Objectives:

Actively following a conversation can be demanding and limited cognitive resources must be allocated to the processing of speech, retaining and encoding the perceived content, and preparing an answer. The aim of the present study was to disentangle the allocation of effort into the effort required for listening (listening effort) and the effort required for retention (memory effort) by means of pupil dilation.

Design:

Twenty-five normal-hearing German speaking participants underwent a sentence final word identification and recall test, while pupillometry was conducted. The participants task was to listen to a sentence in four-talker babble background noise and to repeat the final word afterward. At the end of a list of sentences, they were asked to recall as many of the final words as possible. Pupil dilation was recorded during different list lengths (three sentences versus six sentences) and varying memory load (recall versus no recall). Additionally, the effect of a noise reduction algorithm on performance, listening effort, and memory effort was evaluated.

Results:

We analyzed pupil dilation both before each sentence (sentence baseline) as well as the dilation in response to each sentence relative to the sentence baseline (sentence dilation). The pupillometry data indicated a steeper increase of sentence baseline under recall compared to no recall, suggesting higher memory effort due to memory processing. This increase in sentence baseline was most prominent toward the end of the longer lists, that is, during the second half of six sentences. Without a recall task, sentence baseline declined over the course of the list. Noise reduction appeared to have a significant influence on effort allocation for listening, which was reflected in generally decreased sentence dilation.

Conclusion:

Our results showed that recording pupil dilation in a speech identification and recall task provides valuable insights beyond behavioral performance. It is a suitable tool to disentangle the allocation of effort to listening versus memorizing speech.

To increase the ecological validity of outcomes from laboratory evaluations of hearing and hearing devices, it is desirable to introduce more realistic outcome measures in the laboratory. This article presents and discusses three outcome measures that have been designed to go beyond traditional speech-in-noise measures to better reflect realistic everyday challenges. The outcome measures reviewed are: the Sentence-final Word Identification and Recall (SWIR) test that measures working memory performance while listening to speech in noise at ceiling performance; a neural tracking method that produces a quantitative measure of selective speech attention in noise; and pupillometry that measures changes in pupil dilation to assess listening effort while listening to speech in noise. According to evaluation data, the SWIR test provides a sensitive measure in situations where speech perception performance might be unaffected. Similarly, pupil dilation has also shown sensitivity in situations where traditional speech-in-noise measures are insensitive. Changes in working memory capacity and effort mobilization were found at positive signal-to-noise ratios (SNR), that is, at SNRs that might reflect everyday situations. Using stimulus reconstruction, it has been demonstrated that neural tracking is a robust method at determining to what degree a listener is attending to a specific talker in a typical cocktail party situation. Using both established and commercially available noise reduction schemes, data have further shown that all three measures are sensitive to variation in SNR. In summary, the new outcome measures seem suitable for testing hearing and hearing devices under more realistic and demanding everyday conditions than traditional speech-in-noise tests.

People with hearing impairment typically have difficulties following conversations in multi-talker situations. Previous studies have shown that utilizing eye gaze to steer audio through beamformers could be a solution for those situations. Recent studies have shown that in-ear electrodes that capture electrooculography in the ear (EarEOG) can estimate the eye-gaze relative to the head, when the head was fixed. The head movement can be estimated using motion sensors around the ear to create an estimate of the absolute eye-gaze in the room. In this study, an experiment was designed to mimic a multi-talker situation in order to study and model the EarEOG signal when participants attempted to follow a conversation. Eleven hearing impaired participants were presented speech from the DAT speech corpus (Bo Nielsen et al., 2014), with three targets positioned at -30 degrees, 0 degrees and +30 degrees azimuth. The experiment was run in two setups: one where the participants had their head fixed in a chinrest, and the other where they were free to move their head. The participants task was to focus their visual attention on an LED-indicated target that changed regularly. A model was developed for the relative eye-gaze estimation, taking saccades, fixations, head movement and drift from the electrode-skin half-cell into account. This model explained 90.5% of the variance of the EarEOG when the head was fixed, and 82.6% when the head was free. The absolute eye-gaze was also estimated utilizing that model. When the head was fixed, the estimation of the absolute eye-gaze was reliable. However, due to hardware issues, the estimation of the absolute eye-gaze when the head was free had a variance that was too large to reliably estimate the attended target. Overall, this study demonstrated the potential of estimating absolute eye-gaze using EarEOG and motion sensors around the ear.

Auditory attention identification methods attempt to identify the sound source of a listeners interest by analyzing measurements of electrophysiological data. We present a tutorial on the numerous techniques that have been developed in recent decades, and we present an overview of current trends in multivariate correlation-based and model-based learning frameworks. The focus is on the use of linear relations between electrophysiological and audio data. The way in which these relations are computed differs. For example, canonical correlation analysis (CCA) finds a linear subset of electrophysiological data that best correlates to audio data and a similar subset of audio data that best correlates to electrophysiological data. Model-based (encoding and decoding) approaches focus on either of these two sets. We investigate the similarities and differences between these linear model philosophies. We focus on (1) correlation-based approaches (CCA), (2) encoding/decoding models based on dense estimation, and (3) (adaptive) encoding/decoding models based on sparse estimation. The specific focus is on sparsity-driven adaptive encoding models and comparing the methodology in state-of-the-art models found in the auditory literature. Furthermore, we outline the main signal processing pipeline for how to identify the attended sound source in a cocktail party environment from the raw electrophysiological data with all the necessary steps, complemented with the necessary MATLAB code and the relevant references for each step. Our main aim is to compare the methodology of the available methods, and provide numerical illustrations to some of them to get a feeling for their potential. A thorough performance comparison is outside the scope of this tutorial.

The behavior of a person during a conversation typically involves both auditory and visual attention. Visual attention implies that the person directs his or her eye gaze toward the sound target of interest, and hence, detection of the gaze may provide a steering signal for future hearing aids. The steering could utilize a beamformer or the selection of a specific audio stream from a set of remote microphones. Previous studies have shown that eye gaze can be measured through electrooculography (EOG). To explore the precision and real-time feasibility of the methodology, seven hearing-impaired persons were tested, seated with their head fixed in front of three targets positioned at -30 degrees, 0 degrees, and +30 degrees azimuth. Each target presented speech from the Danish DAT material, which was available for direct input to the hearing aid using head-related transfer functions. Speech intelligibility was measured in three conditions: a reference condition without any steering, a condition where eye gaze was estimated from EOG measures to select the desired audio stream, and an ideal condition with steering based on an eye-tracking camera. The "EOG-steering" improved the sentence correct score compared with the "no-steering" condition, although the performance was still significantly lower than the ideal condition with the eye-tracking camera. In conclusion, eye-gaze steering increases speech intelligibility, although real-time EOG-steering still requires improvements of the signal processing before it is feasible for implementation in a hearing aid.

Difficulties arising in everyday speech communication often result from the acoustical environment, which may contain interfering background noise or competing speakers. Thus, listening and understanding speech in noise can be exhausting. Two experiments are presented in the current study that further explored the impact of masker type and Signal-to-Noise Ratio (SNR) on listening effort by means of pupillometry. In both studies, pupillary responses of participants were measured while performing the Danish Hearing in Noise Test (HINT; Nielsen and Dau, 2011). The first experiment aimed to replicate and extend earlier observed effects of noise type and semantic interference on listening effort (Koelewijn et al., 2012). The impact of three different masker types, i.e. a fluctuating noise, a 1-talker masker and a 4-talker masker on listening effort was examined at a fixed speech intelligibility. In a second experiment, effects of SNR on listening effort were examined while presenting the HINT sentences across a broad range of fixed SNRs corresponding to intelligibility scores ranging from 100% to 0% correct performance. A peak pupil dilation (PPD) was calculated and a Growth Curve Analysis (GCA) was performed to examine listening effort involved in speech recognition as a function of SNR. The results of two experiments showed that the pupil dilation response is highly affected by both masker type and SNR when performing the HINT. The PPD was highest, suggesting the highest level of effort, for speech recognition in the presence of the 1-talker masker in comparison to the 4-talker babble and the fluctuating noise masker. However, the disrupting effect of one competing talker disappeared for intelligibly levels around 50%. Furthermore, it was demonstrated that the pupillary response strongly varied as a function of SNRs. Listening effort was highest for intermediate SNRs with performance accuracies ranging between 30% and 70% correct. GCA revealed time-dependent effects of the SNR on the pupillary response that were not reflected in the PPD. (C) 2018 Elsevier B.V. All rights reserved.

Listening to speech in noise can be effortful but when motivated people seem to be more persevering. Previous research showed effects of monetary reward on autonomic responses like cardiovascular reactivity and pupil dilation while participants processed auditory information. The current study examined the effects of monetary reward on the processing of speech in noise and related listening effort as reflected by the pupil dilation response. Twenty-four participants (median age 21 yrs) performed two speech reception threshold (SRT) tasks, one tracking 50% correct (hard) and one tracking 85% correct (easy), both of which they listened to and repeated sentences uttered by a female talker. The sentences were presented with a single male talker or, in a control condition, in quiet. Participants were told that they could earn a high (5 euros) or low (0.20 euro) reward when repeating 70% or more of the sentences correctly. Conditions were presented in a blocked fashion and during each trial, pupil diameter was recorded. At the end of each block, participants rated the effort they had experienced, their performance, and their tendency to quit listening. Additionally, participants performed a working memory capacity task and filled in a need-for-recovery questionnaire as these tap into factors that influence the pupil dilation response. The results showed no effect of reward on speech perception performance as reflected by the SRT. The peak pupil dilation showed a significantly larger response for high than for low reward, for the easy and hard conditions, but not the control condition. Higher need for recovery was associated with a higher subjective tendency to quit listening. Consistent with the Framework for Understanding Effortful Listening, we conclude that listening effort as reflected by the peak pupil dilation is sensitive to the amount of monetary reward. (C) 2018 The Authors. Published by Elsevier B.V.

Objective: People with hearing impairment are likely to experience higher levels of fatigue because of effortful listening in daily communication. This hearing-related fatigue might not only constrain their work performance but also result in withdrawal from major social roles. Therefore, it is important to understand the relationships between fatigue, listening effort, and hearing impairment by examining the evidence from both subjective and objective measurements. The aim of the present study was to investigate these relationships by assessing subjectively measured daily-life fatigue (self-report questionnaires) and objectively measured listening effort (pupillometry) in both normally hearing and hearing-impaired participants. Design: Twenty-seven normally hearing and 19 age-matched participants with hearing impairment were included in this study. Two self-report fatigue questionnaires Need For Recovery and Checklist Individual Strength were given to the participants before the test session to evaluate the subjectively measured daily fatigue. Participants were asked to perform a speech reception threshold test with single-talker masker targeting a 50% correct response criterion. The pupil diameter was recorded during the speech processing, and we used peak pupil dilation (PPD) as the main outcome measure of the pupillometry. Results: No correlation was found between subjectively measured fatigue and hearing acuity, nor was a group difference found between the normally hearing and the hearing-impaired participants on the fatigue scores. A significant negative correlation was found between self-reported fatigue and PPD. A similar correlation was also found between Speech Intelligibility Index required for 50% correct and PPD. Multiple regression analysis showed that factors representing "hearing acuity" and "self-reported fatigue" had equal and independent associations with the PPD during the speech in noise test. Less fatigue and better hearing acuity were associated with a larger pupil dilation. Conclusions: To the best of our knowledge, this is the first study to investigate the relationship between a subjective measure of daily-life fatigue and an objective measure of pupil dilation, as an indicator of listening effort. These findings help to provide an empirical link between pupil responses, as observed in the laboratory, and daily-life fatigue.

