Remote Microphone Systems for Cochlear Implant Recipients in Small Group Settings.

PURPOSE: Cochlear implant (CI) recipients often experience speech recognition difficulty in noise in small group settings with multiple talkers. In traditional remote microphones systems, one talker wears a remote microphone that wirelessly delivers speech to the CI processor. This system will not transmit signals from multiple talkers in a small group. However, remote microphone systems with multiple microphones allowing for adaptive beamforming may be beneficial for small group situations with multiple talkers. Specifically, a remote microphone with an adaptive multiple-microphone beamformer may be placed in the center of the small group, and the beam (i.e., polar lobe) may be automatically steered toward the direction associated with the most favorable speech-to-noise ratio. The signal from the remote microphone can then be wirelessly delivered to the CI sound processor. Alternately, each of the talkers in a small group may use a remote microphone that is part of a multi-talker network that wirelessly delivers the remote microphone signal to the CI sound processor. The purpose of this study was to compare the potential benefit of an adaptive multiple-microphone beamformer remote microphone system and a multi-talker network remote microphone system. METHOD: Twenty recipients, ages 12 to 84 years, with Advanced Bionics CIs completed sentence-recognition-in-noise tasks while seated at a desk surrounded by three loudspeakers at 0, 90, and 270 degrees. These speakers randomly presented the target speech while competing noise was presented from four loudspeakers located in the corners of the room. Testing was completed in three conditions: 1) CI alone, 2) Remote microphone system with an adaptive multiple-microphone beamformer, and 3) and a multi-talker network remote microphone system each with five different signal levels (15 total conditions). RESULTS: Significant differences were found across all signal levels and technology conditions. Relative to the CI alone, sentence recognition improvements ranged from 14-23 percentage points with the adaptive multiple-microphone beamformer and 27-47 percentage points with the multi-talker network with superior performance for the latter remote microphone system. CONCLUSIONS: Both remote microphone systems significantly improved speech recognition in noise of CI recipients when listening in small group settings, but the multi-talker network provided superior performance.

A Novel Performance-Based Paradigm of Care for Cochlear Implant Follow-Up.

OBJECTIVES: Utilize a multi-institutional outcomes database to determine expected performance for adult cochlear implant (CI) users. Estimate the percentage of patients who are high performers and achieve performance plateau. STUDY DESIGN: Retrospective database study. METHODS: Outcomes from 9,448 implantations were mined to identify 804 adult, unilateral recipients who had one preoperative and at least one postoperative consonant-nucleus-consonant (CNC) word score. Results were examined to determine percent-correct CNC word recognition preoperatively and at 1, 3, 6, 12, and 24 months after activation. Outcomes from 318 similar patients who also had at least three postoperative CNC word scores were examined. Linear mixed-effects regression was used to examine CNC word performance over time. The time when each patient achieved maximum performance was recorded as a surrogate for time of performance plateau. Patients were assigned as candidates for less intense follow-up if they were high performers and achieved performance plateau. RESULTS: Among 804 patients with at least one postoperative score, CNC score improved at all time intervals. Average performance after the 3-month time interval was 47.2% to 51.5%, indicating a CNC ≥ 50% cutoff for high performers. Among 318 patients with at least three postoperative scores, performance improved from 1 to 3 (P = .001), 3 to 6 (P = .001), and 6 to 12 (P = .01) months. Scores from the 12- and 24-month intervals did not significantly differ (P = .09). By 12 months after activation, 59.7% of patients were considered candidates for less intense follow-up. CONCLUSION: Findings suggest that CNC ≥ 50% is a reasonable cutoff to separate high performers from low performers. Within 12 months after activation, 59.7% of patients were good candidates for less intense follow-up. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:S1-S10, 2022.

Characteristic Deviations of Auditory Evoked Potentials in Individuals with Autism Spectrum Disorder.

