Impact of frequency compression on music perception

To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway. This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017-2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants' hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16-25 dB), mild (PTA4, 26-40 dB), moderate (PTA4, 41-55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates. The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants' hearing status with performance on the MoCA test. While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

This study aimed to evaluate the efficacy of music training on the improvement of musical perception among hearing-impaired listeners using a systematic review and meta-analysis. Article search was conducted from five databases, Scopus, ScienceDirect, Web of Knowledge, CINAHL, and PubMed. A total of 186 participants from 10 studies investigating the music training effects on individuals fitted with hearing assistive devices and outcome measurements were included. The meta-analysis showed standardized mean difference as a measure of the effect size, in musical improvement between the preand post-training. Although the funnel plot yielded an asymmetrical graph, the Egger’s regression showed no significant publication bias. Interestingly, subgroup analysis showed that the training effect was greater in children than in adults. With a necessity of longer training period to significantly improve their musical perception, cochlear implant only users had better effect compared to bi-modal users with both cochlear implant and hearing aids. However, the difference in the training effect between the users with and without previous musical experience was nonsignificant. The present study concludes that auditory music training brings hearing-impaired listeners into better musical perception while informing that training effects differ depending on age, duration of the training, and the type of hearing device used.

Objective: This review aims to highlight the key elements of music perception and its mechanisms in normal hearing people and people with hearing impairments. Design: A systematic literature search was conducted using the National Library of Medicine's search service – PubMed (website: http://www.ncbi.nlm.nih.gov/sites/entrez), with the subject headings ‘Music perception’, ‘Hearing impairment’ and ‘Normal hearing people’ or ‘Cochlear implant’ or ‘Hearing aid’. Results: The key evidence available and the mechanisms of poor music perception in hearing impaired people with hearing devices were reviewed, including hearing aid (HA) alone, cochlear implant (CI) alone or bimodal (HA+ CI) stimulation. People with hearing impairment have limited ability to fully utilize fine temporal structure and frequency selectivity, and consequently musical pitch, melody and timbre perception in people with hearing impairment is significantly impaired. Conclusion: The poor ability to accurately perceive music for hearing aids users is mainly due to the damaged cochlea and device distortion, whereas cochlear implant recipients typically have poor music perception because of reduced extraction of temporal and spectral information in music.

By 24 mo of age, most typically developing infants with normal hearing successfully transition to the production of words that can be understood about 50% of the time. This study compares early phonological development in children with and without hearing loss to gain a clearer understanding of the effects of hearing loss in early-identified children. A secondary goal was to identify measures of early phonetic development that are predictors of later speech production outcomes. The vocalizations and early words of 21 infants with normal hearing and 12 early-identified infants with hearing loss were followed longitudinally over a period of 14 mo (from 10 to 24 mo of age). Thirty-minute mother-child interaction samples were video recorded at 6- to 8-wk intervals in a laboratory playroom setting. Vocalizations produced at 16 and 24 mo were categorized according to communicative intent and recognizable words versus other types. Groups were compared on the structural complexity of words produced at 24 mo of age. Parent report measures of vocabulary development were collected from 10 to 30 mo of age, and Goldman-Fristoe Test of Articulation scores at 36 mo were used in regression analyses. Both groups increased the purposeful use of voice between 16 and 24 mo of age. However, at 24 mo of age, the toddlers with hearing loss produced significantly fewer words that could be recognized by their mothers. Their samples were dominated by unintelligible communicative attempts at this age. In contrast, the samples from normal hearing children were dominated by words and phrases. At 24 mo of age, toddlers with normal hearing were more advanced than those with hearing loss on seven measures of the structural complexity of words. The children with normal hearing attempted more complex words and productions were more accurate than those of children with hearing loss. At 10 to 16 mo of age, the groups did not differ significantly on parent-report measures of receptive vocabulary. However, the hearing loss group was much slower to develop expressive vocabulary and demonstrated larger individual differences than the normal hearing group. Six children identified as atypical differed from all other children in vowel accuracy and complexity of word attempts. However, both atypical infants and typical infants with hearing loss were significantly less accurate than normal hearing infants in consonant and word production. Early measures of syllable production predicted unique variance in later speech production and vocabulary outcomes. The transition from babble to words in infants with hearing loss appears to be delayed but parallel to that of infants with normal hearing. These delays appear to exert significant influences on expressive vocabulary development. Parents may appreciate knowing that some children with hearing loss may develop early vocabulary at a slower rate than children with normal hearing. Clinicians should monitor landmarks from babble onset through transitions to words. Indicators of atypical development were delayed and/or limited use of syllables with consonants, vowel errors and limited production of recognizable words.

