FRESH Noise - A Fresh Approach to Pediatric Testing

Keeley Moore: FRESH noise, or frequency-specific hearing assessment noise, is a narrowband noise (NBN) stimulus designed for the purpose of measuring hearing thresholds. It is frequency specific due to extremely steep filter slopes. Because of these steeply sloping filters slopes, the stimulus does not spread beyond the desired frequency range. In addition to being frequency specific, it is appropriate for threshold testing because it is calibrated in dB HL, unlike narrowband noise. FRESH noise came about because of the realization that narrowband noise was being used as a stimulus for testing. Studies show that when you test threshold levels with different stimuli, you find approximately the same threshold results with pure tones, frequency modulated tones, and FRESH noise. However, with narrowband noise, threshold values not consistent with thresholds obtained with the other stimuli. This obviously leads to errors in testing. Narrowband noise was originally designed not as a testing stimuli but as a masking noise, in order to address the challenge of how to go about testing an individual ear.

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FRESH Noise - A Fresh Approach to Pediatric Testing

Keeley Moore: FRESH noise, or frequency-specific hearing assessment noise, is a narrowband noise (NBN) stimulus designed for the purpose of measuring hearing thresholds. It is frequency specific due to extremely steep filter slopes. Because of these steeply sloping filters slopes, the stimulus does not spread beyond the desired frequency range. In addition to being frequency specific, it is appropriate for threshold testing because it is calibrated in dB HL, unlike narrowband noise. FRESH noise came about because of the realization that narrowband noise was being used as a stimulus for testing. Studies show that when you test threshold levels with different stimuli, you find approximately the same threshold results with pure tones, frequency modulated tones, and FRESH noise. However, with narrowband noise, threshold values not consistent with thresholds obtained with the other stimuli. This obviously leads to errors in testing. Narrowband noise was originally designed not as a testing stimuli but as a masking noise, in order to address the challenge of how to go about testing an individual ear.

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FRESH Noise - A Fresh Approach to Pediatric Testing

Keeley Moore: FRESH noise, or frequency-specific hearing assessment noise, is a narrowband noise (NBN) stimulus designed for the purpose of measuring hearing thresholds. It is frequency specific due to extremely steep filter slopes. Because of these steeply sloping filters slopes, the stimulus does not spread beyond the desired frequency range. In addition to being frequency specific, it is appropriate for threshold testing because it is calibrated in dB HL, unlike narrowband noise. FRESH noise came about because of the realization that narrowband noise was being used as a stimulus for testing. Studies show that when you test threshold levels with different stimuli, you find approximately the same threshold results with pure tones, frequency modulated tones, and FRESH noise. However, with narrowband noise, threshold values not consistent with thresholds obtained with the other stimuli. This obviously leads to errors in testing. Narrowband noise was originally designed not as a testing stimuli but as a masking noise, in order to address the challenge of how to go about testing an individual ear.

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Validation of the Home Hearing Test™.

Validation of the Home Hearing Test™.

