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Music Perception of Hearing Impaired Listeners

Permanent Link: http://ufdc.ufl.edu/UFE0041026/00001

Material Information

Title: Music Perception of Hearing Impaired Listeners Effects of Hearing Aid Settings and Personality Factors
Physical Description: 1 online resource (108 p.)
Language: english
Creator: Johnston, Kristin
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: amplification, audiology, hearing, music, personality
Communication Sciences and Disorders -- Dissertations, Academic -- UF
Genre: Communication Sciences and Disorders thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: MUSIC PERCEPTION OF HEARING IMPAIRED LISTENERS: EFFECTS OF HEARING AID SETTINGS AND PERSONALITY FACTORS Kristin Nicole Johnston 352-273-6550 knjohn@phhp.ufl.edu Communication Sciences and Disorders Supervisory committee chair: James W. Hall III Doctor of Philosophy December 2009 Music has long been considered a beneficial part of life. Listening to music may result in better mood, positive cardiovascular and hormonal changes, as well as both short and long-term cognitive benefits. The goal of the present study is to provide information regarding the possible relationship between hearing aid settings and music perception, specifically: objective measures of hearing aid output, music perception performance for pitch, melody, and timbre identification; subjective ratings of music perception; and various personality factors for adult hearing aid users. Results have clinical implications for hearing aid fitting to enhance music listening. There are currently no published reports of effects of digital hearing aid circuit music settings on music perception in hearing impaired listeners. The outcome of this study will also provide a basis for future research for design of hearing aids.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Kristin Johnston.
Thesis: Thesis (Ph.D.)--University of Florida, 2009.
Local: Adviser: Hall, Jay.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0041026:00001

Permanent Link: http://ufdc.ufl.edu/UFE0041026/00001

Material Information

Title: Music Perception of Hearing Impaired Listeners Effects of Hearing Aid Settings and Personality Factors
Physical Description: 1 online resource (108 p.)
Language: english
Creator: Johnston, Kristin
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: amplification, audiology, hearing, music, personality
Communication Sciences and Disorders -- Dissertations, Academic -- UF
Genre: Communication Sciences and Disorders thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: MUSIC PERCEPTION OF HEARING IMPAIRED LISTENERS: EFFECTS OF HEARING AID SETTINGS AND PERSONALITY FACTORS Kristin Nicole Johnston 352-273-6550 knjohn@phhp.ufl.edu Communication Sciences and Disorders Supervisory committee chair: James W. Hall III Doctor of Philosophy December 2009 Music has long been considered a beneficial part of life. Listening to music may result in better mood, positive cardiovascular and hormonal changes, as well as both short and long-term cognitive benefits. The goal of the present study is to provide information regarding the possible relationship between hearing aid settings and music perception, specifically: objective measures of hearing aid output, music perception performance for pitch, melody, and timbre identification; subjective ratings of music perception; and various personality factors for adult hearing aid users. Results have clinical implications for hearing aid fitting to enhance music listening. There are currently no published reports of effects of digital hearing aid circuit music settings on music perception in hearing impaired listeners. The outcome of this study will also provide a basis for future research for design of hearing aids.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Kristin Johnston.
Thesis: Thesis (Ph.D.)--University of Florida, 2009.
Local: Adviser: Hall, Jay.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0041026:00001


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1 MUSIC PERCEPTION OF HEARING-IMPAIRED LISTENERS: EFFECTS OF HEARING AID SETTINGS AND PERSONALITY FACTORS By KRISTIN NICOLE JOHNSTON A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2009

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2 2009 Kristin Nicole Johnston

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3 To my Family

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4 ACKNOWLEDGMENTS My thanks go first to my God who made me, my Christ who saves me, and the Holy Spirit who grants me strength and comfort. I am deeply indebted to my husband, Jameson Johnston, for his love, support, and friendship through two doctoral degree programs. He has shouldered a lot of responsibility with the birth of our first son, Gideon, and the expectant arrival of our second son, Ezekiel. Without the blessing, encouragement, and inspiration he has provided, this project would not have come to completion. I am also thankful for the joy that both he and my children bring to my life, keeping me grounded in the things that matter most. I am also grateful for the support and encouragement of my parents, John and Phyllis Braswell, and brothers, Heath and Stephen, who always made me feel that I could accomplish whatever I desired regardless of the challenges I may face. I also acknowledge my doctoral committee members: Dr. Jay Hall (chair), Dr. Alice Holmes, Dr. Scott Griffiths, and Dr. David Smith. I am thankful for their time and effort in supporting and guiding me through this process. I am also grateful to Dr. Colleen LePrell for her assistance and advice. I am grateful for the support of colleagues and friends at the University of Florida, Dr. Hannah Siburt and Dr. Brittany Sakowicz, and those who have moved on to faraway places, Dr. Nicole Kriesman and Dr. Andrew John. I am grateful to Phonak, Inc. for grant funding of this project and to Ilana Glick for her work as research assistant on this project. I also acknowledge University of Florida Speech and Hearing Center staff members Tracy Crawley and Meghan McCaghren for their assistance. Lastly, I am thankful to the staff of the University of Florida Departments of Communication

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5 Sciences and Disorders and Communicative Disorders: Ms. Idella King, Mrs. Debbie Butler, Mrs. Jessie Runge, and Ms. Erika Banks-Payne for many years of assistance regarding details of course schedules, assistantships, and grants.

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6 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES ............................................................................................................ 8 LIST OF FIGURES .......................................................................................................... 9 LIST OF ABBREVIATIONS ........................................................................................... 10 ABSTRACT ................................................................................................................... 11 CHAPTER 1 INTRODUCTION .................................................................................................... 12 Significance and Implications .................................................................................. 12 Review of Literature ................................................................................................ 13 Research Questions ............................................................................................... 18 Objective Electroacoustic Measures ................................................................ 18 Real Ear Insertion Gain (REIG) .................................................................. 18 Speech Intelligibility Index (SII) .................................................................. 18 Music Ratings by Listening Condition ............................................................... 18 Music Perception, Song Preference, and Personality ...................................... 19 Music Perception by Listening Condition .......................................................... 19 Speech Perception by Listening Condition ....................................................... 19 2 METHODS .............................................................................................................. 20 Participants ............................................................................................................. 20 Measures and Materials .......................................................................................... 21 Procedure ............................................................................................................... 24 Order of Test Procedures, Conditions, and Music Excerpts ............................. 24 Questionnaires ................................................................................................ 24 Audiologic Procedures ..................................................................................... 25 Hearing Aid Fitting and Verification .................................................................. 25 Objective Electroacoustic Measurement .......................................................... 26 Speech Perception Testing .............................................................................. 27 Music Ratings ................................................................................................... 27 Musical Excerpts .............................................................................................. 28 Music Perception Testing ................................................................................. 28 Soundbooth and Equipment Setup ................................................................... 28 Speaker ...................................................................................................... 28 Routing of signals ...................................................................................... 29 Preparation of music and speech stimuli ................................................... 30 Hearing Aids and Hearing Aid Fitting Equipment ............................................. 31

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7 3 RESULTS ............................................................................................................... 40 Objective Electroacoustic Measures ....................................................................... 40 Speech Intelligibility Index (SII) ........................................................................ 40 Real Ear Insertion Gain (REIG) ........................................................................ 40 Music Ratings by Listening Condition ..................................................................... 41 Music Perception, Song Preference, and Personality Factors ................................ 42 Music Perception by Listening Condition ................................................................ 44 Speech Perception by Listening Condition ............................................................. 45 Qualitative Analysis ................................................................................................ 46 ........................................ 48 4 DISCUSSION ......................................................................................................... 67 Summary of Music Quality Ratings ......................................................................... 67 Development of a New Music Quality Rating Tool ........................................... 69 Relationship between Objective and Subjective Findings ................................ 70 Participant Observations .................................................................................. 72 Assessment of Music Perception ..................................................................... 72 Personality Factors as Predictors of Outcomes ................................................ 73 Speech Perception in the Music Setting ........................................................... 74 5 CONCLUDING REMARKS ..................................................................................... 75 APPENDIX A INFORMED CONSENT FORM ............................................................................... 76 B TABLES OF HEARING AID OUTPUTS AND TARGETS ....................................... 86 REFERENCES ............................................................................................................ 105 BIOGRAPHICAL SKETCH .......................................................................................... 108

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8 LIST OF TABLES Table page 2-1 Hearing aid and hearing loss information ........................................................... 33 2-2 Age, gender, and music history information ....................................................... 34 2-3 Pure tone air conduction audiometric thresholds in dB HL for the right e ar ........ 35 2-4 Pure tone air con duction audiometric thresholds in dB HL for the left e ar .......... 36 3-1 Speech Intelligibility Index (SII) ........................................................................... 49 3-2 Real Ear Insertion Gain (REIG) in dB SPL for right ear ...................................... 50 3-3 Real Ear Insertion Gain (RIEIG) in dB SPL for left ear ....................................... 52 3-4 Music rating scales by condition ......................................................................... 54 3-5 Personality factors as predictors of dependent variables (music ratings and song preference rankings) .................................................................................. 56 3-6 University of Washington Clinical Assessment of Music Perception (UWCAMP) by listening condition .............................................................................. 57 3-7 Measures of speech understanding by listening condition ................................ 58 3-8 Abbreviated Profile of Hearing Aid Benefit (APHAB) regarding fitting of ............................................................................ 59

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9 LIST OF FIGURES Figure page 2-1 Diagram of setup of soundbooth ......................................................................... 37 2-2 Spectral Analysis: Average Third Octave Band Levels ....................................... 38 2-3 Sound level over time for music excerpts ........................................................... 39 3-1 Speech Intelligibility Index (SII) ........................................................................... 60 3-2 Mean Real Ear Insertion Gain (REIG) for 40 dB SPL (A), 65 dB SPL (B), and 80 dB SPL (C) input levels for right and left ears in dB SPL ............................... 61 3-3 Music ratings by listening condition for Loudness (A), Fullness (B), Crispness (C), Naturalness (D), Overall Fidelity (E), and Total Music Ratings (F) .............. 62 3-4 Thresholds for the University of Washington Clinical Assessment of Music (UW-CAMP) pitch perception subtest by listening condition ............................... 64 3-5 Performance on the University of Washington Clinical Assessment of Music Perception (UW-CAMP) for the melody and timbre subtests .............................. 65 3-6 Performance on speech materials by listening condition .................................... 66

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10 LIST OF ABBREVIATIONS ANSI American National Standards Institute APHAB Abbreviated Profile of Hearing Aid Benefit BTE Behind-the-ear CIC Completelyin -the-canal CNC Consonant Nucleus Consonant dB A Decibels A weighting scale dB HL Decibels hearing level dB SPL Decibels sound pressure level DNT Did not test HINT Hearing In Noise Test Hz Hertz ITC In -the-canal ITE In -the-ear n/a Not applicable n/t No target generated PTA Pure tone average REIG Real Ear Insertion Gain REUR/G Real Ear Unaided Response or Gain RITE Receiverin -theear SII Speech Intelligibility Index SRT Speech reception threshold UW -CAMP University of Washington Clinical Assessment of Music Perception

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11 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy MUSIC PERCEPTION OF HEARING-IMPAIRED LISTENERS : EF FECTS OF HEARING AID SETTINGS AND PERSONALITY FACTORS By Kristin Nicole Johnston December 2009 Chair: James W. Hall III Major: Communication Sciences and Disorders Music has long been considered a beneficial part of life. Listening to music may result in better mood, positive cardiovascular and hormonal changes, as well as both short and long-term cognitive benefits. The goal of the present study is to provide information regarding the possible relationship between hearing aid settings and music perception, specifically: objective measures of hearing aid output, music perception performance for pitch, melody, and timbre identification; subjective ratings of music perception; and various personality factors for adult hearing aid users. In the current investigation, 20 adult male and female hearing aid users between the ages of 40 and 82 years of age were recruited for a hearing aid fitting to obtain subjective measures of music perception (based on identification tasks and judgments of music quality) a nd objective electroacoustic measures of hearing aid output. These measures and the hearing aid fitting were completed in one visit. Results have clinical implications for hearing aid fitting to enhance music listening. There are currently no published reports of the effects of digital hearing aid circuit music settings on music perception in hearingimpaired listeners. The outcome of this study will also provide a basis for future research for design of hearing aids.

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12 CHAPTER 1 INTRODUCTION Significance and Implications Music has long been considered a beneficial part of life. Mockel et al. (1994) found that listening to music resulted in better mood as well as positive cardiovascular and hormonal changes. Schellenberg (2005) reported that music listening and lessons in normal hearers can result in both short and long-term cognitive benefits. It is desirable to also optimize the music listening experience for hearing-impaired listeners. Unfortunately, little is known about the effect of amplification on music perception in hearing-impaired listeners. A major goal of the current study was to provide information regarding objective measures of hearing aid output in the music setting, and to relate those measures to subjective perception. Results of the investigation have clinical and research implications in the fitting and design of hearing aids in regards to music listening for hearing-impaired individuals, and may provide a basis for future research. The findings of this investigation provide evidence on outcome measures for perceived benefit of music settings now available in hearing aids. Future research is likely to further define optimal settings for music listening with hearing aids as reported by hearing-impaired listeners. In addition to the potential impact of this research on hearing aid design, objective measures of sound output in relation to listener preference and music style can be used to provide a framework for amplification or manipulation of sound output of various music players (players of MPEG-1 Audio Layer 3, more commonly referred to as different transducers (earbud style ear phones, traditional headphones, or sound attenuating or canceling circum-aural headphones). This is timely information in an era

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13 of technology development catering to use of combination devices, such as cell phones that also store and play music files such as MP3. Information is needed to ensure that such technological advances are appropriately accessible and enjoyable by people with hearing impairment. Due to the rate of technological improvement in modern day cell phones and music players, there is potential for funding of research to improve compatibility of these devices with currently available hearing aids. In an effort to improve telephone communication by hearing-impaired persons, considerable research effort has focused on improving the compatibility between hearing aids and cell phones (Berger, 2001; Latzel et al., 2001; Sorri et al., 2003; Kozma-Spytek and Harkins, 2005) There are, in contrast, few raw data or guidelines for compatibility between music players (i.e. cell phone MP3 players, iPod) and hearing aids. It is reasonable to expect that hearing-impaired individuals desire to listen to and enjoy music just like individuals with normal hearing acuity. Therefore, further study is necessary to better understand hearing aid settings (i.e. processing strategies and gain characteristics) and coupling strategies between hearing aids and devices such as cell phones and MP3 players that optimize music listening and perception for hearing-impaired individuals. Review of Literature Much is known regarding hearing aid use and speech perception (Hallgren et al. 2005; Plyler et al., 2007; Shanks et al., 2007; Bentler et al., 2008; Klemp and Dhar, 2008; Shi and Doherty, 2008). Much research has also focused on understanding cochlear implant use and its relationship to speech perception (Kong et al., 2005) and music perception (Mirza et al. 2003). In contrast, there is scant research on hearing aids and music perception.

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14 Comparisons of performance of cochlear implant users versus hearing aid users in various music perception tasks showed better performance for hearing aid users in some tasks (Looi et al., 2008). For pitch perception of one, half-, and quarter-octave intervals, hearing aid users showed significantly better performance than cochlear implant users. Better performance was also noted for hearing aid users for melody recognition. There was no significant difference between the groups for tasks related to rhythm or instrument recognition. In his text regarding the physics and psychophysics of music, Roederer (1973) outlined three main primary sensations associated with musical sound. They included pitch, also referred to as altitude or height, loudness, al so called strength or intensity, and quality, or timbre, sometimes referred to as distinguishability. According to Roederer, these aspects of sound perception allow listeners to differentiate between music and noise. To investigate effects of amplification on music perception in hearing-impaired individuals, a clinical assessment of music perception, described in the Methodology section of this text, was utilized, which included subtests for pitch, melody, and timbre perception. Current literature describing hearing aid technology and fitting research does not provide a clear consensus regarding optimal settings of hearing aid parameters for listening to music. Dependent upon the manufacturer and model of a hearing aid, various parameters can be manipulated by a hearing care provider to enhance the include, but are not limited to, linear or nonlinear circuitry, signal processing (analogue or digital), compression ratio, threshold knee point, compression limiting (input or output), attack and release times, and amount of gain or amplification. In a report on

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15 amplification of a music signal, Chasin (2003) indicated that sound quality of music is greatly affected by a balance between the lower frequency fundamental energy and higher frequency harmonics. This is in agreement with previous studies of pitch and timbre perception. As Roederer (1973) states, quality or timbre is derived from the perception of the spectrum of a musical sound in combination with the proportion to which upper harmonics interact and mix with one another and the fundamental frequency of the musical sound associated with a particular instrument. Chasin (2003) argued that use of a single channel hearing aid is the best solution to achieve this balance. Due to the larger crest factor for music than speech, the kneepoint in the input-compression circuit should be set approximately 5 to 8 dB higher than it would be for speech. Crest factor is the difference between the root mean square value of a sound and its peak intensity. For speech the typical crest factor is 12 dB, while for music it can range from 18 to 20 dB. Increasing the kneepoint for input-compression should prevent the hearing aid from prematurely entering its non-linear phase. Another recommendation in the programming or selection of hearing aids for listening to music included use of a wide dynamic range compression (WDRC) circuit. This recommendation stemmed from the observation that most musicians with hearing loss have a mild to moderate hearing loss in the mid to high frequency range due to excessive exposure to music or to presbycusis resulting in outer hair cell damage, otherwise known as cochlear hearing loss. A number of years ago, Franks (1982) investigated effects of analog hearing aid processing on perception and preference judgments of music by normal hearing individuals and those with mild to moderate hearing loss. Franks used a hearing aid

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16 with a frequency response of 100 to 5300 Hz that permitted adjustment of low frequency cutoff to investigate the effects of extended low frequency range. A second hearing aid with a frequency response of 400 to 6300 Hz, which included a greater high frequency response, was used to evaluate the effects of an extended high frequency range. While normal hearing individuals showed a preference for both extended high and low frequency ranges, individuals with mild to moderate hearing loss showed accurate perception and reported a preference for extended low frequency ranges. These findings reflect the relative importance of low frequency information in music perception and hearing aid adjustments that allow low frequency information. Chasin and Russo (2004) investigated optimal music listening settings for hearing aids using experimentally designed wearable devices. The investigation centered on the specific hearing aid parameter of peak input limiting level. Results from the Chasin and Russo (2004) investigation led to recommendations for future design of hearing aids in regards to the peak input limiting level. In an investigation of compression and expansion of the temporal envelope, Van Buuren et al. (1999) used a rating scale of segments of music to evaluate sound quality judgments for normal hearing listeners and hearing-impaired listeners. When compared with linear amplification, compression amplification had a negative effect on appreciation of music by both listeners with normal hearing and listeners with hearing impairment. Conversely, a more recent study by Davies-Venn et al. (2007) suggested that listeners with mild to moderate hearing loss preferred wideband dynamic range compression (WDRC) rather than linear amplification when rating the pleasantness of music. WDRC also seemed to be preferred when the outcome measure was an impression of the quality of music.