Recent studies have shown that activating the noise reduction scheme in hearing aids results in a smaller peak pupil dilation (PPD), indicating reduced listening effort, at 50% and 95% correct sentence recognition with a 4-talker masker. The objective of this study was to measure the effect of the noise reduction scheme (on or off) on PPD and sentence recognition across a wide range of signal-to-noise ratios (SNRs) from +16 dB to -12 dB and two masker types (4-talker and stationary noise). Relatively low PPDs were observed at very low (-12 dB) and very high (+16 dB to +8 dB) SNRs presumably due to giving up and easy listening, respectively. The maximum PPD was observed with SNRs at approximately 50% correct sentence recognition. Sentence recognition with both masker types was significantly improved by the noise reduction scheme, which corresponds to the shift in performance from SNR function at approximately 5 dB toward a lower SNR. This intelligibility effect was accompanied by a corresponding effect on the PPD, shifting the peak by approximately 4 dB toward a lower SNR. In addition, with the 4-talker masker, when the noise reduction scheme was active, the PPD was smaller overall than that when the scheme was inactive. We conclude that with the 4-talker masker, noise reduction scheme processing provides a listening effort benefit in addition to any effect associated with improved intelligibility. Thus, the effect of the noise reduction scheme on listening effort incorporates more than can be explained by intelligibility alone, emphasizing the potential importance of measuring listening effort in addition to traditional speech reception measures. (C) 2018 Elsevier B.V. All rights reserved.

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n=31) or wait-list control (n=30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly - S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohens d=0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohens d=0.61, 95% CI [0.04, 1.19], and quality of life, Cohens d=0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.

Objectives: Speech perception in adverse listening situations can be exhausting. Hearing loss particularly affects processing demands, as it requires increased effort for successful speech perception in background noise. Signal processing in hearing aids and noise reduction (NR) schemes aim to counteract the effect of noise and reduce the effort required for speech recognition in adverse listening situations. The present study examined the benefit of NR schemes, applying a combination of a digital NR and directional microphones, for reducing the processing effort during speech recognition. Design: The effect of noise (intelligibility level) and different NR schemes on effort were evaluated by measuring the pupil dilation of listeners. In 2 different experiments, performance accuracy and peak pupil dilation (PPD) were measured in 24 listeners with hearing impairment while they performed a speech recognition task. The listeners were tested at 2 different signal to noise ratios corresponding to either the individual 50% correct (L50) or the 95% correct (L95) performance level in a 4-talker babble condition with and without the use of a NR scheme. Results: In experiment 1, the PPD differed in response to both changes in the speech intelligibility level (L50 versus L95) and NR scheme. The PPD increased with decreasing intelligibility, indicating higher processing effort under the L50 condition compared with the L95 condition. Moreover, the PPD decreased when the NR scheme was applied, suggesting that the processing effort was reduced. In experiment 2, 2 hearing aids using different NR schemes (fast-acting and slow-acting) were compared. Processing effort changed as indicated by the PPD depending on the hearing aids and therefore on the NR scheme. Larger PPDs were measured for the slow-acting NR scheme. Conclusions: The benefit of applying an NR scheme was demonstrated for both L50 and L95, that is, a situation at which the performance level was at a ceiling. This opens the opportunity for new means of evaluating hearing aids in situations in which traditional speech reception measures are shown not to be sensitive.

Objective: In a clinical setting, theories of health behaviour change could help audiologists and other hearing health care professionals understand the barriers that prevent people with hearing problems to seek audiological help. The transtheoretical (stages of change) model of health behaviour change is one of these theories. It describes a persons journey towards health behaviour change (e.g. seeking help or taking up rehabilitation) in separate stages: precontemplation, contemplation, preparation, action, and, finally, maintenance. A short self-assessment measure of stages of change may guide the clinician and facilitate first appointments. This article describes correlations between three stages of change measures of different lengths, one 24-item and two one-item. Design: Participants were recruited through an online hearing screening study. Adults who failed the speech-in-noise recognition screening test and who had never undergone a hearing aid fitting were invited to complete further questionnaires online, including the three stages of change measures. Study sample: In total, 224 adults completed the three measures. Results: A majority of the participants were categorised as being in one of the information- and help-seeking stage of change (contemplation or preparation). The three stages of change measures were significantly correlated. Conclusions Our results support further investigating the use of a one-item measure to determine stages of change in people with hearing impairment.

Objectives: To undertake a systematic review of available evidence on the effect of hearing impairment and hearing aid amplification on listening effort. Two research questions were addressed: Q1) does hearing impairment affect listening effort? and Q2) can hearing aid amplification affect listening effort during speech comprehension? Design: English language articles were identified through systematic searches in PubMed, EMBASE, Cinahl, the Cochrane Library, and PsyclNFO from inception to August 2014. References of eligible studies were checked. The Population, Intervention, Control, Outcomes, and Study design strategy was used to create inclusion criteria for relevance. It was not feasible to apply a meta-analysis of the results from comparable studies. For the articles identified as relevant, a quality rating, based on the 2011 Grading of Recommendations Assessment, Development, and Evaluation Working Group guidelines, was carried out to judge the reliability and confidence of the estimated effects. Results: The primary search produced 7017 unique hits using the keywords: hearing aids OR hearing impairment AND listening effort OR perceptual effort OR ease of listening. Of these, 41 articles fulfilled the Population, Intervention, Control, Outcomes, and Study design selection criteria of: experimental work on hearing impairment OR hearing aid technologies AND listening effort OR fatigue during speech perception. The methods applied in those articles were categorized into subjective, behavioral, and physiological assessment of listening effort. For each study, the statistical analysis addressing research question Q1 and/or Q2 was extracted. In seven articles more than one measure of listening effort was provided. Evidence relating to Q1 was provided by 21 articles that reported 41 relevant findings. Evidence relating to Q2 was provided by 27 articles that reported 56 relevant findings. The quality of evidence on both research questions (Q1 and Q2) was very low, according to the Grading of Recommendations Assessment, Development, and Evaluation Working Group guidelines. We tested the statistical evidence across studies with nonparametric tests. The testing revealed only one consistent effect across studies, namely that listening effort was higher for hearing-impaired listeners compared with normal-hearing listeners (Q1) as measured by electroencephalographic measures. For all other studies, the evidence across studies failed to reveal consistent effects on listening effort. Conclusion: In summary, we could only identify scientific evidence from physiological measurement methods, suggesting that hearing impairment increases listening effort during speech perception (Q1). There was no scientific, finding across studies indicating that hearing aid amplification decreases listening effort (Q2). In general, there were large differences in the study population, the control groups and conditions, and the outcome measures applied between the studies included in this review. The results of this review indicate that published listening effort studies lack consistency, lack standardization across studies, and have insufficient statistical power. The findings underline the need for a common conceptual framework for listening effort to address the current shortcomings.

Purpose: This article describes the Second International Meeting on Internet and Audiology, which took place at the Eriksholm Research Centre, Oticon A/S, Denmark September 24 to 25, 2015, and introduces the research forum arising from the meeting. Method: The potential gains of the Internet within audiology are framed within the central role of quality connections among people, ideas, and objects. First, the meeting is summarized. Second, the 11 articles arising from the meeting and collected in this research forum are grouped into 2 themes: design and evaluation. Last, the benefits of interoperability and standardization are discussed. Conclusion: We look forward to the day when the Internet is an integral part of audiology, and we invite readers to attend future editions of the International Meeting on Internet and Audiology.

The audiogram predicts amp;lt;30% of the variance in speech-reception thresholds (SRTs) for hearing-impaired (HI) listeners fitted with individualized frequency-dependent gain. The remaining variance could reflect suprathreshold distortion in the auditory pathways or nonauditory factors such as cognitive processing. The relationship between a measure of suprathreshold auditory function-spectrotemporal modulation (STM) sensitivity-and SRTs in noise was examined for 154 HI listeners fitted with individualized frequency-specific gain. SRTs were measured for 65-dB SPL sentences presented in speech-weighted noise or four-talker babble to an individually programmed master hearing aid, with the output of an ear-simulating coupler played through insert earphones. Modulation-depth detection thresholds were measured over headphones for STM (2cycles/octave density, 4-Hz rate) applied to an 85-dB SPL, 2-kHz lowpass-filtered pink-noise carrier. SRTs were correlated with both the high-frequency (2-6 kHz) pure-tone average (HFA; R-2 = .31) and STM sensitivity (R-2 = .28). Combined with the HFA, STM sensitivity significantly improved the SRT prediction (Delta R-2 = .13; total R-2 = .44). The remaining unaccounted variance might be attributable to variability in cognitive function and other dimensions of suprathreshold distortion. STM sensitivity was most critical in predicting SRTs for listenersamp;lt;65 years old or with HFA amp;lt;53 dB HL. Results are discussed in the context of previous work suggesting that STM sensitivity for low rates and low-frequency carriers is impaired by a reduced ability to use temporal fine-structure information to detect dynamic spectra. STM detection is a fast test of suprathreshold auditory function for frequencies amp;lt;2 kHz that complements the HFA to predict variability in hearing-aid outcomes for speech perception in noise.

OBJECTIVE: Acceptance and readiness to seek professional help have shown to be important factors for favourable audiological rehabilitation outcomes. Theories from health psychology such as the transtheoretical (stages-of-change) model could help understand behavioural change in people with hearing impairment. In recent studies, the University of Rhode Island change assessment (URICA) has been found to have good predictive validity.

DESIGN: In a previous study, 224 Swedish adults who had failed an online hearing screening completed URICA and two other measures of stages of change. This follow-up aimed to: (1) determine prevalence of help-seeking at a hearing clinic and hearing aid uptake, and (2) explore the predictive validity of the stages of change measures by a follow-up on the 224 participants who had failed a hearing screening 18 months previously.

STUDY SAMPLE: A total of 122 people (54%) completed the follow-up online questionnaire, including the three measures and questions regarding experience with hearing help-seeking and hearing aid uptake.

RESULTS: Since failing the online hearing screening, 61% of participants had sought help. A good predictive validity for a one-item measure of stages of change was reported.

CONCLUSIONS: The Staging algorithm was the stages of change measure with the best ability to predict help-seeking 18 months later.

Context Although the pupil light reflex has been widely used as a clinical diagnostic tool for autonomic nervous system dysfunction, there is no systematic review available to summarize the evidence that the pupil light reflex is a sensitive method to detect parasympathetic dysfunction. Meanwhile, the relationship between parasympathetic functioning and hearing impairment is relatively unknown. Objectives To 1) review the evidence for the pupil light reflex being a sensitive method to evaluate parasympathetic dysfunction, 2) review the evidence relating hearing impairment and parasympathetic activity and 3) seek evidence of possible connections between hearing impairment and the pupil light reflex. Methods Literature searches were performed in five electronic databases. All selected articles were categorized into three sections: pupil light reflex and parasympathetic dysfunction, hearing impairment and parasympathetic activity, pupil light reflex and hearing impairment. Results Thirty-eight articles were included in this review. Among them, 36 articles addressed the pupil light reflex and parasympathetic dysfunction. We summarized the information in these data according to different types of parasympathetic-related diseases. Most of the studies showed a difference on at least one pupil light reflex parameter between patients and healthy controls. Two articles discussed the relationship between hearing impairment and parasympathetic activity. Both studies reported a reduced parasympathetic activity in the hearing impaired groups. The searches identified no results for pupil light reflex and hearing impairment. Discussion and Conclusions As the first systematic review of the evidence, our findings suggest that the pupil light reflex is a sensitive tool to assess the presence of parasympathetic dysfunction. Maximum constriction velocity and relative constriction amplitude appear to be the most sensitive parameters. There are only two studies investigating the relationship between parasympathetic activity and hearing impairment, hence further research is needed. The pupil light reflex could be a candidate measurement tool to achieve this goal.

