Speech Perception in Noise Using Directional Microphones in Open-Canal Hearing Aids

2008 ◽  
Vol 19 (07) ◽  
pp. 571-578 ◽  
Author(s):  
Emily J. Klemp ◽  
Sumitrajit Dhar
Keyword(s):  
Data Collection ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Analysis Data ◽  
Impaired Hearing ◽  
Directional Microphones ◽  
Hearing In Noise ◽  
Hearing Instruments ◽  
Data Collection And Analysis ◽  
Bilateral Sensorineural Hearing Loss

Background: Individuals with impaired hearing find it difficult to understand speech in the presence of background noise—a problem addressed effectively by directional microphones. As open-canal fittings have become increasingly popular in the recent past, so has the debate about the effective directional benefit available from these devices. Purpose: This study investigates the benefit of directional microphones in two commercially available open-canal behind-the-ear hearing aids using the Hearing in Noise Test (HINT). Study Sample: Sixteen individuals, between 50 and 85 year of age, with high-frequency bilateral sensorineural hearing loss and no previous hearing aid experience participated in this study. Data Collection and Analysis: Data Collection and Analysis: Individuals were asked to repeat sentences (presented at 0° azimuth) in the presence of a diffuse-field uncorrelated broadband speech-shaped noise. HINT performance was compared across hearing instruments and conditions using a linear model with repeated measures. Results: There was a directional advantage of 2.6 dB as compared to the unaided condition. Average performance was worse in the omnidirectional mode as compared to the unaided condition. Conclusions: These results suggest that directional signal processing should not be precluded in open-canal instruments for listening in noisy environments.

The Effects of Noise Reduction Technologies on the Acceptance of Background Noise

2013 ◽  
Vol 24 (08) ◽  
pp. 649-659 ◽  
Author(s):  
Kristy Jones Lowery ◽  
Patrick N. Plyler
Keyword(s):  
Noise Reduction ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Background Noise ◽  
Negative Effects ◽  
Directional Microphones ◽  
Repeated Measures Design ◽  
Noise Type ◽  
Data Collection And Analysis ◽  
Speech Spectrum

Background: Directional microphones (D-Mics) and digital noise reduction (DNR) algorithms are used in hearing aids to reduce the negative effects of background noise on performance. Directional microphones attenuate sounds arriving from anywhere other than the front of the listener while DNR attenuates sounds with physical characteristics of noise. Although both noise reduction technologies are currently available in hearing aids, it is unclear if the use of these technologies in isolation or together affects acceptance of noise and/or preference for the end user when used in various types of background noise. Purpose: The purpose of the research was to determine the effects of D-Mic, DNR, or the combination of D-Mic and DNR on acceptance of noise and preference when listening in various types of background noise. Research Design: An experimental study in which subjects were exposed to a repeated measures design was utilized. Study Sample: Thirty adult listeners with mild sloping to moderately severe sensorineural hearing loss participated (mean age 67 yr). Data Collection and Analysis: Acceptable noise levels (ANLs) were obtained using no noise reduction technologies, D-Mic only, DNR only, and the combination of the two technologies (Combo) for three different background noises (single-talker speech, speech-shaped noise, and multitalker babble) for each listener. In addition, preference rankings of the noise reduction technologies were obtained within each background noise (1 = best, 3 = worst). Results: ANL values were significantly better for each noise reduction technology than baseline; and benefit increased significantly from DNR to D-Mic to Combo. Listeners with higher (worse) baseline ANLs received more benefit from noise reduction technologies than listeners with lower (better) baseline ANLs. Neither ANL values nor ANL benefit values were significantly affected by background noise type; however, ANL benefit with D-Mic and Combo was similar when speech-like noise was present while ANL benefit was greatest for Combo when speech spectrum noise was present. Listeners preferred the hearing aid settings that resulted in the best ANL value. Conclusion: Noise reduction technologies improved ANL for each noise type, and the amount of improvement was related to the baseline ANL value. Improving an ANL with noise reduction technologies is noticeable to listeners, at least when examined in this laboratory setting, and listeners prefer noise reduction technologies that improved their ability to accept noise.

