Audibility Extender

Dead regions in the cochlea

Kuk et al, 2009
High Frequency Sounds

Birds
“S”
“Sh”
Frequency lowering techniques
 Available techniques
either transpose or
compress sound in the
frequency domain

 Aim is to make high

frequency sounds
audible
Frequency lowering techniques
How does the Audibility
Extender improve audibility?

 Otherwise inaudible
high frequency
sounds are made
audible
 Detection of
environmental sounds
 Identification of high
frequency speech
sounds
How does the
Audibility Extender function?
Linear frequency
transposition:
/ Analyse spectrum
/ Find sound
/ Set target
/ Transpose sound
/ Filter sound
/ Overlay sound
Preserves the temporal
structure of sounds!
Why
Poorer
Goodusehearing,
transposition?
hearing,
poorer resolution
good resolution
Good Moderate Poor
resolution resolution resolution

Dead region

Low to high frequencies

 Initial
preference

Individualising Language
the start performance
frequency in adults

Children and
Effects of
language
counselling
development

Effects of
acclimatisation
and training
Subjective initial preference
The Audibility Extender vs standard program setting

 High rating for simple

stimuli (birdsong,
Birdsong
music)
 Initial lower rating for Music
complex stimuli
(speech) Speech
 Preference increases
for speech
Auriemmo et al, 2009
Kuk et al, 2006, 2007c
Language performance
High frequency speech sounds
Succesful use with children
Sound examples showing improvement in /s/ sound

They get some money and go outside and wait. They sit on the
sidewalk until he comes. All of the kids want to buy some cold ice cream
to eat.

Initial fitting After 6 weeks

Auriemmo, 2009 Auriemmo, 2009
Effects of training,
acclimatisation and counselling
 Councelling on expectations facilitates
acceptance

Kuk et al, 2007b

Individualising the start frequency
 The choice of an
optimal start
frequency contributes
to the ultimate succes
 Procedure for
individual fine tuning
is described in:
Kuk et al, 2007, Hearing
Review
Main conclusions from studies
 The Audibility Extender improves speech perception and
production for children and adults with a severe-to-
profound high frequency hearing loss
 Initial low preference for speech sounds
 Counselling is necessary to facilitate acceptance
 Acclimatisation and training are essential for improvements
in speech perception/production
 Progress in language scores and acceptance occur fast
after targeted use of the Audibility Extender
 Individualising the start frequency further improves
performance on language tests
 Increase in confidence and self-esteem in school-aged
children
Recommendations on Audibility
Extender use
 Recommended
audiogram range
 Severe-to-profound
high frequency
hearing loss
 Reasonable mid-
frequency resolution
 Do not lower if it can
be amplified!
Recommendations on Audibility
Extender use
 Purpose is to improve audibility - primarily for speech
sounds
 Optimally set as first program
 Used on a 24/7 basis
 Combined with training

 To encourage Audibility Extender use:

 Accept occasional (on-demand) use of Audibility Extender
 Accept use of a higher than needed start frequency
 Gradual adjustment of start frequency over time

 Training and counselling!

Audibility Extender studies
Auriemmo J, Kuk F, Stenger P (2008). Criteria for Evaluating Performance of Linear Frequency Transposition
in Children, Hearing Journal, 61(4), 50-54

Auriemmo J, Kuk F, Lau C, Marshall S, Thiele N, Pikora M, Quick D, Stenger P (2009). Effect of Linear
Frequency Transposition on Speech Recognition and Production of School-Aged Children. Journal of the
American Academy of Audiology, 20(5)

Korhonen P, Kuk F (2008), Use of Linear Frequency Transposition in Simulated Hearing Loss. J Am Acad
Audiol, 19(10)

Kuk F, Korhonen P, Peeters H, Keenan D, Jessen A, Andersen H. (2006). Linear Frequency Transposition:
Extending the Audibility of High-Frequency Information, Hear Rev, 13(11), 42, 44-46, 48

Kuk F, Keenan D, Peeters H, Korhonen P, Hau O, Andersen H.(2007a). Critical Factors in Ensuring Efficacy of Frequency
Transposition. Part 1: Individualizing the Start Frequency, Hear Rev 14(3): 60, 62-64, 66

Kuk F, Keenan D, Peeters H, Lau C, Crose, B.(2007b), Critical Factors in Ensuring Efficacy of Frequency Transposition. Part
2: Facilitating initial adjustment, Hearing Review, 14(4), 90, 92,95-96

Kuk F, Peeters H, Keenan D, Lau C (2007c), Use of Frequency Transposition in a Tin-Tube Open-Ear Fitting,
Hearing Journal, 60(4), 59-63

Kuk F, Keenan D, Korhonen P, Lau C (2009). Efficacy of Linear, Efficacy of Linear Frequency Transposition
on Consonant Identification in Quiet and Noise, J Am Acad Audiol , 20(8)

Smith J, Dann M, Brown M (2009), An Evaluation of Frequency Transposition for Hearing-Impaired School
Age Children. Deafness & Education International, 11 (2), 62-82
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