Subscribe to RSS
The Effect of Hearing Aids on Sound Localization in Mild Unilateral Conductive Hearing Loss
Background Binaural hearing is of utmost importance for communicating in noisy surroundings and localizing the direction of sound. Unilateral hearing loss (UHL) affects the quality of life in both childhood and adulthood, speech development, and academic achievements. Sound amplification using air-conducting hearing aids (HAs) is a common option for hearing rehabilitation of UHL. The processing time of digital HAs can significantly delay the acoustic stimulation in 3 to 10 milliseconds, which is far longer than the maximal natural interaural time difference (ITD) of 750 microseconds. This can further impair spatial localization in these patients.
Purpose We sought to assess whether HA effects on ITD and interaural level difference (ILD) impair localization among subjects with unilateral conductive hearing loss (UCHL).
Research Design “Normal”-hearing participants underwent localization testing in different free field settings.
Study Sample Ten volunteers with “normal”-hearing thresholds participated.
Intervention Repeated assessments were compared between “normal” (binaural) hearing, UCHL induced by insertion of an inactivated HA to the ear canal (conductive HL), and amplification with a HA.
Results In UCHL mode, with HA switched-off, localization was significantly impaired compared to “normal” hearing (NH; η2 = 0.151). Localization error was more pronounced when sound was presented from the front and from the side of the occluded ear. When switched-on, amplification with HAs significantly improved localization for all participants compared to UCHL. Better localization with HAs was seen in high frequencies compared to low frequencies (η2 = 0.08, 0.03). Even with HAs, localization did not reach that of NH (η2 = 0.034).
Conclusions Mild UCHL caused localization to deteriorate. HAs significantly improved sound localization, albeit the delay caused by the device processing time. Most of the improvements were seen in high-frequency sounds, representing a beneficial effect of amplification on ILD. Our results have potential clinical value in situations of mild CHL, for instance, otitis media with effusion.
All the authors approved the final article.
Informed consent was obtained for experimentation with human subjects. The privacy rights of human subjects were always observed.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.
The paper was not previously presented at a professional meeting.
Received: 20 December 2021
Accepted: 24 June 2022
Accepted Manuscript online:
01 July 2022
Article published online:
30 December 2022
© 2022. American Academy of Audiology. This article is published by Thieme.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Zurek PM. A predictive model for binaural advantages in speech intelligibility. J Acoust Soc Am 1982; 71 (S1): 87
- 2 Strutt J. Our perception of the direction of a source of sound 1. Nature 1876; 14 (341) 32-33
- 3 Kuhn GF. Model for the interaural time differences in the azimuthal plane. J Acoust Soc Am 1977; 62 (01) 157-167
- 4 Bauer RW, Matuzsa JL, Blackmer RF, Glucksberg S. Noise localization after unilateral attenuation. J Acoust Soc Am 1966; 40 (02) 441-444
- 5 Rothpletz AM, Wightman FL, Kistler DJ. Informational masking and spatial hearing in listeners with and without unilateral hearing loss. J Speech Lang Hear Res 2012; 55 (02) 511-531
- 6 Hutson KA, Durham D, Imig T, Tucci DL. Consequences of unilateral hearing loss: cortical adjustment to unilateral deprivation. Hear Res 2008; 237 (1-2): 19-31
- 7 Cañete OM, Purdy SC, Brown CRS, Neeff M, Thorne PR. Impact of unilateral hearing loss on behavioral and evoked potential measures of auditory function in adults. J Am Acad Audiol 2019; 30 (07) 564-578
- 8 Gravel JS, Wallace IF. Effects of otitis media with effusion on hearing in the first 3 years of life. J Speech Lang Hear Res 2000; 43 (03) 631-644
- 9 Whitton JP, Polley DB. Evaluating the perceptual and pathophysiological consequences of auditory deprivation in early postnatal life: a comparison of basic and clinical studies. J Assoc Res Otolaryngol 2011; 12 (05) 535-547
- 10 Agterberg MJ, Snik AF, Hol MK, Van Wanrooij MM, Van Opstal AJ. Contribution of monaural and binaural cues to sound localization in listeners with acquired unilateral conductive hearing loss: improved directional hearing with a bone-conduction device. Hear Res 2012; 286 (1-2): 9-18
- 11 Chapman DA, Stampfel CC, Bodurtha JN. et al. Impact of co-occurring birth defects on the timing of newborn hearing screening and diagnosis. Am J Audiol 2011; 20 (02) 132-139
- 12 Shargorodsky J, Curhan SG, Curhan GC, Eavey R. Change in prevalence of hearing loss in US adolescents. JAMA 2010; 304 (07) 772-778
