Widex Ireland ISHAA presentation
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Widex provides evidence-based audiological solutions to address common challenges. Their Audibility Extender uses frequency lowering techniques to make high-frequency sounds audible for those with severe-to-profound hearing loss. Studies show it improves speech perception and production. Their Speech Enhancer tailors noise reduction and speech enhancement to optimize speech understanding in noise without compromising comfort. Their Zen program uses fractal tones to help relax 70% of users and reduce tinnitus effects. Widex solutions are supported by research demonstrating benefits for speech, language development, and relaxation.
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Widex Ireland ISHAA presentation
- 1. WIDEXAudiological Professionalism, EVIDENCE and solutions LISE HENNINGSEN Audiological Research & Communication, Widex ISHAA, IRELAND, APRIL 2010
- 2. AGENDA Introduction WHAT IS IMPORTANT A good starting point THE IMPORTANCE OF A GOOD DIALOGUE Knowing where to start EVIDENCE BASED PRACTICE Significant challenges WIDEX SOLUTIONS
- 4. “The average hearing impaired adult waits 7 years beyond first recognitionbefore seeking corrective measures” www.hear-it.org Hearing loss occurs slowly, and day to day changes are minimal. Many people associate hearing loss with ageing and stigma.
- 5. If one is truly to succeed in leading a person to a specific place, one must first and foremost take care to find him where he is and begin there Søren Kierkegaard, 1859
- 6. A good dialogueA good start to find the right solution
- 7. Counselling - satisfaction Professional counselling Increasingunderstanding Increased trust Increasedacceptance Increasedcustomersatisfaction
- 12. ARE THE ISSUES REALLY UNDERSTOOD?
- 15. Evidence based practice Evidence-based practice combines the best available evidence from research with patient choices and individual clinical judgement (Cox, 2005) Decision - Making
- 16. Evidence based practice Evidence-based practice gives a sound foundation for decision making in the audiological practice The approach is: ONE hearing problem and one patient at a time. 5 step process to tackle one problem at a time.
- 17. Evidence based practice Formulate a focused and answerable question Search for the best available evidence Evaluate evidence for validity and relevance Make recommendations based on evidence, clinical expertise, user needs Evaluate the results and determine ways to improve further
- 18. Evidence based practice Formulate a focused and answerable question Search for the best available evidence Evaluate evidence for validity and relevance Make recommendations based on evidence, clinical expertise, user needs Evaluate the results and determine ways to improve further
- 19. Evidence based practice EFFICACY EVIDENCE MEASURED UNDER IDEAL CONDITIONS ASK:”HOW WELL CAN IT WORK?” EFFECTIVENESS EVIDENCE MEASURED IN THE REAL WORLD ASK:”HOW WELL DOES IT WORK?”
- 20. Widex solutionsthe most well known challenges and empirical evidence
- 21. Audiological cornerstones Maintaining the dynamics of everyday sound Soft, normal and loud sounds
- 22. Audiological cornerstones Precision in fitting The sound pressure level must be as intended
- 23. Audiological cornerstones Comfort and clarity of speech in noise Noise reduction and speech enhancement must be relative to degree of hearing loss
- 25. Listening in background noise
- 27. Hearing from a distance
- 28. Sounds of nature
- 29. Telephone use
- 31. SIGNATURE FEATURES AUDIBILITY EXTENDER ZEN TONES SPEECH ENHANCER
- 32. Key findings The Audibility Extender improves the perception and production of important speech sounds – especially high-frequency consonants Zen tones can help a large portion of the hearing-impaired population relax and concentrate; tinnitus sufferers have also rated Zen as helping reduce the effects of tinnitus The Speech Enhancer improves speech intelligibility in noise
- 33. The audibility extenderfinding the sound and moving it
- 34. Frequency lowering techniques AVAILABLE TECHNIQUES EITHER TRANSPOSE OR COMPRESS SOUND IN THE FREQUENCY DOMAIN AIM IS TO MAKE HIGH FREQUENCY SOUNDS AUDIBLE
- 36. Good hearing, good resolution Poorer hearing, poorer resolution Why use transposition? Good resolution Moderate resolution Poor resolution Dead region Low to high frequencies
- 37. Main points from studies The Audibility Extender improves speech perception and production for children and adults with severe-to-profound high frequency hearing loss Acclimatisation and training are essential for improvements in speech perception/production Initial low preference for speech sounds Progress in language scores and acceptance occur fast after targeted use of the Audibility Extender Counselling is necessary to facilitate acceptance Increase in confidence and self-esteem in school-aged children
- 38. Language performance Improvement of perception and production of speech sounds is documented in a wide range of studies KUK ET AL, 2009
