William Noble

The Speech, Spatial and Qualities of Hearing Scale (SSQ)

The Speech, Spatial and Qualities of Hearing Scale (SSQ) is designed to measure a range of hearing disabilities across several domains. Particular attention is given to hearing speech in a variety of competing contexts, and to the directional, distance and movement components of spatial hearing. In addition, the abilities both to segregate sounds and to attend to simultaneous speech streams are assessed, reflecting the reality of hearing in the everyday world. Qualities of hearing experience include ease of listening, and the naturalness, clarity and identifiability of different speakers, different musical pieces and instruments, and different everyday sounds. Application of the SSQ to 153 new clinic clients prior to hearing aid fitting showed that the greatest difficulty was experienced with simultaneous speech streams, ease of listening, listening in groups and in noise, and judging distance and movement. SSQ ratings were compared with an independent measure of handicap. After differences in hearing level were controlled for, it was found that identification, attention and effort problems, as well as spatial hearing problems, feature prominently in the disability-handicap relationship, along with certain features of speech hearing. The results implicate aspects of temporal and spatial dynamics of hearing disability in the experience of handicap. The SSQ shows promise as an instrument for evaluating interventions of various kinds, particularly (but not exclusively) those that implicate binaural function. Sumario La Escala de Audición para el Lenguaje, la Audición Espacial y las Cualidades Auditivas (SSQ) está disen˜ada para medir un rango de discapacidades auditivas en varios ámbitos. Se da atención particular a la captación del lenguaje en una variedad de contexto competitivos, y a los componentes direccionales, de distancia y movimiento de la audición espacial. Además, se evalúan las capacidades para segregar sonidos y de distinguir mensajes lingu¨ísticos simultáneos, que reflejan la realidad de la audición en situaciones cotidianas. La experiencia de las cualidades auditivas incluye la facilidad de escuchar, y la naturalidad, claridad y capacidad de identificar a diferentes hablantes, diferentes piezas musicales e instrumentos, y diferentes sonidos de la vida diaria. La aplicación del SSQ a 153 nuevos clientes, antes de la adaptación de su auxiliar auditivo, mostró que la mayor dificultad era experimentada frente a mensajes lingu¨ísticos simultáneos, en la facilidad para escuchar, la audición en grupos en ruido y ante el juicio sobre la distancia y el movimiento. Las mediciones del SSQ fueron comparadas con una medida independiente de desventaja. Luego de controlar las medidas del nivel auditivo, se encontró que la identificación, la atención y los problemas de esfuerzo, al igual que los problemas de audición espacial, fueron los más relevantes en la relación discapacidad-desventaja. La SSQ se muestra promisoria como instrumento para evaluar intervenciones de varios tipos, particularmente (pero no de manera exclusiva) aquellas que involucran la función auditiva binaural.

The Archaeology of Perception: Traces of Depiction and Language [and Comments and Reply]

Depiction, particularly the making of images to resemble things, can only have emerged prehistorically incommunities with shared systems of meanings. We argue, on the basis of an articulation of Gibsons ecological theory of perception, Meads distinction between communication and language, and a portmanteau theory of language and mind relying on the insights of, among others, Ryle, Vygotsky, and Olson, that depiction transforms communication into language. The rapid change in numerous practices observable at the end of the Upper Pleistocene becomes understandable when communication is seen to be tuming into language as here defined. It is for this reason that the period in question represents the point of evolution of modem human beings.

