Individual Differences Offer Insight Into Clinical Recommendations for Directional and Remote Microphone Technology Use in Children

Electrophysiological Measures of Listening-in-Noise With and Without Remote Microphone System Use in Autistic and Non-Autistic Youth

OBJECTIVES

This study examined the neural mechanisms by which remote microphone (RM) systems might lead to improved behavioral performance on listening-in-noise tasks in autistic and non-autistic youth.

DESIGN

Cortical auditory evoked potentials (CAEPs) were recorded in autistic (n = 25) and non-autistic (n = 22) youth who were matched at the group level on chronological age ( M = 14.21 ± 3.39 years) and biological sex. Potentials were recorded during an active syllable identification task completed in quiet and in multi-talker babble noise with and without the use of an RM system. The effects of noise and RM system use on speech-sound-evoked P1-N1-P2 responses and the associations between the cortical responses and behavioral performance on syllable identification were examined.

RESULTS

No group differences were observed for behavioral or CAEP measures of speech processing in quiet or in noise. In the combined sample, syllable identification in noise was less accurate and slower than in the quiet condition. The addition of the RM system to the noise condition restored accuracy, but not the response speed, to the levels observed in quiet. The CAEP analyses noted amplitude reductions and latency delays in the noise compared with the quiet condition. The RM system use increased the N1 amplitude as well as reduced and delayed the P2 response relative to the quiet and noise conditions. Exploratory brain-behavior correlations revealed that larger N1 amplitudes in the RM condition were associated with greater behavioral accuracy of syllable identification. Reduced N1 amplitude and accelerated P2 response were associated with shorter syllable identification response times when listening with the RM system.

CONCLUSIONS

Findings suggest that although listening-in-noise with an RM system might remain effortful, the improved signal to noise ratio facilitates attention to the sensory features of the stimuli and increases speech sound identification accuracy.

Parents' experiences of remote microphone systems for children with hearing loss

PURPOSE

Remote microphone systems improve intelligibility in difficult conditions when the performance of hearing aids/cochlear implants is insufficient. The purpose of this study was to explore parents' experiences with remote microphone systems for their children with hearing loss and to determine the advantages and disadvantages as perceived by parents.

MATERIALS AND METHODS

Data were collected by means of semi-structured interviews with parents of children with moderate to profound bilateral hearing loss (2-19 years old). The open coding method and thematic analysis were used. The final sample consisted of 19 mothers and 9 fathers who had experience with remote microphone systems.

RESULTS

Parents listed the advantages of remote microphone systems for their child, for themselves and for other carers, such as better hearing and understanding, a life more similar to that of their peers without hearing loss, safety in road traffic, lower fatigue, vocabulary acquisition, better school results. Some limitations were identified, namely low benefits, technical issues and a reluctance to use the device by children or teachers.

CONCLUSIONS

It is crucial to provide parents with information about assistive devices and the consequences of limited access to hearing speech. Professionals should motivate parents, children and teachers to use remote microphone systems even in situations when the benefit may not be obvious if there is a potential benefit for the child.

IMPLICATIONS FOR REHABILITATIONThe main advantages of remote microphone systems perceived by parents are better hearing and understanding, a life more similar to peers without hearing loss, safety in traffic, lower fatigue, vocabulary acquisition and better school results.The main disadvantages are for parents: persisting hearing problems, low benefits, technical issues and a reluctance to use the device by children or teachers.Sufficient and accurate information is needed about remote microphone systems, but also about the consequences of hearing loss in general.The possibility to try wireless devices before buying and troubleshooting help is appreciated.

Predictors of Listening-Related Fatigue in Adolescents With Hearing Loss

PURPOSE

Self-reported listening-related fatigue in adolescents with hearing loss (HL) was investigated. Specifically, the extent to which listening-related fatigue is associated with school accommodations, audiologic characteristics, and listening breaks was examined.

METHOD

Participants were 144 adolescents with HL ages 12-19 years. Data were collected online via Qualtrics. The Vanderbilt Fatigue Scale-Child was used to measure listening-related fatigue. Participants also reported on their use of listening breaks and school accommodations, including an Individualized Education Program (IEP) or 504 plan, remote microphone systems, closed captioning, preferential seating, sign language interpreters, live transcriptions, and notetakers.

RESULTS

After controlling for age, HL laterality, and self-perceived listening difficulty, adolescents with an IEP or a 504 plan reported lower listening-related fatigue compared to adolescents without an IEP or a 504 plan. Adolescents who more frequently used remote microphone systems or notetakers reported higher listening-related fatigue compared to adolescents who used these accommodations less frequently, whereas increased use of a sign language interpreter was associated with decreased listening-related fatigue. Among adolescents with unilateral HL, higher age was associated with lower listening-related fatigue; no effect of age was found among adolescents with bilateral HL. Listening-related fatigue did not differ based on hearing device configuration.