BACKGROUND: Neurological, structural, and behavioral abnormalities are widely reported in individuals with autism spectrum disorder (ASD); yet there are no objective markers to date. We postulated that by using dominant and nondominant ear data, underlying differences in auditory evoked potentials (AEPs) between ASD and control groups can be recognized. PURPOSE: The primary purpose was to identify if significant differences exist in AEPs recorded from dominant and nondominant ear stimulation in (1) children with ASD and their matched controls, (2) adults with ASD and their matched controls, and (3) a combined child and adult ASD group and control group. The secondary purpose was to explore the association between the significant findings of this study with those obtained in our previous study that evaluated the effects of auditory training on AEPs in individuals with ASD. RESEARCH DESIGN: Factorial analysis of variance with interaction was performed. STUDY SAMPLE: Forty subjects with normal hearing between the ages of 9 and 25 years were included. Eleven children and 9 adults with ASD were age- and gender-matched with neurotypical peers. DATA COLLECTION AND ANALYSIS: Auditory brainstem responses (ABRs) and auditory late responses (ALRs) were recorded. Adult and child ASD subjects were compared with non-ASD adult and child control subjects, respectively. The combined child and adult ASD group was compared with the combined child and adult control group. RESULTS: No significant differences in ABR latency or amplitude were observed between ASD and control groups. ALR N1 amplitude in the dominant ear was significantly smaller for the ASD adult group compared with their control group. Combined child and adult data showed significantly smaller amplitude for ALR N1 and longer ALR P2 latency in the dominant ear for the ASD group compared with the control group. In our earlier study, the top predictor of behavioral improvement following auditory training was ALR N1 amplitude in the dominant ear. Correspondingly, the ALR N1 amplitude in the dominant ear yielded group differences in the current study. CONCLUSIONS: ALR peak N1 amplitude is proposed as the most feasible AEP marker in the evaluation of ASD.

Factors Associated with Speech-Recognition Performance in School-Aged Children with Cochlear Implants and Early Auditory-Verbal Intervention.

BACKGROUND: Considerable variability exists in the speech recognition abilities achieved by children with cochlear implants (CIs) due to varying demographic and performance variables including language abilities. PURPOSE: This article examines the factors associated with speech recognition performance of school-aged children with CIs who were grouped by language ability. RESEARCH DESIGN: This is a single-center cross-sectional study with repeated measures for subjects across two language groups. STUDY SAMPLE: Participants included two groups of school-aged children, ages 7 to 17 years, who received unilateral or bilateral CIs by 4 years of age. The High Language group (N = 26) had age-appropriate spoken-language abilities, and the Low Language group (N = 24) had delays in their spoken-language abilities. DATA COLLECTION AND ANALYSIS: Group comparisons were conducted to examine the impact of demographic characteristics on word recognition in quiet and sentence recognition in quiet and noise. RESULTS: Speech recognition in quiet and noise was significantly poorer in the Low Language compared with the High Language group. Greater hours of implant use and better adherence to auditory-verbal (AV) therapy appointments were associated with higher speech recognition in quiet and noise. CONCLUSION: To ensure maximal speech recognition in children with low-language outcomes, professionals should develop strategies to ensure that families support full-time CI use and have the means to consistently attend AV appointments.

Meta-Analysis of Speech Recognition Outcomes in Younger and Older Adults With Cochlear Implants.

Purpose Meta-analyses were conducted to compare pre- to postoperative speech recognition improvements and postoperative scores after cochlear implantation in younger (< 60 years) and older (> 60 years) adults. Method Studies were identified with electronic databases and through manual search of the literature. In the primary analyses, effect sizes between pre- and postoperative scores for each age group were calculated using a formula appropriate for repeated-measures designs. Using the effect sizes, two separate meta-analyses using a random-effects restricted maximum likelihood model were conducted for experiments using word and sentence recognition stimuli in quiet. Secondary meta-analyses were conducted to examine average postimplant, percent correct word recognition, sentence recognition, and speech recognition in noise in studies that included both older and younger age groups. Traditional Hedges's g effect sizes were calculated between the two groups. Results For the primary analyses, experiments using word and sentence recognition stimuli yielded significant, large effect sizes for the younger and older adult cochlear implant recipients with no significant differences between the older and younger age groups. However, the secondary meta-analyses of postoperative scores suggested significant differences between age groups for stimuli in quiet and noise. Conclusions Although older and younger adults with implants achieve the same magnitude of pre- to postimplant speech recognition benefit in quiet, the overall postoperative speech recognition outcomes in quiet and noise are superior in younger over older adults. Strategies to mitigate these group differences are critical for ensuring optimal outcomes in elderly individuals who are candidates for cochlear implants.