In adaptive Speech Reception Threshold (SRT) tests used in the audiological clinic, speech is presented at signal to noise ratios (SNRs) that are lower than those generally encountered in real-life communication situations. At higher, ecologically valid SNRs, however, SRTs are insensitive to changes in hearing aid signal processing that may be of benefit to listeners who are hard of hearing. Previous studies conducted in Swedish using the Sentence-final Word Identification and Recall test (SWIR) have indicated that at such SNRs, the ability to recall spoken words may be a more informative measure. In the present study, a Danish version of SWIR, known as the Sentence-final Word Identification and Recall Test in a New Language (SWIRL) was introduced and evaluated in two experiments. The objective of experiment 1 was to determine if the Swedish results demonstrating benefit from noise reduction signal processing for hearing aid wearers could be replicated in 25 Danish participants with mild to moderate symmetrical sensorineural hearing loss. The objective of experiment 2 was to compare direct-drive and skin-drive transmission in 16 Danish users of bone-anchored hearing aids with conductive hearing loss or mixed sensorineural and conductive hearing loss. In experiment 1, performance on SWIRL improved when hearing aid noise reduction was used, replicating the Swedish results and generalizing them across languages. In experiment 2, performance on SWIRL was better for direct-drive compared with skin-drive transmission conditions. These findings indicate that spoken word recall can be used to identify benefits from hearing aid signal processing at ecologically valid, positive SNRs where SRTs are insensitive.

Purpose Seeing the talker's face improves speech understanding in noise, possibly releasing resources for cognitive processing. We investigated whether it improves free recall of spoken two-digit numbers.

Method Twenty younger adults with normal hearing and 24 older adults with hearing loss listened to and subsequently recalled lists of 13 two-digit numbers, with alternating male and female talkers. Lists were presented in quiet as well as in stationary and speech-like noise at a signal-to-noise ratio giving approximately 90% intelligibility. Amplification compensated for loss of audibility.

Results Seeing the talker's face improved free recall performance for the younger but not the older group. Poorer performance in background noise was contingent on individual differences in working memory capacity. The effect of seeing the talker's face did not differ in quiet and noise.

Conclusions We have argued that the absence of an effect of seeing the talker's face for older adults with hearing loss may be due to modulation of audiovisual integration mechanisms caused by an interaction between task demands and participant characteristics. In particular, we suggest that executive task demands and interindividual executive skills may play a key role in determining the benefit of seeing the talker's face during a speech-based cognitive task

Objectives: This study considered speech modified by additive babble combined with noise-suppression processing. The purpose was to determine the relative importance of the signal modifications, individual peripheral hearing loss, and individual cognitive capacity on speech intelligibility and speech quality. Design: The participant group consisted of 31 individuals with moderate high-frequency hearing loss ranging in age from 51 to 89 years (mean = 69.6 years). Speech intelligibility and speech quality were measured using low-context sentences presented in babble at several signal-to-noise ratios. Speech stimuli were processed with a binary mask noise-suppression strategy with systematic manipulations of two parameters (error rate and attenuation values). The cumulative effects of signal modification produced by babble and signal processing were quantified using an envelope-distortion metric. Working memory capacity was assessed with a reading span test. Analysis of variance was used to determine the effects of signal processing parameters on perceptual scores. Hierarchical linear modeling was used to determine the role of degree of hearing loss and working memory capacity in individual listener response to the processed noisy speech. The model also considered improvements in envelope fidelity caused by the binary mask and the degradations to envelope caused by error and noise. Results: The participants showed significant benefits in terms of intelligibility scores and quality ratings for noisy speech processed by the ideal binary mask noise-suppression strategy. This benefit was observed across a range of signal-to-noise ratios and persisted when up to a 30% error rate was introduced into the processing. Average intelligibility scores and average quality ratings were well predicted by an objective metric of envelope fidelity. Degree of hearing loss and working memory capacity were significant factors in explaining individual listeners intelligibility scores for binary mask processing applied to speech in babble. Degree of hearing loss and working memory capacity did not predict listeners quality ratings. Conclusions: The results indicate that envelope fidelity is a primary factor in determining the combined effects of noise and binary mask processing for intelligibility and quality of speech presented in babble noise. Degree of hearing loss and working memory capacity are significant factors in explaining variability in listeners speech intelligibility scores but not in quality ratings.

Purpose: The purpose of this research forum article is to describe the impetus for holding the First International Meeting on Internet and Audiology (October 2014) and to introduce the special research forum that arose from the meeting. Method: The rationale for the First International Meeting on Internet and Audiology is described. This is followed by a short description of the research sections and articles appearing in the special issue. Six articles consider the process of health care delivery over the Internet; this includes health care specific to hearing, tinnitus, and balance. Four articles discuss the development of effective Internet-based treatment programs. Six articles describe and evaluate Internet-based interventions specific to adult hearing aid users. Conclusion: The fledgling field of Internet and audiology is remarkably broad. The Second International Meeting on Internet and Audiology ocurred in September 2015.

Purpose: Studies point to low help-seeking after a failed hearing screening. This research forum article presents the research protocol for a randomized controlled trial of motivational interviewing via the Internet to promote help-seeking in people who have failed an online hearing screening. Method: Adults who fail a Swedish online hearing screening, including a speech-in-noise recognition test, will be randomized to either an intervention group (participating in motivational interviewing) or an active control group (reading a book on history of hearing aids). Both of the conditions will be delivered via the Internet. The primary outcome is experience with seeking health care and using hearing aids 9 months after the intervention. Secondary outcomes are changes in before and after measures of self-reported hearing difficulties, anxiety, depression, and quality of life. Stages of change and self-efficacy in hearing help-seeking are measured immediately after intervention and at a 9-month follow-up for the purpose of mediation analysis. Results: The results of this randomized controlled trial may help bridge the gap between hearing screening and successful hearing rehabilitation. Conclusion: Although no large instantaneous benefits are expected, a slow change toward healthy behaviors-seeking health care and using hearing aids-would shed light on how to use the Internet to assist people with hearing impairment.

Purpose: The purpose of the two studies presented in this research forum article was to develop audiological rehabilitation programs for experienced hearing aid users and evaluate them in online versions. In this research forum article, the differences between the two studies are discussed. Method: Two randomized controlled trials (RCTs) were performed evaluating the efficacy of online rehabilitation, including professional guidance by an audiologist. In each RCT, the effects of the online programs were compared with the effects measured in a control group. Results: The results from the first RCT showed a significant increase in activity and participation for both groups with participants in the intervention group improving more than those in the control group. At the 6-month follow-up, after the study, the significant increase was maintained; however, amounts of increase in the two groups were no longer significantly different. The results from the second RCT showed significant increase in activity and participation for the intervention group, although the control group did not improve. Conclusions: The results from the RCTs provide evidence that the Internet can be used to deliver rehabilitation to hearing-aid users and that their problems are reduced by the intervention; however, the content of the online rehabilitation program requires further investigation.

Purpose: The purpose of this paper is to share the lessons that were learned about the process of implementing an Internet-based, randomized controlled trial (RCT) in general clinical practice (GCP) and to address some of the advantages of using the Internet as a tool to implement a RCT in GCP. The RCT implemented focused on investigating Internet-based aural rehabilitation (AR) in addition to hearing aid (HA)-fitting supplemented with telephone support, and it was applied in a clinical setting. The results of this RCT and the questionnaires chosen will be presented in an article elsewhere. Procedure: Here, the procedure of the implemented trial is presented, and the implementation challenges are presented and discussed. Specifically, we describe the trial research question, recruitment strategy, patient eligibility criteria, the questionnaires, clinician participation, funding and time (for the clinicians), and risks and benefits (for the participants). Discussion: The trial implementation showed that AR in addition to HA-fitting can be carried out in GCP using the Internet. Using an Internet-based RCT overcomes some of the challenges of implementing a trial in GCP.

The aim of the current study was to test the hypothesis that adults experiencing hearing difficulties who are aware of their difficulties but have not taken any action would fall under contemplation and preparation stages based on the transtheoretical stages-of-change model. The study employed a cross-sectional design. The study was conducted in United Kingdom and 90 participants completed University of Rhode Island Change Assessment (URICA) scale as well as measures of self-reported hearing disability, self-reported anxiety and depression, self-reported hearing disability acceptance, and provided additional demographic details online. As predicted, the results indicate that a high percentage of participants (over 90%) were in the contemplation and preparation stages. No statistically significant differences were observed among groups of stage with highest URICA scores and factors such as: years since hearing disability, self-reported hearing disability, self-reported anxiety and depression, and self-reported hearing disability acceptance. Cluster analysis identified three stages-of-change clusters, which were named as: decision making (53% of sample), participation (28% of sample), and disinterest (19% of sample). Study results support the stages-of-change model. In addition, implications of the current study and areas for future research are discussed.

Objectives: Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. Design: In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. Results: A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. Conclusions: The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

The main focus of this paper is to discuss the importance of “evaluating the process of change” (i.e., process evaluation) in people with disability by studying their lived experiences. Detailed discussion is made about “why and how to investigate the process of change in people with disability?” and some specific examples are provided from studies on patient journey of persons with hearing impairment (PHI) and their communication partners (CPs). In addition, methodological aspects in process evaluation are discussed in relation to various metatheoretical perspectives. The discussion has been supplemented with relevant literature. The healthcare practice and disability research in general are dominated by the use of outcome measures. Even though the values of outcome measures are not questioned, there seems to be a little focus on understanding the process of change over time in relation to health and disability. We suggest that the process evaluation has an additional temporal dimension and has applications in both clinical practice and research in relation to health and disability.

Listening in noise is often perceived to be effortful. This is partly because cognitive resources are engaged in separating the target signal from background noise, leaving fewer resources for storage and processing of the content of the message in working memory. The Auditory Inference Span Test (AIST) is designed to assess listening effort by measuring the ability to maintain and process heard information. The aim of this study was to use AIST to investigate the effect of background noise types and signal-to-noise ratio (SNR) on listening effort, as a function of working memory capacity (WMC) and updating ability (UA). The AIST was administered in three types of background noise: steady-state speech-shaped noise, amplitude modulated speech-shaped noise, and unintelligible speech. Three SNRs targeting 90% speech intelligibility or better were used in each of the three noise types, giving nine different conditions. The reading span test assessed VVMC, while UA was assessed with the letter memory test. Twenty young adults with normal hearing participated in the study. Results showed that AIST performance was not influenced by noise type at the same intelligibility level, but became worse with worse SNR when background noise was speech-like. Performance on AIST also decreased with increasing memory load level. Correlations between AIST performance and the cognitive measurements suggested that WMC is of more importance for listening when SNRs are worse, while UA is of more importance for listening in easier SNRs. The results indicated that in young adults with normal hearing, the effort involved in listening in noise at high intelligibility levels is independent of the noise type. However, when noise is speech-like and intelligibility decreases, listening effort increases, probably due to extra demands on cognitive resources added by the informational masking created by the speech fragments and vocal sounds in the background noise.

