PubMed · 7145852
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P Montandon. 1982-09-28. [Hearing aid evaluation].. https://pubmed.ncbi.nlm.nih.gov/7145852/
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Hearing aid gain-assignment schemes known as "prescriptions" were not designed for fitting hearing aids that modify their frequency responses to reduce background noise interference. Rather, prescriptions were developed for hearing aids having single, fixed frequency responses and aim to optimize speech reception in relatively quiet environments. Even though prescriptions do not apply to noisy conditions specifically, they embody the trade between maximizing speech audibility and maintaining loudness comfort that is critical to frequency-gain characteristic selection independent of whether noise is present or absent. The articulation index (AI) was used to examine the extent to which prescriptions' deference to loudness comfort causes them to fall short of maximizing speech spectrum audibility, thereby revealing (roughly) the magnitude of the loudness control built into prescriptions. AIs for speech amplified by an AI-maximizing rule (MAX AI) (Rankovic, Freyman, & Zurek, 1992) and according to several prescriptions were calculated as a function of hearing loss degree and configuration for quiet and noisy conditions. In quiet, AIs for prescriptions were similar to one another when presented with the same audiogram but were drastically smaller than MAX AIs, implying that prescriptions limit speech audibility to a large extent to prevent loudness discomfort. In noise, maximizing the AI required frequency-gain characteristics that were substantially different from prescription-assigned characteristics and that were unique to each noise/audiogram combination. A loudness constraint for the MAX AI scheme was developed to account for the gain discrepancy between prescription AIs and MAX AIs observed in the quiet condition, based on the highest comfortable loudness (HCL) equations presented by Cox (1989) in combination with a loudness model (von Paulus & Zwicker, 1972). The MAX AI scheme with the new loudness control was extended to specify frequency-gain characteristics expected to be optimal for several conditions containing noise, and examples are presented.
In the recent literature on dynamic compression in hearing aids, a controversial discussion about the benefit of multichannel compression with short time constants has been raised. In this paper, some experimental results are contributed to the discussion: For low signal-to-noise ratios, a detrimental effect of fast multichannel compression on speech intelligibility in normal hearing listeners is found. However, a distinct degradation in speech quality and virtually no decrease in speech intelligibility is observed for comparatively high signal-to-noise ratios and compression ratios of up to 3. Since the predictions of the Speech Transmission Index deviate substantially from these results, its applications as an objective measure of intelligibility may not be extended to compressed speech.
Indications, advantages and disadvantages of different types of bone-anchored hearing aids and middle ear implants are discussed and compared with conventional hearing devices. The hearing results obtained at the University of Würzburg in 4,195 middle ear surgeries, from January 1988-August 1993, are presented. In those cases where tympanoplasty wasn't able to provide a good hearing result, the additional use of a conventional hearing aid was sufficient. If the gain and maximum output of the implantable hearing aid is improved in the future, the implant may be able to provide intelligible hearing also to patients with a profound sensorineural hearing loss. At this point implantable hearing aids will become really necessary, irreplaceable devices.