Educational Challenges During the Pandemic for Students Who Have Hearing Loss.

Purpose The COVID-19 pandemic introduced new educational challenges for students, teachers, and caregivers due to the changed and varied learning environments, use of face masks, and social distancing requirements. These challenges are particularly pronounced for students with hearing loss who often require specific accommodations to allow for equal access to the curriculum. The purpose of this study was to document the potential difficulties that students with hearing loss faced during the pandemic and to generate recommendations to promote learning and engagement based on findings. Method A qualitative survey was designed to document the frequency of various learning situations (i.e., in person, remote virtual, and blended), examine the accessibility of technology and course content, and quantify hearing issues associated with safety measures and technology use in school-age students with hearing loss. Survey questions were informed from key educational issues reported in published articles and guidelines. The survey was completed by 416 educational personnel who work with students with hearing loss. Results Respondents indicated that most of their schools were providing remote or blended (in-person and remote) learning consisting of synchronous and asynchronous learning. Common accommodations for students with hearing loss were only provided some of the time with the exception of sign language interpreters, which were provided for almost all students who required them. According to the respondents, both students and caregivers reported issues or discomfort with the technology required for remote learning. Conclusion To ensure that students with hearing loss are provided equal access to the curriculum, additional accommodations should be considered to address issues arising from pandemic-related changes to school and learning practices including closed captioning, transcripts/notes, recordings of lectures, sign language interpreters, student check-ins, and family-directed resources to assist with technology issues.

Behavioral Auditory Processing in Children and Young Adults with Autism Spectrum Disorder.

BACKGROUND: Auditory-processing deficits are common in children and adults who are diagnosed with autism spectrum disorder (ASD). These deficits are evident across multiple domains as exhibited by the results from subjective questionnaires from parents, teachers, and individuals with ASD and from behavioral auditory-processing testing. PURPOSE: Few studies compare subjective and behavioral performance of adults and children diagnosed with ASD using commercially available tests of auditory processing. The primary goal of the present study is to compare the performance of adults and children with ASD to age-matched, neurotypical peers. The secondary goal is to examine the effect of age on auditory-processing performance in individuals with ASD relative to age-matched peers. RESEARCH DESIGN: A four-group, quasi-experimental design with repeated measures was used in this study. STUDY SAMPLE: Forty-two adults and children were separated into four groups of participants: (1) 10 children with ASD ages 14 years or younger; (2) 10 age-matched, neurotypical children; (3) 11 adolescents and young adults with ASD ages 16 years and older; and (4) 11 age-matched, neurotypical adolescents or young adults. DATA COLLECTION AND ANALYSIS: Data from each participant were collected in one test session. Data were analyzed with analysis of variance (ANOVA), repeated measures ANOVA, or nonparametric analyses. Effect sizes were calculated to compare performance between those with ASD and those who were neurotypical within each age group. RESULTS: Across all the questionnaires and the majority of the behavioral test measures, participants with ASD had significantly poorer ratings or auditory-processing performance than age-matched, neurotypical peers. Adults had more favorable performance than children on several of the test measures. Medium to large effect sizes corroborated the significant results. CONCLUSION: Overall, the questionnaires and behavioral tests used in this study were sensitive to detecting auditory-processing differences between individuals diagnosed with ASD and those who are considered neurotypical. On most test measures, children performed more poorly than adults. The findings in this study support that both children and adults with ASD exhibit auditory-processing difficulties. Appropriate school and work accommodations will be necessary to ensure appropriate access to speech in challenging environments.

