Effect of Masker Head Orientation, Listener Age, and Extended High-Frequency Sensitivity on Speech Recognition in Spatially Separated Speech.

OBJECTIVES: Masked speech recognition is typically assessed as though the target and background talkers are all directly facing the listener. However, background speech in natural environments is often produced by talkers facing other directions, and talker head orientation affects the spectral content of speech, particularly at the extended high frequencies (EHFs; >8 kHz). This study investigated the effect of masker head orientation and listeners' EHF sensitivity on speech-in-speech recognition and spatial release from masking in children and adults. DESIGN: Participants were 5- to 7-year-olds (n = 15) and adults (n = 34), all with normal hearing up to 8 kHz and a range of EHF hearing thresholds. Speech reception thresholds (SRTs) were measured for target sentences recorded from a microphone directly in front of the talker's mouth and presented from a loudspeaker directly in front of the listener, simulating a target directly in front of and facing the listener. The maskers were two streams of concatenated words recorded from a microphone located at either 0° or 60° azimuth, simulating masker talkers facing the listener or facing away from the listener, respectively. Maskers were presented in one of three spatial conditions: co-located with the target, symmetrically separated on either side of the target (+54° and -54° on the horizontal plane), or asymmetrically separated to the right of the target (both +54° on the horizontal plane). RESULTS: Performance was poorer for the facing than for the nonfacing masker head orientation. This benefit of the nonfacing masker head orientation, or head orientation release from masking (HORM), was largest under the co-located condition, but it was also observed for the symmetric and asymmetric masker spatial separation conditions. SRTs were positively correlated with the mean 16-kHz threshold across ears in adults for the nonfacing conditions but not for the facing masker conditions. In adults with normal EHF thresholds, the HORM was comparable in magnitude to the benefit of a symmetric spatial separation of the target and maskers. Although children benefited from the nonfacing masker head orientation, their HORM was reduced compared to adults with normal EHF thresholds. Spatial release from masking was comparable across age groups for symmetric masker placement, but it was larger in adults than children for the asymmetric masker. CONCLUSIONS: Masker head orientation affects speech-in-speech recognition in children and adults, particularly those with normal EHF thresholds. This is important because masker talkers do not all face the listener under most natural listening conditions, and assuming a midline orientation would tend to overestimate the effect of spatial separation. The benefits associated with EHF audibility for speech-in-speech recognition may warrant clinical evaluation of thresholds above 8 kHz.

Spatial Hearing and Functional Auditory Skills in Children With Unilateral Hearing Loss.

Purpose The purpose of this study was to characterize spatial hearing abilities of children with longstanding unilateral hearing loss (UHL). UHL was expected to negatively impact children's sound source localization and masked speech recognition, particularly when the target and masker were separated in space. Spatial release from masking (SRM) in the presence of a two-talker speech masker was expected to predict functional auditory performance as assessed by parent report. Method Participants were 5- to 14-year-olds with sensorineural or mixed UHL, age-matched children with normal hearing (NH), and adults with NH. Sound source localization was assessed on the horizontal plane (-90° to 90°), with noise that was either all-pass, low-pass, high-pass, or an unpredictable mixture. Speech recognition thresholds were measured in the sound field for sentences presented in two-talker speech or speech-shaped noise. Target speech was always presented from 0°; the masker was either colocated with the target or spatially separated at ±90°. Parents of children with UHL rated their children's functional auditory performance in everyday environments via questionnaire. Results Sound source localization was poorer for children with UHL than those with NH. Children with UHL also derived less SRM than those with NH, with increased masking for some conditions. Effects of UHL were larger in the two-talker than the noise masker, and SRM in two-talker speech increased with age for both groups of children. Children with UHL whose parents reported greater functional difficulties achieved less SRM when either masker was on the side of the better-hearing ear. Conclusions Children with UHL are clearly at a disadvantage compared with children with NH for both sound source localization and masked speech recognition with spatial separation. Parents' report of their children's real-world communication abilities suggests that spatial hearing plays an important role in outcomes for children with UHL.

Pediatric Hearing Loss Guidelines and Consensus Statements-Where Do We Stand?

A large number of guidelines and position statements have been published with the aim of improving outcomes for children with hearing loss. The purpose of this article is to review the current state of clinical practice guidelines as they relate to screening, diagnosis, and management of hearing loss in children. This summary is intended for the practicing otolaryngologist.

Spatial Release from Masking Using Clinical Corpora: Sentence Recognition in a Colocated or Spatially Separated Speech Masker.

