Nancy Tye-Murray

Unilateral Hearing Loss Is Associated With Worse Speech-Language Scores in Children

OBJECTIVE: To determine whether children with unilateral hearing loss (UHL) demonstrate worse language skills than their siblings with normal hearing, and whether children with UHL are more likely to receive extra assistance at school. PATIENTS AND METHODS: We conducted a case-control study of 6- to 12-year-old children with UHL compared with sibling controls (74 pairs, n = 148). Scores on the oral portion of the Oral and Written Language Scales (OWLS) were the primary outcome measure. Multivariable analysis was used to determine whether UHL independently predicted OWLS scores after we controlled for potential confounding variables. RESULTS: Children with UHL had worse scores than their siblings on language comprehension (91 vs 98; P = .003), oral expression (94 vs 101; P = .007), and oral composite (90 vs 99; P < .001). UHL independently predicted these OWLS scores when multivariable regression was used with moderate effect sizes of 0.3 to 0.7. Family income and maternal education were also independent predictors of oral expression and oral composite scores. No differences were found between children with right- or left-ear UHL or with varying severity of hearing loss. Children with UHL were more likely to have an individualized education plan (odds ratio: 4.4 [95% confidence interval: 2.0–9.5]) and to have received speech-language therapy (odds ratio: 2.6 [95% confidence interval: 1.3–5.4]). CONCLUSIONS: School-aged children with UHL demonstrated worse oral language scores than did their siblings with normal hearing. These findings suggest that the common practice of withholding hearing-related accommodations from children with UHL should be reconsidered and studied, and that parents and educators should be informed about the deleterious effects of UHL on oral language skills.

Auditory-visual speech perception and auditory-visual enhancement in normal-hearing younger and older adults.

Objective: The purpose of the present study was to examine the effects of age on the ability to benefit from combining auditory and visual speech information, relative to listening or speechreading alone. In addition, the study was designed to compare visual enhancement (VE) and auditory enhancement (AE) for consonants, words, and sentences in older and younger adults. Design: Forty-four older adults and 38 younger adults with clinically normal thresholds for frequencies of 4 kHz and below were asked to identify vowel-consonant-vowels (VCVs), words in a carrier phrase, and semantically meaningful sentences in auditory-only (A), visual-only (V), and auditory-visual (AV) conditions. All stimuli were presented in a background of 20-talker babble, and signal-to-babble ratios were set individually for each participant and each stimulus type to produce approximately 50% correct in the A condition. Results: For all three types of stimuli, older and younger adults obtained similar scores for the A condition, indicating that the procedure for individually adjusting signal-to-babble ratios was successful at equating A scores for the two age groups. Older adults, however, had significantly poorer performance than younger adults in the AV and V modalities. Analyses of both AE and VE indicated no age differences in the ability to benefit from combining auditory and visual speech signals after controlling for age differences in the V condition. Correlations between scores for the three types of stimuli (consonants, words, and sentences) indicated moderate correlations in the V condition but small correlations for AV, AE, and VE. Conclusions: Overall, the findings suggest that the poorer performance of older adults in the AV condition was a result of reduced speechreading abilities rather than a consequence of impaired integration capacities. The pattern of correlations across the three stimulus types indicates some overlap in the mechanisms mediating AV perception of words and sentences and that these mechanisms are largely independent from those used for AV perception of consonants.

Longitudinal study of children with unilateral hearing loss

Children with unilateral hearing loss (UHL) have been found to have lower language scores, and increased rate of speech therapy, grade failures, or needing Individualized Education Plans (IEPs). The objective of this study was to determine whether language skills and educational performance improved or worsened over time in a cohort of children with UHL.

Rehabilitation factors contributing to implant benefit in children

This study was performed to investigate factors contributing to auditory, speech, language, and reading outcomes after 4 to 6 years of multichannel cochlear implant use in children with prelingual deafness. The analysis controlled for the effects of child, family, and implant characteristics so that the educational factors most conducive to maximum implant benefit could be identified. We tested 136 children from across the United States and Canada. All were 8 or 9 years of age, had an onset of deafness before 3 years of age, underwent implantation by 5 years of age, and resided in a monolingual English-speaking home environment. Characteristics of the child and the family (primarily nonverbal IQ) accounted for approximately 20% of the variance in outcome after implantation. An additional 24% was accounted for by implant characteristics and 12% by educational variables, particularly communication mode. Oral education appears to be an important educational choice for children who have undergone cochlear implantation before 5 years of age.

The Structure of Working Memory Abilities Across the Adult Life Span

The present study addresses three questions regarding age differences in working memory: (1) whether performance on complex span tasks decreases as a function of age at a faster rate than performance on simple span tasks; (2) whether spatial working memory decreases at a faster rate than verbal working memory; and (3) whether the structure of working memory abilities is different for different age groups. Adults, ages 20-89 (n = 388), performed three simple and three complex verbal span tasks and three simple and three complex spatial memory tasks. Performance on the spatial tasks decreased at faster rates as a function of age than performance on the verbal tasks, but within each domain, performance on complex and simple span tasks decreased at the same rates. Confirmatory factor analyses revealed that domain-differentiated models yielded better fits than models involving domain-general constructs, providing further evidence of the need to distinguish verbal and spatial working memory abilities. Regardless of which domain-differentiated model was examined, and despite the faster rates of decrease in the spatial domain, age group comparisons revealed that the factor structure of working memory abilities was highly similar in younger and older adults and showed no evidence of age-related dedifferentiation.

