Oticon success 2011 An International Survey Oticon s hearing instrument uses advanced signal processing technologies to help preserve many of the natural characteristics of speech while enriching sound quality. The experience and observations from new users, experienced users and hearing healthcare professionals with regard to these technologies will be presented here. Douglas L. Beck Au.D. Director of Professional Relations Oticon Inc. Somerset, NJ.
INTRODUCTION: Oticon is Oticon s premium family of high performance hearing instruments built on the RISE 2 platform. The Rise 2 platform allows high processing speed with twice the calculating power of the original RISE, in a smaller physical size without additional power (i.e., battery) consumption. s breakthrough technologies preserve signal fidelity to facilitate the natural process of speech understanding. Although there are many advanced technologies within, this paper will briefly review only two specific advanced technology concepts within. Specifically, Speech Guard and Spatial Sound 2.0 will be addressed. Speech Guard and Spatial Sound 2.0 are innovative technology concepts designed to maintain many of the important, subtle and natural characteristics of speech while simultaneously enriching sound quality, increasing speech intelligibility and decreasing listening effort in quiet and noisy situations. Spatial Sound 2.0 is an advanced binaural signal processing concept founded on; Extended Bandwidth, Open Ear Fittings, Receiver-In-The-Ear Technology (RITE) and Binaural Processing. Binaural Processing is designed to preserve sound dynamics such as interaural loudness differences (ILDs) between the ears - and to emphasize sounds from the ear with the better signal-tonoise ratio, thus making it easier to listen in challenging listening situations. Speech Guard is a dual analysis (short and longterm averaging windows), non-linear signal processing technology that preserves the fine modulation of the speech signal more so than traditional compression systems to enable the listener to detect and use minimal temporal acoustic loudness cues to maximize speech understanding. Specifically, the goal of Speech Guard is to monitor and respond to ongoing speech (and other sound) signals and to process speech sounds without negatively affecting sound quality and without disrupting the intricate dynamics of speech.
Earlier Performance Study: From November, 2009 through February, 2010, thirty-nine participants (average age 68 years, age range 20 to 80 years) were recruited to participate in a study comparing their aided hearing aid experiences with, to their previous (i.e., other ) hearing aid fitting. Nineteen participants from Oticon A/S, Smorum, Denmark and 20 participants from Hörzentrum, Oldenburg, Germany participated. Evaluated parameters included speech intelligibility, sound quality, spatial observations and patient preferences. All participants were within the fitting range of the devices and all presented with flat or sloping, mild-to-moderate hearing loss. In brief, Overall Preference scores demonstrated 72% of participants rated as Much Better or Somewhat Better than the other modern hearing aid. Those who preferred noted the following reasons (in descending order); better sound quality (32%), better speech understanding (22%), better design/physical comfort (19%) and separation of sounds (8%), hear more (8%), easier handling (7%) and less feedback (3%) and less concentration needed (1%). Results using the Speech, Spatial and Qualities of hearing scale (SSQ) indicated performed statistically significantly better than the other modern hearing aid. was rated superior in quiet, listening to one person (p<0.01), in quiet, 5 persons around a table (p< 0.05), in a busy restaurant, 5 persons around a table (p<0.01), constant noise one speaker (p<0.05), crowded room of speakers, follow one speaker (p<0.01) and start of a sentence, more speakers (p<0.01). For SSQ questions such as; knowing who is speaking in a meeting with many people, the ability to localize a dog barking outdoors, the direction and/or distance of a truck or bus, the direction of a person based on their voice or footsteps and sounds being where you expect them to be, performed statistically significantly better (at either p<0.01 or p<0.05) than the other hearing aid. Listening Effort revealed large and consistent benefits for by reducing from considerable to Oticon 2011: An International Survey 3
moderate effort across the two types of noise tested. Finally, Speech-In-Noise tests did demonstrate a statistically significant overall group benefit of 1.3 db when wearing. New International Survey: In February and March, 2011, Oticon sought to confirm the results of the earlier study across a broad cross-section of patients and professionals. Therefore, first-time hearing aid users, experienced hearing aid users and hearing healthcare professionals were recruited from Canada, Germany, the United Kingdom and the United States. Surveys based on hearing aid experience (new users versus experienced users) and hearing aid fitting experience (see appendix) were distributed in Canada, Germany, the United Kingdom (UK) and the United States (US) to professionals selected by Oticon. The professionals selected and distributed the surveys to end-users each of whom had more than one month experience with. In the final analysis, survey participants included 73 new users, 76 experienced users and 149 Hearing Healthcare Professionals (HHPs). Each survey participant group (first-time hearing aid users, experienced hearing aid users and hearing healthcare professionals) selected and rated their response on a scale of 0 through 10 whereby 0 represented the lowest possible score or least favorable performance level and 10 represented the highest possible score or most favorable performance level. In each of the three group discussions which follow, all responses from each group (first-time hearing aid users, experienced hearing aid users and hearing healthcare professionals) were averaged. The group s mean response is indicated in parenthesis following the question/statement. First-time users: Profile of Respondents: The New User survey respondents were 55% male and 45% female. Age ranges were distributed as follows; 0-20 years = 1.4%, 21-40 years = 5.5%, 41-60 years = 31.5%, 61-to 80 years = First-time user listening performance A: Your ability to separate sounds by their direction in noise B: Your ability to follow conversations in noisy situations A B Unaided C: Your ability to follow a conversation while ignoring other voices C D: The degree of effort it takes for you D