The results of a psychophysical study of the characteristics of auditory perception of sound rhythmic sequences in a risk group for age-related hearing loss: elderly people aged 60 to 78 years (Group 1: = 39; M = 15, F = 24, normal hearing according to pure tone threshold audiometry) were presented. The comparison groups included young subjects aged 18 to 30 years with normal hearing (Group 2: = 47; 24 men and 23 women) and elderly people aged 62 to 76 years with grade 2 bilateral sensorineural hearing loss who do not use hearing aids (Group 3: = 30; 14 men and 16 women). Age and gender differences in rhythm recognition were analyzed. The experimental stimuli corresponded to sequences of 3 tone bursts (F = 1000 H2) of varying duration (300, 600 ms; 150 ms pause), forming 6 rhythmic pattern variants (long-short-long, short-short-long, etc.). Additionally, 20 elderly subjects from Group 1 and 22 young subjects from Group 2 took part in short-term auditory memory testing using the auditory digit series reproduction method (Jacobs test). The correlation between the indicators of rhythmic pattern recognition and auditory memory was assessed. The obtained data confirmed the influence of age and hearing condition on rhythm perception. The reliable decrease in its indicators (p < 0.01) observed in elderly subjects with normal hearing thresholds. In this group, gender differences in the “success” of auditory rhythm perception and their relationship with the characteristics of short-term auditory memory were also evident. The results are discussed in the context of using rhythmic sound sequences in testing programs and sensory-cognitive training for the early detection and prevention of age-related hearing problems, including central auditory analysis and auditory memory processes.

Speak on time! Effects of a musical rhythmic training on children with hearing loss

<p><strong>Objectives:</strong> Despite vast amounts of research examining the influence of hearing loss on speech perception, comparatively little is known about its influence on music perception. No standardized test exists to quantify music perception of hearing-impaired (HI) persons in a clinically practical manner. This study presents the Adaptive Music Perception (AMP) test as a tool to assess important aspects of music perception with hearing loss.</p> <p><strong>Design:</strong> A computer-driven test was developed to determine the discrimination thresholds of 10 low-level physical dimensions (e.g., duration, level) in the context of perceptual judgments about musical dimensions: meter, harmony, melody, and timbre. In the meter test, the listener is asked to judge whether a tone sequence is duple or triple in meter. The harmony test requires that the listener make judgments about the stability of the chord sequences. In the melody test, the listener must judge whether a comparison melody is the same as a standard melody when presented in transposition and in the context of a chordal accompaniment that serves as a mask. The timbre test requires that the listener determines which of two comparison tones is different in timbre from a standard tone (ABX design). Twenty-one HI participants and 19 normal-hearing (NH) participants were recruited to carry out the music tests. Participants were tested twice on separate occasions to evaluate test-retest reliability.</p> <p><strong>Results:</strong> The HI group had significantly higher discrimination thresholds than the NH group in 7 of the 10 low-level physical dimensions: frequency discrimination in the meter test, dissonance and intonation perception in the harmony test, melody-to-chord ratio for both melody types in the melody test, and the perception of brightness and spectral irregularity in the timbre test. Small but significant improvement between test and retest was observed in three dimensions: frequency discrimination (meter test), dissonance (harmony test), and attack length (timbre test). All other dimensions did not show a session effect. Test-retest reliability was poor (<0.6) for spectral irregularity (timbre test); acceptable (>0.6) for pitch and duration (meter test), dissonance and intonation (harmony test), and melody-to-chord ratio I and II (melody test); and excellent (>0.8) for level (meter test) and attack (timbre test).</p> <p><strong>Conclusion:</strong> The AMP test revealed differences in a wide range of music perceptual abilities between NH and HI listeners. The recognition of meter was more difficult for HI listeners when the listening task was based on frequency discrimination. The HI group was less sensitive to changes in harmony and had more difficulties with distinguishing melodies in a background of music. In addition, the thresholds to discriminate timbre were significantly higher for the HI group in brightness and spectral irregularity dimensions. The AMP test can be used as a research tool to further investigate music perception with hearing aids and compare the benefit of different music processing strategies for the HI listener. Future testing will involve larger samples with the inclusion of hearing aided conditions allowing for the establishment of norms so that the test might be appropriate for use in clinical practice.</p>