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17 A survey by Leek et al. (2008) confirmed that at least 25 to 30% of elderly hearing aid wearers experience some level of difficulty with music listening. These hearing aid wearers may require some extra attention in counseling or hearing aid programming such as incorporation of a music setting to alleviate these difficulties. One can see fro m the investigations listed above that, while some work has been completed in this area of research, much more remains to be done in the area of music perception and hearing aid parameters as a factor in design and programming of hearing aids. Although research of music perception as it relates to hearing aid use is relatively new and sparse, much is already known in the broader realm of music perception in listeners with normal hearing. Kopacz (2005) reported an intriguing study of the effects of personality traits on preference of certain music elements. Personality was assessed using the 16 PF Questionnaire originally developed by Cattell et al. (1957). Music preference was assessed through use of the Questionnaire of Musical Preferences created by the authors for use in the investigation (Kopacz, 2005). The author concluded that personality or temperament traits of a listener should be taken into account when choosing musical pieces for use in music therapy. Various temperament traits have an effect on preference for more or less stimulating pieces of music. The same piece of music most likely will not have the same energizing or relaxing effect for a person who is an extrovert as it would for one who is an introvert. These findings indicate personality traits could also serve as factors affecting music perception and music enjoyment of hearing-impaired listeners. With current fitting software, most hearing aids are designed so that clinicians can manipulate parameter settings such as compression ratio, threshold knee point, input-

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18 compression limiting level, output-compression limiting level, attack and release times, and amount of gain and output in specific frequency ranges. Currently, there are few published reports documenting optimal hearing aid parameters or settings for listening to music. The purpose of the current investigation is to contribute to the body of knowledge regarding music perception of hearing-impaired listeners and the effects of hearing aid setting by systematically evaluating objective measures of hearing aid output, performance on measures of music perception, and subjective ratings of music stimuli. A secondary objective is to evaluate the effects of personality traits on the perception and enjoyment of music by hearing-impaired listeners. Research Questions Objective Electroacoustic Measures Real Ear Insertion Gain (REIG) Do objective electroacoustic measures of hearing aid output reflect significant differences in sound pressure level output for the research hearing aid in the music Speech Intelligibility Index (SII) Do objective electroacoustic measures of hearing aid output reflect significant differences in predicted speech intelligibility index (SII) measures for the research the speech setting? Music Ratings by Listening Condition Do subjective music perception ratings indicate listening to music in the music setting of the research hearing aid is perceived as superior quality when compared with

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19 participant is using no hearing aid at all (unaided condition)? Music Perception, Song Preference, and Personality Do statistically significant differences in music perception and song preference exist for different personality factors? Music Perception by Listening Condition Do statistically significant differences exist for performance on three subtests of the UW-CAMP (pitch perception, identification of musical excerpts of modified common melodies without rhythmic cues, and timbre identification) in the following different listening conditions: research hearing ai speech setting, and unaided? Speech Perception by Listening Condition Do statistically significant differences in speech perception exist for the following listening conditions: research hearing aid in musi speech setting, and unaided?

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20 CHAPTER 2 METHODS Participants Upon University of Florida Institutional Review Board (UF IRB) approval, 20 adult males and females, ages 40 to 82 years with a mean age of 64 years, were recruited from the community by advertisement (flyers, announcements at community meetings, and word of mouth). Subjects included thirteen males and seven females. Three inclusion criteria were used: 1) bilateral hearing loss with age of onset > 18 years of age, 2) use of bilateral amplification for at least two months, and 3) gradual sloping configuration of hearing loss (defined as hearing thresholds between 0 and 50 dB HL at 250 and 500 Hz, between 30 and 70 dB HL at 1000 and 2000 Hz, and between 50 and 90 dB HL at 4000 and 8000 Hz) of sensorineural origin. Exceptions were made to the above audiologic criteria in cases where thresholds exceeded the defined range by no more than 5 dB HL at one frequency per ear or where thresholds were below the defined range by no more than 15 dB HL at one frequency per ear. All participants had symmetrical hearing loss. In other words, the difference between thresholds for the two ears was less than 20 dB at all frequencies tested. See Tables 2-1 and 2-2 for a summary of participant characteristics. For a summary of participant audiometric data, see Tables 2-3 and 2-4. Although there is great variability in configuration and etiology of hearing loss within the general population of adults with hearing impairment, in this study a small group of individuals with similar configurations and etiologies was targeted. Prior experience with bilateral amplification was necessary to reduce variability in hearing aid experience and adjustment to amplification among study participants. Participants were paid for their participation. All participants were provided with an

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21 audiologic evaluation free of charge by the researcher. Participants for whom custom earmolds were made for use in the study were allowed to keep the earmolds. Measures and Materials Each potential subject completed a demographic and audiologic history questionnaire prior to participation in data collection to verify compliance with enrollment criteria. An audiologic evaluation was also completed to determine if the potential subject met audiologic criteria. Participants completed the MIPS Revised (Millon Index of Personality Styles Revised), a standardized measure of personality profiles. The MIPS Revised contains 180 true/false items on personality. As a means of ach participant completed the Abbreviated Profile of Hearing Aid Benefit (APHAB) to evaluate benefit perceived with use of his or her own hearing aids (Cox, 1997). The Abbreviated Profile of Hearing Aid Benefit (APHAB) is a regularly utilized clinical tool for subjective verification of hearing aid fitting. It consists of two practice questions and 24 questionnaire items to determine the percentage of the time the hearing aid user experiences ease or difficulty in various communication situations either with or without hearing aids. The Audioscan Verifit system is a device used for the electroacoustic analysis of hearing aid output. Output is measured at the level of the par ear measure) or using a coupler device. System capabilities include various input levels such as 50, 65, and 85 dB SPL using a variety of acoustic stimuli (speech of male or female, tones, or speech spectrum shaped noise). Information provided by the Audioscan Verifit includes the real ear insertion gain (REIG) and predicted speech intelligi bility index (SII). The REIG is a representation of the amount of gain provided by

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22 the hearing aid when accounting for loss of acoustic resonance of the open ear that occurs when the ear is filled with a hearing aid or earmold. One can either measure the natural acoustic resonance of the open ear canal or use an average value. The SII is a form of an audibility-index, which uses a weighting system to assign importance to different aspects of the acoustic signal in order to predict audibility of speech for a given level of sound output (Sherbecoe and Studebaker, 2003). A higher SII value is associated with better predicted audibility of the speech signal. The music-rating questionnaire used in the current investigation was developed for use in an investigation of music perception reported by Chasin and Russo (2004). Chasin and Russo adapted a scale originally developed by Gabrielsson et al. (1988) for evaluation of sound quality of various sound transducers. The original scale by Gabrielsson and colleagues included ratings for the following: softness, brightness, clarity, fullness, nearness, loudness, spaciousness, and total impression. The scale was adapted by Chasin and Russon to include five perceptual parameters for which each one is rated on a five point scale (1 = poorest to 5 = best). The following five perceptual parameters are used: Loudness, Fullness, Crispness, Naturalness, an d Overall Fidelity. The definitions provided by Chasin and Russo (2004) for the above parameters are as follows: Loudness: the music is sufficiently loud, in contrast to soft or faint Fullness: the music is full, in contrast to thin Crispness: the music is clear and distinct, in contrast to blurred, and diffuse Naturalness: the music seems to be as if there is no hearing aid, and the music

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23 Overall Fidelity: the dynamics and range of the music is not constrained or narrow A total score can be calculated by combining scores of the individual scales with a highest possible score of 25. Although, specific data regarding validity and reliability measures for the Chasin and Russo (2004) scale are not currently available, the scale was used for the current study as there were no reports of alternative music rating scales that have been used with hearing-impaired listeners. The University of Washington Clinical Assessment of Music Perception (UWCAMP) Version 1.0 (Copyright 2006 University of Washington All Rights Reserved) was administered to each participant (Liu et al., 2006). UW -CAMP contributors are Jay Rubinstein, Grace Liu, Kaibao Nie, Ward Drennan, Jeff Longnion, Robert Kang, Chad Ruffin, and John Ho Won. The UW-CAMP is a software based assessment of music perception in the areas of pitch direction identification, melody identification, and timbre identification. The pitch subtest requires listeners to determine which of two tones heard was perceived as higher in pitch. The melody subtest requires listeners to identify which melody was heard from a closed set of twelve familiar melodies. The melodies are adapted versions of common melodies for which the rhythm information has been removed. The timbre subtest requires listeners to identify which instrument was played in a clip from a closed set of eight instruments. Each of the three subtests (pitch, melody, and timbre) provides a practice portion prior to the actual test items. The practice portion for the pitch subtest provides the listeners with feedback regarding the correct answer. The practice portions for the melody and timbre subtests provide the listener with the opportunity to listen to each melody or instrument excerpt prior to beginning the identification task.

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24 Procedure Order of Test Procedures, Conditions, and Music Excerpts For all participants order of the following tests was randomized: speech perception measures, UW-CAMP, and music ratings. Order of the three musical excerpts as well as order of the three listening conditions was randomized across participants. For example, a participant might have completed the listening conditions in the following order: unaided, music setting of Phonak hearing aid, and speech setting of own hearing aid. Within those conditions, the participant would have completed the speech perception measures, then the music ratings, followed by the UW-CAMP. The music excerpts would have been presented in the following order: Classical, Pop, and Rock. In other words, the order of testing was not varied within participants or visits, but each participant was assigned a test order, condition order, and music excerpt order. The assigned test order was randomized across participants to reduce effects of order of presentation on the measurement outcomes. Questionnaires Prior to the beginning of any screening measures or data collection, the IRB approved informed consent form was reviewed with the participant and signed by the participant and researcher. Refer to Appendix A to view the informed consent form. The MIPS questionnaire and APHAB questionnaire were completed by the participants in paper and pencil form. If there were any questions on the part of the participant regarding the APHAB questionnaire, the items were reviewed in a face to face interview style. The demographic and history questionnaire was completed in a face to face interview style with each participant.

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25 Audiologic Procedures A comprehensive audiologic evaluation was completed by the researcher (a licensed Audiologist) at no charge to the participant prior to participation in this investigation. This included pure tone air and bone conduction audiometry and measurement of speech reception threshold using inserts within a sound-treated audiometric test room. A Grason-Stadler, Inc 1761 (GSI-61) clinical audiometer was used for the audiologic evaluation. Tympanometry was completed using the GrasonStadler, Inc. Tympstar immittance bridge. All of the above mentioned equipment was within compliance for calibration with appropriate standards from the American National Standards Institute (ANSI). Hearing Aid Fitting and Verification The participants were fit bilaterally with behind-the-ear hearing aids. For the purpose of this study, the hearing aids being used were fit with the use of a custom fit earmold. Custom earmolds were made for individuals who did not already have custom earmolds with standard tubing assembly. The hearing aids were fit using standard clinical protocols, including the following: use of the most recent audiogram, application changes based on patient feedback regarding quality of sound (signal is perceived as even or balanced between ears, sufficiently loud without being too loud, and absence of hearing aid feedback), and verification of hearing aid fitting with real ear measures of hearing aid output. Automatic feedback reduction tests were not run; however, if feedback was reported it was addressed with manual adjustments to the involved gain parameters. Real ear measures were recorded using the Audioscan Verifit system to document output of the research hearing aid. The Abbreviated Profile of Hearing Aid

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26 Benefit (APHAB) questionnaire was administered at the time of the fitting to verify that speech perception measures, the hearing aids were worn bilaterally in all aided listening conditions. Participants were not informed of details regarding the setting of the Phonak hearing aid, but were asked to just complete the various listening tasks while wearing them. Objective Electroacoustic Measurement Real ear measures were recorded using the Audioscan Verifit system to document output of the Phonak aid in the speech setting at the level of the ear canal. A measure of open ear acoustics was not recorded. Revit (2002) recommends against using the patient real ear unaided response or gain (REUR/G) in the current application of real ear insertion gain (REIG) and instead recommends use of the average-ear unaided response/gain curves available within the Audioscan Verifit system. The Phonak fitting provides targets for gain at input levels of 40, 60, and 80 dB SPL. The Audioscan Verifit system provides NAL-NL1 targets for gain at input levels of 50, 65, and 80 dB SPL as well as a prediction of the Speech Intelligibility Index (SII) at various input levels. REIG was measured and SII values were generated using a pink noise stimulus for levels of 40, 65, and 80 dB SPL in order to obtain multiple level measures. Pink noise is the recommended stimulus for use with the NAL-NL1 formula (Audioscan Verifit User Manual, Section 16.6, 2008). This was deemed the most appropriate stimulus for use in (Phonak, 2008) and also due to its flat frequency response (Audioscan Verifit User Manual, Section 17.5, 2008). The participant sat directly in front of the loudspeaker (0

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27 azimuth) for measurement recordings. These measures were obtained after all fitting and programming adjustments had been made to the hearing aids at the time of the fitting of the research hearing aid. No programming changes were made to the Speech Perception Testing The speech perception of participants was evaluated using sentences from the Hearing In Noise Test (HINT) presented without competing noise and words from the Consonant-Nucleus-Consonant (CNC) word list. Both of these speech perception measures are commonly utilized in clinical assessment of speech perception of hearingimpaired listeners. The speech stimuli were presented in sound field in the soundtreated audiologic test room with the participant seated 1 to 1.5 meters away from and directly in front of the loudspeaker (0 azimuth). Speech materials were presented at a level of approximately 55 dB SPL, a moderate to soft conversational level in quiet conditions. Speech perception testing was completed for the following listening aid) and unaided. Music Ratings Participants were also asked to rate perceived quality of three musical excerpts using the previously described music rating scale that was used in an investigation by Chasin and Russo (2004). Subjects were provided with the rating scale prior to listening to the music stimuli and making perceptual judgments for each listening condition. For three different musical excerpts, participants provided ratings on the following scales: Loudness, Fullness, Crispness, Naturalness, and Overall Fidelity. The three musical excerpts represented the Pop, Rock, and Classical genres. Participants were asked to

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28 first listen to approximately 30 to 45 seconds of the 90 second excerpts before indicating their responses on the quality rating scales. The following three listening conditions were assigned in random order for each participant: speech setting Musical Excerpts Three genres (Pop, Rock, and Classical) were represented with the musical exc er p Tchiakosvsky. Multiple music samples were used rather than a single sample due to potential effects of the different frequency spectra represented by the different genres as well as differences in preference of music style for different listeners. Music Perception Testing Subjects were asked to complete all three subtests of the software based UWCAMP (previously described in the Measures/Materials section). The listening setting (Phonak hearing aid) and unaided. Soundbooth and Equipment Setup Speaker For all listening tasks (speech perception, music ratings, and music perception), subjects were seated in a sound-treated audiometric test room approximately 1 to 1.5 meters away from and directly in front of the speaker (0 azimuth). See Figure 2-1 for a diagram of the set up the soundbooth. The speaker used was the Rokit 5 Powered speaker from KRK Systems. Specifications of the speaker include a 5 inch glass

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29 aramid composite woofer and 1 inch neodymium soft dome tweeter with ferro fluid. Input to the speaker was by an XLR (3 pin) plug. A DIN plug was used at the level of the audiometer to connect to the speaker. Frequency response of the speaker is 53 Hz through 20 kHz with a peak reported SPL of 106 dB. Capabilities of the speaker include 75 Watt bi-amp dynamic power with 18 dB octave filters; however, for use in the current study, the amplification of the speaker itself was set to 0 dB. All of the above mentioned equipment was within compliance for calibration with appropriate standards from the American National Standards Institute (ANSI). Routing of signals The software-based UW-CAMP was administered via a laptop situated on a moveable desk in front of the participant. The laptop used with the UW-CAMP was connected to the audiometer via the external jack typically is used for CD input for speech audiometry using a 6 ft shielded audio cable with one 1/8 inch stereo right-angle plug to two phono (RCA) plugs. There was no audible cross talk present with use of the audio cable. The speech materials and music samples were routed to the audiometer using an Apple iPod touch. The volume level of the iPod touch was set to maximum to ensure consistent intensity level between presentations of different stimuli. The same shielded audio cable described above was used to connect the iPod touch to the external input jack of the audiometer. Output of the music and speech stimuli to the speaker was controlled via the audiometer. The level of the output for each stimulus was set using the audiometer dial.