- 39. Effects of training acclimatisation and counselling Training and acclimatisation are necessary to fully realise the potential of the Audibility Extender Korhonen et al, 2008
- 40. Effects of counselling Counselling on expectations facilitates acceptance Kuk et al, 2007b
- 41. Successful use with children Beneficial for language development Especially high frequency consonant production Increased confidence and self-esteem AURIEMMO ET AL, 2009
- 42. The speech enhancertailor-made noise reduction and speech enhancement
- 43. Speech enhancer Speech enhancement and noise reduction system Based on Speech Intelligibility Index (SII) optimisation Ensures optimum SII in all listening environments Speech is heard clearly under noisy conditions
- 44. Adapts to situations and clients KAROLINA SMEDS ET AL., 2009
- 45. Main findings from studies The Speech Enhancer can improve speech intelligibility in noise The Speech Enhancer does not compromise listener comfort in noisy environments Measurements of long-term average gain changes with the Speech Enhancer activated/deactivated confirm that the Speech Enhancer varies with SNR and hearing loss
- 46. Effect on speech intelligibility The Speech Enhancer can improve speech intelligibility in noise PEETERS, ET AL., 2009
- 48. zenwhen audibility is not the only focus
- 49. Zen Harmonic sound program Based on fractal technology Adjustable tempo and pitch Six different zen styles for relaxation and concentration purposes
- 50. Main findings from studies On average, 70% rated the Zen styles as relaxing By adjusting the Zen tones to the preferences of the subjects, 86% found the fine tuned Zen style to be relaxing. The Zen tones can provide a relaxing listening background. Helps a large portion of the hearing impaired population relax and concentrate. Tinnitus sufferers, who are under double strain, rate the effects of tinnitus significantly milder after six months of daily Zen use
- 51. A Zen study – relaxation On average, 70% chose “somewhat relaxing” or “very relaxing” KUK & PEETERS, 2008
- 52. A Zen study – concentration Concentration improved significantly when usingZen compared to usingthe master program KUK AND PEETERS, ORCA (2008)
- 53. A Zen study – tinnitus 10 out of 14 subjects reported that the effects of their tinnitus were milder after 6 months of daily Zen use The change in THI score was significant for five of the subjects SWEETOW, 2009
- 54. AGENDA IMPORTANT A GOOD DIALOGUE EVIDENCE SOLUTIONS
- 55. In order truly to help someone, I must understand more than he does; but first and foremost i must understand what he understands. If I do not do that, my greater understanding will be of no help to him Søren Kierkegaard, 1859
Editor's Notes
- First of all I would like to thank ISHAA and Widex Ireland for the invitation to come to Ireland. It is a special pleasure to be here to tlak about significiant issues in our profession and the in the development of hearing aids.
- My presentation is set in 4 major chapters – at first I would like to focus on some of the most important perspectives in the profession of rehabilitative audiology. It lies very close ot my heart to ensure that we do not loose focus of why we are here and who we work for primarily. In this business it is essential that we never forget that we are in here to make people hear again – enjoy the sounds of life again.In the second part I would like to touch upon the importance of good dialogue – I believe the key to succes in hearing aid fitting is founded in the dialogue between the hearing aid dispenser and the person with hearing loss.The basis for a good choice in hearing aid fitting is knowledge – a well documented approach is evidence based practice – a practice where a health care professional finds a professional foundation for the decisions he or she needs to makeLastly I would like to share with you some of the evidence that has been published about 3 of Widex’ signature features and share with you some of the considerations about these features.
- When you start to work within the field of rehabilitative audiology you realise that there are significant factors that have great impact on our work, our success rate and our professional satisfaction. I started working in the field of audiology in the late 80’s and although I considered myself to be very meticulous and competent – I often stumbled on obstacles and challenges that had nothing to do with the actual hearing loss or hearing aid fitting - these obstacles and challenges stemmed from something else, something beyond audiology.
- If we acknowledge Soeren Kierkegaards thinking we also must look at how we can get to know where the customer is and what his needs and wants are. A good start is a good dialogue – this is how we make sure to start where the end user is. In our work with Widex Human Capacity we found that along side the strong counselling competencies we also need to have strong communication skills and this was indeed the central focus of Widex Human Capacity.
