Methods and Applications of the Audibility Index in Hearing Aid Selection and Fitting

During the first half of the 20th century, communications engineers at Bell Telephone Laboratories developed the articulation model for predicting speech intelligibility transmitted through different telecommunication devices under varying electroacoustic conditions. The profession of audiology adopted this model and its quantitative aspects, known as the Articulation Index and Speech Intelligibility Index, and applied these indices to the prediction of unaided and aided speech intelligibility in hearing-impaired listeners. Over time, the calculation methods of these indices-referred to collectively in this paper as the Audibility Index-have been continually refined and simplified for clinical use. This article provides (1) an overview of the basic principles and the calculation methods of the Audibility Index, the Speech Transmission Index and related indices, as well as the Speech Recognition Sensitivity Model, (2) a review of the literature on using the Audibility Index to predict speech intelligibility of hearing-impaired listeners, (3) a review of the literature on the applicability of the Audibility Index to the selection and fitting of hearing aids, and (4) a discussion of future scientific needs and clinical applications of the Audibility Index.

[1]  H Dillon Hearing aid evaluation: predicting speech gain from insertion gain. , 1993, Journal of speech and hearing research.

[2]  K. D. Kryter Validation of the Articulation Index , 1962 .

[3]  V Viljanen,et al.  Acoustic conditions for speech communication in classrooms. , 1991, Scandinavian audiology.

[4]  L.L. Beranek,et al.  The Design of Speech Communication Systems , 1947, Proceedings of the IRE.

[5]  J. Punch,et al.  Probe Microphone Measurements: Hearing Aid Selection and Assessment , 1992 .

[6]  Robyn M. Cox,et al.  The Abbreviated Profile of Hearing Aid Benefit , 1995 .

[7]  K. D. Kryter PROPOSED METHODS FOR THE CALCULATION OF THE ARTICULATION INDEX , 1961 .

[8]  A. Neuman,et al.  Children's perception of speech in reverberation. , 1983, The Journal of the Acoustical Society of America.

[9]  C V Pavlovic,et al.  Articulation index predictions of speech intelligibility in hearing aid selection. , 1988, ASHA.

[10]  J. C. Webster Interpretations of speech and noise characteristics of NTID learning centers , 1979 .

[11]  P. Newall,et al.  Hearing aid gain and frequency response requirements for the severely/profoundly hearing impaired. , 1990, Ear and hearing.

[12]  J Jerger,et al.  Speech understanding in the elderly. , 1989, Ear and hearing.

[13]  M W Skinner,et al.  Speech intelligibility in noise-induced hearing loss: effects of high-frequency compensation. , 1980, The Journal of the Acoustical Society of America.

[14]  G R Popelka,et al.  Factors which Affect Measures of Speech Audibility with: Hearing Aids , 1987, Ear and hearing.

[15]  G A Studebaker,et al.  Evaluating relative speech recognition performance using the proficiency factor and rationalized arcsine differences. , 1995, Journal of the American Academy of Audiology.

[16]  H. Levitt,et al.  Phoneme errors on a nonsense syllable test , 1975 .

[17]  D Byrne Effects of frequency response characteristics on speech discrimination and perceived intelligibility and pleasantness of speech for hearing-impaired listeners. , 1986, The Journal of the Acoustical Society of America.

[18]  S. Gordon-Salant,et al.  Accuracy of speech intelligibility index predictions for noise-masked young listeners with normal hearing and for elderly listeners with hearing impairment. , 1995, Journal of speech and hearing research.

[19]  T Houtgast,et al.  A physical method for measuring speech-transmission quality. , 1980, The Journal of the Acoustical Society of America.

[20]  G A Studebaker,et al.  Age-related changes in monosyllabic word recognition performance when audibility is held constant. , 1997, Journal of the American Academy of Audiology.

[21]  C V Pavlovic,et al.  Frequency importance functions for a feature recognition test material. , 1988, The Journal of the Acoustical Society of America.

[22]  B Kollmeier,et al.  The effect of multichannel dynamic compression on speech intelligibility. , 1995, The Journal of the Acoustical Society of America.

[23]  W. R. Farrell,et al.  Speech Privacy in Buildings , 1962 .

[24]  D Byrne,et al.  Maximizing Effective Audibility in Hearing Aid Fitting , 2001, Ear and hearing.

[25]  C V Pavlovic,et al.  Transfer functions and correction factors used in hearing aid evaluation and research. , 1989, Ear and hearing.

