Recent efforts have focused on developing auditory assessments that are accessible to a wider range of researchers and clinicians without the need for specialized auditory equipment or expertise. Different threshold estimation methods have been developed in an effort to facilitate more efficient, automated measurements for this purpose. The current work tested whether a commonly used, simple approach to measuring performance on a spatial release from speech-on-speech masking task was equivalent to a procedure that estimates performance from individual psychometric functions. In addition,this work aimed to compare threshold estimates across a computer-based implementation of this task in MATLAB and a tablet-based implementation using the Portable Automated Rapid Testing (PART) app. Spatial release from speech-on-speech masking was assessed using the Coordinate Response Measure (CRM) speech corpus with a progressive tracking procedure that decreased the target-to-masker ratio (TMR) from + 10 to −8 dB in 2-dB steps with each TMR condition repeated twice. Analysis was completed on a dataset consisting of 93 participants who completed testing in MATLAB and a dataset of 44 participants who completed testing in PART. Participants varied in age and hearing sensitivity. Results have implications for the use of portable, automated methods for assessing spatial release from speech-on-speech masking.

Previous research has demonstrated that remote testing of suprathreshold auditory function using distributed technologies can produce results that closely match those obtained in laboratory settings with specialized, calibrated equipment. This work has facilitated the validation of various behavioral measures in remote settings that provide valuable insights into auditory function. In the current study, we sought to address whether a broad battery of auditory assessments could explain variance in self-report of hearing handicap. To address this, we used a portable psychophysics assessment tool along with an online recruitment tool (Prolific) to collect auditory task data from participants with (n = 84) and without (n = 108) self-reported hearing difficulty. Results indicate several measures of auditory processing differentiate participants with and without self-reported hearing difficulty. In addition, we report the factor structure of the test battery to clarify the underlying constructs and the extent to which they individually or jointly inform hearing function. Relationships between measures of auditory processing were found to be largely consistent with a hypothesized construct model that guided task selection. Overall, this study advances our understanding of the relationship between auditory and cognitive processing in those with and without subjective hearing difficulty. More broadly, these results indicate promise that these measures can be used in larger scale research studies in remote settings and have potential to contribute to telehealth approaches to better address people's hearing needs.

Threshold estimation procedures are widely used to measure the stimulus level corresponding to a specified probability of response. The weighted up-and-down procedure, familiar to many due to its use in standard pure-tone audiometry, allows the experimenter to target any probability of response by using different ascending and descending step sizes. Unfortunately, thresholds have a signed mean error that made using weighted staircases inadvisable. The current study evaluated a correction to eliminate the error. Monte Carlo simulations of weighted staircases were used to test the effectiveness of the proposed correction for yes-no and forced-choice tasks with Gaussian and log-Weibull psychometric functions. Results showed that the proposed correction was effective over a wide range of step size magnitudes and ratios with a symmetric psychometric function and less effective when there was asymmetry due to the shape of the function or a high guess or lapse rate. The proposed correction facilitates the use of weighted staircases to target an arbitrary probability of response.

A surprising number of citations of studies on psychophysical methods come from journals in which the topics do not include psychophysics. Powerful tools have been developed by statisticians to support experimental methods originally borrowed from psychophysics, some of which predate the simplistic and misleading analyses that are commonly cited. This Letter adapts selected results from the mathematical foundations of transformed staircases. Two key results are presented, a more accurate definition of the targeted probability of response and a method to calculate the distribution of signal levels presented-sequentially and asymptotically-that will support advancements in data collection, analysis, and interpretation.

Purpose: Regulatory changes in the United States introduced over-the-counter (OTC) hearing aids with the goal of increasing the accessibility and affordability of hearing healthcare. It is critical to understand the values inherent to hearing healthcare systems to evaluate their effectiveness in serving people with hearing difficulty. In this study, we evaluated the relative importance of values across service delivery models, and the extent to which the introduction of OTC hearing aids represents a values shift relative to traditional audiology. Method: We performed a qualitative content analysis of two document categories: critique documents that motivated the creation of OTC hearing aids, and regulatory documents that defined OTC hearing aids. Team members coded portions of text for the values they expressed. In total, 29,235 words were coded across 72 pages in four documents. Rank-order analyses were performed to determine the prioritization of values within each category of documents and subsequently compare values between OTC and traditional audiology documents analyzed in a previous study. Results: Critique and regulatory documents both prioritized values related to reducing barriers to hearing aid access and use but the lack of a significant correlation in the rank order of values in these documents was evidence of inconsistency between the motivation and implementation of OTC hearing aids. Differences in the rank order of values in the OTC documents compared to traditional audiology were consistent with a values shift. Conclusions: The introduction of OTC as a solution to low hearing aid use represents a values shift, challenging the values of traditional audiology. This research demonstrates a need to establish the values of hearing healthcare service delivery through a consensus of stakeholders, including individuals from diverse backgrounds underserved by the traditional model.

