Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss

Objectives: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. Design: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. Results: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants’ daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. Conclusions: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study’s generalizability (e.g., participant’s lifestyle) are discussed. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: Yu-Hsiang Wu is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability, Independent Living, and Rehabilitation Research, and the Retirement Research Foundation. Octav Chipara is currently receiving grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Science Foundation. Jacob Oleson is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, National Heart, Lung, and Blood Institute, Department of Defense, Centers for Disease Control and Prevention, Fogarty International Center, and the Iowa Department of Public Health. The current research was supported by National Institute on Deafness and Other Communication Disorders (R03DC012551) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5020-01-00). The current research was supported by NIH/NIDCD R03DC012551 (title: Minimal Technologies for Hearing Aid Success in Elderly Adults) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 90RE5020-01-00 (title: RERC on Improving the Accessibility, Usability, and Performance of Technology for Individuals Who are Deaf or Hard of Hearing). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and the reader should not assume endorsement by the Federal Government. Portions of this paper were presented at the annual conference of the American Auditory Society, March 3, 2016, Scottsdale, AZ. Y.-H.W. designed experiments, interpreted data, and wrote the article; E.S. collected data; O.C. and S.S.H. developed EMA software and processed EMA data; S.D. and J.O. provided statistical analysis. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to declare. Address for correspondence: Yu-Hsiang Wu, 125C SHC, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, IA 52242, USA. E-mail: yu-hsiang-wu@uiowa.edu Received March 8, 2018; accepted August 29, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Efficacy and Effectiveness of Advanced Hearing Aid Directional and Noise Reduction Technologies for Older Adults With Mild to Moderate Hearing Loss

Objectives: The purpose of the present study was to investigate the laboratory efficacy and real-world effectiveness of advanced directional microphones (DM) and digital noise reduction (NR) algorithms (i.e., premium DM/NR features) relative to basic-level DM/NR features of contemporary hearing aids (HAs). The study also examined the effect of premium HAs relative to basic HAs and the effect of DM/NR features relative to no features. Design: Fifty-four older adults with mild-to-moderate hearing loss completed a single-blinded crossover trial. Two HA models, one a less-expensive, basic-level device (basic HA) and the other a more-expensive, advanced-level device (premium HA), were used. The DM/NR features of the basic HAs (i.e., basic features) were adaptive DMs and gain-reduction NR with fewer channels. In contrast, the DM/NR features of the premium HAs (i.e., premium features) included adaptive DMs and gain-reduction NR with more channels, bilateral beamformers, speech-seeking DMs, pinna-simulation directivity, reverberation reduction, impulse NR, wind NR, and spatial NR. The trial consisted of four conditions, which were factorial combinations of HA model (premium versus basic) and DM/NR feature status (on versus off). To blind participants regarding the HA technology, no technology details were disclosed and minimal training on how to use the features was provided. In each condition, participants wore bilateral HAs for 5 weeks. Outcomes regarding speech understanding, listening effort, sound quality, localization, and HA satisfaction were measured using laboratory tests, retrospective self-reports (i.e., standardized questionnaires), and in-situ self-reports (i.e., self-reports completed in the real world in real time). A smartphone-based ecological momentary assessment system was used to collect in-situ self-reports. Results: Laboratory efficacy data generally supported the benefit of premium DM/NR features relative to basic DM/NR, premium HAs relative to basic HAs, and DM/NR features relative to no DM/NR in improving speech understanding and localization performance. Laboratory data also indicated that DM/NR features could improve listening effort and sound quality compared with no features for both basic- and premium-level HAs. For real-world effectiveness, in-situ self-reports first indicated that noisy or very noisy situations did not occur very often in participants’ daily lives (10.9% of the time). Although both retrospective and in-situ self-reports indicated that participants were more satisfied with HAs equipped with DM/NR features than without, there was no strong evidence to support the benefit of premium DM/NR features and premium HAs over basic DM/NR features and basic HAs, respectively. Conclusions: Although premium DM/NR features and premium HAs outperformed their basic-level counterparts in well-controlled laboratory test conditions, the benefits were not observed in the real world. In contrast, the effect of DM/NR features relative to no features was robust both in the laboratory and in the real world. Therefore, the present study suggests that although both premium and basic DM/NR technologies evaluated in the study have the potential to improve HA outcomes, older adults with mild-to-moderate hearing loss are unlikely to perceive the additional benefits provided by the premium DM/NR features in their daily lives. Limitations concerning the study’s generalizability (e.g., participant’s lifestyle) are discussed. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: Yu-Hsiang Wu is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability, Independent Living, and Rehabilitation Research, and the Retirement Research Foundation. Octav Chipara is currently receiving grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and the National Science Foundation. Jacob Oleson is currently receiving grants from the National Institute on Deafness and Other Communication Disorders, National Heart, Lung, and Blood Institute, Department of Defense, Centers for Disease Control and Prevention, Fogarty International Center, and the Iowa Department of Public Health. The current research was supported by National Institute on Deafness and Other Communication Disorders (R03DC012551) and the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5020-01-00). The current research was supported by NIH/NIDCD R03DC012551 (title: Minimal Technologies for Hearing Aid Success in Elderly Adults) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 90RE5020-01-00 (title: RERC on Improving the Accessibility, Usability, and Performance of Technology for Individuals Who are Deaf or Hard of Hearing). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and the reader should not assume endorsement by the Federal Government. Portions of this paper were presented at the annual conference of the American Auditory Society, March 3, 2016, Scottsdale, AZ. Y.-H.W. designed experiments, interpreted data, and wrote the article; E.S. collected data; O.C. and S.S.H. developed EMA software and processed EMA data; S.D. and J.O. provided statistical analysis. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to declare. Address for correspondence: Yu-Hsiang Wu, 125C SHC, Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, IA 52242, USA. E-mail: yu-hsiang-wu@uiowa.edu Received March 8, 2018; accepted August 29, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Wideband Absorbance and 226-Hz Tympanometry in the Prediction of Optimal Distortion Product Otoacoustic Emission Primary Tone Levels