J Am Acad Audiol. 2016 May;27(5):416-420

Authors: Margolis RH, Killion MC, Bratt GW, Saly GL

Abstract
BACKGROUND: The Home Hearing Test™ (HHT) is an automated pure-tone threshold test that obtains an air-conduction audiogram at five test frequencies. It was developed to provide increased access to hearing testing and support home telehealth programs.
PURPOSE: The study was conducted as part of an audiology telehealth trial based at the U.S. Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Air-conduction audiograms obtained by the HHT were compared to results obtained in the clinic.
RESEARCH DESIGN: Prospective, repeated measures.
STUDY SAMPLE: Twenty-eight participants, aged 44-88 yr (mean = 65) were recruited from the Nashville U.S. Department of Veterans Affairs audiology clinic. Participants were required to have a Windows personal computer in the home and were self-reported to be comfortable with using computers. Two participants had normal hearing and 26 had hearing loss of various severities and configurations.
DATA COLLECTION AND ANALYSIS: Audiograms were obtained in the audiology clinic by experienced audiologists following standard clinical protocols. Participants were provided with a kit for installing HHT on their home computers. The HHT air-conduction audiogram is obtained with Automated Method for Testing Auditory Sensitivity (AMTAS(®)), described in previous publications. Threshold pairs (clinic versus HHT) were analyzed by determining distributions of threshold differences and absolute differences. These were compared to distributions of differences between manual threshold pairs obtained by two audiologists and AMTAS(®) versus manual threshold pairs obtained under laboratory conditions.
RESULTS: Threshold differences (clinic versus HHT) were slightly larger than differences between thresholds obtained by two audiologists and AMTAS(®) versus manual threshold differences obtained under laboratory conditions. The differences were not statistically significant.
CONCLUSIONS: HHT air-conduction audiograms agree well with audiograms obtained in the clinic. HHT is well suited to home telehealth applications and personal use.

PMID: 27179261 [PubMed - as supplied by publisher]

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Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

J Am Acad Audiol. 2016 May;27(5):406-415

Authors: Bardy F, Sjahalam-King J, Van Dun B, Dillon H

Abstract
PURPOSE: To determine if one-octave multitone (MT) stimuli increase the amplitude of cortical auditory-evoked potentials (CAEPs) in individuals with a hearing loss when compared to standard pure-tone (PT) stimuli and narrow-band noise (NBN).
RESEARCH DESIGN: CAEPs were obtained from 16 hearing-impaired adults in response to PT and MT auditory stimuli centered around 0.5, 1, 2, and 4 kHz and NBN centered around 1 and 2 kHz. Hearing impairment ranged from a mild to a moderate hearing loss in both ears. Auditory stimuli were monaurally delivered through insert earphones at 10 and 20 dB above threshold. The root mean square amplitude of the CAEP and the detectability of the responses using Hotelling's T² were calculated and analyzed.
RESULTS: CAEP amplitudes elicited with MT stimuli were on average 29% larger than PT stimuli for frequencies centered around 1, 2, and 4 kHz. No significant difference was found for responses to 0.5-kHz stimuli. Significantly higher objective detection scores were found for MT when compared to PT. For the 1- and 2-kHz stimuli, the CAEP amplitudes to NBN were not significantly different to those evoked by PT but a significant difference was found between MT stimuli and both NBN and PT. The mean detection sensitivity of MT for the four frequencies was 80% at 10 dB SL and 95% at 20 dB SL, and was comparable with detection sensitivities observed in normal-hearing participants.
CONCLUSIONS: Using MT stimuli when testing CAEPs in adults with hearing impairment showed larger amplitudes and a higher objective detection sensitivity compared to using traditional PT stimuli for frequencies centered around 1, 2, and 4 kHz. These findings suggest that MT stimuli are a clinically useful tool to increase the efficiency of frequency-specific CAEP testing in adults with hearing impairment.

PMID: 27179260 [PubMed - as supplied by publisher]

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Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

