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Audiology and Speech Research > Volume 19(3); 2023 > Article


Praveena and Priya: Evaluating the Benefit of Hearing Aid Using Paired Words in
Tamil
Research Paper


Audiol Speech Res 2023;19(3):190-200.

Published online: July 31, 2023

DOI: https://doi.org/10.21848/asr.230089


EVALUATING THE BENEFIT OF HEARING AID USING PAIRED WORDS IN TAMIL




Jayakumar Praveena, Vincent Churchill Soundaraj Priya

Department of Audiology and Speech Language Pathology, SRM Medical College
Hospital and Research Center, SRM Institute of Science and Technology,
Kattankullathur, India

Correspondence: Jayakumar Praveena, MASLP Department of Audiology and Speech
Language Pathology, SRM Medical College Hospital and Research Center, SRM
Institute of Science and Technology, Kattankullathur 603203, India
Tel: +91-741816586 E-mail: praveenaind@gmail.com



Received January 6, 2023       Revised May 30, 2023       Accepted June 5, 2023

Copyright © 2023 Korean Academy of Audiology

This is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.



ABSTRACT


PURPOSE

Subjective measurements, such as speech audiometry, are essential to determine
the perception of speech as it provides insight regarding perceptual abilities.
The present study aimed to develop paired word test stimuli in Tamil and
evaluate their utility for assessing the benefits of a hearing aid.


METHODS

The stimuli were 30 paired words which were paired to rhythm containing almost
all vowels and consonants of the Tamil language differing in one or more
distinctive features, such as place, manner, voicing features of consonants, and
height, duration, and rounding features of vowels. The paired words test was
administered to 60 participants with normal hearing and 60 participants with
hearing impairment. The correct identification scores and their percentage were
computed to notice the benefit provided by their hearing aids.


RESULTS

The overall performance of individuals with normal hearing on the paired
identification was high, suggesting that these paired word test materials could
be used for individuals with hearing impairment to assess hearing aid benefit. A
greater improvement in recognition scores for paired words was obtained after
being fitted with a hearing aid in individuals with hearing impairment. It was
noticed that due to hearing loss, the audibility of perception reduces, yielding
lower scores in paired word identification.


CONCLUSION

When the proper fitting was done, the percentage of identification scores was
increased. Therefore, the present study concludes that speech perception
abilities can be evaluated and quantified using these paired word tests.



Hearing loss, Paired words, Speech perception, Tamil

Go to :



INTRODUCTION

Hearing impairment results in difficulty to interpret speech sounds, reduces the
ability to communicate, causes a delay in the acquisition of language.
Prevalence of sensorineural hearing loss are about 4.5% to 18.3% of in India
(Verma et al., 2021). The most common management suggested for individuals with
sensorineural hearing loss is use if hearing aids. The benefit of hearing aids
has to be assessed post fitting as the primary need of hearing aid is to provide
good speech perception and in-turn better communication (Perez & Edmonds, 2012).
The use of speech audiometry is an important subjective test to assess the
speech perception in individuals using hearing aids. Speech perception tests,
provides information on word recognition abilities by the hearing aid users
which helps to determine the benefit of the hearing aid for the individuals with
hearing loss. The most commonly used speech test materials are monosyllabic
words, spondees, monosyllabic words that are phonemically balanced, and
sentences.
The Tamil language is a classical language that belongs to the family of
Dravidian languages. The Tamil script has five vowels, 18 consonants and six
extra consonants. The five vowels are classified into short and long and two
diphthongs. The 18 consonants are categorized into three categories with six in
each category: hard, soft or nasal and medium. The Tamil language has various
meaningful sound combinations and their identification of the same in the
ongoing speech is crucial for speech recognition and comprehension. For native
Tamil speakers, the Tamil spondees and phonetically balanced words (Samuel,
1976) are widely used for speech audiometry. The words in these lists have
changes in familiarity and certain words in the list have become inappropriate
usage words in the current Tamil linguistic scenario. Thus, a new word list is
required for speech perception test in Tamil. There are minimal pair words
developed in various Indian languages such as Tamil and Hindi (Sahoo &
Nandurkar, 2020; Vijayakumar et al., 2021). The minimal pair words developed in
Tamil is picture based and has been developed for children using cochlear
implant. However, there is no existing paired Tamil word list for adults with
hearing loss. This study will help us to understand the paired word perception.
While using paired words for speech perception assessment in individuals with
hearing loss, their auditory discrimination ability along with the auditory
identification skill can be better understood. As perception of minimally
varying words will require good audibility and also repeating two words in
single presentation will increase their cognitive load. These factors will
support that paired words identification can be more difficult than the
traditional monosyllable word identification.
Performance on paired words test may help the clinician to identify and provide
realistic expectations of auditory performance under unaided and aided
situations. In addition, for speech audiometry evaluations to be valid and
accurate, individuals should be evaluated in their native language (Ramkissoon,
2001). Similarly, audiologists and other researchers also have suggested the
importance of using linguistically appropriate vernacular diagnostic tools.
Several enthusiasts have developed speech audiometry materials in several
languages across the world. Therefore, in this study to address the need
individuals with hearing loss, paired words were developed in Tamil language to
evaluate their effectiveness in an individual with hearing impairment. The study
aimed to develop and standardize paired words material in Tamil. To compare the
paired word identification in individuals with hearing impairment under aided
and unaided conditions in comparison with normal hearing individuals.
Go to :