Individual differences in working memory capacity (WMC) are associated with speech recognition in adverse conditions, reflecting the need to maintain and process speech fragments until lexical access can be achieved. When working memory resources are engaged in unlocking the lexicon, there is less Cognitive Spare Capacity (CSC) available for higher level processing of speech. CSC is essential for interpreting the linguistic content of speech input and preparing an appropriate response, that is, engaging in conversation. Previously, we showed, using a Cognitive Spare Capacity Test (CSCT) that in young adults with normal hearing, CSC was not generally related to WMC and that when CSC decreased in noise it could be restored by visual cues. In the present study, we investigated CSC in 24 older adults with age-related hearing loss, by administering the CSCT and a battery of cognitive tests. We found generally reduced CSC in older adults with hearing loss compared to the younger group in our previous study, probably because they had poorer cognitive skills and deployed them differently. Importantly, CSC was not reduced in the older group when listening conditions were optimal. Visual cues improved CSC more for this group than for the younger group in our previous study. CSC of older adults with hearing loss was not generally related to WMC but it was consistently related to episodic long term memory, suggesting that the efficiency of this processing bottleneck is important for executive processing of speech in this group.

Background noise can make speech communication tiring and cognitively taxing, especially for individuals with hearing impairment. It is now well established that better working memory capacity is associated with better ability to understand speech under adverse conditions as well as better ability to benefit from the advanced signal processing in modern hearing aids. Recent work has shown that although such processing cannot overcome hearing handicap, it can increase cognitive spare capacity, that is, the ability to engage in higher level processing of speech. This paper surveys recent work on cognitive spare capacity and suggests new avenues of investigation.

Objective: Previous research shows that the internet can be used in the rehabilitation of hearing aid users. By further developing the online program, it might be possible to foster behavioral changes that will positively affect hearing aid users.

Design: A randomized controlled study with two groups of participants. The intervention group underwent a five-week online intervention while the control group was referred to a waiting-list. Questionnaires were used as outcome measures.

Study Sample: Seventy-six experienced hearing aid users participated in the study, ranging in age from 26 to 81 years (mean 69.3 years).

Results: The findings showed significant improvements in the intervention group after the intervention, measured by the Hearing Handicap Inventory for the Elderly. The effects were maintained and improved at the follow-up. Furthermore, the results indicated that the participants in the intervention group improved at two items of the International Outcome Inventory for Hearing Aids, and the effects were partly maintained at the followup. Finally, significant improvements in the domain of psychosocial wellbeing were found at the follow-up.

Conclusions: This study provides further evidence that the internet can be used to deliver intervention of rehabilitation to hearing aid users.

The present study aimed to investigate the changing relationship between aided speech recognition and cognitive function during the first six months of hearing aid use. Twentyseven first-time hearing aid users with symmetrical mild to moderate sensorineural hearing loss were recruited. Aided speech recognition thresholds in noise (SRTs) were obtained in the hearing aid fitting session as well as at three and six months post-fitting. Cognitive abilities were assessed using a reading span test, which is a measure of working memory capacity, and a cognitive test battery. Results showed a significant correlation between reading span and SRT during the hearing aid fitting session. This relation was significantly weakened over the first six months of hearing aid use. Multiple regression analysis showed that reading span was the main predictor of SRT when hearing aids were first fitted, but that pure-tone average hearing threshold (PTA) was the main predictor six months later. This indicates that working memory capacity plays a more important role in speech recognition in noise before than after six months of use. We argue that new hearing aid users engage working memory capacity to recognize unfamiliar processed speech signals but that as familiarization proceeds, engagement of working memory capacity is reduced.

Listening to speech in noise depletes cognitive resources, affecting speech processing. The present study investigated how remaining resources or cognitive spare capacity (CSC) can be deployed by young adults with normal hearing. We administered a test of CSC (CSCT; Mishra et al., 2013) along with a battery of established cognitive tests to 20 participants with normal hearing. In the CSCT, lists of two-digit numbers were presented with and without visual cues in quiet, as well as in steady-state and speech-like noise at a high intelligibility level. In low load conditions, two numbers were recalled according to instructions inducing executive processing (updating, inhibition) and in high load conditions the participants were additionally instructed to recall one extra number, which was the always the first item in the list. In line with previous findings, results showed that CSC was sensitive to memory load and executive function but generally not related to working memory capacity (WMC). Furthermore, CSCT scores in quiet were lowered by visual cues, probably due to distraction. In steady-state noise, the presence of visual cues improved CSCT scores, probably by enabling better encoding. Contrary to our expectation, CSCT performance was disrupted more in steady-state than speech-like noise, although only without visual cues, possibly because selective attention could be used to ignore the speech-like background and provide an enriched representation of target items in working memory similar to that obtained in quiet. This interpretation is supported by a consistent association between CSCT scores and updating skills.

Objectives For the last decade a host of different projects have been launched to allow persons who are concerned about their hearing status to quickly and at a low cost test their hearing ability. Most often, this is carried out without collecting complementary information that could be correlated with hearing impairment. In this two-part study we first, present the development and validation of a novel Internet-based hearing test, and second, report on the associations between this test and phonological representation, quality of life and self-reported hearing difficulties.

Design Cross-sectional study.

Setting An opportunity sample of participants was recruited at the Stockholm central station for the first study. All parts of the second study were conducted via the Internet, with testing and self-report forms adapted for online use.

Participants The first part of the study was carried out in direct contact with the participants, and participants from the second study were recruited by means of advertisements in newspapers and on webpages. The only exclusion criterion was that participants had to be over 18 years old. Most participants were between 60 and 69 years old. There were almost an equal number of men and women (total n=316).

Outcome measures 48 participants failed the Internet-based hearing screening test. The group failing the test reported more problems on the Amsterdam Inventory of Auditory Disability. In addition, they were found to have diminished phonological representational skills. However, no difference in quality of life was found.

Conclusions Almost one in five participants was in need of contacting their local hearing clinic. This group had more complaints regarding tinnitus and hyperacusis, rated their own hearing as worse than those who passed, and had a poorer capability of generating accurate phonological representations. This study suggests that it is feasible to screen for hearing status online, and obtain valid data.

PURPOSE:

The purpose of the present study was to evaluate the new Cognitive Spare Capacity Test (CSCT), which measures aspects of working memory capacity for heard speech in the audiovisual and auditory-only modalities of presentation.

METHOD:

In Experiment 1, 20 young adults with normal hearing performed the CSCT and an independent battery of cognitive tests. In the CSCT, they listened to and recalled 2-digit numbers according to instructions inducing executive processing at 2 different memory loads. In Experiment 2, 10 participants performed a less executively demanding free recall task using the same stimuli.

RESULTS:

CSCT performance demonstrated an effect of memory load and was associated with independent measures of executive function and inference making but not with general working memory capacity. Audiovisual presentation was associated with lower CSCT scores but higher free recall performance scores.

CONCLUSIONS:

CSCT is an executively challenging test of the ability to process heard speech. It captures cognitive aspects of listening related to sentence comprehension that are quantitatively and qualitatively different from working memory capacity. Visual information provided in the audiovisual modality of presentation can hinder executive processing in working memory of nondegraded speech material.

Objectives: It has been shown that noise reduction algorithms can reduce the negative effects of noise on memory processing in persons with normal hearing. The objective of the present study was to investigate whether a similar effect can be obtained for persons with hearing impairment and whether such an effect is dependent on individual differences in working memory capacity.

Design: A sentence-final word identification and recall (SWIR) test was conducted in two noise backgrounds with and without noise reduction as well as in quiet. Working memory capacity was measured using a reading span (RS) test.

Study sample: Twenty-six experienced hearing-aid users with moderate to moderately severe sensorineural hearing loss.

Results: Noise impaired recall performance. Competing speech disrupted memory performance more than speech-shaped noise. For late list items the disruptive effect of the competing speech background was virtually cancelled out by noise reduction for persons with high working memory capacity.

Conclusions: Noise reduction can reduce the adverse effect of noise on memory for speech for persons with good working memory capacity. We argue that the mechanism behind this is faster word identification that enhances encoding into working memory.

The objective of the study was to further the Ida Institute model on communication partner’s (CPs) journey through experiences of person with hearing impairment (PHI), based on the perspectives of CPs. Qualitative approach using thematic analysis and process mapping. Nine CPs of hearing aid users participated in the study, recruited through the Swansea hearing impaired support group. Semi-structured interviews were conducted and the data were used to develop a CP journey template. The Ida Institute model (based on professionals’ perspective) was compared with the new template developed (based on CPs perspectives). Seven main phases were identified which include: (1) contemplation; (2) awareness; (3) persuasion; (4) validation; (5) rehabilitation; (6) adaptation; and (7) resolution. The results suggest some commonalities and differences between the views of professionals and CPs. A new phase ‘adaptation’ was identified from CPs’ reported experiences, which was not identified by professionals in the Ida Institute model. The CP journey model could be a useful tool during audiological enablement/rehabilitation sessions to promote discussion between the PHI and the CP. In addition, it can be used in the training of hearing healthcare professionals.

OBJECTIVE:

The purpose of this study was to investigate the influence of the type of speech material on the benefit obtained from temporal fine structure (TFS) information in speech for young normal-hearing (YNH) and older hearing-impaired (OHI) participants.

DESIGN:

The design was based on the work of . They measured the speech reception thresholds for a target talker in a background talker as a function of the frequency range over which TFS information was available. The signal was split into 32 channels, each with a bandwidth equal to the equivalent rectangular bandwidth of the "normal" auditory filter at the same center frequency. Above a cutoff (CO) channel, channels were vocoded and contained only temporal envelope information. Channels up to and including CO were not processed. Hopkins et al. found that, as CO was increased, speech reception thresholds decreased more for normal-hearing participants than for participants with cochlear hearing loss, suggesting that the latter were less able to use TFS information. We used the same design, but compared results when the target speech materials were open-set sentences, as used by Hopkins et al., and when they were more predictable sentences with a closed word set (Danish Dantale 2).

RESULTS:

With the open-set material, YNH listeners benefited more from TFS information than OHI listeners, replicating . For the YNH participants, the benefit of adding TFS was greater for the open-set material than for the closed-set material, while no difference in TFS benefit across speech materials was found for the OHI participants.

CONCLUSIONS:

The choice of speech material is important when assessing the benefit of TFS. Several factors may facilitate recognition in the absence of TFS cues, including small set size, predictable temporal structure of the target speech, and contextual effects. We speculate that TFS information is useful for reducing informational masking, by providing cues for the perceptual segregation of the target and background. When the target speech is highly predictable, informational masking may be minimal, rendering TFS cues unnecessary.

Background

When evaluating hearing rehabilitation, it is reasonable to use self-report questionnaires as outcome measure. Questionnaires used in audiological research are developed and validated for the paper-and-pencil format. As computer and Internet use is increasing, standardized questionnaires used in the audiological context should be evaluated to determine the viability of the online administration format.

The aim of this study was to compare administration of questionnaires online versus paper- and pencil of four standardised questionnaires used in hearing research and clinic. We included the Hearing Handicap Inventory for the Elderly (HHIE), the International Outcome Inventory for Hearing Aids (IOI-HA), Satisfaction with Amplification in Daily Life (SADL), and the Hospital Anxiety and Depression Scale (HADS).

Methods

A cross-over design was used by randomly letting the participants complete the questionnaires either online or on paper. After 3 weeks the participants filled out the same questionnaires again but in the other format. A total of 65 hearing-aid users were recruited from a hearing clinic to participate on a voluntary basis and of these 53 completed both versions of the questionnaires.

Results

A significant main effect of format was found on the HHIE (p < 0.001), with participants reporting higher scores on the online format than in the paper format. There was no interaction effect. For the other questionnaires were no significant main or interaction effects of format. Significant correlations between the two ways of presenting the measures was found for all questionnaires (p<0.05). The results from reliability tests showed Cronbachs α’s above .70 for all four questionnaires and differences in Cronbachs α between administration formats were negligible.