J Am Acad Audiol. 2016 May;27(5):395-405

Authors: Sidiras C, Iliadou VV, Chermak GD, Nimatoudis I

Abstract
BACKGROUND: Including speech recognition in noise testing in audiological evaluations may reveal functional hearing deficits that may otherwise remain undetected.
PURPOSE: The current study explored the potential utility of the Speech-in-Babble (SinB) test in the assessment of central auditory processing disorder (CAPD) in young children for whom diagnosis is challenging.
RESEARCH DESIGN: A cross-sectional analysis.
STUDY SAMPLE: Forty-one Greek children 4-13 yr of age diagnosed with CAPD and exhibiting listening and academic problems (clinical group) and 20 age-matched controls with no listening or academic problems participated in the study.
DATA COLLECTION AND ANALYSIS: All participants' auditory processing was assessed using the same tests and instrumentation in a sound-treated room. Two equivalent lists of the SinB test, developed at the Psychoacoustic Laboratory of the Aristotle University of Thessaloniki, were administered monaurally in a counterbalanced order. SinB consists of lists of 50 phonetically balanced disyllabic words presented in background multitalker babble. Five signal-to-noise ratios (SNRs) were used in a fixed order. The children were instructed to repeat the word after each presentation. The SNR at which the child achieved 50% correct word identification served as the dependent variable or outcome measure, with higher SinB scores (measured in SNR dB) corresponding to poorer performance.
RESULTS: SinB performance was better (lower SNR) for the normal control group versus the clinical group [F(1,35) = 43.03, p < 0.0001]. SinB inversely correlated with age for both CAPD and control groups (r = -0.648, p << 0.001 and r = -0.658, p < 0.005, respectively). Regression analysis revealed that linear models better explained the variance in the data than a quadratic model for both the control and CAPD groups. The slope (beta value of the linear model) was steeper for the clinical group compared to the control group (beta = -0.306 versus beta = -0.130, respectively). An analysis of covariance run with age as the covariate to assess the potential effect of comorbidity on SinB performance in children with CAPD with and without comorbid conditions revealed no significant differences between groups [F(1,38) = 0.149, p > 0.05].
CONCLUSIONS: This study offers the first detailed presentation of the performance of Greek children on a Greek language SinB test. The main finding is that SinB scores improved as a function of age in a constant manner as represented by the slope of the linear regression line for both CAPD and control groups. Results suggest that this speech recognition in competition test holds promise for differentiating typically developing Greek children from those children with CAPD across the age range studied here (4-13 yr). The SinB seemed rather immune to the presence of comorbid conditions presented by some of the children in this study, suggesting its potential utility as a valid measure of central auditory processing. While there are many speech-in-noise or competition tests in English, there are fewer in other languages. Tests like the SinB should be developed in other languages to ensure that children demonstrating "listening" problems can be properly evaluated.

PMID: 27179259 [PubMed - as supplied by publisher]

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Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

J Am Acad Audiol. 2016 May;27(5):388-394

Authors: Duke MM, Wolfe J, Schafer E

Abstract
BACKGROUND: Cochlear implant (CI) recipients often experience difficulty understanding speech in noise and speech that originates from a distance. Many CI recipients also experience difficulty understanding speech originating from a television. Use of hearing assistance technology (HAT) may improve speech recognition in noise and for signals that originate from more than a few feet from the listener; however, there are no published studies evaluating the potential benefits of a wireless HAT designed to deliver audio signals from a television directly to a CI sound processor.
PURPOSE: The objective of this study was to compare speech recognition in quiet and in noise of CI recipients with the use of their CI alone and with the use of their CI and a wireless HAT (Cochlear Wireless TV Streamer).
RESEARCH DESIGN: A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in competing noise (65 dBA) with the CI sound processor alone and with the sound processor coupled to the Cochlear Wireless TV Streamer.
STUDY SAMPLE: Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study.
DATA COLLECTION AND ANALYSIS: Participants were evaluated in four conditions including use of the sound processor alone and use of the sound processor with the wireless streamer in quiet and in the presence of competing noise at 65 dBA. Speech recognition was evaluated in each condition with two full lists of Computer-Assisted Speech Perception Testing and Training Sentence-Level Test sentences presented from a light-emitting diode television.
RESULTS: Speech recognition in noise was significantly better with use of the wireless streamer compared to participants' performance with their CI sound processor alone. There was also a nonsignificant trend toward better performance in quiet with use of the TV Streamer. Performance was significantly poorer when evaluated in noise compared to performance in quiet when the TV Streamer was not used.
CONCLUSIONS: Use of the Cochlear Wireless TV Streamer designed to stream audio from a television directly to a CI sound processor provides better speech recognition in quiet and in noise when compared to performance obtained with use of the CI sound processor alone.

PMID: 27179258 [PubMed - as supplied by publisher]

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The Effect of the Arabic Computer Rehabilitation Program "Rannan" on Sound Detection and Discrimination in Children with Cochlear Implants.

