Discrimination of gain increments in speech

During a hearing-aid fitting, the gain applied across frequencies is often adjusted from an initial prescription in order to meet individual needs and preferences. These gain adjustments in one or more frequency bands are commonly verified using speech in quiet (e.g., the clinician’s own voice). Such adjustments may be unreliable and inefficient if they are not discriminable. To examine what adjustments are discriminable when made to speech, the current study measured the just-noticeable differences (JNDs) for gain increments in male, single-talker sentences. Sentences were presented with prescribed gains to the better ears of 41 hearing-impaired listeners. JNDs were measured at d' of 1 for octave-band, dual-octave-band and broadband increments using a fixed-level, same-different task. The JNDs and interquartile ranges (IQRs) for 0.25, 1 and 4 kHz octave-band increments were 6.4 [4.0-7.8], 6.7 [4.6-9.1] and 9.6 [7.3-12.4] dB respectively. The JNDs and IQRs for low, mid and high-frequency dual-octave-band increments were 3.7 [2.5-4.6], 3.8 [2.9-4.7] and 6.8 [4.7-9.1] dB, respectively. The JND for broadband increments was 2.0 [1.5-2.7] dB. High-frequency dual-octave-band JNDs were positively correlated with high-frequency pure-tone thresholds and sensation levels, suggesting an effect of audibility for this condition. All other JNDs were independent of pure-tone threshold and sensation level. JNDs were independent of age and hearing-aid experience. These results suggest using large initial adjustments when using short sentences in a hearing-aid fitting to ensure patient focus, followed by smaller subsequent adjustments, if necessary, to ensure audibility, comfort and stability

The perceptual limitations of troubleshooting hearing-aids based on patients’ descriptions

ObjectivesHearing-aid frequency-gain responses are routinely adjusted by clinicians to patient preferences and descriptions. This study measured the minimum gain adjustments required to elicit preferences, and the assignment of descriptors to gain adjustments, to perceptually evaluate description-based troubleshooting.DesignParticipants judged whether short sentences with ±0-12 dB gain adjustments in one of three frequency bands were “better”, “worse” or “no different” from the same sentence at their individual real-ear or prescribed gain. If judged “better” or “worse”, participants were then asked to assign one of six common sound-quality descriptors to their preference.Study SampleThirty-two adults (aged 51-75 years) all with hearing-aid experience.ResultsMedian preference thresholds, the minimum gain adjustments to elicit “better” or “worse” judgments, ranged from 4-12 dB, increasing with frequency. There was some between-participant agreement in preferences: participants generally preferred greater low-frequency gain. Within-participant reliability for preferences was moderate. There was, however, little between-participant agreement in descriptor selection for gain adjustments. Furthermore, within-participant reliability for descriptor selection was weak.ConclusionsThe scale of gain adjustments necessary to elicit preferences, along with the low agreement and reliability in descriptors for these adjustments questions the efficiency and efficacy of current description-based troubleshooting, especially with short speech stimuli

Discrimination of Gain Increments in Speech-Shaped Noises

Frequency-dependent gain adjustments are routine in hearing-aid fittings, whether in matching to real-ear targets or fine-tuning to patient feedback. Patient feedback may be unreliable and fittings inefficient if adjustments are not discriminable. To examine what gain adjustments are discriminable, we measured the just-noticeable differences (JNDs) for level increments in speech-shaped noises processed with prescription gains. JNDs were measured in the better ears of 38 participants with hearing impairment using a fixed-level, same-different task. JNDs were measured for increments at six individual frequency-bands: a 0.25-kHz low-pass band; octave-wide bands at 0.5, 1, 2, and 4 kHz; and a 6-kHz high-pass band. JNDs for broadband increments were also measured. JNDs were estimated at d’ of 1 for a minimally discriminable increment in optimal laboratory conditions. The JND for frequency-band increments was 2.8 dB excluding the 0.25-kHz low-pass band, for which the JND was 4.5 dB. The JND for broadband increments was 1.5 dB. Participants’ median frequency-band and broadband JNDs were positively correlated. JNDs were mostly independent of age, pure-tone thresholds, and cognitive score. In consideration of self-fitting adjustments in noisier conditions, JNDs were additionally estimated at a more sensitive d’ of 2. These JNDs were 6 dB for bands below 1 kHz, and 5 dB for bands at and above 1 kHz. Overall, the results suggest noticeable fine-tuning adjustments of 3 dB and self-fitting adjustments of 5 dB

The effect of stimulus duration on preferences for gain adjustments when listening to speech

Objectives: In the personalisation of hearing-aid fittings, gain is often adjusted to suit patient preferences using live speech. When using brief sentences as stimuli, the minimum gain adjustments necessary to elicit consistent preferences (“preference thresholds”) were previously found to be much greater than typical adjustments in current practice. The current study examined the role of duration on preference thresholds. Design: Participants heard 2, 4 and 6-s segments of a continuous monologue presented successively in pairs. The first segment of each pair was presented at each individual’s real-ear or prescribed gain. The second segment was presented with a ±0–12 dB gain adjustment in one of three frequency bands. Participants judged whether the second was “better”, “worse” or “no different” from the first. Study sample: Twenty-nine adults, all with hearing-aid experience. Results: The minimum gain adjustments needed to elicit “better” or “worse” judgments decreased with increasing duration for most adjustments. Inter-participant agreement and intra-participant reliability increased with increasing duration up to 4 s, then remained stable. Conclusions: Providing longer stimuli improves the likelihood of patients providing reliable judgments of hearing-aid gain adjustments, but the effect is limited, and alternative fitting methods may be more viable for effective hearing-aid personalisation