Previous research has demonstrated that remote testing of suprathreshold auditory function using distributed technologies can produce results that closely match those obtained in laboratory settings with a specialized, calibrated equipment. This work has facilitated internet-based recruitment of participants and the validation of various behavioral measures that provide valuable insights into auditory function. These measures include aspects of auditory processing, self-reported hearing difficulties, and cognition. In this study, we used the portable psychophysics assessment tool (PART) along with online participant recruitment to test a wide variety of audition-relevant measures in those with (n = 92) and without (n = 100) self-reported hearing loss. We assessed each measure’s ability to discriminate between these two groups, as well as their reliability and multi-variate relationships. We found that several measures of auditory processing effectively differentiated between the groups. All previously tested measures showed similar test–retest reliabilities with this online approach. Additionally, multi-variate relationships, including cognition and self-reported hearing, were strikingly consistent across groups. In sum, this work further validates remote testing as a reliable general methodology.

We previously introduced an adaptive psychophysical method called the adaptive scan (AS) that is readily available in the digital app PART. AS presents multiple progressive tracks (e.g., “scans”) each of which comprises a range of stimulus values whose positioning adapts based on a listener´s performance. Each scan is intended to contain trials above and below a listener´s detection or discrimination threshold for an auditory cue, which is anticipated to increase familiarity with the tested cues. Previously, AS was validated against other known adaptive psychophysical methods (e.g., up-down staircases) and the method of constant stimulus using the QUEST algorithm. QUEST allowed for targeting the same point in the psychometric function (e.g., 80% threshold) in all methods tested. However, the QUEST procedure is parametric, requires many trials, and is not easily applied to the diversity of psychophysical tests that AS can be useful for. Here, we examine a variety of alternative approaches to estimate threshold from the AS procedure. This work adds to the usability of AS in particular and psychophysical testing in general.

Objectives: Previous research documented the values of audiology through a qualitative content analysis of documents representing traditional, best-practice hearing health care. The primary objective of this study was to validate the existing list of audiology values. Through a nationwide survey, this study aimed to elicit the values of practicing audiologists, with a specific focus on the prescription and dispensing of amplification devices, to ensure a comprehensive understanding of their priorities. Additionally, this study sought to identify any values missing from the original list and determine the rank order importance of these values, comparing this to the prioritization of values found in best-practice audiology documents. This comparison aimed to assess the alignment of recommended guidelines and real-world practices in hearing health care. Design: An online survey was distributed to audiologists to elicit the prioritization of values from hearing health care providers. Participants were tasked with sorting and ranking 18 items, each representing a specific value in hearing health care, based on importance. Respondents were encouraged to suggest and rank the importance of additional values not included in the list. Audiologists were recruited from professional association mailing lists and direct contact. Respondent demographics were representative of U.S. audiologists. Qualitative content analysis was used to interpret values suggested by audiologists. Kendall's rank distance test was used to compare values prioritization between audiologists and best-practice audiology documents. Results: After filtering out incomplete or disqualifying responses, data from 289 audiologists across 46 states were analyzed. Additional values suggested by respondents aligned with existing values from best-practice documents; thus, no new values were added as a result of this study. A ranked list of values based on mean order of importance was elicited from U.S.-based audiologists. There was substantial agreement between survey results and the rank order of values found in best-practice audiology documents. A demographic subgroup analysis revealed a broad agreement among audiologists in the rank order of values. Conclusions: This study validated a comprehensive list of values in audiology and identified the rank order of values among a nationally representative sample of audiologists. The findings provide a foundation for future investigations into how these values influence decision-making processes for individuals with hearing difficulty. Addressing values conflicts as potential barriers to hearing health care usage can lead to solutions aligned with values of specific populations, ultimately improving the adoption and effectiveness of hearing health care interventions. Supplemental Material: https://doi.org/10.23641/asha.27478149

A major barrier to the clinical application of psychophysical testing of central auditory processes is the time required to obtain precise estimates of different listening abilities. In this study, we validate a novel adaptive scan (AS) method of threshold estimation that is designed to adapt on a range of values around threshold rather than on a single threshold value. This method has the advantage of providing the listener with greater familiarity with the stimulus characteristics near threshold while maintaining precise measurement and increasing time-efficiency. Additionally, we explore the time-efficiency of AS through comparison with two more conventional adaptive algorithms and the method of constant stimuli in two common psychophysical tasks: the detection of a gap in noise and the detection of a tone in noise. Seventy undergraduates without hearing complaints were tested using all four methods. The AS method provided similar threshold estimates with similar precision to those from the other adaptive methods and, thus, it is a valid adaptive method of psychophysical testing. We also provide an analysis of the AS method based on precision metrics to propose a shortened version of the algorithm that maximizes the time/precision tradeoff and can achieve similar thresholds to the adaptive methods tested in the validation. This work lays the foundation for using AS across a wide variety of psychophysical assessments and experimental situations where different levels of precision and/or time-efficiency may be required.

