Hearing Research 432 (2023) 108743

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Hearing Research
journal homepage: www.elsevier.com/locate/heares

Research Paper

Binaural pre-processing for contralateral sound field attenuation can

improve speech-in-noise intelligibility for bilateral hearing-aid users
Fernando M. San-Victoriano a,b, Almudena Eustaquio-Martín a,b,
Enrique A. Lopez-Poveda a,b,c,∗
a
Laboratorio de Audición Computacional y Psicoacústica, Instituto de Neurociencias de Castilla y León, Universidad de Salamanca, 37007 Salamanca, Spain
b
Grupo de Audiología, Instituto de Investigación Biomédica de Salamanca, Universidad de Salamanca, 37007 Salamanca, Spain
c
Departamento de Cirugía, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain

a r t i c l e i n f o a b s t r a c t

Article history: We have recently proposed a binaural sound pre-processing method to attenuate sounds contralateral to
Received 24 October 2022 each ear and shown that it can improve speech intelligibility for normal-hearing (NH) people in sim-
Revised 21 January 2023
ulated “cocktail party” listening situations (Lopez-Poveda et al., 2022, Hear Res 418:108,469). The aim
Accepted 24 March 2023
here was to evaluate if this benefit remains for hearing-impaired listeners when the method is com-
Available online 25 March 2023
bined with two independently functioning hearing aids, one per ear. Twelve volunteers participated in
Keywords: the experiments; five of them had bilateral sensorineural hearing loss and seven were NH listeners with
Noise reduction simulated bilateral conductive hearing loss. Speech reception thresholds (SRTs) for sentences in compe-
Binaural unmasking tition with a source of steady, speech-shaped noise were measured in unilateral and bilateral listening,
Binaural hearing and for (target, masker) azimuthal angles of (0°, 0°), (270°, 45°), and (270°, 90°). Stimuli were processed
Hearing device through a pair of software-based multichannel, fast-acting, wide dynamic range compressors, with and
Beamformer
without binaural pre-processing. For spatially collocated target and masker sources at 0° azimuth, the
pre-processing did not affect SRTs. For spatially separated target and masker sources, the pre-processing
improved SRTs when listening bilaterally (improvements up to 10.7 dB) or unilaterally with the acousti-
cally better ear (improvements up to 13.9 dB), while it worsened SRTs when listening unilaterally with
the acoustically worse ear (decrements of up to 17.0 dB). Results show that binaural pre-processing for
contralateral sound attenuation can improve speech-in-noise intelligibility in laboratory tests also for bi-
lateral hearing-aid users.
© 2023 The Authors. Published by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)

1. Introduction
Understanding speech presented in competition with other
sounds is still one of the main challenges faced by people with
hearing loss (Abrams and Kihm, 2015). Hearing-impaired (HI) lis-
teners require up to 9 dB higher signal-to-noise ratios (SNRs) than
people with normal hearing (NH) to achieve the same amount of
intelligibility (e.g., Festen and Plomp, 1990; Peters et al., 1998). For
this reason, hearing aids (HAs) and other hearing devices often in-
corporate sound pre-processing methods aimed at improving the
SNR before the stimulus is further processed and delivered to the
user.
∗
Corresponding author at: Instituto de Neurociencias de Castilla y León, Univer-
sidad de Salamanca, Calle Pintor Fernando Gallego 1, 37007 Salamanca, Spain.
E-mail address: ealopezpoveda@usal.es (E.A. Lopez-Poveda).
Among these strategies are beamformers, i.e., systems that ex-
ploit the physical separation between the target and masker sound
sources to improve the SNR. Beamformers often favor sounds com-
ing from the front of the listener while attenuating interfering
sounds from other directions (Kates, 2008). Sometimes, however,
the beamformer’s directivity pattern is guided by sound source
identification methods, listener eye tracking, or adapts for chang-
ing listening scenarios (Kollmeier and Kiessling, 2018). These ap-
proaches usually require two or more microphones and a high de-
mand for computational power to improve the SNR. For HA users,
unilateral beamformers provide large benefits for sentence recogni-
tion in noise compared to omnidirectional approaches while bilat-
eral beamformers provide smaller, but statistically significant ben-
efits over unilateral beamformers (Picou and Ricketts, 2019).