Patients utilizing a hearing aid and a cochlear implant: Speech perception and localization

Objective The purpose of this pilot study was to document speech perception and localization abilities in patients who use a cochlear implant in one ear and a hearing aid in the other ear. Design We surveyed a group of 111 cochlear implant patients and asked them whether they used a hearing aid on their unimplanted ear. The first three patients who were available were tested on word and sentence recognition and localization tasks. Speech stimuli were presented from the front in quiet and in noise. In the latter conditions, noise was either from the front, the right, or the left. Localization was tested with noise bursts presented at 45° from the right or left. In addition we asked the patients about their abilities to integrate the information from both devices. Results Speech perception tests in quiet showed a binaural advantage for only one of the three patients for words and none for sentences. With speech and noise both in front of the patient, two patients performed better with both devices than with either device alone. With speech in front and noise on the hearing aid side, no binaural advantage was seen, but with noise on the cochlear implant side, one patient showed a binaural advantage. Localization ability improved with both devices for two patients. The third patient had above-chance localization ability with his implant alone. Conclusions A cochlear implant in one ear and a hearing aid in the other ear can provide binaural advantages. The patient who did not show a clear binaural advantage had the poorest hearing aid alone performance. The absolute and relative levels of performance at each ear are likely to influence the potential for binaural integration.

Optimal Outcome Measures, Research Priorities, and International Cooperation

&NA; The participants in the Eriksholm Workshop on “Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids” debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self‐report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health‐care delivery systems. A set of seven core items is proposed for further study.

Effects of bilateral versus unilateral hearing aid fitting on abilities measured by the Speech, Spatial, and Qualities of Hearing scale (SSQ)

The Speech, Spatial and Qualities of Hearing Scale (Gatehouse & Noble, ) was applied to three independent clinical groups: 144 people prior to being fitted with amplification; 118 people with six months experience with unilateral amplification; and 42 people with six months experience with bilateral amplification. For traditional speech hearing contexts (one-on-one, in groups, in quiet, in noise) there was benefit with one aid, and no further benefit with two. By contrast, hearing speech in demanding contexts (divided or rapidly switching attention) showed benefit with one aid and further benefit with two. In the spatial domain, directional hearing showed some benefit with one hearing aid, and particular further benefit in distance and movement discrimination from fitting with two. There was some benefit from unilateral fitting for elements of the qualities domains (clarity, naturalness, recognisability, segregation of sounds), with no consistent sign of further benefit from two. Bilateral fitting added benefit with respect to listening effort. Two hearing aids offer advantage in demanding and dynamic contexts; these contexts are argued as significant in the maintenance of social competence and emotional wellbeing. The present results go toward establishing the real-world advantages of bilateral hearing aid fitting and suggest that previous, inconclusive clinical findings reflect inquiry limited to more traditional areas of hearing function. Sumario Se aplicó la escala de cualidades auditiva, espacial y del lenguaje (Gatehouse & Noble, ) a tres grupos clínicos independientes: 144 personas, antes de adaptarles auxiliares auditivos; 118 personas con 6 meses de experiencia con amplificación unilateral y 42 personas con 6 meses de experiencia con amplificación bilateral. Se encontró beneficio de la amplificación unilateral en el contexto de habla tradicional (uno a uno, en grupo, en silencio y en ruido) y no hubo beneficio posterior en el modo bilateral. En contraste, bajo condiciones de discriminación del lenguaje en contexto demandante (atención dividida o cambio de rápido de atención) hubo beneficio con un solo un auxiliar, y mayor beneficio con dos. En el dominio espacial, hubo cierto beneficio en la audición direccional con un solo auxiliar auditivo y particularmente resultó benéfica la condición bilateral en la discriminación de distancia y movimiento. Hubo cierto beneficio de la condición unilateral para elementos de cualidad (claridad, naturalidad, fácil discriminación, segregación de sonidos) sin signos consistentes de beneficio con amplificación bilateral. La amplificación bilateral benefició el menor esfuerzo para escuchar. Hay ventajas con dos auxiliares auditivos en contexto demandante o dinámico; estos contextos son considerados como significativos en el mantenimiento de la competencia social y el bienestar emocional. Estos resultados se encaminan a establecer las ventajas de la amplificación bilateral en el mundo real y sugieren que los hallazgos clínicos previos e inconclusos, reflejan información limitada a áreas más tradicionales de la función auditiva.

