Browsing by Subject "hearing aids"

Now showing 1 - 3 of 3
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    The effort of mentally repairing speech in individuals with hearing loss
    (2023-11) Gianakas, Steven
    Over 460 million people worldwide have hearing loss (HL) that negatively impacts their ability to communicate (Davis & Hoffman, 2019). In the clinic, performance is measured by the percentage of words a listener repeats correctly. However, these scores reflect not only the health of the auditory system but also the listener’s ability to mentally repair misperceptions by using knowledge of the language and context (“cognitive repair”). Standard measures of speech perception cannot detect if a person used cognitive repair or if they accurately heard speech (with no need for repair). Detecting a person’s reliance on cognitive repair is important because while reliance on an extra moment to use context is helpful in the testing booth, it may break down in the real world as the next sentence would be heard before the previous sentence was fully processed. We hypothesize that continual need for cognitive repair is at the heart of what makes listening effortful, and what ultimately leads to increased fatigue (Edwards, 2017), anxiety (Morata et al., 2005), and social withdrawal (Hughes et al., 2018) for people with HL. The goals of this dissertation are to (1) identify listener reliance on cognitive repair, (2) measure the timeline of cognitive repair and its interference with ongoing processing, and (3) measure the relief from effort resulting from priming. The first study demonstrates the use of a clinically feasible test using behavioral measures that identifies when a listener relies on the moment immediately following the sentence to use context. Importantly, this test will better identify patients with HL who use cognitive repair during clinical testing which can lead to improved individualized patient centered care. The second study uses a dual-task paradigm to better identify the amount of time needed for cognitive repair after a sentence. During this time the listener would be susceptible to interference from an upcoming sentence in real-world conversation. The third study uses pupillometry to measure how the effort of repairing speech is affected by listeners having a preview of the missing word.
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    Improving hearing aid outcomes in background noise: An investigation of outcome measures and patient factors
    (2022-11) Oeding, Kristi
    Background noise is reported to be one of the most difficult listening environments by hearing aid users. Digital noise reduction and directional microphones have been added to hearing aids and remote microphones and frequency modulation systems as accessories to help augment speech understanding in background noise for hearing aid users. Despite having this technology, patients still have concerns in background noise. This indicates that there is still a need for evidence-based tools for assessing patient speech understanding needs as well as quantifying amplification benefits in noise to help improve these situations. This dissertation seeks to investigate the advantages and disadvantages of current evidence-based practices tools available for improving speech understanding in noise for individuals with hearing loss. Three main research findings are reported in this dissertation. The first study examined the viability of using functional near infrared spectroscopy (fNIRS), a tool that can be used to measure the hemodynamic response to neural activity in the brain. This study sought to examine if fNIRS is a viable clinical tool for assessing the impact of different listening conditions, speech materials, and hearing aid settings on listening effort. Behavioral data supported the impact of signal degradation on intelligibility and that syntactically complex speech results in greater difficulty parsing content. fNIRS data supported that this difficulty in parsing content could be considered listening effort due to contrasts in hemodynamic responses in the lateral inferior frontal gyrus between grammatically simple and complex constructions. Future work should consider evaluating fNIRS in an older hearing loss group with contrasting degrees of hearing loss and speech complexity. The second study examined the viability of using spectral-ripple modulation detection thresholds (SMD), a tool that could help assess a person's broadband spectral processing abilities as an alternative for a person's speech understanding in noisy environments. In this study, SMD thresholds were examined in a group with normal hearing and a group with hearing loss to determine the impact of bandwidth and intensity on SMD thresholds. Results revealed a significant difference in bandwidth and level within the hearing loss and normal hearing groups, but not across groups. Future work should examine this effect using audibility-controlled conditions across the listener groups, such as simulating a hearing aid in these situations to determine the impact of amplification on SMD thresholds. The final study examined various listener factors that could influence a person's noise tolerance. The acceptable noise level test was used as a metric for noise tolerance. The listener factors that were examined included personality traits, digits in noise ability, and working memory along with hearing aid factors to determine if they can predict a person’s acceptable noise level. Results revealed that the Device Oriented Subjective Outcome subscale of listening effort and the digits in noise task were able to predict the acceptable noise level of a hearing aid user. Future work should look at other patient factors to predict noise tolerance. These three research studies aimed to determine what tests can provide a better assessment of listening needs in noise for persons with hearing loss. The second goal was to determine if individual factors were able to predict a person’s ability to tolerate background noise. The end goal of these studies is to use this information along with future research to determine which individuals would benefit from specific hearing aid settings and/or auditory training based on outcome measures and individual factors.
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    Toward the Development of an Intervention to Improve Hearing Aid Access for Older People With Dementia
    (2024-01) Urbanski, Dana
    Over-the-counter (OTC) hearing aids were recently introduced to improve the affordability and accessibility of hearing aids; however, these devices are designed for self-directed hearing aid fittings which may not be feasible for all older adults. Notably, older people with co-occurring dementia and hearing loss are likely to face significant barriers when using OTC hearing aids. This creates an urgent health inequity: if people with dementia cannot successfully use OTC hearing aids, they may be left without an affordable and accessible option for their hearing healthcare. This dissertation includes three studies that establish necessary scientific groundwork for developing a behavioral intervention program to facilitate successful OTC hearing aid use in community-dwelling people with dementia and their family caregivers. The first study is a proof-of-concept trial which shows that OTC hearing aids are effective for well-selected older adult hearing aid candidates with mild-to-moderate hearing loss and normal cognition. The second study is a large secondary data analysis which reveals significant unmet hearing aid need in people with dementia—and shows that this need is disproportionately concentrated among people with dementia living at home in the community versus other institutional or congregate care settings. These data suggest an intervention for OTC hearing aid use might be most successful when targeted to community-dwelling people with dementia. Finally, the third study is a qualitative exploration of dementia care stakeholder views on the feasibility and acceptability of OTC hearing aids for community-dwelling people with dementia and their family caregivers. Results reveal key advantages of OTC hearing aids for people with dementia—but also indicate a host of stakeholder-perceived barriers which need to be addressed to promote successful OTC hearing aid use in this population.