Audiovisual integration and lipreading abilities of older adults with normal and impaired hearing

Objective: The purpose of the current study was to examine how age-related hearing impairment affects lipreading and auditory-visual integration. The working hypothesis for the investigation was that presbycusic hearing loss would increase reliance on visual speech information, resulting in better lipreading and auditory-visual integration in older persons who have hearing impairment, compared with older persons who have normal hearing. Design: This study compared the performance of 53 adults with normal hearing (above age 65) and 24 adults with mild-to-moderate hearing impairment (above age 65) on auditory-only (A), visual-only (V), and auditory-visual (AV) speech perception, using consonants, words, and sentences as stimuli. All testing was conducted in the presence of multi-talker background babble, set individually for each participant and each type of stimulus, to obtain approximately equivalent A performance across the groups. In addition, we compared the two groups of participants on measures of auditory enhancement, visual enhancement, and auditory-visual integration that were derived from the A, V and AV performance scores. Results: In general, the two groups of participants performed similarly on measures of V and AV speech perception. The one exception to this finding was that the participants with hearing impairment performed significantly better than the participants with normal hearing on V identification of words. Measures of visual enhancement, auditory enhancement, and auditory-visual integration did not differ as a function of hearing status. Conclusions: Overall, the results of the current study suggest that despite increased reliance on visual speech information, older adults who have hearing impairment do not exhibit better V speech perception or auditory-visual integration than age-matched individuals who have normal hearing. These findings indicate that inclusion of V and AV speech perception measures can provide important information for designing maximally effective audiological rehabilitation strategies.

Auditory-visual discourse comprehension by older and young adults in favorable and unfavorable conditions

This investigation examined how age and test condition affect ones ability to comprehend discourse passages, and determined whether age and test condition affect discourse comprehension and closed-set sentence recognition in a similar way. Young and older adults were tested with closed-set sentences from the newly-created build-a-sentence test (BAS) and a series of discourse passages in two audiovisual conditions: favorable, where the talkers head was clearly visible and the signal-to-babble ratio (SBR) was more optimal; and unfavorable, where the contrast sensitivity of the visual signal was reduced and the SBR was less optimal. The older participants recognized fewer words in the BAS than the young participants in both test conditions. Degrading the viewing and listening conditions led to a greater decline in their performance than in the young participants’ performance. The older participants also did not perform as well at comprehending spoken discourse in the two test conditions. However, unlike the results from the BAS, the age difference for discourse comprehension was not exacerbated by unfavorable conditions. When attempting to comprehend discourse, older adults may draw upon verbal and cognitive abilities that are relatively insensitive to age.

Effects of communication mode on skills of long-term cochlear implant users

In contrast to predictions by Deaf activists, this group of adolescents with and without cochlear implants had strikingly similar identity beliefs. Both groups indicated a high degree of approval of Bicultural identity statements, which reflect a balanced view of the hearing and deaf cultures. Although the sample was small, inspection of the data indicates that the absolute values and distributional characteristics for the DIDS scores of the two groups were highly similar on all scales except the Hearing identity scale. Because many implant users receive audiological benefit, it is not surprising that they describe emulating the hearing majority as a desirable goal.

Conversational fluency of children who use cochlear implants.

Purpose Children who have significant hearing loss often experience difficulty in engaging in everyday conversations. They may spend an inordinate amount of time in communication breakdown or in silence. The purpose of the present investigation was to assess the oral conversation fluency of young cochlear implant users using both objective and subjective measuring procedures. Conversational fluency relates to how smoothly a conversation unfolds. The children’s performance was compared with that of children who have normal hearing, and related to other measures of communication skill and other child variables. Design One hundred eighty-one cochlear implant users and 24 children with normal hearing engaged in conversations with a clinician, using an oral mode of communication. Audio-video tapes of the conversations were analyzed to yield the following measures: percent of time the child and clinician spent trying to repair a breakdown in communication, percent of time the two spent sitting in silence, and the ratio between the amount of time the child spoke and the amount of time the clinician spoke. In addition, for the cochlear implant users, 10 judges viewed excerpts of the tapes and gave their impressions and reactions to the children and their conversations, using five-point rating scales. The objective and subjective measures were related to the children’s speech intelligibility, mean length utterance, and speech recognition in both an auditory-only and auditory-plus-vision condition. Results The cochlear implant users spent significantly more time in communication breakdown and in silence than the children with normal hearing, and children who are in an educational placement that emphasizes oral communication spent less time in breakdown than children who are in educational placement that use both speech and sign. Speech intelligibility and receptive language were the best predictors of communication breakdown. Judges perceived children who spent less time in communication breakdown more favorably than children who spent more time, and reacted to them more positively. Finally, there was a high correlation between the subjective measures of the conversation and the objective measures. Conclusions Educational programs should provide explicit instruction to promote conversational fluency. The results show a need for communication therapy, and suggest that the children will be perceived and reacted to more favorably if they learn how to manage communication difficulties. The results also support the need for extensive speech-language therapy for these children. The objective measures employed in this investigation appear to be a valid and useful means for assessing conversational fluency.

Developmental shifts in children's sensitivity to visual speech: A new multimodal picture-word task

This research developed a multimodal picture-word task for assessing the influence of visual speech on phonological processing by 100 children between 4 and 14 years of age. We assessed how manipulation of seemingly to-be-ignored auditory (A) and audiovisual (AV) phonological distractors affected picture naming without participants consciously trying to respond to the manipulation. Results varied in complex ways as a function of age and type and modality of distractors. Results for congruent AV distractors yielded an inverted U-shaped function with a significant influence of visual speech in 4-year-olds and 10- to 14-year-olds but not in 5- to 9-year-olds. In concert with dynamic systems theory, we proposed that the temporary loss of sensitivity to visual speech was reflecting reorganization of relevant knowledge and processing subsystems, particularly phonology. We speculated that reorganization may be associated with (a) formal literacy instruction and (b) developmental changes in multimodal processing and auditory perceptual, linguistic, and cognitive skills.