Samantha J. Gustafson

Listening effort and perceived clarity for normal-hearing children with the use of digital noise reduction

Objectives: The goal of this study was to evaluate how digital noise reduction (DNR) impacts listening effort and judgment of sound clarity in children with normal hearing. It was hypothesized that when two DNR algorithms differing in signal-to-noise ratio (SNR) output are compared, the algorithm that provides the greatest improvement in overall output SNR will reduce listening effort and receive a better clarity rating from child listeners. A secondary goal was to evaluate the relation between the inversion method measurements and listening effort with DNR processing. Design: Twenty-four children with normal hearing (ages 7 to 12 years) participated in a speech recognition task in which consonant-vowel-consonant nonwords were presented in broadband background noise. Test stimuli were recorded through two hearing aids with DNR off and DNR on at 0 dB and +5 dB input SNR. Stimuli were presented to listeners and verbal response time (VRT) and phoneme recognition scores were measured. The underlying assumption was that an increase in VRT reflects an increase in listening effort. Children rated the sound clarity for each condition. The two commercially available HAs were chosen based on: (1) an inversion technique, which was used to quantify the magnitude of change in SNR with the activation of DNR, and (2) a measure of magnitude-squared coherence, which was used to ensure that DNR in both devices preserved the spectrum. Results: One device provided a greater improvement in overall output SNR than the other. Both DNR algorithms resulted in minimal spectral distortion as measured using coherence. For both devices, VRT decreased for the DNR-on condition, suggesting that listening effort decreased with DNR in both devices. Clarity ratings were also better in the DNR-on condition for both devices. The device showing the greatest improvement in output SNR with DNR engaged improved phoneme recognition scores. The magnitude of this improved phoneme recognition was not accurately predicted with measurements of output SNR. Measured output SNR varied in the ability to predict other outcomes. Conclusions: Overall, results suggest that DNR effectively reduces listening effort and improves subjective clarity ratings in children with normal hearing but that these improvements are not necessarily related to the output SNR improvements or preserved speech spectra provided by the DNR.

Needs of Parents of Children Who Are Deaf/Hard of Hearing With Autism Spectrum Disorder

Little is known about children who are deaf or hard of hearing (D/HH) with a coexisting autism spectrum disorder (ASD). The objective of our study was to understand the needs of children who are D/HH with coexisting ASD. We posed questions for group discussion about diagnostic process, impact of dual diagnosis on communication, and helpful resources. Four parents of three children participated. Challenges in the diagnostic process included the challenges in the appropriateness of the evaluation tools and the limited expertise of the professionals performing the evaluations. Broad-based special educational settings were perceived as helpful. Families described a range of broad-based communication strategies (spoken, sign, and written language, augmentative communication approaches). Families prioritized a focus on behavior and day-to-day functioning over academic performance. Families recognized the lack of professionals who understand ASD and deafness but have found the internet and technology as a mechanism to connect to information and families with similar needs.

Speech-Processing Fatigue in Children: Auditory Event-Related Potential and Behavioral Measures

Purpose Fatigue related to speech processing is an understudied area that may have significant negative effects, especially in children who spend the majority of their school days listening to classroom instruction. Method This study examined the feasibility of using auditory P300 responses and behavioral indices (lapses of attention and self-report) to measure fatigue resulting from sustained listening demands in 27 children (M = 9.28 years). Results Consistent with predictions, increased lapses of attention, longer reaction times, reduced P300 amplitudes to infrequent target stimuli, and self-report of greater fatigue were observed after the completion of a series of demanding listening tasks compared with the baseline values. The event-related potential responses correlated with the behavioral measures of performance. Conclusion These findings suggest that neural and behavioral responses indexing attention and processing resources show promise as effective markers of fatigue in children.

Management of Children with Mild, Moderate, and Moderately Severe Sensorineural Hearing Loss

Any degree of hearing loss can have a negative impact on child development. The amount of impact is largely determined by the type, quality, and timeliness of intervention. Early identification and management of hearing loss is essential for minimizing the impact of hearing loss and ensuring that children can reach their cognitive, linguistic, educational, and social potential. Advances in hearing technology and broadening of candidacy for same, have resulted in improved outcomes for many children with hearing loss. Through ongoing hearing monitoring throughout childhood, children with congenital, late-onset, or progressive losses can receive timely management from interprofessional, collaborative teams.