The Effect of the Arabic Computer Rehabilitation Program "Rannan" on Sound Detection and Discrimination in Children with Cochlear Implants.

J Am Acad Audiol. 2016 May;27(5):380-387

Authors: Hagr A, Garadat SN, Hassan SM, Malki K, Al Ohali Y, Al Ghamdi N, Al Nafjan A, Al Masaad A, Al Hamid S

Abstract
PURPOSE: The aim of this work is to examine the efficacy of using computer-based training program (Rannan) as an intervention approach to enhance sound detection and discrimination in Arabic-speaking children with cochlear implants (CIs).
RESEARCH DESIGN: A prospective study comparing performance between two groups of children. Participants were divided into two equal groups that were matched in age and programming strategies. Group I received the traditional clinic-based therapy and group II received the same traditional therapy approach in addition to a computer-based program.
STUDY SAMPLE: A total of 26 children with CIs in the age range of 3-6.5 yr were recruited from King Abdulaziz University Hospital.
DATA COLLECTION AND ANALYSIS: Listening Progress Profile and Infant-Toddler Meaningful Integration Scale were used preoperatively, and to compare performance between the two groups at 1-, 3-, 6-, and 12-mo after device-fitting. Data were subjected to mixed analysis of variance.
RESULTS: Both assessment tools (Listening Progress Profile and Infant-Toddler Meaningful Integration Scale) revealed that group II scored higher than group I.
CONCLUSION: The study demonstrated that using computer-based training in addition to the traditional rehabilitation therapy can serve as a facilitative tool to enhance the benefit achieved from CI.

PMID: 27179257 [PubMed - as supplied by publisher]

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A Phoneme Perception Test Method for High-Frequency Hearing Aid Fitting.

A Phoneme Perception Test Method for High-Frequency Hearing Aid Fitting.

J Am Acad Audiol. 2016 May;27(5):367-379

Authors: Schmitt N, Winkler A, Boretzki M, Holube I

Abstract
BACKGROUND: Outcomes with hearing aids (HAs) can be assessed using various speech tests, but many tests are not sensitive to changes in high-frequency audibility.
PURPOSE: A Phoneme Perception Test (PPT), designed for the phonemes /s/ and /ʃ/, has been developed to investigate whether detection and recognition tasks are able to measure individual differences in phoneme audibility and recognition for various hearing instrument settings. These capabilities were studied using two different fricative stimulus materials. The first set of materials preserves natural low-level sound components in the low- and mid-frequency ranges (LF set); the second set of materials attempts to limit the audibility to high-frequency fricative noise (nLF set). To study the effect on phoneme detection and recognition when auditory representations of /s/ and /ʃ/ are modified, a too strong nonlinear frequency compression (NLFC) setting was applied.
RESEARCH DESIGN: Repeated measure design was used under several different conditions.
STUDY SAMPLE: A total of 31 hearing-impaired individuals participated in this study. Of the 31 participants, 10 individuals did not own HAs but were provided with them during the study and 21 individuals owned HAs and were experienced users. All participants had a symmetrical sensorineural hearing loss.
DATA COLLECTION AND ANALYSIS: The present study applied a phoneme detection test and a recognition test with two different stimulus sets under different amplification conditions. The statistical analysis focused on the capability of the PPT to measure the effect on audibility and perception of high-frequency information with and without HAs, and between HAs with two different NLFC settings ("default" and "too strong").
RESULTS: Detection thresholds (DTs) and recognition thresholds (RTs) were compared with respective audiometric thresholds in the free field for all available conditions. Significant differences in thresholds between LF and nLF stimuli were observed. The thresholds for nLF stimuli showed higher correlation to the corresponding audiometric thresholds than the thresholds for LF stimuli. The difference in thresholds for unaided and aided conditions was larger for the stimulus set nLF than for the stimulus set LF. Also, thresholds were similar in both aided conditions for stimulus set LF, whereas a large difference between amplifications was observed for the stimulus set nLF. When NLFC was set "too strong," DTs and RTs differed significantly for /s/.
CONCLUSIONS: The findings from this study strongly suggest that measuring DTs and RTs with the stimulus set nLF is beneficial and useful to quantify the effects of HAs and NLFC on high-frequency speech cues for detection and recognition tasks. The findings also suggest that both tests are necessary because they assess audibility as well as recognition abilities, particularly as they relate to speech modification algorithms. The experiments conducted in this study did not allow for any acclimatization of the participants to increased high-frequency gain or NLFC. Further investigations should therefore examine the impact on DTs and RTs in the PPT as well as the contrasting effects of strong setting of NLFC to DTs and RTs because of (re)learning of modified auditory representations of /s/ and /ʃ/ as caused by NLFC.