- Counselling is guidance and helping – it is facilitating the change process in hearing aid fitting – making the transition from person with hearing loss to person with hearing aid more smooth and gentle.Counselling will increase the end-users understand, trust and acceptance throughout the rehabilitative process. The goal is naturally to ensure the highest degree of user satisfaction – setting the person with hearing loss free from the worrries of not be certain about what was heard, what was misunderstood and what missed out on.Counselling is part of most educational programs – however the skill of dialogue in professional relations is just as important and must be practised and polished in our work
- The hearing aid dispenser balances the fine art og knowledge integration and decision making. For all of us it is essential to know WHY we make the choices we do and why we make the recommendation we do. Very convenient and extremely relevant starting point for this is evidence based practice.Evidence-based practice has its origin in Evidence Based Medicine, and has been a well-known approach in the pharmaceutical industry for many years. Evidence-based practice has been discussed in the audiological field for the last 5 years. Widex has carried out several dispenser focus group surveys in different countries – and the feedback was clear – all dispensers asked for more evidence to support their hearing aid choice. Evidence to support a hearing aid choice is the fundamental approach to evidence-based practice ....
- Widex’ focus is on providing the best possible starting point for making the clinical decisions involved in helping the client. We follow evidence-based practice. It’s important to understand three issues about evidence-based practice. First, “best available evidence”, which ideally refers to well-designed, patient-centred clinical research on the efficacy and effectiveness of rehabilitative treatments for hearing loss. This includes such matters as prescriptive fitting methods, technological innovations, audiological rehabilitation services, etc. Secondly, practitioners must use clinical acumen and rapport-building skills to describe and clarify each patient’s particular problems and circumstances, as well as their personal priorities and viewpoint. Thirdly, in EBP, these two types of knowledge (research results and patient specifics) are integrated in the optimal way for each individual. This means extracting the research evidence that is relevant to the patient’s situation and applying it prudently with consideration for what is likely to work in this unique set of circumstances.[click] According to Robin Cox ….Evidence-based practice (EBP) is the process by which audiologists make patient treatment decisions based on a careful study of the clinical evidence to make the right hearing aid choice
- Many questions arise when a clinician fits hearing aids and the perspective is ……do we have evidence to answer any of these questions. The questions could be are low knee-points better than high?Is frequency transposition better than frequency compression?Can a hearing aid help tinnitus patients ?Knowing the best current evidence on a topic provides justification for a clinician’s recommendations…….The basic principle behind evidence-based practice is that ...it tackles one problem and one patient at a time
- The approach to evidence-based practice is….. STEP1 Formulate a focused and answerable question…. STEP2Search for the best available evidence……STEP3Evaluate evidence for validity and relevance……. STEP4 make recommendations by combining collected evidence, clinical expertise and user requirements……….. STEP5evaluate the results and determine ways to improve……
- Let’s for a moment focus on step 3: Evaluate evidence for validity and relevanceAs professionals we profit from a systematic approach in our work – we also need to be efficient and swift in our work. Therefore we also need a strategy when we evaluate evidence that may influence our professional decisions and our client recommendationsIf we take a closer look at how to evaluate evidence…… an viableoption is to categorise according to efficacy, which is evidence measured under ideal conditions …like laboratory conditions…….….or according to effectiveness, which is evidence measured in the real world.
- The efficacy of a treatment is how well a feature or hearing aid CAN work given the best possible scenario………This is an example of an efficacy set-up. We want to make a comparison between an adaptive directional microphone system and an omnidirectional microphone. The hearing impaired person is placed in an anechoic room with a speaker in front playing speech and a speaker behind playing noise. The omnicirectional microphone will pick up noise and speech, whereas the directional microphone system will be able to zoom in on the speech from in front and dampen the noise.The effectiveness of a treatment is how well a feature or hearing aid works in the real world. In the effectiveness set-up, the hearing impaired is asked to try out both settings in real life situations. The hearing impaired is in this case trying to follow a conversation from an actual speaker in everyday sounds and noises.Finally he is asked to fill out a questionnaire to evaluate whether the adaptive directional michrophone helps when trying to follow a conversation in a noisy environment.
- We have now looked at the importance of a clear client perspective, a constructive dialogue and evidence based practice. Now is the time to turn our attention to widex solutions to some of the well known challenges our end-users are faced with every day.