MATERIALS AND METHODS

The study design was case-control research where individuals with normal hearing
are compared with individuals having a hearing impairment. This study was
approved by the Scientific and Ethics Committee of our Institute. The committee
declared that all processes contributing to this work comply with the ethical
standards and the reference number of ethical clearance is 1295/IEC.


PARTICIPANTS

The study comprised total of 120 native Tamil-speaking participants enrolled
through purposive convenient sampling. They are divided into two groups: group A
contains 60 participants with normal hearing and group B contains 60
participants with hearing loss. In both groups, the participants were in the age
range of 41 to 80 years and were categorized commonly as older adults with the
age range between 41 to 60 years and geriatrics with the age range between 61 to
80 years. Each group had an equal number of older adults (n = 30) and geriatrics
(n = 30). Similarly, the gender ratio for both groups was also equal (male = 30
and female = 30).


INCLUSION CRITERIA FOR INDIVIDUALS WITH NORMAL HEARING AND HEARING IMPAIRMENT

The subjects with the following criteria were included in the study: speakers
with native Tamil language or having good proficiency in Tamil. For individuals
with normal hearing, no complaints of decreased hearing sensitivity, and with
pure tone average ≤ 20 dB hearing level (HL). Individuals with a hearing
impairment must have acquired bilateral symmetrical moderate to severe
sensorineural hearing loss. The audiometric configuration not varying > 20 dB HL
across frequencies. Only binaural hearing aid fitting users were included and
unilateral fitting was excluded.


PROCEDURES

The Tamil language has various meaningful sound combinations of vowels and
consonants and their identification of the same in the ongoing speech is crucial
for speech recognition and comprehension. Therefore, the proposed study used a
paired word list containing almost all vowels and consonants of the Tamil
language to assess the benefit of a hearing aid under unaided and aided
conditions in individuals with hearing impairment.


PHASE 1: DEVELOPMENT OF PAIRED WORDS TEST STIMULUS

STEP 1: SELECTION OF TEST STIMULI

A total of 230 Tamil words that were used in day-to-day communication were taken
from the manual remediation manual for phonological disorders (Indumathy &
Lalitha, 2015). These 230 words Tamil words were subjected to familiarity rating
by 50 native Tamil-speaking adults. Initially, 115 pairs of words were rated as
most familiar and familiar. These words were paired with 50 sets of rhyming
words. All vowels and consonants of the Tamil language were selected. Then, out
of 115 pairs only 50 pairs were selected based on to form paired words and the
acceptable contrasting distinctive features such as place, manner, voicing
features of consonants, and height, duration, and rounding features of vowels.
In the Tamil language constructing a word list with familiarity and having only
one distinctive feature was difficult. Thus, paired words word list was
considered where more than one feature varied. The list contained almost all
vowels except /aʊ/ and consonants of the Tamil language. The targeted vowels and
consonant are positioned such that it occurs in the initial word position of a
pair and then in the medial word position of the following pair. In Tamil
language, few consonants like /ƞ/, /ɲ/, /t/, /ɳ/, /ɻ /, /ɭ /, /r/, and /n/ have
less or no words having these consonants in initial position and even if such
words are found, appropriate contrasting couldn’t be found based on similarity.
Therefore, these consonants were included only in the medial position of the
pair.