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30 Preparation of music and speech stimuli The music excerpts were chosen through use of an an informal survey of 22 people for the purpose of identifying the most versus least memorable or recognizable songs. From results of that survey, we established a final list of three recognizable songs, each representing one genre (Pop, Rock or Classical ). We obtained quality CD recordings of each song, which we then converted to AIFF electronic form for presentation through an Apple iPod touch. We used the free downloadable software, Audacity, to analyze the AIFF versions of songs and adjust them each to be approximately equivalent in overall level relative to one another. We also converted quality CD recordings of speech test stimuli (HINT and CNC Lists) to AIFF electronic form for presentation through an Apple iPod touch. Files were loaded to iTunes for playback on the iPod touch without any further processing of the stimuli. In other words, additional features available such as volume adjustment and equalizer presets were not used. Prior to data collection, all stimuli were played through a KRK Rokit5 Studio monitor speaker, described previously, in the free field in a sound booth. The volume setting of the iPod touch was fixed at maximum volume across stimuli. Music and speech material stimuli were sampled at 0.001 ms intervals using the PULSE 12.5 spectrum/intensity analyzer from Brel & Kjr. Intervals lasting 62.5 ms (1/16 sec) of these virtually continuous data samples were averaged in 1/3-octave bands with 67% overlap across intervals. The measurement period was the duration of the individual song or word or sentence list. Constant percentage band (CPB=1/3 octave) levels were me asured in both dB SPL and dB A. Level versus time information was plotted as the summed level across CPBs (100 ms intervals). The levels obtained from measurement

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31 procedure described above were used to determine the audiometer dial setting for the desired sound level at the location of the listeners head in free-field within the sound booth for each stimulus (songs and speech materials). See Figure 2-2 for details of the frequency spectrum of the three musical excerpts. See Figure 2-3 for details of the sound level plotted over time for the three musical excerpts. Hearing Aids and Hearing Aid Fitting Equipment The hearing aids used in this study include those already owned by the participants, which encompassed a wide variety in styles as well as make and model. However, all were either custom fit in-the-ear products or used a custom earmold assembly resulting in a vented system. None of the participants utilized an open-fit system. n hearing aids is reported, specific fitting parameters and the frequency response capabilities of See Table 2-1 for a description of participants in this project was the Phonak Exelia Micro behind-the-ear (BTE) hearing aid. The Phonak disabled: WindBlock Management (reduces wind noise), EchoBlock System (adaptive re verberation canceller), and WhistleBlock Technology (identifies and reduces feedback). The microphone was kept in an omnidirectional mode. The SoundRelax (reduces impulse sounds) The reported frequency response of the Phonak Exelia Micro BTE is <100 Hz through 7200 Hz. Programming of the hearing aids was accomplished using the iPFG Successware 2.1a fitting software loaded on a Dell laptop and connected via the NOAHlink Bluetooth

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32 system. For all participants, the Music program was selected for the Startup Program and the TacTronic Switch and Volume Control were disabled. This ensured that subjects used the correct program when listening with the Phonak hearing aids.

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33 Table 2-1. Hearing aid and hearing loss information Subject label Manufacturer Model Directional Digital signal processing Style Age of hearing aids in years Duration of hearing loss in years Duration of hearing aid use in years 1 Phonak Unknown Unknown Yes ITE 3 17 11 2 Oticon Go Yes Yes ITE 3 15 3 3 Oticon Syncro Yes Yes ITE 4 15 12 4 Phonak Savia Art Yes Yes ITC 1 56 10 5 Phonak Claro Yes Yes BTE 4 48 4 6 Oticon Epoq Yes Yes RITE with custom molds 1 7 6.5 7 Oticon Tego Pro Yes Yes BTE 3 5 4.5 8 Res ound Plus 5 No Yes ITE 1 1 1 9 Phonak Extra Yes Yes BTE 3 20 20 10 Starkey unknown No Yes CIC 2 35 10 11 Oticon Syncro Yes Yes CIC 4 29 10 12 Oticon Go Pro Yes Yes BTE 1 11 10 13 Oticon Vigo Pro Yes Yes RITE with custom molds 0.5 5 0.5 14 Oticon T ego Pro Yes Yes BTE 1 4 31 15 Oticon Syncro Yes Yes ITE 3 7 3 16 Widex Senso Vita Yes Yes BTE 3 30 26 17 Resound Canta 4 Yes Yes BTE 5 56 10 18 Beltone Unknown No Yes CIC 3 50 22 19 Audibel Unknown No Yes CIC 2 17 17 20 Widex Diva Yes Yes ITC 4 44 7

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34 Table 2-2. Age, gender, and music history information Subject label Age Gender Are you satisfied with your current hearing aids for music listening Do you listen to music regularly How often do you listen to music? Do you enjoy music? What is your preferred style of music? 1 76 M Yes, considering situation with hearing loss Yes Daily Yes Quartet Singing 2 67 M Yes Yes twice a week or more Yes Old hym n s or country western 3 45 F No Yes Daily Yes A variety listens to music at work and home compu ter 4 68 F Yes Yes Daily Yes Old Time (Andy Williams, Percy Faith), 1960's 5 68 M Yes No 4 5 hours a month Yes Classical 6 65 F No No Occasionally 4 5 times a week Yes Broadway musicals, show tunes 7 69 F Yes (too much background noise in car) Yes, when in the car Only in the car Yes Easy listening, 40s, 50s, 60s 8 82 M Yes (too much background noise in car) Yes Daily Yes Country, Big Band 9 69 M No Yes Daily Yes Classical, Jazz 10 41 M Yes (too much background noise in car) Yes Daily Yes Popular and Classic Rock 11 60 M No Not much, can be annoying with his hearing the way it is weekly, TV shows Yes Popular music 12 61 M Yes Yes Daily, when driving Yes Country Music 13 66 M Yes and No No Daily Yes Old Country, Late 40s 14 40 F Yes Yes 5 t imes a week Yes Classic Rock, Folk, Classical 15 63 F Yes Yes 3 4 times a week Yes Many (rock, country, folk, classical, R&B, pop) 16 60 F Yes No once a month Yes Easy listening 17 76 M No Yes Daily Yes All types 18 72 M No Yes Daily Yes Country, Ope ra, Classical 19 59 M No Yes 6 hr/day Yes Classical, Sinatra, Ella Fitzgerald, Mozart 20 68 M Yes Yes Daily Yes Latin, 1950s

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35 Table 2-3. Pure tone air conduction audiometric thresholds in dB HL for the right e ar Subject label 250 Hz 500 Hz 750 Hz 10 00 Hz 1500 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz SRT (dB HL) PTA (dB HL) 1 35 40 DNT 40 50 70 80 80 85 85 45 50 2 45 55 DNT 50 DNT 65 95 100 105 NR 55 57 3 45 55 70 75 DNT 70 60 65 65 65 65 68 4 35 40 DNT 45 DNT 60 60 65 60 60 45 48 5 15 25 DNT 3 0 45 55 60 70 80 80 30 37 6 25 40 DNT 50 DNT 60 55 60 65 90 45 50 7 30 45 DNT 55 DNT 60 55 50 35 45 50 53 8 15 30 45 50 60 70 75 75 75 75 45 50 9 35 45 DNT 50 DNT 55 55 60 55 75 50 50 10 40 45 DNT 55 DNT 60 60 70 75 70 50 53 11 35 40 DNT 50 DNT 65 65 70 65 60 55 52 12 30 40 DNT 45 50 75 90 90 65 65 55 53 13 35 40 DNT 45 DNT 55 75 80 75 75 45 46 14 30 25 40 50 DNT 60 65 65 DNT 55 45 45 15 25 30 DNT 30 40 50 50 55 60 60 35 37 16 40 45 55 65 DNT 75 80 75 70 90 50 62 17 45 60 DNT 65 DNT 75 75 75 75 80 70 67 18 45 55 DNT 55 DNT 65 55 70 85 85 60 58 19 30 35 DNT 45 DNT 50 65 65 70 75 40 43 20 10 15 DNT 15 55 65 85 85 75 60 25 32 Average 32 40 53 48 50 63 68 71 71 71 48 51 Std. deviation 10.321 11.410 13.229 13.206 7.071 7.847 13.018 11.907 14.230 12.536 10.809 9.322 Minimum 10 15 40 15 40 50 50 50 35 45 25 32 Maximum 45 60 70 75 60 75 95 100 105 90 70 68

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36 Table 2-4. Pure tone air conduction audiometric thresholds in dB HL for the left e ar Subject label 250 Hz 500 Hz 750 Hz 1000 Hz 1500 Hz 2 000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz SRT (dB HL) PTA (dB HL) 1 40 40 DNT 40 55 70 75 75 75 70 40 50 2 25 55 DNT 40 DNT 55 75 90 85 75 50 50 3 40 55 65 70 DNT 65 60 60 60 55 55 63 4 40 45 DNT 45 DNT 60 60 55 60 60 50 50 5 5 20 DNT 30 40 45 60 65 70 7 5 35 32 6 15 30 DNT 40 DNT 50 55 45 45 65 45 40 7 40 45 DNT 50 DNT 60 45 40 45 70 45 52 8 10 25 40 45 DNT 50 65 65 70 65 40 40 9 35 40 DNT 45 DNT 50 55 55 45 60 45 45 10 40 45 DNT 55 DNT 60 60 60 65 55 50 53 11 40 45 DNT 55 DNT 60 65 65 75 60 55 53 12 30 35 DNT 45 50 75 85 85 80 60 50 52 13 35 40 DNT 40 50 60 70 75 75 70 45 46 14 20 30 40 50 DNT 60 65 60 DNT 55 40 47 15 30 35 DNT 35 40 50 50 55 55 55 40 40 16 35 40 DNT 50 DNT 60 65 70 75 80 40 50 17 45 45 65 65 DNT 70 80 85 85 85 65 60 18 50 50 DNT 55 DNT 70 75 75 70 70 60 58 19 35 40 DNT 45 DNT 45 70 60 70 70 40 43 20 10 10 DNT 15 60 65 65 70 70 55 20 30 Average 31 39 53 46 49 59 65 66 67 66 46 48 Std. deviation 12.732 11.251 14.434 11.951 8.010 8.675 10.000 12.968 12.507 9.018 9.720 8.511 Minimum 5 10 40 15 40 45 45 40 45 55 20 30 Maximum 50 55 65 70 60 75 85 90 85 85 65 63

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37 Figure 2-1 Diagram of setup of soundbooth

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38 Figure 2-2. Spectral Analysis: Average Third Octave Band Levels

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39 Figure 2-3. Sound level over time for music excerpts

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40 CHAPTER 3 RESULTS For all data analysis, an alpha level of .05 was used, where, if p <.05, then the null hypothesis was rejected. Two-sided tests of significance were reported unless otherwise noted. Objective Electroacoustic Measures Fo r each participant, objective electroacoustic measures were recorded using the Phonak hearing aid using the music setting. Measurements included real ear insertion gain (REIG) and predicted speech intelligibility index (SII) for the following input levels for both sets of hearing aids: 40, 65, and 80 dB SPL. Speech Intelligibility Index (SII) Repeated measures General Linear Model ANOVA was used to test for effect of hearing aid condition on predicted speech intelligibility. Hearing aid condition did not have a significant effect on predicted speech intelligibility for any of the input levels for the right or left ears Results indicate that predicted speech intelligibility was not compromised for individuals listening in the music setting of the Phonak hearing aid. Refer to Figure 3-1 and Table 3-1 for a summary of findings including statistical values and descriptive statistics for SII measures. Real Ear Insertion Gain (REIG) Repeated measures General Linear Model ANOVA was used to test for effect of hearing aid condition on measured REIG. A significant effect of hearing aid condition was found for some of the REIG measures for the right and left ears. These results indicate significant differences between the two sets of hearing aids in terms of the

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41 amount of gain provided. The amount of gain in the music setting of the Phonak hearing aids differed significantly from the amount of gain provided in the speech setting the right ear, the music setting of the Phonak hearing aids provided significantly less d 500 Hz (both at 40 dB SPL input level) and at 1500 Hz (at 65 dB SPL input level). Also for the right ear, the music setting of the Phonak hearing aids provided significantly more gain Hz and 6000 Hz (both at 65 and 80 dB SPL input levels). For the left ear, the music setting of the Phonak hearing aids provided significantly less gain than the speech setting of the t levels), 500 Hz (for 40 and 65 dB SPL input levels), 750 Hz (at 40 dB SPL input level), and at 1500 Hz (at 40 dB SPL input level). Also for the left ear, the music setting of the Phonak hearing aids provided significantly more gain than the speech setti hearing aids at 6000 Hz (at 65 and 80 dB SPL input levels). Refer to Figure 3-2 and Tables 3-2 and 3-3 for a summary of findings including statistical values and descriptive statistics for REIG measures. Refer to Appendix B for a summary of raw data regarding prescriptive gain targets and REIG measurements for each participant. Music Ratings by Listening Condition Music ratings were completed by each participant in three listening conditions: using the speech setting of the pa the Phonak hearing aids, and unaided. Repeated measures General Linear Model ANOVA was used to detect effects of the three listening conditions for the three musical excerpts that were used for this task. The results were analyzed for the five individual

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42 scale responses (Loudness, Fullness, Crispness, Naturalness, and Overall Fidelity) and for the total score of the music rating. When the five individual scale responses are all combined, the total score has the potential to be 25. For all rating scales and the total music rating, a significant main effect of listening condition was found for all three musical excerpts. For all rating scales and the total music rating, pairwise comparisons (LSD no adjustments for multiple comparisons) showed that use of the speech setting aids resulted in significantly higher quality ratings than the unaided listening conditio n for all three musical excerpts. Pairwise comparisons also indicated significantly higher quality ratings for the music setting of the Phonak hearing aids than the speech setting usical excerpts: Fullness (Rock), Crispness (Pop and Classical), Naturalness (Rock), Overall Fidelity (Pop and Classical), and Total Music Rating (Pop, Rock, and Classical). For the following rating scales and musical excerpts the assumption of sphericity for the repeated measures General Linear Model ANOVA was violated, so the GreenhouseGeisser correction was applied within the model: Loudness scale (Rock and Classical) and Fullness scale (Rock and Classical). Refer to Figure 3-3 and Table 3-4 for a summary of findings including statistical values and descriptive statistics for the music rating scale results. Music Perception, Song Preference, and Personality Factors Each participant completed a personality questionnaire (MIPS), which results in a profile of personality based on 6 motivating styles, 8 thinking styles, and 10 behaving ratings. Each participant was also asked to rate the three song excerpts (Pop selection

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43 Let It Be, Rock selection We Will Rock You, and Classical Selection Dance of the Sugarplum Fairies, Nutcracker) in order of preference. Personality traits were also compared with song preference. Linear regression was used to test the effects of individual personality factors as predictors for the dependent variable of subjective music ratings. The personality factor labeled 8A with high prevalence scores for the song rating scores in the music setting of the Phonak hearing aids listening condition for the Pop and Rock musical excerpts. The personality factor labeled 6A with high prevalence tor for total song rating scores in the music setting of the Phonak hearing aids listening condition for the Classical musical excerpt. The personality factor labeled 10B with high prevalence to be a predictor for total song rating scores in the unaided listening condition for the Pop and Rock musical excerpts. All significant predictors were found to have a moderately strong positive correlation with the dependent variable, meaning that individuals with higher prevalence scores for the indicated personality factors tended to generate a total music quality rating that was higher for the affected dependent variable(s). No predictors were found for the following dependent variables: total music rating in the speech setting of the unaided listening condition for the Classical musical excerpt. Discriminant analysis was used to detect the potential effect preference ranking for the three musical excerpts (Pop, Rock, and Classical). Discriminant analysis indicated the following personality factors as predictors of song

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44 preference ranking: Motivating Style 1A Pleasure-Enhancing and Behaving Style 9B Confident-Asserting. The personality factor 1A was most highly predictive of the following song preference ranking of most to least favored: Pop, Classical, and Rock. The personality factor 9B was most highly predictive of the following song preference ranking of most to least favored: Rock, Classical, Pop. Linear regression was used to test whether individual song preference rankings served as a predictor for music quality ratings. No effect of song preference was found for music quality ratings indicating that individuals did not allow their preference for a particular type of music to affect their ratings of the quality of the different musical excerpts. Refer to Table 3-5 for a summary of findings including statistical values for the effects of personality factors. Music Perception by Listening Condition The UW-CAMP was completed by each participant in three listening conditions: setting of the Phonak hearing aids, and unaided. Repeated measures General Linear Model ANOVA was used to detect effects of the three listening conditions on performance in the three subtests of the UW-CAMP. The results were analyzed for the each of the three subtests: pitch perception, melody identification, and timbre identification. For the pitch perception subtest the assumption of sphericity for the repeated measures General Linear Model ANOVA was violated, so the Greenhouse-Geisser correction was applied within the model. For performance on all three subtests, no effect of listening condition was found. Refer to Figures 3-4 and 35 and Table 3-6 for a summary of findings including statistical values and descriptive statistics for performance on the UW-CAMP.

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45 Speech Perception by Listening Condition Speech perception tasks were completed by each participant in three listening music setting of the Phonak hearing aids, and unaided. Repeated measures General Linear Model ANOVA was used to detect effects of the three listening conditions for performance on lists of CNC words and HINT sentences presented in quiet. Two lists each of the CNC and the HINT material were presented for each listening condition. Scores were averaged for the two lists presented to generate a total score for performance on the CNC and HINT materials for each listening condition. Scores on the CNC word lists consisted of a word score and phoneme score. For the repeated measures General Linear Model ANOVA, the assumption of sphericity was violated for scores on the CNC words and HINT lists in quiet. For these models, the GreenhouseGeisser correction was used. Results indicated a significant main effect for listening conditions for the CNC word (F[49.865]; p < .01) and phoneme (F[34.686]; p <.01) scores and for the HINT (F[13.686]; p < .01) scores. Pairwise comparisons showed that for all speech measures, performance in the unaided condition was significantly worse than both the music setting of the Phonak hearing aids and the speech setting of the performance using the music setting of the Phonak hearing aids and the speech setting materials in quiet was not compromised by listening in the music setting of a hearing aid. It is possible that differences were not detected between the two hearing aid conditions due to a ceiling effect of performance on the HINT and possibly the CNC. Future studies should include a more challenging speech perception protocol such as

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46 speech in a background of noise. Refer to Figure 3-6 and Table 3-7 for a summary of findings including statistical values and descriptive statistics for the speech perception tasks. Qualitative Analysis It was not a direct stated purpose of the study to determine what factors might predict music quality ratings or performance on the subtests of the UW-CAMP. However, because some individuals were found to indicate more benefit from use of the music setting in the music quality ratings while others were not, further analysis of the data was conducted to determine what characteristics, if any, might differ between these two groups of people. In addition, although there was no significant effect of listening condition on performance for the three subtest of the UW-CAMP, some individuals did perform better than others and reflect greater benefit with use of the music setting of the Phonak hearing aid while others reflected best performance with their own hearing aids. Specific characteristics of these individuals were also explored. Linear regression was used to test the effects of the several variables as predictors for the dependent variables of subjective music ratings and performance on the UW-CAMP subtests S pecifically, variables were tested as predictors of the benefit calculated as the difference between ratings and UW-CAMP performance for the two hearing aid conditions (music setting of the Phonak hearing aid versus the speech setting of the potential predictors: age; gender; duration of hearing loss; duration of hearing aid use; duration of hearing loss prior to beginning use of hearing aids; age, style, and music rating of the Pop and Classical musical excerpts, no predictors were found for the

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47 benefit perceived with the music setting. For the total music rating of the Rock musical excerpt, duration of hearing aid use was found to be a significant predictor of benefit perceived with the music setting. A significant strong positive correlation was found between duration of hearing aid use and benefit perceived with the music setting when rating the Rock musical excerpt (F [25.903]; p < .0 1; Pearson correlation = .806) meaning that longer duration of hearing aid use was associated with greater benefit perceived in the music setting for the Rock musical excerpt For benefit reflected in performance on the pitch perception subtest of the UW-CAMP with use of the music setting, manufac significant predictor of benefit reflected in performance on the pitch perception subtest with base frequency of 262 Hz. For benefit reflected in performance on the pitch perception subtest of the UW-CAMP with use of the music setting, manufacturer and benefit reflected in performance on the pitch perception subtest with base frequency of 330 Hz. Age predictor of benefit reflected in performance on the pitch perception subtest with base frequency of 391 Hz, when using the music setting. The relationship was a negative correlation ind from use of the music setting than those with newer hearing aids. See Table 2-1 for Results indicated that for the melody and timbre subtests of the UW-CAMP, no predictors were found for the benefit reflected in performance with the music setting.