We have recently proposed a binaural pre-processing method
that can improve speech recognition with two microphones, one
per ear. The method involves linear subtraction of the weighted

https://doi.org/10.1016/j.heares.2023.108743
0378-5955/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
F.M. San-Victoriano, A. Eustaquio-Martín and E.A. Lopez-Poveda
contralateral sound spectrum from the spectrum at each ear with
weights equal to the ratio of ipsilateral to contralateral head-
related transfer functions (HRTF) averaged over an appropriate az-
imuth range. Instead of favoring sounds in front of the listener, our
method favors sounds ipsilateral to each ear by attenuating con-
tralateral sounds (Lopez-Poveda et al., 2022). Because in free-field,
multi-talker scenarios the target sound source is unlikely centered
(Grange and Culling, 2016), the method can improve the SNR in
the ear closer to the target. And because listeners can switch at-
tention to the ear with the better SNR for the momentary target
(e.g., Bronkhorst and Plomp, 1988), the method can improve intelli-
gibility in ‘cocktail party’ scenarios. We showed that, for NH listen-
ers tested in simulated cocktail party situations, the algorithm can
improve the SNR at 50% sentence recognition (termed the speech
reception threshold or SRT) by up to 9.6 dB for speech in compe-
tition with up to three masker sources, depending on the masker
type and location.
It remains to be shown, however, whether the benefits
found for NH listeners also apply to HA users. Because our
method attenuates contralateral sounds and nonlinear (compres-
sive) HAs amplify low-level sounds more than high-level sounds
(Edwards, 2003), in theory, HAs could partly undo the contralat-
eral sound attenuation produced by our method, resulting in less
(or no) benefit for HA users than for NH listeners.
The aim of the present study was to investigate the speech-
in-noise intelligibility benefits of our pre-processing method for
HI listeners when the method is used together with two inde-
pendently functioning HAs, one per ear. Aided SRTs for sentences
in competition with a source of speech-shaped noise (SSN) were
compared for pre-processed and unprocessed stimuli in various
simulated spatial configurations of the target and masker sources
and in various listening modes, i.e., listening binaurally or listen-
ing unilaterally with either ear. Because the aim was to investigate
if contralateral sound attenuation can help HA users overall (i.e.,
regardless of hearing loss etiology and magnitude), participants in-
cluded five people with bilateral sensorineural hearing loss (SNHL)
and seven people with simulated bilateral conductive hearing loss
(NH listeners fitted with foam earplugs).
2. Methods
Procedures were approved by the Ethics Committee of the Uni-
versity of Salamanca. Unless otherwise stated, methods were as in
Lopez-Poveda et al. (2022), where details can be found. For con-
ciseness, only a summary is given here.
Participants. Participants were volunteers and not paid for
their time. All of them signed an informed consent to participate
in the study. Seven NH adults (six women, age range: 22 to 29 yr.,
mean = 26 yr., SD = 2.65 yr.), and five HI adults (three women,
age range: 53 to 61 yr., mean = 58.2 yr., SD = 3.35 yr.) partici-
pated in the experiments. All of them had normal otoscopy. HI lis-
teners were clinically diagnosed with bilateral, moderate-to-severe
SNHL and regularly wore bilateral HAs. NH listeners had no his-
tory of hearing disorders, and their audiometric thresholds were
<25 dB HL at all octave frequencies from 125 to 80 0 0 Hz. NH lis-
teners were bilaterally fitted with foam earplugs (3MTM E-A-RTM
classic) to simulate a conductive hearing loss. Fig. 1 shows the au-
diograms for all individual participants and demonstrates that the
use of earplugs produced mild-to-moderate hearing losses, as in-
tended.