STEP 2: FAMILIARITY TESTING OF PAIRED WORDS

The 50 paired words were then subjected to familiarity testing where it was
given to 25 native Tamil speakers of age ranging from 20 to 60 years who were
from different regions across Tamil Nadu. The judges were instructed to rate the
pairs as most familiar, familiar and unfamiliar based on usage of words in
day-to-day context. The final list for the study contained 30 paired words which
were rated as the most familiar and familiar. The final word list is given in
Appendix 1.

STEP 3: FINALIZATION OF PAIRED WORDS

These 30 paired words were given to two linguistic experts for the content
validity and the two experts agreed upon that the given words pairs are
acceptable minimal and paired words in Tamil language. Hence, the final word
list contained monosyllabic, bi-syllabic and one pair of tri-syllabic words
containing almost all vowels and consonants in Tamil.

STEP 4: RECORDING OF PAIRED WORDS

Three native female Tamil speakers were instructed to read the paired words at a
natural articulation rate with normal intonation pattern and with slight short
pause between the pair and a longer pause between each paired words. The talkers
were asked to produce each pair at least three times and the best production of
the pair was used in the final recording. The test stimulus was recorded in a
sound treated studio with an Apple Mac Book Pro equipped with Logic Pro X
software (Apple Inc, Mumbai, India) and a RODE (voice condenser) microphone
which was placed at 10 cm away from the speaker and was stored as a 32-bit wav
file (44.1 kHz). Each recording took place for around 30 minutes as multiple
trials were required. Each of the recorded pair were normalized for equal
amplitude across the stimuli. Later, noise spectrum was eliminated by taking
sample of the ambient noise.
These three audio recordings were played to five audiologists and were asked to
judge the audibility, naturalness and the clarity of pairs. The first female
talker list was the judged to be more natural and clear and thus it was chosen
for administration to the subjects. The audio recorded 30 paired words (list 1)
were used as test stimulus for individuals with normal hearing and with hearing
impairment (unaided testing). Then the same 30 paired words were randomized
using Logic Pro X software to create list 2 and used for individuals with
hearing impairment (aided testing).


PHASE 2: ADMINISTRATION OF BEHAVIORAL TESTING TO THE SUBJECTS WITH NORMAL
HEARING AND SUBJECTS WITH HEARING IMPAIRMENT

Before the testing, all the participants were educated regarding the study and
appropriate written consent was obtained from the participants.
Otoscopic examination and acoustic immittance were conducted for all the
participants included in the study to confirm no middle ear pathology. The pure
tone air conduction threshold was ≤ 20 dB HL for normal hearing individuals at
all octave frequencies (500 Hz, 1,000 Hz and 2,000 Hz & 4,000 Hz). The speech
recognition threshold also correlated with pure tone average (± 12 dB HL) and
their speech identification scores were ≥ 80% in speech audiometry in both ears
(Tamil spondees and phonemically balanced words; Samuel, 1976). Similarly, for
subjects with hearing impairment, the pure tone air conduction threshold ranged
between 41 to 90 dB HL with the audiogram configuration variation ≤ 20 dB HL
across all octave frequencies. Moreover, speech recognition threshold correlated
with pure tone average and the speech identification scores were ≥ 60% in both
ears.


PHASE 3: ADMINISTRATION OF PAIRED WORDS TEST MATERIAL TO THE SUBJECTS WITH
NORMAL HEARING AND SUBJECTS WITH HEARING IMPAIRMENT

The testing was conducted in a sound treated booth with ambient noise level
within ANSI specifications (Acoustical Society of America, 1999), the patients
were seated comfortably one meter apart from the loudspeakers. The recorded test
stimulus was routed from the external laptop to the calibrated audiometer with
ANSI S3.6-1996 (Acoustic Society of America, 1996) standards and therefore to
the participants via loud speaker placed at zero-degree azimuth. The test
stimuli were presented at 60 dB HL for all the participants regardless of degree
of hearing loss and all the participants were instructed to listen carefully and
repeat back the words heard.
Before the testing, real ear measurements were done to make sure that the given
hearing aids have adequate gain, if required re-programming and tuning were done
for individuals with hearing impairment. Test trial was done for all the
participants using five paired words apart from the list to make the subjects
understand the testing procedure. Following the trial, the list 1 paired words
were presented in free field for individuals with normal hearing and with
hearing impairment (unaided). Then the list 2 randomized paired words were
presented to the same individuals with hearing impairment after fitting with
hearing aids bilaterally. The list 2 was used to avoid potential learning and
order effects of the test stimulus.
Voice recorder was used to record the participant’s verbal responses and was
analyzed for number of correct paired words identification. A score of one was
assigned if the participants were able to correctly repeat the paired words and
a score of zero was given if the participant were unable to repeat the pair or
incorrect.