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48 Informal observation of the data, shows that for the three subjects who showed greatest benefit with the music setting for total music ratings of the Rock excerpt, duration of hearing aid use was 12, 31, and 26 years. For the three subjects who showed greatest benefit with the music setting for performance on the pitch perception subtest with base frequency of 262 Hz, manufacturers of their own hearing aids were Starkey and Oticon. For the three subjects who showed greatest benefit with the music setting for performance on the pitch perception subtest with base frequency of 330 Hz, manufacturers and styles of their own hearing aids were Resound/ITE, Phonak/BTE, and Oticon/CIC. Although it was not intended as a specific outcome of this study, the APHAB was completed by participants to document the appropriateness of their current use of amplification. Results indicated that participants were receiving appropriate hearing aid benefit using their own hearing aids. See Table 3-8 for a summary of APHAB scores.

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49 Table 3-1. Speech Intelligibility Index (SII) Ear Input level Condition Mean Std. deviati on Main effect (F) Pairwise comparisons ( p ) Right 40 dB SPL Subject 54.10 14.553 .409 0.530 Phonak 52.45 9.923 65 dB SPL Subject 50.15 14.254 .323 0.577 Phonak 48.80 11.124 80 dB SPL Subject 40.85 13.088 .610 0.444 Phonak 42.40 11.989 Left 40 dB SPL Subject 58.40 12.991 .902 0.354 Phonak 56.60 9.069 65 dB SPL Subject 54.35 13.374 .288 0.598 Phonak 53.30 10.100 80 dB SPL Subject 45.25 12.863 1.117 0.304 Phonak 47.00 11.022 NOTE: No significant differences we re noted between hearing aid conditions for predicted SII at any input levels.

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50 Table 3-2. Real Ear Insertion Gain (REIG) in dB SPL for right e ar Ear Frequency Input level Condition Mean Std. deviation Pairwise comparisons ( p ) Notes Right 250 Hz 40 dB SPL Subject 1.500 3.236 < .05 Phonak less gain Phonak 0.200 1.240 65 dB SPL Subject 0.550 2.114 0.707 Phonak 0.400 1.231 80 dB SPL Subject 0.200 1.989 0.785 Phonak 0.100 1.334 500 Hz 40 dB SPL Subject 7.650 6.352 < .05 Phonak less gain Phonak 4.450 4.548 65 dB SPL Subject 4.350 4.837 0.398 Phonak 3.550 3.591 80 dB SPL Subject 2.000 3.539 0.416 Phonak 2.650 2.777 750 Hz 40 dB SPL Subject 12.300 8.951 0.262 Phonak 10.250 7.115 65 dB SPL Subject 7.600 7.029 0.440 Phonak 6.400 6.369 80 dB SPL Subject 3.550 5.216 0.175 Phonak 5.100 5.300 1000 Hz 40 dB SPL Subject 16.050 10.460 0.340 Phonak 13.900 7.594 65 dB SPL Subject 11.300 8.118 0.512 Phonak 10.000 6.316 80 dB SPL Subject 6.200 6.313 0.382 Phonak 7.600 5.286 1500 Hz 40 dB SPL Subject 22.950 11.772 0.700 Phonak 21.350 17.107 65 dB SPL Subject 21.600 10.495 < .05 Phonak less gain Phonak 16.800 6.678 80 dB SPL Subject 16.000 8.748 0.145 Phonak 13.450 5.916 2000 Hz 40 dB SPL Subject 18.450 11.161 0.540 Phonak 20.000 7.427 65 dB SPL Subject 17.600 9.583 0.814 Phonak 18.100 6.215 80 dB SPL Subject 12.650 7.400 0.564 Phonak 13.650 5.752 3000 Hz 40 dB SPL Subject 13.100 11.452 0.588 Phonak 14.550 5.453 65 dB SPL Subject 11.400 10.908 0.164 Phonak 14.950 5.336 80 dB SPL Subject 6.050 8.805 0.053 Phonak 11.050 6.312

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51 Table 3-2. Continued. Ear Frequency Input level Condition Mean Std. deviation Pairwise comparisons ( p ) Notes 4000 Hz 40 dB SPL Subject 9.700 9.009 0.707 Phonak 10.600 6.427 65 dB SPL Subject 8.200 8.918 < .05 Phonak more gain Phonak 12.800 5 .217 80 dB SPL Subject 2.500 7.640 < .01 Phonak more gain Phonak 8.850 5.363 6000 Hz 40 dB SPL Subject 5.500 4.947 0.098 Phonak 8.150 4.727 65 dB SPL Subject 0.400 9.173 < .01 Phonak more gain Phonak 11.050 6.716 80 d B SPL Subject 5.000 8.627 < .01 Phonak more gain Phonak 7.750 5.618

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52 Table 3-3. Real Ear Insertion Gain (RIEIG) in dB SPL for left e ar Ear Frequency Input level Condition Mean Std. deviation Pairwise comparisons ( p ) Notes Left 250 Hz 40 dB SPL Subject 3.150 4.591 < .05 Phonak less gain Phonak 1.050 2.417 65 dB SPL Subject 2.200 2.505 < .05 Phonak less gain Phonak 1.200 1.642 80 dB SPL Subject 1.450 2.012 < .05 Phonak less gain Phonak 0.850 1.387 500 Hz 40 dB SPL Subject 8.300 8.007 < .05 Phonak less gain Phonak 4.100 4.388 65 dB SPL Subject 5.100 5.955 < .05 Phonak less gain Phonak 2.350 3.048 80 dB SPL Subject 2.600 3.331 0.234 Phonak 1.800 2.441 750 Hz 40 dB SPL Subject 11.950 10 .699 < .05 Phonak less gain Phonak 8.100 7.738 65 dB SPL Subject 7.200 9.012 0.140 Phonak 4.700 6.292 80 dB SPL Subject 3.150 5.824 0.549 Phonak 3.800 4.873 1000 Hz 40 dB SPL Subject 15.700 9.879 0.068 Phonak 12.100 7.312 65 dB SPL Subject 10.950 8.513 0.321 Phonak 9.100 6.265 80 dB SPL Subject 5.200 6.387 0.178 Phonak 7.050 5.365 1500 Hz 40 dB SPL Subject 21.700 9.102 < .01 Phonak less gain Phonak 16.950 7.309 65 dB SPL Subject 20.200 8.495 < .01 Phonak less gain Phonak 15.400 6.435 80 dB SPL Subject 14.900 7.867 0.077 Phonak 12.450 5.726 2000 Hz 40 dB SPL Subject 19.550 8.696 0.512 Phonak 18.350 5.806 65 dB SPL Subject 18.500 7.473 0.196 Phonak 16.200 4.830 80 dB SPL Subject 12.950 6.160 0.530 Phonak 12.100 4.541 3000 Hz 40 dB SPL Subject 14.200 8.776 0.651 Phonak 13.350 4.848 65 dB SPL Subject 12.500 7.990 0.447 Phonak 13.900 4.303 80 dB SPL Subje ct 7.050 7.200 0.066 Phonak 10.350 4.682

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53 Table 3-3. Continued. Ear Frequency Input level Condition Mean Std. deviation Pairwise comparisons ( p ) Notes 4000 Hz 40 dB SPL Subject 10.500 8.678 0.904 Phonak 10.250 6.904 65 dB SPL Su bject 9.150 8.816 0.254 Phonak 11.750 6.016 80 dB SPL Subject 3.700 8.523 0.056 Phonak 8.350 6.098 6000 Hz 40 dB SPL Subject 4.850 8.145 0.155 Phonak 7.600 4.925 65 dB SPL Subject 0.550 10.354 < .01 Phonak more gain Phonak 10.500 7.045 80 dB SPL Subject 2.450 8.841 < .02 Phonak more gain Phonak 7.150 6.360

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54 Table 3-4. Music rating scales by condition Rating scale Musical excerpt & main effects of condition Condition Mean Std. deviation Pairwise comparisons ( p ) Notes Unaided subject Unaided phonak Subject phonak Loudness Pop Unaided 2.50 1.00 < .01 < .01 .131 F[22.101] Subject 3.95 1.15 p < .01 Phonak 4.40 0.60 Rock Unaided 3.45 0.83 < .01 < .01 .267 F[36.516] Subject 4.75 0.55 p < .01 Phonak 4.90 0.31 Classical Unaided 3.15 1.04 < .01 < .01 .214 F[29.485] Subject 4.60 0.68 p < .01 Phonak 4.80 0.41 Fullness Pop Unaided 2.70 0.98 < .01 < .01 .053 F[19.127] Subject 3.85 1.09 p < .01 Ph onak 4.40 0.68 Rock Unaided 3.20 0.70 < .01 < .01 <.05 Phonak rated significantly higher than Subject F[43.421] Subject 4.40 0.82 p < .01 Phonak 4.75 0.55 Classical Unaided 3.30 1.22 < .01 < .01 .379 F[20.693] Subject 4.55 0.76 p < .01 Phonak 4.70 0.57 Crispness Pop Unaided 2.60 1.05 < .01 < .01 < .01 Phonak rated significantly higher than Subject F[24.974] Subject 3.70 1.08 p < .01 Phonak 4.60 0.68 Rock Unaided 2.80 1.06 < .01 < .01 .330 F[32.818] Subje ct 4.20 0.89 p < .01 Phonak 4.40 0.75 Classical Unaided 3.00 1.26 < .01 < .01 < .01 Phonak rated significantly higher than Subject F[24.643] Subject 4.10 0.72 p < .01 Phonak 4.70 0.57 Naturalness Pop Unaided 2.75 1.21 < .01 < .01 .077 F[14.577] Subject 3.90 1.12 p < .01 Phonak 4.45 0.83 Rock Unaided 3.20 1.06 < .01 < .01 < .01 Phonak rated significantly higher than Subject F[23.504] Subject 4.20 0.89 p < .01 Phonak 4.75 0.44 Classical Unaided 3.15 1.2 3 < .01 < .01 .262 F[20.310] Subject 4.40 0.82 p < .01 Phonak 4.65 0.75 Overall Fidelity Pop Unaided 2.80 1.11 < .01 < .01 < .01 Phonak rated significantly higher than Subject F[18.615] Subject 3.75 0.97 p < .01 Phonak 4.50 0.61 Rock Unaided 3.15 0.88 < .01 < .01 .057 F[28.847] Subject 4.35 0.75 p < .01 Phonak 4.75 0.44 Classical Unaided 3.20 1.01 < .01 < .01 < .05 Phonak rated significantly higher than Subject F[25.322] Subject 4.35 0.81 p < .01 Phonak 4.75 0.44

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55 Table 3-4. Continued Rating scale Musical excerpt & main effects of condition Condition Mean Std. deviation Pairwise comparisons ( p ) Notes Unaided subject Unaided phonak Subject phonak Total Music Rating Pop Unaided 13.35 4.48 < .01 < .01 < .05 Phonak rated significantly higher than Subject F[26.068] Subject 19.15 4.89 p < .01 Phonak 22.35 2.72 Rock Unaided 15.80 3.24 < .01 < .01 < .05 Phonak rated significantly higher than Subject F[64.612] Subject 21.90 3.16 p < .01 Phonak 23.55 1.73 Classical Unaided 15.80 5.13 < .01 < .01 < .05 Phonak rated significantly higher than Subject F[34.393] Subject 22.00 3.11 p < .01 Phonak 23.60 1.82 NOTE: In all scales for all musical excerpts, the Unai ded condition rated significantly worse (lower) than both the Subject and Phonak conditions. Only significant differences between Subject and Phonak ratings are noted in the table.

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56 Table 3-5. Personality factors as predictors of dependent variables (music ratings and song preference rankings) Dependent variable Condition Musical e xcerpt MIPS predictor(s) Significance ( p ) Partial correlation Total music rating Unaided Pop Behaving style (10B: dutiful/conforming) < .05 0.502 Rock Behaving sty le (10B: dutiful/conforming) < .05 0.594 Classical none Subject Pop none Rock none Classical none Phonak Pop Behaving style (8A: asocial/withdrawing) < .05 0.542 Rock Behaving style (8A: asocial/withdrawing) < .05 0.474 Classical Thinking s tyle (6A: thought guided) < .05 0.493 Canonical correlation Song ranking N/A N/A Motivating Style (1A: Pleasure Enhancing) 0.941 Behaving Style (9B: Confident Asserting) NOTE: No significant predictors were foun d for the Unaided (Classical) condition or the Subject (Pop, Rock, and Classical) conditions.

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57 Table 3-6. University of Washington Clinical Assessment of Music Perception (UWCAMP) by listening condition UW CAMP subtest Base frequency Condition Mean Std. deviation Pitch Perception 262 Hz Unaided 1.486 1.256 F[0.572]; p = 0.569 Subject 1.919 1.671 Phonak 1.601 1.492 330 Hz Unaided 1.634 1.873 Subject 1.928 2.329 Phonak 1.356 1.133 391 Hz Unaided 2.128 2.915 Subject 2.109 3.051 Phonak 2.548 3.158 Melody N/A Unaided 0.590 0.296 F[0.335]; p = 0.718 Subject 0.607 0.235 Phonak 0.581 0.281 Timbre N/A Unaided 0.610 0.184 F[1.919]; p = 0.161 Subject 0.604 0.180 Phonak 0.646 0.148 NOTE: No main effect of listening cond ition was found for any of the above measures (F and p values in table).

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58 Table 3-7. Measures of speech understanding by listening condition Speech material Condition Mean Std. deviation Pairwise comparisons ( p ) Unaided subject Unaided phonak S ubject phonak CNC Word Score Unaided 0.35 0.25 < .01 < .01 0.072 F[49.865]; p < .01 Subject 0.70 0.22 Phonak 0.65 0.17 CNC Phoneme Score Unaided 0.53 0.28 < .01 < .01 0.083 F[34.686]; p < .01 Subject 0.83 0.16 Phonak 0.80 0.16 HINT i n quiet Unaided 0.69 0.37 < .01 < .01 0.882 F[13.686]; p < .01 Subject 0.95 0.11 Phonak 0.95 0.09 NOTE: For all speech materials a main effect of condition was noted (F and p values in table). Pairwise comparisons indicated significantly bette r performance in both the Subject and Phonak conditions than the Unaided condition with no significant differences noted between Subject and Phonak conditions.

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59 Table 3-8. Abbreviated Profile of Hearing Aid Benefit (APHAB) regarding fitting of pa Condition Ease of communication Background noise Reve r beration Aversiveness Global scores Mean Scores Unaided 0.59 0.74 0.71 0.24 0.68 Aided 0.19 0.33 0.28 0.46 0.27 Benefit 0.40 0.14 0.43 0.23 0.41

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60 Figure 3-1. Speech Intelligibility Index (SII)

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61 Figure 3-2. Mean Real Ear Insertion Gain (REIG) for 40 dB SPL (A), 65 dB SPL (B), and 80 dB SPL (C) input levels for right and left ears in dB SPL

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62 Figure 3-3. Music ratings by listening condition for Loudness (A), Fullness (B), Crispness (C), Naturalness (D), Overall Fidelity (E), and Total Music Ratings (F)

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63 Figure 3-3. Continued.

