Hearing Aid Technology Settings and Speech-in-Noise Difficulties

Abstract

Purpose: Hearing aids are the primary method to manage hearing loss. However, there are limited recommendations for when and how to set advanced hearing aid features. The purpose of this study is to describe how hearing aid features are utilized in clinically fit devices and to evaluate the relationship between the fitted hearing aid feature and the Quick Speech-in-Noise Test (QuickSIN). Method: Data from two laboratories were evaluated retrospectively, resulting in 107 bilateral hearing aid participants who obtained their hearing aids at clinics in their communities. Ages ranged from 60 to 93 years. Degree of speech-in-noise difficulty was evaluated using the QuickSIN (mild, moderate, or severe). Settings for directionality, digital noise reduction (DNR), and hearing assistive technology (HAT) use were documented. Directionality was categorized as omnidirectional, fixed (full-time directional), or adaptive (adjusts automatically based on noise source). DNR was recorded as either on or off. HAT use was recorded as either yes or no. Results: QuickSIN scores ranged from −1.5 to 25 dB SNR loss ( M = 7). A moderate correlation was determined for QuickSIN scores and pure-tone averages. Adaptive directionality was used most often, most participants had DNR turned on, and HAT use was low. The biggest contributions to the Chi-square test for directionality and degrees of speech-in-noise difficulty together were fixed/severe, fixed/moderate, and adaptive/mild. Conclusions: In this clinical sample, there was limited HAT use and advanced features are not set in a way that is consistent with speech-in-noise abilities. It is likely that patients fit with noise management that is not suited to their listening abilities are experiencing increased difficulties in challenging listening environments that could potentially be mitigated with alternative management. Evidence-based research on prefitting measures of speech in noise to help inform patient-centered clinical decisions is needed.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults

“…However, some hearing aid settings may significantly degrade the input signal in ways that hamper auditory processing, undermine speech perception or listening comfort, and increase listening effort ( 124 , 125 ). The primary role of audiologists should be to address the concerns of, and provide benefit to, the individual patient, so it is important that the patient is given the opportunity for input and that these signal enhancement principles are understood and alternative settings considered ( 126 ). In general, hearing aid users with greater cognitive ability appear to benefit more from hearing aids ( 127 ).…”

Hearing function moderates age-related changes in brain morphometry in the HCP Aging cohort

“…Difficulty hearing in noise can occur in older adults without measurable peripheral hearing loss [Dubno et al, 2002; Helfer and Freyman, 2008; Schoof and Rosen, 2014], where tracking speech with competing talkers (vs. other types of noise) may be particularly affected [Helfer and Freyman, 2008; Rajan and Cainer, 2008; Schoof and Rosen, 2014; Tun et al, 2002]. In people with peripheral hearing loss, amplification does not always improve hearing in noise, though directionality settings may be under-utilized [Davidson et al, 2022]. However, it is unclear why such hearing in noise difficulties arise, and few therapies are available if amplification strategies fail.…”

“…In typical populations, thresholds on WIN tasks are correlated with pure-tone thresholds assessed via air conduction, though the strength of this correlation depends on the population studied and the manner of WIN task administration [Fitzgerald et al, 2023; Holmes and Griffiths, 2019; Humes, 2021; Kam and Fu, 2020; Leaver, 2024; Vermiglio et al, 2020]. Although difficulty hearing in noisy environments can sometimes persist after hearing aid use [Davidson et al, 2022] and may indicate central hearing loss [C. Kohrman et al, 2020], these phenomena appear to be occur less frequently than peripheral/sensorineural hearing loss [Spankovich et al, 2018]. Therefore, in databases like the HCP that do not select for or exclude hearing loss during recruitment, WIN threshold is most likely to reflect peripheral hearing loss.…”

Design and Development of a Spanish Hearing Test for Speech in Noise (PAHRE)

“…The aim here was to ensure that the person being tested starts the test successfully, and also to obtain more precise information by using 3 dB steps (smaller steps were discarded because of their impact on the time taken to carry out the test, with consequently greater effort and fatigue by the person being tested). These aspects are considered essential because they allow the improvement of the selection and fitting of the hearing aids based on its advanced features to improve SNR, such as directionality and digital noise reduction [ 25 , 27 , 28 , 71 ]. Prospective studies of this test will be necessary to assess the speech discrimination loss as the SNR decreases for different age groups in the normal hearing people.…”

“…In this way, this information will allow assessment of the SNR loss in the people with hearing loss and, therefore, the degrees of speaking in noise difficulty as established by the QuickSIN test (mild, moderate, or severe). Based on these results, patient-centred clinical decisions can be made regarding the advanced features of the hearing aid, the use of hearing assistive technology taking as an example the recent study by Davidson et al [ 71 ], or even the need for auditory training.…”