Effect of minimal hearing loss on children's ability to multitask in quiet and in noise

Impact of room acoustics and visual cues on speech perception and talker localization by children with mild bilateral or unilateral hearing loss

Introduction

This study evaluated the ability of children (8-12 years) with mild bilateral or unilateral hearing loss (MBHL/UHL) listening unaided, or normal hearing (NH) to locate and understand talkers in varying auditory/visual acoustic environments. Potential differences across hearing status were examined.

Methods

Participants heard sentences presented by female talkers from five surrounding locations in varying acoustic environments. A localization-only task included two conditions (auditory only, visually guided auditory) in three acoustic environments (favorable, typical, poor). Participants were asked to locate each talker. A speech perception task included four conditions [auditory-only, visually guided auditory, audiovisual, auditory-only from 0° azimuth (baseline)] in a single acoustic environment. Participants were asked to locate talkers, then repeat what was said.

Results

In the localization-only task, participants were better able to locate talkers and looking times were shorter with visual guidance to talker location. Correct looking was poorest and looking times longest in the poor acoustic environment. There were no significant effects of hearing status/age. In the speech perception task, performance was highest in the audiovisual condition and was better in the visually guided and auditory-only conditions than in the baseline condition. Although audiovisual performance was best overall, children with MBHL or UHL performed more poorly than peers with NH. Better-ear pure-tone averages for children with MBHL had a greater effect on keyword understanding than did poorer-ear pure-tone averages for children with UHL.

Conclusion

Although children could locate talkers more easily and quickly with visual information, finding locations alone did not improve speech perception. Best speech perception occurred in the audiovisual condition; however, poorer performance by children with MBHL or UHL suggested that being able to see talkers did not overcome reduced auditory access. Children with UHL exhibited better speech perception than children with MBHL, supporting benefits of NH in at least one ear.

Speech perception in noise, working memory, and attention in children: A scoping review

PURPOSE

Speech perception in noise is an everyday occurrence for adults and children alike. The factors that influence how well individuals cope with noise during spoken communication are not well understood, particularly in the case of children. This article aims to review the available evidence on how working memory and attention play a role in children's speech perception in noise, how characteristics of measures affect results, and how this relationship differs in non-typical populations.

METHOD

This article is a scoping review of the literature available on PubMed. Forty articles were included for meeting the inclusion criteria of including children as participants, some measure of speech perception in noise, some measure of attention and/or working memory, and some attempt to establish relationships between the measures. Findings were charted and presented keeping in mind how they relate to the research questions.

RESULTS

The majority of studies report that attention and especially working memory are involved in speech perception in noise by children. We provide an overview of the impact of certain task characteristics on findings across the literature, as well as how these affect non-typical populations.

CONCLUSION

While most of the work reviewed here provides evidence suggesting that working memory and attention are important abilities employed by children in overcoming the difficulties imposed by noise during spoken communication, methodological variability still prevents a clearer picture from emerging.

Speech Understanding in Complex Environments by School-Age Children with Mild Bilateral or Unilateral Hearing Loss

Numerous studies have shown that children with mild bilateral (MBHL) or unilateral hearing loss (UHL) experience speech perception difficulties in poor acoustics. Much of the research in this area has been conducted via laboratory studies using speech-recognition tasks with a single talker and presentation via earphones and/or from a loudspeaker located directly in front of the listener. Real-world speech understanding is more complex, however, and these children may need to exert greater effort than their peers with normal hearing to understand speech, potentially impacting progress in a number of developmental areas. This article discusses issues and research relative to speech understanding in complex environments for children with MBHL or UHL and implications for real-world listening and understanding.

Hearing aid benefits in children with mild bilateral hearing loss: AUDIO-INFANS study

OBJECTIVES

There is a lack of consensus regarding the definition, consequences, and management of mild bilateral hearing loss in children. The objective of this study is to analyze the benefit of hearing aids in children with mild bilateral hearing loss by evaluating their functional hearing.

METHODS

This retrospective study included 57 children with mild bilateral hearing loss between 20 dB HL and 40 dB HL. Pure tone and speech audiometry thresholds were assessed with and without hearing aids. Two groups were subsequently formed: group E with an effective use of hearing aids (>10 h/day), and group IE whose use of hearing aids was deemed ineffective (<10 h/day).

RESULTS

Without hearing aids, the initial median of hearing level was 35 dB HL and 36 dB HL in the right and left ears, respectively, compared to 23 dB HL and 25 dB HL with hearing aids. The Lafon test performed on 25 children at 55 dB HL and 65 dB HL showed results ranging from 0% to 100% without hearing aids and from 90% to 100% with hearing aids. Scores obtained with hearing aids were significantly higher than those without them at an average speech level. Median age at diagnosis and at prescription were found to significantly influence the daily use of hearing aids.

CONCLUSIONS

Our results show that in the case of mild bilateral hearing loss, hearing aids have positive effects on the functional hearing of children and help them to no longer be disadvantaged. This study highlights the need to provide regular support to these children to ensure their optimal care in the event of hearing-related problems. Coordination between the different professionals working with these children is also necessary for their follow-up and appropriate management.

Age and Hearing Ability Influence Selective Attention During Childhood

OBJECTIVES

The purpose of the present study was to determine whether age and hearing ability influence selective attention during childhood. Specifically, we hypothesized that immaturity and disrupted auditory experience impede selective attention during childhood.

DESIGN

Seventy-seven school-age children (5 to 12 years of age) participated in this study: 61 children with normal hearing and 16 children with bilateral hearing loss who use hearing aids and/or cochlear implants. Children performed selective attention-based behavioral change detection tasks comprised of target and distractor streams in the auditory and visual modalities. In the auditory modality, children were presented with two streams of single-syllable words spoken by a male and female talker. In the visual modality, children were presented with two streams of grayscale images. In each task, children were instructed to selectively attend to the target stream, inhibit attention to the distractor stream, and press a key as quickly as possible when they detected a frequency (auditory modality) or color (visual modality) deviant stimulus in the target, but not distractor, stream. Performance on the auditory and visual change detection tasks was quantified by response sensitivity, which reflects children's ability to selectively attend to deviants in the target stream and inhibit attention to those in the distractor stream. Children also completed a standardized measure of attention and inhibitory control.

