Jonas Brännström

Does the speaker's voice quality influence children's performance on a language comprehension test?

Abstract Purpose. A small number of studies have explored childrens perception of speakers’ voice quality and its possible influence on language comprehension. The aim of this explorative study was to investigate the relationship between the examiners voice quality, the childs performance on a digital version of a language comprehension test, the Test for Reception of Grammar (TROG-2), and two measures of cognitive functioning. Method. The participants were (n = 86) mainstreamed 8-year old children with typical language development. Two groups of children (n = 41/45) were presented with the TROG-2 through recordings of one female speaker: one group was presented with a typical voice and the other with a simulated dysphonic voice. Result. Significant associations were found between executive functioning and language comprehension. The results also showed that children listening to the dysphonic voice achieved significantly lower scores for more difficult sentences (“the man but not the horse jumps”) and used more self-corrections on simpler sentences (“the girl is sitting”). Conclusion. Findings suggest that a dysphonic speakers voice may force the child to allocate capacity to the processing of the voice signal at the expense of comprehension. The findings have implications for clinical and research settings where standardized language tests are used.

Stages of Change in Adults Who Have Failed an Online Hearing Screening.

Objectives: Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. Design: In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. Results: A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. Conclusions: The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

Societal costs of hearing disorders: A systematic and critical review of literature.

Abstract Objective: The objective of this study was to perform a critical and systematic literature review of studies on societal costs due to hearing disorders. Design: We used predefined search terms and inclusion/exclusion criteria. Systematic searches were conducted in Medline, Cochrane Library, Google Scholar, and other relevant websites. The review included studies written in English or Swedish between 1995 and the end of January 2012. Study sample: We identified four published studies and four reports that met the pre-defined inclusion criteria. Results: Swedish cost studies primarily focused on costs of hearing aids. International studies with a societal perspective used different costing approaches and were limited to specific patient populations. Hearing disorders impact the social welfare system more than the medical care system. Indirect costs account for the major part and direct medical costs for a minor part of the total costs of hearing disorders. Conclusions: There is a need for further studies estimating societal costs for all degrees of hearing disorders, in particular since a large part of the people with hearing disorders are of working age.

Are children with stronger cognitive capacity more or less disturbed by classroom noise and dysphonic teachers

Abstract Purpose: This study aimed to explore if dysphonic voice quality affects childrens performance on a language comprehension test, the Test for Reception of Grammar-2 (TROG-2), performed in simultaneous background noise (non-semantic babble). A further aim was to investigate the role of Working Memory Capacity (WMC) and Executive Functioning (EF) in coping with the voice against a background of babble conditions. Method: Ninety-three mainstreamed 8 year old children with typical language development were tested for WMC and EF. Two groups of children (n = 47/46) were formed and presented with recordings of TROG-2 instructions read by one female speaker: one group was presented with recordings with induced dysphonic voice quality, the other with recordings of typical voice. Both groups listened to the voice recordings in competing babble noise at a Signal-to-Noise Ratio of + 10 dB. Result: Significant differences were found for the interaction between cognitive capacity and the TROG-2 results in relation to the voice conditions. In the dysphonic voice condition, children with better WMC results scored higher at the easier comprehension tasks. In the typical voice condition, children with better WMC and EF results scored higher on the more difficult tasks. Seventeen per cent of the variance for the TROG-2 results was explained by the WMC and EF results. There was no overall effect on the childrens performance depending of voice condition. Conclusion: The effect of the speakers voice quality on childrens performance varies depending on the prevalence of background babble noise and on the task demands. The dysphonic voice and babble noise seem to demand allocation of cognitive capacities at the cost of language comprehension.

A virtual speaker in noisy classroom conditions : supporting or disrupting children’s listening comprehension?

