audiology

Making Sense of Sound

Rush College of Health Sciences

In most auditory testing, the emphasis is on accuracy in speech recognition, since speech is our primary means of communication. But myriad sounds beyond language are key to our understanding of the world around us.

“A car honking, a baby crying, a fire alarm — recognizing these sounds can be important to our safety,” explained Valeriy Shafiro, Ph.D. “And there are also lots of nonlinguistic environmental sounds we enjoy listening to: the sound of the ocean, the wind in the trees when we walk in the woods.” Shafiro, an associate professor of communication disorders and principal investigator in the Rush Auditory Research Laboratory, conducts research in hearing and speech perception that focuses on finding new ways to diagnose auditory deficits and improve communication abilities in adults. These new diagnostic techniques have the potential to improve the quality of life of a variety of audiology patients — even well beyond the groups Shafiro is currently studying.

Addressing a rehab deficit 

Much of Shafiro’s lab’s past work, which has been funded by the National Institutes of Health (NIH), the American Speech-Language-Hearing Foundation (ASHFoundation) and the Hearing Health Foundation, formerly known as the Deafness Research Foundation, has assessed the ability of people with cochlear implants to recognize a variety of nonspeech sounds — a particularly useful means of auditory assessment in a large, urban medical center that treats many non-English speakers.

A recent study tested listeners’ ability to recognize those sounds with or without the contextual clues present in everyday life. For example, an ambiguous sound can be perceived as a burning fuse when preceded by the sound of a match being struck and followed by the sound of an explosion, but it may be perceived as bacon frying when surrounded by other kitchen sounds.

Credit: Rush University

Credit: Rush University

“Compared with people with normal hearing, people with cochlear implants show some pretty clear deficits in identifying environmental sounds as well as speech,” Shafiro said. “Research from several labs, including ours, shows the possibility for cochlear implant users to improve if they work on it. But there are few readily available opportunities for these patients to obtain rehabilitation, for reasons including travel difficulties, health care reimbursements and scope of practice.”

Shafiro is now evaluating the usefulness of Internet-based environmental sound and speech training for people who rely on cochlear implants in daily life. “A Randomized Controlled Trial to Evaluate the Benefits of an Internet-Based Auditory Training Program for Cochlear Implant Patients,” a two-year grant from the ASHFoundation, aims to help fill the rehabilitation deficit for adults who receive cochlear implants.

“With Internet access now widely available, patients can do the auditory exercises online, at their own pace and without having to travel,” Shafiro said. When completed, the study will give him and his colleagues a deeper understanding of the benefits and challenges of computerized auditory training.

Hearing-dementia link

Measuring listeners’ recognition of nonlinguistic sounds was also a component of a recent study from the Rush Auditory Research Laboratory in collaboration with the Rush Alzheimer’s Disease Center.

“Hearing, Speech and Episodic Memory in Older African-American and White Adults,” funded with a grant from the NIH, examined a topic of wide current interest: the relationship between aging, hearing loss and cognitive deficits. As Baby Boomers age, research like this has major implications for the health and well-being of older adults. “Some recent research has reported that people with a greater rate of age-related hearing loss also have a greater rate of cognitive decline,” Shafiro explained.

“Typical tests of working memory are based on retaining words or numbers, but we wanted to explore this further by measuring both nonspeech and speech perception.” 

Using tests previously designed by Stanley Sheft, senior researcher at the Rush Auditory Research Laboratory and principal investigator on the study, the team measured the ability of a cohort of community-dwelling older adults without known dementia to discriminate brief nonlinguistic sound patterns.

The addition of nonlinguistic sounds produced somewhat different results than those yielded by previous research. Although other studies have associated speech perception with cognitive performance, the Rush study did not find this correlation when measuring hearing thresholds or the ability to recognize speech in noise.

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However, “We found a relationship between working memory and the ability to discriminate brief auditory patterns,” said Shafiro, who hopes to revisit the study cohort in the future to see whether the tests may be predictive of the trajectory of cognitive decline.

This article was repurposed with permission from Rush University Medical Center, and originally appeared in the Rush College of Health Sciences magazine Impact. Valeriy Shafiro, Ph.D., is a 2008 Emerging Research Grants recipient.

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ReSound LiNX Quattro: More Access to Sound; Rechargeable Convenience

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By Dr. Laurel A. Christensen

In September, GN Hearing launched ReSound LiNX Quattro. Described as the world’s first “Premium Plus” hearing aid, ReSound LiNX Quattro has generated strong interest among the hearing loss community. As ReSound’s Chief Audiology Officer, I’ve answered many questions about this latest innovation in hearing to facilitate informed decision-making. Here are two of the most common questions I receive.

