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Author: admin, 27.02.2015. Category: Is There A Cure For Tinnitus

Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. Frequency lowering strategies are generally used in the hearing industry as an alternative for patients who do not benefit from traditional amplification in the high frequencies. Jennifer Groth, AuD, is Director of Audiology Communications at GN ReSound Global Audiology in Glenview, Ill.
The clinical challenge for this feature resides in identifying which individuals will receive benefit from frequency lowering, and which would be fitted more successfully with traditional amplification, as no definitive candidacy criteria for frequency lowering have been established to date. Hearing loss that slopes to greater degrees of severity for the high frequencies is commonly encountered in hearing clinics.
For the patient, many consonant sounds important for accurate speech discrimination are located in the high frequency region. The inaudibility of certain phonemes produced at typical speech levels may present significant problems for the patient. In the real-world scenario of continuous discourse, people can often decipher messages even when not all the acoustic information is present.
The relative importance of different types of redundancy in speech and communication shifts, depending on both acoustic and intrinsic factors. The need for and desirability of adequate high-frequency audibility extends beyond the realm of speech to environmental sounds. Traditional amplification using wide dynamic range compression (WDRC) will provide greater audibility for low-level sounds in the necessary frequency regions, in an attempt to raise the level of speech and other environmental sounds to an audible level per the individual’s hearing loss. Aside from the technical issues in providing these significant high-frequency gains, a physiological issue has also been suggested in the literature. If adequate gain cannot be provided by the compressor, or if the patient does not receive benefit in speech understanding from this degree of high-frequency amplification, an effective alternative to provide audibility may be a frequency lowering approach. In some frequency lowering approaches, this also results in reducing the bandwidth of the device to a lower frequency. Current research has revealed some interesting patient characteristics that would contraindicate the use of frequency lowering for certain individuals.
At the other end of the age spectrum, children fitted with nonlinear frequency compression (NLFC) may perform better in some areas but poorer in others, as compared to their traditionally fitted peers.5 Poorer consonant articulation scores were revealed in this study for children fitted with frequency compression.
The configuration or slope of the hearing loss may also be an important factor to consider. Finally, certain cost-benefit decisions are involved when enabling frequency lowering for a patient. In the absence of the patient considerations outlined above, and when judicious use of the feature is employed, frequency lowering may be an appropriate tool to use for individual patients who do not receive adequate benefits from traditional amplification. In addition to the shared goal of audibility, ReSound Sound Shaper employs much of the same terminology as amplitude compression. Verification of the audibility of these compressed signals is important, since a frequency-lowered signal that is still inaudible to the patient defeats the purpose of turning the feature on. All frequency-lowering techniques introduce a compromise between audibility and sound quality. As previously stated, there are no defined guidelines about which individual patients will be the best candidates for frequency lowering. To this end, Sound Shaper is incorporated in Aventa 3 with a limited number of settings, which were found through internal testing to provide the greatest audibility benefit while also minimizing deleterious effects on the sound quality.
The effects of frequency compression on sound quality are not easily generalized to all users. To provide the greatest listening benefits with minimal signal distortion, Sound Shaper was developed as a proportional frequency compression strategy. The main benefit of a proportional frequency compression technique is that there is less distortion as compared to a nonlinear compression strategy. The results for both devices show that the frequency of the hearing aid output is lowered, and to approximately the same degree. Sound quality for music was also evaluated for proportional and non-proportional frequency compression via a predictive model. Identical 10-second segments of pop music presented at 60 dB SPL (RMS) were recorded through each hearing instrument for each of these hearing losses.
Results for all three types of hearing losses showed the same trends, so for simplicity, the averages of these results for each frequency compression setting are depicted in Figure 6. This indicates that stronger frequency compression settings are predictive of poorer sound quality regardless of which method of frequency compression is used.