The Effects of Receiver Placement on Probe Microphone, Performance, and Subjective Measures with Open Canal Hearing Instruments

2010 ◽  
Vol 21 (04) ◽  
pp. 249-266 ◽  
Author(s):  
Lynzee N. Alworth ◽  
Patrick N. Plyler ◽  
Monika Bertges Reber ◽  
Patti M. Johnstone
Keyword(s):  
Repeated Measures ◽  
Hearing Aid ◽  
Clinical Importance ◽  
Ease Of Use ◽  
Subjective Measures ◽  
Repeated Measures Design ◽  
Hearing Instruments ◽  
Data Collection And Analysis ◽  
Significant Difference ◽  
Occlusion Effect

Background: Open canal hearing instruments differ in method of sound delivery to the ear canal, distance between the microphone and the receiver, and physical size of the devices. Moreover, RITA (receiver in the aid) and RITE (receiver in the ear) hearing instruments may also differ in terms of retention and comfort as well as ease of use and care for certain individuals. What remains unclear, however, is if any or all of the abovementioned factors contribute to hearing aid outcome. Purpose: To determine the effect of receiver location on performance and/or preference of listeners using open canal hearing instruments. Research Design: An experimental study in which subjects were exposed to a repeated measures design. Study Sample: Twenty-five adult listeners with mild sloping to moderately severe sensorineural hearing loss (mean age 67 yr). Data Collection and Analysis: Participants completed two six-week trial periods for each device type. Probe microphone, objective, and subjective measures (quiet, noise) were conducted unaided and aided at the end of each trial period. Results: Occlusion effect results were not significantly different between the RITA and RITE instruments; however, frequency range was extended in the RITE instruments, resulting in significantly greater maximum gain for the RITE instruments than the RITA instruments at 4000 and 6000 Hz. Objective performance in quiet or in noise was unaffected by receiver location. Subjective measures revealed significantly greater satisfaction ratings for the RITE than for the RITA instruments. Similarly, preference in quiet and overall preference were significantly greater for the RITE than for the RITA instruments. Conclusions: Although no occlusion differences were noted between instruments, the RITE did demonstrate a significant difference in reserve gain before feedback at 4000 and 6000 Hz. Objectively; no positive benefit was noted between unaided and aided conditions on speech recognition tests. These results suggest that such testing may not be sensitive enough to determine aided benefit with open canal instruments. However, the subjective measures (Abbreviated Profile of Hearing Aid Benefit [APHAB] and subjective ratings) did indicate aided benefit for both instruments when compared to unaided. This further suggests the clinical importance of subjective measures as a way to measure aided benefit of open-fit devices.

Hearing Aids for Ménière's Syndrome: Implications of Hearing Fluctuation

2008 ◽  
Vol 19 (05) ◽  
pp. 430-434 ◽  
Author(s):  
Celene McNeill ◽  
Catherine M. McMahon ◽  
Philip Newall ◽  
Mary Kalantzis
Keyword(s):  
Data Collection ◽  
Research Design ◽  
Hearing Aids ◽  
Great Satisfaction ◽  
Hearing Thresholds ◽  
Data Collection And Analysis

Background: Hearing fluctuation imposes the biggest challenge in the fitting of hearing aids for patients with Ménière's syndrome. Purpose: This study shows that the problem maybe be overcome by allowing the patients to test their own hearing and to program their own hearing aids to adjust for hearing fluctuation. Research Design and Study Sample: A group of 40 participants diagnosed with Ménière's syndrome were fitted with Widex Senso Diva hearing aids and were provided with a portable Senso Programmer 3 (SP3) that allowed them to measure their own hearing thresholds at up to 14 different frequencies and to program their own devices. Intervention: The participants were instructed to test their hearing three times a day for 8 weeks and to program their hearing aids according to the measured thresholds. Data Collection and Analysis: All participants recorded some degree of hearing fluctuation during the 8-week trial. Results and Conclusions: Among participants, 70 percent continued to program their hearing aids on a regular basis and reported great satisfaction with amplification because they are now able to adjust their own devices when their hearing fluctuates.