Attention-deficit/hyperactivity disorder in children with hearing loss.

The purpose of this research was twofold: firstly, to develop a music perception test (MPT) for hearing-aid users, and secondly, to evaluate the influence of non-linear frequency compression (NFC) on music perception with the use of the self-compiled test. This article focuses on the description of the development and validation of the MPT. To date, the main direction in frequency-lowering hearing-aid studies has been in relation to speech perception abilities. As hearing-aid technology has improved, interest has grown in musical perception as a dimension that could improve hearing-aid users' quality of life. The MPT was designed to evaluate different aspects of rhythm, timbre, pitch and melody. The development of the MPT could be described as design-based. Phase 1 of the study included test development and recording, while phase 2 entailed presentation of stimuli to normal hearing listeners (n = 15) and hearing-aid users (n = 4). Based on the findings of phase 2, item analysis was performed to eliminate or change stimuli that resulted in high error rates. During phase 3 the adapted version of the test was performed on a smaller group of normal hearing listeners (n = 4) and 20 hearing-aid users. Results proved that adults with normal hearing as well as adults using hearing aids were able to complete all the sub-tests of the MPT, although hearing-aid users scored lower on the various sub-tests than normal hearing listeners. For the rhythm section of the MPT normal hearing listeners scored on average 93.8% versus 75.5% of hearing-aid users; for the timbre section the scores were 83% versus 62.3% respectively. Normal hearing listeners obtained an average score of 86.3% for the pitch section and 88.2% for the melody section, compared with the 70.8% and 61.9% respectively obtained by hearing-aid users. This implies that the MPT can be used successfully for assessment of music perception in hearing-aid users within the South African context and may therefore result in more effective hearing-aid fittings taking place. The test can be used as a counselling tool to assist audiologists and patients in understanding the problems they experience regarding music perception, and might be used for future musical training in areas where participants experience problems in customising individual fittings.

The risk of developing Parkinson disease (PD) after objective hearing loss is unknown. PD studies using self-reported hearing loss are insensitive, and objective data are lacking. To examine the association of hearing loss with incident PD in US veterans and its effect modification by well-established prodromal conditions and hearing aids. This cohort study analyzed electronic health record data from the US Department of Veterans Affairs for veterans who had an audiogram from January 1, 1999, to December 30, 2022. Individuals with data missing or a preexisting PD diagnosis were excluded. Audiogram-confirmed hearing loss. Cumulative incidence of PD was calculated with adjustment for competing risk of death. Among 7 296 051 veterans with an audiogram, 3 596 365 were included. They were mostly male (n = 3 452 898 [96%]) and had a mean (SD) age of 67 (10.3) years. A total of 750 010 individuals (20.8%) had normal hearing at the time of audiometry examination; among those with hearing loss, 1 080 651 (30.0%), 1 039 785 (28.9%), 568 296 (15.8%), and 157 623 (4.3%) individuals had mild (20-<35 dB), moderate (35-<50 dB), moderate to severe (50-<65 dB), and severe to profound (65-120 dB) hearing loss, respectively. Age, gender, and smoking history were balanced between all exposed and unexposed groups with further adjustment for race, ethnicity, and frailty. At 10 years after the baseline audiogram, the numbers of additional cases of PD were 6.1 (95% CI, 4.5-7.79, 15.8 (95% CI, 12.8-18.8), 16.2 (95% CI, 11.9-20.6), and 12.1 (95% CI, 4.5-19.6) among veterans with mild, moderate, moderate to severe, and severe to profound hearing loss, respectively, compared with those with normal hearing. When combined with established prodromal conditions, hearing loss was associated with 5.7 (95% CI, 2.2-9.2) additional cases of PD at 10 years compared with either condition alone. With prompt hearing aid dispensation, incident cases of PD decreased by 21.6 cases (95% CI, 19.5-23.6) at 10 years. Hearing loss appears to be an independent risk factor for later development of PD. Hearing aids attenuate this risk, and therefore widespread screening for hearing loss and appropriate use of hearing aids may reduce the incidence of PD. Additional studies are needed to examine the mechanisms underlying the association between hearing loss and PD.