Sound Shaper provides hearing care professionals with another tool to improve high-frequency audibility, especially for individuals who do not receive optimal results with traditional amplification. Good intervention plans will include close monitoring, follow-ups and any changes needed along the way. However, all of these strategies introduce distortion and potentially do more harm than good. A review of the literature reveals many studies with conflicting results and recommendations. It is for these reasons that frequency lowering strategies are typically regarded as alternatives to consider for patients who do not receive the expected benefits from traditional amplification in the high frequencies.
This hearing loss configuration, however, presents its own challenges, both for the patient and for the hearing care professional.
Steeply sloping high-frequency hearing loss, with the speech banana and English phonemes superimposed to indicate areas of audibility and inaudibility for the patient. A speech banana is superimposed on the audiogram, which indicates the common distribution of speech sounds in the frequency-intensity realm over time. This is due to the linguistic and acoustic redundancy of speech communication; speech contains more information than is needed to decode it. One-third octave band importance functions for nonsense syllables and continuous discourse.
This is illustrated by the band importance functions for different types of speech material in calculating the Speech Intelligibility Index2 (Figure 2).


As shown in Figure 1, a hearing loss of this configuration and degree affects the audibility for environmental sounds, such as birdsong. Steeply sloping high-frequency hearing loss, with typical environmental sounds superimposed to indicate areas of audibility and inaudibility for the patient.
The success of this approach often depends on the severity of the hearing loss in the high frequencies; for greater degrees of high-frequency hearing loss, traditional amplification may have limited success in providing audibility for these high-frequency sounds. For some individuals, it has been suggested that providing traditional high-frequency amplification for severe high-frequency hearing losses may not be beneficial if the corresponding high-frequency areas on the cochlear basilar membrane represent a “dead region.” A dead region is generally characterized by non-functioning inner hair cells. Frequency lowering strategies work through the displacement of signals from higher frequencies to lower frequencies, where beneficial amplification may be achieved. Although all frequency lowering approaches introduce some degree of distortion due to the artificial movement of some frequencies to a different region, the benefit in audibility may result in a favorable compromise for some individuals. For example, older patients who have a known working memory or cognitive deficit may be more susceptible to distortion created by certain hearing aid features.4 As frequency lowering is known to create distortion to some extent through artificial alteration of the high frequencies, these patients may receive greater benefit from traditional amplification. Overall, the study revealed insufficient evidence to suggest global language ability differences between the children fitted with NLFC and those fitted traditionally. A recent study indicated that, while NLFC was beneficial for high-frequency consonant recognition, it was not as beneficial for speech recognition in noise.12 Further, the methodology and care taken when fitting this feature was highlighted as a factor in the benefit it can provide. Of the frequency lowering approaches used today by the hearing industry, the most commonly fitted strategy is frequency compression. To this end, ReSound has introduced Sound Shaper, available in Aventa 3.6 fitting software, as a tool to be used by the fitter to meet the needs of the individual patient. Frequency compression changes the input to a more amenable output above a cut-off threshold, or kneepoint. Audioscan Verifit Speechmap display showing verification measurements with Sound Shaper “Off” (blue) and Sound Shaper set to “Moderate” (green).
Figure 4 illustrates one possible method of ensuring audibility for a previously inaudible stimulus. Some users will benefit greatly from the increased audibility of high-frequency sounds, while others may be bothered by the feature’s inherent distortion and perceptual sound quality. In addition, consideration was taken to ensure that different settings provided distinctly different results, to simplify the process of setting Sound Shaper.
This means that the relationships between frequency-compressed inputs are constant; in other words, the frequency compression ratio is constant for all input frequencies. Spectrograms for a swept pure-tone were measured unprocessed (upper- and lower-left panels), and with both amplitude and frequency compression activated (upper- and lower-right panels).
To illustrate the differences in the processing of a signal, a pure-tone sweep was processed through ReSound’s proportional frequency compression and another manufacturer’s non-proportional frequency compression to create spectrograms (Figure 5).