Tone-detection thresholds are the primary index of hearing. Although standard audiometry nominally estimates the stimulus level corresponding to 50% detection, thresholds are biased upward to an average of 98.1% at 500 Hz [Marshall, L. & Jesteadt, W. J Speech Hear Res 29, 82–91. (1986)]. This has been explained by the large difference in the probability of detection between stimulus levels near threshold. However, bias is greater than predicted for measured psychometric functions and does not change proportionally with step size. In standard audiometry, the stopping rule is defined with flexibility for clinical judgement. Our hypothesis is that upward bias is caused by stopping at the first opportunity, because it makes specific ordered combinations of hits and misses impossible, like hit-hit-miss. Monte Carlo simulations were used to compare audiometric thresholds obtained using different stopping rules. Thresholds obtained when stopping at the first opportunity had greater upward bias compared to a fixed-trial stopping rule independent of the total number of trials presented, as predicted. When a baseline test is biased upward by stopping at the first opportunity, a follow-up test may inadvertently miss a significant change in hearing by continuing to present stimuli after the first opportunity to stop. [Work supported by R01DC015051.]

Purpose: Untreated hearing loss is a significant public health issue affecting the quality of life of millions of Americans. Barriers to treatment invite novel and innovation solutions, but as these solutions create new treatment delivery models, they also may—purposefully or accidentally—challenge the values of the field. Method: Value-sensitive design methodology is used in this study to identify the values in current hearing health care service delivery. We performed qualitative content analysis of questionnaires, clinical practice guidelines, and professional ethics documents that represent the intended and enacted values in audiology. Results: The result is a comprehensive list of values that can be used as a structured codebook for systematic textual analysis of materials representing current best practices in the provision of hearing health care services. A secondary result is an analysis of the relative importance of values in audiology, inferred from the frequency of references to each value. Conclusions: Subjective benefit, professional duties, and self-efficacy were the core values identified in the current provision of audiologic care, and these values should be central to considerations for new hearing health care models and technologies.

Acoustics research involving human participants typically takes place in specialized laboratory settings. Listening studies, for example, may present controlled sounds using calibrated transducers in sound-attenuating or anechoic chambers. In contrast, remote testing takes place outside of the laboratory in everyday settings (e.g., participants' homes). Remote testing could provide greater access to participants, larger sample sizes, and opportunities to characterize performance in typical listening environments at the cost of reduced control of environmental conditions, less precise calibration, and inconsistency in attentional state and/or response behaviors from relatively smaller sample sizes and unintuitive experimental tasks. The Acoustical Society of America Technical Committee on Psychological and Physiological Acoustics launched the Task Force on Remote Testing (https://tcppasa.org/remotetesting/) in May 2020 with goals of surveying approaches and platforms available to support remote testing and identifying challenges and considerations for prospective investigators. The results of this task force survey were made available online in the form of a set of Wiki pages and summarized in this report. This report outlines the state-of-the-art of remote testing in auditory-related research as of August 2021, which is based on the Wiki and a literature search of papers published in this area since 2020, and provides three case studies to demonstrate feasibility during practice.

The purpose of this manuscript is to provide pharmacists with education on hearing loss that colleagues in audiology believe is most critical for pharmacists. As well as highlighting insightful interventions pharmacists can make in collaboration with hearing professionals, such as audiologists, otolaryngologists, and otologists, to improve patient care. This project was initiated by professional students at the University of Maryland in both Baltimore and College Park campuses, after completing the interprofessional elective course IPE Care in Geriatrics. Upon completion of the course, the authors performed an extensive literature search and reviewed publications pertaining to pharmacy, audiology, and their integration.Hearing loss can have a significant impact on a patient's quality of life. Older people are at an increased risk for experiencing hearing impairment, but often do not seek help from health care providers. Collaboration between audiologists, otolaryngologists, and pharmacists has the potential to improve patients' access to hearing health and break barriers for patients. Important interventions that pharmacists can make to better serve their patients with hearing loss include screening, enhancing communication, and hearing aid assistance. This article also provides guidance on identifying patients who would be candidates for over-the-counter hearing aids and patients who should be referred to a hearing professional. This skill will become increasingly relevant with the emergence of over-the-counter hearing aids.