RESULTS

Younger children and children with hearing loss demonstrated lower response sensitivity, and therefore poorer selective attention, than older children and children with normal hearing, respectively. The effect of hearing ability on selective attention was observed across the auditory and visual modalities, although the extent of this group difference was greater in the auditory modality than the visual modality due to differences in children's response patterns. Additionally, children's performance on a standardized measure of attention and inhibitory control related to their performance during the auditory and visual change detection tasks.

CONCLUSIONS

Overall, the findings from the present study suggest that age and hearing ability influence children's ability to selectively attend to a target stream in both the auditory and visual modalities. The observed differences in response patterns across modalities, however, reveal a complex interplay between hearing ability, task modality, and selective attention during childhood. While the effect of age on selective attention is expected to reflect the immaturity of cognitive and linguistic processes, the effect of hearing ability may reflect altered development of selective attention due to disrupted auditory experience early in life and/or a differential allocation of attentional resources to meet task demands.

Minimal and Mild Hearing Loss in Children: Association with Auditory Perception, Cognition, and Communication Problems

OBJECTIVES

"Minimal" and "mild" hearing loss are the most common but least understood forms of hearing loss in children. Children with better ear hearing level as low as 30 dB HL have a global language impairment and, according to the World Health Organization, a "disabling level of hearing loss." We examined in a population of 6- to 11-year-olds how hearing level ≤40.0 dB HL (1 and 4 kHz pure-tone average, PTA, threshold) is related to auditory perception, cognition, and communication.

DESIGN

School children (n = 1638) were recruited in 4 centers across the United Kingdom. They completed a battery of hearing (audiometry, filter width, temporal envelope, speech-in-noise) and cognitive (IQ, attention, verbal memory, receptive language, reading) tests. Caregivers assessed their children's communication and listening skills. Children included in this study (702 male; 752 female) had 4 reliable tone thresholds (1, 4 kHz each ear), and no caregiver reported medical or intellectual disorder. Normal-hearing children (n = 1124, 77.1%) had all 4 thresholds and PTA <15 dB HL. Children with ≥15 dB HL for at least 1 threshold, and PTA <20 dB (n = 245, 16.8%) had minimal hearing loss. Children with 20 ≤PTA <40 dB HL (n = 88, 6.0%) had mild hearing loss. Interaural asymmetric hearing loss ( left PTA - right PTA ≥10 dB) was found in 28.9% of those with minimal and 39.8% of those with mild hearing loss.

RESULTS

Speech perception in noise, indexed by vowel-consonant-vowel pseudoword repetition in speech-modulated noise, was impaired in children with minimal and mild hearing loss, relative to normal-hearing children. Effect size was largest (d = 0.63) in asymmetric mild hearing loss and smallest (d = 0.21) in symmetric minimal hearing loss. Spectral (filter width) and temporal (backward masking) perceptions were impaired in children with both forms of hearing loss, but suprathreshold perception generally related only weakly to PTA. Speech-in-noise (nonsense syllables) and language (pseudoword repetition) were also impaired in both forms of hearing loss and correlated more strongly with PTA. Children with mild hearing loss were additionally impaired in working memory (digit span) and reading, and generally performed more poorly than those with minimal loss. Asymmetric hearing loss produced as much impairment overall on both auditory and cognitive tasks as symmetric hearing loss. Nonverbal IQ, attention, and caregiver-rated listening and communication were not significantly impaired in children with hearing loss. Modeling suggested that 15 dB HL is objectively an appropriate lower audibility limit for diagnosis of hearing loss.

CONCLUSIONS

Hearing loss between 15 and 30 dB PTA is, at ~20%, much more prevalent in 6- to 11-year-old children than most current estimates. Key aspects of auditory and cognitive skills are impaired in both symmetric and asymmetric minimal and mild hearing loss. Hearing loss <30 dB HL is most closely related to speech perception in noise, and to cognitive abilities underpinning language and reading. The results suggest wider use of speech-in-noise measures to diagnose and assess management of hearing loss and reduction of the clinical hearing loss threshold for children to 15 dB HL.

Listening Effort in School-Age Children With Normal Hearing Compared to Children With Limited Useable Hearing Unilaterally

Objectives Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design Two groups of school-age children (aged 7-12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (-12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of "task difficulty" and "hard to think" were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.

Children with hearing loss can predict during sentence processing

Listeners readily anticipate upcoming sentence constituents, however little is known about prediction when the input is suboptimal, such as for children with hearing loss (HL). Here we examined whether children with hearing aids and/or cochlear implants use semantic context to predict upcoming spoken sentence completions. We expected reduced prediction among children with HL, but found they were able to predict similarly to children with normal hearing. This suggests prediction is robust even when input quality is chronically suboptimal, and is compatible with the idea that recent advances in the management of pre-lingual HL may have minimised some of the language processing differences between children with and without HL.

Disentangling listening effort and memory load beyond behavioural evidence: Pupillary response to listening effort during a concurrent memory task

Recent research has demonstrated that pupillometry is a robust measure for quantifying listening effort. However, pupillary responses in listening situations where multiple cognitive functions are engaged and sustained over a period of time remain hard to interpret. This limits our conceptualisation and understanding of listening effort in realistic situations, because rarely in everyday life are people challenged by one task at a time. Therefore, the purpose of this experiment was to reveal the dynamics of listening effort in a sustained listening condition using a word repeat and recall task. Words were presented in quiet and speech-shaped noise at different signal-to-noise ratios (SNR): 0dB, 7dB, 14dB and quiet. Participants were presented with lists of 10 words, and required to repeat each word after its presentation. At the end of the list, participants either recalled as many words as possible or moved on to the next list. Simultaneously, their pupil dilation was recorded throughout the whole experiment. When only word repeating was required, peak pupil dilation (PPD) was bigger in 0dB versus other conditions; whereas when recall was required, PPD showed no difference among SNR levels and PPD in 0dB was smaller than repeat-only condition. Baseline pupil diameter and PPD followed different variation patterns across the 10 serial positions within a block for conditions requiring recall: baseline pupil diameter built up progressively and plateaued in the later positions (but shot up when listeners were recalling the previously heard words from memory); PPD decreased at a pace quicker than in repeat-only condition. The current findings demonstrate that additional cognitive load during a speech intelligibility task could disturb the well-established relation between pupillary response and listening effort. Both the magnitude and temporal pattern of task-evoked pupillary response differ greatly in complex listening conditions, urging for more listening effort studies in complex and realistic listening situations.