Binaural pre-processing method. Level-adjusted, HRTF-filtered
sounds were pre-processed using the binaural weighted subtrac-
tion method of Lopez-Poveda et al. (2022) as follows:
L ( f ) = L ( f ) − β ( f ) · R ( f ) (1)
2
Hearing Research 432 (2023) 108743
R ( f ) = R ( f ) − α ( f ) · L ( f ) (2)
where L( f ) and R( f ) denote the complex frequency spectra of the
unprocessed stimuli reaching the left and right ear, respectively;
L ( f ) and R ( f ) denote the corresponding complex frequency spec-
tra of the processed stimuli at the left and right ear, respectively;
and α ( f ) and β ( f ) are the subtraction weights. The weights are
also complex numbers, i.e., with magnitude and phase. Lopez-
Poveda et al. (2022) tested the pre-processing method for NH lis-
teners using β0◦ −180◦ and α180◦ −360◦ calculated as follows:
180
θ =0 Hθ L ( f )
β0◦ −180◦ ( f ) = 180 (3)
θ =0 Hθ R ( f )
360
Hθ R ( f )
α180◦ −360◦ ( f ) = θ360
=180
(4)
θ =180 Hθ L ( f )
where θ denotes azimuthal angle, going from 0° for a source right
in front to 360° clockwise, and Hθ L ( f ) and Hθ R ( f ) are the complex
HRTF for the left and right ear for a KEMAR (Gardner and Mar-
tin, 1995). Here, the subtraction weights β and α were calculated
by integrating KEMAR HRTFs over the azimuth range 60°−120° and
240°−300°, respectively, as follows:
120
θ =60 Hθ L ( f )
β60◦ −120◦ ( f ) = 120 (5)
θ =60 Hθ R ( f )
300
Hθ R ( f )
α240◦ −300◦ ( f ) = θ300
=240
(6)
θ =240 Hθ L ( f )
The integration over a narrower angle than used by Lopez-
Poveda et al. (2022) was intended to attenuate a wider range
of contralateral frequencies, i.e., with the present weights the di-
rectivity pattern for the left ear was as shown in Fig. 2C rather
than that in Fig. 2A of Lopez-Poveda et al. (2022). Therefore,
as illustrated in supplementary Fig. S1, we expected that the
pre-processing would improve intelligibility over slightly different
target-masker spatial configurations here than reported by Lopez-
Poveda et al. (2022).
Hearing aid. To compensate for their hearing loss, all par-
ticipants were aided in their two ears by a software-based im-
plementation of a 12-channel, dynamic range compressor (1–
80 0 0 Hz). The compressor was of the type known as “return-
to-zero” (Giannoulis et al., 2012). The HA was programmed with
attack and release times of 5 and 200 ms, respectively. These
time constants were chosen to produce a moderately fast-acting
gain control (Moore, 2008). The gain in each frequency channel of
the HA was adjusted for each participant according to their air-
conduction audiometry as follows: for input sound pressure level
(SPL) of 65 dB, the gain was as prescribed by the NAL-R rule
(Byrne and Dillon, 1986); for input sound levels lower/higher than
65 dB SPL, the gain was higher/lower so that the compression ra-
tio was 2 dB/dB. For levels lower than the compression threshold
(20 dB SPL), the gain was linear; and at very high levels, no gain
was applied (see supplementary Fig. S2).
Procedures. SRTs were measured using an adaptive procedure.
The target was a sentence from the Spanish matrix sentence test
(Hochmuth et al., 2012). The masker was a single source of SSN
with the average long-term spectrum of the matrix sentences. Dur-
ing an SRT measurement, the speech level was fixed at 65 dB SPL
and the masker level varied adaptively using a one-down, one-
up rule. The SRT was thus defined as the SNR at which listeners
recognized 50% of full sentences (Levitt, 1971). Twenty sentences
were presented to measure an SRT. The initial SNR was set either
equal to 0 dB (for listeners with simulated conductive loss) or was
adjusted individually (for listeners with SNHL) as low as possible
F.M. San-Victoriano, A. Eustaquio-Martín and E.A. Lopez-Poveda
Fig. 1. Individual pure-tone air-conduction audiometric thresholds for listeners with simulated conductive loss (circles) and sensorineural hearing loss (squares). Crosses
indicate conditions where the limit of the audiometer (Interacoustics AD229e) was reached without a response from the participant.