Conclusions

For three of the four included questionnaires the participants’ scores remained consistent across administrations and formats. For the fourth included questionnaire (HHIE) a significant difference of format with a small effect size was found. The relevance of the difference in scores between the formats depends on which context the questionnaire is used in. On balance, it is recommended that the administration format remain stable across assessment points.

OBJECTIVE:

The purpose of this study was to investigate the influence of the type of speech material on the benefit obtained from temporal fine structure (TFS) information in speech for young normal-hearing (YNH) and older hearing-impaired (OHI) participants.

DESIGN:

The design was based on the work of . They measured the speech reception thresholds for a target talker in a background talker as a function of the frequency range over which TFS information was available. The signal was split into 32 channels, each with a bandwidth equal to the equivalent rectangular bandwidth of the "normal" auditory filter at the same center frequency. Above a cutoff (CO) channel, channels were vocoded and contained only temporal envelope information. Channels up to and including CO were not processed. Hopkins et al. found that, as CO was increased, speech reception thresholds decreased more for normal-hearing participants than for participants with cochlear hearing loss, suggesting that the latter were less able to use TFS information. We used the same design, but compared results when the target speech materials were open-set sentences, as used by Hopkins et al., and when they were more predictable sentences with a closed word set (Danish Dantale 2).

RESULTS:

With the open-set material, YNH listeners benefited more from TFS information than OHI listeners, replicating . For the YNH participants, the benefit of adding TFS was greater for the open-set material than for the closed-set material, while no difference in TFS benefit across speech materials was found for the OHI participants.

CONCLUSIONS:

The choice of speech material is important when assessing the benefit of TFS. Several factors may facilitate recognition in the absence of TFS cues, including small set size, predictable temporal structure of the target speech, and contextual effects. We speculate that TFS information is useful for reducing informational masking, by providing cues for the perceptual segregation of the target and background. When the target speech is highly predictable, informational masking may be minimal, rendering TFS cues unnecessary.

Objective: This study evaluated the quality and readability of English-language internet information for adults with hearing impairment and their significant others. Design: Two keyword pairs (hearing loss and hearing aids) were entered into five country-specific versions of the most commonly used internet search engine in May 2011. Sample: For each of the 10 searches, the first 10 relevant websites were included. After removing duplicates, a total of 66 websites were assessed. Their origin (commercial, non-profit organization, or government), date of last update, quality (Health On the Net (HON) certification and DISCERN scores), and readability (Flesch Reading Ease Score, Flesch-Kincaid Grade Level Formula, and Simple Measure Of Gobbledygook) were assessed. Results: Most websites were of commercial origin and had been updated within the last 18 months. Their quality and readability was highly variable. Only 14% of the websites had HON certification. Websites that were of non-profit organization origin had significantly higher DISCERN scores. Readability measures show that on average, only people with at least 11-12 years of education could read and understand the internet information presented. Conclusions: Based on these results, this article provides a list of recommendations for website developers and clinicians wishing to incorporate internet information into their practice.

OBJECTIVE:

This study investigated the perspectives of adults with hearing impairment on hearing help-seeking and rehabilitation.

DESIGN:

Individual semi-structured interviews were completed.

STUDY SAMPLE:

In total, 34 adults with hearing impairment in four countries (Australia, Denmark, UK, and USA) participated. Participants had a range of experience with hearing help-seeking and rehabilitation, from never having sought help to being satisfied hearing-aid users.

RESULTS:

Qualitative content analysis identified four main categories ('perceiving my hearing impairment', 'seeking hearing help', 'using my hearing aids', and 'perspectives and knowledge') and, at the next level, 25 categories. This article reports on the densest categories: they are described, exemplified with interview quotes, and discussed.

CONCLUSIONS:

People largely described hearing help-seeking and rehabilitation in the context of their daily lives. Adults with hearing impairment rarely described clinical encounters towards hearing help-seeking and rehabilitation as a connected process. They portrayed interactions with clinicians as isolated events rather than chronologically-ordered steps relating to a common goal. Clinical implications of the findings are discussed.

BACKGROUND:

Audiologic rehabilitation aims to improve communication for people with hearing impairment. Education is widely regarded as an integral part of rehabilitation, but the effect of the delivery method of an educational program on the experience of hearing problems has rarely been investigated in controlled trials.

PURPOSE:

The purpose of this study was to examine the short-term effects of complementing an educational program for hearing aid users with telephone consultations, delivered through weekly discussions with the subjects about information obtained from a book on hearing and hearing aids.

RESEARCH DESIGN:

This study used a randomized, controlled design.

STUDY SAMPLE:

In total, 69 hearing aid users were randomly assigned to an intervention group (n = 33) or a control group (n = 36).

INTERVENTION:

The intervention group had access to a book and received weekly topic-based reading instructions related to the different chapters of the book. Five telephone calls were made to the members of the intervention group. During the calls, an audiologist discussed new information with the participant as needed. The control participants also read the book, but they did not discuss the contents of the book with a professional.

DATA COLLECTION AND ANALYSIS:

The Hearing Handicap Inventory for the Elderly (HHIE), the Hospital Anxiety and Depression Scale (HADS), and the International Outcome Inventory for Hearing Aids (IOI-HA) were used to measure the outcomes of this study.

RESULTS:

Participants in the intervention group had a reduction in self-reported hearing handicap, while there were no significant changes in the control group. In the intervention group, 45% of the participants showed an improvement of ≥36% on the HHIE, while only 17% of the control group showed an improvement of ≥36%. There were also improvements on the HADS total and the depression subscale for the intervention group. No changes occurred on the IOI-HA.

CONCLUSIONS:

Reading about hearing and hearing aids can reduce the hearing handicap and reported anxiety in hearing aid users. In this study, discussing the content of the book that was provided with a professional during weekly telephone consultations and having weekly home assignments further improved emotional well-being, as demonstrated by the HHIE (emotional scale) and HADS (depression scale), but these activities had no effect on hearing aid outcomes as measured by the IOI-HA.

Stuart Gatehouse was one of the pioneers of cognitive hearing science. The ease of language understanding (ELU) model (Rönnberg) is one example of a cognitive hearing science model where the interplay between memory systems and signal processing is emphasized. The mismatch notion is central to ELU and concerns how phonological information derived from the signal, matches/mismatches phonological representations in lexical and semantic long-term memory (LTM). When signals match, processing is rapid, automatic and implicit, and lexical activation proceeds smoothly. Given a mismatch, lexical activation fails, and working or short-term memory (WM/STM) is assumed to be invoked to engage in explicit repair strategies to disambiguate what was said in the conversation. In a recent study, negative long-term consequences of mismatch were found by means of relating hearing loss to episodic LTM in a sample of old hearing-aid wearers. STM was intact (Rönnberg et al.). Beneficial shortterm consequences of a binary masking noise reduction scheme on STM was obtained in 4-talker babble for individuals with high WM capacity, but not in stationary noise backgrounds (Ng et al.). This suggests that individuals high on WM capacity inhibit semantic auditory distraction in 4-talker babble while exploiting the phonological benefits in terms of speech quality provided by binary masking (Wang). Both long-term and short-term mismatch effects, apparent in data sets including behavioral as well as subjective (Rudner et al.) data, need to be taken into account in the design of future hearing instruments.

Background: By using the Internet in the audiological rehabilitation process, it might be possible in a cost-effective way to include additional rehabilitation components by informing and guiding hearing aid users about such topics as communication strategies, hearing tactics, and how to handle hearing aids. Purpose: To evaluate the effectiveness of an online education program for adult experienced hearing aid users including professional guidance by an audiologist and compare it with the effects of participation in an online discussion forum without any professional contact. Research Design: A randomized controlled study with two groups of participants. Repeated measures at prestudy, immediate follow-up, and a 6 mo follow-up. Study Sample: Fifty-nine experienced hearing aid users participated in the study, ranging in age from 24 to 84 yr (mean 63.5 yr). Intervention: The intervention group (N=29) underwent a five-week rehabilitative online education in which activities for each week included information, tasks, and assignments, and contact with a professional audiologist was included. The participants in the control group (N=30) were referred to an online discussion forum without any audiologist contact.. Data Collection and Analysis: A set of questionnaires administered online were used as outcome measures: (1) Hearing Handicap Inventory for the Elderly, (2) International Outcome Inventory for Hearing Aids, (3) Satisfaction with Amplification in Daily Life, and (4) Hospital Anxiety and Depression Scale. Results: Significant improvements measured by the Hearing Handicap Inventory for the Elderly were found in both groups of participants, and the effects were maintained at the 6 mo follow-up. The results on the Hospital Anxiety and Depression Scale showed that the participants in the intervention group showed reduced symptoms of depression immediately/6 mo after the intervention. At the 6 mo follow-up participants in the control group reported fewer symptoms of anxiety than they did before the intervention started. Conclusions: This study provides preliminary evidence that the Internet can be used to deliver education to experienced hearing aid users who report residual hearing problems such that their problems are reduced by the intervention. The study also suggests that online discussion forums could be used in rehabilitation. A combination of online professional supervised education and online informal discussions could be a promising rehabilitation tool.

Intelligibility of ideal binary masked noisy speech was measured on a group of normal hearing individuals across mixture signal to noise ratio (SNR) levels, masker types, and local criteria for forming the binary mask. The binary mask is computed from time-frequency decompositions of target and masker signals using two different schemes: an ideal binary mask computed by thresholding the local SNR within time-frequency units and a target binary mask computed by comparing the local target energy against the long-term average speech spectrum. By depicting intelligibility scores as a function of the difference between mixture SNR and local SNR threshold, alignment of the performance curves is obtained for a large range of mixture SNR levels. Large intelligibility benefits are obtained for both sparse and dense binary masks. When an ideal mask is dense with many ones, the effect of changing mixture SNR level while fixing the mask is significant, whereas for more sparse masks the effect is small or insignificant.

Intelligibility of ideal binary masked noisy speech was measured on a group of normal hearing individuals across mixture signal to noise ratio (SNR) levels, masker types, and local criteria for forming the binary mask. The binary mask is computed from time-frequency decompositions of target and masker signals using two different schemes: an ideal binary mask computed by thresholding the local SNR within time-frequency units and a target binary mask computed by comparing the local target energy against the long-term average speech spectrum. By depicting intelligibility scores as a function of the difference between mixture SNR and local SNR threshold, alignment of the performance curves is obtained for a large range of mixture SNR levels. Large intelligibility benefits are obtained for both sparse and dense binary masks. When an ideal mask is dense with many ones, the effect of changing mixture SNR level while fixing the mask is significant, whereas for more sparse masks the effect is small or insignificant.

The working memory model for Ease of Language Understanding (ELU) proposes that language understanding under taxing conditions is related to explicit cognitive capacity. We refer to this as the mismatch hypothesis, since phonological representations based on the processing of speech under established conditions may not be accessed so readily when input conditions change and a match becomes problematic. Then, cognitive capacity requirements may differ from those used for processing speech hitherto. In the present study, we tested this hypothesis by investigating the relationship between aided speech recognition in noise and cognitive capacity in experienced hearing aid users when there was either a match or mismatch between processed speech input and established phonological representations. The settings in the existing digital hearing aids of the participants were adjusted to one of two different compression settings which processed the speech signal in qualitatively different ways ("fast" or "slow"). Testing took place after a 9-week period of experience with the new setting. Speech recognition was tested under different noise conditions and with match or mismatch (i.e. alternative compression setting) manipulations of the input signal. Individual cognitive capacity was measured using a reading span test and a letter monitoring test. Reading span, a reliable measure of explicit cognitive capacity, predicted speech recognition performance under mismatch conditions when processed input was incongruent with recently established phonological representations, due to the specific hearing aid setting. Cognitive measures were not main predictors of performance under match conditions. These findings are in line with the ELU model.