Purpose

Distortion product otoacoustic emission (DPOAE) amplitude is sensitive to the primary tone level separation effective within the cochlea. Despite potential for middle ear sound transmission characteristics to affect this separation, no primary tone level optimization formula accounts for its influence. This study was conducted to determine if inclusion of ear- and frequency-specific immittance features improves primary tone level optimization formula performance beyond that achieved using a univariate, L ₂-based formula.

Method

For 30 adults with normal hearing, DPOAE, wideband absorbance, and 226-Hz tympanometry measures were completed. A mixed linear modeling technique, incorporating both primary tone and acoustic immittance features, was used to generate a multivariable formula for the middle ear–specific recommendation of primary tone level separations for f ₂ = 1–6 kHz. The accuracy with which L _1OPT, or the L ₁ observed to maximize DPOAE level for each given L ₂, could be predicted using the multivariable formula was then compared with that of a traditional, L ₂-based univariate formula for each individual ear.

Results

Use of the multivariable formula L ₁ = 0.47L ₂ + 2.40A + f _2param + 38 [dB SPL] resulted in significantly more accurate L _1OPT predictions than did the univariate formula L ₁ = 0.49L ₂ + 41 [dB SPL]. Although average improvement was small, meaningful improvements were identified within individual ears, especially for f ₂ = 1 and 6 kHz.

Conclusion

Incorporation of a wideband absorbance measure into a primary tone level optimization formula resulted in a minor average improvement in L _1OPT prediction accuracy when compared with a traditional univariate optimization formula. Further research is needed to identify characteristics of ears that might disproportionately benefit from the additional measure.

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Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users

Purpose

The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit.

Method

This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study.

Results

No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization.

Conclusion

Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.

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Wideband Absorbance and 226-Hz Tympanometry in the Prediction of Optimal Distortion Product Otoacoustic Emission Primary Tone Levels

Purpose

Distortion product otoacoustic emission (DPOAE) amplitude is sensitive to the primary tone level separation effective within the cochlea. Despite potential for middle ear sound transmission characteristics to affect this separation, no primary tone level optimization formula accounts for its influence. This study was conducted to determine if inclusion of ear- and frequency-specific immittance features improves primary tone level optimization formula performance beyond that achieved using a univariate, L ₂-based formula.

Method

For 30 adults with normal hearing, DPOAE, wideband absorbance, and 226-Hz tympanometry measures were completed. A mixed linear modeling technique, incorporating both primary tone and acoustic immittance features, was used to generate a multivariable formula for the middle ear–specific recommendation of primary tone level separations for f ₂ = 1–6 kHz. The accuracy with which L _1OPT, or the L ₁ observed to maximize DPOAE level for each given L ₂, could be predicted using the multivariable formula was then compared with that of a traditional, L ₂-based univariate formula for each individual ear.

Results

Use of the multivariable formula L ₁ = 0.47L ₂ + 2.40A + f _2param + 38 [dB SPL] resulted in significantly more accurate L _1OPT predictions than did the univariate formula L ₁ = 0.49L ₂ + 41 [dB SPL]. Although average improvement was small, meaningful improvements were identified within individual ears, especially for f ₂ = 1 and 6 kHz.

Conclusion

Incorporation of a wideband absorbance measure into a primary tone level optimization formula resulted in a minor average improvement in L _1OPT prediction accuracy when compared with a traditional univariate optimization formula. Further research is needed to identify characteristics of ears that might disproportionately benefit from the additional measure.

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Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users

Purpose

The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit.

Method

This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study.

Results

No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization.

Conclusion

Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.

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Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families

Purpose

The goal of this study was to identify predictors of expressive vocabulary in young Spanish-speaking children who are deaf or hard of hearing living in the United States.

Method

This cross-sectional study considered 53 children with bilateral hearing loss between 8 and 34 months of age (M = 24, SD = 6.9). Demographic variables, variables related to the hearing loss, and intervention variables were included in a hierarchical regression analysis to predict expressive vocabulary quotients from the MacArthur Inventario del Desarrollo de Habilidades Comunicativas (Communicative Development Inventories; Jackson-Maldonado et al., 2003).

Results

Chronological age, degree of hearing loss, functional hearing ability ratings, age of enrollment in early intervention, and the interaction between chronological age and age of intervention accounted for 61.5% of the vocabulary variance. Children who received intervention by 6 months of age achieved significantly higher vocabulary outcomes than children who started intervention later.

Conclusion

The children's mean vocabulary outcomes were below average when compared with hearing peers. This was especially true for older children, children with moderately-severe-to-profound hearing loss, and children who began intervention after 6 months of age. This delay in vocabulary outcomes has the potential to interfere with future reading and academic outcomes.

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