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64 Figure 3-4. Thresholds for the University of Washington Clinical Assessment of Music (UW-CAMP) pitch perception subtest by listening condition

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65 Figure 3-5. Performance on the University of Washington Clinical Assessment of Music Perception (UW-CAMP) for the melody and timbre subtests

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66 Figure 3-6. Performance on speech materials by listening condition

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67 CHAPTER 4 DISCUSSION Hearing-impaired individuals may experience difficulties in enjoying music even with the use of hearing aids (Leek et al., 2008). Formal investigation of the relationship between hearing aid use and music perception is limited. Although music has been utilized for sound quality judgments in investigations of amplification use for hearingimpaired listeners (Punch, 1978; Hawkins and Naidoo, 1993; Gabrielsson et al., 1988; VanBuurn et al., 1999; Moore et al., 2005; Ricketts, Dittbemer and Johnson, 2008; Tan and Moore, 2008), to our knowledge there are no published reports of the effects of digital hearing aid circuitry designed for enhancement of music signals on music perception of hearing-impaired listeners. The present investigation evaluated for a group of individuals with hearing loss, the potential benefit of using the music setting in a Phonak hearing aid versus using the speech setting in their own hearing aids or listening without amplification (unaided) when listening to specific musical excerpts and completing music perception tasks. We anticipated that the music setting of the Phonak aids for music listening and that musical quality ratings would reflect this perceived benefit. Summary of Music Quality Ratings Hearing-impaired subjects in this investigation perceived superior music quality when listening with a hearing aid in the music setting in comparison to listening with their own hearing aids or without amplification. For a report of significant findings on the quality ratings scales see the Results section of this text. We are not aware of other reports of user perception of music quality with use of the music setting in a clinically

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68 available hearing instrument. The current investigation showed that hearing aid users do prefer the use of the music setting in a hearing aid such as the Phonak Exelia behind-the-ear device over the use of the speech setting in their own hearing aids or no amplification at all. Future investigations should include other hearing aid models and hearing aids from various manufacturers as there may be some effects of differences in hearing aid circuitry as well as proprietary gain algorithms. In the current investigation, participants were not provided the opportunity to acclimate to the Phonak Exelia hearing varied by participant. This was not found to be a significant predictor of benefit, but it is an important factor to keep in mind regarding the potential effects of acclimation or lack thereof. Potential reasons for the preference for the music setting for music listening include a flatter frequency response due to use of omnidirectional processing and a gain algorithm that provides more linear amplification in the high frequencies. In addition, in the music setting, algorithms for wind noise reduction, background noise reduction, impulse sound reduction, and cancellation or reduction of feedback were disabled. hearing aids may be related to the use of directional microphone processing, feedback and noise reduction algorithms, and gain that utilizes more compression in the high frequencies than the music setting. In the current investigation it is not known exactly hearing aids. However, it is likely that for a number of participants one or all of these speech setting characteristics served to degrade the perceived quality of the music signal. We cannot conclusively rule out the possibility that the digital circuit and fitting

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69 algorithm of the Phonak hearing aid itself or even the placebo effect and rather than the music setting, contributed to user preference. Since participants were not blinded to what hearing aid or setting was in use, it is also possible that they demonstrated a bias towards the Phonak hearing aid. However, we did find that the following characteristics of the participants own hearing aids did not have a significant effect on perceived benefit with the Phonak hearing aids for the music rating outcomes: age, manufacturer, or style of hearing aids. Our findings are consistent with those of Leek et al. (2003) indicating that some hearing aid users do experience difficulty with music listening. The participants of the current study, which included adult and elderly hearing aid users certainly perceived benefit when listening to music in the music setting. Based on these findings, we believe it would be appropriate to incorporate a music setting into hearing aid fittings for adult and elderly hearing aid users. Development of a New Music Quality Rating Tool It appears that the music rating scale used in the present study may be inadequate for investigation of the relation between amplification and music perception. In both of the aided conditions (the Phonak hearing aids and p possible ceiling effect was apparent, which could have made it difficult to detect true differences between the two aided listening conditions. Additionally, some participants made comments to the effect that they were not completely familiar with the concept associated with a particular rating scale. One participant suggested including a scale to address the clarity of lyrics within a musical excerpt. Another potential scale to include would be discernability of individual instruments. As stated in a previous section of the text, the scale used in this investigation has not been validated. It was developed for use in a study of the perception of music quality as it related to various peak input

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70 limiting levels in an experimentally designed wearable device. Although, this scale provides a starting point for investigating the perception of the quality of a music signal, an alternative measurement tool for investigating the relationship between amplification and music appreciation might be more appropriate. We propose the use of a continuous scale on which a participant can mark a response between two extremes as opposed to a discrete choice of one through five. For example, for a scale labeled uld provide a scale with the descriptor completely unintelligible at the far left end and completely intelligible at the far right end. This would allow a person to indicate how intelligible or unintelligible the lyrics seem to be. The researcher would then simply apply a score to the response by measuring where on the continuous scale the response was indicated. A number of other ratings scales should be included in the initial development of the rating scale. A measurement tool of this sort would require validation in a group of hearing-impaired listeners who use amplification. Through validation of the new measurement tool some of the individual scales would be combined or eliminated if they are found to be closely correlated to on e another. Relationship between Objective and Subjective Findings Findings also supported the notion of a relationship between hearing aid output in the music setting and perceived quality of the musical excerpts. Objective electroacoustic measures of hearing aid output showed significant differences in the high frequency output of the hearing aid settings. Specifically, the music setting of the Phonak hearing aids provided more gain for medium (65 dB SPL) and loud (80 dB SPL) inputs than the speech setti for high frequency aspects of the musical signal likely contributed to the perception of a

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71 crisper musical signal. Statistical findings regarding hearing aid output and music quality ratings were consistent with observations made by participants. As mentioned in an earlier section of the text, Franks (1982) found that, while individuals with normal hearing preferred an extended high and low frequency range for listening to analog hearing aid processed music, individuals with hearing loss preferred an extended low frequency range. It is plausible that introducing more gain for medium and loud inputs for some of the lower frequencies, might serve to further increase the quality perception of the music signal in the music setting of a digital hearing aid as well. Recordings of electroacoustic output in the current study indicated that the music setting in fact provided significantly less gain at low frequencies than the speech setting of the par increased low frequency amplification on perception of the quality of a music signal. Although the technology used in an investigation by VanBuuren et al. (1999) is not necessarily comparable to the digital hearing aid circuit used in the current study, our findings are consistent with those of VanBurren in regards to a preference for linear amplification for music listening. This seems to be the case based on objective findings in the current study reflecting more linear gain characteristics for the music setting. However, our findings differ from those of Davies-Venn et al. (2007) who found that listeners with mildto -moderate hearing loss indicated a slightly significant preference for WDRC over linear amplification with peak clipping or compression limiting when rating the pleasantness and perceived quality of music. Davies-Venn et al. investigated the effects of linear versus non-linear circuitry on quality ratings for speech and music. The authors mentioned that WDRC may have been preferred due to the variable intensity of

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72 the music signal where WDRC might serve to increase the perception of some of the softer sounds in a musical piece that a hearing-impaired individual could miss. Participant Observations Consistent with the statistical findings, participants made several observations everything, wow," after listening to the musical excerpts in the music setting of the Phonak hearing aid. Another participant stated that with the music setting of the Phonak hearing aid she could feel the emotion of the music and the experience was much better. Another participant made the observation that the primary difference noticed between the speech setting of his own hearing aids and music setting of the Phonak hearing aids was crispness of the signal. Assessment of Music Perception We did not find a relationship between listening condition (use of hearing aids or unaided) and performance on any of the UW-CAMP subtests. The designers of the UW -CAMP did not intend it specifically for use with hearing-impaired individuals who use hearing aids, but rather for use with cochlear implant users (Nimmons et al., 2008). Clear differences exist between the auditory system mechanics for hearing aid and cochlear implant users. At its simplest, hearing aid users have the advantage of varying degrees of residual hearing as well as acoustic stimulation of the auditory system structures. Whereas cochlear implant users traditionally have minimal to no usable residual hearing to make use of acoustical stimulation of the auditory system and function exclusively on electrical stimulation of the auditory nerve at the level of the cochlea. Further explanation of this process is beyond the scope of this paper. Looi et al. (2008) found significant differences in the perceptual abilities of cochlear implant

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73 users and hearing aid users for pitch perception in music listening tasks with hearing aid users demonstrating superior performance. Additionally, the general audiometric configuration for the participants in this study indicated preserved low frequency hearing or hearing thresholds reflective of no worse than a mild to moderate hearing loss. This residual low frequency hearing could have certainly played a role in performance on the pitch perception tasks, which used fairly low base frequencies. Consequently, one can see that a measurement tool that is sensitive to differences in perceptual abilities of cochlear implant users might not be appropriate for use with hearing aid users. Personality Factors as Predictors of Outcomes Interestingly, even with the relatively small sample size of the current investigation, music quality and song preference rankings. Specifically, people who were classified as more dutiful or conforming tended to rate the Pop and Rock excerpts higher in total music quality in the unaided listening condition. Participants classified as more asocial or withdrawing tended to rate the Pop and Rock excerpts higher in total music quality in the music setting listening condition while those classified as thought-guided tended to rate the Classical excerpt higher in total music quality in the music setting listening condition. There were no significant effects of personality factors found in the listening own hearing aids. It is not clear what these findings mean specifically, however, it is clear that some aspects of personality do different listening conditions and for different types of music. This relationship might be more clearly defined if a personality profile assessment and music ratings protocol was used with a larger group of participants. Additionally, people who were classified as

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74 more pleasure-enhancing tended to rank preference of the three musical excerpts in the following order: Pop, Classical, and Rock. People who were classified as more confident and asserting tended to rank preference of the three musical excerpts in the following order: Rock, Classical, and Pop. Interestingly, individual preference of the three musical excerpts did not have a significant effect on music quality ratings, lending credibility to the responses provided by the participants. Speech Perception in the Music Setti ng Speech perception did not appear to be compromised by use of the music setting. We anticipated that speech perception in quiet of traditional clinically utilized speech materials would not be significantly affected by use of the music setting. Results indicated that there was no significant difference in performance between use of the hearing aids. This finding was encouraging when considering that participants did not get the opportunity to acclimate to the new hearing aid settings prior to testing. However, it is possible as noted previously in the text that differences were not found due to ceiling effects with the speech materials used. Our measurements of speech perception did not include any speech in the presence of background noise stimuli. Future investigations could certainly take into account listening in a background of noise, speech, or music.

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75 CHAPTER 5 CONCLUDING REMARKS We believe findings of the current investigation support the use of a music setting for music listening with hearing aids. Our findings also provide a basis for future investigations regarding music listening with hearing aids. Future studies should include additional styles, models, and manufacturers of hearing aids. Gain characteristics regarding the extension of low and high frequency ranges as well as implementation of linear gain at the extended low and high frequency ranges should be investigation. These gain characteristics could also be investigated in alternative transducers for hearing-impaired users desire an alternative to coupling the hearing aids with the music playing device. For example, an investigation could apply various gain characteristics to the music signal to be played through earbud style earphones or circum-aural headphones. Similarly, the above mentioned gain characteristics should be investigated in the music setting of a digital hearing aid.

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76 APPENDIX A INFORMED CONSENT FORM

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86 APPENDIX B TABLES OF HEARING AID OUTPUTS AND TARGETS

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87 Table B. Hearing aid outputs and prescriptive target levels in dB SPL Subject label Target or REIG* Right ear (soft input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 1 A 5 n/a 17 23 n/a 29 32 n/a 34 n/a n/t n/a n/t n/t n/a B n/a 4 n/a n/a 14 n/a n/a 33 n/a 46 n/a 42 n/a n/a 21 C 0 n/a 1 8 n/a 12 14 n/a 19 n/a 7 n/a 4 4 n/a D 2 n/a 1 2 n/a 9 22 n/a 23 n/a 24 n/a 26 9 n/a 2 A 12 n/a 24 29 n/a 35 37 n/a 37 n/a n/t n/a n/t n/t n/a B n/a 13 n/a n/a 17 n/a n/a 30 n/a 45 n/a 40 n/a n/a 19 C 1 n/a 17 22 n/a 16 18 n/a 28 n/a 24 n/a 6 11 n/a D 8 n/a 13 17 n/a 18 23 n/a 24 n/a 21 n/a 7 3 n/a 3 A 17 n/a n/t n/t n/a 4 6 45 n/a 42 n/a 37 n/a n/t n/t n/a B n/a 14 n/a n/a 29 n/a n/a 36 n/a 40 n/a 36 n/a n/a 18 C 2 n/a 6 22 n/a 29 32 n/a 29 n/a 23 n/a 12 6 n/a D 9 n/a 20 25 n/a 28 36 n/a 26 n/a 22 n/a 20 5 n/a 4 A 4 n/a 17 23 n/a 30 33 n/a 33 n/a 30 n/a n/t n/t n/a B n/a 3 n/a n/a 15 n/a n/a 30 n/a 40 n/a 39 n/a n/a 19 C 2 n/a 1 8 n/a 12 15 n/a 17 n/a 18 n/a 15 9 n/a D 2 n/a 17 26 n/a 31 34 n/a 27 n/a 27 n/a 21 18 n/a 5 A 0 n/a 8 16 n/a 22 28 n/a 29 n/a 27 n/a n/t n/t n/a B n/a 1 n/a n/a 4 n/a n/a 24 n/a 3 5 n/a 32 n/a n/a 11 C 1 n/a 1 1 n/a 8 11 n/a 17 n/a 7 n/a 3 2 n/a D 1 n/a 0 0 n/a 4 11 n/a 8 n/a 4 n/a 10 0 n/a 6 A 1 n/a 17 25 n/a 32 34 n/a 33 n/a 29 n/a 27 n/t n/a B n/a 1 n/a n/a 13 n/a n/a 29 n/a 37 n/a 34 n/a n/a 15 C 0 n/a 0 7 n/a 14 1 9 n/a 16 n/a 15 n/a 13 5 n/a D 1 n/a 7 11 n/a 20 33 n/a 29 n/a 23 n/a 12 5 n/a 7 A 5 n/a 20 27 n/a 35 36 n/a 35 n/a 31 n/a 28 23 n/a B n/a 3 n/a n/a 18 n/a n/a 29 n/a 37 n/a 33 n/a n/a 9 C 1 n/a 0 6 n/a 16 21 n/a 24 n/a 16 n/a 6 4 n/a D 0 n/a 7 1 7 n/a 27 33 n/a 29 n/a 14 n/a 7 7 n/a 8 A 0 n/a 14 25 n/a 32 36 n/a 34 n/a n/t n/a n/t n/t n/a B n/a 1 n/a n/a 15 n/a n/a 34 n/a 42 n/a 38 n/a n/a 19 C 2 n/a 1 11 n/a 15 24 n/a 24 n/a 18 n/a 17 5 n/a D 0 n/a 3 9 n/a 16 33 n/a 31 n/a 22 n/a 15 3 n/ a

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88 Subject label Target or REIG* Right ear (soft input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 9 A 5 n/a 19 25 n/a 32 33 n/a 33 n/a 29 n/a 27 n/t n/a B n/a 4 n/a n/a 17 n/a n/a 28 n/a 38 n/a 37 n/a n/a 20 C 1 n/a 7 11 n/a 9 7 n/a 7 n/a 10 n/a 3 6 n/a D 4 n/a 10 22 n/a 20 15 n/a 15 n/a 14 n/a 5 18 n/a 10 A 8 n/a 20 27 n/a 35 36 n/a 35 n/a 32 n/a n/t n/t n/a B n/a 5 n/a n/a 18 n/a n/a 29 n/a 38 n/a 38 n/a n/a 20 C 1 n/a 11 12 n/a 15 14 n/a 10 n/a 8 n/a 11 3 n/a D 1 n/a 9 13 n/a 21 22 n/a 19 n/a 14 n/a 13 2 n/a 11 A 6 n/a 18 25 n/a 33 35 n/a 34 n/a 32 n/a n/t n/t n/a B n/a 4 n/a n/a 19 n/a n/a 35 n/a 44 n/a 42 n/a n/a 21 C 2 n/a 6 11 n/a 17 24 n/a 26 n/a 22 n/a 22 17 n/a D 8 n/a 17 19 n/a 21 31 n/a 18 n/a 14 n/a 13 6 n/a 12 A 5 n/a 19 25 n/a 32 33 n/a 35 n/a n/t n/a n/t n/t n/a B n/a 2 n/a n/a 13 n/a n/a 31 n/a 43 n/a 37 n/a n/a 19 C 1 n/a 0 2 n/a 8 17 n/a 22 n/a 11 n/a 2 11 n/a D 1 n/a 4 12 n/a 20 28 n/a 26 n/a 21 n/a 12 6 n/a 13 A 3 n/a 16 23 n/a 30 32 n/a 31 n/a 32 n/a n/t n/t n/a B n/a 3 n/a n/a 13 n/a n/a 26 n/a 40 n/a 39 n/a n/a 19 C 1 n/a 6 7 n/a 7 16 n/a 23 n/a 18 n/a 8 5 n/a D 0 n/a 8 11 n/a 12 18 n/a 22 n/a 12 n/a 0 3 n/a 14 A 1 n/ a 11 22 n/a 31 33 n/a 32 n/a 30 n/a n/t n/t n/a B n/a 1 n/a n/a 14 n/a n/a 31 n/a 41 n/a 39 n/a n/a 18 C 1 n/a 5 14 n/a 19 22 n/a 25 n/a 16 n/a 16 13 n/a D 1 n/a 16 26 n/a 31 39 n/a 27 n/a 20 n/a 17 7 n/a 15 A 0 n/a 10 16 n/a 22 26 n/a 28 n/a 25 n/ a 23 n/t n/a B n/a 1 n/a n/a 4 n/a n/a 21 n/a 33 n/a 31 n/a n/a 13 C 0 n/a 2 7 n/a 10 8 n/a 18 n/a 9 n/a 2 8 n/a D 0 n/a 4 7 n/a 11 11 n/a 17 n/a 13 n/a 9 6 n/a 16 A 12 n/a 23 32 n/a 41 42 n/a 39 n/a n/t n/a n/t n/t n/a B n/a 10 n/a n/a 22 n/a n/a 37 n/a 45 n/a 43 n/a n/a 23 C 0 n/a 7 19 n/a 23 30 n/a 32 n/a 21 n/a 21 17 n/a D 2 n/a 0 5 n/a 3 6 n/a 4 n/a 7 n/a 5 4 n/a

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89 Subject label Target or REIG* Right ear (soft input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 H z 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 17 A 17 n/a 30 36 n/a 43 44 n/a 42 n/a n/t n/a n/t n/t n/a B n/a 20 n/a n/a 30 n/a n/a 42 n/a 48 n/a 46 n/a n/a 28 C 1 n/a 9 25 n/a 26 29 n/a 28 n/a 15 n/a 17 9 n/a D 1 n/a 10 19 n/a 23 32 n/a 21 n/a 1 n/a 1 3 n/a 18 A 13 n/a 25 31 n/a 38 39 n/a 28 n/a 33 n/a n/t n/t n/a B n/a 13 n/a n/a 19 n/a n/a 31 n/a 38 n/a 36 n/a n/a 25 C 2 n/a 7 8 n/a 18 87 n/a 18 n/a 13 n/a 16 16 n/a D 0 n/a 6 8 n/a 12 23 n/a 13 n/a 15 n/a 17 3 n/a 19 A 0 n/ a 14 21 n/a 29 30 n/a 29 n/a 29 n/a n/t n/t n/a B n/a 1 n/a n/a 11 n/a n/a 23 n/a 36 n/a 36 n/a n/a 17 C 1 n/a 1 5 n/a 10 8 n/a 6 n/a 11 n/a 12 3 n/a D 0 n/a 2 3 n/a 9 7 n/a 12 n/a 16 n/a 2 4 n/a 20 A 0 n/a 3 10 n/a 16 n/t n/a 30 n/a n/t n/a n/t n/t n/a B n/a 1 n/a n/a 3 n/a n/a 29 n/a 36 n/a 31 n/a n/a 13 C 0 n/a 3 1 n/a 6 11 n/a 11 n/a 9 n/a 6 9 n/a D 1 n/a 3 0 n/a 3 16 n/a 10 n/a 14 n/a 12 2 n/a NOTE: n/a = not applicable, n/t = no target generated; *For "Target or REIG," A = NAL NL1 Target, B = Phonak Music Target, C = REIG Music Setting (Phonak hearing aid), and D = REIG Speech Setting (participant's hearing aid).