Purpose: The aim of this study was to develop and validate an interview instrument for assessing outcome following hearing aid fitting based on clinical global impressions.

Method: The Audiological Rehabilitation Clinical Global Impression (AR-CGI) was developed and used in a telephone interview in two separate samples. The first sample (N=69) consisted of hearing aid owners who had participated in two intervention studies and the second sample consisted of hearing aid owners receiving regular services from a hearing clinic (N=21). Following the structured telephone interview, participants were categorized into three categories: Successful, Successful with some limitations, or Unsuccessful.

Results: A vast majority were categorized as Successful (80% of the intervention sample and 71% of the clinical sample). Those categorized as successful were found to differ from those categorized as less successful in terms of age and self-reported hearing aid use, depressed mood, and residual participation restriction, but they did not differ in terms of degree of hearing loss.

Conclusion: It is suggested that the brevity and usefulness of the AR-CGI makes it a potential tool for further use in audiological settings.

For a given mixture of speech and noise, an ideal binary time-frequency mask is constructed by comparing speech energy and noise energy within local time-frequency units. It is observed that listeners achieve nearly perfect speech recognition from gated noise with binary gains prescribed by the ideal binary mask. Only 16 filter channels and a frame rate of 100Hz are sufficient for high intelligibility. The results show that, despite a dramatic reduction of speech information, a pattern of binary gains provides an adequate basis for speech perception

Rudner et al (2008) showed that when compression release settings are manipulated in the hearing instruments of Swedish habitual users, the resulting mismatch between the phonological form of the input speech signal and representations stored in long-term memory leads to greater engagement of explicit cognitive processing under taxing listening conditions. The mismatch effect is manifest in significant correlations between performance on cognitive tests and aided-speech-recognition performance in modulated noise and/or with fast compression release settings. This effect is predicted by the ELU model (Ronnberg et al, 2008). In order to test whether the mismatch effect can be generalized across languages, we examined two sets of aided speech recognition data collected from a Danish population where two cognitive tests, reading span and letter monitoring, had been administered. A reanalysis of all three datasets, including 102 participants, demonstrated the mismatch effect. These findings suggest that the effect of phonological mismatch, as predicted by the ELU model (Ronnberg et al, this issue) and tapped by the reading span test, is a stable phenomenon across these two Scandinavian languages.

Objectives: The working memory framework for Ease of Language Understanding predicts that speech processing becomes more effortful, thus requiring more explicit cognitive resources, when there is mismatch between speech input and phonological representations in long-term memory. To test this prediction, we changed the compression release settings in the hearing instruments of experienced users and allowed them to train for 9 weeks with the new settings. After training, aided speech recognition in noise was tested with both the trained settings and orthogonal settings. We postulated that training would lead to acclimatization to the trained setting, which in turn would involve establishment of new phonological representations in long-term memory. Further, we postulated that after training, testing with orthogonal settings would give rise to phonological mismatch, associated with more explicit cognitive processing.

Design: Thirty-two participants (mean = 70.3 years, SD = 7.7) with bilateral sensorineural hearing loss (pure-tone average = 46.0 dB HL, SD = 6.5), bilaterally fitted for more than 1 year with digital, two-channel, nonlinear signal processing hearing instruments and chosen from the patient population at the Linkooping University Hospital were randomly assigned to 9 weeks training with new, fast (40 ms) or slow (640 ms), compression release settings in both channels. Aided speech recognition in noise performance was tested according to a design with three within-group factors: test occasion (T1, T2), test setting (fast, slow), and type of noise (unmodulated, modulated) and one between-group factor: experience setting (fast, slow) for two types of speech materials-the highly constrained Hagerman sentences and the less-predictable Hearing in Noise Test (HINT). Complex cognitive capacity was measured using the reading span and letter monitoring tests.

Prediction: We predicted that speech recognition in noise at T2 with mismatched experience and test settings would be associated with more explicit cognitive processing and thus stronger correlations with complex cognitive measures, as well as poorer performance if complex cognitive capacity was exceeded.

Results: Under mismatch conditions, stronger correlations were found between performance on speech recognition with the Hagerman sentences and reading span, along with poorer speech recognition for participants with low reading span scores. No consistent mismatch effect was found with HINT.

Conclusions: The mismatch prediction generated by the working memory framework for Ease of Language Understanding is supported for speech recognition in noise with the highly constrained Hagerman sentences but not the less-predictable HINT.

This study which included 23 experienced hearing aid users replicated several of the experiments reported in Gatehouse et al (2003, 2006) with new speech test material, language, and test procedure. The performance measure used was SNR required for 80% correct words in a sentence test. Consistent with Gatehouse et al, this study indicated that subjects showing a low score in a cognitive test (visual letter monitoring) performed better in the speech recognition test with slow time constants than with fast time constants, and performed better in unmodulated noise than in modulated noise, while subjects with high scores on the cognitive test showed the opposite pattern. Furthermore, cognitive test scores were significantly correlated with the differential advantage of fast-acting versus slow-acting compression in conditions of modulated noise. The pure tone average threshold explained 30% of the variance in aided speech recognition in noise under relatively simple listening conditions, while cognitive test scores explained about 40% of the variance under more complex, fluctuating listening conditions, where the pure tone average explained less than 5% of the variance. This suggests that speech recognition under steady-state noise conditions may underestimate the role of cognition in real-life listening.

Two experiments were conducted to investigate possible relationships between cognitive function and hearing aid use. In Experiment 1. 72 first-time hearing aid users were tested for speech recognition in noise (Hagerman sentence test) with and without hearing aids. Cognitive function was assessed by tests of working memory (reading span test) and verbal information-processing speed. The results indicate that. after controlling for age and hearing loss, significant correlations exist between the measures of cognitive performance and speech recognition in noise, both with and without hearing aids. High cognitive performance was associated with high performance in the speech recognition task. In Experiment 2, 17 first-time hearing aid users with either high or low working-memory capacity tested ail experimental hearing aid which processed the sound differently depending on whether or not speech was detected. The results revealed that those with high working-memory capacity were better than those with low capacity at identifying and reporting the specific processing effects of the aid. This may have implications for how reported results should be interpreted in a research context, how a person's rehabilitation needs are formulated, and how hearing aid controls should be supervised. In conclusion, careful attention should be paid to the cognitive status of listeners, as it can have a significant influence on their ability to utilize their hearing aids.

Objective: The aim of the current study was to assess aided speech-in-noise outcomes and relate those measures to auditory sensitivity and processing, different types of cognitive processing abilities, and signal processing in hearing aids.

Material and method: Participants were 200 hearing-aid wearers, with a mean age of 60.8 years, 43% females, with average hearing thresholds in the better ear of 37.4 dB HL. Tests of auditory functions were hearing thresholds, DPOAEs, tests of fine structure processing, IHC dead regions, spectro-temporal modulation, and speech recognition in quiet (PB words). Tests of cognitive processing function were tests of phonological skills, working memory, executive functions and inference making abilities, and general cognitive tests (e.g., tests of cognitive decline and IQ). The outcome test variables were the Hagerman sentences with 50 and 80% speech recognition levels, using two different noises (stationary speech weighted noise and 4-talker babble), and three types of signal processing (linear gain, fast acting compression, and linear gain plus a non-ideal binary mask). Another sentence test included typical and atypical sentences with contextual cues that were tested both audio-visually and in an auditory mode only. Moreover, HINT and SSQ were administrated.

Analysis: Factor analyses were performed separate for the auditory, cognitive, and outcome tests.

Results: The auditory tests resulted in two factors labeled SENSITIVITY and TEMPORAL FINE STRUCTURE, the cognitive tests in one factor (COGNITION), and the outcome tests in the two factors termed NO CONTEXT and CONTEXT that relates to the level of context in the different outcome tests. When age was partialled out, COGNITION was moderately correlated with the TEMPORAL FINE STRUCTURE and NO CONTEXT factors but only weakly correlated with the CONTEXT factor. SENSITIVITY correlated weakly with TEMPORAL FINE STRUCTURE and CONTEXT, and moderately with NO CONTEXT, while TEMPORAL FINE STRUCTURE showed weak correlation with CONTEXT and moderate correlation with NO CONTEXT. CONTEXT and NO CONTEXT had a  moderate correlation. Moreover, the overall results of the Hagerman sentences showed 0.9 dB worse SNR with fast acting compression compared with linear gain and 5.5 dB better SNR with linear  gain and noise reduction compared with only linear gain.

Conclusions: For hearing aid wearers, the ability to recognize speech in noise is associated with both sensory and cognitive processing abilities when the speech materials have low internal context. These associations are less prominent when the speech material has contextual cues.

The working memory plays an important role in successfully overcoming adverse listening conditions and should consequently be considered when designing and testing hearing aids. A number of studies have established the relationship between hearing in noise and working memory involvement, but with the Sentence-final Word Identification and Recall (SWIRL) test, it is possible to show that working memory is also involved in listening under favorable conditions and that noise reduction has a positive influence in situation with very little noise. Although the capacity of the working memory is a finite individual size, its involvement can differ with fatigue and other factors and individualization of hearing aids should take this into account to obtain the best performance. A way of individually adapting hearing aids is based on changes in the electrical activity of the brain (EEG). Here we present the possibilities that arise from using EEG and show that ear-mounted electrodes is able to record useful EEG that can be explored for individualization of hearing aids. Such an adaptation could be done based on changes in the electrical activity of the brain (EEG). Here we present the possibilities that arise from using EEG and show that ear-mounted electrodes is able to record useful EEG that can be explored for individualization of hearing aids.

Hearing loss is common, but often both undetected and untreated. In this two-part study we evaluated an online hearing test and used this test to explore potential links between hearing status, cognitive abilities, psychological distress as well as quality of life.

Out of a total of 1370 online recruited participants who completed the procedure, 16.2% failed the online hearing test. Hearing difficulties were more prevalent among the older participants. Poor self-rated hearing ability, as measured by the Amsterdam Inventory of Auditory Handicap, increased the odds ratio for failing the hearing test (OR 2.34, 95 % CI 1.74-3.15). The same was true for scoring above the cut-off score of 11 on the anxiety subscale on the Hospital Anxiety and Depression Scale (OR 2.55, 95 % CI 1.22-5.33). On the other hand, good performance on the cognitive tasks lowered the risk for a failed hearing test.

We conclude that online hearing tests may have the potential to reduce the time lag between noticing hearing difficulties and beginning a process to address the problem. Moreover, online data collection facilitate large scale investigations on the links between hearing, cognition and perceived communication and mental health problems.

Background noise makes listening more cognitively demanding, especially for persons with hearingimpairment, and this seems to aect memory encoding. It is not clear whether this decrement can berestored by providing visual cues. In the present study, we investigated whether long term memoryencoding of speech, in quiet and in background noise adjusted to retain intelligibility, improves whenthe talkers face is visible, and whether such an enhancement is associated with working memorycapacity. Twenty adults with normal hearing in Experiment 1 and 24 adults with hearing loss inExperiment 2 listened to lists of 13 two-digit numbers, with or without seeing the talkers face, andthen recalled as many numbers as possible in any order. The lists were presented in quiet as wellin a steady-state speech-weighted noise and the International Speech Testing Signal at a signal-tonoiseratio individually adapted to give an intelligibility level of approximately 90%. Amplicationcompensated for loss of audibility. Working memory capacity was measured using the reading spantest. Seeing the talkers face did enhance free recall performance. However, whereas the eect size foradults with normal hearing was large, for adults with hearing impairment it was small. Further, therewas no evidence that visual cues specically compensated for performance decrements due to noiseor serial position and there was no evidence of an association between working memory capacity andperformance with visual cues. However, good working memory capacity did improve performance forearly list items, reecting facilitation of long-term memory encoding, for both groups when stimuliwere presented in steady-state noise. For participants with hearing impairment, good working memorycapacity was associated with good performance on late list items in quiet, reecting facilitationof working memory encoding. This pattern of results indicates that steady-state background noisereduces the cognitive capacity available for the long-term memory encoding of speech that is necessaryfor enduring retention of spoken information, irrespective of hearing status, but provides no evidencethat this is specically compensated for by visual cues. It also demonstrates that for individuals withhearing impairment, short term retention of speech heard even under the most favourable conditionsis a function of individual working memory capacity. These ndings support and extend the Ease ofLanguage Understanding Model.

