. Results Significant and similar bilateral benefits were measured for both modalities on all tasks except listening effort, where bilateral benefits were not identified in either modality. Predictive variables were related to bilateral benefits in some conditions. With audiovisual stimuli, increasing hearing loss, unaided speech recognition in noise, and unaided subjective spatial ability were significantly correlated with increased benefits for many outcomes. With AO stimuli, these same predictive variables were not significantly correlated with outcomes. No predictive variables were correlated with bilateral benefits for sentence recognition in either modality. Conclusions Hearing aid users can expect significant bilateral hearing aid advantages for ecologically relevant, complex laboratory tests. Although future confirmatory work is necessary, these data indicate the presence of vision strengthens the relationship between bilateral benefits and degree of hearing loss.

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