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90 Subject label Target or REIG* Left ear (soft input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 H z 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 1 A 7 n/a 17 23 n/a 29 34 n/a 34 n/a n/t n/a n/t n/t n/a B n/a 4 n/a n/a 11 n/a n/a 31 n/a 43 n/a 39 n/a n/a 20 C 1 n/a 2 5 n/a 8 17 n/a 21 n/a 8 n/a 15 4 n/a D 0 n/a 0 2 n/a 10 24 n/a 26 n/a 16 n/a 14 2 n/a 2 A 3 n/a 22 25 n/a 29 31 n/a 33 n/a 33 n/a n/t n/t n/a B n/a 3 n/a n/a 13 n/a n/a 25 n/a 40 n/a 38 n/a n/a 19 C 1 n/a 8 14 n/a 12 18 n/a 22 n/a 18 n/a 5 6 n/a D 17 n/a 14 12 n/a 13 19 n/a 18 n/a 20 n/a 7 5 n/a 3 A 13 n/a n/t 35 n/a 43 42 n/a 40 n/a 36 n/a 32 n/t n/a B n/a 7 n/a n/a 27 n/a n/a 34 n/a 39 n/a 36 n/a n/a 15 C 1 n/a 9 23 n/a 28 32 n/a 22 n/a 19 n/a 14 10 n/a D 8 n/a 20 26 n/a 30 33 n/a 21 n/a 16 n/a 6 3 n/a 4 A 7 n/a 19 25 n/a 31 33 n/a 33 n/a 30 n/a 27 n/t n/a B n/a 4 n/a n/a 15 n/a n/a 30 n/a 40 n/a 37 n/a n/a 19 C 1 n/a 0 7 n/a 12 18 n/a 21 n/a 16 n/a 15 17 n/a D 5 n/a 24 33 n/a 38 37 n/a 32 n/a 17 n/a 20 10 n/a 5 A 0 n/a 5 13 n/a 20 25 n/a 26 n/a 26 n/a n/t n/t n/a B n/a 1 n/a n/a 4 n/a n/a 22 n/a 34 n/a 31 n/a n/a 12 C 1 n/a 0 1 n/a 4 13 n/a 16 n/a 8 n/a 2 2 n/a D 0 n/a 1 0 n/a 9 18 n/a 14 n/a 3 n/a 3 2 n/a 6 A 0 n/a 11 19 n/a 26 28 n/a 29 n/a 27 n/a 23 21 n/a B n/a 1 n/a n/a 8 n/a n/a 23 n/a 34 n/a 32 n/a n/a 15 C 0 n/a 1 1 n/a 4 11 n/a 15 n/a 10 n/a 0 4 n/a D 0 n/a 2 6 n/a 9 23 n/a 27 n/a 17 n/a 10 9 n/a 7 A 7 n/a 20 26 n/a 33 35 n/a 34 n/a 27 n/a 25 25 n/a B n/a 4 n/a n/a 16 n/a n/a 29 n/a 34 n/a 28 n/a n/a 16 C 1 n/a 1 1 n/a 7 11 n/a 20 n/a 10 n/a 1 15 n/a D 2 n/a 1 6 n/a 11 19 n/a 20 n/a 8 n/a 8 6 n/a 8 A 0 n/a 9 20 n/a 27 29 n/a 29 n/a 29 n/a n/t n/t n/a B n/a 1 n/a n/a 12 n/a n/a 26 n/a 38 n/a 38 n/a n/a 20 C 0 n/a 4 10 n/a 13 15 n/a 14 n/a 13 n/a 16 2 n/a D 2 n/a 4 5 n/a 10 23 n/a 21 n/a 17 n/a 1 3 4 n/a

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91 Subject label Target or REIG* Left ear (soft input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 9 A 2 n/a 16 22 n/a 29 30 n/a 30 n/a 28 n/a 25 23 n/a B n/a 2 n/a n/a 13 n/a n/a 26 n/a 36 n/a 35 n/a n/a 16 C 1 n/a 5 14 n/a 12 5 n/a 5 n/a 7 n/a 7 5 n/a D 2 n/a 10 22 n/a 20 15 n/a 15 n/a 14 n/a 5 18 n/a 10 A 8 n/a 20 27 n/a 35 36 n/a 35 n/a 32 n/a 28 n/t n/a B n/a 5 n/a n/a 21 n/a n/a 32 n/a 41 n/a 39 n/a n/a 19 C 1 n/a 6 9 n/a 15 20 n/a 16 n/a 13 n/a 17 7 n/a D 1 n/a 4 6 n/a 16 28 n/a 28 n/a 22 n/a 24 2 n/a 11 A 8 n/a 20 27 n/a 35 36 n/a 35 n/a 32 n/a n/t n/t n/a B n/a 8 n/a n/a 23 n/a n/a 34 n/a 44 n/a 43 n/a n/a 24 C 9 n/a 11 17 n/a 20 24 n/a 22 n/a 20 n/a 12 7 n/a D 10 n/a 20 21 n/a 20 29 n/a 24 n/a 26 n/a 24 22 n/a 12 A 4 n/a 16 24 n/a 32 33 n/a 35 n/a n/t n/a n/t n/t n/a B n/a 2 n/a n/a 12 n/a n/a 31 n/a 41 n/a 34 n/a n/a 16 C 0 n/a 1 1 n/a 6 13 n/a 22 n/a 7 n/a 3 6 n/a D 0 n/a 0 4 n/a 1 0 21 n/a 21 n/a 13 n/a 8 5 n/a 13 A 3 n/a 16 22 n/a 28 32 n/a 32 n/a 31 n/a n/t n/t n/a B n/a 3 n/a n/a 11 n/a n/a 27 n/a 40 n/a 38 n/a n/a 19 C 3 n/a 7 6 n/a 8 16 n/a 23 n/a 12 n/a 12 4 n/a D 6 n/a 15 17 n/a 20 21 n/a 21 n/a 12 n/a 2 4 n/a 14 A 0 n/a 13 22 n/a 31 33 n/a 32 n/a 30 n/a 26 n/t n/a B n/a 1 n/a n/a 14 n/a n/a 31 n/a 42 n/a 38 n/a n/a 18 C 2 n/a 4 15 n/a 19 24 n/a 26 n/a 15 n/a 12 15 n/a D 0 n/a 16 29 n/a 34 37 n/a 33 n/a 25 n/a 18 12 n/a 15 A 0 n/a 13 19 n/a 25 26 n/a 29 n/a 26 n/a 24 n/t n/a B n/a 1 n/a n/a 7 n/a n/a 21 n/a 33 n/a 32 n/a n/a 15 C 1 n/a 0 3 n/a 8 9 n/a 14 n/a 18 n/a 0 4 n/a D 2 n/a 14 16 n/a 13 13 n/a 16 n/a 24 n/a 11 6 n/a 16 A 5 n/a 17 25 n/a 32 34 n/a 33 n/a 31 n/a n/t n/t n/a B n/a 3 n/a n/a 15 n/a n /a 28 n/a 39 n/a 38 n/a n/a 19 C 0 n/a 0 5 n/a 14 16 n/a 23 n/a 11 n/a 17 6 n/a D 1 n/a 0 0 n/a 2 3 n/a 0 n/a 8 n/a 7 3 n/a

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92 Subject label Target or REIG* Left ear (soft input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 17 A 13 n/a 23 33 n/a 40 41 n/a 38 n/a n/t n/a n/t n/t n/a B n/a 17 n/a n/a 30 n/a n/a 39 n/a 45 n/a 46 n/a n/a 30 C 3 n/a 14 24 n/a 27 29 n/a 24 n/a 15 n/a 17 17 n/a D 4 n/a 8 22 n/a 25 23 n/a 25 n/a 14 n/a 24 7 n/a 18 A n/t n/a 24 30 n/a 37 39 n/a 38 n/a n/t n/a n/t n/t n/a B n/a 15 n/a n/a 19 n/a n/a 33 n/a 44 n/a 42 n/a n/a 20 C 4 n/a 9 10 n/a 13 28 n/a 23 n/a 23 n/a 22 12 n/a D 7 n/a 12 13 n/a 15 29 n/a 19 n/a 19 n/a 15 3 n/a 19 A 2 n/a 15 22 n/a 29 29 n/a 28 n/a 30 n/a 25 n/t n/a B n/a 3 n/a n/a 13 n/a n/a 21 n/a 37 n/a 37 n/a n/a 19 C 1 n/a 3 1 n/a 13 10 n/a 10 n/a 17 n/a 15 4 n/a D 1 n/a 0 2 n/a 2 6 n/a 4 n/a 3 n/a 3 16 n/a 20 A 0 n/a 1 9 n/a 15 n/t n/a 30 n/a n/t n/a n/ t n/t n/a B n/a 1 n/a n/a 3 n/a n/a 29 n/a 36 n/a 32 n/a n/a 12 C 2 n/a 1 3 n/a 1 10 n/a 8 n/a 7 n/a 3 5 n/a D 1 n/a 1 1 n/a 7 13 n/a 6 n/a 12 n/a 8 10 n/a NOTE: n/a = not applicable, n/t = no target generated; *For "Target or REIG," A = NAL N L1 Target, B = Phonak Music Target, C = REIG Music Setting (Phonak hearing aid), and D = REIG Speech Setting (participant's hearing aid).

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93 Subject label Target or REIG* Right ear (medium input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 1 A 2 n/a 11 17 n/a 21 25 n/a 33 n/a 32 n/a n/t n/t n/a B n/a 3 n/a n/a 11 n/a n/a 28 n/a 42 n/a 40 n/a n/a 21 C 0 n/a 0 4 n/a 7 19 n/a 20 n/a 19 n/a 22 11 n/a D 0 n/a 1 1 n/a 4 20 n/a 19 n/a 18 n/a 18 11 n/a 2 A 7 n/a 17 22 n/a 26 29 n/a 32 n/a 36 n/a n/t n/t n/a B n/a 11 n/a n/a 13 n/a n/a 26 n/a 40 n/a 41 n/a n/a 19 C 1 n/a 15 19 n/a 16 17 n/a 23 n/a 24 n/a 13 15 n/a D 7 n/a 9 13 n/a 14 23 n/a 25 n/a 22 n/a 8 14 n/a 3 A 9 n/a 21 30 n/a 38 37 n/a 36 n/a 28 n/a 26 n/t n/a B n/a 12 n/a n/a 24 n/a n/a 31 n/a 35 n/a 32 n/a n/a 16 C 0 n/a 5 18 n/a 21 28 n/a 26 n/a 21 n/a 12 7 n/a D 1 n/a 11 15 n/a 19 30 n/a 23 n/a 21 n/a 20 0 n/a 4 A 2 n/a 11 17 n/a 22 26 n/a 29 n/a 25 n/a 23 23 n/a B n/a 3 n/a n/a 12 n/a n/a 26 n/a 35 n/a 35 n/a n/a 17 C 1 n/a 2 4 n/a 7 12 n/a 15 n/a 17 n/a 14 13 n/a D 1 n/a 13 20 n/a 24 31 n/a 26 n/a 25 n/a 17 16 n/a 5 A 0 n/a 4 10 n/a 14 22 n/a 26 n/a 24 n/a 22 n/t n/a B n/a 1 n/a n/a 4 n/a n/a 20 n/a 31 n/a 30 n/a n/a 11 C 1 n/a 1 3 n/a 4 9 n/a 14 n/a 8 n/a 6 0 n/a D 1 n/a 2 3 n/a 3 12 n/a 9 n/a 0 n/a 13 4 n/a 6 A 0 n/a 11 18 n/a 25 27 n/a 29 n/a 24 n/a 22 n/t n/a B n/a 1 n/a n/a 10 n/a n/a 24 n/a 32 n/a 31 n/a n/a 15 C 1 n/a 2 3 n/a 10 17 n/a 13 n/a 13 n/a 12 6 n/a D 1 n/a 1 3 n/a 11 26 n/a 23 n/a 15 n/a 7 2 n/a 7 A 1 n/a 13 20 n/a 27 29 n/a 29 n/a 24 n/a 21 18 n/a B n/a 2 n/a n/a 14 n/a n/a 25 n/a 32 n/a 29 n/a n/a 7 C 1 n/a 1 1 n/a 15 18 n/a 20 n/a 14 n/a 7 0 n/a D 1 n/a 3 9 n/a 16 26 n/a 25 n/a 12 n/a 5 2 n/a 8 A 0 n/a 8 18 n/a 25 29 n/a 33 n/a 30 n/a 23 n/t n/a B n/a 1 n/a n/a 12 n/a n/a 29 n/a 39 n/a 36 n/a n/a 18 C 1 n/a 2 5 n/a 11 22 n/a 22 n/a 13 n/a 18 8 n/a D 1 n/a 0 10 n/a 12 31 n/a 28 n/a 18 n/a 10 8 n/a

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94 Subject label Target or REIG* Right ear (medium input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 9 A 2 n/a 12 18 n/a 25 26 n/a 27 n/a 24 n/a 22 23 n/a B n/a 3 n/a n/a 14 n/a n/a 24 n/a 33 n/a 33 n/a n/a 19 C 2 n/a 6 6 n/a 4 4 n/a 4 n/a 8 n/a 4 7 n/a D 2 n/a 3 7 n/a 5 10 n/a 12 n/a 10 n/a 6 17 n/a 10 A 4 n/a 13 20 n/a 27 29 n/a 29 n/a 26 n/a 24 n/t n/a B n/a 4 n/a n/a 14 n/a n/a 25 n/a 33 n/a 33 n/a n/a 19 C 1 n/a 7 8 n/a 11 12 n/a 8 n/a 6 n/a 10 1 n/a D 3 n/a 8 10 n/a 19 22 n/a 17 n/a 11 n/a 10 13 n/a 11 A 2 n/a 11 18 n/a 25 28 n/a 31 n/a 27 n/a 23 n/t n/a B n/a 4 n/a n/a 16 n/a n/a 30 n/a 39 n/a 38 n/a n/a 20 C 3 n/a 5 6 n/a 13 21 n/a 22 n/a 22 n/a 22 21 n/a D 4 n/a 12 14 n/a 12 31 n/a 25 n/a 17 n/a 21 6 n/a 12 A 1 n/a 12 19 n/a 24 25 n/a 35 n/a n/t n/a n/t n/t n/a B n/a 2 n/a n/a 10 n/a n/a 27 n/a 41 n/a 39 n/a n/a 18 C 1 n/a 1 1 n/a 6 16 n/a 22 n/a 22 n/a 13 20 n/a D 0 n/a 0 4 n/a 17 28 n/a 23 n/a 18 n/a 10 0 n/a 13 A 2 n/a 10 16 n/a 22 25 n/a 26 n/a 30 n/a n/t n/t n/a B n/a 2 n/a n/a 10 n/a n/a 22 n/a 35 n/a 37 n/a n/a 18 C 1 n/a 3 2 n/a 2 13 n/a 22 n/a 18 n/a 12 9 n/a D 0 n/a 6 9 n/a 10 19 n/a 23 n/a 13 n/a 1 4 n /a 14 A 0 n/a 6 15 n/a 24 27 n/a 28 n/a 26 n/a 22 n/t n/a B n/a 1 n/a n/a 12 n/a n/a 27 n/a 37 n/a 36 n/a n/a 17 C 0 n/a 5 9 n/a 11 20 n/a 21 n/a 17 n/a 16 18 n/a D 0 n/a 9 16 n/a 23 39 n/a 24 n/a 18 n/a 16 5 n/a 15 A 0 n/a 6 10 n/a 14 19 n/a 24 n/ a 21 n/a 20 22 n/a B n/a 1 n/a n/a 4 n/a n/a 18 n/a 29 n/a 28 n/a n/a 12 C 0 n/a 1 5 n/a 6 6 n/a 16 n/a 9 n/a 5 11 n/a D 1 n/a 3 4 n/a 4 3 n/a 10 n/a 8 n/a 6 1 n/a 16 A 6 n/a 16 25 n/a 33 35 n/a 36 n/a 33 n/a 25 n/t n/a B n/a 9 n/a n/a 18 n/a n/a 31 n/a 39 n/a 37 n/a n/a 22 C 0 n/a 4 14 n/a 18 26 n/a 26 n/a 19 n/a 18 19 n/a D 1 n/a 2 1 n/a 1 7 n/a 3 n/a 17 n/a 8 12 n/a

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95 Subject label Target or REIG* Right ear (medium input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 H z 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 17 A 9 n/a 22 28 n/a 35 36 n/a 37 n/a 33 n/a 26 n/t n/a B n/a 19 n/a n/a 26 n/a n/a 37 n/a 43 n/a 41 n/a n/a 26 C 0 n/a 6 18 n/a 19 26 n/a 27 n/a 14 n/a 16 14 n/a D 0 n/a 8 19 n/a 23 32 n/a 24 n/a 1 n/a 0 14 n/a 18 A 7 n/a 18 24 n/a 30 31 n/a 32 n/a 25 n/a 25 n/t n/a B n/a 11 n/a n/a 15 n/a n/a 27 n/a 33 n/a 32 n/a n/a 24 C 3 n/a 5 5 n/a 12 24 n/a 14 n/a 11 n/a 13 20 n/a D 0 n/a 4 4 n/a 9 22 n/a 11 n/a 12 n/a 11 6 n/a 19 A 0 n/a 8 15 n/a 21 23 n/a 24 n/a 26 n/a 22 n/t n/a B n/a 1 n/a n/a 8 n/a n/a 20 n/a 32 n/a 33 n/a n/a 17 C 0 n/a 1 6 n/a 12 11 n/a 11 n/a 15 n/a 16 6 n/a D 2 n/a 1 2 n/a 4 0 n/a 6 n/a 12 n/a 5 5 n/a 20 A 0 n/a 1 5 n/a 7 n/t n/a 30 n/a n/t n/a n/t n/t n/a B n/a 1 n/a n/a 3 n/a n/a 24 n/a 34 n/a 32 n/a n/a 11 C 1 n/a 3 1 n/a 5 15 n/a 16 n/a 9 n/a 7 15 n/a D 1 n/a 3 2 n/a 6 20 n/a 14 n/a 18 n/a 16 2 n/a NOTE: n/a = not applicable, n/t = no target generated; *For "Target or REIG," A = NAL NL1 Target, B = Phonak Music Target, C = REIG Music Setting (Phonak hearing aid), and D = REIG Speech Setting (participant's hearing aid).