Fig. 2. Aided versus unaided SRTs in quiet for the five listeners with SNHL when
listening bilaterally or unilaterally with the left and the right ear. The speech source
was at 0° azimuth. Squares and crosses illustrate individual, and group mean scores,
respectively. Error bars illustrate one standard deviation. ∗ ∗ ∗ p ≤ 0.001.
while making sure that listeners could recognize the first test sen-
tence. The SNR changed in 4-dB steps between sentences 1 and 5,
and in 2-dB steps between sentences 5 and 20. The SRT was cal-
culated as the mean of the final 11 SNRs (the SNR for the 21st
sentence was calculated and used in the SRT estimate but not pre-
sented). SRT estimates whose standard deviations (SDs) exceeded
3.5 dB were discarded and repeated. Three valid SRT estimates
were measured per condition and the mean was taken as the fi-
nal SRT.
Conditions. SRTs were measured in unilateral and bilateral lis-
tening modes. Unilateral listening tests involved processing stim-
uli through the algorithm but stimulating only one ear. SRTs were
measured for three spatial configurations: S0 N0 with the speech
and noise source collocated in front of the listener at 0° azimuth;
S270 N45 with the speech and noise sources at 270° and 45° az-
3
Hearing Research 432 (2023) 108743
imuth, respectively; and S270 N90 with the speech and noise sources
at 270° and 90° azimuth, respectively. These spatial configura-
tions were the same as tested by Lopez-Poveda et al. (2022) and
were selected as representative of conditions where the benefit
of the pre-processing algorithm was expected to be zero, small-
to-moderate, and large, respectively (supplementary Fig. S1B). All
sound sources were at eye level (0° elevation). Spatial configura-
tions were simulated by convolving monophonic recordings with
HRTFs for a KEMAR manikin (Gardner and Martin, 1995). Note
that for conditions with non-collocated target and masker sources
(S270 N45 and S270 N90 ), the ear with the better acoustic SNR was
the left ear.
For listeners with simulated conductive loss, 36 SRTs in SSN
were measured per participant: 2 listening modes (bilateral and
unilateral with the left ear) × 2 processing conditions (with and
without pre-processing) × 3 spatial configurations (S0 N0 , S270 N45 ,
and S270 N90 ) × 3 SRT estimates per condition. Measurements were
organized in three blocks of 12 SRT measurements each, one block
per SRT estimate.
For listeners with SNHL, 54 SRTs in SSN were measured per par-
ticipant: 3 listening modes (bilateral, unilateral with the left ear,
and unilateral with the right ear) × 2 processing conditions (with
and without processing) × 3 spatial configurations (S0 N0 , S270 N45 ,
and S270 N90 ) × 3 SRT estimates per condition. Measurements were
organized in three blocks of 18 SRT measurements each, one block
per SRT estimate.
Within each block, conditions were administered in random or-
der. Participants did not know which condition they were being
tested on (single blind approach).
As a control, for listeners with SNHL, SRTs were also measured
in quiet and for a speech source at 0° azimuth to verify that the
experimental HA and fitting rule successfully restored audibility.
Equipment. During the measurements, listeners were seated
in a double-wall sound booth. The MATLAB software environ-
ment (R2017b, The Mathworks, Inc.) was used to perform all sig-
nal processing and implement all test procedures. Stimuli were
sampled at a rate of 44,100 Hz and with 24-bit resolution. Stim-
uli were controlled using custom-made software and played via
an RME Fireface UCX soundcard and presented to the listeners
via Sennheiser HD-580 circumaural headphones. SPL were cali-
brated by placing the headphones on a KEMAR head equipped
F.M. San-Victoriano, A. Eustaquio-Martín and E.A. Lopez-Poveda
with a Zwislocki DB-100 coupler connected to a sound level me-
ter (Brüel&Kjaer, mod. 2238). Calibration was performed at 1 kHz
and the obtained sensitivity was used at all other frequencies.