Remote Microphone Technology for Children with Hearing Loss or Auditory Processing Issues.

School classrooms are noisy and reverberant environments, and the poor acoustics can be a barrier to successful learning in children, particularly those with multiple disabilities, auditory processing issues, and hearing loss. A new set of listening challenges have been imposed by the recent global pandemic and subsequent online learning requirements. The goal of this article is to review the impact of poor acoustics on the performance of children with auditory processing issues, mild hearing loss, and unilateral hearing loss. In addition, we will summarize the evidence in support of remote microphone technology by these populations.

Benefits of a Hearing Registry: Cochlear Implant Candidacy in Quiet Versus Noise in 1,611 Patients.

Purpose This retrospective study used a cochlear implant registry to determine how performing speech recognition candidacy testing in quiet versus noise influenced patient selection, speech recognition, and self-report outcomes. Method Database queries identified 1,611 cochlear implant recipients who were divided into three implant candidacy qualifying groups based on preoperative speech perception scores (≤ 40% correct) on the AzBio sentence test: quiet qualifying group, +10 dB SNR qualifying group, and +5 dB SNR qualifying group. These groups were evaluated for demographic and preoperative hearing characteristics. Repeated-measures analysis of variance was used to compare pre- and postoperative performance on the AzBio in quiet and noise with qualifying group as a between-subjects factor. For a subset of recipients, pre- to postoperative changes on the Speech, Spatial and Qualities of Hearing Scale were also evaluated. Results Of the 1,611 patients identified as cochlear implant candidates, 63% of recipients qualified in quiet, 10% qualified in a +10 dB SNR, and 27% qualified in a +5 dB SNR. Postoperative speech perception scores in quiet and noise significantly improved for all qualifying groups. Across qualifying groups, the greatest speech perception improvements were observed when tested in the same qualifying listening condition. For a subset of patients, the total Speech, Spatial and Qualities of Hearing Scale ratings improved significantly as well. Conclusion Patients who qualified for cochlear implantation in quiet or background noise test conditions showed significant improvement in speech perception and quality of life scores, especially when the qualifying noise condition was used to track performance.

Effects of Auditory Training on Electrophysiological Measures in Individuals with Autism Spectrum Disorder.

BACKGROUND: Identifying objective changes following an auditory training program is central to the assessment of the program's efficacy. PURPOSE: This study aimed (1) to objectively determine the efficacy of a 12-week auditory processing training (APT) program in individuals with autism spectrum disorder using auditory evoked potentials (AEPs) and (2) to identify the top central AEP predictors of the overall score on the Test of Auditory Processing Skills-3 (TAPS-3), the primary behavioral outcome measure of the APT program published in our earlier article. RESEARCH DESIGN: A one-group pretraining, posttraining design was used. STUDY SAMPLE: The sample included 15 children and young adults diagnosed with autism spectrum disorder. Participants underwent the APT program consisting of computerized dichotic training, one-on-one therapist-directed auditory training, and the use of remote microphone technology at home and in the classroom. DATA COLLECTION AND ANALYSIS: All participants underwent pre- and posttraining auditory brain stem responses (ABRs), complex auditory brain stem responses (cABRs), and auditory late responses (ALRs). Test results from ABRs and ALRs were grouped based on scores obtained in their dominant and nondominant ears. Paired t-tests were used to assess the efficacy of the training program, and least absolute shrinkage and selection operator regression was used to assess the relationship between ALRs and the TAPS-3 overall summed raw score reported in our earlier article. RESULTS AND CONCLUSIONS: When compared with pretraining results, posttraining results showed shorter ABR latencies and larger amplitudes. The cABRs showed decreased latencies of the frequency following waves, a reduction in pitch error, and enhancement of pitch strength and phase shift. ALR results indicated shorter latencies and larger amplitudes. Our earlier article showed that the TAPS-3 overall score was significantly higher after training. This study showed that the top three ALR predictors of TAPS-3 outcomes were P1 amplitude in the dominant ear, and N1 amplitude in the dominant and nondominant ears.

