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Preserving localization in hearing instrument fittings

As part of the hearing instrument fitting process, clinicians often ask patients whether they can tell where sounds are coming from. Not uncommonly, patients will report that the sound picture is somewhat artificial even though they are hearing better. They may report a distorted sense of loudness for near and far sound sources, or that things sound jumbled and confusing in complicated listening environments. This can be at least partly attributed to disrupted cues to localization. Localization of sounds is central to auditory perception. Although we tend to think of localization as the ability to explicitly pinpoint the position of particular sound sources, it is a much more fundamental aspect of hearing upon which we unconsciously and effortlessly rely. Localization allows listeners to construct auditory scenes, giving them a sense of the space that they are in and how objects in that space relate to one another. As such, it merits more attention in hearing instrument fitting than is typically given. The main goal of hearing instruments is to amplify sounds to compensate for hearing loss. Secondary goals may be improving signal-to-noise ratio or maintaining listening comfort, and while these goals may be achieved, it can be at the expense of cues to localization. In addition, the physical design of a hearing instrument can alter localization cues. It is a challenge to achieve amplification—including the benefits of directionality—without localization drawbacks; however, technology that is capable of accomplishing both goals is available. Advanced directional processing, which is applied to high frequency sounds while an omnidirectional response is maintained in the low frequencies, both improves signal-to-noise ratio relative to omnidirectional processing and preserves important localization cues. This paper describes how localization ability can be affected by hearing instruments, and summarizes the findings of a study conducted at K.U.Leuven in Belgium, which investigated the effects of omnidirectional and directional processing schemes on left/right and front/back localization.