3. Results
3.1. SRTs in quiet
For the five participants with SNHL and for a speech source at
0° azimuth, the use of the HA (without pre-processing) improved
mean SRTs in quiet from 63.6 to 33.7 dB SPL [two-tail paired Stu-
dent’s t-test, t(4)=6.435, p = 0.003] in bilateral listening, from 71.6
to 37.3 dB SPL [t(4)=17.949, p<0.001] in unilateral listening with
the left ear, and from 72.5 to 42.1 dB SPL in unilateral listening
with the right ear [t(4)=11.733, p<0.001] (Fig. 2). These improve-
ments are comparable or greater than HA improvements reported
elsewhere (e.g., Duquesnoy and Plomp, 1983; Moore et al., 1985;
Peters et al., 1998), which shows that our software-based HA and
fitting rule were reasonable in restoring audibility and intelligibil-
ity in quiet.
3.2. Listening unilaterally with the acoustically better ear
Fig. 3A shows aided SRTs with and without pre-processing in
unilateral listening with the left ear (i.e., the acoustically bet-
ter when there was one) and for three spatial configurations
of the speech and noise sources. Fig. 3B illustrates correspond-
ing SRT improvements produced by the pre-processing method
in each case. A two-way repeated measures analysis of the vari-
ance (RMANOVA) was conducted to test for the effect of process-
ing (with and without pre-processing) and spatial configuration
(S0 N0 , S270 N45 , S270 N90 ) on the SRT. The test revealed a significant
main effect of pre-processing [F(1,11)=338.49, p<0.001]. Mean SRTs
(across locations and participants) were significantly better for pre-
processed than for unprocessed stimuli (−13.3 vs −8.3 dB SNR,
respectively). It also revealed a significant main effect of spatial
configuration [F(2,22)=1269.52, p<0.001]. Post-hoc pairwise tests
with Bonferroni correction showed that SRTs were significantly
worse (higher) for collocated than for spatially separated speech
and noise sources [S0 N0 vs S270 N45 , p<0.001; S0 N0 vs S270 N90 ,
p<0.001], and they were significantly better in the S270 N90 than in
the S270 N45 condition (p<0.001). The interaction between process-
ing and spatial configuration was also significant [F(2,22)=377.77,
p<0.001]. Post-hoc pairwise comparisons with Bonferroni correc-
tion showed that pre-processing improved SRTs significantly in the
S270 N45 (p = 0.002) and S270 N90 (p<0.001) configurations, but not
in the S0 N0 condition (p = 0.153).
3.3. Listening bilaterally
Fig. 3C shows individual and group mean SRTs obtained in bi-
lateral listening with and without pre-processing for the three
target-masker spatial configurations. Fig. 3D depicts individual, and
group mean SRT improvements in each case. A two-way RMANOVA
revealed a significant main effect of processing [F(1,11)=113.16,
p<0.001]. Mean SRTs (across locations and participants) were sig-
nificantly better for pre-processed than for unprocessed stimuli
(−13.6 vs −9.8 dB SNR, respectively). It also revealed a signifi-
cant main effect of spatial configuration [F(2,22)=564.33, p<0.001].
Post-hoc pairwise tests with Bonferroni correction showed that
SRTs were significantly worse (higher) in the collocated condition
than in any of the spatially separated conditions [S0 N0 vs S270 N45 ,
p<0.0 01; S0 N0 vs S270 N90 , p<0.0 01], and they were significantly
better in the S270 N90 than in the S270 N45 condition (p<0.001). The
interaction between processing and spatial configuration was also
4
Hearing Research 432 (2023) 108743
significant [F(2,22)=297.90, p<0.001]. Post-hoc pairwise compar-
isons with Bonferroni correction showed that the pre-processing
improved SRTs significantly only in the S270 N90 (p<0.001), but not
in the S0 N0 (p = 0.331) or the S270 N45 (p = 0.067) configurations.