Listening Effort in Native and Nonnative English-Speaking Children Using Low Linguistic Single- and Dual-Task Paradigms

Purpose It is not clear if behavioral indices of listening effort are sensitive to changes in signal-to-noise ratio (SNR) for young children (7-12 years old) from multilingual backgrounds. The purpose of this study was to explore the effects of SNR on listening effort in multilingual school-aged children (native English, nonnative English) as measured with a single- and a dual-task paradigm with low-linguistic speech stimuli (digits). The study also aimed to explore age effects on digit triplet recognition and response times (RTs). Method Sixty children with normal hearing participated, 30 per language group. Participants completed single and dual tasks in three SNRs (quiet, -10 dB, and -15 dB). Speech stimuli for both tasks were digit triplets. Verbal RTs were the listening effort measure during the single-task paradigm. A visual monitoring task was the secondary task during the dual-task paradigm. Results Significant effects of SNR on RTs were evident during both single- and dual-task paradigms. As expected, language background did not affect the pattern of RTs. The data also demonstrate a maturation effect for triplet recognition during both tasks and for RTs during the dual-task only. Conclusions Both single- and dual-task paradigms were sensitive to changes in SNR for school-aged children between 7 and 12 years of age. Language background (English as native language vs. English as nonnative language) had no significant effect on triplet recognition or RTs, demonstrating practical utility of low-linguistic stimuli for testing children from multilingual backgrounds.

Auditory Comprehension in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss

Purpose The purpose of this study was to measure auditory comprehension performance in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH) in quiet and in the presence of child-produced two-talker babble (TTB). Method Listeners were school-aged children (7-12 years) with permanent UHL (n = 25) or NH (n = 14). Comprehension of three short stories taken from the Test of Narrative Language (Gillam & Pearson, 2004) was measured in quiet and in the presence of TTB at two signal-to-noise ratios (SNRs): (a) +6 dB and (b) the individualized SNR required to achieve 50% sentence understanding in the presence of the same TTB masker in a prior study (Griffin, Poissant, & Freyman, 2019). Target/masker spatial configuration was 0°/±60° azimuth. Results As a group, subjects with UHL demonstrated auditory comprehension abilities in favorable listening environments (i.e., quiet, +6 dB SNR) that were statistically equivalent to the NH group. However, in the most challenging listening condition (individualized SNR), many subjects with UHL demonstrated poorer comprehension performance than their age-matched peers with NH. Comprehension abilities were not associated with degree of UHL, unaided speech intelligibility index at 65 dB SPL in the impaired ear, side of UHL, or sex. Conclusions As a group, children with UHL demonstrated deficits in auditory comprehension compared to age-matched peers with NH in challenging listening environments. Findings highlight the importance of ensuring good SNRs for children with UHL.

Hearing and Auditory Processing Abilities in Primary School Children with Learning Difficulties

OBJECTIVES

This study aimed to investigate hearing and auditory processing ability in primary school children with learning difficulties (LD).

DESIGN

A nonrandomized, cross-sectional single measure research design was used. A total of 486 children, aged 7.7 to 10.8 years and attending years 3 and 4 in six primary schools, were classified as having an LD (n = 67) or being typically developing (TD, n = 419). This classification was based on a Learning Score generated from their school report results and National Assessment Program - Literacy and Numeracy scores. All children attempted a conventional hearing assessment (CHA) involving pure-tone audiometry, tympanometry, acoustic reflexes (AR), and otoacoustic emissions (OAEs). Children returning pure-tone audiometry results within normal limits also attempted an auditory processing assessment (APA) including dichotic digits (DD) and low-pass filtered speech (LPFS) tests.

RESULTS

In children with LD, 21/67 (31.4%) failed the CHA, 20/58 (34.5%) failed the APA, and 32/58 (55.2%) failed the overall hearing assessment (OHA) if they failed either or both CHA and APA. In comparison, in TD children, 55/413 (13.3%) failed the CHA, 52/314 (16.6%) failed the APA, and 86/313 (27.5%) failed the OHA. Proportionally, children with LD were 2.4 times more likely than TD children to fail the CHA, 2.1 times more likely to fail the APA, and 2.0 times more likely to fail the OHA. In children who had completed the OHA, multiple linear regressions showed average AR thresholds, DD scores, and LPFS scores explained 13 to 18% of the variance in the Learning Score.

CONCLUSION

The potential for hearing impairment should be investigated in children with LD. These investigations should begin with CHA, and for children returning normal-hearing thresholds, should continue with measures of AR, DD, and LPFS, to ensure these children receive the appropriate auditory support needed to enhance their learning.

Prevalence of Mild Hearing Loss in Schoolchildren and its Association with their School Performance

Introduction  Hearing is important for the proper development of every child, especially for those younger than 5 years of age, because it helps in the development of language and speech. Emotional and social problems, as well as issues with academic performance, can result from hearing loss even of mild degree. Early diagnosis and management can overcome those negative impacts.

Objective  To determine the prevalence of mild hearing loss in primary-school children and its association with their school performance.

Methods  A comparative cross-sectional study was conducted at a regular school. The study included the random selection of 120 apparently normal students (aged 6-9 years) who were considered as having normal hearing by their parents. A total of 20 students were excluded from the study due to the presence of wax in their ears. Finally, the study was conducted with 100 students. All participants were subjected to a basic audiological evaluation, and the Screening Instrument for Targeting Educational Risk (SIFTER) questionnaire was given to their teachers to evaluate their school performance.

Results  From a total of 100 students, we confirmed that 23 (23%) had mild hearing loss, 17 (17%) had bilateral conductive hearing loss, and 6 (6%) had bilateral sensorineural hearing loss. The students who had low attention and communication performance were significantly associated with mild hearing loss.

Conclusion  The prevalence of mild hearing loss was of 23% (23 cases). This problem had an effect on the communication and attention in school; and it might affect academic performance later in life. A hearing assessment is highly recommended for every child, especially those who have a low rate of academic performance.

The effects of using hearing aids and a frequency modulated system on listening effort among adolescents with hearing loss

Objective: To develop a web-based application for a colour pattern memory recognition task as the secondary task of a dual-task paradigm and to compare the listening effort required by adolescents with hearing loss (HL) under two conditions (HA and HA + FM system), to adolescents with normal hearing (NH).Design: Cohort study. The participants underwent a dual-task paradigm, including the Hearing in Noise Test as the primary task and a colour memory task as the secondary task. A platform, PALETA, was developed to assess the secondary task.Study sample: In total, 31 adolescents were enrolled, of which 13 adolescents had HL and 18 adolescents had NH (mean age, 14 years).Results: Adolescents with NH scored significantly better on the secondary task compared to participants with HL using a HA. However, on analysing response time, no significant differences were observed among the groups.Conclusion: PALETA is proposed as a test procedure for the secondary task. The results revealed that the use of an FM system reduces the listening effort that adolescents with HL deploy to recognise speech in noise, and that listening effort data by number of correct responses is a way of investigating the benefits of using FM system.

Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification

OBJECTIVES

Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs).

DESIGN

A total of 82 children (aged 6-13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort.

RESULTS

Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs.

CONCLUSIONS

This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom.

Moderate Reverberation Does Not Increase Subjective Fatigue, Subjective Listening Effort, or Behavioral Listening Effort in School-Aged Children

Background noise and reverberation levels in typical classrooms have negative effects on speech recognition, but their effects on listening effort and fatigue are less well understood. Based on the Framework for Understanding Effortful Listening, noise and reverberation would be expected to increase both listening effort and fatigue. However, previous investigations of the effects of reverberation for adults have resulted in mixed findings. Some discrepancies in the literature might be accounted for by methodological differences; behavioral and subjective indices of listening effort do not often align in adults. The effects of sustained listening on self-reported fatigue in school-aged children are also not well understood. The purposes of this project were to (1) evaluate the effects of noise and reverberation on listening effort in school-aged children using behavioral and subjective measures, (2) compare subjective and behavioral indices of listening effort, and (3) evaluate the effects of reverberation on self-reported fatigue. Twenty typically developing children (10-17 years old) participated. Participants completed dual-task testing in two rooms that varied in terms of reverberation, an audiometric sound booth and a moderately reverberant room. In each room, testing was completed in quiet and in two levels of background noise. Participants provided subjective ratings of listening effort after completing the dual-task in each listening condition. Subjective ratings of fatigue were completed before and after testing in each level of reverberation. Results revealed background noise, not reverberation, increased behavioral and subjective listening effort. Subjective ratings of perceived performance, ease of listening, and desire to control the listening situation revealed a similar pattern of results as word recognition performance, making them poor candidates for providing an indication of behavioral listening effort. However, ratings of time perception were moderately correlated with behavioral listening effort. Finally, sustained listening for approximately 25 min increased self-reported fatigue, although changes in fatigue were comparable in low and moderately reverberant environments. In total, these data offer no evidence that a moderate level of reverberation increases listening effort or fatigue, but the data do support the reduction of background noise in classrooms.

Investigating Speech Recognition and listening effort with different device configurations in adult cochlear implant users

OBJECTIVES

The purpose of this study was to investigate speech recognition in noise and listening effort among a group of adults with cochlear implants (CIs). Two main research questions were addressed. First, what are the effects of omni versus directional microphone configuration on speech recognition and listening effort for noisy conditions? Second, what is the effect of unilateral versus bimodal or bilateral CI listening on speech recognition and listening effort in noisy conditions?

DESIGN

Sixteen adults (mean age 58 years) with CIs participated. Listening effort was measured using a dual-task paradigm and also using a self-reported rating of difficulty scale. In the dual-task measure, participants were asked to repeat monosyllabic words while at the same time press a button in response to a visual stimulus. Participants were tested in two baseline conditions (speech perception alone and visual task alone) and in the following experimental conditions: (1) quiet with an omnidirectional microphone, (2) noise with an omnidirectional microphone, (3) noise with a directional microphone, and (4) noise with a directional microphone and with a second sided CI or hearing aid. When present, the noise was fixed with a +5 dB signal-to-noise ratio. After each listening condition, the participants rated the degree of listening difficulty.

RESULTS

Changing the microphone from omni to directional mode significantly enhanced speech recognition in noise performance. There were no significant changes in speech recognition between the unilateral and bimodal/bilateral CI listening conditions. Listening effort, as measured by reaction time, increased significantly between the baseline and omnidirectional quiet listening condition though did not change significantly across the remaining listening conditions. Self-perceived listening effort revealed a greater effort for the noisy conditions, and reduced effort with the move from an omni to a directional microphone.

CONCLUSIONS

Directional microphones significantly improve speech in noise recognition over omnidirectional microphones and allowed for decreased self-perceived listening effort. The dual task used in this study failed to show any differences in listening effort across the experimental conditions and may not be sensitive enough to detect changes in listening effort.

Behavioral Assessment of Listening Effort Using a Dual-Task Paradigm

Published investigations (n = 29) in which a dual-task experimental paradigm was employed to measure listening effort during speech understanding in younger and older adults were reviewed. A summary of the main findings reported in the articles is provided with respect to the participants’ age-group and hearing status. Effects of different signal characteristics, such as the test modality, on dual-task outcomes are evaluated, and associations with cognitive abilities and self-report measures of listening effort are described. Then, several procedural issues associated with the use of dual-task experiment paradigms are discussed. Finally, some issues that warrant future research are addressed. The review revealed large variability in the dual-task experimental paradigms that have been used to measure the listening effort expended during speech understanding. The differences in experimental procedures used across studies make it difficult to draw firm conclusions concerning the optimal choice of dual-task paradigm or the sensitivity of specific paradigms to different types of experimental manipulations. In general, the analysis confirmed that dual-task paradigms have been used successfully to measure differences in effort under different experimental conditions, in both younger and older adults. Several research questions that warrant further investigation in order to better understand and characterize the intricacies of dual-task paradigms were identified.

Current practice of ototoxicity management across the United Kingdom (UK)

OBJECTIVE

Effective management of patients diagnosed with ototoxicity is needed to reduce hearing and balance damage which affects communication and life quality. Despite widespread recommendations to monitor and manage ototoxicity in an early and effective manner, there is limited evidence to support the actual implementation of these recommendations for affected patient groups in healthcare services across the UK with limited publications available. In this study, an online questionnaire analysed the current practice of ototoxicity management and patient pathways across the UK once the diagnosis of ototoxicity was confirmed, targeting Audiologists, ENTs/AVPs and GPs.

DESIGN

Qualitative Survey Study.

STUDY SAMPLE

A randomised sample of hearing services in the UK, including audiology departments; GP practices and local health settings were targeted with a total of 134 completed surveys.

RESULTS

About 72% reported the absence of ototoxicity management protocols within their centre. Results depicted great inconsistency and variation across the UK in ototoxicity management services provided, treatment modification, monitoring and referral pathways.

