Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO

Skepticism Lab How Low Can You Go: A Tale of One Frequency Lowering Technique Alyson Harmon & Casey Adkins Purdue University SLHS 605

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Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO

As graduate clinicians, we are constantly faced with challenging cases of possibly the most common configuration of hearing loss: high frequency hearing loss. Equally as frequent, we are inundated with a constant flow of information regarding new and changing technologies that claim to address this plaguing problem of inaccessibility to high frequency information. These new technologies are referred to as Frequency Lowering technology. Furthermore, in what seems to be an effort to fuel the flame of our frustration, each hearing aid manufacturer uses different strategies, formulae, and algorithms to achieve their claims of superior frequency lowering. The objective of this skepticism lab is to evaluate one manufacturers frequency lowering technique for its functional efficacy both in terms of processing claims and benefits to the hearing aid user. Phonaks SoundRecover is the focus of this investigation and scrutiny. Technical Description The general technical name for this specific frequency lowering technology is Nonlinear Frequency Compression. Phonak has coined the term SoundRecover in referring to their proprietary processing algorithms and formulae. The SoundRecover technology is included in any hearing aid device that is a part of the SPICE or CORE technology platforms, including the Exelia Art, Audeo YES, Naida, and Nios family products. Ideal candidates that may benefit from this technology are those individuals with mild to moderate & moderate to profound hearing losses. Several signal processing techniques are utilized for Nonlinear Frequency Compression to be successful, namely digital filtering. A hearing aid is a series of band pass filters that are being manipulated via the compression process. In its most basic form, a hearing aid is an input output function, and frequency lowering is simply a digital manipulation if the input. That being said, it becomes evident that Nonlinear Frequency Compression is designed to move inaudible frequencies into a users audible frequency range; restoring audibility for high frequency inputs. Filter properties are set and adjusted by the audiologists so that individual hearing thresholds are considered. These properties include the compression ratio and cut off frequency. The fitting process begins with the audiologist setting the adjustable start frequency and compression ratio based upon the users individual hearing thresholds. By doing so, the source region, or the frequency range that is subject to lowering, is also set. Once an input signals spectral properties exceed the start frequency, that particular input is compressed into the target region, which is then made audible to the user. Figure 1.1 This figure demonstrates the nonlinear frequency compression process as described by Dr. Joshua Alexander in a 2012 ISHA presentation. The shaded purple region represents the combination of the original signal and the compressed high frequencies.

Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO

Figure 1.2 This figure from Alexanders 2012 ISHA presentation illustrates the effects of varying start frequencies and compression ratios.

There are several tradeoffs that are associated with enabling the SoundRecover feature. First and foremost, it should be noted that Phonaks proprietary software prescribes a default compression ratio and start frequency for each user, which according to research literature, may in fact not be ideal (Alexander, 2012). The activation of this particular frequency lowering technology also comes with an increase in processing time and power consumption due to the fact that the SoundRecover is always active if the hearing aid is on. User Benefit Suggestions One very important factor to consider when evaluating hearing aid technologies such as Phonaks SoundRecover is user efficacy, or how useful this feature will be in a wearers everyday life. Nonlinear Frequency Compression works to provide listeners with audibility to the full spectrum of sounds, despite their hearing loss. This leads to improvements in speech understanding, specifically in the perception of fricatives and affricates in both children and adults (Alexander, 2012; Bonhert et al., 2010). This access to high frequency sounds also works to improve the development of speech and language in children. Apart from speech, SoundRecover also improves awareness of the sound environment and listening pleasure, such as in the clarity of music (Alexander, 2012). Frequency lowering techniques have been around for some time. In fact, experiments in frequency lowering are dated back to the 1960s! However, it has only recently returned to being a hot topic of interest. Aside from the past experiments in frequency lowing, the only previous attempt to provide audibility to high frequencies was to increase amplification. However, there also exists a natural mechanism that can inadvertently provide frequency-lowering capabilities. Dead regions are a natural form of frequency lowering in that the degradation of hearing sensory cells can result in the upward spread of excitation. Specifically, if an individual had a degraded basal portion of the basilar membrane (loss of the sensory cell function for high frequencies), than high frequency input that would normally be encoded on said basal regions would actually be transposed to more apical regions (hence frequency lowering!). Although this is a

Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO

natural form of frequency lowering, it is uncontrolled and can result in high levels of distortion The cost-benefit ratio for a hearing aid user is very important to analyze, because frequency lowering essentially changes the signal for better or worse. The questions of interest that ought to be addressed is, How often will the user benefit? SoundRecover is constantly active, not adaptive. This suggests that once the audiologist activates the technology in the hearing aid, it remains active as long as the hearing aid is turned on, not solely when high frequency features are present. It can provide benefit when listening to speech, listening to music, and any time there is high frequency input beyond the start frequency. However, as is with any feature that alters the fidelity of the original signal, there are several tradeoffs of enabling the feature. If parameters are incorrectly set, speech intelligibility may be poorer than if the user had no amplification whatsoever. Users may experience some undesirable alteration of pitch and sound quality. Also, the utilization of SoundRecover requires a mild acclimization period to receive full benefit, meaning users may need some time to get used to the new listening quality (Nyffeler, 2008). Lastly, they may experience a decrease in the accurate perception of vowels and other consonants due to distortion. Experimental Design In evaluating SoundRecover, it is important to know exactly how the feature works through careful experimentation and data collection/analysis. In this case, some of the work has already been completed through the use of the SoundRecover Fitting Assistant, developed by Joshua Alexander, Ph.D., CCC-A at Purdue University. This tool can be used to optimize the adjustable parameters in order to maximize the use of the audible bandwidth based on the following criterion: audible output bandwidth, audible input bandwidth, start frequency, and compression ratio. The SoundRecover Fitting Assistant works by comparing up to three different parameter settings and provides a visual representation of how the output of the hearing aid will vary accordingly based on a users maximum audible output frequency. It can be used in accordance with the Verifit system to plot the hearing aids output using different inputs settings. The Verifit system is a tool used to verify that hearing aid settings are set to optimize benefit for a particular hearing loss based on prescriptive targets that are recommended according to evidencebased fitting rationales. Technical and Efficacy Checks In order to demonstrate the effectiveness of Nonlinear Frequency Compression, Figure 1.3 displays multiple SoundRecover settings. The green tracing represents SoundRecover deactivated, in which you can see that the high frequency maximum audible output capable of being produced by the hearing aid is inaudible based on the users hearing thresholds, represented by the red circles and their connecting lines. In comparison, the pink tracing represents SoundRecover activated, in which you can see that the maximum audible output is now audible to the user.

Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO

Figure 1.3 This figure from Alexanders 2012 ISHA presentation illustrates hearing aid output with SoundRecover both on (pink) & off (green)

Experimental Results There are numerous studies that evaluate the performance of this Nonlinear Frequency Lowering technology. Dr. Joshua Alexanders 2012 ISHA presentation, from which the previous figures have been obtained, also included the results of an experiment which affirmed the improvement in fricative/affricate identification using Nonlinear Frequency Compression for a variety of hearing losses. He also found that in cases where the user has a very restricted audibility bandwidth, it is better to tradeoff an increase in compression ratio for a high start frequency (Alexander, 2012). The effectiveness of Nonlinear Frequency Compression in improving high frequency speech detection and recognition ability for both adult and child listeners has also been found in a study conducted by Bohnert, Nyffeler, & Keilmann. Specifically, they saw a significant improvement of consonant and plural recognition (Bohnert et al., 2010). A separate paper, which Nyffeler authored alone, demonstrated the improved perception of high frequency speech using Nonlinear Frequency Compression. He established that the use of such technology provided a significant, measurable advantage for speech intelligibility in both a quiet and noisy environment as compared to three other competitor products (Nyffeler, 2008). Lastly, Wolfe et al. were able to illustrate positive long-term effects using nonlinear frequency compression in children with moderate hearing loss (2011). They discovered that in some cases, improvement with Nonlinear Frequency Compression enabled increased with a longer period of acclimatization to the technology. Saboteur In research and its associated explorative literature, the results are often limited to the conditions and methods of the specific experiment and its environment. The logic then follows that hearing aid features such as SoundRecover may have their limitations

Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO and are merely presented by the manufacturers in their best light. Case in point, for a patient to maximize their benefit from using Phonaks SoundRecover technology, it is imperative that the feature parameters be appropriately set based on the individuals hearing loss. For example, setting too low of start frequency may create a sound quality, which can be detrimental for identification of phonemes that rely heavily on formant frequency, especially vowels (Alexander, 2012). In general, there is a large degree of variability among users and their benefit, so each parameter must be optimized individually, as opposed to relying on default settings, otherwise the feature may have negative effects. The following two conditions are examples of SoundRecover parameter settings, illustrated using Dr. Alexanders SoundRecover Fitting Assistant, which may result in inadequate frequency compression of the signal: . 1. Start Frequency set too high Based on a maximal output frequency of 3100 Hz, if you set the start frequency to 2.3 kHz, and the compression ratio to 2.3, then your maximum audible input will be 4970 Hz. This results in a loss of high frequency information.

2. Start frequency set too low Based on a maximal output frequency of 3100 Hz, if you set the start frequency to 1.7, kHz and the compression ratio to 2.1, then your maximum audible input will be 6000 Hz. This results in an output that does not optimize the maximum audible bandwidth. The user isnt receiving the amount of frequency information that they need and that the hearing aid capable of producing. Judgment Phonak does a very good job of advertising and visualizing the perceived benefits of their SoundRecover technology. They have numerous videos of people now being able to hear the songs of the birds and the /sh/s and /s/s of the wearers female companion thanks to their hearing aids frequency lowering. The idea of being able to provide these users with access to these high frequency sounds, which they were before missing, is very exciting and something that is worth investigating. The skepticism research points out that not every feature is going to work for every patient and their hearing loss. Especially with SoundRecover, whose benefit relies so heavily on the parameters being set appropriately; there is a large amount of individual variability in efficacy. As a clinician, it is important to weigh the pros and the cons, therefore making the best decision for patients and their specific hearing needs. Knowing the high prevalence of fricatives and affricates (high frequency phonemes) in speech, it can be presumed that inaccessibility to these high pitches would result in significantly reduced speech understanding, and in the younger populations, severely degraded speech and language development. Hence, the benefit of a technology such as SoundRecover, is clearly evident if used correctly.

Running Head: SKEPTICISM LAB: HOW LOW CAN YOU GO References Alexander, J. (2012, March). Frequency Lowering in Hearing Aids. Lecture presented at ISHA Convention, Indianapolis, IN. Bohnert, A., Nyffeler, M. & Keilmann, A. (2010). Advantages of non-linear frequency compression algorithm in noise, Eur Arch Otorhinolaryngol;267(7):1045-1053. Nyffeler, M. (2008). The Nada Power hearing instrument family - Field Test Results demonstrate better speech clarity unparalleled in its class. Audiology Online.

Wolfe, J. et al. (2011). Long-term effect of non-linear frequency compression for children with moderate hearing loss. Int J Audiol. 2011 Jun;50(6):396-404.