3.4. Listening unilaterally with the acoustically worse ear
To assess the effect of pre-processing when listening unilat-
erally with the acoustically worse ear (i.e., with the ear con-
tralateral to the target), SRTs were also measured for the five
participants with SNHL listening unilaterally with the right ear
(Fig. 3E,F). A two-way RMANOVA revealed a significant main effect
of processing [F(1,4)=160.42, p<0.001]. Mean SRTs (across loca-
tions and participants) were significantly worse for pre-processed
than for unprocessed stimuli (13.5 vs 3.0 dB SNR, respectively).
It also revealed a significant main effect of spatial configuration
[F(2,8)=728.98, p<0.001]. Post-hoc pairwise tests with Bonferroni
correction showed that SRTs were significantly better (lower) in
the collocated condition than in any of the spatially separated con-
ditions [S0 N0 vs S270 N45 , p<0.001; S0 N0 vs S270 N90, p<0.001], and
they were not significantly different in the S270 N90 and S270 N45
conditions (p = 1.0 0 0). The interaction between processing and
spatial configuration was also significant [F(2,8)=231.75, p<0.001].
Post-hoc pairwise comparisons with Bonferroni correction showed
that the pre-processing worsened SRTs significantly in all spa-
tial configurations: p<0.001 in S270 N45 , p = 0.001 in S270 N90 , and
p = 0.032 in S0 N0 .
3.5. Comparisons across participant groups
Because the aim was to investigate the effect of the algorithm
for HA users overall, the analyses reported in the preceding sec-
tions were done by combining data for all participants. For com-
pleteness, however, this section reports complementary analyses
aimed at comparing the performance of participants with (simu-
lated) conductive loss and SNHL as well as the benefit of the pre-
processing method for the two participant groups.
A RMANOVA with type of hearing loss as a between-subject
factor and processing and spatial configuration as within-subject
factors revealed that SRTs were overall better for participants
with (simulated) conductive hearing loss than for participants
with SNHL, both in bilateral listening [−13.2 vs. −9.6 dB SNR;
F(1,10)=8.341, p = 0.016] and in unilateral listening with the left
ear [−12.0 vs. −8.9 dB SNR; F(1,10)=10.577, p = 0.009]. Note that
the comparison could not be extended to unilateral listening with
the right ear because participants with conductive hearing loss
were not tested in that condition.
A RMANOVA with type of hearing loss as a between-subject
factor and spatial configuration as within-subject factor revealed
that in unilateral listening, the algorithm provided a significantly
larger benefit for participants with SNHL than for those with
conductive loss [5.7 vs. 4.5 dB; F(1,10)=8.011, p = 0.018]. Post
hoc pairwise comparisons revealed, however, that the benefit was
different only in the S270 N90 configuration [difference=2.6 dB,
p = 0.014], but not in the other spatial configurations [S0 N0 :
−0.63 dB, p = 0.922; S270 N45 : 1.1 dB, p = 0.149]. In bilateral
listening, the benefit provided by the algorithm was 3.4 dB for
participants with conductive hearing loss compared to 4.3 dB for
participants with SNHL, and the difference was not significant
[F(1,10)=2.031, p = 0.185].