CONCLUSION

Developing and advocating national guidelines are intended not only to inform clinical decision making but to provide minimum standards of care in ototoxicity management and offer greater awareness and education to improve patients' quality of life.

Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana

Objective. To describe and quantify hearing impairment among children referred to the audiology clinic in Princess Marina Hospital, a public referral hospital in Botswana. Methods. In a retrospective case series, we reviewed medical records of children aged 10 years and younger whose hearing was assessed between January 2006 and December 2015 at the audiology clinic of Princess Marina Hospital in Gaborone, Botswana. Results. Of 622 children, 50% were male, and median age was 6.7 years (interquartile range = 5.0-8.3). Hearing impairment was diagnosed in 32% of clinic attendees, comprising sensorineural (23%), conductive (25%), and mixed (11%) hearing loss, while 41% of children with diagnosed hearing impairment did not have a classification type. Hearing impairment was mild in 22.9%, moderate in 22.4%, severe in 19.4%, profound in 16.9%, and of undocumented severity in 18.4%. Children younger than 5 years were 2.7 times (95% confidence interval = 1.29-5.49; P = .008) more likely to be diagnosed with sensorineural hearing impairment compared with those older than 5 years. By contrast, children older than 5 years were 9.6 times (95% confidence interval = 2.22-41.0; P = .002) more likely to be diagnosed with conductive hearing loss compared with those under 5 years. Conclusion. Hearing impairment was common among children referred to this audiology clinic in Botswana. Of those with hearing impairment, more than a third had moderate or severe deficits, suggesting that referrals for hearing assessments are not occurring early enough. Hearing awareness programs individually tailored to parents, educators, and health care workers are needed. Neonatal and school hearing screening programs would also be beneficial.

Tone perception in Mandarin-speaking school age children with otitis media with effusion

OBJECTIVES

The present study explored tone perception ability in school age Mandarin-speaking children with otitis media with effusion (OME) in noisy listening environments. The study investigated the interaction effects of noise, tone type, age, and hearing status on monaural tone perception, and assessed the application of a hierarchical clustering algorithm for profiling hearing impairment in children with OME.

METHODS

Forty-one children with normal hearing and normal middle ear status and 84 children with OME with or without hearing loss participated in this study. The children with OME were further divided into two subgroups based on their severity and pattern of hearing loss using a hierarchical clustering algorithm. Monaural tone recognition was measured using a picture-identification test format incorporating six sets of monosyllabic words conveying four lexical tones under speech spectrum noise, with the signal-to-noise ratio (SNR) conditions ranging from -9 to -21 dB.

RESULTS

Linear correlation indicated tone recognition thresholds of children with OME were significantly correlated with age and pure tone hearing thresholds at every frequency tested. Children with hearing thresholds less affected by OME performed similarly to their peers with normal hearing. Tone recognition thresholds of children with auditory status more affected by OME were significantly inferior to those of children with normal hearing or with minor hearing loss. Younger children demonstrated poorer tone recognition performance than older children with OME. A mixed design repeated-measure ANCOVA showed significant main effects of listening condition, hearing status, and tone type on tone recognition. Contrast comparisons revealed that tone recognition scores were significantly better under -12 dB SNR than under -15 dB SNR conditions and tone recognition scores were significantly worse under -18 dB SNR than those obtained under -15 dB SNR conditions. Tone 1 was the easiest tone to identify and Tone 3 was the most difficult tone to identify for all participants, when considering -12, -15, and -18 dB SNR as within-subject variables. The interaction effect between hearing status and tone type indicated that children with greater levels of OME-related hearing loss had more impaired tone perception of Tone 1 and Tone 2 compared to their peers with lesser levels of OME-related hearing loss. However, tone perception of Tone 3 and Tone 4 remained similar among all three groups. Tone 2 and Tone 3 were the most perceptually difficult tones for children with or without OME-related hearing loss in all listening conditions.

CONCLUSIONS

The hierarchical clustering algorithm demonstrated usefulness in risk stratification for tone perception deficiency in children with OME-related hearing loss. There was marked impairment in tone perception in noise for children with greater levels of OME-related hearing loss. Monaural lexical tone perception in younger children was more vulnerable to noise and OME-related hearing loss than that in older children.

Speech-Processing Fatigue in Children: Auditory Event-Related Potential and Behavioral Measures

PURPOSE

Fatigue related to speech processing is an understudied area that may have significant negative effects, especially in children who spend the majority of their school days listening to classroom instruction.

METHOD

This study examined the feasibility of using auditory P300 responses and behavioral indices (lapses of attention and self-report) to measure fatigue resulting from sustained listening demands in 27 children (M = 9.28 years).

RESULTS

Consistent with predictions, increased lapses of attention, longer reaction times, reduced P300 amplitudes to infrequent target stimuli, and self-report of greater fatigue were observed after the completion of a series of demanding listening tasks compared with the baseline values. The event-related potential responses correlated with the behavioral measures of performance.

CONCLUSION

These findings suggest that neural and behavioral responses indexing attention and processing resources show promise as effective markers of fatigue in children.

Child-Adult Differences in Using Dual-Task Paradigms to Measure Listening Effort

PURPOSE

The purpose of the project was to investigate the effects modifying the secondary task in a dual-task paradigm to measure objective listening effort. To be specific, the complexity and depth of processing were increased relative to a simple secondary task.

METHOD

Three dual-task paradigms were developed for school-age children. The primary task was word recognition. The secondary task was a physical response to a visual probe (simple task), a physical response to a complex probe (increased complexity), or word categorization (increased depth of processing). Sixteen adults (22-32 years, M = 25.4) and 22 children (9-17 years, M = 13.2) were tested using the 3 paradigms in quiet and noise.

RESULTS

For both groups, manipulations of the secondary task did not affect word recognition performance. For adults, increasing depth of processing increased the calculated effect of noise; however, for children, results with the deep secondary task were the least stable.

CONCLUSIONS

Manipulations of the secondary task differentially affected adults and children. Consistent with previous findings, increased depth of processing enhanced paradigm sensitivity for adults. However, younger participants were more likely to demonstrate the expected effects of noise on listening effort using a secondary task that did not require deep processing.