Introduction: The objective of our study was to evaluate musical perception and its relation to the quality of life in patients with bimodal binaural auditory stimulation.Materials and Methods: Nineteen adult patients with a cochlear implant (CI) for minimum 6 months, and moderate to severe contralateral hearing loss with a hearing aid (HA), and 21 normal hearing adults were included in this prospective, cross-sectional study. Pure-tone and speech audiometry, musical test evaluating sound perception characteristics and musical listening abilities, Munich questionnaire for musical habits, and the APHAB questionnaire were recoded. Performance in musical perception test with HA, CI, and HA + CI, and potential correlations between music test, audiometry and questionnaires were investigated.Results: Bimodal stimulation improved musical perception in several features (sound brightness, roughness, and clarity) in comparison to unimodal hearing, but CI did not add to HA performances in texture, polyphony or musical emotion and even appeared to interfere negatively in pitch perception with HA. Musical perception performances (sound clarity, instrument recognition) appeared to be correlated to hearing-related quality of life (APHAB RV and EC subdomains) but not with speech performances suggesting that the exploration of musical perception complements speech understanding evaluation to better describe every-day life hearing handicap.Conclusion: Testing musical sound perception provides important information on hearing performances as a complement to speech audiometry and appears to be related to hearing-related quality of life.

Objective: This study aimed to 1) investigate the influence of nonlinear frequency compression (NLFC) in hearing aids on intelligibility of speech produced by children with hearing loss; and 2) examine whether clinicians’ or parents’ judgments might be correlated with those of inexperienced listeners. Methods: Twenty-seven adult listeners with normal hearing who reported no experience listening to speech produced by people with hearing loss were asked to judge the intelligibility of speech samples of eight hearingimpaired children under four aided conditions. Also, the parents and the clinicians who provided services to the children provided ratings. The children were enrolled in a four-period multi-site trial that was aimed to compare the effects of conventional processing with NLFC in hearing aids on children’s performance. In that study, the children were familiarized with each of four hearing-aid setting for at least six weeks before they were evaluated using a range of tests, including the production of 20 sentences. The current study used the recorded sentences as stimuli for intelligibility judgments. Each listener heard sentences produced by two child-talkers, 40 from each talker. The stimuli were presented to listeners at 65 dB SPL via headphones. Four child-talkers received ratings from eight listeners and four from seven listeners. Results: Group-level results indicate that speech intelligibility was rated to be better by inexperienced listeners when children used NLFC than when they did not. Three child-talkers showed a significant advantage with NLFC activation. These results are consistent with the estimated audible bandwidth of hearing aids for individual talkers. Significant positive correlations for intelligibility ratings between inexperienced listeners and clinicians were found, but neither correlated with ratings from parents. Conclusions: The use of NLFC improved intelligibility of speech produced by children, on average, as rated by inexperienced listeners. Clinicians’ judgment of children’s speech production is a clinically viable tool for evaluating the effectiveness of amplification for children.

Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited. To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization. This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022. Audiometric hearing loss severity and participant-reported hearing aid use. The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement. Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92). In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.

The purpose of this study was to analyze distortion product otoacoustic emission (DPOAE) level and signal to noise ratio in a group of infants from birth to 4 months of age to optimize prediction of hearing status. DPOAEs from infants with normal hearing (NH) and hearing loss (HL) were used to predict the presence of conductive HL (CHL), sensorineural HL (SNHL), and mixed HL (MHL). Wideband ambient absorbance was also measured and compared among the HL types. This is a prospective, longitudinal study of 279 infants with verified NH and HL, including conductive, sensorineural, and mixed types that were enrolled from a well-baby nursery and two neonatal intensive care units in Cincinnati, Ohio. At approximately 1 month of age, DPOAEs (1-8 kHz), wideband absorbance (0.25-8 kHz), and air and bone conduction diagnostic tone burst auditory brainstem response (0.5-4 kHz) thresholds were measured. Hearing status was verified at approximately 9 months of age with visual reinforcement audiometry (0.5-4 kHz). Auditory brainstem response air conduction thresholds were used to assign infants to an NH or HL group, and the efficacy of DPOAE data to classify ears as NH or HL was analyzed using receiver operating characteristic (ROC) curves. Two summary statistics of the ROC curve were calculated: the area under the ROC curve and the point of symmetry on the curve at which the sensitivity and specificity were equal. DPOAE level and signal to noise ratio cutoff values were defined at each frequency as the symmetry point on their respective ROC curve, and DPOAE results were combined across frequency in a multifrequency analysis to predict the presence of HL. Single-frequency test performance of DPOAEs was best at mid to high frequencies (3-8 kHz) with intermediate performance at 1.5 and 2 kHz and chance performance at 1 kHz. Infants with a conductive component to their HL (CHL and MHL combined) displayed significantly lower ambient absorbance values than the NH group. No differences in ambient absorbance were found between the NH and SNHL groups. Multifrequency analysis resulted in the best prediction of HL for the SNHL/MHL group with poorer sensitivity values when infants with CHL were included. Clinical interpretation of DPOAEs in infants can be improved by using age-appropriate normative ranges and optimized cutoff values. DPOAE interpretation is most predictive at higher F2 test frequencies in young infants (2-8 kHz) due to poor test performance at 1 to 1.5 kHz. Multifrequency rules can be used to improve sensitivity while balancing specificity. Last, a sensitive middle ear measure such as wideband absorbance should be included in the test battery to assess possibility of a conductive component to the HL.

This systematic literature review explored the relationship between hearing loss, the use of hearing aids or cochlear implants, and late-deafened adults' perception and appreciation of, and participation in, music. To identify articles, four databases were searched, MEDLINE, Scopus, Embase, and American Psychological Association (APA) PsycINFO, using terms associated with hearing loss, hearing aids, cochlear implants, music perception, appreciation, or participation. The included studies were empirical, written in English, peer reviewed, used any research method, had no date restrictions, and involved late-deafened adults. A formal risk of bias evaluation was undertaken using the Joanna Briggs Institute (JBI) Critical Appraisal tools. A double-blind review of 2595 articles was completed in June 2023, with a total of 131 studies meeting the inclusion criteria. Typically, the reviewed articles focused on music perception testing. The studies included more than 6900 adult participants with hearing loss. Data relating to the review question were extracted and thematically coded. Only 18 studies reported on music experiences for adults who had hearing loss with or without hearing aids. The remaining 113 articles related to cochlear implant users, and 91 of these focused primarily on identification of musical structural components. The reviewed articles consistently established that hearing loss and hearing devices have a substantial, generally negative, impact on music perception. The psychosocial and emotional need for music was mostly overlooked, with few studies focusing on music appreciation, enjoyment, social connectedness, or participation. Further research is needed to understand the broader context of how hearing loss and hearing devices impact personal experiences including mental and physical well-being and quality of life.