Effects of Auditory Training and Remote Microphone Technology on the Behavioral Performance of Children and Young Adults Who Have Autism Spectrum Disorder.

BACKGROUND: Individuals who have a normal pure-tone audiogram but are diagnosed with autism spectrum disorder (ASD) often exhibit poorer speech recognition and auditory processing when compared with neurotypical peers with normal pure-tone audiograms. PURPOSE: The purpose of this study was to determine the efficacy and effectiveness of a 12-week auditory processing training (APT) program that was designed to address the deleterious effects of background noise and auditory processing deficits that are common among individuals diagnosed with ASD. RESEARCH DESIGN: A repeated measures design was used. STUDY SAMPLE: The sample consisted of 15 high-functioning children and young adults who had a formal diagnosis of ASD and who were recruited from local clinics and school districts. INTERVENTION: Participants completed the 12-week APT program consisting of computerized dichotic training, one-on-one therapist-directed auditory training, and the use of remote microphone (RM) technology at home and in the classroom. DATA COLLECTION AND ANALYSIS: Participants completed a comprehensive test battery to assess general auditory processing skills, speech recognition in noise, acceptance of background noise, spatial processing, binaural integration abilities, self-perceived difficulties, and observed behaviors. Testing was conducted before (n = 15), immediately after (n = 15), and 12 weeks after (n = 7) the completion of the APT program. Paired t-tests, repeated measures analysis of variance, or nonparametric tests were used to analyze the data. RESULTS: On average, the APT program significantly enhanced general auditory processing abilities, including binaural integration and subjective listening abilities in the classroom. When the RM was used, significantly improved speech recognition and improved acceptance of background noise was measured relative to a condition with no technology. CONCLUSIONS: Following the APT program, the participants exhibited the greatest improvements in testing that required binaural integration and auditory working memory. The use of the RM technology was able to address the deleterious effects of noise on speech recognition in noise and acceptance of noise levels.

Speech Recognition in Noise in Adults and Children Who Speak English or Chinese as Their First Language.

BACKGROUND: Speech recognition of individuals who are listening to a nonnative language is significantly degraded in the presence of background noise and may be influenced by proficiency, age of acquisition, language experience, and daily use of the nonnative language. PURPOSE: The purpose of this study is to examine and compare speech recognition in noise performance across test conditions with varying signal-to-noise ratios (SNRs) as well as the presence of vocal and spatial cues in listeners who speak American English as a native language or Mandarin Chinese as a native language. Self-rated English proficiency and experience were collected for native Mandarin Chinese speakers to determine its relationship to performance on the test measures. RESEARCH DESIGN: A cross-sectional repeated measures design was used for the study. STUDY SAMPLE: Four groups of participants were included in the study. The adult groups consisted of 25 adults who speak native English and 25 adults who speak native Mandarin Chinese with English as an additional language. The pediatric groups consisted of 16 children who speak native English and 16 children who speak native Mandarin Chinese with English as an additional language. DATA COLLECTION AND ANALYSES: Percent correct speech recognition in noise was assessed at three SNRs (-3, 0, +3 dB) using the adult or pediatric versions of the AzBio sentence test. The Listening in Spatialized Noise-Sentence (LiSN-S) test was used to determine the effect of providing spatial and vocal cues on the speech recognition in noise performance of the groups of participants. The data for each age group and test measure were analyzed with a repeated measures analysis of variance. Correlation analyses were performed to examine relationships between English proficiency and experience on performance across the speech recognition test conditions. RESULTS: Analysis of the data from the adult or pediatric AzBio sentence test identified a significant effect of native language for adults but no significant effect for children. The higher SNRs yielded better performance for all listeners. On the LiSN-S test, results for the adult and pediatric groups were similar and showed significantly better performance for the native English speakers in every test condition. The demographic and language characteristics that most affected speech recognition performance across the test measures included the length of time the person lived in the United States, the age of English acquisition, the number of minutes per day English was spoken by the participant, and the self-rated English proficiency. CONCLUSIONS: The findings in this study highlight the importance and benefit of higher SNRs as well as the provision of vocal and spatial cues for improving speech recognition performance in noise of adult and pediatric listeners who speak Mandarin Chinese as a native language.