The difference is that, for the non-proportional method (lower-right panel), there is more distortion in the output than with the proportional method (upper-right panel) used in Sound Shaper. In this comparison, each hearing instrument was programmed for three hearing losses: mild flat, mild sloping to moderately severe, and mild sloping to profound.
The recordings were then analyzed through the Hearing Aid Speech Quality Index (HASQI),16 which is based on coherence  between the input and output signals of the hearing aid, and yields a score on a linear scale from 0 to 100%.
Better sound quality for music is suggested by the HASQI for Sound Shaper than for a non-proportional frequency compression (FC) strategy with similar kneepoints and compression ratios. The highest HASQI scores relative to the input signal were obtained when frequency compression was deactivated (the “Off” setting). These results are also in agreement with other research regarding sound quality for music with frequency lowering.15 However, the HASQI results overall predicted better sound quality for the proportional frequency compression technique (Sound Shaper) than for the non-proportional frequency compression strategy. Ching TYC, Day J, Zhang V, Dillon H, Van Buynder P, Seeto M, Hou S, Marnane V, Thomson J, Street L, Wong A, Burns L, Flynn C. This article outlines considerations when fitting a patient with frequency lowering, as well as current research suggesting when this type of feature may not be as beneficial. There appears to be no general consensus on benefit for groups of people fitted with this feature versus those fitted without it. Individual phonemes indicate on the audiogram their specific frequency and intensity ranges in everyday speech. Vowel formant transitions, which indicate place of articulation for the consonants that precede and follow them, provide acoustic cues to help identify those consonants correctly. High-frequency acoustic information is more important for correct identification of nonsense syllables (red curve) than continuous discourse (black curve), in which knowledge of the language assists in correct identification of speech. For this patient, these environmental sounds will be inaudible without some form of high-frequency amplification (Figure 3). This study suggested that some manufacturer default settings of NLFC for a patient may still fail to provide audibility for the compressed signal, especially in the case of more severe hearing losses. Just as WDRC and other types of amplitude compression “move” low-intensity sounds to higher intensity levels for the individual, frequency compression “moves” high-frequency sounds to a lower, more aidable region. The degree of frequency compression applied can be expressed as the frequency compression ratio. For instance, two individuals with similar hearing losses may derive the greatest benefit from different frequency compression kneepoints and ratios, or from no frequency lowering at all. This is in contrast to a non-proportional or nonlinear frequency compression strategy, in which the relationship between compressed inputs (ie, the ratio) changes as the frequency increases. The lower-right panel shows the results for another manufacturer’s non-proportional frequency compression, while the upper-right panel shows the results for Sound Shaper.
Gains were set according to the default prescriptive targets in the respective manufacturer’s fitting software.
A higher HASQI score predicts better sound quality, as the output sound will be more similar to the input sound, with less added noise and distortion relative to the original input sound.
For both frequency compression techniques, the HASQI score was inversely related to the aggressiveness of the algorithm.
ReSound Sound Shaper is designed as an option that enables hearing care professionals to better accommodate the needs of their individual patients.
A randomized controlled trial of nonlinear frequency compression versus conventional processing in hearing aids: Speech and language of children at three years of age.


Effects of low pass filtering on the intelligibility of speech in noise for people with and without dead regions at high frequencies.
Effects of low-pass filtering on the intelligibility of speech in quiet for people with and without dead regions at high frequencies. Implications of high-frequency cochlear dead regions for fitting hearing aids to adults with mild to moderately severe hearing loss.
Determination of preferred parameters for multichannel compression using individually fitted simulated hearing aids and paired comparisons.
High-frequency amplification and sound quality in listeners with normal through moderate hearing loss. Benefits from non-linear frequency compression hearing aids in a clinical setting: The effects of duration of experience and severity of high-frequency hearing loss.
The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the childa€™s speech, language, and social skills will reach their full potential.Early intervention program services help young children with hearing loss learn language skills and other important skills. However, research suggests that it can be highly beneficial for certain individuals, when fitted appropriately. Sounds below the hearing thresholds on the figure are audible to the patient, and sounds above the thresholds are inaudible.
