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26.01.2014
Three audio metrically matched groups of adults with hearing loss were tested to determine at what age performance declined relative to that expected on the basis of audibility. Scores for WDRC-amplified speech were slightly lower than for linearly amplified speech across all groups and noise conditions. The small reduction in scores for amplitude-modulated compared to steady noise and lack of ageinteraction suggests that the substantial deficit seen with age in multitalker babble for previous studies was due to some effect not elicited here, such as informational masking.This hypothesis is consistent with recent data that audibility also over-predicted adults performance in interrupted speech spectrum noise (Dubno et al, 2002). For example, Souza and Turner (1994) found speech recognition of older listeners with hearing loss to be 20% poorer, on average, in a background of multitalker babble versus a speech-spectrum noise with the same temporal characteristics. We do not know what the relationship between audibility and recognition will be when speech in noise is WDRC amplified. Use of measured instead of nominal compression ratios was based onprevious work (Souza and Turner, 1999) that demonstrated improved accuracy of AAI predictions with that method.ProcedureThe listener was seated in a double walled sound-treated booth. Passages were paired according to the instructions forthe CST, in which predetermined passage pairs of are equal difficulty. As dictated by the test instructions, the listener was told the passage topic prior to each passage.
After the listener was informed of the passage topic, one sentence was played at a time.The experimenter was seated outside the sound booth and recorded the responses as the listener repeated the sentences through an intercom system. For each condition, a percent-correct score was calculated for each passage pair based on50 words. Sixteen test conditions were presented in random order, each consisting of a different background noise (steady state, amplitude modulated), SNR (-2, +2, +6, and +10 dB), and amplification type (linear, WDRC).RESULTSMean scores for each group and testcondition, averaged across the four signal-to-noise ratios, are shown in Table 3. Variability was higher for the groupswith hearing loss than for the group with normal hearing and increased slightly with increasing age.
As expected, these listeners performed well evenat reduced signal audibility, reaching an asymptotic score of 100%. Sherbecoe and Studebakera€™s (2003) performance predictions for the Connected Speech Test are also shown, along with the 95% critical difference range for these materials (Cox et al, 1988). Scores for the WDRC-amplified speech were also well predicted at moderate to high audibility, although our listeners with normal hearing performed better than predicted at low audibility. Performance for the three older groups with hearing loss is shown in Figure 4 (linear) and Figure 5 (WDRC). In each panel, predicted score according to Sherbecoe and Studebaker (2003) was plotted for comparison, along with the 95% critical difference values (Cox et al, 1988). The range of audibility was the same in each of the three groups, as expected because the mean audiogram was the same in each group. In comparison to the listeners with normal hearing, the listeners withhearing loss showed greater performancevariability, and performance for each group was poorer than predicted on the basis of audibility.Figure 3.
Results are shown for the linearly amplified speech in steady noise (filled circles) and amplitude modulated noise (opencircles) and for the WDRC amplified speech in steady noise (filled triangles) and amplitude-modulated noise (open triangles).