Preliminary evaluation of a novel non-linear frequency compression scheme for use in children.

OBJECTIVE: The primary goal of this study was to evaluate a new form of non-linear frequency compression (NLFC) in children. The new NLFC processing scheme is adaptive and potentially allows for a better preservation of the spectral characteristics of the input sounds when compared to conventional NLFC processing. DESIGN: A repeated-measures design was utilised to compare the speech perception of the participants with two configurations of the new adaptive NLFC processing to their performance with the existing NLFC. The outcome measures included the University of Western Ontario Plurals test, the Consonant-Nucleus-Consonant word recognition test, and the Phonak Phoneme Perception test. STUDY SAMPLE: Study participants included 14 children, aged 6-17 years, with mild-to-severe low-frequency hearing loss and severe-to-profound high-frequency hearing loss. RESULTS: The results indicated that the use of the new adaptive NLFC processing resulted in significantly better average word recognition and plural detection relative to the conventional NLFC processing. CONCLUSION: Overall, the adaptive NLFC processing evaluated in this study has the potential to significantly improve speech perception relative to conventional NLFC processing.

Voice gender and the segregation of competing talkers: Perceptual learning in cochlear implant simulations.

Two experiments explored the role of differences in voice gender in the recognition of speech masked by a competing talker in cochlear implant simulations. Experiment 1 confirmed that listeners with normal hearing receive little benefit from differences in voice gender between a target and masker sentence in four- and eight-channel simulations, consistent with previous findings that cochlear implants deliver an impoverished representation of the cues for voice gender. However, gender differences led to small but significant improvements in word recognition with 16 and 32 channels. Experiment 2 assessed the benefits of perceptual training on the use of voice gender cues in an eight-channel simulation. Listeners were assigned to one of four groups: (1) word recognition training with target and masker differing in gender; (2) word recognition training with same-gender target and masker; (3) gender recognition training; or (4) control with no training. Significant improvements in word recognition were observed from pre- to post-test sessions for all three training groups compared to the control group. These improvements were maintained at the late session (one week following the last training session) for all three groups. There was an overall improvement in masked word recognition performance provided by gender mismatch following training, but the amount of benefit did not differ as a function of the type of training. The training effects observed here are consistent with a form of rapid perceptual learning that contributes to the segregation of competing voices but does not specifically enhance the benefits provided by voice gender cues.

Creating a framework for data sharing in cochlear implant research.

OBJECTIVES: To summarize the development process of a national database that was designed to facilitate communication and collaboration, improve care, and create a framework for aggregate data sharing in cochlear implant (CI) research. METHODS: A group of nationally represented, multidisciplinary CI providers cooperated to define a standard set of data elements to incorporate into a database built by them in association with a group of computer scientists and software designers. CI centers across the USA, then, joined the non-profit Auditory Implant Initiative to use the database for their own clinical purposes and to help contribute to the national de-identified dataset for research and analytics. RESULTS: Approximately 12 months after the full release of the database, clinical information on 373 patients has been entered from 17 different CI centers representing 61 hearing professionals. A blend of six academic, seven private, and four non-profit CI centers participated in this phase of the data sharing network. DISCUSSION: The adoption of a single, standardized database by 17 centers throughout the USA has begun a framework for data sharing in CI research. Future steps include (1) expanding adoption, (2) scaling the database to include more patients, (3) streamlining the legal hurdles required for adoption, and (4) integrating the database with other software platforms (e.g. electronic health records, processors). CONCLUSION: A standardized clinical outcomes database that is utilized by a growing network of CI centers can help strengthen research through aggregate data sharing.

Assistive technology evaluations: Remote-microphone technology for children with Autism Spectrum Disorder.