Kindergarten teachers' evaluation: perceptions of the new Israeli multiple domains performance tool

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Yael Cohen-Azaria
Keyword(s):  
Data Collection ◽  
Analysis Data ◽  
Kindergarten Teachers ◽  
Ministry Of Education ◽  
Content Type ◽  
Data Collection And Analysis ◽  
Teachers Attitudes ◽  
Multiple Domains ◽  
Depth Interviews

Purpose In 2012, the Israeli Ministry of Education and its Testing and Evaluation Department introduced a new tool to evaluate the quality of kindergarten teachers’ work. This paper aims to identify how kindergarten teachers perceive the new multiple domains performance tool. Design/methodology/approach The study applied a qualitative paradigm of data collection and analysis. Data collection consisted of semi-structured in-depth interviews conducted with 36 kindergarten teachers. Findings Findings indicated that most kindergarten teachers perceive their work plan and the kindergarten climate as the most important evaluation domains, while perceiving involving parents as the least important and even an unnecessary domain. One-third of them indicated that an innovation domain should be added. Also, the kindergarten teachers perceived the use of the KT-MDPT as both positive and negative. Originality/value There is a clear dearth in scholarly literature dealing with the evaluation of the quality of kindergarten teachers’ work. This study is the first to reveal Israeli kindergarten teachers' attitudes regarding this new tool for work quality evaluation.

scholarly journals Sentence Recognition in Noise and Perceived Benefit of Noise Reduction on the Receiver and Transmitter Sides of a BICROS Hearing Aid

2013 ◽  
Vol 24 (10) ◽  
pp. 980-991 ◽  
Author(s):  
Kristi Oeding ◽  
Michael Valente
Keyword(s):  
Noise Reduction ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Background Noise ◽  
Signal To Noise Ratio ◽  
Hearing Aid ◽  
Directional Microphones ◽  
Sentence Recognition ◽  
Clinically Significant ◽  
The Impact

Background: In the past, bilateral contralateral routing of signals (BICROS) amplification incorporated omnidirectional microphones on the transmitter and receiver sides and some models utilized noise reduction (NR) on the receiver side. Little research has examined the performance of BICROS amplification in background noise. However, previous studies examining contralateral routing of signals (CROS) amplification have reported that the presence of background noise on the transmitter side negatively affected speech recognition. Recently, NR was introduced as a feature on the receiver and transmitter sides of BICROS amplification, which has the potential to decrease the impact of noise on the wanted speech signal by decreasing unwanted noise directed to the transmitter side. Purpose: The primary goal of this study was to examine differences in the reception threshold for sentences (RTS in dB) using the Hearing in Noise Test (HINT) in a diffuse listening environment between unaided and three aided BICROS conditions (no NR, mild NR, and maximum NR) in the Tandem 16 BICROS. A secondary goal was to examine real-world subjective impressions of the Tandem 16 BICROS compared to unaided. Research Design: A randomized block repeated measures single blind design was used to assess differences between no NR, mild NR, and maximum NR listening conditions. Study Sample: Twenty-one adult participants with asymmetric sensorineural hearing loss (ASNHL) and experience with BICROS amplification were recruited from Washington University in St. Louis School of Medicine. Data Collection and Analysis: Participants were fit with the National Acoustic Laboratories’ Nonlinear version 1 prescriptive target (NAL-NL1) with the Tandem 16 BICROS at the initial visit and then verified using real-ear insertion gain (REIG) measures. Participants acclimatized to the Tandem 16 BICROS for 4 wk before returning for final testing. Participants were tested utilizing HINT sentences examining differences in RTS between unaided and three aided listening conditions. Subjective benefit was determined via the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire between the Tandem 16 BICROS and unaided. A repeated measures analysis of variance (ANOVA) was utilized to analyze the results of the HINT and APHAB. Results: Results revealed no significant differences in the RTS between unaided, no NR, mild NR, and maximum NR. Subjective impressions using the APHAB revealed statistically and clinically significant benefit with the Tandem 16 BICROS compared to unaided for the Ease of Communication (EC), Background Noise (BN), and Reverberation (RV) subscales. Conclusions: The RTS was not significantly different between unaided, no NR, mild NR, and maximum NR. None of the three aided listening conditions were significantly different from unaided performance as has been reported for previous studies examining CROS hearing aids. Further, based on comments from participants and previous research studies with conventional hearing aids, manufacturers of BICROS amplification should consider incorporating directional microphones and independent volume controls on the receiver and transmitter sides to potentially provide further improvement in signal-to-noise ratio (SNR) for patients with ASNHL.