STATISTICAL ANALYSIS

The collected data were analyzed using SPSS software version 22 (International
Business Machine Corporation, New York, NY, USA). All numerical data were
analyzed by calculating mean and standard deviation. Comparison between two
groups and across groups were carried out using independent t test and analysis
of variance (ANOVA). A p value, less than 0.05 was considered as significant
result. For each of the participants of normal hearing and hearing impairment,
correct identification of paired words (n = 30) and the percentage of scores
were analyzed.
Go to :



RESULTS

The study comprised of two group A and B where group A consist of 60
participants with normal hearing and group B consist of 60 participants with
hearing impairment. These two groups were broadly classified based on age (older
adults and geriatrics) and gender (male and female). For participants with
normal hearing, the mean age of older adults and geriatrics are 50.5 and 69.67
years of age respectively. Similarly, for participants with hearing impairment,
the mean age of older adults and geriatrics are 46.6 and 70.4 years of age
respectively. For each group, there were equal number of male (n = 30) and
female participants (n = 30). In addition, the individuals with hearing
impairment were categorized into three groups concerning degree of hearing loss:
moderate (mean pure tone average [PTA] = 47.63 dB HL), moderately severe (mean
PTA = 63.05 dB HL), and severe (mean PTA = 81.02 dB HL).


PAIRED WORDS IDENTIFICATION IN INDIVIDUALS WITH NORMAL HEARING AND HEARING LOSS

The correct identification scores on 30 paired words were obtained in
individuals with normal hearing and hearing loss where a descriptive statistic
was used to quantify the results. The mean score of correct paired words
identification for individuals with normal hearing, hearing loss in unaided and
aided conditions were mean (M) = 25.73, M = 6.6, M = 19.82, respectively. The
overall percentage of correct identification score 86%, 22% and 66% for
individuals with normal hearing, hearing loss in unaided and aided conditions
respectively. Independent t test p value (p < 0.05) indicated statistically
significant difference between unaided and aided conditions. There was
statistically significant difference between normal hearing and individuals with
hearing impairment under aided conditions with a p value indicating (p < 0.05)
(Table 1).

TABLE 1.

Identification of correct paired words in individuals with normal hearing (n =
60) and hearing impairment (n = 60)

Mean SD % of correct identification Normal 25.74 2.63 85.77 Unaided 6.6 4.75
22.00 Aided 19.82 3.86 66.06

SD: standard deviation




PAIRED WORDS IDENTIFICATION ACROSS DEGREE OF HEARING IMPAIRMENT

Descriptive statistics was done to observe the difference in mean correct
identification scores and percentage across degree of hearing loss in both
conditions. ANOVA was done to measure the identification scores of correct
paired words across degree of hearing loss; moderate, moderately severe and
severe under aided and unaided conditions. The overall mean scores were for
individuals with moderate degree, moderately severe and severe were M = 23.05, M
= 20.15, M = 16.25. Their percentage of correct identification scores were
moderate degree = 78.33%, moderately severe = 67.17% and severe = 54.17% under
aided conditions. Moreover, ANOVA (F = 4.831 and p = 0.010) shows a statistical
difference across degree of hearing loss under aided conditions in the
identification of correct pairs (Table 2, 3).

TABLE 2.

Comparison of correct paired words identification across degrees of hearing
impairment under unaided and aided conditions (n = 20)

Degree of HL Fitting condition Mean SD % of correct identification Moderate
Unaided 11.90 3.45 39.67 Aided 23.05 2.42 78.33 Moderately severe Unaided 5.85
1.95 19.50 Aided 20.15 3.05 67.17 Severe Unaided 2.05 1.50 6.83 Aided 16.25 2.59
54.17

HL: hearing loss, SD: standard deviation



TABLE 3.