52.1% and 81 to 100 years = 9.6%. With regard to hearing aid style; minirite was worn by 74%, RITE = 2.7%, BTE= 15.1%, ITE = 0.0%, ITC = 6.8% and CIC/MIC were worn by 1.4% of participants. 87.7% wore binaural fittings and nearly two-thirds of all respondents wore their hearing aids all day. Question/Statement (First-time user mean response) Rate the extent to which you feel tired and/or mentally exhausted after wearing all day. (16.5%) Rate the physical comfort of. (86.9%) Rate how easily you can adjust in changing listening situations. (84.2%) Rate the overall sound quality with respect to your expectations. (84.3%) Rate your satisfaction with the adaptation period with. (86.4%) Rate the extent to which s overall quality meets your quality requirements. (86.3%) Rate your overall satisfaction with based on your overall hearing instrument experience. (86%) Rate how likely you would be to choose today. (87%) Rate how likely you would be to recommend to others. (88.1%) Rate your ability to determine where a sound comes from: (80.4% with, 45.7% without) Rate your ability to separate sounds by their direction in noise. (77.0% with, 43.3% without) Rate your ability to know exactly where sounds come from in noise. (79.9% with, 45.5% without) Rate speech clarity in quiet. (92.6% with, 57.3% without) Rate your ability to following conversations in noise. (77.8% with AGil, 34.1% without) Evaluation by first-time users First-time user satisfaction with hearing instruments A: Rate the overall sound quality with respect to your expectations 40% B: Rate to what extent you have been satisfied with the length of the adaptation period with A Proportion of respondents 30% 20% 10% B Not at all satisfied Extremely satisfied Oticon 2011: An International Survey 5
Rate your ability to follow a conversation in speech noise while ignoring other voices. (77.7% with, 35.6% without) First-time Users rate very high in terms of physical comfort and they perceive use as almost effortless. First-time Users expect high quality sounds and they rate s sound quality very high. First-time Users are very satisfied with their personal adaptation time and meets their quality requirements. First-time Users rate their overall satisfaction as very high. First-time users are very likely to recommend and re-purchase and was determined to be a major improvement across all sound related aspects as compared to the same situation unaided. Rate your degree of effort to hear what is said in conversations. (16.4% with, 58.8% without) Rate your ability to recognize people you know based on the sound of their voice. (87.8% with, 63.3% without) First-time user: Summary & Conclusions The fact that respondents perceive their acclimatization process as relatively short and effortless can be supported by their significant gains in speech understanding and that they highly value the sound quality and comfort of the instruments. Experienced users: Profile of Respondents: The Experienced User survey respondents were 56% male and 44% female. Ages were distributed as follows; 0-20 years =0%, 21-40 years = 6.6%, 41-60 years = 22.4%, 61-to 80 years = 64.5% and 81 to 100 years = 6.6%. With regard to hearing aid styles; minirite was worn by 74%, RITE = 2.7%, BTE= 15.1%, ITE = 0.0%, ITC = 6.8% and CIC/MIC were worn by 1.4% of participants. 63% wore binaural fittings and nearly 78% of all respondents wore their hearing aids all day. Experienced Users listening performance A: Your ability to separate sounds by their direction in noise B: Your ability to follow conversations in noisy situations A B Previous C: Your ability to follow a conversation while ignoring other voices C D: The degree of effort it takes for you to hear what is being said in conversations D
Question/Statement (Experienced user mean response): Rate your ability to determine the direction from which someone is speaking when you cannot see that person. ( 77.3%, Other 49.2%) Rate your ability to separate sounds by their direction when multiple important sounds are occurring simultaneously. ( 73.3%, Other 41.4%) Rate to what extent you experience sounds exactly where you expect them to be. ( 79.7%, Other 50.2%) Rate how you experience clarity of speech with regard to one-on-one conversation in quiet. ( 93.2%, Other 67.4%) Rate to what extent you can follow conversations in noise. ( 77.1%, Other 41.1%) Rate to what extend you can follow a conversation while ignoring other voices. ( 77%, Other 40.7%) Rate the degree of effort to hear what is being said in conversations with others. ( 16.2%, Other 47.4%) Rate the extent to which you feel tired or mentally exhausted after wearing hearing instruments all day. ( 11%, Other 29.7%) Rate the extent to which you recognize different people you know by the sound of their voice. ( 88.5%, Other 70%) Rate the physical comfort of your hearing instruments. ( 89.9%, Other 68.6%) Rate how easy it is to adjust your hearing instrument in changing listening situations. ( 86.5%, Other 56.9%) Rate how the overall sound quality meets your expectations. ( 85.7%, Other 56%) Rate your satisfaction with regard to the length of the adaptation period. ( 89.6%, Other 63.8%) Evaluation by experienced users Experienced user satisfaction with compared to previous hearing instruments A: Rate the overall sound quality with respect to your expectations 40% Previous B: Rate to what extent you have been satisfied with the length of the adaptation period with Previous Proportion of respondents 30% 20% 10% Not at all satisfied Extremely satisfied Oticon 2011: An International Survey 7