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96 Subject label Target or REIG* Left ear (medium input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 1 A 4 n/a 11 17 n/a 21 27 n/a 33 n/a 30 n/a n/t n/t n/a B n/a 4 n/a n/a 9 n/a n/a 26 n/a 39 n/a 37 n/a n/a 19 C 0 n/a 2 4 n/a 8 15 n/a 19 n/a 14 n/a 18 10 n/a D 0 n/a 0 3 n/a 3 17 n/a 21 n/a 15 n/a 11 1 n/a 2 A 0 n/a 15 18 n/a 21 24 n/a 27 n/a 30 n/a n/t n/t n/a B n/a 3 n/a n/a 10 n/a n/a 21 n/a 35 n/a 39 n/a n/a 18 C 1 n/a 5 11 n/a 10 13 n/a 16 n/a 17 n/a 11 6 n/a D 8 n/a 7 5 n/a 7 20 n/a 19 n/a 18 n/a 6 15 n/a 3 A 6 n /a 19 27 n/a 35 35 n/a 33 n/a 27 n/a 25 26 n/a B n/a 5 n/a n/a 22 n/a n/a 29 n/a 34 n/a 31 n/a n/a 14 C 0 n/a 5 16 n/a 23 28 n/a 18 n/a 17 n/a 13 14 n/a D 3 n/a 14 18 n/a 21 28 n/a 19 n/a 16 n/a 7 3 n/a 4 A 4 n/a 12 18 n/a 23 26 n/a 29 n/a 25 n/a 2 1 24 n/a B n/a 4 n/a n/a 12 n/a n/a 26 n/a 35 n/a 33 n/a n/a 17 C 1 n/a 1 4 n/a 6 15 n/a 17 n/a 15 n/a 13 19 n/a D 2 n/a 17 27 n/a 30 34 n/a 30 n/a 17 n/a 21 10 n/a 5 A 0 n/a 2 8 n/a 14 19 n/a 21 n/a 24 n/a 22 n/t n/a B n/a 1 n/a n/a 3 n/a n/a 19 n/a 30 n/a 30 n/a n/a 11 C 1 n/a 0 2 n/a 3 13 n/a 14 n/a 9 n/a 6 2 n/a D 2 n/a 0 4 n/a 7 19 n/a 18 n/a 6 n/a 2 6 n/a 6 A 0 n/a 6 12 n/a 19 22 n/a 24 n/a 23 n/a 18 19 n/a B n/a 1 n/a n/a 7 n/a n/a 20 n/a 30 n/a 28 n/a n/a 14 C 0 n/a 0 1 n/a 1 9 n/a 12 n/a 8 n/a 0 2 n/a D 1 n/a 1 1 n/a 2 19 n/a 23 n/a 12 n/a 6 7 n/a 7 A 4 n/a 13 19 n/a 25 27 n/a 29 n/a 20 n/a 17 21 n/a B n/a 3 n/a n/a 12 n/a n/a 24 n/a 30 n/a 25 n/a n/a 14 C 0 n/a 1 1 n/a 2 10 n/a 18 n/a 8 n/a 3 14 n/a D 0 n/a 0 2 n/a 5 15 n/a 16 n/a 5 n/a 7 5 n/a 8 A 0 n/a 5 14 n/a 21 23 n/a 24 n/a 26 n/a 22 n/t n/a B n/a 1 n/a n/a 9 n/a n/a 22 n/a 34 n/a 35 n/a n/a 19 C 1 n/a 1 6 n/a 11 14 n/a 11 n/a 12 n/a 18 4 n/a D 1 n/a 0 3 n/a 13 25 n/a 22 n/a 15 n/a 10 4 n/a

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97 Su bject label Target or REIG* Left ear (medium input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 9 A 1 n/a 10 16 n/a 22 23 n/a 24 n/a 23 n/a 21 20 n/a B n/a 2 n/a n/a 10 n/a n/a 22 n/a 32 n/a 31 n/a n/a 15 C 1 n/a 3 9 n/a 10 3 n/a 3 n/a 6 n/a 5 8 n/a D 1 n/a 3 7 n/a 5 10 n/a 12 n/a 10 n/a 6 17 n/a 10 A 4 n/a 13 20 n/a 27 29 n/a 29 n/a 26 n/a 23 n/t n/a B n/a 4 n/a n/a 17 n/a n/a 28 n/a 36 n/a 35 n/a n/a 18 C 2 n/a 5 4 n/a 10 18 n/a 14 n/a 11 n/a 15 9 n/a D 2 n/a 6 6 n/a 13 28 n/a 26 n/a 19 n/a 21 1 n/a 11 A 4 n/a 13 20 n/a 27 29 n/a 29 n/a 27 n/a 23 n/t n/a B n/a 7 n/a n/a 19 n/a n/a 30 n/a 39 n/a 39 n/a n/a 22 C 6 n/a 6 10 n/a 14 21 n/a 20 n/a 19 n/a 15 15 n/a D 7 n/a 14 16 n/a 13 27 n/a 27 n/a 26 n/a 25 25 n/a 12 A 1 n/a 10 17 n/a 23 25 n/a 35 n/a n/t n/a n/t n/t n/a B n/a 1 n/a n/a 9 n/a n/a 27 n/a 39 n/a 36 n/a n/a 15 C 1 n/a 2 4 n/a 5 13 n/a 19 n/a 14 n/a 8 11 n/a D 1 n/a 2 2 n/a 9 26 n/a 25 n/a 12 n/a 10 0 n/a 13 A 2 n/a 10 16 n/a 20 25 n/a 28 n/a 28 n/a n/t n/t n/a B n/a 2 n/a n/a 8 n/a n/a 23 n/a 35 n/a 36 n/a n/a 19 C 3 n/a 1 1 n/a 5 18 n/a 20 n/a 12 n/a 15 10 n/a D 4 n/a 11 14 n/a 16 20 n/a 19 n/a 9 n/a 3 4 n/a 14 A 0 n/a 8 16 n/a 24 27 n/a 28 n/a 27 n/a 22 23 n/a B n/a 1 n/a n/a 12 n/a n/a 27 n/a 37 n/a 35 n/a n/a 16 C 0 n/a 3 9 n/a 15 21 n/a 23 n/a 19 n/a 15 19 n/a D 1 n/a 9 20 n/a 28 32 n/a 27 n/a 18 n/a 12 8 n/a 15 A 0 n/a 7 12 n/a 17 19 n/a 24 n/a 21 n/a 20 22 n/a B n/a 1 n/a n/a 6 n/a n/a 18 n/a 29 n/a 29 n/a n/a 13 C 1 n/a 0 1 n/a 6 6 n/a 12 n/a 15 n/a 3 3 n/a D 1 n/a 9 8 n/a 5 3 n/a 9 n/a 19 n/a 9 2 n/a 16 A 2 n/a 11 18 n/a 25 27 n/a 29 n/a 27 n/a 23 n/t n/a B n/a 2 n/a n/a 12 n/a n/a 24 n/a 34 n/a 34 n/a n/a 18 C 1 n/a 0 2 n/a 10 14 n/a 21 n/a 13 n/a 17 10 n/a D 0 n/a 1 3 n/a 3 4 n/a 1 n/a 11 n/a 11 13 n/a

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98 Subject label Target or REIG* Left ear (medium input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 H z 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 17 A 7 n/a 16 26 n/a 32 34 n/a 34 n/a 33 n/a n/t n/t n/a B n/a 16 n/a n/a 26 n/a n/a 34 n/a 40 n/a 42 n/a n/a 29 C 3 n/a 10 20 n/a 21 26 n/a 22 n/a 17 n/a 17 30 n/a D 3 n/a 7 18 n/a 20 22 n/a 22 n/a 14 n/a 2 2 10 n/a 18 A 9 n/a 16 23 n/a 29 32 n/a 34 n/a 31 n/a 25 n/t n/a B n/a 13 n/a n/a 15 n/a n/a 28 n/a 38 n/a 36 n/a n/a 18 C 3 n/a 6 5 n/a 8 25 n/a 20 n/a 20 n/a 18 12 n/a D 7 n/a 9 11 n/a 9 26 n/a 16 n/a 15 n/a 12 5 n/a 19 A 1 n/a 9 15 n/a 21 22 n/ a 22 n/a 28 n/a 22 n/t n/a B n/a 2 n/a n/a 10 n/a n/a 18 n/a 32 n/a 34 n/a n/a 19 C 1 n/a 3 3 n/a 15 12 n/a 13 n/a 21 n/a 19 7 n/a D 1 n/a 0 0 n/a 7 12 n/a 8 n/a 0 n/a 3 15 n/a 20 A 0 n/a 0 4 n/a 7 n/t n/a 30 n/a 26 n/a 22 n/t n/a B n/a 1 n/a n/a 3 n/a n/a 25 n/a 32 n/a 29 n/a n/a 10 C 2 n/a 1 3 n/a 1 14 n/a 12 n/a 11 n/a 6 9 n/a D 1 n/a 0 2 n/a 9 17 n/a 10 n/a 15 n/a 11 8 n/a NOTE: n/a = not applicable, n/t = no target generated; *For "Target or REIG," A = NAL NL1 Target, B = Phonak Mu sic Target, C = REIG Music Setting (Phonak hearing aid), and D = REIG Speech Setting (participant's hearing aid).

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99 Subject label Target or REIG* Right ear (loud input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 24 00 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 1 A 0 n/a 5 10 n/a 11 17 n/a 30 n/a 32 n/a n/t n/t n/a B n/a 2 n/a n/a 9 n/a n/a 22 n/a 35 n/a 35 n/a n/a 20 C 0 n/a 0 4 n/a 3 15 n/a 15 n/a 17 n/a 18 7 n/a D 0 n/a 1 2 n/a 2 14 n/a 12 n/a 9 n/a 8 3 n/ a 2 A 3 n/a 11 15 n/a 17 21 n/a 26 n/a 39 n/a n/t n/t n/a B n/a 7 n/a n/a 9 n/a n/a 19 n/a 33 n/a 37 n/a n/a 19 C 0 n/a 11 14 n/a 12 11 n/a 15 n/a 20 n/a 10 12 n/a D 4 n/a 3 7 n/a 7 13 n/a 16 n/a 11 n/a 1 21 n/a 3 A 5 n/a 14 23 n/a 31 31 n/a 29 n /a 21 n/a 22 27 n/a B n/a 8 n/a n/a 18 n/a n/a 23 n/a 27 n/a 25 n/a n/a 9 C 1 n/a 3 14 n/a 17 23 n/a 20 n/a 16 n/a 7 3 n/a D 2 n/a 4 8 n/a 12 22 n/a 14 n/a 12 n/a 10 9 n/a 4 A 0 n/a 4 10 n/a 14 18 n/a 23 n/a 21 n/a 23 24 n/a B n/a 2 n/a n/a 9 n /a n/a 20 n/a 29 n/a 28 n/a n/a 11 C 1 n/a 1 4 n/a 5 8 n/a 10 n/a 12 n/a 9 9 n/a D 2 n/a 7 12 n/a 15 21 n/a 16 n/a 16 n/a 6 7 n/a 5 A 0 n/a 0 3 n/a 5 14 n/a 19 n/a 21 n/a 24 n/t n/a B n/a 1 n/a n/a 3 n/a n/a 15 n/a 25 n/a 27 n/a n/a 10 C 1 n/a 0 3 n/a 1 6 n/a 10 n/a 5 n/a 4 5 n/a D 1 n/a 1 5 n/a 2 8 n/a 6 n/a 2 n/a 14 6 n/a 6 A 0 n/a 5 11 n/a 17 20 n/a 23 n/a 19 n/a 21 26 n/a B n/a 1 n/a n/a 7 n/a n/a 19 n/a 26 n/a 24 n/a n/a 14 C 1 n/a 1 3 n/a 7 13 n/a 8 n/a 10 n/a 8 4 n/a D 0 n/a 2 2 n/a 4 18 n/a 16 n/a 6 n/a 1 5 n/a 7 A 0 n/a 7 13 n/a 19 21 n/a 23 n/a 19 n/a 16 14 n/a B n/a 2 n/a n/a 10 n/a n/a 19 n/a 26 n/a 23 n/a n/a 3 C 1 n/a 1 1 n/a 12 15 n/a 15 n/a 9 n/a 4 2 n/a D 1 n/a 1 2 n/a 6 16 n/a 17 n/a 4 n/a 0 3 n /a 8 A 0 n/a 3 11 n/a 17 23 n/a 30 n/a 29 n/a n/t n/t n/a B n/a 1 n/a n/a 8 n/a n/a 23 n/a 33 n/a 32 n/a n/a 13 C 1 n/a 2 3 n/a 8 18 n/a 16 n/a 11 n/a 14 5 n/a D 1 n/a 1 5 n/a 5 23 n/a 20 n/a 9 n/a 0 16 n/a

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100 Subject label Target or REIG* Rig ht ear (loud input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 9 A 0 n/a 6 12 n/a 17 18 n/a 20 n/a 19 n/a 21 22 n/a B n/a 2 n/a n/a 10 n/a n/a 19 n/a 27 n/a 26 n/a n/a 13 C 1 n/a 5 4 n/a 1 1 n/a 1 n/a 4 n/a 1 4 n/a D 1 n/a 1 1 n/a 0 2 n/a 1 n/a 0 n/a 4 8 n/a 10 A 2 n/a 7 13 n/a 19 21 n/a 23 n/a 21 n/a 24 n/t n/a B n/a 3 n/a n/a 10 n/a n/a 19 n/a 26 n/a 27 n/a n/a 13 C 1 n/a 5 5 n/a 7 8 n/a 3 n/a 1 n/a 5 3 n/a D 4 n/a 10 11 n/a 19 22 n/a 14 n/a 8 n/a 8 14 n/a 11 A 0 n/a 5 11 n/a 17 21 n/a 26 n/a 24 n/a 24 26 n/a B n/a 3 n/a n/a 12 n/a n/a 24 n/a 32 n/a 31 n/a n/a 14 C 3 n/a 4 4 n/a 9 17 n/a 18 n/a 17 n/a 17 17 n/a D 4 n/a 8 7 n/a 3 22 n/a 15 n/a 7 n/a 11 4 n/a 12 A 0 n/a 6 11 n/a 14 17 n/a 33 n/a 37 n/a n/t n/t n/a B n/a 2 n/a n/a 7 n/a n/a 20 n/a 36 n/a 36 n/a n/a 12 C 1 n/a 2 2 n/a 5 13 n/a 17 n/a 22 n/a 13 16 n/a D 0 n/a 1 0 n/a 12 25 n/a 21 n/a 17 n/a 9 2 n/a 13 A 0 n/a 4 9 n/a 14 17 n/a 20 n/a 29 n/a n/t n/t n/a B n/a 2 n/a n/a 7 n/a n/a 16 n/a 29 n/a 32 n/a n/a 14 C 1 n/a 0 1 n/a 0 10 n/a 18 n/a 13 n/a 8 6 n/a D 1 n/a 1 0 n/a 1 14 n/a 20 n/a 9 n/a 3 6 n/a 14 A 0 n/a 1 8 n/a 17 20 n/a 23 n/a 24 n/a 23 26 n/a B n/a 1 n/a n/a 9 n/a n/a 22 n/a 31 n/a 30 n/a n/a 11 C 0 n/a 5 8 n/a 9 16 n/a 17 n/a 13 n/a 12 14 n/a D 1 n/a 6 8 n/a 12 27 n/a 16 n/a 10 n/a 12 3 n/a 15 A 0 n/a 0 4 n/a 5 11 n/a 16 n/a 16 n/a 19 23 n/a B n/a 1 n/a n/a 3 n/a n/a 14 n/a 24 n/a 23 n/a n/a 9 C 1 n/a 1 5 n/a 5 4 n/a 12 n/a 6 n/a 2 8 n/a D 1 n/a 2 3 n/a 3 1 n/a 5 n/a 3 n/a 2 7 n/a 16 A 3 n/a 10 18 n/a 25 29 n/a 33 n/a 32 n/a 25 29 n/a B n/a 6 n/a n/a 12 n/a n/a 24 n/a 31 n/a 29 n/a n/a 16 C 0 n/a 3 11 n/a 14 21 n/a 20 n/a 13 n/a 13 14 n/ a D 1 n/a 2 1 n/a 1 7 n/a 3 n/a 17 n/a 8 12 n/a

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101 Subject label Target or REIG* Right ear (loud input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 17 A 5 n/a 16 2 1 n/a 26 29 n/a 33 n/a 29 n/a 25 n/t n/a B n/a 14 n/a n/a 19 n/a n/a 28 n/a 34 n/a 32 n/a n/a 18 C 1 n/a 2 15 n/a 14 20 n/a 21 n/a 11 n/a 9 9 n/a D 1 n/a 4 14 n/a 17 25 n/a 17 n/a 4 n/a 6 19 n/a 18 A 4 n/a 12 17 n/a 22 24 n/a 26 n/a 18 n/a 24 n /t n/a B n/a 8 n/a n/a 10 n/a n/a 20 n/a 26 n/a 25 n/a n/a 18 C 3 n/a 4 2 n/a 9 19 n/a 9 n/a 6 n/a 8 15 n/a D 1 n/a 1 1 n/a 4 17 n/a 6 n/a 7 n/a 5 8 n/a 19 A 0 n/a 2 8 n/a 14 15 n/a 17 n/a 24 n/a 23 27 n/a B n/a 1 n/a n/a 6 n/a n/a 15 n/a 26 n /a 28 n/a n/a 14 C 2 n/a 3 10 n/a 15 13 n/a 13 n/a 17 n/a 16 4 n/a D 3 n/a 2 2 n/a 0 0 n/a 1 n/a 6 n/a 4 7 n/a 20 A 0 n/a 0 0 n/a 0 n/t n/a 25 n/a 34 n/a n/t n/t n/a B n/a 1 n/a n/a 3 n/a n/a 17 n/a 30 n/a 30 n/a n/a 2 C 0 n/a 4 1 n/a 1 18 n/a 17 n/a 2 n/a 1 8 n/a D 1 n/a 2 2 n/a 7 25 n/a 23 n/a 22 n/a 16 4 n/a NOTE: n/a = not applicable, n/t = no target generated; *For "Target or REIG," A = NAL NL1 Target, B = Phonak Music Target, C = REIG Music Setting (Phonak hearing aid), and D = RE IG Speech Setting (participant's hearing aid).