Multitasking During Degraded Speech Recognition in School-Age Children

Multitasking requires individuals to allocate their cognitive resources across different tasks. The purpose of the current study was to assess school-age children's multitasking abilities during degraded speech recognition. Children (8 to 12 years old) completed a dual-task paradigm including a sentence recognition (primary) task containing speech that was either unprocessed or noise-band vocoded with 8, 6, or 4 spectral channels and a visual monitoring (secondary) task. Children's accuracy and reaction time on the visual monitoring task was quantified during the dual-task paradigm in each condition of the primary task and compared with single-task performance. Children experienced dual-task costs in the 6- and 4-channel conditions of the primary speech recognition task with decreased accuracy on the visual monitoring task relative to baseline performance. In all conditions, children's dual-task performance on the visual monitoring task was strongly predicted by their single-task (baseline) performance on the task. Results suggest that children's proficiency with the secondary task contributes to the magnitude of dual-task costs while multitasking during degraded speech recognition.

Effects of Noise on Speech Recognition and Listening Effort in Children With Normal Hearing and Children With Mild Bilateral or Unilateral Hearing Loss

PURPOSE

This study examined the effects of stimulus type and hearing status on speech recognition and listening effort in children with normal hearing (NH) and children with mild bilateral hearing loss (MBHL) or unilateral hearing loss (UHL).

METHOD

Children (5-12 years of age) with NH (Experiment 1) and children (8-12 years of age) with MBHL, UHL, or NH (Experiment 2) performed consonant identification and word and sentence recognition in background noise. Percentage correct performance and verbal response time (VRT) were assessed (onset time, total duration).

RESULTS

In general, speech recognition improved as signal-to-noise ratio (SNR) increased both for children with NH and children with MBHL or UHL. The groups did not differ on measures of VRT. Onset times were longer for incorrect than for correct responses. For correct responses only, there was a general increase in VRT with decreasing SNR.

CONCLUSIONS

Findings indicate poorer sentence recognition in children with NH and MBHL or UHL as SNR decreases. VRT results suggest that greater effort was expended when processing stimuli that were incorrectly identified. Increasing VRT with decreasing SNR for correct responses also supports greater effort in poorer acoustic conditions. The absence of significant hearing status differences suggests that VRT was not differentially affected by MBHL, UHL, or NH for children in this study.

Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

PURPOSE

A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.

METHOD

Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.

RESULTS

In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.

CONCLUSIONS

Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

Known-Groups and Concurrent Validity of the Mandarin Tone Identification Test (MTIT)

Objective

The Mandarin Tone Identification Test (MTIT) is a new test designed to assess the tone identification abilities of children with hearing impairment (HI). Evidence for reliability and sensitivity has been reported. The present study aimed to evaluate the known-groups and concurrent validity of the MTIT.

Design

The MTIT and Mandarin Pediatric Speech Intelligibility test (MPSI) were administered in quiet and in noise conditions. The known-groups validity was evaluated by comparing the performance of the MTIT on children with two different levels of HI. The MPSI was included to evaluate the concurrent validity of the MTIT.

Study sample

81 children with HI were recruited in the present study. They were Mandarin-speaking children with profound HI (mean age = 9; 0, n = 41) and with moderate to severe HI (mean age = 8; 9, n = 40).

Results

Scores on the MTIT differed between the two groups with different hearing levels suggesting good known-groups validity. A strong relationship between tone and sentence perception both in quiet and in noise provided preliminary evidence for concurrent validity.

Conclusions

The present study confirmed that the MTIT has good known-groups validity and provided preliminary evidence for concurrent validity. The MTIT could be used to evaluate tone identification ability in children with HI with confidence.

Age and gender differences in children and adolescents' attitudes toward noise

OBJECTIVE

Most school-aged children experience exposure to hazardous sound levels via high-risk noise activities (e.g. loud music/concerts, firearms). Little information exists regarding factors influencing pediatric engagement in these activities and use of hearing protection devices. This study explores effects of age, gender, and attitudes toward noise on participation in acoustic risk-taking behaviors and hearing conservation practices in children and adolescents.

DESIGN

Cross-sectional.

STUDY SAMPLE

Children and adolescents (10-19 years) with normal hearing.

RESULTS

Most children and adolescents (86.5%) participate in at least one potentially high-risk noise behavior. The most frequently cited activities include sporting events, concerts, and playing a musical instrument. Use of hearing protection devices varies by activity, with consistent wear while using firearms but inconsistent application during all other activities. Gender, but not age, influences acoustic risk-taking behaviors: Boys engage in significantly more high-risk noise activities than girls. Participants expressed a neutral attitude toward noise that persisted across age and gender, but a trend shifting toward a pro-noise attitude emerges in later adolescence.

CONCLUSIONS

The proliferation of acoustic risk-taking behaviors and lack of hearing conservation practices in children and adolescents requires attention at an early age to prevent future noise-induced hearing loss and subsequent quality of life effects.

Effect of minimal/mild hearing loss on children's speech understanding in a simulated classroom

OBJECTIVES

While classroom acoustics can affect educational performance for all students, the impact for children with minimal/mild hearing loss (MMHL) may be greater than for children with normal hearing (NH). The purpose of this study was to examine the effect of MMHL on children's speech recognition comprehension and looking behavior in a simulated classroom environment. It was hypothesized that children with MMHL would perform similarly to their peers with NH on the speech recognition task but would perform more poorly on the comprehension task. Children with MMHL also were expected to look toward talkers more often than children with NH.

DESIGN

Eighteen children with MMHL and 18 age-matched children with NH participated. In a simulated classroom environment, children listened to lines from an elementary-age-appropriate play read by a teacher and four students reproduced over LCD monitors and loudspeakers located around the listener. A gyroscopic headtracking device was used to monitor looking behavior during the task. At the end of the play, comprehension was assessed by asking a series of 18 factual questions. Children also were asked to repeat 50 meaningful sentences with three key words each presented audio-only by a single talker either from the loudspeaker at 0 degree azimuth or randomly from the five loudspeakers.

RESULTS

Both children with NH and those with MMHL performed at or near ceiling on the sentence recognition task. For the comprehension task, children with MMHL performed more poorly than those with NH. Assessment of looking behavior indicated that both groups of children looked at talkers while they were speaking less than 50% of the time. In addition, the pattern of overall looking behaviors suggested that, compared with older children with NH, a larger portion of older children with MMHL may demonstrate looking behaviors similar to younger children with or without MMHL.