Factors Influencing Hearing Aid Use in the Classroom: A Pilot Study

PURPOSE This pilot study examined factors influencing classroom hearing aid use in school-age children with hearing loss. METHOD The research team visited classrooms of 38 children with mild-to-moderate hearing loss (Grades 1-7) on 2 typical school days, twice per day, to document hearing aid use. In addition, parents reported the number of hours their children used hearing aids at school. RESULTS Nearly 24% of children were observed not wearing their hearing aids in the classroom on either observation day. Both grade level and degree of hearing loss appeared to affect hearing aid use. Children in Grades 5-7 and those with milder hearing losses were less likely to wear hearing aids. Overall, parents accurately reported classroom hearing aid use; however, those with children in Grades 5-7 were less accurate than those with children in earlier grades. CONCLUSIONS These preliminary results suggest that children with milder hearing loss and those in Grades 5-7 are at increased risk for reduced hearing aid use in the classroom. Also, parents of school-age children in these later grades are less accurate reporters of classroom hearing aid use compared to parents of children in earlier grades.

Subjective Fatigue in Children With Hearing Loss Assessed Using Self- and Parent-Proxy Report

Purpose The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings. Method Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years. Results School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their childs fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased. Conclusions School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

Hearing Technology Use and Management in School-Age Children: Reports from Data Logs, Parents, and Teachers

Background: Consistency of hearing aid and remote microphone system use declines as school‐age children with hearing loss age. One indicator of hearing aid use time is data logging, another is parent report. Recent data suggest that parents overestimate their childrens hearing aid use time relative to data logging. The potential reasons for this disparity remain unclear. Because school‐age children spend the majority of their day away from their parents and with their teachers, reports from teachers might serve as a valuable and additional tool for estimating hearing aid use time and management. Purpose: This study expands previous research on factors influencing hearing aid use time in school‐age children using data logging records. Discrepancies between data logging records and parent reports were explored using custom surveys designed for parents and teachers. Responses from parents and teachers were used to examine hearing aid use, remote microphone system use, and hearing aid management in school‐age children. Study Sample: Thirteen children with mild‐to‐moderate hearing loss between the ages of 7 and 10 yr and their parents participated in this study. Teachers of ten of these children also participated. Data Collection and Analysis: Parents and teachers of children completed written surveys about each childs hearing aid use, remote microphone system use, and hearing aid management skills. Data logs were read from hearing aids using manufacturers software. Multiple linear regression analysis and an intraclass correlation coefficient were used to examine factors influencing hearing aid use time and parent agreement with data logs. Parent report of hearing aid use time was compared across various activities and school and nonschool days. Survey responses from parents and teachers were compared to explore areas requiring potential improvement in audiological counseling. Results: Average daily hearing aid use time was ∼6 hr per day as recorded with data logging technology. Children exhibiting greater degrees of hearing loss and those with poorer vocabulary were more likely to use hearing aids consistently than children with less hearing loss and better vocabulary. Parents overestimated hearing aid use by ∼1 hr per day relative to data logging records. Parent‐reported use of hearing aids varied across activities but not across school and nonschool days. Overall, parents and teachers showed excellent agreement on hearing aid and remote microphone system use during school instruction but poor agreement when asked about the childs ability to manage their hearing devices independently. Conclusions: Parental reports of hearing aid use in young school‐age children are largely consistent with data logging records and with teacher reports of hearing aid use in the classroom. Audiologists might find teacher reports helpful in learning more about childrens hearing aid management and remote microphone system use during their time at school. This supplementary information can serve as an additional counseling tool to facilitate discussion about remote microphone system use and hearing aid management in school‐age children with hearing loss.

Fatigue Related to Speech Processing in Children With Hearing Loss: Behavioral, Subjective, and Electrophysiological Measures

Purpose The purpose of this study was to examine fatigue associated with sustained and effortful speech-processing in children with mild to moderately severe hearing loss. Method We used auditory P300 responses, subjective reports, and behavioral indices (response time, lapses of attention) to measure fatigue resulting from sustained speech-processing demands in 34 children with mild to moderately severe hearing loss (M = 10.03 years, SD = 1.93). Results Compared to baseline values, children with hearing loss showed increased lapses in attention, longer reaction times, reduced P300 amplitudes, and greater reports of fatigue following the completion of the demanding speech-processing tasks. Conclusions Similar to children with normal hearing, children with hearing loss demonstrate reductions in attentional processing of speech in noise following sustained speech-processing tasks-a finding consistent with the development of fatigue.

Behavioural measures of listening effort in school-aged children: Examining the effects of SNR, hearing loss, and amplification

Objectives: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs). Design: A total of 82 children (aged 6–13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort. Results: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs. Conclusions: This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom.