Starkey Research & Clinical Blog

The most important factors behind directional microphone benefit

Keidser, G., Dillon, H., Convery, E. & Mejia, J. (2013). Factors influencing individual variation in perceptual directional microphone benefit. Journal of the American Academy of Audiology 24, 955-968.

This editorial discusses the clinical implications of an independent research study and does not represent the opinions of the original authors.

Understanding conversation in noisy environments is one of the most common difficulties for individuals with hearing loss. Counseling and training in communication strategies can help listeners with hearing loss make use of supplemental cues to improve speech understanding in noise. However, no hearing aid feature or clinical intervention is as likely to improve the ability to function in noise as directional microphones. Directional microphones, usually twin microphone designs, offer small but helpful increases in the signal-to-noise ratio, facilitating more comfortable listening and an improved ability to understand speech and function in noisy everyday situations.

Directionality consistently demonstrates benefits to speech perception performance in laboratory studies but the amount of directional benefit achieved by subjects is highly variable, even in studies with similar methods and procedures (Freyaldenhoven et al., 2005). A number of factors have been studied and reports have indicated that variability in directional benefit was unrelated to age (Wu, 2010; O’Brien et al, 2009), degree or configuration of hearing loss (Jesperson & Olsen, 2003; Ricketts & Mueller, 2000) or vent size (Ricketts, 2000; O’Brien et al, 2009). Furthermore, laboratory studies may not always predict everyday performance (Walden et al., 2000; Cord et al., 2002; Cord et al., 2004) so it is unclear how numerous factors could converge to affect individual directional benefit in everyday hearing aid use.

Recently emerging evidence has suggested that cognitive capacity may affect a listener’s ability to make use of directional benefits. Working memory affected hearing aid users’ performance with regard to different compression time constants (Gatehouse et al., 2003; Cox & Xu, 2010) and spatial separation ability (Neher et al., 2009). Dawes et al (2010) reported that differences in hearing aid benefit were partly determined by performance on speed of processing, selective attention and switching tasks. Humes (2007) further reported that cognition may affect individual speech perception abilities in noise. Though cognition declines with age, the changes vary tremendously across individuals and cannot be predicted by age alone (Glisky, 2007), so age and cognition, though related, may affect hearing aid use and speech perception in different ways.

The primary goal of Keidser et al’s study was to investigate the factors that contribute to variability in perceptual directional microphone benefit as measured in the laboratory. Specifically, they were interested in the effects and interaction of three potential sources of variability: differences in the individual SNR achieved by physical directional benefit, differences in the ability to make use of SNR improvements and variability related to measurement error.

Fifty-nine subjects participated in the study. All had bilateral, mild-to-moderate, sensorineural hearing loss.  Age ranged from 54 to 91 years, with an average of 74 years. Of the 59 subjects, 51 had experience with amplification, whereas 8 had never worn hearing aids. For the purpose of the study, subjects were fitted with binaural, behind-the-ear hearing aids with dual-microphones and wide dynamic range compression. Advanced signal processing such as noise reduction and adaptive directionality was turned off. Hearing aids were programmed according to NAL-NL2 targets and had two programs: omnidirectional and directional.

Participants attended two experimental sessions. At the first session, subjects completed cognitive testing. First, they were administered subtests of the Test of Everyday Attention (TEA; Robertson et al., 1996) which uses real-life scenarios to measure auditory selective attention and speed of processing. Working memory was assessed using the Reading Span Test (RST; Daneman & Carpenter, 1980).  In the RST, sentences are presented on a computer screen and subjects indicate whether the sentence was meaningful or not, subjects must also recall either the first or last word of each sentence.

At the second session, hearing aids and earmolds were fitted and vent diameters were measured. The frequency range of amplification was measured, with the low frequency limit (f-amp) defined as the point at which real-ear insertion gain exceeded 3dB. The angle of the microphone ports was measured with reference to the loudspeaker axis. Speech in noise testing was completed, using the Australian Bamford-Kowal-Bench (BKB/A) sentences (Bench et al., 1979) in the presence of 8-talker babble from the NAL Speech and Noise for Hearing Aid Evaluation CD (Keidser et al, 2002). Speech was presented from a loudspeaker 1m in front of the subject. A constant level of uncorrelated multi-talker babble was presented from four loudspeakers surrounding the subject at a distance of 2m. Speech levels were adjusted to arrive at the SNR required to achieve 50% performance.