PMID: 27179256 [PubMed - as supplied by publisher]

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The Expanding Role of Audiology Telepractice.

The Expanding Role of Audiology Telepractice.

J Am Acad Audiol. 2016 May;27(5):366

Authors: McCaslin DL

PMID: 27179255 [PubMed - as supplied by publisher]

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Validation of the Home Hearing Test™.

Validation of the Home Hearing Test™.

J Am Acad Audiol. 2016 May;27(5):416-420

Authors: Margolis RH, Killion MC, Bratt GW, Saly GL

Abstract
BACKGROUND: The Home Hearing Test™ (HHT) is an automated pure-tone threshold test that obtains an air-conduction audiogram at five test frequencies. It was developed to provide increased access to hearing testing and support home telehealth programs.
PURPOSE: The study was conducted as part of an audiology telehealth trial based at the U.S. Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. Air-conduction audiograms obtained by the HHT were compared to results obtained in the clinic.
RESEARCH DESIGN: Prospective, repeated measures.
STUDY SAMPLE: Twenty-eight participants, aged 44-88 yr (mean = 65) were recruited from the Nashville U.S. Department of Veterans Affairs audiology clinic. Participants were required to have a Windows personal computer in the home and were self-reported to be comfortable with using computers. Two participants had normal hearing and 26 had hearing loss of various severities and configurations.
DATA COLLECTION AND ANALYSIS: Audiograms were obtained in the audiology clinic by experienced audiologists following standard clinical protocols. Participants were provided with a kit for installing HHT on their home computers. The HHT air-conduction audiogram is obtained with Automated Method for Testing Auditory Sensitivity (AMTAS(®)), described in previous publications. Threshold pairs (clinic versus HHT) were analyzed by determining distributions of threshold differences and absolute differences. These were compared to distributions of differences between manual threshold pairs obtained by two audiologists and AMTAS(®) versus manual threshold pairs obtained under laboratory conditions.
RESULTS: Threshold differences (clinic versus HHT) were slightly larger than differences between thresholds obtained by two audiologists and AMTAS(®) versus manual threshold differences obtained under laboratory conditions. The differences were not statistically significant.
CONCLUSIONS: HHT air-conduction audiograms agree well with audiograms obtained in the clinic. HHT is well suited to home telehealth applications and personal use.

PMID: 27179261 [PubMed - as supplied by publisher]

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Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