The left panel shows results for speech in steady noise, and the right panel shows results for speech in amplitude-modulated noise. Data shown are for Group 1 (filled circles), Group 2 (open circles), and Group 3 (filled triangles).
To examine the effect of listener age, these data were submitted to a three-way, repeated-measures analysis of variance.
Comparisons were made across the two noise types, two amplification types, and four participant groups.
On average, performance for steady noise was about 1.5% below performance for amplitude modulated noise. Across all conditions and age groups, the actual-predicted difference was larger for linear than for WDRC amplification (p = .021). This was not because of higher WDRC scores; on average, linear scores were higher by 1a€“2%. Instead, this difference reflected higher AAIs (and therefore higher predicted scores) for the linear conditions. The left panel shows results for speech in steady noise, and the right panel shows results for speech in amplitude-modulatednoise. Data shown are for Group 1 (filled circles), Group 2 (open circles), and Group 3 (filled triangles).Solid line shows predicted performance, according to Sherbecoe and Studebaker (2003). Mean Deviation from Predicted Score (in RAU) for Each GroupIn the present study, performance worsened significantly with increasing age, even among listeners younger than75 years. Because the threegroups were well matched for amount of hearing loss, this finding was unlikely to be due to increasing threshold elevation. Indeed, the youngest of the threehearing-impaired groups had the poorest average thresholds within the 1a€“4 kHz range. Such questions are of great interest to researchers as this portion of the population increases, but we have found that practical issues of health, transportation, and fatigue limit the willingness of those adults to volunteer for research studies. We treated age as a categorical variableto allow comparison of performance across audiometrically matched groups. An alternative approach would have been to treat age as a continuousvariable, recruit listeners of various ages regardless of audiogram, and apply statistical controls for degree of hearing loss.
Also, in contrast to the idea that the oldest listeners might be less able to distinguish between the varyingtemporal patterns of the speechand the masker, we found no interaction between age and type of noise. At present, this is the only index that incorporates nonlinear amplification characteristics. For linearly amplified speech, the AAI was nearly identical to the conventional Articulation Index or Speech Intelligibility Index, albeit with small differences in the assumed short- term speech range. Therefore, Speech Intelligibility Index derived performance predictions such as those developed by Sherbecoe and Studebaker (2003)seemed appropriate for comparison.


This was further verified by the close agreement between predicted performance (using the Speech Intelligibility Index-derived transfer function) and our normal-hearing data (Figure 3). Previous work showed that the performance increase for a given increase in AAI was the same forlinearly amplified as for WDRCamplified speech (Souza and Turner,1999), suggesting that the same prediction function could be used for the WDRC condition. Because the long- term average spectrum of the amplitude- modulated noise and the steady noise was the same, the same noise levels were input to the AAI calculation for both noise backgrounds. For the continuous noise used here, even though it is not a constant amplitude noise, the standard audibility index calculation was more appropriate. Some researchershave proposed including a correction for hearing loss a€?desensitizationa€? that would reduce predicted performance to be more typical of listeners with hearing loss.
To that end, we expected that performance by the listeners with hearing loss would fall below predicted performance. Indeed, when considered as a single group of listeners with hearing loss, our results were similar to those reported by Sherbecoe and Studebaker (2003) for a variety of studies with the samematerials. We were more interested in whether the difference between predicted and actual performance varied across age groups, or with different background noises. Thus, the data presented here do not answer thequestion of whether lower-than- predicted performance for Group 1 is due to hearing loss, to age, or to a combination of those factors.Wide-Dynamic Range CompressionAmplificationFor each presented signal-to-noise ratio, audibility was higher for the linear speech. In recent work (Souza et al, 2006), we noted a poorer signal-to-noise ratio at the output of a single channel, fast-acting WDRC system, due to an increase in noise level during the pauses between words. Although this increased the long-term average noise level and therefore lowered the AAI, it may not significantly alter performance. At least for listeners with normal hearing, we expected that increased noise during speech pauses should have little effect on speech recognition, because at those points in the signal there was no speech to recognize.
For listeners with normal hearing, the critical issue was any noise present simultaneously with target words.
This may be why the listeners with normal hearing performed better than predicted at low AAIs (Figure 4).
This study provided a limited view ofperformance relative to that predicted by audibility when speech is WDRC amplified.
Based on previous work, we would expect to see little advantage of WDRC amplification at this input level, and greater improvements over multiple input levels or for low-intensity inputs (Souza and Turner, 1998; Jenstad et al,1999). Second, multichannel WDRC amplification may also offer greater benefit, especially when the noise is lower (or higher) in frequency than speech and when reduced gain in some channels might improve the signal-to- noise ratio. Prediction of speech recognition from audibility and psychoacoustic abilities of hearing impaired listeners.



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