Christopher Flynn

Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study.

Objective: To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment. Design: All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children’s speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes. Results: Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children’s performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age. Conclusions: Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.

A comparison of NAL and DSL prescriptive methods for paediatric hearing-aid fitting: Predicted speech intelligibility and loudness

Abstract Objective: To examine the impact of prescription on predicted speech intelligibility and loudness for children. Design: A between-group comparison of speech intelligibility index (SII) and loudness, based on hearing aids fitted according to NAL-NL1, DSL v4.1, or DSL m[i/o] prescriptions. A within-group comparison of gains prescribed by DSL m[i/o] and NAL-NL2 for children in terms of SII and loudness. Study sample: Participants were 200 children, who were randomly assigned to first hearing-aid fitting with either NAL-NL1, DSL v4.1, or DSL m[i/o]. Audiometric data and hearing-aid data at 3 years of age were used. Results: On average, SII calculated on the basis of hearing-aid gains were higher for DSL than for NAL-NL1 at low input level, equivalent at medium input level, and higher for NAL-NL1 than DSL at high input level. Greater loudness was associated with DSL than with NAL-NL1, across a range of input levels. Comparing NAL-NL2 and DSL m[i/o] target gains revealed higher SII for the latter at low input level. SII was higher for NAL-NL2 than for DSL m[i/o] at medium- and high-input levels despite greater loudness for gains prescribed by DSL m[i/o] than by NAL-NL2. Conclusion: The choice of prescription has minimal effects on speech intelligibility predictions but marked effects on loudness predictions.

Language and speech perception of young children with bimodal fitting or bilateral cochlear implants

Abstract Objectives This paper compares language development and speech perception of children with bimodal fitting (a cochlear implant in one ear and a hearing aid in the opposite ear) or bilateral cochlear implantation. Methods Participants were children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment study. Language development was assessed at 3 years of age using standardized tests. Speech perception was evaluated at 5 years of age. Speech was presented from a frontal loudspeaker, and babble noise was presented either from the front or from both sides. Results On average, there was no significant difference in language outcomes between 44 children with bimodal fitting and 49 children with bilateral cochlear implants; after controlling for a range of demographic variables. Earlier age at cochlear implant activation was associated with better outcomes. Speech perception in noise was not significantly different between children with bimodal fitting and those with bilateral cochlear implants. Compared to normal-hearing children, children with cochlear implants required a better signal-to-noise ratio to perform at the same level, but demonstrated spatial release from masking of a similar magnitude. Conclusions This population-based study found that language scores for children with bilateral implants were higher than those with bimodal fitting or those with unilateral implants, but neither reached significance level.

A randomized controlled comparison of NAL and DSL prescriptions for young children: Hearing-aid characteristics and performance outcomes at three years of age

Abstract Objective: To determine the influence of choice of prescription and other child-, family- and intervention-related factors on speech, language, and functional performance of hearing-impaired children by three years of age. Design and study sample: A randomized controlled design was implemented as part of a population-based, longitudinal study on outcomes of children with hearing impairment (LOCHI) in Australia. Two hundred and eighteen children were randomly assigned to either the NAL or the DSL prescription for first fitting of hearing aids. Their performance outcomes were evaluated. Results: Prescriptive targets were closely matched in childrens hearing aids. There were no significant differences in childrens language, speech production, or functional performance between prescriptions. Parents’ ratings of childrens device usage and loudness discomfort were not significantly different between prescription groups. Functional performance within the first year of fitting together with degree of hearing loss, presence of additional disabilities, and maternal education explained 44% of variation in language ability of children by three years of age. Conclusions: There was no significant association between choice of hearing-aid prescription and variance in childrens outcomes at three years of age. In contrast, additional disability, maternal educational level, and early functional performance were significant predictive factors of childrens outcomes.

A randomized controlled trial of nonlinear frequency compression versus conventional processing in hearing aids: Speech and language of children at three years of age

Abstract Objective: To determine the effect of nonlinear frequency compression (NLFC) on childrens development of speech and language at three years of age. Design: A randomized controlled trial was conducted as part of the population-based longitudinal study on outcomes of children with hearing impairment (LOCHI). Participants were randomly assigned to fitting with NLFC (Phonak Naida V SP or UP) or with conventional processing in hearing aids, prescribed by using either the NAL or the DSL formula. Standardized tests of speech production, receptive and expressive language were administered, and parent ratings were collected. All assessments were double-blinded. Study sample: Participants were 44 of the 450 children in the LOCHI cohort. Results: Compared to children using conventional processing, receptive and expressive language was higher but receptive vocabulary and consonant articulation scores were lower for children who use NLFC. There was increased substitution of affricates by fricatives for children using NLFC, compared to children using conventional amplification. After allowing for the effect of multiple demographic variables, the difference in global language scores between groups was not significant (effect: 0.8 [95% confidence interval: − 6.7, 8.3]). Conclusions: There is insufficient evidence to indicate a difference in language ability between children using NLFC and those using conventional amplification.

