Functional hearing in the classroom: assistive listening devices for students with hearing impairment in a mainstream school setting

Evaluating benefits of remote microphone technology for adults with hearing loss using behavioural and predictive metrics

OBJECTIVE

To investigate the benefit of remote-microphone (RM) systems for adults with sensory hearing loss.

DESIGN

Speech recognition in quiet and in background noise was assessed. Participants with hearing loss underwent testing in two device conditions: hearing aids (HAs) alone and HAs with a RM. Normal hearing participants completed testing in the unaided condition. Predictive speech intelligibility modelling using the Hearing-Aid Speech Perception Index (HASPI) was also performed on recordings of HA processed test material.

STUDY SAMPLE

Twenty adults with sensory hearing loss and 10 adults with normal hearing participated.

RESULTS

Speech recognition for participants with hearing loss improved significantly when using the RM compared to HAs alone fit to Phonak's proprietary prescription. Largest benefits were observed in the most challenging conditions. At the lowest signal-to-noise ratio, participants with hearing loss using a RM outperformed normal hearing listeners. Predicted intelligibility scores produced by HASPI were strongly correlated to behavioural results.

CONCLUSIONS

Adults using HAs who have significant difficulties understanding speech in noise will experience considerable benefits with the addition of a RM. Improvements in speech recognition were observed for all participants using RM systems, including those with relatively mild hearing loss. HASPI modelling reliably predicted the speech perception difficulties experienced.

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.

Verification of EasyGain Settings in the Roger Remote Microphone System

PURPOSE

The purpose of this study was to evaluate how the EasyGain settings on a wireless receiver used with a remote microphone (RM) affected output as a function of hearing loss and receiver type.

METHOD

To assess the effects of the EasyGain setting on a Roger receiver, a Phonak Naida V90 superpower hearing aid (HA), two universal Roger X (02) receivers, two Roger 18 integrated receivers, and a Roger Inspiro transmitter were used. An electroacoustic evaluation was performed for five degrees of hearing loss ranging from a flat 40 to 80 dB HL, and for nine EasyGain settings from +8 to -8 dB with each Roger receiver.

RESULTS

A three-way analysis of variance indicated significant main effects of hearing loss, receiver type and EasyGain settings, as well as their two-way interactions (p < .05). Overall, the output of the integrated receiver was 2.77 dB higher than that of the universal receiver. The change in output with 2-dB changes in EasyGain setting varied with the degree of hearing loss. For mild hearing loss (40 and 50 dB), every 2-dB change in EasyGain produced an average of 1.93 dB (SD = 0.17) change in the root-mean-square (RMS) output. For the higher degrees of hearing loss (60, 70, and 80 dB HL), the change in RMS varied depending on the range of EasyGain setting as follows: when EasyGain was > 0 dB, every 2-dB change in EasyGain setting produced an average change in RMS output of 1.32 dB (SD = 0.41); however, when EasyGain was ≤ 0 dB, every 2-dB change resulted in a mean 1.95 dB (SD = 0.16) change.

CONCLUSIONS

The benefits of EasyGain technology on the RMS output are dependent on the interaction of the receiver type, degree of hearing loss, and EasyGain settings. The results highlight the importance of electroacoustic verification to determine appropriate settings for optimal audibility when using an RM system.

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.

Listening Difficulties of Children With Cochlear Implants in Mainstream Secondary Education

OBJECTIVES

Previous research has shown that children with cochlear implants (CIs) encounter more communication difficulties than their normal-hearing (NH) peers in kindergarten and elementary schools. Yet, little is known about the potential listening difficulties that children with CIs may experience during secondary education. The aim of this study was to investigate the listening difficulties of children with a CI in mainstream secondary education and to compare these results to the difficulties of their NH peers and the difficulties observed by their teachers.

DESIGN

The Dutch version of the Listening Inventory for Education Revised (LIFE-R) was administered to 19 children (mean age = 13 years 9 months; SD = 9 months) who received a CI early in life, to their NH classmates (n = 239), and to their teachers (n = 18). All participants were enrolled in mainstream secondary education in Flanders (first to fourth grades). The Listening Inventory for Secondary Education consists of 15 typical listening situations as experienced by students (LIFEstudent) during class activities (LIFEclass) and during social activities at school (LIFEsocial). The teachers completed a separate version of the Listening Inventory for Secondary Education (LIFEteacher) and Screening Instrument for Targeting Educational Risk.

RESULTS

Participants with CIs reported significantly more listening difficulties than their NH peers. A regression model estimated that 75% of the participants with CIs were at risk of experiencing listening difficulties. The chances of experiencing listening difficulties were significantly higher in participants with CIs for 7 out of 15 listening situations. The 3 listening situations that had the highest chance of resulting in listening difficulties were (1) listening during group work, (2) listening to multimedia, and (3) listening in large-sized classrooms. Results of the teacher's questionnaires (LIFEteacher and Screening Instrument for Targeting Educational Risk) did not show a similar significant difference in listening difficulties between participants with a CI and their NH peers. According to teachers, NH participants even obtained significantly lower scores for staying on task and for participation in class than participants with a CI.

CONCLUSIONS

Although children with a CI seemingly fit in well in mainstream schools, they still experience significantly more listening difficulties than their NH peers. Low signal to noise ratios (SNRs), distortions of the speech signal (multimedia, reverberation), distance, lack of visual support, and directivity effects of the microphones were identified as difficulties for children with a CI in the classroom. As teachers may not always notice these listening difficulties, a list of practical recommendations was provided in this study, to raise awareness among teachers and to minimize the difficulties.

Design and verification of a measurement setup for wireless remote microphone systems (WRMSs)

OBJECTIVE

This work presents the design and verification of a simplified measurement setup for wireless remote microphone systems (WRMSs), which has been incorporated into guidelines of the European Union of Hearing Aid Acousticians (EUHA).

DESIGN

Three studies were conducted. First, speech intelligibility scores within the simplified setup were compared to that in an actual classroom. Second, different WRMSs were compared in the simplified setup, and third, normative data for normal-hearing people with and without WRMS were collected.

STUDY SAMPLE

The first two studies include 40 older hearing impaired and the third study 20 young normal-hearing adults.

RESULTS

Speech intelligibility with WRMS was not different across actual classroom and simplified setup. An analog omnidirectional WRMS showed poorer speech intelligibility and poorer quality ratings than digital WMRSs. The usage of a WRMS in the simplified setup resulted in significantly higher speech intelligibility across all tested background noise levels.

CONCLUSIONS

Despite being a simplified measurement setup, it realistically emulates a situation where people are listening to speech in noise from a distance, such as in a classroom or meeting room. Hence, with standard audiological equipment, the individual benefit of WRMSs can be measured and experienced by the user in clinical practice.

The Benefit of Remote and On-Ear Directional Microphone Technology Persists in the Presence of Visual Information

BACKGROUND

 Both the Roger remote microphone and on-ear, adaptive beamforming technologies (e.g., Phonak UltraZoom) have been shown to improve speech understanding in noise for cochlear implant (CI) listeners when tested in audio-only (A-only) test environments.

PURPOSE

 Our aim was to determine if adult and pediatric CI recipients benefited from these technologies in a more common environment-one in which both audio and visual cues were available and when overall performance was high.

STUDY SAMPLE

 Ten adult CI listeners (Experiment 1) and seven pediatric CI listeners (Experiment 2) were tested.

DESIGN

 Adults were tested in quiet and in two levels of noise (level 1 and level 2) in A-only and audio-visual (AV) environments. There were four device conditions: (1) an ear canal-level, omnidirectional microphone (T-mic) in quiet, (2) the T-mic in noise, (3) an adaptive directional mic (UltraZoom) in noise, and (4) a wireless, remote mic (Roger Pen) in noise. Pediatric listeners were tested in quiet and in level 1 noise in A-only and AV environments. The test conditions were: (1) a behind-the-ear level omnidirectional mic (processor mic) in quiet, (2) the processor mic in noise, (3) the T-mic in noise, and (4) the Roger Pen in noise.

DATA COLLECTION AND ANALYSES

 In each test condition, sentence understanding was assessed (percent correct) and ease of listening ratings were obtained. The sentence understanding data were entered into repeated-measures analyses of variance.

