Auditory & Speech Sciences Laboratory, University of South Florida, Tampa.
University of Central Florida, Orlando.
J Speech Lang Hear Res. 2024 Jun 6;67(6):1868-1885. doi: 10.1044/2024_JSLHR-23-00359. Epub 2024 May 8.
This report describes a hearing device and corresponding fitting protocol designed for use in a transitional intervention for debilitating loudness-based hyperacusis.
The intervention goal is to transition patients with hyperacusis from their typical counterproductive sound avoidance behaviors (i.e., sound attenuation and limited exposure to healthy low-level sounds) into beneficial sound therapy treatment that can expand their dynamic range to the point where they can tolerate everyday sounds and experience an improved quality of life. This requires a combination of counseling and sound therapy, the latter of which is provided via the hearing device technology, signal processing, and precision fitting approach described in this report. The device combines a miniature behind-the-ear sound processor and a custom earpiece designed to maximize the attenuation of external sounds. Output-limiting loudness suppression is used to restrict exposure to offending high-level sounds while unity gain amplification maximizes exposure to healthy and tolerable lower level sounds. The fitting process includes measurement of the real-ear unaided response, the real-ear measurement (REM) system noise floor, the real-ear occluded response, real-ear insertion gain, and the output limit. With these measurements, the device can achieve the prescribed unity gain needed to provide transparent access to comfortable sound levels. It also supports individualized configuration of the therapeutic noise from an on-board sound generator and adaptive output limiting based on treatment-induced increases in dynamic range.
The utility of this device and fitting protocol, in combination with structured counseling, is highlighted in the outcomes of a successful 6-month trial of the transitional intervention described in a companion report in this issue.
本报告介绍了一种听力设备和相应的适配方案，旨在为基于响度的失代偿性听觉过敏的过渡性干预提供服务。
该干预的目标是将听觉过敏患者从其典型的适得其反的声音回避行为（即声音衰减和对健康低水平声音的有限暴露）转变为有益的声音治疗，以扩大其动态范围，使其能够耐受日常声音并体验到生活质量的提高。这需要咨询和声音治疗的结合，后者通过本报告中描述的听力设备技术、信号处理和精确适配方法提供。该设备结合了微型耳后声音处理器和定制耳塞，旨在最大限度地减少外部声音的衰减。输出限制响度抑制用于限制对高电平声音的暴露，同时单位增益放大最大限度地提高对健康和可耐受的低水平声音的暴露。适配过程包括测量未助听的真耳响应、真耳测量（REM）系统噪声底、真耳封闭响应、真耳插入增益和输出限制。通过这些测量，该设备可以实现规定的单位增益，以提供对舒适声级的透明访问。它还支持通过板载声音发生器对治疗性噪声进行个性化配置，并根据治疗引起的动态范围增加进行自适应输出限制。
本设备和适配方案与结构化咨询相结合，在本期中的一篇相关报告中成功实施了为期 6 个月的过渡性干预试验，展示了其应用价值。