One way analysis of variance across of degree of hearing impairment under aided
condition (n = 60)

Variables df F p-value Across degree of hearing loss 2 104.629 0.00
Identification under aided condition 1 789.646 0.00 Across degree under aided
condition 2 4.831 0.01




PAIRED WORDS IDENTIFICATION IN NORMAL HEARING AND INDIVIDUALS WITH HEARING
IMPAIRMENT ACROSS AGE

The mean scores for paired words identification across age are depicted in Table
4. Table 4 illustrates that mean values are higher for older adults in
individuals with normal hearing (M = 27.27) as well as in individuals with
hearing impairment (M = 20.30) compared to geriatrics with normal hearing (M =
24.20) and with hearing impairment (M = 13.33). Similarly, the percentage of
correct identification scores for older adults (91%) in individuals with normal
hearing and older adult (68%) in individuals with hearing impairment are on the
higher side compared to geriatrics whose percentage of scores is 81% in normal
hearing and 64% in individuals with hearing impairment.

TABLE 4.

Comparison of older adults and geriatrics in the identification of correct
paired words in normal hearing and individuals with hearing impairment under
aided condition (n = 30)

Normal

--------------------------------------------------------------------------------

Hearing impaired (A)

--------------------------------------------------------------------------------

Mean SD % of correct identification Mean SD % of correct identification Older
adult 27.27 1.01 90.9 20.30 3.65 67.67 Geriatrics 24.20 2.86 80.67 13.33 4.07
64.43

SD: standard deviation




PAIRED WORDS IDENTIFICATION IN NORMAL HEARING AND INDIVIDUALS WITH HEARING
IMPAIRMENT ACROSS GENDER

As shown in Table 5, the mean scores were found to be similar for both male (M =
25.57) and female (M = 25.90) in normal hearing subject also in individuals with
hearing impairment (male = 20.13, female = 19.50) under aided condition, in
paired words identification. Similarly, the percentage of correct identification
also showed minimal difference between male and female (85% and 86%) in normal
hearing individuals and also in individuals with hearing impairment (67% and
65%).

TABLE 5.

Comparison of male and female in the identification of correct paired words in
normal hearing population and individuals with hearing impairment under aided
condition (n = 30)

Normal

--------------------------------------------------------------------------------

Hearing impaired (A)

--------------------------------------------------------------------------------

Mean SD % of correct identification Mean SD % of correct identification Male
25.57 2.64 85.22 20.13 3.87 67.1 Female 25.90 2.66 86.33 19.50 3.9 65.0

SD: standard deviation



Go to :



DISCUSSION

The study aims to develop, standardize a list of 30 paired words in Tamil which
can be used to assess the benefit of hearing aid in individuals with hearing
impairment by comparing the percentage of correct identification scores under
unaided and aided conditions.
At first, the study established the performance in identification of paired
words for individuals with normal hearing where the statistical results showed a
greater performance in them. These results suggested that normal hearing
listeners can understand paired words in quiet environment as long as the pairs
are clear and audible. Therefore, this implies that the same paired words can be
used to investigate contrast perception ability in individuals with hearing
impairment as hearing loss reduces their audibility of speech heard and leads to
distortion (Souza, 2016).
To test the null hypothesis, the identification of paired words was investigated
in individuals with hearing impairment under unaided and aided conditions. A
good improvement in the identification scores were obtained after fitting with
hearing aid suggesting enhanced speech perception with appropriate fitting of
hearing aid as supported by various literature studies. Munro and Lutman(2003)
and Walden et al.(2001) found significant hearing aid benefit in the
identification of consonants under unaided and aided conditions. Similarly,
McRackan et al.(2016) observed substantial improvement in the recognition of
words between unaided and aided conditions. However, Levitt(2001) found that
hearing aid fitting results in improvement of audibility but not in
intelligibility for many hearing aid users with hearing impairment because of
their limited dynamic range which yields limited benefit with hearing aids. The
statistical test checked the overall significance of the data and values (p <
0.05) gave evidence supporting alternate hypothesis concluding that there is
significant difference in the identification of paired words after fitted with
hearing aid.
The performance of paired words recognition between normal hearing and
individuals with hearing impairment after fitted with hearing aid was also
compared. The results showed that even with the presence of hearing aid, the
individuals with hearing impairment performed slightly poorer than normal
hearing individuals suggesting decreased perception ability due to broadened
auditory filter causing difficulty to detect changes in pitch, frequency and
amplitude of speech sounds. The results obtained are consistent with studies
conducted on western population where even after fitting with hearing aid; the
sensorineural subjects have difficulty in perception of speech unlike normal
hearing individuals. Studies by Schultz(1964) and Dubno et al.(1982)
investigated on word recognition scores and found infrequent phonemic confusions
and consonant confusions in sensorineural hearing loss subjects. Therefore, the
obtained statistical results suggest that there is a significant difference in
performance between normal hearing and individuals with hearing impairment under
aided condition thereby accepting alternative hypothesis.
The paired words correct identifications scores across degree of hearing loss;
moderate, moderately severe and severe, across age groups and gender were
compared between individuals with normal hearing and with hearing impairment to
observe for any difference in the speech perception ability.
The statistical result for correct identification of paired words across degree
of hearing indicated greater improvement in the perception of pairs with hearing
aid. The scores were higher for individuals with moderate degree of hearing loss
suggesting lesser the degree of loss greater the improvement. However, within
degree comparison between unaided and aided conditions, the results implied that
the greatest benefit was observed for individuals with severe degree of hearing
loss followed by individuals with moderately severe degree then by individuals
with moderate degree of hearing loss. The reason may be attributed to the
audibility enhancement when fitted with hearing aid. Generally, the perception
of speech itself is difficult in severe and moderately severe degree of hearing
loss due to higher audiometric thresholds but they are least affected by noise
and other factors. Whereas for individuals with moderate degree of hearing loss,
perception of paired words may be distorted due to the perception of external
and internal noise or other factors. This finding was consistent with the study
by Shanks et al.(2002) where they found overall good improvement in speech
recognition between unaided and aided conditions across degree and configuration
of symmetrical sensorineural hearing loss. The authors observed benefit of
hearing aids in subjects with severe degree of hearing loss and decrease in
performance was noticed when presentation level increased from 52 to 74 dB sound
pressure level (SPL) especially for individuals with mild degree of hearing loss
under aided conditions. Boothroyd(1984) also investigated the perception of
speech contrast with different degree of sensorineural hearing loss and had
found higher the degree of loss, lesser the access to perception of contrast.
Similarly, Bilger & Wang(1976) found that pattern of consonant confusion varies
with respect to degree and configuration of sensorineural hearing loss.
Age comparison was also evaluated in subjects with normal hearing and subjects
with hearing impairment where they found that the mean scores were better for
older adults in comparison to geriatrics suggesting speech perception decreases
with advancing age for both individuals with normal and in individuals with
hearing impairment. Generally, auditory and cognitive functions like working
memory capacity, speed of processing and attention abilities decline with
advancing age and may have negative impact on speech recognition whereas age
related hearing loss results in difficulty with speech recognition and may be
poorly compensated by conventional hearing aid. Pittman and Stelmachowicz(2000)
found that ageing affects hearing sensitivity especially at higher frequencies
resulting in loss of phonetic details where discrimination between consonants
becomes difficult. Another study by Dubno et al.(1984), also found that elderly
individuals have difficulty in speech processing despite similar audiograms as
younger adults.
Similarly, in individuals with normal hearing and with hearing impairment, the
paired words identification scores were examined for gender differences. The
average values of raw data for males and females depict small difference across
genders for correct pair identification in both groups. This finding was
supported by a prevalence study observed for age and sex differences in age
related hearing loss (Homans et al., 2017). It was found that older adults are
more prone to age related hearing loss and small significant differences were
obtained between genders. A contrast study found that word recognition scores in
quiet and competing message were observed to be poorer for males compared to
females across all age groups (Wiley et al., 1998).
Subjective measurements such as speech audiometry are essential to determine the
perception of speech as it provides insight regarding the perceptual abilities.
It also plays a major role during the hearing aid fitting, tuning and helps to
predict the aided outcome based on the percentage of correct identification
scores with the use of amplification devices in individuals with hearing
impairment. Therefore, in the present study, paired words test stimuli were
developed, standardized and final test stimuli comprised of totally 30 paired
words containing almost all vowels and consonants of Tamil language differing in
distinctive features such as place, manner, voicing features of consonants and
height, duration, rounding features of vowel. The paired words test was
administered in 60 participants with normal hearing and in 60 participants with
hearing impairment and subjects was asked to repeat back the paired words heard
through loudspeaker placed at zero-degree azimuths. Later, the correct
identification scores and their percentage were computed to notice the benefit
provided by that particular hearing aid.
The overall performance of normal hearing individuals on paired words
identification were high suggesting that these paired words test material can be
used for individuals with hearing impairment to assess hearing aid benefit. A
greater improvement in recognition scores for paired words was obtained after
fitted with hearing aid in individuals with hearing impairment. Despite hearing
aid fitting, the individuals with hearing impairment performed slightly poorer
in comparison to normal hearing individuals. Moreover, individuals with hearing
impairment were evaluated across degree of loss, in which individuals with
moderate degree of hearing impairment yielded higher identification scores
compared to individuals with moderately severe and severe degree of hearing
impairment indicating greater the loss, lesser the perception ability. However,
within each degree comparison between unaided and aided conditions, the greatest
benefit with hearing aid was achieved by individuals with severe degree of
hearing loss as they are least affected by noise and other factors. Demographic
variables such as age and gender were also assessed. Across age, older adults
performed better than geriatrics in both individuals with normal hearing and in
individuals with hearing impairment implying decline in speech processing with
advancing age. Across gender comparison, a small gender difference was observed
in both normal hearing and individuals with hearing impairment concluding both
male and female performs similar. Moreover, identification of first word or a
word in a pair was observed to be better than double correct identification in
paired words in individuals with hearing impairment. This provides evidence that
paired words are more difficult to identify compared to single word
identification. The difficulty in identifying can be attributed to difficulty in
discriminating the acoustically minimally varying words, cognitive loading
required for attending both the words.
Based on the results drawn from the study, we can conclude that the paired words
test was able to provide the correct identification and percentage of scores in
individuals with normal hearing and individuals with hearing impairment across
degree of hearing loss. It was noticed that the audibility and ability to
discriminate between the paired words is poor thus, yielding lower scores in the
paired words identification in individuals with hearing loss. When appropriate
fitting was done, the percentage of identification scores was increased in aided
conditions. Therefore, the present study concludes that speech perception and
discrimination abilities can be evaluated and quantified using these paired
words test.
This test was able to provide a realistic position of an individual with hearing
impairment in perception of speech compared to normal hearing individuals. This
tool can be used in the hearing aid trial and based on the performance of
subjects in pair identification, the audiologist can point out the extent of
benefit, a hearing aid provides for that particular patient. Based on the
scores, tuning becomes plausible and counseling can be done regarding the
different features of hearing aids which can be used to overcome the deficit in
perception ability.
The limitations of this study are only subjects with sensorineural hearing loss
were included and individuals with mixed and medically untreatable conductive
loss subjects were excluded. Similarly, this study was not performed on verbal
children with hearing loss. Distinctive feature analysis was not performed for
the correct identification and only overall identification of contrast was
evaluated.
These paired words material can be used to assess the benefit of hearing aid or
cochlear implant on children with hearing loss. Background noise can be added to
this test material and can be tested with different signal to noise ratios to
observe the performance of individuals with hearing impairment across the degree
of hearing loss as adding of noise represents the realistic setting of the
person with hearing impairment and the processing of speech with noise can be
quantified.
Go to :