RESULTS

 For both adult and pediatric listeners in the AV test conditions in level 1 noise, performance with the Roger Pen was significantly higher than with the T-mic. For both populations, performance in level 1 noise with the Roger Pen approached the level of baseline performance in quiet. Ease of listening in noise was rated higher in the Roger Pen conditions than in the T-mic or processor mic conditions in both A-only and AV test conditions.

CONCLUSION

 The Roger remote mic and on-ear directional mic technologies benefit both speech understanding and ease of listening in a realistic laboratory test environment and are likely do the same in real-world listening environments.

A comparative study of an assistive e-learning interface among students with and without visual and hearing impairments

Purpose: Using a human-computer interaction (HCI) approach, the present study proposes a new e-learning interface with interactional features for use by students with varying visual and hearing needs.Materials and method: Prototypes of these new features have been presented through several screens, including an interaction panel that allows for Button voice, Tab voice, Text voice, and sign language. The interactive features were evaluated by teachers and tested by students with and without visual and hearing impairments. Evaluation of the interface was conducted using a mixed methods design; student satisfaction with the features was measured quantitatively, while teacher perspectives regarding practical issues with implementation were explored through qualitative interviews.Results: The results indicate a high level of satisfaction towards the new interactional features in the suggested user interface among all students regardless of visual and hearing ability.Conclusion: The teachers involved in the study expressed the need for comprehensive cooperation from academic organisations through provision of required support, including technical, financial, and human resources.IMPLICATIONS FOR REHABILITATIONThe existing e-learning systems in higher educational organizations revealed the need to develop and implement instructional communication features based on technological components to support visual-and hearing-impaired students.The implementation of the accessible e-learning system is an important strategical approach to enhance flexible access to learning contents for all students who are unable to attend a traditional mode of learning.This type of accessible e-learning system, along with teachers' support, is needed to develop a more comprehensive understanding of the self-management of the student's learning process; giving students the opportunity to study according to their individual abilities, schedules and locations.The integration of appropriate visual and hearing assistive technology (AT) and its related applications, embedded within the educational technology infrastructure, are important resources to enhance the educational outcomes for visual- and hearingimpaired students.

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.

Translation and validation of the Listen Inventory for Education Revised into Dutch

INTRODUCTION

In Belgium the majority of children with CI's are being educated in mainstream schools. In mainstream schools difficult listening situations occur (e.g. due to background noise) which may result in educational risks for children with CI's. A tool that identifies potential listening difficulties, the English Listen inventory for Education Revised (LIFE-R), was translated and validated into Dutch for elementary and secondary schools (LIFE-NL, LIFE2-NL respectively).

METHODS

Two forward-backward translations were performed followed by a linguistic evaluation and validation by a multidisciplinary committee. The LIFE-NL was further validated on content by pre-testing the questionnaire in 5 students with hearing loss (8-13 years). After minor cross-cultural adaptations normative data were assembled from 187 normal-hearing (NH) students enrolled in mainstream secondary education (1st to 4th grade). The normative data were further analysed based on grade and school type. Additionally, the internal consistency was evaluated by calculating Cronbach's alpha for 3 different scales of the LIFE2-NL: the LIFE total (situation 1-15), LIFE class (situation 1-10: listening situations in classroom) and LIFE social (situation 11-15: social listening situations in school).

RESULTS

NH students scored on average 72.0 (SD = 19.9%) on the LIFE2-NL, indicating they experience some difficulties in secondary mainstream schools. The most difficult listening situations were those where fellow students are noisy or when students have to listen in large classrooms. NH students scored significantly higher on the LIFE class compared to the LIFE social (84.1 ± 14.7% vs. 68.1 ± 19.0%, p < .000). Moreover the LIFE social tend to decrease from the 3rd grade on. The different subscales of the LIFE2-NL showed high internal consistency (Cronbach's alpha of 0.86, 0.89 and 0.75 for LIFE total, LIFE class and LIFE social respectively).

CONCLUSION

The LIFE-NL and LIFE2-NL are valid Dutch translations of the original LIFE-R and are fully comprehensible for students with hearing loss. The normative data of the LIFE2-NL provide a representative framework for interpreting the results of mainstreamed students with hearing loss in secondary schools.