BACKGROUND: Speech recognition in complex multisource environments is challenging, particularly for listeners with hearing loss. One source of difficulty is the reduced ability of listeners with hearing loss to benefit from spatial separation of the target and masker, an effect called spatial release from masking (SRM). Despite the prevalence of complex multisource environments in everyday life, SRM is not routinely evaluated in the audiology clinic. PURPOSE: The purpose of this study was to demonstrate the feasibility of assessing SRM in adults using widely available tests of speech-in-speech recognition that can be conducted using standard clinical equipment. RESEARCH DESIGN: Participants were 22 young adults with normal hearing. The task was masked sentence recognition, using each of five clinically available corpora with speech maskers. The target always sounded like it originated from directly in front of the listener, and the masker either sounded like it originated from the front (colocated with the target) or from the side (separated from the target). In the real spatial manipulation conditions, source location was manipulated by routing the target and masker to either a single speaker or to two speakers: one directly in front of the participant, and one mounted in an adjacent corner, 90° to the right. In the perceived spatial separation conditions, the target and masker were presented from both speakers with delays that made them sound as if they were either colocated or separated. RESULTS: With real spatial manipulations, the mean SRM ranged from 7.1 to 11.4 dB, depending on the speech corpus. With perceived spatial manipulations, the mean SRM ranged from 1.8 to 3.1 dB. Whereas real separation improves the signal-to-noise ratio in the ear contralateral to the masker, SRM in the perceived spatial separation conditions is based solely on interaural timing cues. CONCLUSIONS: The finding of robust SRM with widely available speech corpora supports the feasibility of measuring this important aspect of hearing in the audiology clinic. The finding of a small but significant SRM in the perceived spatial separation conditions suggests that modified materials could be used to evaluate the use of interaural timing cues specifically.

Spatial Hearing as a Function of Presentation Level in Moderate-to-Severe Unilateral Conductive Hearing Loss.

HYPOTHESIS: Patients with moderate-to-severe unilateral conductive hearing loss (UCHL) can make use of binaural difference cues when stimuli are presented at a high enough intensity to provide audibility in the affected ear. BACKGROUND: Spatial hearing is essential for listening in complex environments and sound source localization. Patients with UCHL have decreased access to binaural difference cues, resulting in poorer spatial hearing abilities compared with listeners with normal hearing. METHODS: Twelve patients with moderate-to-severe UCHL, most due to atresia (83.3%), and 12 age-matched controls with normal hearing bilaterally participated in this study. Outcome measures included: 1) spatial release from masking, and 2) sound source localization. Speech reception thresholds were measured with target speech (Pediatric AzBio sentences) presented at 0 degree and a two-talker masker that was either colocated with the target (0 degree) or spatially separated from the target (symmetrical, ±90 degrees). Spatial release from masking was quantified as the difference between speech reception thresholds in these two conditions. Localization ability in the horizontal plane was assessed in a 180 degree arc of 11 evenly-spaced loudspeakers. These two tasks were completed at 50 and 75 dB SPL. RESULTS: Both children and adults with UCHL performed more poorly than controls when recognizing speech in a spatially separated masker or localizing sound; however, this group difference was larger at 50 than 75 dB SPL. CONCLUSION: Patients with UCHL experience improved spatial hearing with the higher presentation level, suggesting that the auditory deprivation associated with a moderate-to-severe UCHL does not preclude exposure to-or use of-binaural difference cues.

Spatial Release From Masking in Children: Effects of Simulated Unilateral Hearing Loss.