Following speech in noise testing, individual in-situ SNR levels were measured to determine how room acoustics may have affected hearing aid performance.  Individual 3D AI-DI measurements were obtained to ascertain the physical directional benefit for each subject in the test environment. The 3D AI-DI scores are directivity measurements weighted by the Articulation Index model, as measured in the center of a 3D array of 41 loudspeakers (Killion et al, 1998). In-situ SNR and 3D-AI-DI measures were computed for broadband (BB), low-frequency (LF, <2000Hz) and high-frequency (HF, >2000Hz) ranges.

Cognitive test scores were weakly correlated. The only auditory cognitive test, the ASA, was not correlated with audiological pure tone average (PTA) but was weakly correlated with age. For the physical measures, broadband (BB) and low-frequency (LF) in-situ SNRs were strongly correlated with each other. The low-frequency limit or f-amp, was highly correlated to the LF in-situ measures as well as to PTA and vent diameter. These correlations indicate that participants who had higher PTAs (more hearing loss) had smaller vent diameters, frequency responses extending further into the low-frequencies and more physical benefit from directional microphones at low frequencies.

The average perceptual directional benefit as measured by SRTn was 2.7dB, with a range from 0.3 to 5.3dB.  No participants showed negative effects of directionality.  When comparing benefit ranges in individual trials versus the mean of the three trials, effectively removing any variability attributable to random measurement errors, the range of benefit was reduced from around 9.2 dB to 5.0dB. Therefore, about half of the variation in directional microphone benefit was explained by measurement errors.  Variation in perceptual directional benefit was not correlated with age or configuration (slope) of hearing loss. Analysis of the cognitive and the in-situ measures of physical directionality showed that the only factors exerting a significant effect on perceptual benefit were LF 3D AI-DI, ASA scores and microphone angle.

With reference to the goals of their study, Keidser and her colleagues found that measurement error, physical directionality and the individual ability to make use of directional cues may contribute to variability in perceptual directional benefit. About half of the variability in measured perceptual directional benefit was attributable to measurement error associated with speech-in-noise testing. Measurement error could include head movements during testing causing brief head shadow effects, problems with speech test list equivalence (Dillon, 1982) and potential practice effects. The authors suggest that multiple measurements of perceptual directional benefit, in each test condition, should always be carried out in order to mitigate the effects of measurement error.

In agreement with previous reports, there was no direct relation between perceptual directional benefit and age, PTA or configuration of hearing loss, though there was a relation to vent diameter. Greater perceptual directional benefit was derived when greater physical directivity was achieved in the low frequencies, which was related to decreased vent diameter. This result is in agreement with previous work showing increased directional benefit with more occluded molds as compared to more open fittings (Ricketts, 2000; Fabry, 2006; Klemp & Dhar, 2008).

A more upward-pointing microphone angle was associated with improved perceptual directional benefit. This is in agreement with a report by Ricketts (2000) that showed increased physical directivity as microphone angle exceeded 20 degrees from the horizontal plane. The effect of microphone angle in the current study was small, accounting for only 4% of the variation. Because the interaction of microphone angle with other hearing aid and environmental characteristics is unknown, the authors do not recommend that clinicians deliberately fit hearing aids with microphones pointing upward.

The outcomes of this study emphasize the importance of low-frequency amplification to achieve optimal directional benefit. The lower limit of the amplification range as well as vent diameter have an effect on physical directivity that affects the perceptual benefit that can be derived from directionality. Thus, it is of particular importance for clinicians to not only select appropriate venting characteristics for each individual, but to ensure that the range of amplification is set in a manner that accounts for venting effects. Programming software requires the entry of acoustic parameters to guide frequency response characteristics, especially in the low frequency range; failure to enter the correct acoustic properties risks over or under amplifying the low-frequency range.