4. Discussion
The aim of the present study was to investigate if our binau-
ral pre-processing method for contralateral sound attenuation im-
proves speech-in-noise intelligibility for HA users as it does for NH
F.M. San-Victoriano, A. Eustaquio-Martín and E.A. Lopez-Poveda Hearing Research 432 (2023) 108743

Fig. 3. The effect of front-end pre-processing (FE) on aided SRTs. Left panels illustrate individual and group mean aided SRTs with (FE-HA) and without (HA) pre-processing,
while right panels depict SRT improvements produced by the pre-processing in each case. A, B. Listening with the left ear alone, i.e., the acoustically better ear when there
was one. C, D. Listening bilaterally. E, F. Listening with the right ear alone, i.e., the acoustically worse ear when there was one (only tested for listeners with SNHL). In all
panels, circles and squares illustrate scores for individuals with simulated conductive loss and SNHL, respectively; crosses represent group mean scores (N = 12 in panels A-D,
and N = 5 in E-F). Error bars illustrate one standard deviation. Bottom, middle and top lines in each box plot denote the 25, 50 (median), and 75 percentiles, respectively.
n.s.: not significant, ∗ p ≤ 0.05, ∗ ∗ p ≤ 0.01, ∗ ∗ ∗ p ≤ 0.001.

listeners (Lopez-Poveda et al., 2022). We have shown that with
this method, mean aided SRTs for sentences in competition with
SSN improve by up to 10.7 dB when listening bilaterally and up to
13.9 dB when listening unilaterally with the acoustically better ear
(Fig. 3).
Contrary to expectations, for matching listening modes, SRTs
improvements tended to be greater for HA users (present study)
than for NH listeners (reported by Lopez-Poveda et al., 2022). For
example, when listening bilaterally the largest improvement for HA
users was 10.7 dB in the S270 N90 spatial configuration compared

5
F.M. San-Victoriano, A. Eustaquio-Martín and E.A. Lopez-Poveda
Fig. 4. Correlation between the SRT improvement produced by the pre-processing method and the pure tone average (PTA) threshold (mean threshold at 0.5, 1.0, 2.0 and
4 kHz) in unilateral and bilateral listening for different azimuthal locations of the speech (S) and noise (N) sources, as indicated by the inset.
to 9.6 dB in the S270 N45 configuration for NH listeners. The im-
provement could be larger for HA users because SRTs in the cor-
responding reference condition (without pre-processing) tended to
be worse (higher) for HA users than for NH listeners (−14.1 vs
−17.9, respectively), hence HA users had greater room for im-
provement. Indeed, SRT improvements tended to increase with in-
creasing hearing loss, particularly for spatially separated target and
masker sources (Fig. 4). The greater SRT improvements for HA
users could also be due to the use of different subtraction weights,
i.e., β 60°−120° and α 240°−300° used here for HA users compared to
β 0°−180° and α 180°−360° (also referred to as β diff and α diff ) used by
Lopez-Poveda et al. (2022) for NH listeners. The difference in sub-
traction weights likely explains why the largest SRT improvement
occurred for different spatial configurations for HA users and NH
listeners (S270 N90 vs S270 N45 ) (supplementary Fig. S1; see also Fig.
12 from Lopez-Poveda et al., 2022).
Previous reports have shown that the intelligibility improve-
ment that results from spatially separating the target and masker
sources (known as spatial release from masking) can be less
for HA users than for NH listeners presumably partly because
HA compression reduces inter-aural level differences (Festen and
Plomp, 1986; Marrone et al., 2008). Here, the pre-processing im-
proved SRTs more for spatially separated than for collocated tar-
get and masker sources both when listening bilaterally (Fig. 3D)
and unilaterally with the acoustically better ear (Fig. 3B). In other
words, the pre-processing increased spatial release from masking
relative to unprocessed, aided conditions. This shows that besides
improving speech-in-noise intelligibility, contralateral sound field
attenuation can also increase spatial release from masking for HA
users.
Seven of the present participants had simulated rather than ac-
tual conductive hearing losses and their audiometric thresholds
were overall better than those of the five listeners with SNHL
(Fig. 1). Nonetheless, the simulated losses were representative of
real conductive losses and were large enough for HA treatment
(Hoppe and Hesse, 2017). Because the aim of the study was to
investigate if contralateral sound attenuation can help HA users
overall (i.e., regardless of the type of hearing loss), heterogeneity
in thresholds and hearing loss etiology was desirable.
