scholarly journals Improvement of Adult BTE Hearing Aid Wearers' Front/Back Localization Performance Using Digital Pinna-Cue Preserving Technologies: An Evidence-Based Review

2014 ◽  
Vol 18 (3) ◽  
pp. 97 ◽  
Author(s):  
Jingjing Xu ◽  
Woojae Han
Keyword(s):  
Hearing Aid ◽  
Evidence Based ◽  
Localization Performance

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

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

Left-Right and Front-Back Spatial Hearing with Multiple Directional Microphone Configurations in Modern Hearing Aids

2014 ◽  
Vol 25 (09) ◽  
pp. 791-803 ◽  
Author(s):  
Evelyne Carette ◽  
Tim Van den Bogaert ◽  
Mark Laureyns ◽  
Jan Wouters
Keyword(s):  
Sound Localization ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Performance Measure ◽  
Frequency Dependent ◽  
Binaural Cues ◽  
Directional Microphone ◽  
Spectral Cues ◽  
Localization Performance ◽  
Asymmetric Configuration

Background: Several studies have demonstrated negative effects of directional microphone configurations on left-right and front-back (FB) sound localization. New processing schemes, such as frequency-dependent directionality and front focus with wireless ear-to-ear communication in recent, commercial hearing aids may preserve the binaural cues necessary for left-right localization and may introduce useful spectral cues necessary for FB disambiguation. Purpose: In this study, two hearing aids with different processing schemes, which were both designed to preserve the ability to localize sounds in the horizontal plane (left-right and FB), were compared. Research Design: We compared horizontal (left-right and FB) sound localization performance of hearing aid users fitted with two types of behind-the-ear (BTE) devices. The first type of BTE device had four different programs that provided (1) no directionality, (2–3) symmetric frequency-dependent directionality, and (4) an asymmetric configuration. The second pair of BTE devices was evaluated in its omnidirectional setting. This setting automatically activates a soft forward-oriented directional scheme that mimics the pinna effect. Also, wireless communication between the hearing aids was present in this configuration (5). A broadband stimulus was used as a target signal. The directional hearing abilities of the listeners were also evaluated without hearing aids as a reference. Study Sample: A total of 12 listeners with moderate to severe hearing loss participated in this study. All were experienced hearing-aid users. As a reference, 11 listeners with normal hearing participated. Data Collection and Analysis: The participants were positioned in a 13-speaker array (left-right, –90°/+90°) or 7-speaker array (FB, 0–180°) and were asked to report the number of the loudspeaker located the closest to where the sound was perceived. The root mean square error was calculated for the left-right experiment, and the percentage of FB errors was used as a FB performance measure. Results were analyzed with repeated-measures analysis of variance. Results: For the left-right localization task, no significant differences could be proven between the unaided condition and both partial directional schemes and the omnidirectional scheme. The soft forward-oriented system and the asymmetric system did show a detrimental effect compared with the unaided condition. On average, localization was worst when users used the asymmetric condition. Analysis of the results of the FB experiment showed good performance, similar to unaided, with both the partial directional systems and the asymmetric configuration. Significantly worse performance was found with the omnidirectional and the omnidirectional soft forward-oriented BTE systems compared with the other hearing-aid systems. Conclusions: Bilaterally fitted partial directional systems preserve (part of) the binaural cues necessary for left-right localization and introduce, preserve, or enhance useful spectral cues that allow FB disambiguation. Omnidirectional systems, although good for left-right localization, do not provide the user with enough spectral information for an optimal FB localization performance.

Pediatric Audiology in North America: Current Clinical Practice and How It Relates to the American Academy of Audiology Pediatric Amplification Guideline

2016 ◽  
Vol 27 (03) ◽  
pp. 166-187 ◽  
Author(s):  
Sheila Moodie ◽  
Eileen Rall ◽  
Leisha Eiten ◽  
George Lindley ◽  
Dave Gordey ◽  
...  
Keyword(s):  
Clinical Practice ◽  
North America ◽  
Data Collection ◽  
Practice Guidelines ◽  
Best Practice ◽  
Intervention Program ◽  
Hearing Aid ◽  
Evidence Based ◽  
Pediatric Audiology ◽  
Family Centered