NOTES

Ethical Statement

The methodology for this study was approved by the Institutional Ethics
Committee of the SRMIST (Ethics approval number: 1295/IEC/2017).

Declaration of Conflicting Interests

The authors declare that they have no conflict of interest.

Funding

N/A

Author Contributions

Conceptualization: Jayakumar Praveen, Priya VCS. Data curation: Priya VCS.
Formal analysis: Jayakumar Praveen, Priya VCS. Writing—original draft: Jayakumar
Praveen, Priya VCS. Writing—review & editing: Jayakumar Praveen, Priya VCS.
Approval of final manuscript: all authors.


ACKNOWLEDGMENTS

Authors would like to thank all the participants in the current study. We thank
the Dr. Sundaram A., Dean of Medical College and Dr. Savitha V.H., Professor and
Head of Audiology and Speech Language Pathology, for permitting us to conduct
the study.





REFERENCES

Acoustical Society of America. (1996). Specification for Audiometers.
(pp.13-17). Melville, NY: Acoustical Society of America.


Acoustical Society of America. (1999). Maximum Permissible Ambient Noise Levels
for Audiometric Test Rooms. (pp.4-9). Melville, NY: Acoustical Society of
America.


Bilger, R. C. & Wang, M. D. (1976). Consonant confusions in patients with
sensorineural hearing loss. Journal of Speech and Hearing Research, 19(4),
718-748.