The present evaluations were limited to HAs with a compres-
sion ratio of 2 dB/dB, and with attack and release times of 5 and
200 ms, respectively. These settings were chosen because they are
within the range of values preferred by HA users (Neuman et al.,
6
Hearing Research 432 (2023) 108743
1994). In theory, the greater the compression ratio and the faster
the compressor, the less the advantages of the pre-processing
should be because the method attenuates contralateral sounds
and nonlinear compressors amplify weaker sounds more and more
quickly with greater compression ratios and faster time constants.
Further research is necessary to generalize the found benefits to
other HA settings or to cochlear implants, which apply instanta-
neous compression to map the wider range of acoustic hearing into
the narrower range of electric hearing (e.g., Lopez-Poveda et al.,
2006).
The present findings, together with the ease of implementation
already discussed in Lopez-Poveda et al. (2022), reaffirm that bin-
aural weighted subtraction is potentially useful for implementation
as a binaural sound pre-processing strategy in bilateral HAs. Since
contralateral sound attenuation can improve speech-in-noise intel-
ligibility for listeners with normal hearing (Lopez-Poveda et al.,
2022), the method could also be implemented in consumer elec-
tronic hearing devices (e.g., Chong-White et al., 2022) to help peo-
ple who suffer from speech-in-noise difficulties but no hearing
loss, a condition sometimes referred to as King-Kopetzky syndrome
(Zhao et al., 2007).
In the present tests, stimuli were presented over headphones
and spatial configurations were simulated by filtering monophonic
recordings through free-field KEMAR HRTFs for a fixed distance of
1.4 m. Test conditions were limited to a single masker source (SSN)
and to static heads and sound sources. Furthermore, both the HAs
and the pre-processing algorithm were implemented in software.
These conditions are far from realistic. In realistic listening situa-
tions, HA microphones may be located behind the ear, the type of
target and the type and number of interfering sources may vary
from moment to moment, the different sources may be at dif-
ferent distances from the listener, potentially moving, and/or not
so spatially separated, heads may rotate, and the room may have
reverberation. In addition, in realistic hardware implementations,
the pre-processing algorithm would almost certainly operate over
a narrower frequency range (e.g., as determined by the HA mi-
crophones), with non-matched HRTFs (Lopez-Poveda et al., 2022),
and would involve delays in bilateral signal exchange. These factors
were disregarded in the present tests and may affect the benefit of
the algorithm. Furthermore, given the weak relationship between
beamformer benefits in laboratory tests with self-perceived field
benefits (e.g., Cord et al., 2004; Gnewikow et al., 2009), the algo-
rithm may turn out to be less beneficial in realistic settings and
F.M. San-Victoriano, A. Eustaquio-Martín and E.A. Lopez-Poveda
implementations than reported here. Further research is necessary
to generalize the found benefits to more realistic implementations
and test conditions. Nevertheless, the pre-processing method pro-
posed by Lopez-Poveda et al. (2022) holds promise to improve the
intelligibility of speech in noise and enhance spatial release from
masking also for HA users.
CRediT authorship contribution statement
Fernando M. San-Victoriano: Investigation, Formal analysis,
Data curation, Visualization, Writing – original draft, Writing – re-
view & editing. Almudena Eustaquio-Martín: Software, Investiga-
tion, Formal analysis, Data curation, Visualization, Writing – re-
view & editing. Enrique A. Lopez-Poveda: Conceptualization, Su-
pervision, Funding acquisition, Project administration, Methodol-
ogy, Writing – review & editing.
Acknowledgements
We thank Milagros J. Fumero and Gabriela Araujo Chavéron for
help with data collection. Work supported by the Spanish Ministry
of Science and Innovation (grant PID2019–108985GB-I00) and by
MED-EL GmbH (Innsbruck, Austria).
Supplementary materials
Supplementary material associated with this article can be
found, in the online version, at doi:10.1016/j.heares.2023.108743.
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