Aided cortical response, speech intelligibility, consonant perception and functional performance of young children using conventional amplification or nonlinear frequency compression

OBJECTIVE The aim of this study was to compare conventional processing with nonlinear frequency compression (NLFC) in hearing aids for young children with bilateral hearing loss. METHODS Sixty-four children aged between 2 and 7 years with bilateral hearing aids were recruited. Evaluations of cortical responses, speech intelligibility rating, consonant perception and functional performance were completed with the children wearing their personal hearing aids with conventional processing. The children were then refitted with new hearing aids with NLFC processing. Following a six-week familiarization period, they were evaluated again while using their hearing aids with NLFC activated. RESULTS The mean speech intelligibility rating and the number of cortical responses present for /s/were significantly higher when children were using NLFC processing than conventional processing in their hearing aids (p<0.05). Parents judged the childrens functional real life performance with the NLFC hearing aids to be similar or better than that with the childrens own hearing aids in both quiet and noisy situations. The mean percent consonant score was higher with NLFC processing compared to conventional processing, but the difference did not reach the 5% significance level (p=0.056). An overall figure of merit (FOM) was calculated by averaging the standardized difference scores between processing schemes for all measures. Regression analysis revealed that, on average, greater advantage for NLFC processing was associated with poorer hearing at 4 kHz. CONCLUSIONS Compared to conventional processing, the use of NLFC was, on average, effective in increasing audibility of /s/as measured by cortical evaluations, and higher ratings on speech intelligibility and functional performance in real life by parents. On average, greater benefits from NLFC processing was associated with poorer hearing at 4 kHz.

Factors influencing speech perception in noise for 5-year-old children using hearing aids or cochlear implants

Abstract Objective: We investigated the factors influencing speech perception in babble for 5-year-old children with hearing loss who were using hearing aids (HAs) or cochlear implants (CIs). Design: Speech reception thresholds (SRTs) for 50% correct identification were measured in two conditions – speech collocated with babble, and speech with spatially separated babble. The difference in SRTs between the two conditions give a measure of binaural unmasking, commonly known as spatial release from masking (SRM). Multiple linear regression analyses were conducted to examine the influence of a range of demographic factors on outcomes. Study sample: Participants were 252 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Results: Children using HAs or CIs required a better signal-to-noise ratio to achieve the same level of performance as their normal-hearing peers but demonstrated SRM of a similar magnitude. For children using HAs, speech perception was significantly influenced by cognitive and language abilities. For children using CIs, age at CI activation and language ability were significant predictors of speech perception outcomes. Conclusions: Speech perception in children with hearing loss can be enhanced by improving their language abilities. Early age at cochlear implantation was also associated with better outcomes.

Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation

Abstract Objective: We investigated effects of aetiology and age at implantation on changes in threshold (T) levels, comfortable (C) levels and dynamic range (DR) for cochlear implants (CIs) in children over the first five years of life. Design: Information was collected at 6 months post-activation of CIs, and at 3 and 5 years of age. Study sample: One hundred and sixty-one children participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Results: Children with neural and structural cochlear lesions had higher T-levels and C-levels as compared to those without these conditions. Parameter settings varied from manufacturer’s defaults more often in the former than in the latter group. Investigation of the effect of age at implantation for children without neural and structural cochlear lesions showed that those implanted at ≤12 months of age had higher T-levels and narrower DR at 6 months post-activation, as compared to the later-implanted group. For both early- and later-implanted groups, the C-levels at 6 months post-activation were lower than those at age 3 and 5 years. There were no significant differences in T-levels, C-levels, or DR between age 3 and 5 years. Conclusions: Aetiology and age at implantation had significant effects on T-levels and C-levels.

Hearing aid fitting and developmental outcomes of children fit according to either the NAL or DSL prescription: fit-to-target, audibility, speech and language abilities

Abstract Objective: This study examined the influence of prescription on hearing aid (HA) fitting characteristics and 5-year developmental outcomes of children. Design: A randomised controlled trial implemented as part of a population-based study on Longitudinal Outcomes of Children with Hearing Impairment (LOCHI). Study sample: Two-hundred and thirty-two children that were fit according to either the National Acoustic Laboratories (NAL) or Desired Sensation Level (DSL) prescription. Results: Deviation from targets and root-mean-square error in HA fitting revealed no significant difference between fitting prescriptions. Aided audibility quantified by using the Speech Intelligibility Index (SII) model showed that DSL provided higher audibility than NAL at low and medium input levels but not at high input level. After allowing for hearing loss desensitisation, differences in audibility between prescription groups were significant only at low input level. The randomised trial of prescription that was implemented for 163 children revealed no significant between-group differences in speech production, perception, and language; but parent-rated functional performance was higher for the DSL than for the NAL group. Conclusions: Proximity to prescriptive targets was similar between fitting prescriptions. The randomised trial revealed differences in aided audibility at low input level between prescription groups, but no significant differences in speech and language abilities.