title: A comparison of gain for adults from generic hearing aid prescriptive methods: impacts on predicted loudness, frequency bandwidth, and speech intelligibility.
abstract: BACKGROUND
  Prescriptive methods have been at the core of modern hearing aid fittings for the past several decades. Every decade or so, there have been revisions to existing methods and/or the emergence of new methods that become widely used. In 2001 Byrne et al provided a comparison of insertion gain for generic prescriptive methods available at that time.
  
  
  OBJECTIVE
  The purpose of this article was to compare National Acoustic Laboratories-Non-linear 1 (NAL-NL1), National Acoustic Laboratories-Non-linear 2 (NAL-NL2), Desired Sensation Level Multistage Input/Output (DSL m[i/o]), and Cambridge Method for Loudness Equalization 2-High-Frequency (CAMEQ2-HF) prescriptive methods for adults on the amplification characteristics of prescribed insertion gain and compression ratio. Following the differences observed in prescribed insertion gain among the four prescriptive methods, analyses of predicted specific loudness, overall loudness, and bandwidth of cochlear excitation and effective audibility as well as speech intelligibility of the international long-term average speech spectrum (ILTASS) at an average conversational input level were completed. These analyses allow for the discussion of similarities and differences among the present-day prescriptive methods.
  
  
  METHODS
  The impact of insertion gain differences among the methods is examined for seven hypothetical hearing loss configurations using models of loudness perception and speech intelligibility.
  
  
  METHODS
  Hearing loss configurations for adults of various types and degrees were selected, five of which represent sensorineural impairment and were used by Byrne et al; the other two hearing losses provide an example of mixed and conductive impairment.
  
  
  METHODS
  Prescribed insertion gain data were calculated in 1/3-octave frequency bands for each of the seven hearing losses from the software application of each prescriptive method over multiple input levels. The insertion gain data along with a diffuse field-to-eardrum transfer function were used to calculate output levels at the eardrums of the hypothetical listeners. Levels of hearing loss and output were then used in the Moore and Glasberg loudness model and the ANSI S3.5-1997 Speech Intelligibility Index model.
  
  
  RESULTS
  NAL-NL2 and DSL m[i/o] provided comparable overall loudness of approximately 8 sones for the five sensorineural hearing losses for a 65 dB SPL ILTASS input. This loudness was notably less than that perceived by a normal-hearing person for the same input signal, 18.6 sones. NAL-NL2 and DSL m[i/o] also provided comparable predicted speech intelligibility in quiet and noise. CAMEQ2-HF provided a greater average loudness, similar to NAL-NL1, with more high-frequency bandwidth but no significant improvement to predicted speech intelligibility.
  
  
  CONCLUSIONS
  Definite variation in prescribed insertion gain was present among the prescriptive methods. These differences when averaged across the hearing losses were, by and large, negligible with regard to predicted speech intelligibility at normal conversational speech levels. With regard to loudness, DSL m[i/o] and NAL-NL2 provided the least overall loudness, followed by CAMEQ2-HF and NAL-NL1 providing the most loudness. CAMEQ2-HF provided the most audibility at high frequencies; even so, the audibility became less effective for improving speech intelligibility as hearing loss severity increased.
authors: James H. Quillen VA Medical Center, Mountain Home, TN, USA. earl.johnson@va.gov
authors: Earl E
authors: EE
authors: Johnson
authors: Harvey
authors: H
authors: Dillon
mesh_terms: D000328:Adult; D001301:Audiometry, Pure-Tone; D004867:Equipment Design; D006310:Hearing Aids; D006319:Hearing Loss, Sensorineural / Q000534:rehabilitation*; D006801:Humans; D008144:Loudness Perception; D010470:Perceptual Masking; D010898:Pitch Perception; D055656:Prescriptions; D012984:Software; D013018:Sound Spectrography; D013063:Speech Discrimination Tests; D013067:Speech Perception