J Am Acad Audiol. 2016 May;27(5):406-415

Authors: Bardy F, Sjahalam-King J, Van Dun B, Dillon H

Abstract
PURPOSE: To determine if one-octave multitone (MT) stimuli increase the amplitude of cortical auditory-evoked potentials (CAEPs) in individuals with a hearing loss when compared to standard pure-tone (PT) stimuli and narrow-band noise (NBN).
RESEARCH DESIGN: CAEPs were obtained from 16 hearing-impaired adults in response to PT and MT auditory stimuli centered around 0.5, 1, 2, and 4 kHz and NBN centered around 1 and 2 kHz. Hearing impairment ranged from a mild to a moderate hearing loss in both ears. Auditory stimuli were monaurally delivered through insert earphones at 10 and 20 dB above threshold. The root mean square amplitude of the CAEP and the detectability of the responses using Hotelling's T² were calculated and analyzed.
RESULTS: CAEP amplitudes elicited with MT stimuli were on average 29% larger than PT stimuli for frequencies centered around 1, 2, and 4 kHz. No significant difference was found for responses to 0.5-kHz stimuli. Significantly higher objective detection scores were found for MT when compared to PT. For the 1- and 2-kHz stimuli, the CAEP amplitudes to NBN were not significantly different to those evoked by PT but a significant difference was found between MT stimuli and both NBN and PT. The mean detection sensitivity of MT for the four frequencies was 80% at 10 dB SL and 95% at 20 dB SL, and was comparable with detection sensitivities observed in normal-hearing participants.
CONCLUSIONS: Using MT stimuli when testing CAEPs in adults with hearing impairment showed larger amplitudes and a higher objective detection sensitivity compared to using traditional PT stimuli for frequencies centered around 1, 2, and 4 kHz. These findings suggest that MT stimuli are a clinically useful tool to increase the efficiency of frequency-specific CAEP testing in adults with hearing impairment.

PMID: 27179260 [PubMed - as supplied by publisher]

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Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

J Am Acad Audiol. 2016 May;27(5):395-405

Authors: Sidiras C, Iliadou VV, Chermak GD, Nimatoudis I

Abstract
BACKGROUND: Including speech recognition in noise testing in audiological evaluations may reveal functional hearing deficits that may otherwise remain undetected.
PURPOSE: The current study explored the potential utility of the Speech-in-Babble (SinB) test in the assessment of central auditory processing disorder (CAPD) in young children for whom diagnosis is challenging.
RESEARCH DESIGN: A cross-sectional analysis.
STUDY SAMPLE: Forty-one Greek children 4-13 yr of age diagnosed with CAPD and exhibiting listening and academic problems (clinical group) and 20 age-matched controls with no listening or academic problems participated in the study.
DATA COLLECTION AND ANALYSIS: All participants' auditory processing was assessed using the same tests and instrumentation in a sound-treated room. Two equivalent lists of the SinB test, developed at the Psychoacoustic Laboratory of the Aristotle University of Thessaloniki, were administered monaurally in a counterbalanced order. SinB consists of lists of 50 phonetically balanced disyllabic words presented in background multitalker babble. Five signal-to-noise ratios (SNRs) were used in a fixed order. The children were instructed to repeat the word after each presentation. The SNR at which the child achieved 50% correct word identification served as the dependent variable or outcome measure, with higher SinB scores (measured in SNR dB) corresponding to poorer performance.
RESULTS: SinB performance was better (lower SNR) for the normal control group versus the clinical group [F(1,35) = 43.03, p < 0.0001]. SinB inversely correlated with age for both CAPD and control groups (r = -0.648, p << 0.001 and r = -0.658, p < 0.005, respectively). Regression analysis revealed that linear models better explained the variance in the data than a quadratic model for both the control and CAPD groups. The slope (beta value of the linear model) was steeper for the clinical group compared to the control group (beta = -0.306 versus beta = -0.130, respectively). An analysis of covariance run with age as the covariate to assess the potential effect of comorbidity on SinB performance in children with CAPD with and without comorbid conditions revealed no significant differences between groups [F(1,38) = 0.149, p > 0.05].
CONCLUSIONS: This study offers the first detailed presentation of the performance of Greek children on a Greek language SinB test. The main finding is that SinB scores improved as a function of age in a constant manner as represented by the slope of the linear regression line for both CAPD and control groups. Results suggest that this speech recognition in competition test holds promise for differentiating typically developing Greek children from those children with CAPD across the age range studied here (4-13 yr). The SinB seemed rather immune to the presence of comorbid conditions presented by some of the children in this study, suggesting its potential utility as a valid measure of central auditory processing. While there are many speech-in-noise or competition tests in English, there are fewer in other languages. Tests like the SinB should be developed in other languages to ensure that children demonstrating "listening" problems can be properly evaluated.