- The most classical cornerstone in Widex hearing aids is our proprietry compression system – the TruSound compression system. The oirigin of this system stems from a detailed understanding of the functionality of the normal hearing ear and effect of hearing loss on the dynamic range.The Widex philosophy has always been the preserve the perception of soft sounds as soft, ensure full audibility and comfort of normal speech and make loud sounds sound loud without being uncomfortable. This is the essence of good sound reproduction for hearing impaired people.
- Another central point has always been to ensure that the intended sound pressure level at the eardrum is in fact the sound pressure level in situ. This is why Widex introduced the Sensogram and the feedback test more than 15 years ago and we have refined the features since then and added new dimensions as AISA (Assessment of in situ acoustics). All of these features are classical widex trademarks and aims to give the dispenser the best precision in fitting. Our belief has always been that the more precise the starting point of any fitting the easier it is to follow up on a fitting with precise fine tuning and counselling. Knowing is understanding.
- The last cornerstone in our development that I would like to mention is our strategies for noise reduction and speech enhancement. We have always been focused on the audibility of speech and when we were able to make our noise reduction algorithm dependant not only on the signal-noise ratio of the environment but also on the individual hearing loss of the hearing loss – serious improvements in sound quality, audibility and speech intelligibility were accomplished..It is all about keeping as much of thenoise spectrum below threshold and as musch of the speech spectrum above threshold. And with increasing hearing loss the balance betwen audibility and intelligibility becomes increasingly delicate.
- The challenges of the hearing impaired population are evident to all of us at Widex. It is the driving force behind all the research and development work in our laboratories. We have more than 200 ingeneers and audiologists devoted to the development of better hearing aids and solutions for our customers.
- Listening in background noise remains a constant challenge
- But relieveing background noise is just one issue. There is a great need to ensure that hearing and listening is associated with pleasure and relaxation.
- Hearing from a distance ensures that you can orientate yourself in the environment... It is important for social interaction.
- Listening in nature is a dimension in life that adds color and experience. Therefore our hearing aids must also focus on this
- And last but not least – using the telephone must be easy and comfortable without feedback and unwanted sounds.
- Let me know share with you some of the information we have compile to facilitate an evidence based approach when fitting Widex hearing aids with the latest in audiological features from our labs
- The signature features we have compiled evidence about are the Audibillity Extender, the frequency transposition feature, the Zen tones, new soothing sound chimes in the hearing aid and the Speech Enhancer, the hearing loss dependant noise reduction / speehc enhancement algorithm based on the Speech Intelligibility Index.
- The findings on our features can be summarised to 3 main findings.
- The Audibility extender is our frequency lowering technique – it has allowed us make high frequency input sounds audible in fittings where the hearing thresholds normally leave the auditory range without significant high frequency components
- Using frequency lowering techniques in the form of either frequency transposition or frequency compression to make high frequency sounds audible has been a subject of research for several decades. Targeting sloping high frequency hearing losses, as well as more severe and profound hearing losses [click], several researchers have over the years gathered evidence supporting the use of such frequency lowering techniques.
- Frequency lowering is a term applied to a wide range of schemes. Overall, we can distinguish between linear frequency transposition, where a part of the signal is moved to a lower frequency area [click], and frequency compression, where all or some of the frequency range is compressed [click]. Widex hearing aids make use of linear frequency transposition in the Audibility Extender program.
- A way to illustrate the concept of frequency transposition is by using a visual analogy. To a certain extent, good resolution means sharpness or clarity. So in this picture, which illustrates good resolution across frequencies - from low to high or from left to right - we see a clear and sharp picture with high contrasts – we can see the details.Please notice the face of the little girl to the far right.[click]As the degree of hearing loss increases, resolution decreases. We cannot tell the difference between two frequencies as easily – they sound the same. The picture becomes more fuzzy. In this case, with a steeply sloping loss, the sharpness or resolution may be good in the low and mid frequencies, but poor in the high frequency regions. And in cases where there may be a dead region, you simply see a “blur” and you cannot tell what it is. Simply amplifying the “blur” tells you there is a “blur”, but does not make identification easier. In this case, we can say that there is a dead region – the information in the high frequencies is missing. [click]The purpose of frequency transposition is to move the important information in the high frequency regions to a lower frequency where it can be identified. In frequency transposition, the information in the high frequencies is moved down to a frequency region where the resolution is still acceptable so the auditory system can utilise the information. Note that the high frequency, when transposed to a mid frequency region, would need good resolution in order for it to be identifiable. The beauty of transposition is that it preserves the lower and mid frequencies – especially the temporal structures – but as you can see, there is a “crowding” of information in the mid frequencies – and thus initial confusion may happen in some cases, making adjustment, training and counselling particularly necessary.