Tone, Rhythm, and Timbre Perception in School-Age Children Using Cochlear Implants and Hearing Aids

2013 ◽  
Vol 24 (09) ◽  
pp. 789-806 ◽  
Author(s):  
Hamish Innes-Brown ◽  
Jeremy P. Marozeau ◽  
Christine M. Storey ◽  
Peter J. Blamey
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
School Age Children ◽  
Impaired Hearing ◽  
School Year ◽  
Temporal Cues ◽  
Wide Range

Background: Children with hearing impairments, especially those using hearing devices such as the cochlear implant (CI) or hearing aid (HA), are sometimes not encouraged to attend music classes, as they or their parents and teachers may be unsure whether the child can perform basic musical tasks. Purpose: The objective of the current study was to provide a baseline for the performance of children using CIs and HAs on standardized tests of rhythm and pitch perception as well as an instrument timbre identification task. An additional aim was to determine the effect of structured music training on these measures during the course of a school year. Research Design: The Intermediate Measures of Music Audiation (IMMA) Tonal and Rhythmic subtests were administered four times, with 6 wk between tests. All children in the study were also enrolled in “Music Club” teaching sessions. Measures were compared between groups and across the four testing sessions. Study Sample: Twenty children from a single school in Melbourne, Australia, were recruited. Eleven (four girls) had impaired hearing, including six with a unilateral CI or CI and HA together (two girls) and five with bilateral HAs (two girls). Nine were normally hearing, selected to match the age and gender of the hearing-impaired children. Ages ranged from 9–13 yr. Intervention: All children participated in a weekly Music Club – a 45 min session of musical activities based around vocal play and the integration of aural, visual, and kinesthetic modes of learning. Data Collection and Analysis: Audiological data were collected from clinical files. IMMA scores were converted to percentile ranks using published norms. Between-group differences were tested using repeated-measures analysis of variance, and between-session differences were tested using a linear mixed model. Linear regression was used to model the effect of hearing loss on the test scores. Results: In the first session, normally hearing children had a mean percentile rank of ˜50 in both the Tonal and Rhythmic subtests of the IMMA. Children using CIs showed trends toward lower scores in the Tonal, but not the Rhythmic, subtests. No significant improvements were found between sessions. In the timbre test, children generally made fewer errors within the set of percussive compared to nonpercussive instruments. The hearing loss level partially predicted performance in the Tonal, but not the Rhythmic, task, and predictions were more significant for nonpercussive compared to percussive instruments. Conclusions: The findings highlight the importance of temporal cues in the perception of music, and indicate that temporal cues may be used by children with CIs and HAs in the perception of not only rhythm, but also of some aspects of timbre. We were not able to link participation in the Music Club with increased scores on the Tonal, Rhythmic, and Timbre tests. However, anecdotal evidence from the children and their teachers suggested a wide range of benefits from participation in the Music Club that extended from increased engagement and interest in music classes into the children's social situations.

Hearing Benefit and Rated Satisfaction in Children with Unilateral Conductive Hearing Loss Using a Transcutaneous Magnetic-Coupled Bone-Conduction Hearing Aid

2016 ◽  
Vol 27 (10) ◽  
pp. 790-804 ◽  
Author(s):  
Melissa J. Polonenko ◽  
Lora Carinci ◽  
Karen A. Gordon ◽  
Blake C. Papsin ◽  
Sharon L. Cushing
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Bone Conduction ◽  
Magnetic Coupling ◽  
Analysis Data ◽  
Nonparametric Tests ◽  
Skin Reactions ◽  
Speech Performance ◽  
Bone Conduction Hearing