CONCLUSIONS

The results of this study demonstrate that, under realistic acoustic conditions, it is difficult to differentiate performance among children with MMHL and children with NH using a sentence recognition task. The more cognitively demanding comprehension task identified performance differences between these two groups. The comprehension task represented a condition in which the persons talking change rapidly and are not readily visible to the listener. Examination of looking behavior suggested that, in this complex task, attempting to visualize the talker may inefficiently utilize cognitive resources that would otherwise be allocated for comprehension.

Tone identification in Mandarin-speaking children with profound hearing impairment

OBJECTIVES

Little is known about the tone identification ability of Mandarin-speaking children with profound hearing impairment (HI) and fitted with hearing aids (HAs). The present study aimed to evaluate the Mandarin tone identification ability in children with profound HI and fitted with HAs, and explore the effects of hearing thresholds, the age of first HA fitting and the duration of HA use on Mandarin tone identification ability.

METHODS

Subjects were Mandarin-speaking children aged 5;4-12;6 years with profound HI (n=41). The Mandarin Tone Identification Test was administered in five test conditions: in -10, -5, 0 and 5dB signal-to-noise ratios (S/Ns) and quiet. Hearing aids were in the usual user's settings, optimized for the best speech reception, and the volume was set to comfortable listening level.

RESULTS

Two-way repeated measures ANOVA showed significant effects of test conditions and tone contrasts in Mandarin tone identification. Post-hoc pairwise comparisons showed significant difference in performance among the five test conditions. Results also indicated that, among the six tone contrasts, the Tone 1/Tone 2 and Tone 2/Tone 3 contrasts were the most difficult tone contrasts in quiet. No significant difference in performance was found among the six tone contrasts in noise. Pearson product-moment correlation showed that the age of first HA fitting, the duration of HA use, aided and unaided average thresholds as well as the aided hearing thresholds in the low frequency region were not significantly correlated with tone identification ability in the five test conditions.

CONCLUSIONS

Consistent with previous findings, the Tone 1/Tone 2 and Tone 2/Tone 3 contrasts were the most difficult to identify in quiet; but the presence of noise resulted in these tone contrasts being equally difficult. Findings also suggest that the tone identification ability of children with profound HI needs to be improved. Although the age of first HA fitting and the duration of HA use were not significantly correlated with tone identification performance in children with profound HI, this finding does not preclude the importance of early HA fitting.

Development and validation of a new Mandarin tone identification test

OBJECTIVES

The objectives of this study were to develop a new Mandarin tone identification test (MTIT) to assess the Mandarin tone identification ability of children with hearing impairment (HI) and at age around 7 years; and to evaluate the reliability and sensitivity of the MTIT.

METHODS

The word materials to be used in the MTIT were developed in Phase I. Monosyllables were chosen to represent the daily repertoire of young children and to avoid the influence of co-articulation and intonation. Each test stimulus set contained four words, with one target, one containing contrastive tone, and two unrelated distracters. All words were depicted using simple pictures, and the test targets in quiet or in noise were presented using recorded stimuli on a custom software. Phase II evaluated the reliability and sensitivity of the MTIT. Participants were 50 normal-hearing native-Mandarin speakers around 7 years of age.

RESULTS

In Phase I, the MTIT was developed as described above. The final test consists of 51 words that are within the vocabulary repertoire of children aged 7 years. In Phase II, with the Mandarin tone identification scores collected from 50 children, the repeated measure ANOVA showed a significant main effect of S/N on MTIT performance (p<0.001). Pairwise comparisons revealed a significant difference in performance across the five S/N conditions (p<0.01) when S/N varied from -30 to -10dB. Cronbach's alpha at -15dB S/N was 0.66, suggesting satisfactory internal consistency reliability. A paired-samples t-test showed that there was no significant difference between the test-retest scores across the five S/N conditions (p>0.05).

CONCLUSIONS

Compared with the available Mandarin tone identification tools, MTIT systematically evaluated the tone identification performance in noisy environment for normal hearing children at age around 7 years. Results also showed satisfactory internal consistency reliability, good test-retest reliability and good sensitivity. In the near future, MTIT could be used to evaluate tone perception ability of children with hearing impairment and help to design hearing rehabilitation strategies for this population at the age critical for their language learning.

Children with Minimal/Mild Hearing Loss: Do We Have a Consensus and is that Important?

Children with minimal/mild hearing loss make up approximately 5% of the school-age population. While there is considerable research indicating that these children experience difficulties in a number of areas, there also is research indicating that they perform similarly to their peers with normal hearing. Understanding the potential difficulties that these children may experience and how their communication access needs may differ from those of their peers with normal hearing is important for habilitation. A lack of clear consensus could negatively impact provision of habilitation services. Awareness of factors that may affect that consensus can be useful in interpreting findings. This paper will address a number of those potential factors.

The Complexities of Fatigue in Children with Hearing Loss

Fatigue is a common phenomenon in our society, and it can have a major impact on an individual's performance and wellbeing. Parents and teachers have long believed that children with hearing loss (CHL) are at increased risk for fatigue. One could easily speculate that toward the end of a school day, CHL may be “physically and mentally spent” as a result of focusing so intently on a teacher's speech, as well as conversations with other students. Moreover, the increased listening effort, stress, and subsequent fatigue experienced by CHL could jeopardize the ability to learn in a noisy classroom environment, thus increasing the risk for problems in school. Only recently, however, have we begun to see empirical studies supporting the notion that CHL experience more fatigue than children with normal hearing (CNH).

This review was developed to enhance the awareness of fatigue among those audiologists interested in serving CHL. To this end, we have presented an overview on fatigue in CHL, including its importance, definitions, prevalence, consequences, and recent developments. The complexity and multifaceted nature of fatigue has been highlighted and the need for additional research on fatigue in CHL is emphasized.

Dose passive smoking induce sensorineural hearing loss in children?

OBJECTIVES

Smoking plays major role in development of vascular and respiratory serious diseases. It has been reported that negative smoker children are prone for conductive hearing impairment due to repeated attacks of Eustachian tube dysfunction and middle ear effusion. This study aims to identify negative smoking as potential risk factor for development of sensorineural hearing loss.