- Improvement of both perception and production of speech has been documented in a wide range of studies. Most recently by Kuk et al in 2009.The table shows consonant perception scores grouped according to phoneme class. These were measured with the standard program, with the Audibility Extender program at initial visit, with the Audibility Extender program after one months’ use, and again after 2 months’ use. The results from the study show that the consonants receiving the most positive impact are the ones with most high frequency energy – the fricatives and the affricatives. Notice the initial confusion with the introduction of the new language cues for the stops, approximants and nasals. These quickly improve over time. Auriemmo J, Kuk F, Stenger P (2008). Criteria for Evaluating Performance of Linear Frequency Transposition in Children, Hearing Journal, 61(4), 50-54Auriemmo J, Kuk F, Lau C, Marshall S, Thiele N, Pikora M, Quick D, Stenger P (2009). Effect of Linear Frequency Transposition on Speech Recognition and Production of School-Aged Children. Journal of the American Academy of Audiology, 20(5)Kuk F, Keenan D, Peeters H, Korhonen P, Hau O, Andersen H.(2007a). Critical Factors in Ensuring Efficacy of Frequency Transposition. Part 1: Individualizing the Start Frequency, Hear Rev 14(3): 60, 62-64, 66Kuk F, Keenan D, Peeters H, Lau C, Crose, B.(2007b), Critical Factors in Ensuring Efficacy of Frequency Transposition. Part 2: Facilitating initial adjustment, Hearing Review, 14(4), 90, 92,95-96Kuk F, Peeters H, Keenan D, Lau C (2007c), Use of Frequency Transposition in a Tin-Tube Open-Ear Fitting, Hearing Journal, 60(4), 59-63Korhonen P, Kuk F (2008), Use of Linear Frequency Transposition in Simulated Hearing Loss. J Am AcadAudiol, 19(10)Kuk F, Keenan D, Korhonen P, Lau C (2009). Efficacy of Linear, Efficacy of Linear Frequency Transposition on Consonant Identification in Quiet and Noise, J Am AcadAudiol , 20(8)Smith J, Dann M, Brown M (2009), An Evaluation of Frequency Transposition for Hearing-Impaired School-Age Children. Deafness & Education International, 11 (2), 62-82
- There is a clear effect of training and acclimatisation related to the use of the Audibility Extender. Several studies have documented the effect of these parameters showing that training improves the utilisation of the new acoustic cues and that training as well as acclimatisation is essential in order to fully realise the potential of the Audibility Extender.I would especially like to highlight results from a study by Korhonen et al (2008), which are illustrated in the graphs. They show identification scores for phonemes without (to the left) and with (to the right) frequency transposition at different time intervals. Results determine that the identification score for phonemes improved significantly for the transposed stimuli (the Audibility Extender) over the non-transposed stimuli (the standard program) after only 30 minutes of training. This indicates that the improvement is not only an effect of training; it is an effect of training combined with the effect of the transposed stimuli.Korhonen P, Kuk F (2008), Use of Linear Frequency Transposition in Simulated Hearing Loss. J Am Acad Audiol, 19(10)Kuk F, Keenan D, Korhonen P, Lau C (2009). Efficacy of Linear, Efficacy of Linear Frequency Transposition on Consonant Identification in Quiet and Noise, J Am Acad Audiol , 20(8)
- Along with training, counselling on expectations when using the Audibility Extender has been shown to facilitate acceptance (Kuk et al, 2007b)Kuk F, Keenan D, Peeters H, Lau C, Crose, B.(2007b), Critical Factors in Ensuring Efficacy of Frequency Transposition. Part 2: Facilitating initial adjustment, Hearing Review, 14(4), 90, 92,95-96
- Language development is of special importance in paediatric audiology. The Audibility Extender has shown good language development results in studies with school age children. This example, from a study by Auriemmo et al in 2009, shows the production of the fricatives /s/ and /z/ in reading and conversation for a group of school aged children.The figure shows the accuracy of the /s/ and /z/ production measured on a reading task (yellow bar) and a conversational task (red bar) with the children’s own hearing aids, the study hearing aid in the standard program after training, and the study hearing aid in the Audibility Extender program after 3 and 6 weeks of training. Analyses of the results show significant improvement in the accuracy and consistency of /s/ and /z/ articulation during both the reading and the conversational task.Further benefits have been recorded in the classroom setting. Here teachers involved in studies with the Audibility Extender have reported improved auditory function as well as increases in confidence and self-esteem for the children after they were fitted with the Audibility Extender (Smith, 2009)Auriemmo J, Kuk F, Stenger P (2008). Criteria for Evaluating Performance of Linear Frequency Transposition in Children, Hearing Journal, 61(4), 50-54Auriemmo J, Kuk F, Lau C, Marshall S, Thiele N, Pikora M, Quick D, Stenger P (2009). Effect of Linear Frequency Transposition on Speech Recognition and Production of School-Aged Children. Journal of the American Academy of Audiology, 20(5)Smith J, Dann M, Brown M (2009), An Evaluation of Frequency Transposition for Hearing-Impaired School-Age Children. Deafness & Education International, 11 (2), 62-82
