Speech, Language, Hearing Science, San Diego State University, San Diego, California, USA.
Ear Hear. 2022 May/Jun;43(3):808-821. doi: 10.1097/AUD.0000000000001141.
This study was a continuation of work on an explore-and-select approach to the self-adjustment of amplification. Goals were to determine (i) the effect of changing the number of adjustment controls from three to two, (ii) the effect of changing the initial adjustment from overall output to high-frequency output, (iii) individual repeatability, (iv) the effect on phoneme recognition of increasing and decreasing overall output relative to the starting and adjusted conditions, and (v) listener reactions to, and opinions of, the self-adjustment procedure.
Twenty-two adults with hearing loss, 10 of whom were hearing aid users, adjusted level and spectrum of connected speech to preference, using three configurations of number and order of adjustment parameters. The three adjustments were replicated to give a total of six. Presentation was monaural, in quiet, using the ear with the better threshold at 2 kHz. The starting condition was a generic prescription for a typical mild-to-moderate hearing loss. Real ear output spectra were measured for the 6 self-adjustments, the generic starting condition, and the individual NAL-NL2 prescriptions for speech at 65 dB SPL. Monaural phoneme recognition in monosyllables was assessed, in quiet, at levels of -14, -7, 0 and +7 dB relative to both the starting and the self-adjusted conditions. Participants completed a questionnaire and their comments on each question were transcribed.
Changing the number of listener controls from 3 to 2 reduced mean adjustment time by around 50% but had negligible effect on group-mean output response. Starting adjustment with high-frequency output rather than overall output resulted in a 2 to 3 dB reduction of group-mean self-adjusted output below 1 kHz. Individual self-adjustments were within ±5 dB of NAL-NL2 prescription (for a 65 dB SPL speech input) for two-thirds of the participants in the high frequencies and for just over half in the low frequencies. In six self-adjustments, individuals self-adjusted, on average, to within ±4 dB of their own mean in both high and low frequencies. There was no evidence that these findings differed for hearing aid users and nonusers. Changes of overall output by ±7 dB after self-adjustment did not significantly affect group mean phoneme recognition. Preference for number and order of self-adjustment differed among participants, as did opinions on self-fitting of hearing aids.
These findings support the conclusion that, for many adults with hearing loss, an explore-and-select procedure for self-adjustment of amplification leads to output values that are repeatable within a few dB, are relatively immune to the number and order of adjustment parameters, and place the average listener well along the plateau of a phoneme recognition versus amplitude function.
本研究是对增益自我调节的探索与选择方法的延续。目的是确定（i）将调节控制的数量从 3 个更改为 2 个的影响，（ii）将初始调节从总输出更改为高频输出的影响，（iii）个体重复性，（iv）相对于起始和调节条件，增加和减少总输出对音位识别的影响，以及（v）听众对自我调节过程的反应和意见。
22 名听力损失成年人，其中 10 名是助听器使用者，使用三种数量和调节参数顺序的配置，根据自己的喜好调节语音的水平和频谱。重复三次调整，共进行六次。采用单耳，在安静环境中，使用 2 kHz 阈值较好的耳朵进行呈现。起始条件是针对典型轻度至中度听力损失的通用处方。为 6 次自我调节、通用起始条件和个人 NAL-NL2 处方的语音测量实际耳输出频谱，在 65 dB SPL 处进行评估。在安静环境中，在相对于起始和自我调节条件的-14、-7、0 和+7 dB 水平下，评估单音节的单耳音位识别。参与者完成了一份问卷，他们对每个问题的评论都被转录下来。
将听众控制的数量从 3 个减少到 2 个，平均调整时间减少了约 50%，但对群体平均输出响应几乎没有影响。从高频输出而不是总输出开始调节，会导致群体平均自我调节输出在 1 kHz 以下降低 2 到 3 dB。对于三分之二的参与者，在高频范围内，有六次自我调节中的两次达到或低于 NAL-NL2 处方（65 dB SPL 语音输入）；在低频范围内，超过一半达到或低于 NAL-NL2 处方。在六次自我调节中，个体自我调节的平均值在高频和低频范围内均在±5 dB 以内。没有证据表明这些发现对助听器使用者和非使用者有影响。自我调节后总输出变化±7 dB 不会显著影响组平均音位识别。参与者对自我调节的数量和顺序有不同的偏好，对助听器的自我适配也有不同的看法。
这些发现支持这样的结论，即对于许多听力损失成年人来说，增益自我调节的探索与选择程序可以产生在几 dB 内可重复的输出值，对调节参数的数量和顺序具有相对的免疫力，并使平均听众在音位识别与幅度函数的高原上处于良好位置。