Background: Bilateral hearing is important for learning, development, and function in complex everyday environments. Children with conductive and mixed hearing loss (HL) have been treated for years with percutaneous coupling through an abutment, which achieves powerful output, but the implant site is susceptible to skin reactions and trauma. To overcome these complications, transcutaneous magnetic coupling systems were recently introduced. Purpose: The purpose of the study was to evaluate whether the new transcutaneous magnetic coupling is an effective coupling paradigm for bone-conduction hearing aids (BCHAs). We hypothesized that magnetic coupling will (1) have limited adverse events, (2) provide adequate functional gain, (3) improve spatial hearing and aid listening in everyday situations, and (4) provide satisfactory outcomes to children and their families given one normal hearing ear. Research Design: Retrospective analysis of audiological outcomes in a tertiary academic pediatric hospital. Study Sample: Nine children aged 5–17 yr with permanent unilateral conductive HL (UCHL) or mixed HL were implanted with a transcutaneous magnet–retained BCHA. Average hearing thresholds of the better and implanted ears were 12.3 ± 11.5 dB HL and 69.1 ± 11.6 dB HL, respectively, with a 59.4 ± 4.8 dB (mean ± standard deviation) conductive component. Data Collection and Analysis: Data were extracted from audiology charts of the children with permanent UCHL or mixed HL who qualified for a surgically retained BCHA and agreed to the magnetic coupling. Outcomes were collected from the 3- to 9-mo follow-up appointments, and included surgical complications, aided audiometric thresholds with varying magnet strength, speech performance in quiet and noise, and patient-rated benefit and satisfaction using questionnaires. Repeated measures analysis of variance was used to analyze audiometric outcomes, and nonparametric tests were used to evaluate rated benefit and satisfaction. Results: All nine children tolerated the device and only one child had discomfort at the wound site. Similar access to sound was achieved regardless of magnet strength. Speech performance did not significantly improve in quiet or noise conditions with +10 and +5 dB signal-to-noise ratio. Children benefited from spatially separating the noise from the speech signal, regardless of whether the noise was directed to the implanted or better ear. When wearing the BCHA, the children reported satisfaction and significant implant benefit, particularly in background noise, but at the expense of increased aversiveness to sound. Conclusions: Our findings, therefore, indicate that providing a transcutaneous magnetic-coupled BCHA to children who have UCHL or mixed HL provides benefit on some objective measures of bilateral hearing, as well as some subjective benefit in noise and everyday situations.

Performance of Directional Microphones for Hearing Aids: Real-World versus Simulation

2004 ◽  
Vol 15 (06) ◽  
pp. 440-455 ◽  
Author(s):  
Cynthia L. Compton-Conley ◽  
Arlene C. Neuman ◽  
Mead C. Killion ◽  
Harry Levitt
Keyword(s):  
Hearing Aids ◽  
Real World ◽  
Noise Source ◽  
Live Performance ◽  
Space Condition ◽  
Directional Microphones ◽  
Directional Microphone ◽  
Simulation Techniques ◽  
Hearing In Noise ◽  
The Absolute

The purpose of this study was to assess the accuracy of clinical and laboratory measures of directional microphone benefit. Three methods of simulating a noisy restaurant listening situation ([1] a multimicrophone/multiloudspeaker simulation, the R-SPACE™, [2] a single noise source behind the listener, and [3] a single noise source above the listener) were evaluated and compared to the "live" condition. Performance with three directional microphone systems differing in polar pattern (omnidirectional, supercardioid, and hypercardioid array) and directivity indices (0.34, 4.20, and 7.71) was assessed using a modified version of the Hearing in Noise Test (HINT). The evaluation revealed that the three microphones could be ordered with regard to the benefit obtained using any of the simulation techniques. However, the absolute performance obtained with each microphone type differed among simulations. Only the R-SPACE simulation yielded accurate estimates of the absolute performance of all three microphones in the live condition. Performance in the R-SPACE condition was not significantly different from performance in the "live restaurant" condition. Neither of the single noise source simulations provided accurate predictions of real-world (live) performance for all three microphones.

scholarly journals Psychometric Comparison of the Hearing in Noise Test and the American English Matrix Test