Effects on sound localization of configuration and type of hearing impairment

Localization ability of 87 bilaterally hearing-impaired listeners was tested in the horizontal and vertical planes, frontally and laterally. In those with sensorineural hearing loss, it was found that deficits in localization accuracy in different regions of auditory space could be related to different configurations of hearing loss. For example, there were associations between vertical plane discrimination and high-frequency sensitivity; and front-rear discrimination and mid-to-high-frequency sensitivity. These results agree with theoretical expectations, while the outcome overall contrasts with previous reports that localization performance is unrelated to audiometric configuration. A comparison of 13 listeners with conductive/mixed types of impairment with a sensorineural-loss group, matched for degree of loss, showed that a conductive component adds significantly to localization disturbance, particularly in the horizontal plane. The probable reason is a disturbance of low-frequency interaural time cues, and this occurs because a higher proportion of low-frequency sound is likely to be transmitted via bone conduction relative to air conduction. Correlations between hearing loss and localization are only moderate, suggesting that aspects of hearing impairment, in addition to simple attenuation, may also reduce auditory localization performance.

Interaural asymmetry of hearing loss, Speech, Spatial and Qualities of Hearing Scale (SSQ) disabilities, and handicap

A series of comparative analyses is presented between a group with relatively similar degrees of hearing loss in each ear (n = 103: symmetry group) and one with dissimilar losses (n = 50: asymmetry group). Asymmetry was defined as an interaural difference of more than 10dB in hearing levels averaged over 0.5, 1, 2 and 4kHz. Comparison was focused on self-rated disabilities as reflected in responses on the Speech, Spatial and Qualities of Hearing Scale (SSQ). The connections between SSQ ratings and a global self-rating of handicap were also observed. The interrelationships among SSQ items for the two groups were analysed to determine how the SSQ behaves when applied to groups in whom binaural hearing is more (asymmetry) versus less compromised. As expected, spatial hearing is severely disabled in the group with asymmetry; this group is generally more disabled than the symmetry group across all SSQ domains. In the linkages with handicap, spatial hearing, especially in dynamic settings, was strongly represented in the asymmetry group, while all aspects of hearing were moderately to strongly represented in the symmetry group. Item intercorrelations showed that speech hearing is a relatively autonomous function for the symmetry group, whereas it is enmeshed with segregation, clarity and naturalness factors for the asymmetry group. Spatial functions were more independent of others in the asymmetry group. The SSQ shows promise in the assessment of outcomes in the case of bilateral versus unilateral amplification and/or implantation. Sumario Se presenta una serie de análisis comparativos entre un grupo con un grado de pérdida auditiva relativamente similar en cada oído (n = 103, grupo simétrico), y uno con pérdidas diferentes (n = 50, grupo asimétrico). La asimetría fue definida como una diferencia interaural de más de 10 dB en los niveles auditivos promediados en 0.5, 1, 2 y 4 kHz. La comparación se concentró en discapacidades auto-establecidas conforme se reflejaron en las respuestas de la Escala de Audición para el Lenguaje, la Audición Espacial y las Cualidades Auditivas (SSQ). Se observó también la conexión entre los puntajes del SSQ y la auto-evaluación global del impedimento. Se analizaron las interrelaciones entre los items de la SSQ para determinar el comportamiento de la SSQ cuando se aplica a grupos cuya audición binaural está más (asimetría) o menos comprometida. Como se esperaba, la audición espacial está severamente alterada en el grupo con asimetría; este grupo se muestra generalmente más discapacitado que el grupo simétrico, en todos los componentes de la SSQ. En su vinculación con la desventaja, la audición espacial, especialmente en contextos dinámicos, estuvo fuertemente representada en el grupo asimétrico, mientras que todos los aspectos de la audición fueron moderada a fuertemente representados en el grupo simétrico. La interacción de los items mostró que la captación del lenguaje es una función relativamente autónoma para el grupo simétrico, mientras que está relacionada con los factores de segregación, de claridad y de naturalidad para el grupo asimétrico. Las funciones espaciales fueron más independientes que las otras en el grupo asimétrico. La SSQ resulta prometedora en la evaluación de resultados en el caso de una amplificación bilateral versus unilateral, y/o en la implantación.

