Running Head: SKEPTICISM LAB: FREQUENCY LOWERING TECHNIQUES IN HEARING AIDS

Skepticism Lab Frequency Lowering Techniques in Hearing Aids Taylor Remick and Krista Ashmore Purdue University SLHS 605

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Frequency lowering is a technique that allows a hearing aid user to experience a wider range of spectral content as well as other benefits. This technique essentially transfers the spectral content from high frequency regions to regions of audibility. High frequency sounds are important, because they provide redundancy and context, which makes speech easier to understand. Some phonemes, such as fricatives and affricates are composed of high frequencies. Without the ability to hear these sounds, messages can be misunderstood. In addition, if a child has a high frequency hearing loss, he has limited access to these sounds and therefore will have a difficult time learning to produce them. This results in a poorer speech production quality. The possible benefits of frequency lowering include, the audibility of high frequency phonemes, such as /f/ and /s/, reduction of listening fatigue and improvement of sound quality by providing a fuller, richer signal. The treatment for high frequency loss that preceded frequency lowering was vocoding and slow playback techniques used for severe to profound high frequency hearing losses. An interest in frequency lowering was sparked in large part due to new technologies that allow for new techniques and with the goal of providing this frequency lowering technique to those with mild-moderate hearing loss. With a mild to moderate loss, frequency lowering has the possibility of extending the bandwidth of information to ultra high frequencies that would not be attainable with regular amplification. The amount of benefit the individual using this technology will receive depends on the manufacturer of the hearing aids as well as the type of degree of hearing loss an individual has. For a precipitous hearing loss, a hearing loss with a sloping configuration towards high frequencies, frequency lowering enhances the bandwidth of audibility by making the high frequency sounds more available. With a moderately severe and greater losses, this feature extends the bandwidth of audibility beyond that that is available with a conventional hearing aid as well as avoids amplifying dead regions, which is a complete loss of audibility in a specific region. For those individuals with a mild or moderate hearing loss, frequency lowering will once again extend the bandwidth beyond what is achievable with a conventional hearing aid. It also has to capability to improve perception and production of high frequency phonemes, such as fricatives. However, there is controversy surrounding frequency lowering due to possible problems encountered with the implementation of the method. One of the problems is the potential distortion caused by the movement of spectral information. In order to create a clear signal, the digital processing system has to change the identity of individual speech sounds. This, unfortunately is not possible with current digital processing systems (DSPs) and therefore results in distortion. Another issue surrounding frequency lowering is the potential of worsening speech understanding due to the distorted frequency information as a result of fitting/squishing the high frequency information into an audible range. Despite these negative aspects, different manufacturers implement variations of frequency lowering with the aim of providing optimal high frequency audibility. Frequency lowering is a broad label considering the varies methods used to by different hearing aid manufacturers. These methods as well as evidence of the efficacy of the method will be discussed throughout this paper. The first technique that will be discussed is Dynamic Linear Frequency Compression (DLFC). AVR Sonovation uses this technique to deliver a rich sound to its hearing aid users. This technique is proportional on a linear scale and is input dependent