- Let’s now for a moment turn our attention to the Speech Enhancer
- The aim of the Speech Enhancer in mind440 is two-fold: to keep speech above the hearing threshold and to keep background noise below the hearing threshold. These aims are reminiscent of the conditions required to maintain a high Speech Intelligibility Index.The Speech Intelligibility Index is an objective measure that correlates closely with speech understanding. The SII can be calculated if one knows the characteristics of the speech spectrum, the noise spectrum and the hearing thresholds (which in mind440 are the Sensogram thresholds).The Speech Enhancer secure the highest SII through a continuous optimisation algorithm. This means that the SII is calculated continuously and the gain is adjusted on the basis of this calculation. There is also an instant comparison of the new SII to the previous SII when the gain is adjusted. If the SII is higher in the new SII, then the gain is adjusted in the same direction. If the SII is lower than the previous SII then the gain is adjusted in the opposite direction.In this way, mind440’s Speech Enhancer always ensures that the optimum SII is provided in all listening environments – thereby ensuring optimum speech intelligibility.The illustration shows a segment of the spectrum of the sound signal. The speech and the noise level can be seen, and it is obvious how the noise level decreases as the speech enhancer comes to it’s full effect.The sound file gives an example on the speech enhancers effect going from silence to the full effect. The set-up for the recording is: Hearing loss: 10,10,40,50 dB HL711 coupler on KEMAR head35mm tubeSpeech signal at 70dB SPL in one loud-speakerNoise at 58 dB SPL (in 5 loudspeakers around the KEMAR head) (Party noise)
- In comparative measurements of noise reduction systems it can be seen that many strategies dampen gain according to the ambient noise conditions. This is a valid aim for a strategy as a listener can be expected to move into new listening environments with different background noise levels. Widex’s Speech Enhancer makes use of the SNR, but it also takes the hearing loss of the client into consideration. This sets the Speech Enhancer apart from conventional noise reduction systems that only dampen sound according to the current noise level without any consideration for the hearing loss of the client. Including the hearing loss of the client in a noise reduction algorithm means that competing noise can be dampened so that it is below the client’s hearing threshold, and speech can be amplified so that it is above the client’s hearing threshold.Measurements of long-term average gain changes with the Speech Enhancer activated/deactivated confirm that the Speech Enhancer varies with SNR and hearing loss.Graph: Figure showing the effect of different hearing losses on long-term average measurements of the Speech Enhancer active in different signal-to-noise ratio conditions. It can be seen that as the low frequency thresholds become progressively worse, from hearing loss 1 to hearing loss 3, the amount of low frequency damping also decreases. Darker colouring indicates greater gain reduction. Measurements were made in a testbox with a speech level of 62 dB SPL (adapted from Smeds et. al., 2009).
- The Speech Enhancer has been verified in laboratory experiments. These results suggest that the Speech Enhancer can significantly increase speech intelligibility in noise. In particular, the Speech Enhancer in combination with an omnidirectional microphone gave test participants an average signal-to-noise ratio advantage of 2.5 dB, in a standardised test of their ability to hear in noise.This is revolutionary as previously only directional microphones have been able to improve speech recognition in noise. The significance of these findings is that they confirm that the Speech Enhancer contributes to speech understanding in noise. Graphs: Average SNR for 50 % correct scores on the HINT test with the Speech Enhancer activated in different microphone settings (n=18). The error bars represent one standard deviation (from Peeters et al., 2009).
