![]() ![]() ![]() Currently, the individualized fitting of advanced hearing-aid parameters, such as the degree of noise reduction, is typically estimated by the clinician based on conversations with the patient, patient characteristics (e.g., age, lifestyle) and intuition, or based on the conventional speech audiometry in quiet ( ISO 8253-3, 2012). To fit the hearing aids such that each patient’s individual needs are met, the clinician needs information about the degree to which the patient is struggling in real life speech-in-noise scenarios, when audibility is compensated for. Most of today’s state-of-the-art hearing aids have the ability to improve speech understanding in challenging speech-in-noise situations, but the need for optimal fitting of these sound-processing features vary greatly among individuals ( Andersen et al., 2021 Zaar et al., 2023b). However, individuals with a sensorineural hearing loss often experience great difficulties in understanding speech in noisy environments ( Kochkin, 2000), also referred to as “supra-threshold distortion”, which is not necessarily well predicted from pure-tone audiometry ( Vermiglio and Fang, 2022) and which amplification alone does not solve ( Plomp, 1978 Grant et al., 2013). The audiogram determines the degree of amplification to be applied in various frequency regions to ensure audibility when fitting a hearing aid. Pure-tone audiometry is one of the first diagnostic measurements that adult hearing-impaired (HI) individuals are exposed to when in need of hearing aids. The ACT can be measured directly after the audiogram using the same set up, adding only a few minutes to the process. Overall, the results of the present study indicate that the ACT test may be considered a reliable, quick-and-simple (and thus clinically viable) test of STM sensitivity. Based on these normative data, the “normalized Contrast Level” (in dB nCL) scale was defined, where 0±4 dB nCL corresponds to normal performance and the greater the positive value of dB nCL, the greater the audible contrast loss. Second, the best stimulation paradigm with 1-second noise “waves” (windowed noise) was chosen, further optimized with respect to step size and logistic-function fitting, and tested in a population of 25 young normal-hearing participants using various types of transducers to obtain normative data. The best stimulation paradigm showed excellent test-retest reliability and good agreement with the established laboratory version. Different stimulation paradigms were tested in 28 hearing-impaired participants and compared to data previously measured in the same participants with an established STM test paradigm. The patient’s threshold is established using a Hughson-Westlake tracking procedure with a three-out-of-five criterion and then refined by post-processing the collected data using a logistic function. First, an experimenter-controlled STM measurement paradigm was developed, in which the patient is presented binaurally with a continuous audibility-corrected noise via headphones and asked to press a pushbutton whenever they hear an STM target sound in the noise. The present study introduces a quick-and-simple clinically viable STM test, named the Audible Contrast Threshold (ACT) test. STM tests thus have the potential to provide highly relevant beyond-the-audiogram information in the clinic, but the available STM tests have not been optimized for clinical use in terms of test duration, required equipment, and procedural standardization. Over the last decade, multiple studies have shown that hearing-impaired listeners’ speech-in-noise reception ability, measured with audibility compensation, is closely associated with performance in spectro-temporal modulation (STM) detection tests. ![]()
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