Rate to what extend your hearing instruments have met your overal expectations. ( 84%, Other 54.1%) Rate to what extent the overall quality of your hearing instruments meets your quality requirements. ( 85.5%, Other 57.4%) Rate your overall satisfaction based on your overall experience. ( 85.8%, Other 55.9%) How likely would you be to choose today. (88.8% likely) How likely is it you would recommend to others. (85.4% likely) Experienced User: SUMMARY & CONCLUSIONS Experienced Users are very satisfied with regard to determining the direction of a sound and their ability to separate sound sources while wearing. Experienced Users rate speech clarity with as excellent and they rate their ability to follow a conversation as good. Experienced Users respond using is much less effortful and the physical fit of is nearly excellent. Experienced Users are extremely satisfied with the adaptation time related to. All these improved factors could be seen as the result of the natural sound provided by main features such as Speech Guard and Spatial Sound 2.0. has lived up to the expectations and quality requirements of Experienced Users. Experienced Users are well satisfied with and their loyalty to is very high with regard to re-purchasing and recommending it to others. represents a major improvement with respect to all sound-related experiences and observations. Fine tuning generally required with to achieve a successful first fit 40% Proportion of respondents 30% 20% 10% Very much Very little
Hearing Healthcare Professionals (HHPs) Question/Statement (HHP mean response): 1. Rate how easy it was to explain the benefits of to patients (78.7%). 2. Rate how satisfied you were with regard to Oticon s support of (84.9%). 3. Rate the usability/flexibility of Genie (software) with respect to (82.3%). 4. Rate the quantity of fine tuning for with Genie (79.7%). 5. Rate the overall reliability of (85.1%). 6. Rate the overall ability of to meet expectations (84.1%). 7. Rate your overall satisfaction with from your overall experience with hearing aids (85.4%). 8. Rate your perception of your patient s overall satisfaction compared to prior fitting (84.9%). 9. Rate how close is to the IDEAL hearing aid (73.1%). 10. Rate your likeliness of recommending to colleagues (85.7%). HHP - SUMMARY & CONCLUSIONS: Hearing Healthcare Providers (HHPs) are very satisfied with based on their overall experience with hearing instruments. HHPs note that their patients are very satisfied with. HHPs would strongly recommend to their colleagues. has lived up to HHPs expectations. HHPs rate s reliability as excellent and requires very little fine tuning at first fitting. HHPs are very satisfied with and Oticon s support. HHPs find it very easy to explain the benefits of AGil to their patients. Dispenser satisfaction with based on overall experience with hearing instruments Dispenser likeliness of recommending to colleagues 40% 40% Proportion of respondents 30% 20% 10% Proportion of respondents 30% 20% 10% Not at all satisfied Extremely satisfied Most unlikely Most likely Oticon 2011: An International Survey 9
OVERALL CONCLUSIONS: The earlier study demonstrated 72% of participants reported an Overall Preference for and they reported; better sound quality, better speech understanding, better design/physical comfort, better separation of sounds, they heard more, they reported easier handling and less feedback, and less concentration was needed while wearing. Analysis of attributes (speech intelligibility, listening comfort, sound quality and overall rating) favored and SSQ ratings showed performed statistically significantly better than the modern reference hearing aid, based on Wilcoxon matched pairs test across multiple sub-tests. Listening Effort tests revealed large benefits for users across the two types of noise tested. Lastly, Speech-In- Noise tests showed a statistically significant overall group benefit of 1.3 db when wearing. The International study demonstrated First-time Users rate very high in terms of physical comfort and New Users perceive use as nearly effortless. First-time Users expect and rate s sound quality and their overall satisfaction with as very high. First-time Users are very likely to recommend and re-purchase. Experienced Users are very satisfied with regard to directionality and their ability to separate sound sources while wearing. Experienced Users rate speech clarity with as excellent and their ability to follow a conversation as good. Hearing Healthcare Providers (HHPs) are very satisfied with based on their overall experience with hearing instruments. HHPs report patients are very satisfied with and they would strongly recommend to their colleagues. Oticon s hearing instrument uses advanced signal processing concepts to help preserve many of the natural characteristics of speech while enriching sound quality. The experiences, observations and outcomes of First-time Users, Experienced Users and hearing Healthcare Professionals with regard to these (same) technologies indicates Spatial Sound 2.0 and Speech Guard do help preserve many of the important, subtle and natural characteristics of speech while simultaneously enriching sound quality, increasing speech intelligibility and decreasing listening effort in quiet and noisy situations.