STUDY

This study was done between January 2010 and November 2012. 411 children aged 5-11 years (8.2 ± 1.5) participated in this study; they were children attending the Ear, Nose, and Throat clinic of a tertiary care hospital and their siblings. The inclusion criteria were: (i) normal speech and language, (ii) absence of any disease or condition that may cause sensorineural hearing loss, and (iii) normal middle ear function on the day of hearing assessment. They were divided into three groups according to the exposure to second-hand smoke at home; group of "no exposure" whereas no smoker in the family (131 children), group of 'mild exposure" whereas the father was the only smoking parent and smoking was prohibited at home (155 children), and group of "heavy exposure", whereas the mother was smoking, or the father was freely smoking at home and in the presence of his children (125 children). Audiological evaluation in the form of pure tone and speech audiometry and immitancemetry was done for the study group.

RESULTS

Audiological evaluation revealed that the prevalence of hearing loss was 3.8%, 4.5% and 12% in the "no exposure", "mild exposure", and "heavy exposure" groups, respectively. Significant difference was only detected between the high exposure group and the other two groups. All children had minimal sensorineural hearing loss, i.e. threshold of frequencies showing hearing loss was 20 or 25 dB HL. The risk ratios (95% confidence interval) for hearing loss in the study subgroups were 1.18 (0.38, 3.64) for mild exposure group (p>0.05), 3.14 (1.18, 8.3) for heavy exposure group (p<0.05).

CONCLUSIONS

Passive smoking in childhood correlates with sensorineural hearing loss, and it is an important risk factor for development of minimal hearing loss. Strict prevention of children exposure to second-hand smoke should be encouraged by every mean.

Predictors of hearing aid use time in children with mild-to-severe hearing loss

PURPOSE

This study investigated predictors of hearing aid (HA) use time for children with mild-to-severe hearing loss (HL). Barriers to consistent HA use and reliability of parent report measures were also examined.

METHOD

Participants included parents of 272 children with HL. Parents estimated the amount of time the child used HAs daily. Regression analysis examined the relationships among independent variables and HA use time. To determine parental accuracy of HA use time, datalogging from the HAs was compared to the parents' estimates.

RESULTS

Longer HA use related to older age, poorer hearing, and higher maternal education. Parental consistency ratings revealed similar findings--younger children and children with milder HL wore HAs less consistently than older children and children with more severe HL. Parents' estimates and datalogging were significantly correlated; however, results suggested that parents overestimate the amount of time their children wear their HAs.

CONCLUSION

Certain variables were significantly related to the amount of time children wore their HAs. Consistency rating scales provided insight into circumstances that were challenging for families. Use of both parent reports and datalogging may allow clinicians and researchers to obtain a general estimate of HA use time.

Predictors of hearing aid use time in children with mild-to-severe hearing loss

PURPOSE

This study investigated predictors of hearing aid (HA) use time for children with mild-to-severe hearing loss (HL). Barriers to consistent HA use and reliability of parent report measures were also examined.

METHOD

Participants included parents of 272 children with HL. Parents estimated the amount of time the child used HAs daily. Regression analysis examined the relationships among independent variables and HA use time. To determine parental accuracy of HA use time, datalogging from the HAs was compared to the parents' estimates.

RESULTS

Longer HA use related to older age, poorer hearing, and higher maternal education. Parental consistency ratings revealed similar findings--younger children and children with milder HL wore HAs less consistently than older children and children with more severe HL. Parents' estimates and datalogging were significantly correlated; however, results suggested that parents overestimate the amount of time their children wear their HAs.

CONCLUSION

Certain variables were significantly related to the amount of time children wore their HAs. Consistency rating scales provided insight into circumstances that were challenging for families. Use of both parent reports and datalogging may allow clinicians and researchers to obtain a general estimate of HA use time.

Experimental investigation of the effects of the acoustical conditions in a simulated classroom on speech recognition and learning in children

The potential effects of acoustical environment on speech understanding are especially important as children enter school where students' ability to hear and understand complex verbal information is critical to learning. However, this ability is compromised because of widely varied and unfavorable classroom acoustics. The extent to which unfavorable classroom acoustics affect children's performance on longer learning tasks is largely unknown as most research has focused on testing children using words, syllables, or sentences as stimuli. In the current study, a simulated classroom environment was used to measure comprehension performance of two classroom learning activities: a discussion and lecture. Comprehension performance was measured for groups of elementary-aged students in one of four environments with varied reverberation times and background noise levels. The reverberation time was either 0.6 or 1.5 s, and the signal-to-noise level was either +10 or +7 dB. Performance is compared to adult subjects as well as to sentence-recognition in the same condition. Significant differences were seen in comprehension scores as a function of age and condition; both increasing background noise and reverberation degraded performance in comprehension tasks compared to minimal differences in measures of sentence-recognition.

Children's performance in complex listening conditions: effects of hearing loss and digital noise reduction

PURPOSE

To determine the effect of hearing loss (HL) on children's performance for an auditory task under demanding listening conditions and to determine the effect of digital noise reduction (DNR) on that performance.

METHOD

Fifty children with normal hearing (NH) and 30 children with HL (8-12 years of age) categorized words in the presence of auditory or visual competitors, or both. Stimuli were presented at 50 dB SPL at a 0-dB signal-to-noise ratio. Children with HL were fitted with behind-the-ear hearing aids that had DNR technology. When DNR was activated, output decreased 4 dB, and signal-to-noise ratio increased 2 dB.

RESULTS

Significant main effects of group and age were observed. Performance for both groups decreased in noise, and the performance of the children with HL decreased further with the addition of the visual task. However, performance was unaffected by DNR. For the children with HL, stimulus audibility and communication skills contributed significantly to performance, whereas their history of hearing aid use did not.

CONCLUSIONS

For the children with HL, tasks unrelated to hearing interfered with their ability to participate in the auditory task. Consistent with previous studies, performance in noise was unaffected by DNR.

School Nurses' Role in Identifying and Referring Children at Risk of Noise-Induced Hearing Loss

Young people are likely to experience noise-induced hearing loss (NIHL), as the use of personal listening devices and other damaging factors (e.g., video games) increases. Little research has examined the role of school health personnel in the prevention and early identification of hearing impairment. A 32-item, valid and reliable survey was developed regarding elementary and middle school nurses' practices concerning hearing loss screening and prevention. The survey instrument was based on the Stages of Change theory and the Health Belief Model. A random sample of 800 nurses was obtained from The National Association of School Nurses. A two-wave mailing was used to achieve a 58% response rate. Forty eight percent indicated there were not many educational programs that addressed NIHL in students. Performing hearing screenings routinely can help identify those students at risk. School nurses need to become advocates for policies and programs that mandate hearing screenings and educational programs to help reduce hearing loss.