Can you share the latest features and improvements in ReSound LiNX Quattro? What makes it “Premium Plus”?

ReSound LiNX Quattro is the fourth generation of the LiNX hearing aid family. LiNX streamlined technology with Made for Apple hearing aids in 2014, and brought remote fine-tuning capabilities to audiology in 2017 with ReSound Assist, which allows for adjustment without an additional clinic visit. Both of these breakthrough features are included with ReSound LiNX Quattro, plus more.  

Built on a newly designed, powerful microchip platform, it brings users an unprecedented combination of benefits, while enabling hearing capabilities never before possible. Putting sound quality first, ReSound LiNX Quattro technology enables patients to hear more “Layers of Sound,” delivering an extended range of sounds never before heard clearly through hearing aids. The sound quality is natural; soft sounds are clear and loud sounds are rich, full, and distortion-free. Users enjoy an especially marked improvement when listening to music.

The powerful radio provides more reliable, faster streaming and connectivity to any wireless accessory or mobile device. Using the ReSound Smart 3D app, users can take advantage of on-the-go sound personalization such as changing hearing aid programs, adjusting volume, decreasing the level of background or wind noise in the environment, and adjusting streaming sounds from a mobile phone. Also included is a geo-tag function for frequently visited locations so users can return to their preferred location-specific settings as desired.

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Finally, ReSound LiNX Quattro is the world’s most advanced rechargeable solution. As many hearing aid users know, changing batteries weekly can be cumbersome, especially for those with impaired dexterity and eyesight. The built-in lithium-ion batteries eliminate the weekly need to change batteries with a rechargeable battery that lasts up to 30 hours. The recharging case holds 90 hours of portable power, greatly reducing the fear of depleted batteries.

How does ReSound LiNX Quattro actually extend the range of hearing? 

ReSound LiNX Quattro introduces four newly designed microchips that combine to deliver twice the memory, 100 percent more speed, and 30 percent more computing power—with 20 percent power consumption reduction.

The new chipset allows for an increase to 116 dB of input dynamic range so that sounds enter the hearing aid without distortion. In addition, the frequency bandwidth has been extended to 9.5 kHz both for the hearing aids and for sounds streamed to the devices.

In many other hearing aids, sounds outside these ranges are not heard or are heavily distorted. With ReSound LiNX Quattro, sounds typically missed such as birds singing, higher-pitched speech, or music are clearly discerned.

And by expanding access to sounds, especially higher frequency sounds, we observe improved spatial perception in users, with more cues for localization.

Learn more about ReSound LiNX Quattro.

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Laurel A. Christensen, Ph.D. is the Chief Audiology Officer of GN ReSound Group.  In this role, she leads Global Audiology & User Experience in Research and Development.  She holds adjunct faculty appointments at Northwestern and Rush Universities and is a former member of the Executive Board of the American Auditory Society and a member of the Advisory Board for the Au.D. Program at Rush University.  In 2015, she received the Distinguished Alumna Award from the Department of Speech and Hearing Sciences at Indiana University.

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How to Buy Hearing Aids

By Barbara Jenkins, Au.D., BCABA

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A friend’s mother needs hearing aids. She has a daughter in the hearing industry, she has insurance to cover hearing aids, she holds a Ph.D. in molecular biology, and she is still overwhelmed and confused by where to go, what the options are, and what is best for her.

Sound familiar? There is so much information—and disinformation—available about hearing aids that even some physicians are confused.

As with any big purchase, selecting a hearing aid can be difficult and confusing if you don’t have the right information or know the correct questions to ask. Bring a copy of this checklist with you on your next appointment, and feel confident in your decision to improve your life through better hearing.

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Hearing Healthcare Checklist

1. Where do I go for a hearing test?

Most hearing loss (up to 90 percent) is a result of non-medically treatable issues. But that means as many as one in 10 people will have a medical issue associated with their hearing loss. If this is your first hearing evaluation it would be prudent to see your primary care doctor first, then be referred to a specialist for a diagnostic audiogram (hearing evaluation).

Audiologists have a minimum of seven years of university training (master’s or doctorate level). Hearing instrument specialists can perform hearing tests but do not have the medical training to rule out medical issues—causes for hearing loss such as syndromes, Ménière’s disease, Usher Syndrome, sudden-onset, genetics, ototoxic drugs, etc.