Boothroyd, A. (1984). Auditory perception of speech contrasts by subjects with
sensorineural hearing loss. Journal of Speech, Language, and Hearing Research,
27(1), 134-144.


Dubno, J. R., Dirks, D. D., & Langhofer, L. R. (1982). Evaluation of
hearing-impaired listeners using a nonsense-syllable test. II. Syllable
recognition and consonant confusion patterns. Journal of Speech and Hearing
Research, 25(1), 141-148.


Dubno, J. R., Dirks, D. D., & Morgan, E. (1984). Effects of age and mild hearing
loss on speech recognition in noise. The Journal of the Acoustical Society of
America, 76(1), 87-96.


Homans, N. C., Metselaar, R. M., Dingemanse, J. G., van der Schroeff, M. P.,
Brocaar, M. P., Wieringa, M. H., et al. (2017). Prevalence of age-related
hearing loss, including sex differences, in older adults in a large cohort
study. The Laryngoscope, 127(3), 725-730.


Indhumathy, R. & Lalitha, R. (2015). Remediation manual for phonological
disorders (Unpublished doctoral thesis). Tamil Nadu, Annamalai University.


Levitt, H. (2001). Noise reduction in hearing aids: A review. Journal of
Rehabilitation Research and Development, 38(1), 111-121.


McRackan, T. R., Ahlstrom, J. B., Clinkscales, W. B., Meyer, T. A., & Dubno, J.
R. (2016). Clinical implications of word recognition differences in earphone and
aided conditions. Otology and Neurotology, 37(10), 1475-1481.


Munro, K. J. & Lutman, M. E. (2003). The effect of speech presentation level on
measurement of auditory acclimatization to amplified speech. The Journal of the
Acoustical Society of America, 114(1), 484-495.


Perez, E. & Edmonds, B. A. (2012). A systematic review of studies measuring and
reporting hearing aid usage in older adults since 1999: A descriptive summary of
measurement tools. PLoS One, 7(3), e31831.


Pittman, A. L. & Stelmachowicz, P. G. (2000). Perception of voiceless fricatives
by normal-hearing and hearing-impaired children and adults. Journal of Speech,
Language, and Hearing Research, 43(6), 1389-1401.


Ramkissoon, I. (2001). Speech recognition thresholds for multilingual
populations. Communication Disorders Quarterly, 22(3), 158-162.


Sahoo, S. & Nandurkar, A. (2020). Performance of normal hearing school age
children on Hindi minimal pair test. Journal of Otolaryngology-ENT Research,
12(1), 13-18.


Samuel, J. D. (1976). Development and standardization of phonetically balanced
test materials in Tamil language (Unpublished dissertation). Mysuru, AIISH.


Schultz, M. C. (1964). Suggested improvement in speech discrimination testing.
Journal of Auditory Research, 4(1), 1-14.


Shanks, J. E., Wilson, R. H., Larson, V., & Williams, D. (2002). Speech
recognition performance of patients with sensorineural hearing loss under
unaided and aided conditions using linear and compression hearing AIDS. Ear and
Hearing, 23(4), 280-290.


Souza, P. (2016). Speech Perception and Hearing Aids. In Popelka, G., Moore, B.,
Fay, R., & Popper, A. Hearing Aids. (pp.151-180). Cham: Springer.


Verma, R. R., Konkimalla, A., Thakar, A., Sikka, K., Singh, A. C., & Khanna, T.
(2021). Prevalence of hearing loss in India. The National Medical Journal of
India, 34(4), 216-222.


Vijayakumar, K., Gunalan, S., & Rajeshwaran, R. (2021). Development of minimal
pair test in Tamil (MPT-T). Journal of Clinical and Diagnostic Research, 15(9),
1-4.


Walden, B. E., Grant, K. W., & Cord, M. T. (2001). Effects of amplification and
speechreading on consonant recognition by persons with impaired hearing. Ear and
Hearing, 22(4), 333-341.


Wiley, T. L., Cruickshanks, K. J., Nondahl, D. M., Tweed, T. S., Klein, R., &
Klein, B. E. (1998). Aging and word recognition in competing message. Journal of
the American Academy of Audiology, 9(3), 191-198.




APPENDICES


APPENDIX 1.

Paired word list in Tamil
asr-230089-Appendix.pdf
Abstract
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
Notes
Acknowledgments
REFERENCES
APPENDICES

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