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      Acceptable noise level as a deciding factor for prescribing hearing aids for older adults with cochlear hearing loss – A scoping review

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          Abstract

          Older adults often find it difficult to perceive speech, especially in noisy conditions. Though hearing aid is one of the rehabilitative devices available to older adults to alleviate hearing loss, some of them may experience annoyance through hearing aid and hence reject it, may be due to circuitry noise and/or background noise. Acceptable noise level is a direct behavioural measure to estimate the extent of how much a person is able to put up with noise while simultaneously listening to speech. Acceptable noise level is a central auditory measure and it is not influenced by age, gender, presentation level or speaker. Using this measure, we can quantify the annoyance level experienced by an individual. This information is of utmost importance and caution should be paid before setting the parameters in hearing aid, especially for those who are unable to accept noise. In this review article, an attempt has been made to document how to optimize the hearing aid program by setting parameters such as noise reduction circuit, microphone sensitivity and gain. These adjustments of parameters might help to reduce rejection rate of hearing aids, especially in those individuals who are annoyed by background noise.

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          Most cited references33

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          Effects of fluctuating noise and interfering speech on the speech-reception threshold for impaired and normal hearing.

          The speech-reception threshold (SRT) for sentences presented in a fluctuating interfering background sound of 80 dBA SPL is measured for 20 normal-hearing listeners and 20 listeners with sensorineural hearing impairment. The interfering sounds range from steady-state noise, via modulated noise, to a single competing voice. Two voices are used, one male and one female, and the spectrum of the masker is shaped according to these voices. For both voices, the SRT is measured as well in noise spectrally shaped according to the target voice as shaped according to the other voice. The results show that, for normal-hearing listeners, the SRT for sentences in modulated noise is 4-6 dB lower than for steady-state noise; for sentences masked by a competing voice, this difference is 6-8 dB. For listeners with moderate sensorineural hearing loss, elevated thresholds are obtained without an appreciable effect of masker fluctuations. The implications of these results for estimating a hearing handicap in everyday conditions are discussed. By using the articulation index (AI), it is shown that hearing-impaired individuals perform poorer than suggested by the loss of audibility for some parts of the speech signal. Finally, three mechanisms are discussed that contribute to the absence of unmasking by masker fluctuations in hearing-impaired listeners. The low sensation level at which the impaired listeners receive the masker seems a major determinant. The second and third factors are: reduced temporal resolution and a reduction in comodulation masking release, respectively.
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            Acceptable noise level as a predictor of hearing aid use.

            Acceptable noise level (ANL) measures a listener's reaction to background noise while listening to speech. Relations among hearing aid use and ANL, speech in noise (SPIN) scores, and listener characteristics (age, gender, pure-tone average) were investigated in 191 listeners with hearing impairment. Listeners were assigned to one of three groups based on patterns of hearing aid use: full-time use (whenever hearing aids are needed), part-time use (occasional use), or nonuse. Results showed that SPIN scores and listener characteristics were not related to ANL or hearing aid use. However, ANLs were related to hearing aid use. Specifically, full-time hearing aid users accepted more background noise than part-time users or nonusers, yet part-time users and nonusers could not be differentiated. Thus, a prediction of hearing aid use was examined by comparing part-time users and nonusers (unsuccessful hearing aid users) with full-time users (successful hearing aid users). Regression analysis determined that unaided ANLs could predict a listener's success of hearing aids with 85% accuracy.
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              Toleration of background noises: relationship with patterns of hearing aid use by elderly persons.

              One of the frequently quoted reasons for the rejection of hearing aids is amplification of background noise. The relationship between hearing aid use and toleration of background noise was assessed. Four groups of elderly subjects (at least 65 years old) and one group of young subjects with normal hearing participated in the study. Each group consisted of 15 subjects. The young subjects and elderly subjects in one group with relatively good hearing were tested for comparison with the hearing-impaired subjects. Elderly subjects in the three remaining groups had acquired hearing losses and had been fitted with hearing aids. The subjects were assigned to three groups on the basis of hearing aid use: full-time users, part-time users, and nonusers. The amount of background noise tolerated when listening to speech was tested. The speech stimulus was a story read by a woman and set at an individually chosen most comfortable level. The maskers were a babble of voices, speech-spectrum noise, traffic noise, music, and the noise of a pneumatic drill. There was a significant interaction between groups and noises. The full-time users tolerated significantly higher levels of music and speech-spectrum noise than part-time users and nonusers. In addition, the full-time users, but not the part-time users, assessed themselves as less handicapped in everyday functions when they wore hearing aids than when they did not wear their hearing aids.
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                Author and article information

                Contributors
                Journal
                J Otol
                J Otol
                Journal of Otology
                Chinese PLA General Hospital
                1672-2930
                11 November 2015
                September 2015
                11 November 2015
                : 10
                : 3
                : 93-98
                Affiliations
                [1]All India Institute of Speech and Hearing, Mysore, India
                Author notes
                []Corresponding author. Tel.: +91 9986511550. hemanthn.shetty@ 123456gmail.com
                Article
                S1672-2930(15)00065-3
                10.1016/j.joto.2015.10.002
                6002566
                97d0abe3-3189-4cb8-b8be-f90bc14e5d75
                © 2015 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 2 September 2015
                : 12 October 2015
                : 28 October 2015
                Categories
                Review Article

                annoyance,amplification,speech perception in noise,older adults,hearing impairment

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