Performance of hearing aid signal processing is often assessed by speech intelligibility in noisetests, such as the HINT, CRM, or SPIN sentences presented in a background of noise or babble.Usually these tests are most sensitive at a signal-to-noise ratio (SNR) below 0 dB. However, in arecent study by Smeds et al. (2012) it was shown that the SNRs in ecological listening situations(e.g. kitchen, babble, and car) were typically well above 0 dB SNR. That is, SNRs where the speechintelligibility in noise tests are insensitive.Cognitive Spare Capacity (CSC) refers to the residual capacity after successful speech perception.In a recent study by Ng et al. (2010), we dened the residual capacity to be number of words recalledafter successful listening to a number of HINT sentences, inspired by Sarampalis et al. (2009).In a recent test with 26 hearing impaired test subjects we showed that close to 100% correctspeech intelligibility in a four talker babble noise required around + 7 dB SNR. At that SNR it wasshown that a hearing aid noise reduction scheme improved memory recall by about 10-15%. Thus,this kind of memory recall test is a possible candidate for assessment of hearing aid functionality inecologically relevant (positive) SNRs

This paper considers evidence of plasticity resulting from congenital and acquired hearing impairment as well as technical and language interventions. Speech communication is hindered by hearing loss. Individuals with normal hearing in childhood may experience hearing loss as they grow older and use technical and cognitive resources to maintain speech communication.The short- and medium-term effects of hearing aid interventions seem to be mediated by individual cognitive abilities and may be specific to listening conditions including speech content, type of background noise and type of hearing aid signal processing. Furthermore, some aspects of cognitive function may decline with age and there is evidence that age-related hearing impairment is associated with poorer long-term memory. It is not yet clear whether improving audition through hearing aid intervention can prevent cognitive decline. Profound deafness from an early age implicates a set of critical choices relating to possible restoration of the auditory signal through the use of prostheses including cochlear implants and hearing aids as well as tomode of communication, sign or speech. These choices have an influence on the organization of the developing brain. In particular, while the cortex may display sensory reorganization in response the linguistic modality of choice, cognitive organization seems to prevail.

Several recent studies have shown a relationship between working memory and the ability of older adults to benefit from specific advanced signal processing algorithms in hearing aids. In this study, we quantify tradeoffs between benefit due to noise reduction and the perceptual costs associated with distortion caused by the noise reduction algorithm. We also investigate the relationship between these tradeoffs and working memory abilities. Speech intelligibility, speech quality and perceived listening effort were measured in a cohort of elderly adults with hearing loss. Test materials were low-context sentences presented in fluctuating noise conditions at several signal-to-noise ratios. Speech stimuli were processed with a binary mask noise-reduction strategy. The amount of distortion produced by the noise reduction algorithm was parametrically varied by manipulating two binary mask parameters, error rate and attenuation rate. Working memory was assessed with a reading span test. Results will be discussed in terms of the extent to which intelligibility, quality and effort ratings are explained by the amount of distortion and/or noise and by working memory ability.[Funded by NIH, Oticon and GN ReSound]

Hearing instruments use complex processing anticipatedto improve speech understanding. While many listenersbenefit from such processing, others do not and thesedifferences are potentiated by adverse listening conditions.Unwanted artefacts of hearing aid signal processing maycontribute to adverse listening conditions (Mattys et al.,2012). Under such conditions cognitive processingresources are allocated to the recovery of degradedinformation at the auditory periphery, leaving fewerresources for understanding the message.Working memory refers to the capacity to hold andmanipulate a set of items in mind, such as speechfragments. A number of recent studies indicate thatindividual working memory capacity influences theindividual benefit of hearing aid signal processing. Ng etal., (under revision) examined the effects of binarymasking noise reduction (Wang et al., 2009) in hearingaids on memory processing of speech perceived in acompeting speech background, using a sentence-finalword identification and recall test. The reading span testwas also administered. The reading span test assessesthe simultaneous processing and memory aspects ofworking memory. Noise reduction lowered the negativeeffect of noise on memory performance. Participants withgood working memory capacity obtained a further benefit.Lunner and Sundewall-Thorén (2007), among others,showed that the individual benefit of fast wide dynamicrange compression was associated with individual workingmemory capacity. Persons with high working memorycapacity benefited most from fast acting compression whilethe persons with low working memory capacity benefitedmost from slow acting compression. Arehart, Souza, Bacaand Kates (in press) showed that elderly individuals withlow working memory capacity were more disadvantagedby frequency compression processing during speechrecognition in noise than elderly individuals with highworking memory capacity. It is possible that the negativeeffects of fast acting wide dynamic compression andfrequency compression for persons with low workingmemory are due to unwanted artefacts of signalprocessing.In conclusion, the benefits of certain givenimplementations of complex processing in hearing aidshave to be weighed against the extra cognitive load thatsuch processing seems to engender, possibly as a resultof unwanted artefacts. Although complex processing mayaid speech understanding in noise for individuals withhearing impairment and especially those with goodworking memory capacity, it seems that for someindividuals with lower working memory capacity, thedrawbacks may outweigh the benefits. This should betaken into account when hearing aids are fitted.

Performance of hearing aid signal processing is often assessed by speech intelligibility in noise tests, such as the HINT, CRM, or SPIN sentences presented in a background of noise or babble. Usually these tests are most sensitive at a signal-to-noise ratio (SNR) below 0 dB. However, in a recent study by Smeds et al. (2012) it was shown that the SNRs in ecological listening situations (e.g. kitchen, babble, and car) were typically well above 0 dB SNR. That is, SNRs where the speech intelligibility in noise tests are insensitive.Cognitive Spare Capacity (CSC) refers to the residual capacity after successful speech perception. In a recent study by Ng et al. (2010), we defined the residual capacity to be number of words recalled after successful listening to a number of HINT sentences, inspired by Sarampalis et al. (2009).In a recent test with 26 hearing impaired test subjects we showed that close to 100% correct speech intelligibility in a four talker babble noise required around + 7 dB SNR. At that SNR it was shown that a hearing aid noise reduction scheme improved memory recall by about 10-15%. Thus, this kind of memory recall test is a possible candidate for assessment of hearing aid functionality in ecologically relevant (positive) SNRs.

The cognitive spare capacity test (CSCT) assesses the ability to process heardinformation stored in working memory. This is important because listening that iseffortful, due to noise or hearing impairment, consumes cognitive resources leavingless capacity available for further processing. The CSCT pinpoints the effectsof modality of presentation (Audiovisual, Audio-only); memory load (High, Low)and different kinds of executive processing demands (Updating, Inhibition). Inthe present study, 24 participants with mild to moderate hearing loss performedCSCT with amplification in quiet, in steady-state noise at an individually adaptedsignal to noise ratio (SNR) rendering intelligibility of ~95% and in modulatednoise (International Speech Test Signal; ISTS) at the same SNR. An independentbattery of cognitive tests was also administered. Analysis of variance showedmain effects of all factors, including better performance with Audiovisual thanAudio-only modality. However, a significant interaction revealed that the Audiovisualbenefit was most prominent in ISTS. The benefit of Audiovisual presentationover Audio-only presentation correlated with the independent measure of workingmemory capacity. The pattern of results suggests that for the hearing impairedpopulation, Audiovisual presentation supports cognitive processing of informationheard in modulated noise and that the magnitude of this benefit is related toworking memory capacity.

In a program grant from the Swedish Council for Working Life and Social Research we are investigating the use of modern information technology in hearing rehabilitation in a broad sense. We use the Internet in this research when we study hearing impaired persons from when the loss is detected to whe  intervention is implemented. In the research we intend to survey online resources, implement selfscreening both in terms of self-assessments and actual hearing screening on the Internet, use online cognitive tests, use the Internet for medical support system aimed to be integrated in health care, test if motivational interviewing methods can be used to facilitate the decision process when seeking treatment, develop and test online counselling for hearing impaired persons, use more open-ended qualitative methods to probe the experiences of acceptance versus experiential avoidance, and finally develop and test web resources for significant others (e.g. parents of children, adult children of older adults without access to the Internet). The program is divided into nine subprojects that are at different stages of their execution. This presentation will give an overview of the activities and outcomes so far in the FAS-IT program.

IntroductionFor some time now it has been acknowledged that there isa link between speech performance in noise, benefit fromamplification and DSP features and non-auditory factors,such as cognitive skills. [Humes, Lunner].The present study aims at 1) confirming this claim and 2)looking directly at the benefit of directionality in a complexfrontal listening task depending on the individual skills asassessed by a number of screening measures.

People with health conditions and their significant others are increasingly turning to the Internet for health information. Accessing health information is, after email and search engine use, the third most common Internet activity (Pew Internet. 2011 ). For people facing a health decision, Internet is the second most influential source of information after clinician advice (Couper et al., 2010). Searching the Internet for a significant other’s health condition is also common (Pew Internet, 2011 ). However, clients do not always methodically analyse the quality of health information accessed on the Internet. For this reason, quality of Internet health information has been widely studied and has been found to vary greatly (for a systematic review, see Eysenbach, Powell, Kuss, & Sa, 2002). In audiology, it is largely unknown whether adults with hearing impairment and their significant others are informed or misinformed by the hearing impairment information they access on the Internet. This study aims to evaluate the Internet hearing information available to people with hearing impairment and their significant others. More specifically, the study is assessing the quality and readability of English-language websites available as of 2011. This study’s methods and emerging results are presented and discussed.

It has been demonstrated that the benefit of signal processing intended for hearingaids is not limited to improvement in speech perception. Sarampalis et al.(2009) showed that the Ephraim-Malah noise reduction algorithm improvedcognitive performance and reduced listening effort for people with normal hearing.However, similar effects for hearing-impaired listeners have not been reported.The present study examines the effect of noise reduction in hearing aidson memory processing of speech perceived in stationary noise and competingspeech background. Twenty-six experienced hearing aid users with symmetricalsensorineural hearing loss were tested. A dual task paradigm, which consists ofa perceptual speech recognition task and a free recall memory task, was used tomeasure the cognitive outcomes with the use of binary time-frequency maskingnoise reduction technique (Wang et al., 2009). Working memory capacity wasmeasured using a reading span test. Results showed that free recall performancein the competing speech background improved with noise reduction in listenerswith better working memory capacity. No such improvement was found in thestationary noise. Listeners with better working memory also performed better inthe stationary noise than in the competing speech background. No effect of backgroundnoises or noise reduction was observed in listeners with limited workingmemory capacity. The study demonstrates that binary masking noise reductiontechnique enhances memory performance in competing speech background forpersons with good working memory capacity. In other words, working memorycapacity also predicts benefit of noise reduction signal processing.

