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Language-independent SNR testing in optimal conditions of the OtoCube

Current tests of hearing abilities in audiologic centra generally involve the administration of an audiogram and word discrimination and speech reception tests in quiet. Although such tests are without any doubt useful components of the diagnostic audio logic test battery, they do not provide information about the patient‟s functional hearing. According to a survey by Kochkin & Marke Trak (2000), many patients‟ hearing aids are in the drawer because they have difficulty understanding conversation in background noise. Lately, a number of speech-in-noise tests have become available providing information about these particular communication difficulties.

However, the existing tests have a number of important pitfalls that make them inadequate to fit hearing aids:

(i) they measure how many words are recognized by the patient at a particular Signal-to-Noise Ratio, i.e. with a pre-set intensity of speech and background noise. However, it is not clear where precisely the SNR should be fixed. What SNR is most typical of day-to-day communication contexts? If the selected SNR is too high, the benefit of the hearing aid may be underestimated; if on the other hand, the SNR is too easy, the hearing benefit may be overestimated and the patient will keep complaining that he/she still does not understand speech well in noisy environments;

(ii) a very small number of speech-in-noise tests has been commercialized (HINT, Hearing In Noise Test, Nilsson, Soli, Sullivan 1994) and offers a computerized system by which sentence recognition in different noise conditions can be assessed. However, this test is available only for a very small number of (non-European) languages, including a.o. American English, Latin American Spanish, Canadian French, Cantonese, Mandarin and Taiwanese Mandarin. Moreover, sentence materials have been normed for children 6 years of age and older only for American English, Canadian French and Cantonese.

According to Ethnologue (5th edition, 2005) there are about 6,912 living languages and 39,491 dialects in the world. It is obvious that the current commercially available speech-in-noise test has important limitations, as speakers of other languages or dialects than the ones listed under (ii) cannot be adequately tested. This is especially striking for Europe, with a population of 499 million inhabitants and a large number of official linguistic communities (23 official languages and 138 linguistic minorities according to Euromosaic studies I and II) of which none are represented in the HINT. Another representative case is India, a country much in need of adequate hearing assessment tools, but with a number of languages and dialects as high as 1652 of which 2 are respectively the 4th and 5th largest languages in the world (Bengali 189 million speakers, Hindi 182 million speakers).

The SNR test to be developed within the proposed project therefore aims at being innovative in four ways:

1) by being language independent;

2) by testing the subject in different noise conditions representative of day-to-day communication; and

3) by supporting testing of younger children with any native language;

4) by testing CI-patients on their perception of speech in noise in optimal testing conditions, i.e. with the test stimuli presented to the CI processor in an acoustically insulated box.

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