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and utilizes a dynamic switching behavior in that if the input is less than 2.5 kHz, the hearing aid leaves it alone, but if the input is greater than 2.5 kHz, the hearing aid switches the analog to digital (A/D) converter to frequency lowering and sinusoid samples are played at a lower rate. Candidates for DLFC include those who have been diagnosed with moderately-severe to profound hearing loss in high frequencies and normal to profound in low frequencies. According to Simpson in 2009, 13 out of 28 children and 6 out of 18 adults reported significant increases (10-20%) in speech understanding with DLFC. However, there was a lack of homogeneity throughout the study, it was found that this technique worked better with more severe hearing loss. Overall, research demonstrates benefit for half of the children tested and one-third of the adults (Simpson, 2009). A second technique that is used by Widex is Frequency Transposition (FT). This method is beneficial to those with diagnosed dead regions and profound loss in the high frequencies as well as precipitous loss in the high frequencies. With this method, the hearing loss should only be up to a moderate degree in the low frequencies to avoid cochlear distortion. Another stipulation is that it not be used to extend high frequency bandwidth for mild to moderate losses. Spectral peak detectors are used in this method by which an octave-wide band is filtered around the strongest peak in the source region and then copied, not cut, down one octave. In order to get the target region, the source region is divided by a factor of two. This method is referred to as the basic Audibility Extender (AE). The expanded AE shifts the octave band around the dominant peak by a factor of three. It is important to note that with this method, the high frequency information is being copied, not cut, meaning that all sounds from sources are still processed and outputted. Due to this, there are concerns of masking between the dual sources of information. When Kuk et al. studied the effectiveness of this technique is 2009, he found that after two months, fricative perception improvements of 5-10% increased to about 20% (Kuk et al, 2009). Other researches, Auriemmo et al. saw a 510% improvement in consonant identification at 50 dB HL presentation level in quiet in adults (Auriemmo, 2009). He also found that the production of /s/ and /z/ improved in accuracy by 10% in children. Smith et al. also found a strong acclimatization effect in children, which is a systematic improvement in auditory performance over time (Kuk et al., 2009).

Figure 1: Diagram of Linear Frequency Transposition

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The third and final technique that will be discussed is Nonlinear Frequency Compression (NFC), which Phonak has termed Sound Recover. With this method, the start frequency and compression ratio are both adjustable. Essentially, filters are compressed in order to achieve audibility of high frequencies within this method. It can be used with moderately-severe as well as mild to moderate losses. It should not be used for precipitous losses greater than 1.5kHz. When a group of 17 adults were studied regarding the effectiveness of frequency lowering, almost half showed improvements in monosyllabic words as well as improved the place of articulation and frication. Other studies, conducted by Glista and Wolfe provided evidence that NFC aids in improvements in plural recognition in both adults and children. However, the literature seems to report more general improvements recorded for children than adults.

Figure 2: Nonlinear frequency compression diagram

Figure 3: Diagram of different frequency lowering techniques Experiment Design: Previous reported research results revealed the efficacy/effectiveness of the frequency lowering technology. The following information is a more detailed way of how one researcher, McDermott, analyzed the technical performance of Widexs Audibility Extender (linear frequency transposition) and Phonaks SoundRecover (nonlinear frequency compression). He did this by measuring outputs of hearing using these difference techniques with the frequency-lowering functions enabled and disabled. He used input signals of sinusoids, flute sounds and speech material. After introduction of

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the stimuli, spectral analysis were carried out on the output signals. The study provided evidence that these two frequency lowering techniques are effective at lowering certain high-frequency acoustic signals. However, both techniques did introduce some amount of distortion. Glista empirically checked the effectiveness of frequency lowering by administering four objective tests including, aided speech sound detection, consonant recognition, plural recognition and vowel recognition. Participants completed each test wearing a conventional hearing aid and then a hearing aid with NFC enabled. An adaptive, computer-controlled version of the Ling six-sound test was used to obtain aided detection thresholds for speech sounds. For the consonant recognition task, a list of 10 highfrequency consonants was used. The items of the list were presented in a fixed, wordmedial context. The plural recognition assessed the ability to use fricatives /s/ and /z/ as bound morphemes, meaning that were presented with other sounds and not isolated. The last test, the vowel recognition task, was administered for the purpose of testing whether frequency compression negatively affected vowel perception. The vowel was presented in the middle of two consonants. During testing of all tests, the presentation level was varied to accommodate the different levels of hearing loss. The testing levels ranged from 50 dB SPL to 65 dB SPL. Experiment Result: In 2009, Glista et al. in 2009 studied the effects of nonlinear frequency compression (NFC) on speech recognition and detection. Four objective tests were administered, including aided speech sound detection, consonant recognition, plural recognition and vowel recognition. Participants completed each test wearing a conventional hearing aid and then a hearing aid with NFC technology. They found that NFC has the capability of improving both speech recognition and detection for both adult and child listeners. More specifically, group level results suggest significant improvement of consonant and plural recognition with frequency lowering enabled. They proved this by testing listeners with a hearing aid that had NFC against those with hearing aids that did not (Glista, et al., 2009). A study conducted by Simpson in 2009 also compared speech understanding in children and adults between conventional hearing aids and those with Dynamic Linear Frequency Compression (DLFC). It was found that 13 out of the 28 children tested as well as 6 out of the 18 adults tested had significant improvements regarding speech understanding when using the hearing aids with DLFC. The improvement ranged from 10-20% (Simpson, 2009). Another study that looks at the benefits of frequency lowering is one conducted by Kuk et al. in 2009. In this study, the authors researched the effect of frequency transposition on fricative perception. Each subject went through 20-30 minutes of daily training for 1 month. After 2 months of training, the authors found fricative perception improvement of 5-10% increased to approximately 20%. The authors did note no significant degradation or improvement between frequency lowering and convention hearing aids in noise (Kuk, 2009).

