Lisa Lucks Mendel

Current considerations in pediatric speech audiometry

Current considerations in pediatric speech perception assessment are highlighted in this article with a focus on specific test principles and variables that must be addressed when evaluating speech perception performance in children. Existing test materials are reviewed with an emphasis on the level of sensitivity and standardization that they have for accurate assessment of a childs speech perception performance. A test battery approach is advocated because speech perception is an abstract construct, and in order to provide a comprehensive assessment of a childs capabilities, information is needed from several sources of concrete data. The importance of ongoing speech perception assessment in children is also emphasized because a childs progress over time must be monitored to determine if improvements need to be made with amplification and intervention efforts. Results from pediatric speech perception assessments can provide practical information regarding the prognosis of speech, language, reading, and cognitive abilities of children as well as steps that need to be taken in the intervention process.

A study of recorded versus live voice word recognition

Abstract Objective: To determine administration times for word recognition presented via monitored live voice (MLV) and compact disc (CD) recordings. Design: A quasi-experimental design was used. Fifty-word NU-6 lists were presented in three conditions: (1) MLV, (2) short ISI CD recording, and (3) long ISI CD recording. Study sample: Listeners with normal hearing (NH) and hearing impairment (HI) participated in this study. Results: Average administration time using MLV was significantly shorter than using recorded word lists for both groups of listeners. MLV presentation to the NH listeners was significantly faster than the MLV presentation to the HI listeners. There were no significant differences between groups in the administration times for any of the recorded lists (long or short ISI). Considerably more variability in administration time was observed for MLV presentation compared to recorded presentations. Conclusions: MLV presentation was about one minute faster than the shortest CD recording of the NU-6 fifty-item word lists, but it was only 49 seconds quicker when administering tests to individuals with hearing loss. Because the majority of our patients are hearing impaired, the difference of 49 seconds is not clinically significant. This difference is even less when 25-item word lists are used. Sumario Objetivo: Determinar los tiempos de presentación para el reconocimiento de palabras presentadas con voz viva monitorizada (MLV) o con grabaciones de disco compacto (CD). Diseño: Se utilizó un diseño quasi-experimental. Se presentaron listas NU-6 de cincuenta palabras en tres condiciones: (1) MLV, (2) grabación corta ISI CD y (3) grabación larga ISI CD. Muestra de estudio: Participaron en este estudio personas con audición normal (NH) y con pérdida auditiva (HI). Resultados: El tiempo promedio de presentación usando MLV fue significativamente más corto que al usar listas grabadas de palabras, en ambos grupos. La presentación con MLV en personas del grupo NH fue significativamente más rápida que la presentación MLV a las personas del grupo HI. No se apreciaron diferencias significativas entre ambos grupos en los tiempos de presentación con cualquiera de las listas grabadas (ISI larga o corta). Se observó una variabilidad considerablemente mayor en los tiempos de administración con material MLV, comparado con las presentaciones grabadas. Conclusiones: La presentación con MLV fue cerca de un minuto más rápida que las grabaciones más cortas en CD de las listas de palabras NU-6 de cincuenta cada una, pero fue solamente 49 segundos más rápida cuando se presentaron las pruebas a personas con pérdida auditiva. Como la mayoría de nuestros pacientes tiene problemas auditivos, la diferencia de 49 segundos no es clinicamente significativa. Esta diferencia es incluso menor cuando se usan listas de 25 palabras.

