# Maximizing hearing aid outcomes with spectro-temporal modulation sensitivity

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2020 · $151,996

## Abstract

PROJECT SUMMARY/ABSTRACT
Advanced age is associated with an increase in likelihood of having presbycusis, a hearing impairment treated
primarily through the use of hearing aids (HA) and aural rehabilitation. With twenty percent of the population
predicted to be 65 years or older by 2030, hearing loss is a public health concern. A significant problem is that
the prevalence of HA use among people with hearing loss is low, and untreated hearing loss contributes to a
reduced quality of life, avoidance of social situations, and feelings of loneliness. The most common
shortcoming of HA is poor performance in noisy environments, but traditional standard-of-care audiometry
does a poor job explaining why this occurs. Many factors beyond the audiogram have been suggested as
possible explanations for poor speech understanding in noise; however, none have explained a substantial
portion of the variance in outcomes until recently. Both hearing loss and age cause declines in the ability to use
fine temporal and spectral cues. Recent evidence suggests that sensitivity to joint spectro-temporal
modulations (STM; i.e., spectral patterns that change over time, as occur in natural speech sounds) explains a
significant portion of the variance in speech understanding in noise, after controlling for audibility. Notably,
STM is also predictive of self-reported outcomes. Individual differences in STM sensitivity, combined with the
known effects that HA processing has on distorting spectro-temporal cues, mean that some HA users may be
set up for failure. It is hypothesized that successful HA use partially depends on a person’s ability to process
spectro-temporal signals and the integrity of the cues (distorted by HA processing) delivered to the listener’s
auditory system. The long-term goal is to optimize a novel evidence-based, HA-fitting intervention, by building
on a strong set of preliminary data showing that sensitivity to STM is a robust predictor of speech
understanding in noise and self-reported outcomes for HA users. The first aim is to comprehensively describe
the nature of the interaction between HA distortion and STM sensitivity and subsequent effects on aided
outcomes using an observational approach. Under this aim, validation of suspected underlying mechanisms
responsible for STM sensitivity will also be examined. The second aim is to determine the extent to which
altering spectro-temporal cues, through HA manipulation, affects speech in noise performance, using a
randomized, cross-sectional design. Other patient-centered variables will be assessed, such as working
memory, age, and audibility, which may be responsible for remaining variability in outcomes. This work
translates basic hearing science principles into clinical applications, and will have implications for
individualizing existing clinical treatments.

## Key facts

- **NIH application ID:** 9902400
- **Project number:** 5R21DC016380-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Christi Wise Miller
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $151,996
- **Award type:** 5
- **Project period:** 2018-03-15 → 2020-04-10

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9902400

## Citation

> US National Institutes of Health, RePORTER application 9902400, Maximizing hearing aid outcomes with spectro-temporal modulation sensitivity (5R21DC016380-03). Retrieved via AI Analytics 2026-06-15 from https://api.ai-analytics.org/grant/nih/9902400. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*