PMID: 27179259 [PubMed - as supplied by publisher]

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Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

Recognition of Speech from the Television with Use of a Wireless Technology Designed for Cochlear Implants.

J Am Acad Audiol. 2016 May;27(5):388-394

Authors: Duke MM, Wolfe J, Schafer E

Abstract
BACKGROUND: Cochlear implant (CI) recipients often experience difficulty understanding speech in noise and speech that originates from a distance. Many CI recipients also experience difficulty understanding speech originating from a television. Use of hearing assistance technology (HAT) may improve speech recognition in noise and for signals that originate from more than a few feet from the listener; however, there are no published studies evaluating the potential benefits of a wireless HAT designed to deliver audio signals from a television directly to a CI sound processor.
PURPOSE: The objective of this study was to compare speech recognition in quiet and in noise of CI recipients with the use of their CI alone and with the use of their CI and a wireless HAT (Cochlear Wireless TV Streamer).
RESEARCH DESIGN: A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in competing noise (65 dBA) with the CI sound processor alone and with the sound processor coupled to the Cochlear Wireless TV Streamer.
STUDY SAMPLE: Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study.
DATA COLLECTION AND ANALYSIS: Participants were evaluated in four conditions including use of the sound processor alone and use of the sound processor with the wireless streamer in quiet and in the presence of competing noise at 65 dBA. Speech recognition was evaluated in each condition with two full lists of Computer-Assisted Speech Perception Testing and Training Sentence-Level Test sentences presented from a light-emitting diode television.
RESULTS: Speech recognition in noise was significantly better with use of the wireless streamer compared to participants' performance with their CI sound processor alone. There was also a nonsignificant trend toward better performance in quiet with use of the TV Streamer. Performance was significantly poorer when evaluated in noise compared to performance in quiet when the TV Streamer was not used.
CONCLUSIONS: Use of the Cochlear Wireless TV Streamer designed to stream audio from a television directly to a CI sound processor provides better speech recognition in quiet and in noise when compared to performance obtained with use of the CI sound processor alone.

PMID: 27179258 [PubMed - as supplied by publisher]

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The Effect of the Arabic Computer Rehabilitation Program "Rannan" on Sound Detection and Discrimination in Children with Cochlear Implants.

The Effect of the Arabic Computer Rehabilitation Program "Rannan" on Sound Detection and Discrimination in Children with Cochlear Implants.

J Am Acad Audiol. 2016 May;27(5):380-387

Authors: Hagr A, Garadat SN, Hassan SM, Malki K, Al Ohali Y, Al Ghamdi N, Al Nafjan A, Al Masaad A, Al Hamid S

Abstract
PURPOSE: The aim of this work is to examine the efficacy of using computer-based training program (Rannan) as an intervention approach to enhance sound detection and discrimination in Arabic-speaking children with cochlear implants (CIs).
RESEARCH DESIGN: A prospective study comparing performance between two groups of children. Participants were divided into two equal groups that were matched in age and programming strategies. Group I received the traditional clinic-based therapy and group II received the same traditional therapy approach in addition to a computer-based program.
STUDY SAMPLE: A total of 26 children with CIs in the age range of 3-6.5 yr were recruited from King Abdulaziz University Hospital.
DATA COLLECTION AND ANALYSIS: Listening Progress Profile and Infant-Toddler Meaningful Integration Scale were used preoperatively, and to compare performance between the two groups at 1-, 3-, 6-, and 12-mo after device-fitting. Data were subjected to mixed analysis of variance.
RESULTS: Both assessment tools (Listening Progress Profile and Infant-Toddler Meaningful Integration Scale) revealed that group II scored higher than group I.
CONCLUSION: The study demonstrated that using computer-based training in addition to the traditional rehabilitation therapy can serve as a facilitative tool to enhance the benefit achieved from CI.

PMID: 27179257 [PubMed - as supplied by publisher]

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A Phoneme Perception Test Method for High-Frequency Hearing Aid Fitting.