Acoustics in physical education settings: the learning roadblock

Background: The audibility of teachers and peers is an essential factor in determining the academic performance of school children. However, acoustic conditions in most classrooms are less than optimal and have been viewed as ‘hostile listening environments’ that undermine the learning of children in school. While research has shown that typical classrooms may be acoustically challenging, the acoustic conditions in physical education settings are without a doubt more challenging than in the typical classroom. To date, researchers in physical education have sparingly focused on the way acoustics affect physical education settings. Aims: The focus of this research effort was to measure noise levels in elementary-, middle- and high-school physical education settings and compare them to the American Speech-Language-Hearing Association (ASHA) guidelines (30 dBA) and American National Standards Institute (ANSI) standards (40 dBA). Documentation of these ambient noise levels may give greater understanding to the effect of background noise on student learning in physical education. Methods: Acoustic environments were measured in indoor and outdoor settings in 12 elementary, 4 middle, and 6 high schools in northwest Florida. Nine outdoor, seven gymnasium, and six covered area settings were evaluated. Ambient noise levels were recorded for each unoccupied physical education setting. A sound decibel digital meter which met American National Standard Specification for Sound Level Meters set on the ‘A’-weighted scale and on slow response was used to record the noise levels for each setting. Two-tailed t-tests were used for comparison of the overall mean noise levels in outdoor, gymnasium, and covered physical education settings to the standards established by ANSI and ASHA. Results: The findings showed that all of the settings were significantly (p < .05) higher than the established standards and only 1 of the 22 physical education settings studied had background noise levels at or below 40 dBA. These results also indicate that the physical education settings investigated exhibit ambient noise levels at 10–15 dB higher than recommended levels. Conclusions: In light of the acoustics standards and prior research, these results are discouraging if not alarming. These results also suggest that the background noise in physical education settings is likely detrimental to student learning. These findings indicate an immediate need for administrators to support future research and determine the most appropriate, cost-effective procedures to reduce noise in existing physical education settings. Strategies for reducing high noise levels in physical education settings include sound amplification devices, acoustical modifications, and future construction strategies.

Speech perception in noise for bilingual listeners with normal hearing

Abstract Objective: The purpose of this study was to determine if speech-in-noise ability, as measured by SNR-50 and SNR loss in bilingual Spanish listeners with normal hearing, was affected by test difficulty. Design: Quasi-experimental, non-randomized intervention study. Study sample: Two groups of adult listeners participated: monolingual English listeners with normal hearing (N = 12) and bilingual Spanish listeners with normal hearing who were proficient in English (N = 10). The quick speech-in-noise (QuickSIN), the Bamford-Kowal-Bench speech-in-noise (BKB-SIN), and the words-in-noise (WIN) tests were used to assess signal-to-noise ratio (SNR) loss and SNR-50 for both groups. Results: Despite the fact that the bilinguals had normal hearing and were proficient in English, each of the speech-in-noise tests evaluated indicated the Spanish listeners had measurable SNR loss and higher than normal SNR-50s. Performance on the BKB-SIN was best for both groups, indicating test difficulty had a significant impact on speech perception in noise. Conclusions: Bilingual Spanish listeners with normal hearing exhibited a mild SNR loss comparable to that observed for a person with hearing loss. This decreased performance in noise requires an improved SNR for this population to reach a comparable level of comprehension to their monolingual English counterparts.

Speech intelligibility assessment in a helium environment. II. The speech intelligibility index

The Speech Intelligibility Index (SII) was measured for Navy divers participating in two saturation deep dives and for a group of nondivers to test different communication systems and their components. These SIIs were validated using the Speech Perception in Noise (SPIN) test and the Griffiths version of the Modified Rhyme Test (GMRT). Our goal was to determine if either of these assessments was sensitive enough to provide an objective measure of speech intelligibility when speech was processed through different helmets and helium speech unscramblers (HSUs). Results indicated that SII values and percent intelligibility decreased incrementally as background noise level increased. SIIs were very reliable across the different groups of subjects indicating that the SII was a strong measurement for predicting speech intelligibility to compare linear system components such as helmets. The SII was not useful in measuring intelligibility through nonlinear devices such as HSUs. The speech intelligibility scores on the GMRT and SPIN tests were useful when the system component being compared had a large measurable difference, such as in helmet type. However, when the differences were more subtle, such as differences in HSUs, neither the SPIN nor the GMRT appeared sensitive enough to make such distinctions. These results have theoretical as well as practical value for measuring the quality and intelligibility of helium speech enhancement systems.

Identifying Hearing Loss from Learned Speech Kernels.