Traditionally, hearing instrument signal processing schemes are evaluated where the speech recognition tests in noise are most sensitive, i.e. around 50 percent correct. However, such testing typically leads to ecologically unrealistic negative signal-to-noise ratios. Therefore, memory performance has been suggested as a more ecologically valid outcome measure in conditions with interfering background noises, and where participants perform closer to 100 percent correct. In a recent study by Sarampalis et al. (2009) they used an Ephraim-Mallah noise reduction algorithm and found beneficial effects for normal hearing participants on memory function. However, such memory effects have not been shown for hearing impaired participants. The current study on hearing-impaired subjects evaluated ‘aggressive’ ideal binary masking (IBM, see Wang, et al., 2009), as a proof-of-concept not only for improving speech comprehension but also for its potential effects of masking on memory systems. Furthermore, binary masks estimated from directional microphones (Boldt et al., 2008) were used as a realistic version of binary mask processing. Results show significant main effects of noise type and noise reduction. Noise reduction techniques improved the memory performance in the four-talker babble background, while no such improvement was observed in the steady-state noise background. Participants with higher reading span scores performed significantly better in the memory task, but only in the four-talker babble background.The study demonstrates the binary-masking noise reduction technique helps freeing up cognitive resources and hence enhances memory task performance in the four-talker babble background for hearing-impaired listeners with high reading span performance. The findings suggest that there is a cognitive challenge for the hearing aid industry to improve signal processing options for individuals to improve immediate perception and encoding into memory.

One aim of hearing aid fitting is to reduce the effort of understanding speech, especially in noisy environments. For a good hearing aid fitting, knowledge about the patient’s auditory abilities is necessary, but knowledge about cognitive abilities may also be important.

The Auditory Inference Span Test (AIST) is a dual-task hearing-in-noise test, that combines auditory and memory processing. In AIST, Hagerman sentences are presented in steady state speech-shaped noise at -2dB, -4dB or -6dB SNR and the subject is required to recall and process the information from the sentences by giving button-press responses to multiple-choice questions thereby assessing what the subject could infer from what was heard.

AIST will be administered to 40 normal hearing subjects (29 to date) and performance related to speech reception threshold, working memory capacity and updating ability, as well as subjective rating of listening effort. Preliminary results show a greater SNR-related improvement in AIST scores at low SNRs than can be explained by improved audibility alone, consistent with release of memory resources due to reduced listening effort. There is also a trend towards a positive relationship between AIST scores and individual working memory capacity and updating ability.

• Binaural hearing is necessary for localizing sounds accurately, and for making sense of complex listeningenvironments with many sound sources.• It is important to understand which binaural cues are beneficial for spatial hearing in hearing aid users toinform hearing aid design.• Temporal fine structure, TFS, is thought to be important for voice recognition, segregation of competingtalkers, and listening in the dips of a fluctuating background (Hopkins et al., 2008; Zeng et al., 2005; Lorenzi etal., 2006). Hearing-impaired listeners have a reduced ability to use TFS information (Moore et al., 2006;Hopkins and Moore, 2007; Hopkins and Moore, 2010).• Hopkins and Moore (2010) developed a fast method for measuring sensitivity to binaural TFS (the ability to detectinteraural phase differences, IPD, of pure tones) at low frequencies: the TFS-LF test.• To investigate possible correlations between binaural TFS abilities and spatial hearing, the opportunity wastaken to make use of some earlier data on aided spatial release from masking (Neher et al., 2009). In thatstudy, large inter-subject variation in spatial release from masking was observed, and it was hypothesized thatthis variation could be related to binaural TFS abilities. The TFS-LF test was used with the same subjects as tested byNeher et al.

Recent studies on hearing rehabilitation with group discussions show similar long-term benefits as conventional professional counselling (Abrams et al., 2002; Hickson et al., 2007). The use of professional support for self-help via Internet may reduce anxiety and depression (Andersson et al., 2005). Inspired by those results, we created an online discussion forum for self-help where 29 experienced hearing-aid users communicated, on their own for five weeks. Each week they started the discussions from a given topic, without any professional assistance. We measured their reported subjective hearing problems online using standardized questionnaires (HHIE, IOI-HA and SADL) pre and post the online intervention. The findings show that the participants reduced their reported subjective hearing problems significantly by taking part in the discussions. Six months after the online intervention was finished the significant reduction was persistent.

By using manifest qualitative content analysis of the participants’ online communication we will present results including typical categories and themes in the discussions, as well as peer-to-peer helping behavior.

The findings indicates that interacting with peers have a positive significant effect on the long-term outcome of their hearing rehabilitation. Further development of this tool could be a very useful instrument in the rehabilitation of hearing impaired adults.

References: Abrams, H., Chisholm., T. H., McArdle, R. (2002). A cost-utility analysis of adults group audiologic rehabilitation: Are the benefits worth the cost? Journal of Rehabilitation Research and Development, 5, 549-558.

Andersson, G., Bergström, J., Carlbring, P., Lindefors, N. (2005). The use of internet in the treatment of anxiety disorders. Current opinion in Psychiatry, 18, 73-77.

Hickson, L., Worrall, L., Scarinci, N. (2007). A randomized controlled trial evaluating the Active Communication Education program for older people with hearing impairment. Ear and Hearing, 28, 212-230.

The ideal binary mask is often seen as a goal for time-frequencymasking algorithms trying to increase speech intelligibility, but therequired availability of the unmixed signals makes it difficult to calculatethe ideal binary mask in any real-life applications. In thispaper we derive the theory and the requirements to enable calculationsof the ideal binary mask using a directional system without theavailability of the unmixed signals. The proposed method has a lowcomplexity and is verified using computer simulation in both idealand non-ideal setups showing promising results.Index Terms— Time-Frequency Masking, Directional systems,Ideal Binary Mask, Speech Intelligibility, Sound separation

Digital signal processing hearing aids may provide possibilities for new signal processing strategies to compensate for hearing loss. However, to be practically usable in a headworn hearing aid the digital circuitry needs to fulfil requirements of low power consumption, low supply voltage and small size.

This dissertation deals with the design, implementation, utilization and evaluation of a digital hearing aid based on a filterbank. To obtain low power consumption in an ear level digital hearing aid, the filter bank was designed with high order filters for a selective channel separation, but still of low computational complexity, thanks to most filter coefficients (multiplications) being designed with zero-value, not being necessary to execute. The filterbank was utilized in a general signal processing algorithm together with two flexible compressors in a low frequency (LF) and a high-frequency (HF) channel. In order to adjust signal processing to an individual hearing loss configuration, three different fitting algorithms were developed: LinEar, DynEar and RangeEar. All three algorithms provided individual frequency shaping via the filterbank. RangeEar and DynEar used wide dynamic range syllabic compression in the LF channel, while LinEar used compression limiting. In the HF channel, RangeEar used a slow acting automatic volume control, while DynEar and LinEar used compression limiting. The subjects had access to a manual volume control when using the LinEar or DynEar options whereas RangeEar was fully automatic.

Wearable DSP based experimental instruments were used to evaluate the fitting algorithms under real world conditions. Comparative field tests were carried out with experienced hearing aid users. A commercial ear level digital hearing aid based mainly on one of the fitting algorithms (RangeEar) was also evaluated and compared to conventional analog hearing aids. Evaluation included laboratory testing of speech recognition in noise and sound quality ratings. Questionnaires and interviews were used to assess benefit, handicap and disability, and preference of an algorithm. Seven experiments were performed, resulting in a total of about 100 man-months of field experience.

Results with the experimental wearable instruments did not indicate one general good-for-all algorithm, but different algorithms resulting in preference and performance depending on the hearing loss configuration. Sound quality ratings of overall impression, clearness and possibly speech recognition in noise were important factors determining preference for an algorithm. Results indicate that the preference for an algorithm can be predicted from auditory dynamic range data alone. LinEar preference subjects had a relatively flat auditory dynamic range response, whereas DynEar and RangeEar preference subjects had more sloping configurations. It was hypothesized that the different preferences were affected by different susceptibility to masking of high frequency sounds by amplified low frequency sounds.

Results with the ear level digital test aid indicated that the test aid provided significantly more benefit, less experienced handicap, better speech recognition in noise, and clearer sounds as compared to conventional analog aids. Regarding general preference, 80 % of the subjects, stating a certain preference, preferred the test aid as compared to their current well fitted aid.

Hearing device (1) adapted to be worn by an individual and comprising: a housing (2) arranged at an ear; an input means (3, 4, 5, 6) providing one or more input audio signals; a signal processing circuit (7, 8) processing at least one of said one or more input audio signals to provide a processed audio signal; an output transducer (10) providingt an audible signal to the individual in dependence on the processed audio signal; two or more electrodes (13, 14, 20) detecting electric brain potentials of the individual; and a brain-wave measurement circuit (15, 21, 25) determining one or more EEG signals from electric signals received from the two or more electrodes (13, 14, 20), wherein the hearing device (1) further comprises: a first spectrum analyser (11, 12) adapted to repeatedly determine first audio spectra of at least one signal from the group of signals consisting of said one or more audio input signals and the audible signal; a reconstructor (16) adapted to repeatedly reconstruct second audio spectra from the one or more EEG signals; a first correlator (17, 18) adapted to repeatedly determine a first coherence between the first and the second audio spectra; and a control unit (19) adapted to alter said processing in dependence on the first coherence.

The invention relates to a method of operating a hearing instrument for processing an input sound and to provide an output stimulus according to a user's particular needs. The invention further relates to a system, a computer readable medium and a data processing system. The object of the present invention is to provide an improved customization of a hearing instrument. The problem is solved in that the method comprises the steps a) providing an estimate of the present cognitive load of the user; b) providing processing of an input signal originating from the input sound according to a user's particular needs; and c) adapting the processing in dependence of the estimate the present cognitive load of the user. This has the advantage that the functionality of the hearing aid system is adapted to the current mental state of the user. The estimate of the present cognitive load of a user is produced by in-situ direct measures of cognitive load (e.g. based on EEG-measurements, body temperature, etc.) or by an on-line cognitive model in the hearing aid system whose parameters have been preferably adjusted to fit to the individual user. An estimate of a user's cognitive status or cognitive load can e.g. be based on an estimate of the user's working memory capacity. The invention may e.g. be used in applications where a hearing impaired user's current mental resources are challenged.

A hearing aid includes at least one electrode located at a surface of a housing of the hearing aid to allow the electrodes to contact the skin of a user during use of the hearing aid, at least one electrode being adapted to pick up a low voltage signal from the user's brain, an amplifier unit operationally connected to the electrode(s) and adapted for amplifying the low voltage signal(s) to provide amplified brain signal(s), and a signal processing unit adapted to process the amplified brain signal(s) to provide a processed brain signal as well as to apply a time and frequency dependent gain to an input audio signal and to provide a processed audio output signal. Also a method of operating a hearing aid and a hearing aid system.

The invention relates to a portable processing system adapted for being worn by a user and comprising an input transducer for converting an input sound to an electric input signal, and a signal processing unit adapted for processing an SPU-input signal originating from the electric input signal. The invention further relates to use of such system. The object of the present invention is to provide an alerting device aiding a user in administering the dose of a hearing protecting agent. The problem is solved in that the signal processing unit comprises a monitoring part for monitoring and determining an accumulated sound dose AccD in the electric input signal from a start time t0 and for generating an alarm output at a threshold time t₀+Δt_th when a predefined dose threshold D_th is reached, wherein the predefined dose threshold D_th is set in relation to a recommended intake of a predefined hearing protecting agent to ensure an intended effect of the hearing protecting agent. An advantage of the present invention is that it helps a user to follow a prescribed dose administration scheme. The invention may e.g. be used in applications where a user taking hearing protecting medicine is exposed to acoustically different or noisy or loud environments.