Of course there are many factors to consider when choosing venting, gain and output characteristics, but achieving optimal directional benefit should be considered among them.  Equalizing low-frequency gain in a directional program for use in noise may be advisable to achieve better directivity, but conversely, reduction of low-frequency gain in noise programs may be more comfortable and therefore more desirable for hearing aid users. Careful consideration of the way in which these variables interact for each individual is critical to their success with hearing aids in their daily activities.

 

References

Bench, R., Doyle, J., Daly, N. & Lind, C. (1979). The BKB/A Speech Reading (Lipreading) Test. Victoria: La Trobe University.

Cord, M., Surr, R., Walden, B. & Olson, L. (2002). Performance of directional microphone hearing aids in everyday life. Journal of the American Academy of Audiology 13 (6), 295-307.

Cord, M., Surr, R., Walden, B. & Dyrlund, O. (2004). Relationship between laboratory measures of directional advantage and everyday success with directional microphone hearing aids. Journal of the American Academy of Audiology 15(5), 353-364.

Cox, R. & Xu, J. (2010). Short and long compression release times: speech understanding, real world preferences and association with cognitive ability. Journal of the American Academy of Audiology 21(2), 121-138.

Daneman, M. & Carpenter, P. (1980). Individual differences in working memory and reading. Journal of Verbal Learning and Verbal Behavior 19(4), 450-466.

Dawes, P., Munro, K., Kalluri, S., Nooraei, N. & Edwards, B. (2010). Older adults, hearing aids and listening effort. Paper presented at IHCON, August 11-15, Lake Tahoe.

Dillon, H. (1982). A quantitative examination of the sources of speech discrimination test score variability. Ear and Hearing, 3(2), 51-58.

Fabry, D. (2006). Facts vs. myths: the “skinny” on open-fit hearing aids. Hearing Review 13, 20-25.

Freyaldenhoven, M., Nabelek, A., Burchfield, S. & Thelin, J. (2005). Acceptable noise level as a measure of directional hearing aid benefit. Journal of the American Academy of Audiology 16(4), 228-236.

Gatehouse, S., Naylor, G. & Elberling, C. (2003). Benefits from hearing aids in relation to the interaction between the user and the environment. International Journal of Audiology 42 (Suppl. 1), S77-S85.

Glisky, E. (2007). Changes in cognitive function in human aging. In: Riddle DR, ed. Brain Aging: Models, Methods and Mechanisms. Boca Raton, FL: CRC Press, chpt. 1. www.ncbi.nlm.nih.gov/books/NBK3885.

Humes, L. (2007). The contributions of audibility and cognitive factors to the benefit provided by amplified speech to older adults. Journal of the American Academy of Audiology 18(7), 590-603.

Jesperson, C. & Olsen, S. (2003). Does directional benefit vary systematically with omnidirectional performance? Hearing Review 10, 16-24, 62.

Keidser, G., Ching, T. & Dillon, H. (2002). The National Acoustic Laboratories’ (NAL) CDs of Speech and Noise for Hearing Aid Evaluation: normative data and potential applications. Australian New Zealand Journal of Audiology 24(1), 16-35.

Keidser, G., Dillon, H., Convery, E. & Mejia, J. (2013). Factors influencing individual variation in perceptual directional microphone benefit. Journal of the American Academy of Audiology 24, 955-968.

Killion, M., Schulein, R. & Christensen, L. (1998). Real-world performance of an ITE directional microphone. Hearing Journal 51(4), 24-38.

Klemp, E. & Dhar, S. (2008). Speech perception in noise using directional microphones in open canal hearing aids. Journal of the American Academy of Audiology 19(7), 571-578.

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O’Brien, A., McLelland, M. & Keidser, G. (2009). The Effect of Asymmetric Directionality on Speech Recognition in Noise. NAL Report 019. Sydney: National Acoustic Laboratories.

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Wu, Y. (2010). Effect of age on directional microphone hearing aid benefit and preference. Journal of the American Academy of Audiology 21(2), 78-89.