The physical properties of larger receivers, which are used in high-power hearing instruments, result in a high-frequency roll-off that is at a lower frequency than what is observed for lower-power hearing instruments. Sound Shaper compresses the frequencies above the kneepoint, effectively moving them closer together.
For these reasons, the best approach to applying and fitting frequency compression is often a conservative one.
These spectrograms show that less distortion is generated by the Sound Shaper proportional frequency compression strategy than by the non-proportional frequency compression approach. Colors indicate the intensity of the signal, with red indicating the most intense and blue indicating the least intense. This pattern is similar to what was observed by Parsa and colleagues14 in their investigation on the effect of nonlinear frequency compression on sound quality.
Sound Shaper is a proportional frequency compression approach that can provide high frequency audibility for individuals who do not receive it through traditional amplification, and was developed with the goal of preserving sound quality and minimizing distortion to the extent that is currently possible. This provides the input frequencies in a smaller region that is more usable to the hearing instrument user. Both hearing instruments were programmed with amplitude compression for a mild-to-moderate hearing loss, with similar frequency compression kneepoints and ratios.
The “Strong” setting had a frequency compression kneepoint as close to 2 kHz as possible, with the same 2:1 compression ratio as used by the “Moderate” setting. Services for children from birth through 36 months of age are called Early Intervention or Part C services. Even if your child has not been diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. Through this system, you can ask for an evaluation.Special Education (3-22 years)Special education is instruction specifically designed to address the educational and related developmental needs of older children with disabilities, or those who are experiencing developmental delays. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.Early Hearing Detection and Intervention (EHDI) ProgramEvery state has an Early Hearing Detection and Intervention (EHDI) program. EHDI also promotes timely follow-up testing and services or interventions for any family whose child has a hearing loss. If your child has a hearing loss or if you have any concerns about your childa€™s hearing, call toll free 1-800-CDC-INFO or contact your local EHDI Program coordinator to find available services in your state.TechnologyMany people who are deaf or hard-of-hearing have some hearing.
Technology does not "cure" hearing loss, but may help a child with hearing loss to make the most of their residual hearing.
This may give them the chance to learn speech skills at a young age.There are many styles of hearing aids. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.Cochlear ImplantsA cochlear implant may help many children with severe to profound hearing loss a€” even very young children. A cochlear implant sends sound signals directly to the hearing nerve.A cochlear implant has two main parts a€” the parts that are placed inside the ear during surgery, and the parts that are worn outside the ear after surgery.
The parts outside the ear send sounds to the parts inside the ear.CDC and the Food and Drug Administration (FDA) carried out studies in 2002 and 2006 to learn more about a possible link between cochlear implants and bacterial meningitis in children with cochlear implants. Following are some examples of other assistive devices:FM SystemAn FM system is a kind of device that helps people with hearing loss hear in background noise. FM systems send sound from a microphone used by someone speaking to a person wearing the receiver. An extra piece is attached to the hearing aid that works with the FM system.CaptioningMany television programs, videos, and DVDs are captioned. Captions show the conversation spoken in soundtrack of a program on the bottom of the television screen.Other devicesThere are many other devices available for children with hearing loss.
This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.One type of conductive hearing loss can be caused by a chronic ear infection.
Infections that don't go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.Another type of conductive hearing loss is caused by either the outer and or middle ear not forming correctly while the baby was growing in the mother's womb. Both the outer and middle ear need to work together in order for sound to be sent correctly to the inner ear. Families who have children with hearing loss often need to change their communication habits or learn special skills (such as sign language) to help their children learn language. These skills can be used together with hearing aids, cochlear implants, and other devices that help children hear.Read about learning language A»Family Support ServicesFor many parents, their childa€™s hearing loss is unexpected. Parents sometimes need time and support to adapt to the childa€™s hearing loss.Parents of children with recently identified hearing loss can seek different kinds of support.



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