Effects of high-frequency emphasis and compression time constants on speech intelligibility in noise.

The objectives of the study were to evaluate the effect of different settings with regard to speech intelligibility in noise both objectively and subjectively and thus determine a favoured setting of compression time parameters, pre-set program (high-frequency emphasis) or combination for each individual user in a prospective study. Another objective was to evaluate the relationship between patient characteristics (e.g. slope of hearing loss) and favoured settings. In total, 38 subjects divided over five audiological centres were fitted with the Philips Spaceline D71-40 BTE digital hearing aid. Subjects were asked to compare three predefined compression algorithms with different time constants, slow (indicated by the manufacturer as AVC), intermediate (NORMAL) and fast (SYLLABIC) over two 4-week periods using the intermediate setting in both comparisons and randomizing over the fast and slow conditions. A randomization determined whether a subject started with the comfort-oriented pre-set program (AUTO) or the speech intelligibility-oriented setting with high-frequency emphasis (SPIN). In a third 4-week period, the pre-sets AUTO and SPIN were compared using the setting of the compression time constants that gave the best results during the first two periods. Comparisons were made using a standard speech-in-noise test with three types of noise: continuous speaker noise, modulated ICRA-4 noise, and car noise. The patients were also asked to fill in a Dutch translation and adaptation of the APHAB questionnaire to indicate their impression of performance. The results indicate that no compression algorithm, pre-set or combination is favoured overall. The largest improvement in speech-in-noise scores was found with syllabic compression. The advantageous effect of high-frequency emphasis after optimization of compression timing is small. The APHAB showed that users tend to prefer the SPIN setting. We found no relationship between favoured compression or pre-set and the degree or steepness of the hearing loss User preference and best performance in noise do not always coincide. Acclimatization may play a role. It could be advisable to let a user listen to a subjectively less favoured condition for at least some time if an optimal setting for speech intelligibility in noise is preferred over comfort.