Traditional methods used to assess the auditory processing capabilities of individuals have limited clinical applications as they are time consuming and require specialized hardware. Portable Automated Rapid Testing (PART) is a free application that allows various clinical assessments to be conducted in an automated and rapid fashion using commercially available consumer headphones. Use of this platform in an uncontrolled listening environment has been validated in young listeners with normal hearing, yielding thresholds similar to those reported in laboratory studies. Here, we report auditory processing capabilities measured using PART in a large cohort of older listeners with varying hearing capabilities. Psychoacoustic thresholds for gap detection, spectrotemporal modulation detection, dichotic and diotic frequency modulation detection, and spatial release from masking were obtained from 70 older listeners (age range: 40—75 years; 3-frequency PTA: 8.33—48.33 dB HL). Initial analyses revealed that the thresholds obtained using PART were similar to thresholds obtained in a laboratory environment. Results demonstrate that PART can be used with older listeners with minimal instruction and validate the use of a consumer platform and rapid techniques for the assessment of auditory processing capabilities in older adults with a range of hearing ability.

Staircase procedures are commonly used to identify the stimulus level corresponding to a specific probability of response. The primary benefit of staircase procedures is that they require only that the probability of response changes monotonically with the stimulus level. The probability of response targeted by the procedure is typically estimated from the mean of reversals. However, the mean of reversals can be asymptotically biased away from the targeted probability. Existing methods to address the bias add assumptions about task performance, thereby limiting their use to well understood tasks and listener groups. We evaluated the hypothesis that the bias could be mitigated without adding assumptions by accounting for the effect of invariant procedural parameters on the estimate of the target probability. The approach was successful for staircases with different ascending and descending steps, for which the bias was found to depend on step size only. For other staircases, predicting bias required adding assumptions comparable to existing solutions. Results suggest that the bias is caused by the factthat reversals are influenced by parameters that do not affect the target point. A method is proposed to accurately estimate an arbitrary probability of response without adding assumptions about the task or listeners. [R01DC015051.]

Traditionally, real-time generation of spectro-temporally modulated noise has been performed on a linear amplitude scale, partially due to computational constraints. Experiments often require modulation that is sinusoidal on a logarithmic amplitude scale as a result of the many perceptual and physiological measures which scale linearly with exponential changes in the signal magnitude. A method is presented for computing exponential spectro-temporal modulation, showing that it can be expressed analytically as a sum over linearly offset sidebands with component amplitudes equal to the values of the modified Bessel function of the first kind. This approach greatly improves the efficiency and precision of stimulus generation over current methods, facilitating real-time generation for a broad range of carrier and envelope signals.

Use of the audiogram as the gold standard index of hearing ability amplifies the consequences of error in threshold measurement. A Markov chain model of the audiometric procedure revealed a three-step pattern in the stimuli presented each trial. Monte Carlo simulations were used to generate threshold estimates for a simple listener model. Thresholds sorted by trial had a mean bias consistent with model predictions. An alternate scoring method is proposed that uses equal sampling of Markov states. The resulting threshold targets a specific probability of detection and has no systematic bias as a function of trial.

Frequency modulation (FM) detection at low modulation frequencies is commonly used as an index of temporal fine-structure processing. The present study evaluated the rate of improvement in monaural and dichotic FM across a range of test parameters. In experiment I, dichotic and monaural FM detection was measured as a function of duration and modulator starting phase. Dichotic FM thresholds were lower than monaural FM thresholds and the modulator starting phase had no effect on detection. Experiment II measured monaural FM detection for signals that differed in modulation rate and duration such that the improvement with duration in seconds (carrier) or cycles (modulator) was compared. Monaural FM detection improved monotonically with the number of modulation cycles, suggesting that the modulator is extracted prior to detection. Experiment III measured dichotic FM detection for shorter signal durations to test the hypothesis that dichotic FM relies primarily on the signal onset. The rate of improvement decreased as duration increased, which is consistent with the use of primarily onset cues for the detection of dichotic FM. These results establish that improvement with duration occurs as a function of the modulation cycles at a rate consistent with the independent-samples model for monaural FM, but later cycles contribute less to detection in dichotic FM.

Changes in audiometric thresholds are used to detect auditory insult resulting from exposure to hazardous noise, blasts, and ototoxicity. Stimuli presented during audiometry reflect a stochastic process driven by listener responses, and thus a threshold can be reported after a different number of presentations, e.g., two hits and zero, one, or two misses. We interpret thresholds as equivalent despite large differences in the proportion of hits observed. To test for systematic bias in thresholds obtained after a different number of presentations, a continuous distribution of audiometric threshold as a function of stimulus level was numerically approximated for a fixed listener model tested using 2 and 5 dB ascending steps. Results were sorted by the number of presentations at threshold and summary statistics were calculated directly from the proportion of Monte Carlo simulations reporting each stimulus level as threshold. Thresholds differed systematically as a function of the number of times the threshold stimulus level was presented, consistent with a model combining the probability of meeting the stopping criteria with the asymptotic distribution of ascending trials. The implication is that recording the number of presentations at threshold on the audiogram will improve our ability to detect changes in hearing. [R01DC015051.]