Subjective Fatigue in Children With Unaided and Aided Unilateral Hearing Loss

OBJECTIVES

Fatigue is frequently observed in children with chronic diseases and can affect the quality of life (QoL). However, research in children with unilateral hearing loss (UHL) is scarce. Subsequently, no studies investigated the effects of hearing aids on fatigue in children. This study investigates subjective fatigue and hearing-related QoL in children with UHL. Furthermore, it evaluates the influence of hearing aids, subject-specific factors, and respondent-type on subjective fatigue.

STUDY DESIGN

A cross-sectional study was conducted from June 2020 until September 2020 at the department of otorhinolaryngology in a tertiary referral center.

METHODS

The primary outcome was the difference in subjective fatigue and hearing-related QoL between children with unaided UHL, aided UHL, and normal hearing. Subjective fatigue and hearing-related QoL were measured using the Pediatric Quality of Life Inventory™ Multidimensional Fatigue Scale (PedsQL™-MFS) and Hearing Environments and Reflection on Quality of Life (HEAR-QL™) questionnaires.

RESULTS

Along with 36 aided children with UHL, 34 unaided and 36 normal-hearing children were included. Child reports revealed significantly more cognitive fatigue in children with aided UHL than children with normal hearing (median difference 12.5, P = .013). Parents reported more fatigue in children with UHL compared to normal-hearing siblings. Especially children with aided UHL seemed at increased risk for fatigue. Children with UHL scored lower on hearing-related QoL than children with normal hearing. No apparent differences were found in fatigue and QoL between children with unaided and aided UHL.

CONCLUSION

Children with unaided and even aided UHL seem to experience more subjective fatigue and lower hearing-related QoL than children with normal hearing. Prospective longitudinal studies are required to investigate the influence of hearing aids on fatigue and QoL in individual patients.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021 Laryngoscope, 133:189-198, 2023.

Remote-Microphone Benefit in Noise and Reverberation for Children Who are Hard of Hearing

BACKGROUND

 Remote-microphone (RM) systems are designed to reduce the impact of poor acoustics on speech understanding. However, there is limited research examining the effects of adding reverberation to noise on speech understanding when using hearing aids (HAs) and RM systems. Given the significant challenges posed by environments with poor acoustics for children who are hard of hearing, we evaluated the ability of a novel RM system to address the effects of noise and reverberation.

PURPOSE

 We assessed the effect of a recently developed RM system on aided speech perception of children who were hard of hearing in noise and reverberation and how their performance compared to peers who are not hard of hearing (i.e., who have hearing thresholds no greater than 15 dB HL). The effect of aided speech audibility on sentence recognition when using an RM system also was assessed.

STUDY SAMPLE

 Twenty-two children with mild to severe hearing loss and 17 children who were not hard of hearing (i.e., with hearing thresholds no greater than 15 dB HL) (7-18 years) participated.

DATA COLLECTION AND ANALYSIS

 An adaptive procedure was used to determine the signal-to-noise ratio for 50 and 95% correct sentence recognition in noise and noise plus reverberation (RT 300 ms). Linear mixed models were used to examine the effect of listening conditions on speech recognition with RMs for both groups of children and the effects of aided audibility on performance across all listening conditions for children who were hard of hearing.

RESULTS

 Children who were hard of hearing had poorer speech recognition for HAs alone than for HAs plus RM. Regardless of hearing status, children had poorer speech recognition in noise plus reverberation than in noise alone. Children who were hard of hearing had poorer speech recognition than peers with thresholds no greater than 15 dB HL when using HAs alone but comparable or better speech recognition with HAs plus RM. Children with better-aided audibility with the HAs showed better speech recognition with the HAs alone and with HAs plus RM.

CONCLUSION

 Providing HAs that maximize speech audibility and coupling them with RM systems has the potential to improve communication access and outcomes for children who are hard of hearing in environments with noise and reverberation.

Evaluation of Potential Benefits and Limitations of Noise Management Technologies for Children with Hearing Aids

BACKGROUND

 Children with hearing loss frequently experience difficulty understanding speech in the presence of noise. Although remote microphone systems are likely to be the most effective solution to improve speech recognition in noise, the focus of this study centers on the evaluation of hearing aid noise management technologies including directional microphones, adaptive noise reduction (ANR), and frequency-gain shaping. These technologies can improve children's speech recognition, listening comfort, and/or sound quality in noise. However, individual contributions of these technologies as well as the effect of hearing aid microphone mode on localization abilities in children is unknown.