CONCLUSIONS

Adolescents with HL should be considered at risk for listening-related fatigue regardless of the type of hearing devices used or the degree of HL. The individualized support provided by an IEP or 504 plan may help alleviate listening-related fatigue, especially by empowering adolescents with HL to be self-advocates in terms of their listening needs and accommodations in school. Additional research is needed to better understand the role of specific school accommodations and listening breaks in addressing listening-related fatigue.

A Comparison of Listening Skills of Autistic and Non-Autistic Youth While Using and Not Using Remote Microphone Systems

OBJECTIVES

The purposes of this study were to compare (a) listening-in-noise (accuracy and effort) and (b) remote microphone (RM) system benefits between autistic and non-autistic youth.

DESIGN

Groups of autistic and non-autistic youth that were matched on chronological age and biological sex completed listening-in-noise testing when wearing and not wearing an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in type (syllables, words, sentences, and passages). Several putative moderators of RM system effects on outcomes of interest were also evaluated.

RESULTS

Autistic youth outperformed non-autistic youth in some conditions on listening-in-noise accuracy; listening effort between the two groups was not significantly different. RM system use resulted in listening-in-noise accuracy improvements that were nonsignificantly different across groups. Benefits of listening-in-noise accuracy were all large in magnitude. RM system use did not have an effect on listening effort for either group. None of the putative moderators yielded effects of the RM system on listening-in-noise accuracy or effort for non-autistic youth that were significant and interpretable, indicating that RM system benefits did not vary according to any of the participant characteristics assessed.

CONCLUSIONS

Contrary to expectations, autistic youth did not demonstrate listening-in-noise deficits compared to non-autistic youth. Both autistic and non-autistic youth appear to experience RM system benefits marked by large gains in listening-in-noise performance. Thus, the use of this technology in educational and other noisy settings where speech perception needs enhancement might be beneficial for both groups of children.

Why do many children who are hard of hearing not use remote microphones to compensate for their hearing loss?

Objectives

The aim of the study is to explore parents' reasons for not acquiring remote microphones that would compensate for their child's hearing loss and why some children do not use these devices even after they are purchased.

Background

The benefit of remote microphones for better understanding speech has been proven by multiple studies. Consistent with the research, there is an official recommendation that all children who are hard of hearing should be considered as potential candidates for remote microphone systems in classrooms in Western countries, but in the Czech Republic, only a relatively small number of children use them. Therefore, it is important to focus on the reasons why parents do not buy such devices for their child and why some children do not use an already acquired device.

Methods

Data from 41 semi-structured interviews were collected and analysed using the DIPEx methodology (personal experiences of health and illness), which involves rigorous analysis of narrative interviews of people with particular conditions chosen to represent the widest practicable range of experiences.

Results

Parents report multiple barriers to buying remote microphones: insecurity about the right moment, financial reasons, a lack of information and the child's refusal to use them. The reasons why children do not use such devices despite their being purchased are the reluctance of children and teachers and the low perceived benefit of remote microphones.

Conclusions

These barriers have to be taken into consideration by audiologists, policymakers and other stakeholders when addressing medical, educational and social systems supporting children who are hard of hearing as well as their families. Socio-political measures, improved systems of support for children who are hard of hearing and direct work with families can reduce these barriers.

Clinical Practice Patterns of Fitting Advanced Device Features in Children With Cochlear Implants

PURPOSE

The purpose of this study was to identify common clinical practice patterns for providing advanced noise management features in children with cochlear implants (CIs) and evaluate trends in consideration of clinician experience and comfort with CI manufacturer-specific technology.

METHOD

A mixed-model survey including quantitative and qualitative questions regarding providing advanced noise management features in the pediatric CI population was collected electronically via research electronic data capture. Survey questions spanned approach/philosophy toward provision of features, age of provision, and demographics of respondents. Descriptive statistics were completed to define common clinical practice patterns and demographic information.

RESULTS

A total of 160 pediatric audiologists from 35 U.S. States and five Canadian provinces completed the survey. Most audiologists (73.8%) reported enabling automatic directional microphones, and a vast majority (91%) reported enabling advanced noise processing features such as automatic noise cancellers, wind noise cancellers, and impulse noise cancellers in recipients' main programs. Audiologists ranked features in terms of importance for a school-age child with the top three ranked as automatic noise reduction, automatic directional microphones, and concha-level microphones. Importance of child-specific factors varied depending upon the specific feature of interest.

CONCLUSIONS

Variability exists among providers in enabling advanced noise management features for pediatric CI recipients. Multiple factors, including patient characteristics, provider characteristics, and limited evidence-based guidance, could account for much of the variation. Overall, there is a trend toward automaticity for noise management. Additional studies are warranted to provide the evidence base for confidently programming advanced features for children using CIs.