A Phoneme Perception Test Method for High-Frequency Hearing Aid Fitting.

J Am Acad Audiol. 2016 May;27(5):367-379

Authors: Schmitt N, Winkler A, Boretzki M, Holube I

Abstract
BACKGROUND: Outcomes with hearing aids (HAs) can be assessed using various speech tests, but many tests are not sensitive to changes in high-frequency audibility.
PURPOSE: A Phoneme Perception Test (PPT), designed for the phonemes /s/ and /ʃ/, has been developed to investigate whether detection and recognition tasks are able to measure individual differences in phoneme audibility and recognition for various hearing instrument settings. These capabilities were studied using two different fricative stimulus materials. The first set of materials preserves natural low-level sound components in the low- and mid-frequency ranges (LF set); the second set of materials attempts to limit the audibility to high-frequency fricative noise (nLF set). To study the effect on phoneme detection and recognition when auditory representations of /s/ and /ʃ/ are modified, a too strong nonlinear frequency compression (NLFC) setting was applied.
RESEARCH DESIGN: Repeated measure design was used under several different conditions.
STUDY SAMPLE: A total of 31 hearing-impaired individuals participated in this study. Of the 31 participants, 10 individuals did not own HAs but were provided with them during the study and 21 individuals owned HAs and were experienced users. All participants had a symmetrical sensorineural hearing loss.
DATA COLLECTION AND ANALYSIS: The present study applied a phoneme detection test and a recognition test with two different stimulus sets under different amplification conditions. The statistical analysis focused on the capability of the PPT to measure the effect on audibility and perception of high-frequency information with and without HAs, and between HAs with two different NLFC settings ("default" and "too strong").
RESULTS: Detection thresholds (DTs) and recognition thresholds (RTs) were compared with respective audiometric thresholds in the free field for all available conditions. Significant differences in thresholds between LF and nLF stimuli were observed. The thresholds for nLF stimuli showed higher correlation to the corresponding audiometric thresholds than the thresholds for LF stimuli. The difference in thresholds for unaided and aided conditions was larger for the stimulus set nLF than for the stimulus set LF. Also, thresholds were similar in both aided conditions for stimulus set LF, whereas a large difference between amplifications was observed for the stimulus set nLF. When NLFC was set "too strong," DTs and RTs differed significantly for /s/.
CONCLUSIONS: The findings from this study strongly suggest that measuring DTs and RTs with the stimulus set nLF is beneficial and useful to quantify the effects of HAs and NLFC on high-frequency speech cues for detection and recognition tasks. The findings also suggest that both tests are necessary because they assess audibility as well as recognition abilities, particularly as they relate to speech modification algorithms. The experiments conducted in this study did not allow for any acclimatization of the participants to increased high-frequency gain or NLFC. Further investigations should therefore examine the impact on DTs and RTs in the PPT as well as the contrasting effects of strong setting of NLFC to DTs and RTs because of (re)learning of modified auditory representations of /s/ and /ʃ/ as caused by NLFC.

PMID: 27179256 [PubMed - as supplied by publisher]

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The Expanding Role of Audiology Telepractice.

The Expanding Role of Audiology Telepractice.

J Am Acad Audiol. 2016 May;27(5):366

Authors: McCaslin DL

PMID: 27179255 [PubMed - as supplied by publisher]

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Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Hear Res. 2016 May 10;

Authors: Veugen LC, Hendrikse MM, van Wanrooij MM, Agterberg MJ, Chalupper J, Mens LH, Snik AF, John van Opstal A

Abstract
Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds.. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.

PMID: 27178443 [PubMed - as supplied by publisher]

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Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Horizontal Sound Localization in Cochlear Implant Users with a Contralateral Hearing Aid.

Hear Res. 2016 May 10;

Authors: Veugen LC, Hendrikse MM, van Wanrooij MM, Agterberg MJ, Chalupper J, Mens LH, Snik AF, John van Opstal A

Abstract
Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds.. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.

PMID: 27178443 [PubMed - as supplied by publisher]

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