Speech perception benefits of internet versus conventional telephony for hearing-impaired individuals

Georgios Mantokoudis, Patrick Dubach, Flurin Pfiffner, Martin Kompis, Marco Caversaccio, Pascal Senn, Georgios Mantokoudis, Patrick Dubach, Flurin Pfiffner, Martin Kompis, Marco Caversaccio, Pascal Senn

Abstract

Background: Telephone communication is a challenge for many hearing-impaired individuals. One important technical reason for this difficulty is the restricted frequency range (0.3-3.4 kHz) of conventional landline telephones. Internet telephony (voice over Internet protocol [VoIP]) is transmitted with a larger frequency range (0.1-8 kHz) and therefore includes more frequencies relevant to speech perception. According to a recently published, laboratory-based study, the theoretical advantage of ideal VoIP conditions over conventional telephone quality has translated into improved speech perception by hearing-impaired individuals. However, the speech perception benefits of nonideal VoIP network conditions, which may occur in daily life, have not been explored. VoIP use cannot be recommended to hearing-impaired individuals before its potential under more realistic conditions has been examined.

Objective: To compare realistic VoIP network conditions, under which digital data packets may be lost, with ideal conventional telephone quality with respect to their impact on speech perception by hearing-impaired individuals.

Methods: We assessed speech perception using standardized test material presented under simulated VoIP conditions with increasing digital data packet loss (from 0% to 20%) and compared with simulated ideal conventional telephone quality. We monaurally tested 10 adult users of cochlear implants, 10 adult users of hearing aids, and 10 normal-hearing adults in the free sound field, both in quiet and with background noise.

Results: Across all participant groups, mean speech perception scores using VoIP with 0%, 5%, and 10% packet loss were 15.2% (range 0%-53%), 10.6% (4%-46%), and 8.8% (7%-33%) higher, respectively, than with ideal conventional telephone quality. Speech perception did not differ between VoIP with 20% packet loss and conventional telephone quality. The maximum benefits were observed under ideal VoIP conditions without packet loss and were 36% (P = .001) for cochlear implant users, 18% (P = .002) for hearing aid users, and 53% (P = .001) for normal-hearing adults. With a packet loss of 10%, the maximum benefits were 30% (P = .002) for cochlear implant users, 6% (P = .38) for hearing aid users, and 33% (P = .002) for normal-hearing adults.

Conclusions: VoIP offers a speech perception benefit over conventional telephone quality, even when mild or moderate packet loss scenarios are created in the laboratory. VoIP, therefore, has the potential to significantly improve telecommunication abilities for the large community of hearing-impaired individuals.

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Each data packet originating in a voice over Internet protocol (VoIP)-sending device (not shown) takes a different route through the Internet (TCP/IP network) before arriving at the receiver. Data packets may be delayed or lost on the way. The VoIP software includes two solutions to improve audio quality in these cases: the jitter buffer collects the maximum number of data packets by waiting as long as needed and keeping the time delay to a minimum; and packet loss concealment (PLC) aims to reconstruct lost data packets. Finally, digital data packets are decoded and delivered to a VoIP-compatible user interface, such as a VoIP handheld telephone, a headset, or external loudspeakers.
Figure 2
Figure 2
Lower quartile, median, upper quartile, and 1.5*interquartile range (X = outliers) of aided hearing thresholds in the free sound field for cochlear implant (CI) and hearing aid (HA) users. The analog telephone (public switched telephone network [PSTN]) speech signals are shown in dB hearing level as dotted lines. VoIP = voice over Internet protocol.
Figure 3
Figure 3
Speech perception scores assessed with the HSM Sentence Test are plotted against different signal to noise ratios (SNRs) for cochlear implant users (A), hearing aid users (C), and normal-hearing adults (E) for 4 different VoIP qualities (0%, 5%, 10%, and 20% packet loss) and 1 ideal conventional telephone quality. The impact of different network conditions with increasing data packet loss (x-axis) on word discrimination scores is shown for different SNRs in B, D, and F. The black triangle indicates the speech perception level corresponding to a conventional telephone with a constant and stable transmission. VoIP = voice over Internet protocol.

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