- While the Speech Enhancer can significantly increase speech intelligibility in noise, it does not compromise listener comfort in noisy environments. This can be seen in the results of a study that measured the Acceptable Noise Level (ANL, ANL=MostComfortableLevel-BackgroundNoiseLevel) with the Speech Enhancer. The ANL is a metric that reflects a listeners tolerance of challenging conditions. It is therefore not directly related to the understanding of speech in noise, but is an indication of listening comfort.The results from Peeters et al., (2009) indicate that the Speech Enhancer while benefitting speech intelligibility has a positive effect on the listeners’ tolerance of noisy environments. Graph: Figure X showing the decrease in average ANL with the Speech Enhancer activated in different microphone settings (from Peeters et al., 2009). It can be seen that in the omnidirectional microphone setting the decrease is 3.3 dB and in the directional mode the decrease was 2.9 dB. NB, decreases in ANL indicate improved tolerance.
- The introduction of melodic fractal tones in the hearing aids set a new standard for what hearing aids may have to offer.
- The Zen tones are based on fractal technology, which ensures that the music is predictable without repeating itself. The user has a choice of five Zen styles, and it is possible to further individualise these by adjusting tempo and pitch. The music consists of soothing tones with no lyrics to avoid strong emotions in the listener. The volume can be adjusted in the fitting software or by using the volume control on the hearing aid. To make sure that the Zen tones are audible at all times the Zen program takes the individual hearing loss and background noise into consideration when generating the fractal music. ANIMATION: Right click on the animation an choose play – click on the notes, and the zen tones will start to play. Use the slidebars to adjust volume, tempo and pitch.
- This figure shows how 14 subjects rated four different Zen styles with respect to how relaxing they were perceived. The subjects rated from very relaxing – the lilac pillars - to very tensing – the blue pillars - on a five point scale. As shown in the figure, the majority chose “Very relaxing” or “Somewhat relaxing” for all four Zen styles (on average, seen across the 4 Zen styles, 70% chose “somewhat relaxing” or “very relaxing”). The figure was even higher after fine tuning of the pitch and tempo of each person’s favourite Zen style. 86% found their preferred Zen style to be relaxing after the it had been adjusted to their personal preferences. This highlights the importance of adjustability and choice between different music styles.
- Hearing-impaired persons carried out a concentration task to find out if the individualised Zen style could help them concentrate.In the task, they had to eliminate as many numbers as possible starting from 00 and ending with 99 from a block with numbers. The concentration task was repeated with the hearing aid microphone only (that is, Zen off) and the hearing aid microphone + Zen (that is, Zen on). The results showed a significantly better performance by the participants when the Zen styles were active than when they were deactivated. [The participants’ average performance with the Zen program on is represented by the blue line in the graph. Their performance with the Zen program switched off is indicated by the red line. What we can see is that the blue line is always above the red line - so the participants consistently gave more correct answers when the Zen program was switched on].So, Kuk and Peeters’ results indicate that the Zen styles can help people with a hearing loss both relax and concentrate.
- On this slide you can see a figure that shows the Tinnitus Handicap Scores, that is the impact of tinnitus on daily life and well beeing of the 14 subjects. The lower the score the better. The subjects answered the THI questionnaire several times during the study, and these are the ratings in the beginning of the study and after 6 months with daily zen use. The blue lines show the change in score of each subject. The red bold line is the avarage THI score. If you look into the data,10 of the 14 subjects improvement in the way they experienced the nuisance of their tinnitus. For five of the subjects the improvement was statistic significant.These data indeed indicates that many people will experience a possitive effect of zen on their tinnitus.In respect to this result remember that it is not expected that everyone will like the zen tones. Like music we each have our preferences and some people just don’t like the fractal tones that zen is using
- To sum up we have dwelled on important aspects of the rehabilitative work that have definite impact on the premise for our work. We have an obligation to find the client where he is in order to be helpful to him. Dialogue is essential in all relations and in our work it is essential when we work according to the thinking in Widex Human Capacity – the descriptive phase, the evaluation phase and the rehabilitation phase. This process allows us to incorporate evidence based practice in a convenient manner in our workflow. Last but certainly not least we have looked at some of the most essential findings and evidence for 3 key signature features from Widex the Audibility Extender, the Zen tones and the Speech Enhancer.