If you know that there is no medically treatable issue associated with your hearing loss, either type of provider should be fine. If you’re in doubt, ask your physician which professional they recommend. They might refer you to an ENT (ear, nose, and throat specialist, or otolaryngologist).

2. Where do I buy my hearing aids?

Typically, once an audiologist or hearing instrument specialist has evaluated your hearing, you should be able to purchase your hearing aids from them. Requirements differ by state, but generally speaking the professional is trained in hearing aid selection, fitting, and care.

Make sure you are comfortable with the quality of care and the options offered by the provider. If only one brand of hearing aid is available, that’s a red flag. Be sure your provider offers a range of choices, in all styles and at all price points.

You can also opt to get a second opinion. This will give you additional provider choices, so you can go with the person with whom you feel most comfortable. After all, you will be starting a relationship that may last for years.

3. What style of hearing aid is best for me?

A hearing aid’s style (shape and configuration) is determined by the severity of hearing loss, manual dexterity and vision ability, comfort, and/or cosmetic appeal. Whether you get a larger, behind-the-ear hearing aid, or one that is nearly invisible in the ear canal, the cost is roughly the same. Discuss options with your provider and ask about the benefits and drawbacks to each type of device. Here is a brief overview of hearing aid styles, categorized from a larger size to smaller:

Behind-the-ear (BTE); receiver-in-canal (RIC) (also known as receiver-in-the-ear, RITE): These are currently the most popular due to durability, comfort, and cosmetic appeal. They may be a bit more difficult to put in the ears at first, but since less of the circuitry is inside the ear, they usually offer more natural sound. Also, RICs can be discreet, with only the speaker wire visible at the top of the outer ear.

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In-the-ear (ITE); in-the-canal (ITC): This category is among the best for ease of use. Just one piece goes into the ear, with a portion of the device visible outside the ear. Many people like ITEs because they are easy to insert into the ear, and the battery
life is better than that of their smaller, ITC cousins.

Completely-in-the-canal (CIC); invisible-in-the-canal (IIC): These typically fit deeper into the ear and are a very good choice for people who wear helmets or use stethoscopes. Since they are deep in the canal (making them less visible), the most common complaint is that they may not feel as comfortable as the BTE styles, and depending on usage you must change the batteries once or twice a week. (BTEs and RICs often use larger batteries for more power, and last longer.)

4. Which fidelity level is best for me?

Once you have chosen your preferred style of device, you must choose the fidelity (technology) level of the computer chip in the hearing aid. This is where the cost differences in hearing aids become apparent.

Most manufacturers have three levels of fidelity in their newest hearing aids as well as in their economy-priced models. The higher the level of technology, the better and faster the hearing aid can separate noise from speech. This means the speech and sound information passed to your brain is more accurate. Every level will help one-on-one conversations in quiet environments; the more advanced chips will boost clarity and noise reduction even more effectively. In most cases, get the best hearing aid you can afford, but don’t feel pressured into a decision. Take advantage of the 30- to 60-day trial period that is required in most states (in some cases paying a small fee to return the devices).

5. What other special functions do I need for better hearing?

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In the past few years, new features have emerged that have dramatically changed how we can interact with hearing aids.  

Rechargeable batteries: Rechargeable hearing aids are now available, requiring changing the battery only once every one to three years. These devices are recharged by placing the entire hearing aid unit on its charging dock. Not having to frequently manipulate the battery door is very helpful if you have vision or dexterity issues or if you tend to forget your batteries.

Almost waterproof hearing aids: There are now hearing aids that are so waterproof they actually dry themselves when they get wet. They are also dust- and shock-resistant. These are great for people who frequently spend time outdoors or who just perspire a lot. While it is not recommended swimming with them, these devices should survive taking a shower if you forget to take them out.

Bluetooth-enabled hearing aids: Many manufacturers now give you the ability to adjust your hearing aids with your smartphone, using Bluetooth wireless connectivity. You may even be able to stream sound directly to your hearing aids without the use of an additional device like a neck loop. If you’re tech-savvy, this may be for you.

Once you’ve gone through the items in this checklist, I hope you feel more confident about making decisions and improving your hearing.

Staff writer Barbara Jenkins, Au.D., BCABA, serves as Colorado’s professional state commissioner for people with hearing loss and was awarded the 2010 Leo Doerfler Award for Clinical Excellence by the Academy of Doctors of Audiology. Her office, Advanced Audiology, won the Most Humanitarian Hearing Care Office Award at the 2015 Signia Aspire Conference. For more, see advancedaudiology.com. This article also appeared in the Fall 2017 issue of Hearing Health.

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