[26]  Mead C. Killion New Thinking on Hearing in Noise: A Generalized Articulation Index , 2002 .

[27]  Gerald A. Studebaker,et al.  Acoustical Factors Affecting Hearing Aid Performance , 1992 .

[28]  T. Houtgast,et al.  A review of the MTF concept in room acoustics and its use for estimating speech intelligibility in auditoria , 1985 .

[29]  H. Dillon,et al.  The National Acoustic Laboratories' (NAL) New Procedure for Selecting the Gain and Frequency Response of a Hearing Aid , 1986, Ear and hearing.

[30]  D D Dirks,et al.  Frequency-importance functions for words in high- and low-context sentences. , 1992, Journal of speech and hearing research.

[31]  R Carhart,et al.  An expanded test for speech discrimination utilizing CNC monosyllabic words. Northwestern University Auditory Test No. 6. SAM-TR-66-55. , 1966, [Technical report] SAM-TR. USAF School of Aerospace Medicine.

[32]  G R Popelka,et al.  Neural presbycusis: a diagnostic dilemma. , 1992, The American journal of otology.

[33]  R. M. Sachs,et al.  Anthropometric manikin for acoustic research. , 1975, The Journal of the Acoustical Society of America.

[34]  C V Pavlovic Speech spectrum considerations and speech intelligibility predictions in hearing aid evaluations. , 1989, The Journal of speech and hearing disorders.

[35]  D D Dirks,et al.  Stop-consonant recognition for normal-hearing listeners and listeners with high-frequency hearing loss. II: Articulation index predictions. , 1989, The Journal of the Acoustical Society of America.

[36]  B. Moore,et al.  A Test for the Diagnosis of Dead Regions in the Cochlea , 2000, British journal of audiology.

[37]  R Plomp,et al.  The effect of linguistic entropy on speech perception in noise in young and elderly listeners. , 1991, The Journal of the Acoustical Society of America.

[38]  A. Nabelek,et al.  Reverberant overlap- and self-masking in consonant identification. , 1989, The Journal of the Acoustical Society of America.

[39]  Z Hou,et al.  A Model to Evaluate and Maximize Hearing Aid Performance by Integrating the Articulation Index Across Listening Conditions , 1994, Ear and hearing.

[40]  L Magnusson,et al.  Predicted and Measured Speech Recognition Performance in Noise with Linear Amplification , 2001, Ear and hearing.

[41]  Christine M. Rankovic An Application of the Articulation Index to Hearing Aid Fitting , 1991 .

[42]  L E Humes,et al.  Evaluation of the use of a new compact disc for auditory perceptual assessment in the elderly. , 1996, Journal of the American Academy of Audiology.

[43]  C V Pavlovic,et al.  Use of the articulation index for assessing residual auditory function in listeners with sensorineural hearing impairment. , 1984, The Journal of the Acoustical Society of America.

[44]  B. Moore Dead Regions in the Cochlea: Diagnosis, Perceptual Consequences, and Implications for the Fitting of Hearing Aids , 2001, Trends in amplification.

[45]  C M Reed,et al.  Hearing aids--a review of past research on linear amplification, amplitude compression, and frequency lowering. , 1979, ASHA monographs.

[46]  D D Dirks,et al.  Stop-consonant recognition for normal-hearing listeners and listeners with high-frequency hearing loss. I: The contribution of selected frequency regions. , 1989, The Journal of the Acoustical Society of America.

[47]  L E Humes,et al.  Understanding the speech-understanding problems of the hearing impaired. , 1991, Journal of the American Academy of Audiology.

[48]  Harvey Fletcher,et al.  The Perception of Speech Sounds by Deafened Persons , 1952 .

[49]  M. Liberman,et al.  Single-neuron labeling and chronic cochlear pathology. III. Stereocilia damage and alterations of threshold tuning curves , 1984, Hearing Research.

[50]  Harvey Fletcher,et al.  Speech and hearing in communication, 2nd ed. , 1953 .

[51]  B C Moore,et al.  Perceptual consequences of cochlear hearing loss and their implications for the design of hearing aids. , 1996, Ear and hearing.

[52]  P E Souza,et al.  Effect of preferred volume setting on speech audibility in different hearing aid circuits. , 2001, Journal of the American Academy of Audiology.

[53]  D J Van Tasell,et al.  Effect of Peak Clipping on Speech Recognition Threshold , 1994, Ear and hearing.

[54]  S. Bacon,et al.  Modulation detection in subjects with relatively flat hearing losses. , 1992, Journal of speech and hearing research.