2019 ◽  
Vol 30 (04) ◽  
pp. 315-326 ◽  
Author(s):  
Jumana Harianawala ◽  
Jason Galster ◽  
Benjamin Hornsby
Keyword(s):  
Speech Recognition ◽  
Hearing Aids ◽  
Repeated Measures ◽  
American English ◽  
Hearing Aid ◽  
Speech Corpus ◽  
Speech In Noise ◽  
Hearing In Noise ◽  
Noise Test ◽  
Intensity Functions

AbstractThe hearing in noise test (HINT) is the most popular adaptive test used to evaluate speech in noise performance, especially in context of hearing aid features. However, the number of conditions that can be tested on the HINT is limited by a small speech corpus. The American English Matrix test (AEMT) is a new alternative adaptive speech in noise test with a larger speech corpus. The study examined the relationships between the performance of hearing aid wearers on the HINT and the AEMT.To examine whether there was a difference in performance of hearing aid wearers on the HINT and the AEMT. A secondary purpose, given the AEMT’s steep performance-intensity function, was to determine whether the AEMT is more sensitive to changes in speech recognition resulting from directional (DIR) microphone processing in hearing aids.A repeated measures design was used in this study. Multiple measurements were made on each subject. Each measurement involved a different experimental condition.Ten adults with hearing loss participated in this study.All participants completed the AEMT and HINT, using adaptive and fixed test formats while wearing hearing aids. Speech recognition was assessed in two hearing aid microphone settings—omnidirectional and fixed DIR. All testing was conducted via sound field presentation. Performance on HINT and AEMT were systematically compared across all test conditions using a linear model with repeated measures.The results of this study revealed that adult hearing aid users perform differently on the HINT and AEMT, with adaptive AEMT testing yielding significantly better (more negative) thresholds than the HINT. Slopes of performance intensity functions obtained by testing at multiple fixed signal-to-noise ratios, revealed a somewhat steeper slope for the HINT compared with the AEMT. Despite this steeper slope, the benefit provided by DIR microphones was not significantly different between the two speech tests.The observation of similar DIR benefits of the HINT and AEMT suggests that the HINT and AEMT are equally sensitive to changes in speech recognition thresholds following intervention. Therefore, the decision to use the AEMT or the HINT will depend on the purpose of the study and/or the technology being investigated. Other test related factors such as available sentence corpus, learning effects and test time will also influence test selection.

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient–Clinician Interactions

2017 ◽  
Vol 28 (06) ◽  
pp. 506-521 ◽  
Author(s):  
Stella L. Ng ◽  
Shanon Phelan ◽  
MaryAnn Leonard ◽  
Jason Galster
Keyword(s):  
Data Collection ◽  
Mobile Phones ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Smartphone Application ◽  
Patient Experiences ◽  
Patient Case ◽  
Collective Case Study ◽  
Data Collection And Analysis

Background: Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients’ needs, and attentive to society’s influence. Purpose: The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. “Connected” refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. Research Design: The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. Study Sample: The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. Data Collection and Analysis: The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. Results: The clinician case highlighted clinicians’ heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed patients’ perceptions of themselves as technologically competent or incompetent, and descriptions of how they learned to use the new technology. Between cases, the study found a difference in the response to how the connected hearing aid changed the clinician–patient relationship. While clinicians valued the increased time they spent “getting to know” their patients, patients experienced some frustration specific to the additional troubleshooting related to Bluetooth connectivity. Across cases, there was a resounding theme of “normalization” of hearing aids via their integration with a “normal” technology (mobile phones) and general lack of concern about privacy in relation to the smartphone application and its tracking and geotagging features. Both audiologists and patients credited the connected hearing aids with increased opportunities to participate more fully in everyday life. Conclusions: The introduction of smartphone-connected hearing aids influenced the identities and candidate profiles of hearing aid users, and the nature of time spent in clinical interactions, in important and interesting ways. The influence of connected hearing aids on patient experience and audiology practice calls for continued research and clinical consideration, with implications for clinical decision-making regarding hearing aid candidacy. Further study should look critically at normalization and possible unintended stigmatizing effects of making hearing aids increasingly discreet.

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