Background: There is broad consensus that screening and diagnosis of permanent hearing loss in children must be embedded within a comprehensive, evidence-based, family-centered intervention program. Clinical practice guidelines (CPGs) for pediatric hearing assessment and hearing aid verification aim to reduce variability in practice and increase the use of effective evidence-based diagnostic and treatment options so that optimal outcomes may be achieved. To be of value, guidelines must be translated and implemented into practice and ongoing monitoring of their use in practice should occur. Purpose: This paper provides the results of two studies that aim to examine current pediatric audiology and amplification practice in North America. Research Design: A concurrent embedded mixed methods design was used. Study Sample: An electronic survey was distributed to North American audiologists who delivered pediatric audiology services with 350 audiologists participating in study 1 and 63 audiologists participating in study 2. Data Collection and Analysis: A quantitative approach was the predominant method of data collection. Respondents were prompted to provide additional qualitative text and detail regarding their quantitative response choice. This qualitative text was used during the analysis phase and combined with quantitative results to assist understanding of respondents’ knowledge, skills, and barriers/facilitators to implement best practice in pediatric amplification. Results: Approximately 70% of audiologists reported using best-practice protocols for pediatric hearing aid fitting. Despite widespread knowledge and increased use of CPGs over the last 18 yrs, results of these studies show that variation in practice patterns continue to exist. Several examples of implementation challenges are discussed with recommendations provided. Conclusions: In order for audiologists working with children who are deaf or hard of hearing and their families to achieve the principles of family-centered early intervention, practice guidelines must continue to be developed, disseminated, and translated as they have a positive impact on the services provided. Researchers and clinical audiologists who deliver services must continue to collaborate to understand the “how” and “why” of implementing guidelines into practice and to identify the barriers/facilitators encountered in trying to do so.

Effects of Coordinated Compression and Pinna Compensation Features on Horizontal Localization Performance in Hearing Aid Users

2015 ◽  
Vol 26 (01) ◽  
pp. 080-092 ◽  
Author(s):  
Petri Korhonen ◽  
Chi Lau ◽  
Francis Kuk ◽  
Denise Keenan ◽  
Jennifer Schumacher
Keyword(s):  
Repeated Measures ◽  
Horizontal Plane ◽  
Dynamic Range ◽  
Hearing Aid ◽  
Hearing Impaired ◽  
Localization Accuracy ◽  
Repeated Measures Design ◽  
Dynamic Range Compression ◽  
Data Collection And Analysis ◽  
Localization Performance

Background: Hearing-impaired listeners localize sounds better unaided than aided. Wide dynamic range compression circuits operating independently at each ear in bilateral fittings, and microphone positions of different hearing aid styles, have been cited as a reason. Two hearing aid features, inter-ear coordinated compression (IE) and pinna compensation (PC), were developed to mitigate the compromised aided localization performance. Purpose: This study examined the effect of IE and PC on aided localization performance in the horizontal plane with hearing-impaired listeners. Research Design: A single-blind, repeated-measures design was used. Study Sample: A total of 10 experienced hearing aid users with bilaterally symmetrical sensorineural hearing loss who had previously participated in localization training were evaluated. Data Collection and Analysis: Localization performance was measured using 12 loudspeakers spaced 30° apart on the horizontal plane. Aided performance was evaluated using a behind-the-ear hearing aid at four settings: omnidirectional microphone (Omni), Omni microphone with the PC feature, Omni microphone with IE, and Omni microphone with the PC feature and IE together. In addition, unaided localization performance was measured. Results: Significant improvement in the localization accuracy was measured for sounds arriving from the back when comparing the PC with the Omni conditions. The use of IE reduced the magnitude of errors for some listeners for sounds originating from ±90°. The average reduction in the errors was 7.3°. Conclusions: This study confirmed that the use of the PC feature improved localization for sounds arriving from behind the listener. The use of IE may improve localization for some listeners for sounds arriving from the sides.

