Comparison of Speech-in-Noise and Localization Benefits in Unilateral Hearing Loss Subjects Using Contralateral Routing of Signal Hearing Aids or Bone-Anchored Implants

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d874565e137">Objective</h5> <p id="P1">To compare the benefit of wireless contralateral routing of signal (CROS) technology to bone-anchored implant (BAI) technology in monaural listeners. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d874565e142">Study Design</h5> <p id="P2">Prospective, single-subject</p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d874565e147">Setting</h5> <p id="P3">Tertiary academic referral center</p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d874565e152">Patients</h5> <p id="P4">Adult English speaking subjects using either a CROS hearing aid or BAI as treatment for unilateral severe-profound hearing loss. </p> </div><div class="section"> <a class="named-anchor" id="S5">  </a> <h5 class="section-title" id="d874565e157">Interventions</h5> <p id="P5">Aided performance utilizing the subjects BAI or CROS hearing device.</p> </div><div class="section"> <a class="named-anchor" id="S6">  </a> <h5 class="section-title" id="d874565e162">Main Outcome Measures</h5> <p id="P6">Outcome measures included speech-in-noise perception using the QuickSIN™ speech-in-noise test and localization ability using narrow and broadband stimuli. Performance was measured in the unaided and aided condition and compared to normal hearing controls. Subjective outcomes measures included the Speech Spatial and Qualities hearing scale and the Glasgow Hearing Aid Benefit Profile. </p> </div><div class="section"> <a class="named-anchor" id="S7">  </a> <h5 class="section-title" id="d874565e167">Results</h5> <p id="P7">A significant improvement in speech-in-noise performance for monaural listeners (p<0.0001) was observed, but there was no improvement in localization ability of either CROS or BAI users. There was no significant difference between CROS and BAI subject groups for either outcome measure. BAI recipients demonstrate higher initial disability and handicap over CROS hearing aid users. No significant difference was observed between treatment groups for subjective measures of post-treatment residual disability or satisfaction. </p> </div><div class="section"> <a class="named-anchor" id="S8">  </a> <h5 class="section-title" id="d874565e172">Conclusions</h5> <p id="P8">Our data demonstrate that both CROS and BAI systems provide significant benefit for monaural listeners. There is no significant difference between CROS or BAI systems for objective measures of speech-in-noise performance. CROS and BAI hearing devices do not provide any localization benefit in the horizontal plane for monaural listeners and there is no significant difference between systems. </p> </div>

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Sound localization by human listeners.

J C Middlebrooks, D M Green (1991)

In keeping with our promise earlier in this review, we summarize here the process by which we believe spatial cues are used for localizing a sound source in a free-field listening situation. We believe it entails two parallel processes: 1. The azimuth of the source is determined using differences in interaural time or interaural intensity, whichever is present. Wightman and colleagues (1989) believe the low-frequency temporal information is dominant if both are present. 2. The elevation of the source is determined from spectral shape cues. The received sound spectrum, as modified by the pinna, is in effect compared with a stored set of directional transfer functions. These are actually the spectra of a nearly flat source heard at various elevations. The elevation that corresponds to the best-matching transfer function is selected as the locus of the sound. Pinnae are similar enough between people that certain general rules (e.g. Blauert's boosted bands or Butler's covert peaks) can describe this process. Head motion is probably not a critical part of the localization process, except in cases where time permits a very detailed assessment of location, in which case one tries to localize the source by turning the head toward the putative location. Sound localization is only moderately more precise when the listener points directly toward the source. The process is not analogous to localizing a visual source on the fovea of the retina. Thus, head motion provides only a moderate increase in localization accuracy. Finally, current evidence does not support the view that auditory motion perception is anything more than detection of changes in static location over time.

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Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal-hearing and hearing-impaired listeners.

Gail I Gudmundsen, C Killion, P Niquette … (2004)

This paper describes a shortened and improved version of the Speech in Noise (SIN) Test (Etymotic Research, 1993). In the first two of four experiments, the level of a female talker relative to that of four-talker babble was adjusted sentence by sentence to produce 50% correct scores for normal-hearing subjects. In the second two experiments, those sentences-in-babble that produced either lack of equivalence or high across-subject variability in scores were discarded. These experiments produced 12 equivalent lists, each containing six sentences, with one sentence at each adjusted signal-to-noise ratio of 25, 20, 15, 10, 5, and 0 dB. Six additional lists were also made equivalent when the scores of particular pairs were averaged. The final lists comprise the "QuickSIN" test that measures the SNR a listener requires to understand 50% of key words in sentences in a background of babble. The standard deviation of single-list scores is 1.4 dB SNR for hearing-impaired subjects, based on test-retest data. A single QuickSIN list takes approximately one minute to administer and provides an estimate of SNR loss accurate to +/-2.7 dB at the 95% confidence level.

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Contribution of head shadow and pinna cues to chronic monaural sound localization.

Marc van Wanrooij, A van Opstal (2004)

Monaurally deaf people lack the binaural acoustic difference cues in sound level and timing that are needed to encode sound location in the horizontal plane (azimuth). It has been proposed that these people therefore rely on spectral pinna cues of their normal ear to localize sounds. However, the acoustic head-shadow effect (HSE) might also serve as an azimuth cue, despite its ambiguity when absolute sound levels are unknown. Here, we assess the contribution of either cue in the monaural deaf to two-dimensional (2D) sound localization. In a localization test with randomly interleaved sound levels, we show that all monaurally deaf listeners relied heavily on the HSE, whereas binaural control listeners ignore this cue. However, some monaural listeners responded partly to actual sound-source azimuth, regardless of sound level. We show that these listeners extracted azimuth information from their pinna cues. The better monaural listeners were able to localize azimuth on the basis of spectral cues, the better their ability to also localize sound-source elevation. In a subsequent localization experiment with one fixed sound level, monaural listeners rapidly adopted a strategy on the basis of the HSE. We conclude that monaural spectral cues are not sufficient for adequate 2D sound localization under unfamiliar acoustic conditions. Thus, monaural listeners strongly rely on the ambiguous HSE, which may help them to cope with familiar acoustic environments.