# Benefits of Auditory Training with an Open-Set Sentences-in-Babble-Noise
## 2 Materials and Methods
### Speech Perception (Generalization)  
Speech perception before and after training was assessed following a previous protocol [21] in the participant's home and included the adaptive HeBio amidst speech-shaped noise (SSN) [18], Consonant-Vowel-Consonant (CVC) Words in quiet [18], the Digits in Noise (DIN) test [22], and a subjective auditory perception assessment questionnaire [23]. The tests were presented at 65 dB SPL through a loudspeaker positioned at 0 azimuths and a 1 m distance from the participant. The assessment session took 45 min. Sentence comprehension was conducted using the Adaptive HeBio test. This is an adaptive version of the HeBio, presented amidst SSN. The SSN had frequency ranges and long-term-average-speech-spectra similar to the sentences and were normalized to have RMS amplitudes similar to those of the sentences [18]. The HeBio speech reception threshold in noise (SRTn), with SSN, the signal-to-noise ratio (SNR) for 50% identification, was measured as described for the adaptive HeBio in 4 TBN described in the training section. Each testing session included one list, different from those used in the training. \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multirow{2}{*}{**ID**} & **Age** & \multirow{2}{*}{**Gender**} & **Duration of** & \multirow{2}{*}{**Etiology of**} & \multicolumn{2}{c}{**Hearing Loss Level**} \\ \cline{4-7}  & **(Years)** & & **Hearing Loss** & & **Right** & **Left** \\ \hline ST & 75 & F & 5 & Unknown & Moderate & Minimal to mild \\ HSA & 76 & F & 8 & Unknown & Moderate to profound & Moderate to severe \\ YS & 77 & M & 50 & Unknown & Mild to profound & Mild to severe \\ MS & 75 & M & 10 & Unknown & Mild to moderate-severe & Mild to moderate-severe \\ ND & 72 & F & 10 & Unknown & Mild to severe & Mild to severe \\ EH & 70 & F & 8 & Unknown & Mild to profound & Mild to severe \\ DK & 71 & F & 10 & Unknown & Mild to moderate-severe & Mild to moderate \\ MZ & 66 & M & 14 & Unknown & Mild to moderate-severe & Mild to moderate-severe \\ ZD & 75 & F & 27 & Genetic & Moderate-severe to & Moderate-severe \\ NA & 74 & F & 7 & Unknown & Mild to moderate-severe & Mild to moderate-severe \\ YSH & 88 & M & 4 & Unknown & Mild to moderate-severe & Mild to moderate-severe \\ \hline \hline \end{tabular}
\end{table} 
Table 1: _Cont._Word comprehension was conducted using CVC words in a quiet test. This test consists of 20 lists of 10 meaningful, one-syllable consonant-vowel-consonant phonetically balanced Hebrew words constructed according to the [PERSON] words test [24]. Each list contains all the Hebrew consonants (each appears once) and vowels (each appears twice). The lists are also balanced for word frequency in Hebrew. For each participant, 2 lists of 10 words were presented. Participants were instructed to repeat each word they heard and guess if they were unsure. Results were manually recorded by the experimenter (first author) and expressed as the percentage of correct words. Digits identification using the Digit in Noise (DIN) test. This speech-in-noise test uses digit triplets in steady-state speech noise [25]. In the current study, we used the Hebrew version of the test [22]. The test measures the SRTn in long-term average speech-spectrum noise via a 1-up, 1-down adaptive procedure with a measurement error of 0.7 dB [22]. The noise display level was set at 65 dB SPL. It was first delivered in two practice trials with fixed SNR of +10, then two additional practice trials with steps of 4 dB. In the test, the initial SNR was 0 dB, with steps of 2 dB. Speech in noise threshold (SNR) was defined as the level difference (in dB) between speech and noise display levels, where 50% of the answers were correct. Lower SNR indicates better performance. A subjective auditory perception assessment questionnaire was conducted. A Hebrew translation of the Qualitative Outcomes Assessment for Customized Learning: Exercises for Aural Rehabilitation (clEAR [QOAC]) [23] was used.