[55]  C. Turner,et al.  High-frequency audibility: benefits for hearing-impaired listeners. , 1998, The Journal of the Acoustical Society of America.

[56]  L E Humes,et al.  Evaluation of two clinical versions of the articulation index. , 1992, Ear and hearing.

[57]  Todd A. Ricketts,et al.  Making Sense of Directional Microphone Hearing Aids , 1999 .

[58]  C V Pavlovic,et al.  Derivation of primary parameters and procedures for use in speech intelligibility predictions. , 1987, The Journal of the Acoustical Society of America.

[59]  T. Houtgast,et al.  Predicting speech intelligibility in rooms from the modulation transfer function, I. General room acoustics , 1980 .

[60]  G A Studebaker The effect of equating loudness on audibility-based hearing aid selection procedures. , 1992, Journal of the American Academy of Audiology.

[61]  Harvey Dillon,et al.  NAL-NL1: A new procedure for fitting non-linear hearing aids , 1999 .

[62]  A M Amlani,et al.  Efficacy of directional microphone hearing aids: a meta-analytic perspective. , 2001, Journal of the American Academy of Audiology.

[63]  G. A. Miller The Perception of Speech. , 1951 .

[64]  Margaret W. Skinner,et al.  Hearing Aid Evaluation , 1988 .

[65]  G A Studebaker,et al.  Frequency-importance and transfer functions for the Auditec of St. Louis recordings of the NU-6 word test. , 1993, Journal of speech and hearing research.

[66]  L E Humes,et al.  Factors associated with individual differences in clinical measures of speech recognition among the elderly. , 1994, Journal of speech and hearing research.

[67]  Vern O. Knudsen THE HEARING OF SPEECH IN AUDITORIUMS , 1929 .

[68]  C W Turner,et al.  Quantifying the contribution of audibility to recognition of compression-amplified speech. , 1999, Ear and hearing.

[69]  M A Nerbonne,et al.  Communication Screening Profile: Use with Elderly Clients , 1982, Ear and hearing.

[70]  G A Studebaker,et al.  Frequency-importance and transfer functions for recorded CID W-22 word lists. , 1991, Journal of speech and hearing research.

[71]  Patricia McCarthy Self‐assessment revisited , 1998 .

[72]  P E Souza,et al.  Improving audibility with nonlinear amplification for listeners with high-frequency loss. , 2000, Journal of the American Academy of Audiology.

[73]  M. Kringlebotn,et al.  A graphical method for calculating the speech intelligibility index and measuring hearing disability from audiograms. , 1999, Scandinavian audiology.

[74]  J. Allen,et al.  Loudness growth in 1/2-octave bands (LGOB)--a procedure for the assessment of loudness. , 1990, The Journal of the Acoustical Society of America.

[75]  J. Dubno,et al.  Effects of age and mild hearing loss on speech recognition in noise. , 1984, The Journal of the Acoustical Society of America.

[76]  C V Pavlovic,et al.  An articulation index based procedure for predicting the speech recognition performance of hearing-impaired individuals. , 1986, The Journal of the Acoustical Society of America.

[77]  Patricia McCarthy Self-Assessment Inventories: Theyʼre Not Just For Aural Rehab Anymore! , 1994 .

[78]  M. Robb,et al.  Audibility and recognition of stop consonants in normal and hearing-impaired subjects. , 1987, The Journal of the Acoustical Society of America.

[79]  H Müsch,et al.  Using statistical decision theory to predict speech intelligibility. I. Model structure. , 2001, The Journal of the Acoustical Society of America.

[80]  Louis D. Braida,et al.  Evaluating the articulation index for auditory-visual input. , 1987, The Journal of the Acoustical Society of America.

[81]  D Byrne Effects of bandwidth and stimulus type on most comfortable loudness levels of hearing-impaired listeners. , 1986, The Journal of the Acoustical Society of America.

[82]  Pavlovic Cv Articulation index predictions of speech intelligibility in hearing aid selection. , 1988 .

[83]  L E Humes,et al.  An evaluation of several rationales for selecting hearing aid gain. , 1986, The Journal of speech and hearing disorders.

[84]  G Keidser,et al.  NAL-NL1 procedure for fitting nonlinear hearing aids: characteristics and comparisons with other procedures. , 2001, Journal of the American Academy of Audiology.

[85]  Dianne J. Van Tasell,et al.  Hearing Loss, Speech, and Hearing Aids , 1993 .

[86]  C. P. Janota,et al.  Frequency importance functions for words, sentences, and continuous discourse. , 1996, Journal of speech and hearing research.