PURPOSE

 The objectives of this study were to (1) compare children's speech recognition and subjective perceptions across five hearing aid noise management technology conditions and (2) compare localization abilities across three hearing aid microphone modes.

RESEARCH DESIGN

 A single-group, repeated measures design was used to evaluate performance differences and subjective ratings.

STUDY SAMPLE

 Fourteen children with mild to moderately severe hearing loss.

DATA COLLECTION AND ANALYSIS

 Children's sentence recognition, listening comfort, sound quality, and localization were assessed in a room with an eight-loudspeaker array.

RESULTS AND CONCLUSION

 The use of adaptive directional microphone technology improves children's speech recognition in noise when the signal of interest arrives from the front and is spatially separated from the competing noise. In contrast, the use of adaptive directional microphone technology may result in a decrease in speech recognition in noise when the signal of interest arrives from behind. The use of a microphone mode that mimics the natural directivity of the unaided auricle provides a slight improvement in speech recognition in noise compared with omnidirectional use with limited decrement in speech recognition in noise when the signal of interest arrives from behind. The use of ANR and frequency-gain shaping provide no change in children's speech recognition in noise. The use of adaptive directional microphone technology, ANR, and frequency-gain shaping improve children's listening comfort, perceived ability to understand speech in noise, and overall listening experience. Children prefer to use each of these noise management technologies regardless of whether the signal of interest arrives from the front or from behind. The use of adaptive directional microphone technology does not result in a decrease in children's localization abilities when compared with the omnidirectional condition. The best localization performance occurred with use of the microphone mode that mimicked the directivity of the unaided auricle.

Clinical Practice Patterns With Pediatric Loudness Perception Measures

PURPOSE

Obtaining a patient's loudness discomfort level (LDL) can assist the audiologist in defining their dynamic range so that the hearing device fitting can ensure that low-level sounds are audible, average-level sounds are comfortable, and more intense sounds are loud but not too loud. A 2016 survey showed that 67.5% of 350 pediatric audiologist reported to never or rarely measure LDLs with pediatric patients. The purpose of this study was to identify factors influencing this previously reported limited use of LDL measures.

METHOD

Sixty-two pediatric audiologists in the United States were surveyed using a questionnaire that sought to improve our understanding of the (non)use of loudness perception measures with pediatric patients and to assess familiarity with various loudness perception measurements. In addition, the questionnaire gathered information about the needs of pediatric audiologists in relation to LDL measures.

RESULTS

Audiologist report being largely unfamiliar with methods of assessing loudness perception in children, with categorical loudness scaling being the method with which they are most familiar. In addition, audiologists reported being more willing and able to measure LDLs in older compared to younger pediatric patients. Limited use of pediatric loudness perception measures appears to be driven by a lack of familiarity with measurement methods and the belief that loudness perception measures may not be useful for clinical practice.

CONCLUSIONS

Findings highlight audiologists' need for further information regarding the relevance of loudness perception measurements with pediatric patients and the need for easy-to-implement LDL measurement procedures for pediatric patients of all ages.

Short-Term Pediatric Acclimatization to Adaptive Hearing Aid Technology

Purpose This exploratory study assessed the perceptual, cognitive, and academic learning effects of an adaptive, integrated, directionality, and noise reduction hearing aid program in pediatric users. Method Fifteen pediatric hearing aid users (6-12 years old) received new bilateral, individually fitted Oticon Opn hearing aids programmed with OpenSound Navigator (OSN) processing. Word recognition in noise, sentence repetition in quiet, nonword repetition, vocabulary learning, selective attention, executive function, memory, and reading and mathematical abilities were measured within 1 week of the initial hearing aid fitting and 2 months post fit. Caregivers completed questionnaires assessing their child's listening and communication abilities prior to study enrollment and after 2 months of using the study hearing aids. Results Caregiver reporting indicated significant improvements in speech and sound perception, spatial sound awareness, and the ability to participate in conversations. However, there was no positive change in performance in any of the measured skills. Mathematical scores significantly declined after 2 months. Conclusions OSN provided a perceived improvement in functional benefit, compared to their previous hearing aids, as reported by caregivers. However, there was no positive change in listening skills, cognition, and academic success after 2 months of using OSN. Findings may have been impacted by reporter bias, limited sample size, and a relatively short trial period. This study took place during the summer when participants were out of school, which may have influenced the decline in mathematical scores. The results support further exploration with age- and audiogram-matched controls, larger sample sizes, and longer test-retest intervals that correspond to the academic school year.