The effect of frequency-dependent microphone directionality on horizontal localization performance in hearing-aid users

2009 ◽  
Vol 48 (11) ◽  
pp. 789-803 ◽  
Author(s):  
Gitte Keidser ◽  
Anna O'Brien ◽  
Jens-Uwe Hain ◽  
Margot McLelland ◽  
Ingrid Yeend
Keyword(s):  
Hearing Aid ◽  
Frequency Dependent ◽  
Localization Performance

Fitting Hearing Aids Using Clinical Measures of Loudness Discomfort Levels: An Evidence-Based Review of Effectiveness

2005 ◽  
Vol 16 (07) ◽  
pp. 461-472 ◽  
Author(s):  
Gustav H. Mueller ◽  
Ruth A. Bentler
Keyword(s):  
Hearing Aids ◽  
Statistical Power ◽  
Hearing Aid ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Strong Recommendation ◽  
Hearing Aid Fitting ◽  
Fitting Procedure ◽  
Clinical Measurements ◽  
Clinical Measures

Clinical measurement of the loudness discomfort level (LDL) historically has been part of the hearing aid fitting procedure, and this clinical practice remains popular today. LDL measurements also are recommended in contemporary hearing aid fitting protocols. Yet, surveys show that many hearing aid users are dissatisfied with the loudness of their hearing aids. In this evidence-based review article, we evaluate the effectiveness of clinical LDL measurements. Specifically, we asked the question "Are the clinical measurements of LDL for adult patients predictive of aided acceptance and satisfaction of loudness for high inputs in the real world?" Nearly 200 articles were reviewed; three met the criteria set forth in this review. The evidence supported using unaided LDLs for selecting the maximum real-ear output of hearing aids. No study using aided LDLs or aided loudness verification met the criteria. The level of the evidence for the three articles using unaided LDLs was low; no higher than Level 4. The limited number of studies, the level of evidence, and the statistical power of the studies prevents us from making a strong recommendation concerning the clinical use of LDL measures. Additional research in this area, especially research employing randomized controlled trials would be a useful addition to this body of literature.

Creating the Evidence: Lessons from Cochlear Implants

2005 ◽  
Vol 16 (07) ◽  
pp. 515-522 ◽  
Author(s):  
David Fabry
Keyword(s):  
Cochlear Implants ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Evidence Based ◽  
Class Iii ◽  
Research Technology ◽  
The Past ◽  
The Difference ◽  
Number Of Publications ◽  
The Impact

This paper compares the evidence-based outcomes between cochlear implants and hearing aids during the past several decades. Despite many similarities, there are also some important differences that define the progress for the two disciplines. Perhaps the most significant distinction exists in terms of the difference between the Food and Drug Administration's treatment of hearing aids as Class I medical devices, while cochlear implants are defined as Class III devices. Another point of divergence has been the number of publications in archival, peer-reviewed journals; implant papers have been steadily increasing during the past decade, while hearing aid papers have declined during the same period. The impact of these differences on the past, present, and future of hearing aid and cochlear implant research, technology, and clinical practice is discussed.

Effects of CIC Hearing Aids on Auditory Localization by Listeners With Normal Hearing

2001 ◽  
Vol 44 (6) ◽  
pp. 1209-1214 ◽  
Author(s):  
William R. D'Angelo ◽  
Robert S. Bolia ◽  
Pamela J. Mishler ◽  
Linda J. Morris
Keyword(s):  
Hearing Aids ◽  
Real World ◽  
Hearing Aid ◽  
Normal Hearing ◽  
Broadband Noise ◽  
Auditory Localization ◽  
Ear Canal ◽  
Independent Variables ◽  
Significant Decrement ◽  
Localization Performance

An experiment was conducted to determine the effects of completely-in-the-canal (CIC) hearing aids on auditory localization performance. Six normal-hearing listeners localized a 750-ms broadband noise from loudspeakers ranging in azimuth from –180° to +180° and in elevation from –75° to +90°. Independent variables included the presence or absence of the hearing aid and the elevation of the source. Dependent measures included azimuth error, elevation error, and the percentage of trials resulting in a front-back confusion. The findings indicate a statistically significant decrement in localization acuity, both in azimuth and elevation, occasioned by the wearing of CIC hearing aids. However, the magni-tude of this decrement was small compared to those typically caused by other ear-canal occlusions, such as earplugs, and would probably not engender mislocalization of real-world sounds.

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