Abstract Aim: Seeing a speaker’s face facilitates speech recognition, particularly under noisy conditions. Evidence for how it might affect comprehension of the content of the speech is more sparse. We investigated how children’s listening comprehension is affected by multi-talker babble noise, with or without presentation of a digitally animated virtual speaker, and whether successful comprehension is related to performance on a test of executive functioning. Materials and Methods: We performed a mixed-design experiment with 55 (34 female) participants (8- to 9-year-olds), recruited from Swedish elementary schools. The children were presented with four different narratives, each in one of four conditions: audio-only presentation in a quiet setting, audio-only presentation in noisy setting, audio-visual presentation in a quiet setting, and audio-visual presentation in a noisy setting. After each narrative, the children answered questions on the content and rated their perceived listening effort. Finally, they performed a test of executive functioning. Results: We found significantly fewer correct answers to explicit content questions after listening in noise. This negative effect was only mitigated to a marginally significant degree by audio-visual presentation. Strong executive function only predicted more correct answers in quiet settings. Conclusions: Altogether, our results are inconclusive regarding how seeing a virtual speaker affects listening comprehension. We discuss how methodological adjustments, including modifications to our virtual speaker, can be used to discriminate between possible explanations to our results and contribute to understanding the listening conditions children face in a typical classroom.

Clinical application and psychometric properties of a norwegian questionnaire for the self-assessment of communication in quiet and adverse conditions using two revised APHAB subscales

Background: Difficulty in following and understanding conversation in different daily life situations is a common complaint among persons with hearing loss. To the best of our knowledge, there is currently no published validated Norwegian questionnaire available that allows for a self‐assessment of unaided communication ability in a population with hearing loss. Purpose: The aims of the present study were to investigate a questionnaire for the self‐assessment of communication ability, examine the psychometric properties of this questionnaire, and explore how demographic variables such as degree of hearing loss, age, and sex influence response patterns. Research Design: A questionnaire based on the subscales of the Norwegian translation of the Abbreviated Profile of Hearing Aid Benefit was applied to a group of hearing aid users and normal‐hearing controls. Study Sample: A total of 108 patients with bilateral hearing loss, and 101 controls with self‐reported normal hearing. Data Collection and Analysis: The psychometric properties were evaluated. Associations and differences between outcome scores and descriptive variables were examined. A regression analysis was performed to investigate whether descriptive variables could predict outcome. Results: The measures of reliability suggest that the questionnaire has satisfactory psychometric properties, with the outcome of the questionnaire correlating to hearing loss severity, thus indicating that the concurrent validity of the questionnaire is good. Conclusions: The findings indicate that the proposed questionnaire is a valid measure of self‐assessed communication ability in both quiet and adverse listening conditions in participants with and without hearing loss.

Effects of background noise, talker’s voice, and speechreading on speech understanding by primary school children in simulated classroom listening situations

In the primary school classroom, children are exposed to multiple factors that combine to create adverse conditions for listening to and understanding what the teacher is saying. Four experiments were conducted to investigate the combined effects of background babble noise (quiet vs. noise), voice quality (normal vs. dysphonic), and speechreading (audio-only vs. audio-visual cues) on speech understanding in 245 eight-year old children. Comprehension was tested using narratives from the test of Clinical Evaluation of Language Fundamentals. Background babble noise was composed of several children talking. Visual speech cues were presented using a digitally animated talker. Vocal loading was used to induce a dysphonic (hoarse) voice. Speech understanding was reduced by even low levels of babble noise, but compensated by visual cues. Dysphonia did not significantly reduce comprehension scores, but it was considered unpleasant. There was some evidence that performance in adverse conditions was positively associated with individual differences in cognitive executive function. Overall, these results suggest that multiple factors combine to influence speech understanding and listening effort for child listeners in the primary school classroom. The constellation of these room, talker, modality, and listener factors should be taken into account in the planning and design of educational and learning activities.In the primary school classroom, children are exposed to multiple factors that combine to create adverse conditions for listening to and understanding what the teacher is saying. Four experiments were conducted to investigate the combined effects of background babble noise (quiet vs. noise), voice quality (normal vs. dysphonic), and speechreading (audio-only vs. audio-visual cues) on speech understanding in 245 eight-year old children. Comprehension was tested using narratives from the test of Clinical Evaluation of Language Fundamentals. Background babble noise was composed of several children talking. Visual speech cues were presented using a digitally animated talker. Vocal loading was used to induce a dysphonic (hoarse) voice. Speech understanding was reduced by even low levels of babble noise, but compensated by visual cues. Dysphonia did not significantly reduce comprehension scores, but it was considered unpleasant. There was some evidence that performance in adverse conditions was positively assoc...