Effects of Adaptive Hearing Aid Directionality and Noise Reduction on Masked Speech Recognition for Children Who Are Hard of Hearing

Purpose The purpose of this study was to evaluate speech-in-noise and speech-in-speech recognition associated with activation of a fully adaptive directional hearing aid algorithm in children with mild to severe bilateral sensory/neural hearing loss. Method Fourteen children (5-14 years old) who are hard of hearing participated in this study. Participants wore laboratory hearing aids. Open-set word recognition thresholds were measured adaptively for 2 hearing aid settings: (a) omnidirectional (OMNI) and (b) fully adaptive directionality. Each hearing aid setting was evaluated in 3 listening conditions. Fourteen children with normal hearing served as age-matched controls. Results Children who are hard of hearing required a more advantageous signal-to-noise ratio than children with normal hearing to achieve comparable performance in all 3 conditions. For children who are hard of hearing, the average improvement in signal-to-noise ratio when comparing fully adaptive directionality to OMNI was 4.0 dB in noise, regardless of target location. Children performed similarly with fully adaptive directionality and OMNI settings in the presence of the speech maskers. Conclusions Compared to OMNI, fully adaptive directionality improved speech recognition in steady noise for children who are hard of hearing, even when they were not facing the target source. This algorithm did not affect speech recognition when the background noise was speech. Although the use of hearing aids with fully adaptive directionality is not proposed as a substitute for remote microphone systems, it appears to offer several advantages over fixed directionality, because it does not depend on children facing the target talker and provides access to multiple talkers within the environment. Additional experiments are required to further evaluate children's performance under a variety of spatial configurations in the presence of both noise and speech maskers.

A critical review of hearing-aid single-microphone noise-reduction studies in adults and children

PURPOSE

Single-microphone noise reduction (SMNR) is implemented in hearing aids to suppress background noise. The purpose of this article was to provide a critical review of peer-reviewed studies in adults and children with sensorineural hearing loss who were fitted with hearing aids incorporating SMNR.

METHOD

Articles published between 2000 and 2016 were searched in PUBMED and EBSCO databases.

RESULTS

Thirty-two articles were included in the final review. Most studies with adult participants showed that SMNR has no effect on speech intelligibility. Positive results were reported for acceptance of background noise, preference, and listening effort. Studies of school-aged children were consistent with the findings of adult studies. No study with infants or young children of under 5 years old was found. Recent studies on noise-reduction systems not yet available in wearable hearing aids have documented benefits of noise reduction on memory for speech processing for older adults.

CONCLUSIONS

This evidence supports the use of SMNR for adults and school-aged children when the aim is to improve listening comfort or reduce listening effort. Future research should test SMNR with infants and children who are younger than 5 years of age. Further development, testing, and clinical trials should be carried out on algorithms not yet available in wearable hearing aids. Testing higher cognitive level for speech processing and learning of novel sounds or words could show benefits of advanced signal processing features. These approaches should be expanded to other populations such as children and younger adults. Implications for rehabilitation The review provides a quick reference for students and clinicians regarding the efficacy and effectiveness of SMNR in wearable hearing aids. This information is useful during counseling session to build a realistic expectation among hearing aid users. Most studies in the adult population suggest that SMNR may provide some benefits to adult listeners in terms of listening comfort, acceptance of background noise, and release of cognitive load in a complex listening condition. However, it does not improve speech intelligibility. Studies that examined SMNR in the paediatric population suggest that SMNR may benefit older school-aged children, aged between 10 and 12 years old. The evidence supports the use of SMNR for adults and school-aged children when the aim is to improve listening comfort or reduce listening effort.