J Am Acad Audiol 2019; 30(04): 302-314
DOI: 10.3766/jaaa.17101
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tracking of Noise Tolerance to Predict Hearing Aid Satisfaction in Loud Noisy Environments

Eric Seper
*   Widex Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL
Francis Kuk
*   Widex Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL
Petri Korhonen
*   Widex Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL
Christopher Slugocki
*   Widex Office of Research in Clinical Amplification (ORCA-USA), Lisle, IL
› Author Affiliations
Further Information

Publication History

28 July 2017

01 November 2017

Publication Date:
26 May 2020 (online)



A method that tracked tolerable noise level (TNL) over time while maintaining subjective speech intelligibility was reported previously. Although this method was reliable and efficacious as a research tool, its clinical efficacy and predictive ability of real-life hearing aid satisfaction were not measured.


The study evaluated an adaptive method to estimate TNL using slope and variance of tracked noise level as criteria in a clinical setting. The relationship between TNL and subjective hearing aid satisfaction in noisy environments was also investigated.

Research Design:

A single-blinded, repeated-measures design.

Study Sample:

Seventeen experienced hearing aid wearers with bilateral mild-to-moderately-severe sensorineural hearing loss.

Data Collection and Analysis:

Participants listened to 82-dB SPL continuous speech and tracked the background noise level that they could “put up with” while subjectively understanding >90% of the speech material. Two trials with each babble noise and continuous speech-shaped noise were measured in a single session. All four trials were completed aided using the participants’ own hearing aids. The stimuli were presented in the sound field with speech from 0° and noise from the 180° azimuth. The instantaneous tolerable noise level was measured using a custom program and scored in two ways; the averaged TNL (aTNL) over the 2-min trial and the estimated TNL (eTNL) as soon as the listeners reached a stable noise estimate. Correlation between TNL and proportion of satisfied noisy environments was examined using the MarkeTrak questionnaire.


All listeners completed the tracking of noise tolerance procedure within 2 min with good reliability. Sixty-five percent of the listeners yielded a stable noise estimate after 59.9 sec of actual test time. The eTNL for all trials was 78.6 dB SPL (standard deviation [SD] = 4.4 dB). The aTNL for all trials was 78.0 dB SPL (SD = 3.3 dB) after 120 sec. The aTNL was 79.2 dB SPL (SD = 5.4 dB) for babble noise and 77.0 dB SPL (SD = 5.9 dB) for speech-shaped noise. High within-session test–retest reliability was evident. The 95% confidence interval was 1.5 dB for babble noise and 2.8 dB for continuous speech-shaped noise. No significant correlation was measured between overall hearing aid satisfaction and the aTNL (ρ = 0.20 for both noises); however, a significant relationship between aTNL and proportion of satisfied noisy situations was evident (ρ = 0.48 for babble noise and ρ = 0.55 for speech-shaped noise).


The eTNL scoring method yielded similar results as the aTNL method although requiring only half the time for 65% of the listeners. This time efficiency, along with its reliability and the potential relationship between TNL and hearing aid satisfaction in noisy listening situations suggests that this procedure may be a good clinical tool to evaluate whether specific features on a hearing aid would improve noise tolerance and predict wearer satisfaction with the selected hearing aid in real-life loud noisy situations. A larger sample of hearing aid wearers is needed to further validate these potential uses.

Eric Seper is now at the University of Chicago Medicine.


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