Listening Comprehension and Listening Effort in the Primary School Classroom

In the primary school classroom, children are exposed to multiple factors that combine to create adverse conditions for listening to and understanding what the teacher is saying. Despite the ubiquity of these conditions, there is little knowledge concerning the way in which various factors combine to influence listening comprehension and the effortfulness of listening. The aim of the present study was to investigate the combined effects of background noise, voice quality, and visual cues on children’s listening comprehension and effort. To achieve this aim, we performed a set of four well-controlled, yet ecologically valid, experiments with 245 eight-year-old participants. Classroom listening conditions were simulated using a digitally animated talker with a dysphonic (hoarse) voice and background babble noise composed of several children talking. Results show that even low levels of babble noise interfere with listening comprehension, and there was some evidence that this effect was reduced by seeing the talker’s face. Dysphonia did not significantly reduce listening comprehension scores, but it was considered unpleasant and made listening seem difficult, probably by reducing motivation to listen. We found some evidence that listening comprehension performance under adverse conditions is positively associated with individual differences in executive function. Overall, these results suggest that multiple factors combine to influence listening comprehension and effort for child listeners in the primary school classroom. The constellation of these room, talker, modality, and listener factors should be taken into account in the planning and design of educational and learning activities.

Generic quality of life in persons with hearing loss: a systematic literature review

BackgroundTo the best of our knowledge, no empirically based consensus has been reached as to if, and to what extent, persons with hearing loss (HL) have reduced generic Quality of life (QoL). There seems to be limited knowledge regarding to what extent a hearing aid (HA) would improve QoL. The main aim of the present study was to review studies about the relationship between HL and QoL. A supporting aim was to study the association between distress and HL.MethodsLiterature databases (Cinahl, Pub Med and Web of Science) were searched to identify relevant journal articles published in the period from January 2000 to March 17, 2016. We performed a primary search pertaining to the relationship between HL, HA and QoL (search number one) followed by a supporting search pertaining to the relationship between distress/mood/anxiety and HL (search number two). After checking for duplications and screening the titles of the papers, we read the abstracts of the remaining papers. The most relevant papers were read thoroughly, leaving us with the journal articles that met the inclusion criteria.ResultsTwenty journal articles were included in the present review: 13 were found in the primary search (HL and QoL), and seven in the supporting search (HL and distress). The literature yields equivocal findings regarding the association between generic QoL and HL. A strong association between distress and HL was shown, where distressed persons tend to have a lowered generic QoL. It is suggested that QoL is lowered among HL patients. Some studies suggest an increased generic QoL following the use of HA, especially during the first few months after initiation of treatment. Other studies suggest that HA use is one of several possible factors that contribute to improve generic QoL.ConclusionsThe majority of the studies suggest that HL is associated with reduced generic QoL. Using hearing aids seem to improve general QoL at follow-up within the first year. HL is a risk factor for distress. Further research is needed to explore the relationship between HL and generic QoL, in addition to the importance of influencing variables on this relationship.

Long-term measurements using home audiometry with Békésy’s technique

Abstract Objective: To examine the efficacy of fixed-frequency Békésy’s home audiometry to assess hearing fluctuation and treatment outcomes in patients with subjectively fluctuating hearing loss. Design: SMAPH, a software audiometry program for Windows, was installed and calibrated on laptop computers. Békésy’s audiometry was carried out daily in the patients’ homes, using sound-attenuating earphones. Study sample: Seventeen patients with previously or currently subjectively fluctuating hearing loss. Five patients received of treatment for their conditions during the measurement period. Results: Measurement periods ranged from 6 to 60 days. Varying degrees of compliance were seen, some patients measuring less than 50% of the days, others measuring every day. Based on their long-term measurements the patients were classified into three groups: patients with stable recordings, with fluctuating low-frequency hearing loss, or with fluctuating high-frequency hearing loss. In the patients with stable recordings, significant test–retest differences were seen below 10 dB at frequencies 0.125–8 kHz. Conclusions: Home audiometry with Békésy’s technique can be used to evaluate disease activity and to monitor hearing results after therapy.