REFERENCES and RECOMMENDED READINGS: Beck, DL (2010): Defining Quality In Hearing Aid Fittings. July/August. ENT & Audiology News. Beck, DL. & Olsen, J. (2008): Extended Bandwidths in Hearing Aids Hearing Review, October. http://www.hearingreview.com/issues/articles/2008-10_02.asp Beck, DL. & Sockalingam, R. (2010): Facilitating Spatial Hearing Through Advanced Hearing Aid Technology. Hearing Review - April 2010 http://www.hearingreview.com/issues/articles/2010-04_03.asp Behrens T. (2008): Spatial Hearing in Complex Sound Environments: Clinical Data. Hearing Review. Vol 15, Number 3, pages 94-102. Bruun Hansen L, Holmberg M, Schulte M, Sockalingam R, Behrens T. Improved speech intelligibility and listening effort in complex listening environments with a new amplification system. Presented at: International Conference on Adult Hearing Screening; June 10-12, 2010; Cernobbio, Italy Kidd G Jr, Arbogast TL, Mason CR, Gallun FJ. (2005): The Advantage of Knowing Where to Listen. J Acoust Soc Am. Volume 118, Pages 3804-3815. Lunner, T. (2010): Designing HA signal processing to reduce demand on working memory Hearing Journal: August, Volume 63 - Issue 8 - pp 28,30-31 http://journals.lww.com/thehearingjournal/fulltext/2010/08000/designing_ HA_signal_processing_to_reduce_demand_on.5.aspx Neher,T., Behrens, T. & Beck, DL. (2008): Spatial Hearing and Understanding Speech in Complex Environments. Hearing Review, November. http://www.hearingreview.com/issues/articles/2008-11_03.asp Rönnberg J, Rudner M, Foo C, Lunner T. (2008): Cognition counts: A working memory system for ease of language understanding (ELU). International Journal of Audiology 2008;47(1)S2:S99 S105. Schneider BA, Li L, Daneman M. (2007): How Competing Speech Interferes with Speech Comprehension in Everyday Listening Situations. J Am Acad Audiol. Volume 18, Pages 559 to 572. Simonsen, CS. & Behrens,T. (2009): A New Compression Strategy Based on a Guided Level Estimator Review, December. http://www.hearingreview.com/issues/articles/2009-12_04.asp Hearing Schum, D. & Sockalingam, R. (2010): A New Approach to Nonlinear Signal Processing Hearing Review, July. http://www.hearingreview.com/issues/articles/2010-07_02.asp Sockalingam, R., Beilin, J. & Beck, DL. (2009): Sound Quality Considerations of Hearing Instruments. Hearing Review, March. http://www.hearingreview.com/issues/articles/2009-03_03.asp Sockalingam, R. & PhD, Holmberg, M. (2010): Evidence of the Effectiveness of a Spatial Noise Management System Hearing Review, August. http://www.hearingreview.com/issues/articles/2010-08_06.asp Sockalingam, R., Holmberg, M., Eneroth, K. & Shulte, M. (2009): Binaural hearing aid communication shown to improve sound quality and localization. Hearing Journal, Volume 62 - Issue 10 - pp 46-47 http://journals.lww.com/thehearingjournal/fulltext/2009/10000/binaural_hearing_aid_communication_ shown_to.10.aspx Oticon 2011: An International Survey 11
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