[87]  Arthur Boothroyd,et al.  Developments in Speech Audiometry , 1968 .

[88]  B. Moore,et al.  The Use of Psychophysical Tuning Curves to Explore Dead Regions in the Cochlea , 2001, Ear and hearing.

[89]  D Byrne,et al.  Speech recognition of hearing-impaired listeners: predictions from audibility and the limited role of high-frequency amplification. , 1998, The Journal of the Acoustical Society of America.

[90]  J. Moncur,et al.  Binaural and monaural speech intelligibility in reverberation. , 1967, Journal of speech and hearing research.

[91]  K. D. Kryter Methods for the Calculation and Use of the Articulation Index , 1962 .

[92]  Michael Valente,et al.  Strategies for Selecting and Verifying Hearing Aid Fittings. , 1994 .

[93]  T W Tillman,et al.  Room acoustics effects on monosyllabic word discrimination ability for normal and hearing-impaired children. , 1978, Journal of speech and hearing research.

[94]  J. Pickett,et al.  Monaural and binaural speech perception through hearing aids under noise and reverberation with normal and hearing-impaired listeners. , 1974, Journal of speech and hearing research.

[95]  J. W. Black,et al.  Equally contributing frequency bands in intelligibility testing. , 1959, Journal of speech and hearing research.

[96]  H Müsch,et al.  Using statistical decision theory to predict speech intelligibility. II. Measurement and prediction of consonant-discrimination performance. , 2001, The Journal of the Acoustical Society of America.

[97]  D. Schum,et al.  Actual and predicted word-recognition performance of elderly hearing-impaired listeners. , 1991, Journal of speech and hearing research.

[98]  M Valente Use of Microphone Technology to Improve User Performance in Noise , 1999, Trends in amplification.

[99]  L D Braida,et al.  Intelligibility of conversational and clear speech in noise and reverberation for listeners with normal and impaired hearing. , 1994, The Journal of the Acoustical Society of America.

[100]  D. M. Green,et al.  The effect of vocabulary size on articulation score , 1958 .

[101]  R C Seewald,et al.  The input/output formula: a theoretical approach to the fitting of personal amplification devices. , 1995, The Journal of the Acoustical Society of America.

[102]  P E Souza,et al.  Fitting hearing aids with the Articulation Index: impact on hearing aid effectiveness. , 2000, Journal of rehabilitation research and development.

[103]  L. Humes,et al.  Speech-recognition difficulties of the hearing-impaired elderly: the contributions of audibility. , 1990, Journal of speech and hearing research.

[104]  W A Cooper,et al.  Combining auditory and visual stimuli in the adaptive testing of speech discrimination. , 1978, The Journal of speech and hearing disorders.

[105]  W. H. Sumby,et al.  Visual contribution to speech intelligibility in noise , 1954 .

[106]  R M Cox,et al.  Measuring Satisfaction with Amplification in Daily Life: the SADL scale. , 1999, Ear and hearing.

[107]  G. Studebaker A "rationalized" arcsine transform. , 1985, Journal of speech and hearing research.

[108]  Holcomb Lm,et al.  Articulation index and hearing handicap. , 2000 .

[109]  H. K. Dunn,et al.  Statistical Measurements on Conversational Speech , 1940 .

[110]  Arthur Boothroyd,et al.  Room Acoustics and Speech Perception , 2004 .

[111]  Mead C. Killion The SIN report: Circuits haven't solved the hearing‐in‐noise problem , 1997 .

[112]  C W Turner,et al.  Multichannel compression, temporal cues, and audibility. , 1998, Journal of speech, language, and hearing research : JSLHR.

[113]  H. Fletcher,et al.  The Perception of Speech and Its Relation to Telephony , 1950 .

[114]  S M Abel,et al.  The role of high-frequency hearing in age-related speech understanding deficits , 2000, Scandinavian audiology.

[115]  J. C. Steinberg,et al.  Factors Governing the Intelligibility of Speech Sounds , 1945 .

[116]  D D Dirks,et al.  Application of the Articulation Index and the Speech Transmission Index to the recognition of speech by normal-hearing and hearing-impaired listeners. , 1986, Journal of speech and hearing research.

[117]  P M Zurek,et al.  Consonant reception in noise by listeners with mild and moderate sensorineural hearing impairment. , 1987, The Journal of the Acoustical Society of America.

[118]  A A Montgomery,et al.  Auditory and visual contributions to the perception of consonants. , 1974, Journal of speech and hearing research.