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Simpson, 2009

Tradeoffs: Within frequency lowering, there are two main signal processing tradeoffs. The patient's audible bandwidth is improved by including high-frequency information. This additional information many distort the overall signal due to compression of the sound (high and low frequency information) into the lower frequency range. In addition to that, transposing high frequency information into lower frequency regions also has tradeoffs. The masking and perceptual segregation of mixed signals, and lowering of the unwanted high frequency background noise, can also decrease the signal-to-noise ratio (SNR). This makes speech perception more challenging and may result in distortion if there is a high frequency dead region. Saboteur: In any of the above methods for frequency lowering, there is improved detection of high frequency sounds. However, the speech is not always processed and understood optimally for each individual. Due to the needed adaptation process and individual variability, the outcome and true benefit from frequency lowering is variable. When the spectral information is complex, it becomes increasingly difficult for the system to change the identity of the individual speech sounds, and this is in fact not possible with the current digital signal processers without creating distortion. There is more distortion introduced when the signal is more complex and that distorted frequency information makes speech understanding very challenging (Ross, 2009). As a competing manufacturer, I would set up tests that are designed to examine the speech perception in

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situations with complex multiple talkers and situations with background noise that is not always speech. To examine speech perception, frequency lowering methods would be tested similar to the three studies that were mentioned above. The hearing aids would need to be programmed to control for all other variables, and the starting frequency below 1.5 kHz and used for listeners with precipitous losses. These are variables that will prove the nonlinear frequency compression method to be unsuccessful. If I was competing with Widex's Frequency Transposition, I would also design a test that controls for all other hearing aid variables and use with listeners with more than moderate low frequency hearing loss. These, along with attempting to extend the high frequency bandwidth to mild or moderate losses, all prove to be confounding variables in successful frequency lowering. Judgment: As a clinician, before going through this exercise, I thought that frequency lowering was a concept that can greatly benefit the patient. Now knowing that there are several different confounding variables that are specific to different manufacturers, makes the decision of whether it will truly benefit the patient less clear. As a whole, frequency lowering is a wonderful concept that allows the hearing aid user to take full advantage of their range of audibility, as long as the individual differences and adaptation periods are taken into consideration. References: Glista D, Scollie S, Bagatto M, Seewald R, Parsa V, Johnson A. Evaluation of nonlinear frequency compression: clinical outcomes. Int J Audiol. 2009;48(9):632-644. Kuk, F., Keenan, D., Auriemmo, J. & Korhonen, P. (2009). Re-evaluating the efficacy of frequency transposition, ASHA Leaer, 14(1), 14-17. Simpson, A. (2009). Frequency-lowering devices for managing high-frequency hearing loss: A review, Trend Amplification. 13, 87-106. Serman, M., Hannemann, R., Kornagel, U. (2012). White Paper: micon Frequency Compression. Siemens Ross, M. (2009). Frequency-lowering hearing aids: Increasing the audibility of highfrequency speech sounds. Hearing Loss, March/April,