The goal of this study was to conduct assistive technology evaluations on 12 children diagnosed with Autism Spectrum Disorder (ASD) to evaluate the potential benefits of remote-microphone (RM) technology. A single group, within-subjects design was utilized to explore individual and group data from functional questionnaires and behavioral test measures administered, designed to assess school- and home-based listening abilities, once with and once without RM technology. Because some of the children were unable to complete the behavioral test measures, particular focus was given to the functional questionnaires completed by primary teachers, participants, and parents. Behavioral test measures with and without the RM technology included speech recognition in noise, auditory comprehension, and acceptable noise levels. The individual and group teacher (n=8-9), parent (n=8-9), and participant (n=9) questionnaire ratings revealed substantially less listening difficulty when RM technology was used compared to the no-device ratings. On the behavioral measures, individual data revealed varied findings, which will be discussed in detail in the results section. However, on average, the use of the RM technology resulted in improvements in speech recognition in noise (4.6dB improvement) in eight children, higher auditory working memory and comprehension scores (12-13 point improvement) in seven children, and acceptance of poorer signal-to-noise ratios (8.6dB improvement) in five children. The individual and group data from this study suggest that RM technology may improve auditory function in children with ASD in the classroom, at home, and in social situations. However, variability in the data and the inability of some children to complete the behavioral measures indicates that individualized assistive technology evaluations including functional questionnaires will be necessary to determine if the RM technology will be of benefit to a particular child who has ASD.

The Effect of Noise on the Relationship Between Auditory Working Memory and Comprehension in School-Age Children.

PURPOSE: The objectives of the current study were to examine the effect of noise (-5 dB SNR) on auditory comprehension and to examine its relationship with working memory. It was hypothesized that noise has a negative impact on information processing, auditory working memory, and comprehension. METHOD: Children with normal hearing between the ages of 8 and 10 years were administered working memory and comprehension tasks in quiet and noise. The comprehension measure comprised 5 domains: main idea, details, reasoning, vocabulary, and understanding messages. RESULTS: Performance on auditory working memory and comprehension tasks were significantly poorer in noise than in quiet. The reasoning, details, understanding, and vocabulary subtests were particularly affected in noise (p < .05). The relationship between auditory working memory and comprehension was stronger in noise than in quiet, suggesting an increased contribution of working memory. CONCLUSIONS: These data suggest that school-age children's auditory working memory and comprehension are negatively affected by noise. Performance on comprehension tasks in noise is strongly related to demands placed on working memory, supporting the theory that degrading listening conditions draws resources away from the primary task.

Fitting and verification of frequency modulation systems on children with normal hearing.

BACKGROUND: Several recent investigations support the use of frequency modulation (FM) systems in children with normal hearing and auditory processing or listening disorders such as those diagnosed with auditory processing disorders, autism spectrum disorders, attention-deficit hyperactivity disorder, Friedreich ataxia, and dyslexia. The American Academy of Audiology (AAA) published suggested procedures, but these guidelines do not cite research evidence to support the validity of the recommended procedures for fitting and verifying nonoccluding open-ear FM systems on children with normal hearing. Documenting the validity of these fitting procedures is critical to maximize the potential FM-system benefit in the above-mentioned populations of children with normal hearing and those with auditory-listening problems. PURPOSE: The primary goal of this investigation was to determine the validity of the AAA real-ear approach to fitting FM systems on children with normal hearing. The secondary goal of this study was to examine speech-recognition performance in noise and loudness ratings without and with FM systems in children with normal hearing sensitivity. RESEARCH DESIGN: A two-group, cross-sectional design was used in the present study. STUDY SAMPLE: Twenty-six typically functioning children, ages 5-12 yr, with normal hearing sensitivity participated in the study. INTERVENTION: Participants used a nonoccluding open-ear FM receiver during laboratory-based testing. DATA COLLECTION AND ANALYSIS: Participants completed three laboratory tests: (1) real-ear measures, (2) speech recognition performance in noise, and (3) loudness ratings. Four real-ear measures were conducted to (1) verify that measured output met prescribed-gain targets across the 1000-4000 Hz frequency range for speech stimuli, (2) confirm that the FM-receiver volume did not exceed predicted uncomfortable loudness levels, and (3 and 4) measure changes to the real-ear unaided response when placing the FM receiver in the child's ear. After completion of the fitting, speech recognition in noise at a -5 signal-to-noise ratio and loudness ratings at a +5 signal-to-noise ratio were measured in four conditions: (1) no FM system, (2) FM receiver on the right ear, (3) FM receiver on the left ear, and (4) bilateral FM system. RESULTS: The results of this study suggested that the slightly modified AAA real-ear measurement procedures resulted in a valid fitting of one FM system on children with normal hearing. On average, prescriptive targets were met for 1000, 2000, 3000, and 4000 Hz within 3 dB, and maximum output of the FM system never exceeded and was significantly lower than predicted uncomfortable loudness levels for the children. There was a minimal change in the real-ear unaided response when the open-ear FM receiver was placed into the ear. Use of the FM system on one or both ears resulted in significantly better speech recognition in noise relative to a no-FM condition, and the unilateral and bilateral FM receivers resulted in a comfortably loud signal when listening in background noise. CONCLUSIONS: Real-ear measures are critical for obtaining an appropriate fit of an FM system on children with normal hearing.

Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): an initial investigation.

UNLABELLED: The goal of this initial investigation was to examine the potential benefit of a frequency modulation (FM) system for 11 children diagnosed with autism spectrum disorders (ASD), attention-deficit hyperactivity disorder (ADHD), or both disorders through measures of speech recognition performance in noise, observed classroom behavior, and teacher-rated educational risk and listening behaviors. Use of the FM system resulted in significant average improvements in speech recognition in noise for the children with ASD and ADHD as well as large effect sizes. When compared to typically functioning peers, children with ASD and ADHD had significantly poorer average speech recognition performance in noise without the FM system but comparable average performance when the FM system was used. Similarly, classroom observations yielded a significant increase in on-task behaviors and large effect sizes when the FM system was in use during two separate trial periods. Although teacher ratings on questionnaires showed no significant improvement in the average level of educational risk of participants, they did indicate significant improvement in average listening behaviors during two trial periods with the FM system. Given the significantly better speech recognition in noise, increased on-task behaviors, and improved teacher ratings of listening behaviors with the FM system, these devices may be a viable option for children who have ASD and ADHD in the classroom. However, an individual evaluation including audiological testing and a functional evaluation in the child's primary learning environment will be necessary to determine the benefit of an FM system for a particular student. LEARNING OUTCOMES: 1. The reader will be able to describe the potential benefit of FM systems for children with ASD and/or ADHD. 2. The reader will be able to identify on-task versus off-task listening behaviors in children with ASD and/or ADHD. 3. The reader will be able to explain the components of a successful pre-fit education program that may be necessary prior to fitting an FM system in children with ASD.

Speech recognition and subjective perceptions of neck-loop FM receivers with cochlear implants.

PURPOSE: The goal of this investigation was to determine the potential benefit of using electromagnetically coupled frequency modulation (FM) neck-loop receivers to address common communication difficulties of adults and adolescents with cochlear implants (CIs). METHOD: Fourteen participants with CIs used the neck-loop FM receiver for a trial period and participated in pre- and post trial sessions consisting of speech-recognition-in-noise measures with and without the FM system and a subjective rating scale. Most participants also recorded their experiences during the FM-system trial period in a journal. RESULTS: The results suggested significantly improved speech recognition in noise with the neck-loop FM system before and after the trial period, with no changes in performance between test sessions. On average, the rating scale and journals revealed improvements with the FM system, relative to the CI alone, in noisy environments or situations at a distance from the primary talker or sound source. CONCLUSION: The results of the study suggest that neck-loop FM receivers significantly improved speech recognition in noise and everyday listening challenges of people using the CIs in 2 separate test sessions. Additional research is warranted for other types of neck-loop receivers and CI sound processors.