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102 Subject label Target or REIG* Left ear (loud input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 1 A 1 n/a 5 10 n/a 11 20 n/a 30 n/a 29 n/a n/t n/t n/a B n/a 3 n/a n/a 6 n/a n/a 20 n/a 31 n/a 31 n/a n/a 13 C 0 n/a 2 4 n/a 6 12 n/a 13 n/a 10 n/a 15 6 n/a D 0 n/a 0 3 n/a 1 10 n/a 12 n/a 5 n/a 1 5 n/a 2 A 0 n/a 8 12 n/a 11 16 n/a 20 n/a 29 n/a n/t n/t n/a B n/a 2 n/a n/a 7 n/a n/a 16 n/a 29 n/a 34 n/a n/a 15 C 1 n/a 4 7 n/a 6 9 n/a 10 n/a 13 n/a 7 4 n/a D 5 n/a 1 0 n/a 1 12 n/a 12 n/a 11 n/a 2 20 n/a 3 A 3 n/a 13 21 n/a 28 28 n/a 26 n/a 21 n/a 21 25 n/a B n/a 3 n/a n/a 17 n/a n/a 22 n/a 27 n/a 25 n/a n/ a 8 C 0 n/a 3 12 n/a 19 24 n/a 14 n/a 12 n/a 9 11 n/a D 0 n/a 6 10 n/a 13 20 n/a 10 n/a 8 n/a 2 11 n/a 4 A 1 n/a 6 11 n/a 14 18 n/a 23 n/a 21 n/a 19 24 n/a B n/a 3 n/a n/a 9 n/a n/a 20 n/a 29 n/a 27 n/a n/a 11 C 1 n/a 1 3 n/a 4 11 n/a 13 n/a 12 n/a 9 14 n/a D 0 n/a 5 15 n/a 17 20 n/a 16 n/a 7 n/a 8 5 n/a 5 A 0 n/a 0 2 n/a 6 11 n/a 13 n/a 21 n/a 23 n/t n/a B n/a 1 n/a n/a 3 n/a n/a 15 n/a 25 n/a 27 n/a n/a 10 C 1 n/a 0 1 n/a 1 11 n/a 11 n/a 7 n/a 4 1 n/a D 2 n/a 1 4 n/a 1 11 n/a 12 n/ a 1 n/a 9 11 n/a 6 A 0 n/a 0 6 n/a 11 14 n/a 16 n/a 18 n/a 14 17 n/a B n/a 1 n/a n/a 5 n/a n/a 15 n/a 24 n/a 23 n/a n/a 8 C 0 n/a 1 1 n/a 0 7 n/a 9 n/a 4 n/a 3 5 n/a D 1 n/a 1 3 n/a 2 13 n/a 17 n/a 6 n/a 1 2 n/a 7 A 1 n/a 6 12 n/a 17 20 n /a 23 n/a 13 n/a 11 18 n/a B n/a 2 n/a n/a 9 n/a n/a 19 n/a 24 n/a 20 n/a n/a 9 C 0 n/a 1 1 n/a 1 7 n/a 14 n/a 5 n/a 0 11 n/a D 0 n/a 1 2 n/a 1 9 n/a 8 n/a 1 n/a 2 2 n/a 8 A 0 n/a 0 7 n/a 14 15 n/a 16 n/a 24 n/a 23 n/t n/a B n/a 1 n/a n/a 7 n/a n/a 17 n/a 28 n/a 29 n/a n/a 14 C 1 n/a 1 5 n/a 10 11 n/a 7 n/a 9 n/a 13 2 n/a D 1 n/a 0 1 n/a 7 17 n/a 14 n/a 7 n/a 0 12 n/a

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103 Subject label Target or REIG* Left ear (loud input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 17 00 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 9 A 0 n/a 3 9 n/a 14 15 n/a 17 n/a 18 n/a 19 17 n/a B n/a 1 n/a n/a 7 n/a n/a 18 n/a 26 n/a 2 n/a n/a 9 C 1 n/a 3 7 n/a 7 0 n/a 2 n/a 1 n/a 1 5 n/a D 1 n/a 1 1 n/a 0 2 n/a 1 n/a 0 n/a 4 8 n/a 10 A 2 n/a 7 13 n/a 19 21 n/a 23 n/a 21 n/a 21 26 n/a B n/a 3 n/a n/a 13 n/a n/a 22 n/a 29 n/a 28 n/a n/a 12 C 2 n/a 4 2 n/a 6 13 n/a 9 n/a 6 n/a 10 5 n/a D 2 n/a 7 5 n/a 9 24 n/a 20 n/a 12 n/a 14 3 n/a 11 A 2 n/a 7 13 n/a 19 21 n/a 23 n/a 24 n/a 23 n/t n/a B n/a 5 n/a n/a 15 n/a n/a 24 n/a 32 n/a 31 n/a n/a 16 C 5 n/a 4 7 n/a 10 17 n/a 15 n/a 14 n/a 12 12 n/a D 7 n/a 11 8 n/a 3 18 n/a 16 n/a 14 n/a 11 12 n/a 12 A 0 n/a 4 10 n/a 14 17 n/a 33 n/a 34 n/a n/t n/t n/a B n/a 1 n/a n/a 7 n/a n/a 21 n/a 35 n/a 35 n/a n/a 10 C 1 n/a 2 4 n/a 4 10 n/a 14 n/a 14 n/a 8 9 n/a D 1 n/a 2 4 n/a 2 23 n/a 22 n/a 9 n/a 8 2 n/a 13 A 0 n/a 4 9 n/a 11 17 n/a 23 n/a 27 n/a n/t n/t n/a B n/a 2 n/a n/a 6 n/a n/a 17 n/a 29 n/a 30 n/a n/a 14 C 1 n/a 0 1 n/a 4 15 n/a 15 n/a 8 n/a 12 8 n/a D 1 n/a 2 4 n/a 4 15 n/a 15 n/a 4 n/a 4 10 n/a 14 A 0 n/a 2 9 n/a 17 20 n/a 23 n/a 24 n/a 21 24 n/a B n/a 1 n/a n/a 9 n/a n/a 22 n/a 31 n/a 29 n/a n/a 11 C 0 n/a 3 8 n/a 12 17 n/a 19 n/a 15 n/a 12 15 n/a D 1 n/a 4 10 n/a 17 24 n/a 20 n/a 12 n/a 9 7 n/a 15 A 0 n/a 1 6 n/a 8 11 n/a 16 n/a 16 n/a 19 21 n/a B n/a 1 n/a n/a 5 n/a n/a 14 n/a 23 n/a 23 n/a n/a 7 C 1 n/a 0 1 n/a 6 4 n/a 7 n/a 11 n/a 0 1 n/a D 1 n/a 6 6 n/a 2 2 n/a 3 n/a 11 n/a 2 6 n/a 16 A 0 n/a 5 11 n/a 17 20 n/a 23 n/a 24 n/a 24 n/t n/a B n/a 2 n/a n/a 8 n/a n/a 18 n/a 27 n/a 28 n/a n/a 16 C 1 n/a 0 1 n/a 8 11 n/a 16 n/a 9 n/a 12 7 n/a D 0 n/a 1 3 n/a 3 4 n/a 1 n/a 10 n/a 12 13 n/a

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104 Subject label Target or REIG Left ear (loud input level) 250 Hz 300 Hz 500 Hz 750 Hz 800 Hz 1000 Hz 1500 Hz 1700 Hz 2000 Hz 2400 Hz 3000 Hz 3500 Hz 4000 Hz 6000 Hz 7000 Hz 17 A 4 n/a 9 20 n/a 25 28 n/a 30 n/a 32 n/a n/t n/t n/a B n/a 12 n/a n/a 19 n/a n/a 26 n/a 31 n/a 33 n/a n/a 20 C 2 n/a 7 16 n/a 16 20 n/a 15 n/a 11 n/a 12 24 n/a D 2 n/a 5 13 n/a 16 17 n/a 16 n/a 9 n/a 17 5 n/a 18 A 5 n/a 10 16 n/a 20 25 n/a 30 n/a 29 n/a 25 29 n/a B n/a 9 n/a n/a 10 n/a n/a 21 n/a 30 n/a 28 n/a n/a 11 C 3 n/a 5 2 n/a 4 20 n/a 14 n /a 15 n/a 12 7 n/a D 5 n/a 4 5 n/a 4 21 n/a 11 n/a 11 n/a 8 9 n/a 19 A 0 n/a 3 9 n/a 14 14 n/a 14 n/a 27 n/a 21 27 n/a B n/a 2 n/a n/a 7 n/a n/a 14 n/a 26 n/a 28 n/a n/a 13 C 0 n/a 4 7 n/a 16 14 n/a 15 n/a 22 n/a 21 4 n/a D 1 n/a 2 3 n/a 6 12 n/a 12 n/a 2 n/a 4 4 n/a 20 A 0 n/a 0 0 n/a 0 n/t n/a 25 n/a 24 n/a 24 27 n/a B n/a 1 n/a n/a 3 n/a n/a 18 n/a 27 n/a 24 n/a n/a 2 C 0 n/a 1 0 n/a 1 16 n/a 14 n/a 9 n/a 1 4 n/a D 0 n/a 2 3 n/a 9 28 n/a 21 n/a 25 n/a 22 8 n/a NOTE: n/a = not applicab le, n/t = no target generated; *For "Target or REIG," A = NAL NL1 Target, B = Phonak Music Target, C = REIG Music Setting (Phonak hearing aid), and D = REIG Speech Setting (participant's hearing aid).

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105 REFERENCES Audioscan Verifit Hearing Instru June 2008. Be ntler, R, Wu, Y, Kettel, J, Hurtig, R. (2008) Digital noise reduction: outcomes from laboratory and field studies. International Journal of Audiology 47: 447-460. Berger, H. (2001) He aring aid and cellular telephone compatibility: working toward solutions. Journal of the American Academy of Audiology 12:309 314. Cattell, R Saunder, D, Stice, G. (1957) The sixteen personality factor questionnaire. Champaign, Illinois: IPAT. Chasin, M. (2003) Music and hearing aids. The Hearing Journal 56: 36-41. Chasin, M, Russo, F. (2004) Hearing aids and music. Trends in Amplification 8: 35 -47. Cox, RM. ( 1997) Administration and application of the APHAB. Hearing Journal 50: 32 48. Davies-Venn, E, Souza, P, Fabry, D. (2007) Speech and music quality ratings for linear and nonlinear hearing aid circiutry. Journal of the American Academy of Audiology 18: 688 -699. Franks, J. R. (1982) Judgments of hearing aid processed music. Ear and Hearing 3: 18-23. Gabrielsson, A, Schenkman, B, Hagerman, B. ( 1988) The effects of different frequency responses on sound quality judgments and speech intelligibility. Journal of Speech and Hearing Research 31:166-177. Gfeller, K, Christ, A, Knutson, J, Witt, S, Murray, K, Tyler, R. (2000) Musical backgrounds, listening habits, and aesthetic enjoyment of adult cochlear implant recipients. Journal of the American Academy of Audiology 11:390406. Hallgren, M, Larsby, B, Lyxell, B, Arlinger, S. ( 2005) Speech understanding in quiet and noise, with and without hearing aids. In ternational Journal of Audiology 44: 574-583. Hawkins, D, Naidoo, S. (1993) Comparison of sound quality and clarity with asymmetrical peak clipping and output limiting compressi on Journal of the American Academy of Audiology 4: 221-228. Klemp, E, Dhar, S. (2008) Speech perception in noise using directional microphones in open-canal hearing aids. Journal of the American Academy of Audiology 19: 571-158.

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106 Kong, Y Y, Cruz, R, Jones, J A, Zeng, F G (2005) Music perception with temporal cues in acoustic and electrical Hearing. Ear and Hearing 25:1 73 -185. Kopacz, M. (2005) Personality and music preferences: the influence of personality traits on preferences regarding musical elements. Journal of Music Therap y 42:216-239. Kozma-Spytek, L, Harkins, J. (2005) An evaluation of digital cellular handsets by hearing aid users. Journal of Rehabilitative Research and Development 42: 145156. Latzel, M, Gebhart, T, Kiessling, J. (2001) Benefit of digital feedback suppression system for acoustical telephone communication. Scandinavian Audiology Supplement 52 : 6972. Leek, M, Molis, M, Kubli, L, Tufts, J. (2008). Enjoyment of music by elderly hearingimpaired listeners. Journal of the American Academy of Audiology 19:519-526. Liu, G, Rubinstein, J, Nie, K, Drennan, W, Longnion, J, Kang, R, Ruffin, C, Ho Won, J. University of Washington Clinical Assessment of Music Perception (CAMP), Version 1.0, Copyright ( 2006) University of Washington All Rights Reserved. Looi, V, McDermott, H, McKay, C, Hickson, L. (2008) Music perception of cochlear implant users compared with that of hearing aid users. Ear and Hearing 29:421434. Mirza, S, Douglas, S A, Lindsey, P, Hildreth, T, Hawthorne, M. (2003) Appreciation of music in adult patients with cochlear implants: a patient questionnaire. Cochlear Implants International 4:85-95. Mockel, M, Rocker, L, Stork, T, Vollert, J, Danne, O, Eichstadt, H, Muller, R, Hochrein, H. (1994) Im mediate physiological responses of healthy volunteers to different types of music: cardiovascular, hormonal and mental changes. European Journal of Applied Physiology and Occupational Physiology 68:451159. Moore, B, Marriage, J, Alcantara, J, Glasberg, B. (2005) Comparison of two adaptive procedures for fitting a multi-channel compression hearing aid. International Journal of Audiology 44:345-357. Nimmons, G, Kang, R, Drenna, W, Longnion, J, Ruffin, C, Worman, T, Yueh, B, Rubinstein, J. (2008) Oto logy & Neurotology 29: 149-155. Phonak. (2008) Personal communication with Michael Boretzki on 11/14/2008. Plyler, P, Lowery, K, Hamby, H, Trine, T. (2007) The objective and subjective evaluation of multichannel expansion in wide dynamic range compression hearing instruments. Journal of Speech, Language, and Hearing Research 50: 15 24.

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107 Punch, J (1978) Quality judgments of hearing aid-processed speech and music by normal and otopathologic listeners. Journal of the American Audiology Society 3:179-188. Revit, L. (2002) Real-Ear Measures. In M. Valente ed Strategies for Selecting and Verifying Hearing Aid Fittings, Second Edition New York, NY: Thieme 66 124 Rickets, T, Dittbemer, A, Johnson, E. (2008) High-frequency amplification and sou nd quality in listeners with normal through moderate hearing loss. Journal of Speech, Language, and Hearing Research 51:160-172. Roederer, J. (1973). Introduction to the Physics and Psychophysics of Music. New York: Springer-Verlag. Schellenberg, E G. (2005) Music and cognitive abilities. Current Directions in Psychological Science 14:317-320. Shanks, J, Wilson, R, Stelmachowicz, P, Bratt, G, Williams, D. (2007). Speechrecognition performance after long-term hearing aid use. Journal of the American Academy of Audiology 18: 292 -303. Sherbecoe, R, Studebaker, G. (2003) Audibility-index predictions of normal hearing and hearing-impaired l performance on the connected speech test. Ear and Hearing 24: 71-88. Shi, L, Doherty, K. (2008) Subjective and objective effects of fast and slow compression on the perception of reverberant speech in listeners with hearing loss. Journal of Speech, Language, and Hearing Research 51: 13281340. Sorri, M, Piiparinen, P, Huttunen, K, Haho, M, Tobey, E, Thibodeau, L, Buckley, K. ( 2003) Hearing aid users benefit from induction loop when using digital cellular phones. Ear and Hearing 24:119-132. Tan, C, Moore, B. (2008) Perception of non-linear distortion by hearing-impaired people. International Journal of Audiology 47: 246-256. Van Buuren, R, Festen, J, Houtgast, T. (1999) Compression and expansion of the temporal envelope: Evaluation of speech intelligibility and sound quality. Journal of the Acoustical Society of America 105 :2903-2913.

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108 BI OGRAPHICAL SKETCH Kristin Nicole Johnston was born in Charlotte, NC. She received her Bachelor of Arts degree with a major in Communication Sciences and Disorders in 2001 at the University of Florida. She was awarded the Doctor of Audiology degree from t he University of Florida in 2006. She began work on the Doctor of Philosophy degree in Communication Sciences and Disorders in Fall 2006 and was awarded the degree in December 2009.