Does a hearing-impaired individual’s speech reflect his hearing loss? To investigate this question, we recorded at least four hours of speech data from each of 29 adult individuals, both male and female, belonging to four classes: 3 normal, and 26 severely-to-profoundly hearing impaired with high, medium or low speech intelligibility. Acoustic kernels were learned for each individual by capturing the distribution of his speech data points represented as 20 ms duration windows. These kernels were evaluated using a set of neurophysiological metrics, namely, distribution of characteristic frequencies, equal loudness contour, bandwidth andQ10 value of tuning curve. It turns out that, for our cohort, a feature vector can be constructed out of four properties of these metrics that would accurately classify hearing-impaired individuals with low intelligible speech from normal ones using a linear classifier. However, the overlap in the feature space between normal and hearing-impaired individuals increases as the speech becomes more intelligible. We conclude that a hearing-impaired individual’s speech does reflect his hearing loss provided his loss of hearing has considerably affected the intelligibility of his speech.

Normative data for the Maryland CNC Test.

BACKGROUND The Maryland consonant-vowel nucleus-consonant (CNC) Test is routinely used in Veterans Administration medical centers, yet there is a paucity of published normative data for this test. PURPOSE The purpose of this study was to provide information on the means and distribution of word-recognition scores on the Maryland CNC Test as a function of degree of hearing loss for a veteran population. RESEARCH DESIGN A retrospective, descriptive design was conducted. STUDY SAMPLE The sample consisted of records from veterans who had Compensation and Pension (C&P) examinations at a Veterans Administration medical center (N = 1,760 ears). DATA COLLECTION AND ANALYSIS Audiometric records of veterans who had C&P examinations during a 10 yr period were reviewed, and the pure-tone averages (PTA4) at four frequencies (1000, 2000, 3000, and 4000 Hz) were documented. The maximum word-recognition score (PBmax) was determined from the performance-intensity functions obtained using the Maryland CNC Test. Correlations were made between PBmax and PTA4. RESULTS A wide range of word-recognition scores were obtained at all levels of PTA4 for this population. In addition, a strong negative correlation between the PBmax and the PTA4 was observed, indicating that as PTA4 increased, PBmax decreased. Word-recognition scores decreased significantly as hearing loss increased beyond a mild hearing loss. Although threshold was influenced by age, no statistically significant relationship was found between word-recognition score and the age of the participants. CONCLUSIONS RESULTS from this study provide normative data in table and figure format to assist audiologists in interpreting patient results on the Maryland CNC test for a veteran population. These results provide a quantitative method for audiologists to use to interpret word-recognition scores based on pure-tone hearing loss.

Computer Applications in Educational Audiology.

Educational audiology involves the development, coordination, implementation, and evaluation of numerous, diverse audiological services, generally across several sites. The purpose of this report is to provide an overview of how computer-based technologies can be used by educational audiologists to perform their job responsibilities in an easier, more efficient manner. Computer technologies can be classified into three categories: (a) information systems applications, (b) screening and diagnostic applications, and (c) intervention applications.

Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma

Purpose Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma. Method Conventional frequency (CF = 0.25-8.0 kHz) audiometry, extended high-frequency (EHF = 9.0-16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1-5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores. Results At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463). Conclusion At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.

Derivation of frequency importance functions for the AzBio sentences

Although the AzBio test is well validated, has effective standardization data available, and is highly recommended for Cochlear Implant (CI) evaluation, no attempt has been made to derive a Frequency Importance Function (FIF) for its stimuli. This study derived FIFs for the AzBio sentence lists using listeners with normal hearing. Traditional procedures described in studies by Studebaker and Sherbecoe [(1991). J. Speech. Lang. Hear. Res. 34, 427-438] were applied for this purpose. Participants with normal hearing listened to a large number of AzBio sentences that were high- and low-pass filtered under speech-spectrum shaped noise at various signal-to-noise ratios. Frequency weights for the AzBio sentences were greatest in the 1.5 to 2 kHz frequency regions as is the case with other speech materials. A cross-procedure comparison was conducted between the traditional procedure [Studebaker and Sherbecoe (1991). J. Speech. Lang. Hear. Res. 34, 427-438] and the nonlinear optimization procedure [Kates (2013). J. Acoust. Soc. Am. 134, EL459-EL464]. Consecutive data analyses provided speech recognition scores for the AzBio sentences in relation to the Speech Intelligibility Index (SII). The findings of the authors provide empirically derived FIFs for the AzBio test that can be used for future studies. It is anticipated that the accuracy of predicting SIIs for CI patients will be improved when using these derived FIFs for the AzBio test.