Comparison of speech recognition and localization performance in bilateral and unilateral cochlear implant users matched on duration of deafness and age at implantation.

Objectives: The purpose of this investigation was to compare speech recognition and localization performance of subjects who wear bilateral cochlear implants (CICI) with subjects who wear a unilateral cochlear implant (true CI-only). Design: A total of 73 subjects participated in this study. Specifically, of the 73 subjects, 64 (32 CICI and 32 true CI-only) participated in the word recognition testing; 66 (33 CICI and 33 true CI-only) participated in the sentence recognition testing; and 24 (12 CICI and 12 true CI-only) participated in the localization testing. Because of time constraints not all subjects completed all testing. The average age at implantation for the CICI and true CI-only listeners who participated in the speech perception testing was 54 and 55 yrs, respectively, and the average duration of deafness was 8 yrs for both groups of listeners. The average age at implantation for the CICI and true CI-only listeners who participated in the localization testing was 54 and 53 yrs, respectively, and the average duration of deafness was 10 yrs for the CICI listeners and 11 yrs for the true CI-only listeners. All speech stimuli were presented from the front. The test setup for everyday-sound localization comprised an eight-speaker array spanning, an arc of approximately 108° in the frontal horizontal plane. Results: Average group results were transformed to Rationalized Arcsine Unit scores. A comparison in performance between the CICI score and the true CI-only score in quiet revealed a significant difference between the two groups with the CICI group scoring 19% higher for sentences and 24% higher for words. In addition, when both cochlear implants were used together (CICI) rather than when either cochlear implant was used alone (right CI or left CI) for the CICI listeners, results indicated a significant binaural summation effect for sentences and words. Conclusion: The average group results in this study showed significantly greater benefit on words and sentences in quiet and localization for listeners using two cochlear implants over those using only one cochlear implant. One explanation of this result might be that the same information from both sides are combined, which results in a better representation of the stimulus. A second explanation might be that CICI allow for the transfer of different neural information from two damaged peripheral auditory systems leading to different patterns of information summating centrally resulting in enhanced speech perception. A future study using similar methodology to the current one will have to be conducted to determine if listeners with two cochlear implants are able to perform better than listeners with one cochlear implant in noise.

The effect of head rotations on vertical plane sound localization

Current understanding gives predominant weight to stationary cues for auditory localization. Two experiments were conducted to investigate the possible existence of a dynamic cue. The first experiment involved localization of concealed sources in the upper median vertical plane (MVP) and showed, as expected, that elevation was not detectable with motionless listening when high-frequency energy was absent or when normal pinna function was distorted. Elevation under such conditions did become detectable with horizontal head rotations, provided low-frequency energy was present in the signal. This indicates that the basis of the dynamic cue is variation in the rate of transformation of low-frequency interaural time/phase differences. The second experiment involved localization of sources arrayed throughout upper and lower regions of the MVP and in the left lateral vertical plane (LVP); it showed that upper hemisphere sources can be distinguished somewhat from those in the lower hemisphere, even in motionless listening conditions, but more so with rotation. The greatest benefit for localization from rotation of the head appears to be gained for sources positioned in the front MVP.

The contribution of head motion cues to localization of low-pass noise

Localization of low-pass sounds was tested in relation to aspects of Wallach’s (1939, 1940) hypotheses about the role of head movement in front/back and elevation discrimination. With a 3-sec signal, free movement of the head offered only small advantage over a single rotation through 45° for detecting elevation differences. Very slight rotation, as observed using a 0.5-sec signal, seemed sufficient to prevent front/back confusion. Cluster analysis showed that, in detecting elevation, some listeners benefited from rotation, some benefited from natural movement, and some from both. Evidence was found indicating that a moving auditory system generates information for the whereabouts of sounds, even when the movement does not result in the listener facing the source. Results offer significant if partial support for Wallach’s hypotheses.