OBJECTIVES: The purpose of this study was twofold: (1) to determine the effect of an acute simulated unilateral hearing loss on children's spatial release from masking in two-talker speech and speech-shaped noise, and (2) to develop a procedure to be used in future studies that will assess spatial release from masking in children who have permanent unilateral hearing loss. There were three main predictions. First, spatial release from masking was expected to be larger in two-talker speech than in speech-shaped noise. Second, simulated unilateral hearing loss was expected to worsen performance in all listening conditions, but particularly in the spatially separated two-talker speech masker. Third, spatial release from masking was expected to be smaller for children than for adults in the two-talker masker. DESIGN: Participants were 12 children (8.7 to 10.9 years) and 11 adults (18.5 to 30.4 years) with normal bilateral hearing. Thresholds for 50%-correct recognition of Bamford-Kowal-Bench sentences were measured adaptively in continuous two-talker speech or speech-shaped noise. Target sentences were always presented from a loudspeaker at 0° azimuth. The masker stimulus was either co-located with the target or spatially separated to +90° or -90° azimuth. Spatial release from masking was quantified as the difference between thresholds obtained when the target and masker were co-located and thresholds obtained when the masker was presented from +90° or -90° azimuth. Testing was completed both with and without a moderate simulated unilateral hearing loss, created with a foam earplug and supra-aural earmuff. A repeated-measures design was used to compare performance between children and adults, and performance in the no-plug and simulated-unilateral-hearing-loss conditions. RESULTS: All listeners benefited from spatial separation of target and masker stimuli on the azimuth plane in the no-plug listening conditions; this benefit was larger in two-talker speech than in speech-shaped noise. In the simulated-unilateral-hearing-loss conditions, a positive spatial release from masking was observed only when the masker was presented ipsilateral to the simulated unilateral hearing loss. In the speech-shaped noise masker, spatial release from masking in the no-plug condition was similar to that obtained when the masker was presented ipsilateral to the simulated unilateral hearing loss. In contrast, in the two-talker speech masker, spatial release from masking in the no-plug condition was much larger than that obtained when the masker was presented ipsilateral to the simulated unilateral hearing loss. When either masker was presented contralateral to the simulated unilateral hearing loss, spatial release from masking was negative. This pattern of results was observed for both children and adults, although children performed more poorly overall. CONCLUSIONS: Children and adults with normal bilateral hearing experience greater spatial release from masking for a two-talker speech than a speech-shaped noise masker. Testing in a two-talker speech masker revealed listening difficulties in the presence of disrupted binaural input that were not observed in a speech-shaped noise masker. This procedure offers promise for the assessment of spatial release from masking in children with permanent unilateral hearing loss.

Development of Open-Set Word Recognition in Children: Speech-Shaped Noise and Two-Talker Speech Maskers.

OBJECTIVE: The goal of this study was to establish the developmental trajectories for children's open-set recognition of monosyllabic words in each of two maskers: two-talker speech and speech-shaped noise. DESIGN: Listeners were 56 children (5 to 16 years) and 16 adults, all with normal hearing. Thresholds for 50% correct recognition of monosyllabic words were measured in a two-talker speech or a speech-shaped noise masker in the sound field using an open-set task. Target words were presented at a fixed level of 65 dB SPL throughout testing, while the masker level was adapted. A repeated-measures design was used to compare the performance of three age groups of children (5 to 7 years, 8 to 12 years, and 13 to 16 years) and a group of adults. The pattern of age-related changes during childhood was also compared between the two masker conditions. RESULTS: Listeners in all four age groups performed more poorly in the two-talker speech than the speech-shaped noise masker, but the developmental trajectories differed for the two masker conditions. For the speech-shaped noise masker, children's performance improved with age until about 10 years of age, with little systematic child-adult differences thereafter. In contrast, for the two-talker speech masker, children's thresholds gradually improved between 5 and 13 years of age, followed by an abrupt improvement in performance to adult-like levels. Children's thresholds in the two masker conditions were uncorrelated. CONCLUSIONS: Younger children require a more advantageous signal-to-noise ratio than older children and adults to achieve 50% correct word recognition in both masker conditions. However, children's ability to recognize words appears to take longer to mature and follows a different developmental trajectory for the two-talker speech masker than the speech-shaped noise masker. These findings highlight the importance of considering both age and masker type when evaluating children's masked speech perception abilities.

Xylitol as a prophylaxis for acute otitis media: systematic review.

A systematic review was conducted to evaluate evidence regarding xylitol, a sugar alcohol, as a prophylaxis for acute otitis media (AOM) in children. The authors searched PubMed and other databases to identify evidence. Criteria for included studies were: appear in English-language, peer-reviewed journals; at least quasi-experimental designs; use xylitol; and present outcome data. The authors completed evaluation forms for the included studies at all phases of the review. The authors reviewed 1479 titles and excluded 1435. Abstracts and full texts were reviewed for the remaining 44; four randomized controlled trials met inclusion criteria. Xylitol was a generally well accepted prophylaxis for AOM with few side effects when administered via chewing gum or syrup at 10 g/day given five times daily. Meta-analysis revealed significant treatment effects (Risk ratio = 0.68; 95% confidence interval = 0.57 to 0.83). Xylitol can be a prophylaxis for AOM, but warrants further study, especially of vehicles other than chewing gum for young children, and information is needed regarding cost, duration of administration required, and expected long-term effects.