- 13 Golub JS, Lin FR, Lustig LR, Lalwani AK. Prevalence of adult unilateral hearing loss and hearing aid use in the United States. Laryngoscope 2018; 128 (07) 1681-1686
- 14 Vannson N, James C, Fraysse B. et al. Quality of life and auditory performance in adults with asymmetric hearing loss. Audiol Neurotol 2015; 20 (Suppl. 01) 38-43
- 15 Borton SA, Mauze E, Lieu JEC. Quality of life in children with unilateral hearing loss: a pilot study. Am J Audiol 2010; 19 (01) 61-72
- 16 Appachi S, Specht JL, Raol N. et al. Auditory outcomes with hearing rehabilitation in children with unilateral hearing loss: a systematic review. Otolaryngol Head Neck Surg 2017; 157 (04) 565-571
- 17 Noble W, Sinclair S, Byrne D. Improvement in aided sound localization with open earmolds: observations in people with high-frequency hearing loss. J Am Acad Audiol 1998; 9 (01) 25-34
- 18 Keidser G, Rohrseitz K, Dillon H. et al. The effect of multi-channel wide dynamic range compression, noise reduction, and the directional microphone on horizontal localization performance in hearing aid wearers. Int J Audiol 2006; 45 (10) 563-579
- 19 Stone MA, Moore BCJ. Tolerable hearing aid delays. III. Effects on speech production and perception of across-frequency variation in delay. Ear Hear 2003; 24 (02) 175-183
- 20 Hartmann WM, Macaulay EJ. Anatomical limits on interaural time differences: an ecological perspective. Front Neurosci 2014; 8: 34
- 21 Van den Bogaert T, Klasen TJ, Moonen M, Van Deun L, Wouters J. Horizontal localization with bilateral hearing aids: without is better than with. J Acoust Soc Am 2006; 119 (01) 515-526
- 22 Noble W, Byrne D, Lepage B. Effects on sound localization of configuration and type of hearing impairment. J Acoust Soc Am 1994; 95 (02) 992-1005
- 23 Fostick L, Fink N. Situational awareness: the effect of stimulus type and hearing protection on sound localization. Sensors (Basel) 2021; 21 (21) 7044
- 24 Kumpik DP, King AJ. A review of the effects of unilateral hearing loss on spatial hearing. Hear Res 2019; 372: 17-28
- 25 Thornton JL, Chevallier KM, Koka K, Lupo JE, Tollin DJ. The conductive hearing loss due to an experimentally induced middle ear effusion alters the interaural level and time difference cues to sound location. J Assoc Res Otolaryngol 2012; 13 (05) 641-654
- 26 Polley DB, Thompson JH, Guo W. Brief hearing loss disrupts binaural integration during two early critical periods of auditory cortex development. Nat Commun 2013; 4: 2547
- 27 Moore DR, Hartley DE, Hogan SC. Effects of otitis media with effusion (OME) on central auditory function. Int J Pediatr Otorhinolaryngol 2003; 67 (Suppl. 01) S63-S67
- 28 Pillsbury HC, Grose JH, Hall III JW. Otitis media with effusion in children. Binaural hearing before and after corrective surgery. Arch Otolaryngol Head Neck Surg 1991; 117 (07) 718-723
- 29 Hall III JW, Grose JH, Pillsbury HC. Long-term effects of chronic otitis media on binaural hearing in children. Arch Otolaryngol Head Neck Surg 1995; 121 (08) 847-852
- 30 Byrne D, Noble W. Optimizing sound localization with hearing AIDS. Trends Amplif 1998; 3 (02) 51-73
- 31 Johnstone PM, Nábĕlek AK, Robertson VS. Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. J Am Acad Audiol 2010; 21 (08) 522-534
- 32 Mondelli MFCG, Santos MMD, Feniman MR. Unilateral hearing loss: benefit of amplification in sound localization, temporal ordering and resolution. CoDAS 2019; 32 (01) e20180202
- 33 Parisa A, Reza NA, Jalal SS, Mohammad K, Homa ZK. Horizontal localization in simulated unilateral hearing loss. J Audiol Otol 2017; 22 (01) 39-44
- 34 Zwislocki J, Feldman RS. Just noticeable dichotic phase difference. J Acoust Soc Am 1956; 28 (01) 152-153
- 35 Woodworth RS, Schlosberg H. Experimental Psychology. New York, NY: Holt, Rinehart and Winston; 1965
- 36 Thavam S, Dietz M. Smallest perceivable interaural time differences. J Acoust Soc Am 2019; 145 (01) 458-468
- 37 Dillon H, Keidser G, Obrien A, Silberstein H. Sound quality comparisons of advanced hearing aids. Hear J 2003; 56 (04) 30
- 38 Brotherton H, Plack CJ, Schaette R, Munro KJ. Time course and frequency specificity of sub-cortical plasticity in adults following acute unilateral deprivation. Hear Res 2016; 341: 210-219
- 39 Irving S, Moore DR. Training sound localization in normal hearing listeners with and without a unilateral ear plug. Hear Res 2011; 280 (1-2): 100-108
- 40 Ruscetta MN, Palmer CV, Durrant JD, Grayhack J, Ryan C. Validity, internal consistency, and test/retest reliability of a localization disabilities and handicaps questionnaire. J Am Acad Audiol 2005; 16 (08) 585-595
- 41 Firszt JB, Reeder RM, Dwyer NY, Burton H, Holden LK. Localization training results in individuals with unilateral severe to profound hearing loss. Hear Res 2015; 319: 48-55
- 42 Kuk F, Keenan DM, Lau C, Crose B, Schumacher J. Evaluation of a localization training program for hearing impaired listeners. Ear Hear 2014; 35 (06) 652-666