Putterman Daniel B, Valente Michael
Program in Audiology and Communication Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
J Am Acad Audiol. 2012 May;23(5):366-78. doi: 10.3766/jaaa.23.5.7.
A telecoil (t-coil) is essential for hearing aid users when listening on the telephone because using the hearing aid microphone when communicating on the telephone can cause feedback due to telephone handset proximity to the hearing aid microphone. Clinicians may overlook the role of the t-coil due to a primary concern of matching the microphone frequency response to a valid prescriptive target. Little has been published to support the idea that the t-coil frequency response should match the microphone frequency response to provide "seamless" and perhaps optimal performance on the telephone. If the clinical goal were to match both frequency responses, it would be useful to know the relative differences, if any, that currently exist between these two transducers.
The primary purpose of this study was to determine if statistically significant differences were present between the mean output (in dB SPL) of the programmed microphone program and the hearing aid manufacturer's default t-coil program as a function of discrete test frequencies. In addition, pilot data are presented on the feasibility of measuring the microphone and t-coil frequency response with real-ear measures using a digital speech-weighted noise.
A repeated-measures design was utilized for a 2-cc coupler measurement condition. Independent variables were the transducer (microphone, t-coil) and 11 discrete test frequencies (15 discrete frequencies in the real-ear pilot condition).
The study sample was comprised of behind-the-ear (BTE) hearing aids from one manufacturer. Fifty-two hearing aids were measured in a coupler condition, 39 of which were measured in the real-ear pilot condition. Hearing aids were previously programmed and verified using real-ear measures to the NAL-NL1 (National Acoustic Laboratories-Non-linear 1) prescriptive target by a licensed audiologist.
Hearing aid output was measured with a Fonix 7000 hearing aid analyzer (Frye Electronics, Inc.) in a HA-2 2-cc coupler condition using a pure-tone sweep at an input level of 60 dB SPL with the hearing aid in the microphone program and 31.6 mA/M in the t-coil program. A digital speech weighted noise input signal presented at additional input levels was used in the real-ear pilot condition. A mixed-model repeated-measures analysis of variance (ANOVA) and the Tukey Honestly Significant Difference (HSD) post hoc test were utilized to determine if significant differences were present in performance across treatment levels.
There was no significant difference between mean overall t-coil and microphone output averaged across 11 discrete frequencies (F(1,102) = 0, p < 0.98). A mixed-model repeated-measures ANOVA revealed a significant transducer by frequency interaction (F(10,102) = 13.0, p < 0.0001). Significant differences were present at 200 and 400 Hz where the mean t-coil output was less than the mean microphone output, and at 4000, 5000, and 6300 Hz where the mean t-coil output was greater than the mean microphone output.
The mean t-coil output was significantly lower than the mean microphone output at 400 Hz, a frequency that lies within the typical telephone bandwidth of 300-3300 Hz. This difference may partially help to explain why some patients often complain the t-coil fails to provide sufficient loudness for telephone communication.
对于使用助听器的人来说,当他们打电话时,感应线圈(t线圈)至关重要,因为在电话交流时使用助听器麦克风,由于电话听筒靠近助听器麦克风,可能会产生反馈。临床医生可能会因为主要关注将麦克风频率响应匹配到有效的规定目标而忽略感应线圈的作用。几乎没有文献支持感应线圈频率响应应与麦克风频率响应相匹配以在电话上提供“无缝”且可能是最佳性能的观点。如果临床目标是匹配这两种频率响应,那么了解这两个换能器目前存在的相对差异(如果有的话)将是有用的。
本研究的主要目的是确定在离散测试频率的函数中,已编程的麦克风程序的平均输出(以dB SPL为单位)与助听器制造商的默认感应线圈程序的平均输出之间是否存在统计学上的显著差异。此外,还给出了关于使用数字语音加权噪声通过真耳测量来测量麦克风和感应线圈频率响应的可行性的初步数据。
在2立方厘米耦合器测量条件下采用重复测量设计。自变量是换能器(麦克风、感应线圈)和11个离散测试频率(在真耳初步条件下为15个离散频率)。
研究样本由来自一个制造商的耳背式(BTE)助听器组成。在耦合器条件下测量了52个助听器,其中39个在真耳初步条件下进行了测量。助听器先前已由持牌听力学家通过真耳测量按照NAL-NL1(国家声学实验室-非线性1)规定目标进行编程和验证。
使用Fonix 7000助听器分析仪(Frye Electronics, Inc.)在HA-2 2立方厘米耦合器条件下测量助听器输出,在输入声压级为60 dB SPL时使用纯音扫描,助听器处于麦克风程序且感应线圈程序为31.6 mA/M。在真耳初步条件下使用在额外输入声压级呈现的数字语音加权噪声输入信号。采用混合模型重复测量方差分析(ANOVA)和Tukey真实显著差异(HSD)事后检验来确定在不同治疗水平下性能是否存在显著差异。
在11个离散频率上平均的感应线圈和麦克风总体平均输出之间没有显著差异(F(1,102) = 0,p < 0.98)。混合模型重复测量方差分析显示换能器与频率之间存在显著交互作用(F(10,102) = 13.0,p < 0.0001)。在200和400 Hz处存在显著差异,此时感应线圈平均输出低于麦克风平均输出,而在4000、5000和6300 Hz处,感应线圈平均输出大于麦克风平均输出。
在400 Hz时感应线圈平均输出显著低于麦克风平均输出,该频率处于300 - 3300 Hz的典型电话带宽范围内。这种差异可能部分有助于解释为什么一些患者经常抱怨感应线圈在电话通信中未能提供足够的响度。