[119]  I. Hirsh,et al.  Development of materials for speech audiometry. , 1952, The Journal of speech and hearing disorders.

[120]  C V Pavlovic Band Importance Functions for Audiological Applications , 1994, Ear and hearing.

[121]  D. Pascoe,et al.  Clinical Implications of Nonverbal Methods of Hearing Aid Selection and Fitting , 1980 .

[122]  L Magnusson,et al.  Predicting the speech recognition performance of elderly individuals with sensorineural hearing impairment. A procedure based on the Speech Intelligibility Index. , 1996, Scandinavian audiology.

[123]  R. Plomp,et al.  Effect of reverberation and noise on the intelligibility of sentences in cases of presbyacusis. , 1980, The Journal of the Acoustical Society of America.

[124]  G. Studebaker,et al.  Intensity-importance functions for bandlimited monosyllabic words. , 2002, The Journal of the Acoustical Society of America.

[125]  C. Turner,et al.  Speech audibility for listeners with high-frequency hearing loss. , 1999, American journal of audiology.

[126]  N. P. Erber Interaction of audition and vision in the recognition of oral speech stimuli. , 1969, Journal of speech and hearing research.

[127]  C V Pavlovic,et al.  A frequency importance function for continuous discourse. , 1987, The Journal of the Acoustical Society of America.

[128]  D D Dirks,et al.  Speech recognition and the Articulation Index for normal and hearing-impaired listeners. , 1985, The Journal of the Acoustical Society of America.

[129]  H. Fletcher Relation Between Loudness and Masking , 1937 .

[130]  L E Humes,et al.  Application of the articulation index to the speech recognition of normal and impaired listeners wearing hearing protection. , 1990, The Journal of the Acoustical Society of America.

[131]  A. M. Mimpen,et al.  Speech-reception threshold for sentences as a function of age and noise level. , 1979, The Journal of the Acoustical Society of America.

[132]  G. Studebaker,et al.  Monosyllabic word recognition at higher-than-normal speech and noise levels. , 1999, The Journal of the Acoustical Society of America.

[133]  D Byrne Key issues in hearing aid selection and evaluation. , 1992, Journal of the American Academy of Audiology.

[134]  R Plomp,et al.  The negative effect of amplitude compression in multichannel hearing aids in the light of the modulation-transfer function. , 1988, The Journal of the Acoustical Society of America.

[135]  A. Nabelek,et al.  Monaural and binaural speech perception in reverberation for listeners of various ages. , 1982, The Journal of the Acoustical Society of America.

[136]  J. P. Egan Articulation testing methods , 1948, The Laryngoscope.

[137]  Herman J. M. Steeneken,et al.  Mutual dependence of the octave-band weights in predicting speech intelligibility , 1999, Speech Commun..

[138]  James F. Willott,et al.  Aging and the Auditory System: Anatomy, Physiology, and Psychophysics , 1991 .

[139]  J M Festen,et al.  Considerations on adaptive gain and frequency response in hearing aids. , 1990, Acta oto-laryngologica. Supplementum.

[140]  Edgar Villchur Comments on ‘‘The negative effect of amplitude compression in multichannel hearing aids in the light of the modulation‐transfer function’’ [J. Acoust. Soc. Am. 83, 2322–2327 (1988)] , 1989 .

[141]  C V Pavlovic,et al.  An evaluation of some assumptions underlying the articulation index. , 1984, The Journal of the Acoustical Society of America.

[142]  D A Fabry,et al.  Evaluation of an articulation-index based model for predicting the effects of adaptive frequency response hearing aids. , 1990, Journal of speech and hearing research.

[143]  P G Stelmachowicz,et al.  A Comparison of Threshold‐Based Fitting Strategies for Nonlinear Hearing Aids , 1998, Ear and hearing.

[144]  M A Nerbonne,et al.  Articulation index and hearing handicap. , 2000, Journal of the American Academy of Audiology.

[145]  R Leavitt,et al.  Speech degradation as measured by the Rapid Speech Transmission Index (RASTI). , 1991, Ear and hearing.

[146]  T. Houtgast,et al.  The Modulation Transfer Function in Room Acoustics as a Predictor of Speech Intelligibility , 1973 .

[147]  Mead C. Killion,et al.  The case of the missing dots: Al and SNR loss , 1998 .

[148]  R M Cox,et al.  Development of the Speech Intelligibility Rating (SIR) test for hearing aid comparisons. , 1989, Journal of speech and hearing research.