Predictors of Listening-Related Fatigue in Adolescents With Hearing Loss.

PURPOSE: Self-reported listening-related fatigue in adolescents with hearing loss (HL) was investigated. Specifically, the extent to which listening-related fatigue is associated with school accommodations, audiologic characteristics, and listening breaks was examined. METHOD: Participants were 144 adolescents with HL ages 12-19 years. Data were collected online via Qualtrics. The Vanderbilt Fatigue Scale-Child was used to measure listening-related fatigue. Participants also reported on their use of listening breaks and school accommodations, including an Individualized Education Program (IEP) or 504 plan, remote microphone systems, closed captioning, preferential seating, sign language interpreters, live transcriptions, and notetakers. RESULTS: After controlling for age, HL laterality, and self-perceived listening difficulty, adolescents with an IEP or a 504 plan reported lower listening-related fatigue compared to adolescents without an IEP or a 504 plan. Adolescents who more frequently used remote microphone systems or notetakers reported higher listening-related fatigue compared to adolescents who used these accommodations less frequently, whereas increased use of a sign language interpreter was associated with decreased listening-related fatigue. Among adolescents with unilateral HL, higher age was associated with lower listening-related fatigue; no effect of age was found among adolescents with bilateral HL. Listening-related fatigue did not differ based on hearing device configuration. CONCLUSIONS: Adolescents with HL should be considered at risk for listening-related fatigue regardless of the type of hearing devices used or the degree of HL. The individualized support provided by an IEP or 504 plan may help alleviate listening-related fatigue, especially by empowering adolescents with HL to be self-advocates in terms of their listening needs and accommodations in school. Additional research is needed to better understand the role of specific school accommodations and listening breaks in addressing listening-related fatigue.

Using Microphone Technology to Improve Speech Perception in Noise in Children with Cochlear Implants.

BACKGROUND: Cochlear implant (CI) users are affected more than their normal hearing (NH) peers by the negative consequences of background noise on speech understanding. Research has shown that adult CI users can improve their speech recognition in challenging listening environments by using dual-microphone beamformers, such as adaptive directional microphones (ADMs) and wireless remote microphones (RMs). The suitability of these microphone technologies for use in children with CIs is not well-understood nor widely accepted. PURPOSE: To assess the benefit of ADM or RM technology on speech perception in background noise in children and adolescents with cochlear implants (CIs) with no previous or current use of ADM or RM. RESEARCH DESIGN: Mixed, repeated measures design. STUDY SAMPLE: Twenty (20) children, ten (10) CI users (mean age 14.3 yrs) who used Advanced Bionics HiRes90K implants with research Naida processors, and ten (10) NH age-matched controls participated in this prospective study. INTERVENTION: CI users listened with an ear-canal level microphone, T-Mic (TM), an ADM, and a wireless RM at different audio-mixing ratios. Speech understanding with five microphone settings (TM 100%, ADM, RM + TM 50/50, RM + TM 75/25, RM 100%) was evaluated in quiet and in noise. DATA COLLECTION AND ANALYSIS: Speech perception ability was measured using children's spondee words to obtain a speech recognition threshold for 80% accuracy (SRT80%) in 20-talker babble where the listener sat in a sound booth 1 m (3.28') from the target speech (front) and noise (behind) to test five microphone settings (TM 100%, ADM, RM + TM 50/50, RM + TM 75/25, RM 100%). Group performance-intensity functions were computed for each listening condition to show the effects of microphone configuration with respect to signal-to-noise ratio (SNR). A difference score (CI Group minus NH Group) was computed to show the effect of microphone technology at different SNRs relative to NH. Statistical analysis using a repeated-measures analysis of variance evaluated the effects of the microphone configurations on SRT80% and performance at SNRs. Between-groups analysis of variance was used to compare the CI group with the NH group. RESULTS: The speech recognition was significantly poorer for children with CI than children with NH in quiet and in noise when using the TM alone. Adding the ADM or RM provided a significant improvement in speech recognition for the CI group over use of the TM alone in noise (mean dB advantage ranged from 5.8 for ADM to 16 for RM100). When children with CI used the RM75 or RM100 in background babble, speech recognition was not statistically different from the group with NH. CONCLUSION: Speech recognition in noise performance improved with the use of ADM and RM100 or RM75 over TM-only for children with CIs. Alhough children with CI remain at a disadvantage as compared with NH children in quiet and more favorable SNRs, microphone technology can enhance performance for some children with CI to match that of NH peers in contexts with negative SNRs.

Open-Fit Domes and Children with Bilateral High-Frequency Sensorineural Hearing Loss: Benefits and Outcomes.

BACKGROUND: Open-fit domes (OFDs) coupled with behind-the-ear (BTE) hearing aids were designed for adult listeners with moderate-to-severe bilateral high-frequency hearing loss (BHFL) with little to no concurrent loss in the lower frequencies. Adult research shows that BHFL degrades sound localization accuracy (SLA) and that BTE hearing aids with conventional earmolds (CEs) make matters worse. In contrast, research has shown that OFDs enhance spatial hearing percepts in adults with BHFL. Although the benefits of OFDs have been studied in adults with BHFL, no published studies to date have investigated the use of OFDs in children with the same hearing loss configuration. This study seeks to use SLA measurements to assess efficacy of bilateral OFDs in children with BHFL. PURPOSE: To measure SLA in children with BHFL to determine the extent to which hearing loss, age, duration of CE use, and OFDs affect localization accuracy. RESEARCH DESIGN: A within-participant experimental design using repeated measures was used to determine the effect of OFDs on localization accuracy in children with BHFL. A between-participant experimental design was used to compare localization accuracy between children with BHFL and age-matched controls with normal hearing (NH). STUDY SAMPLE: Eighteen children with BHFL who used CE and 18 age-matched NH controls. Children in both groups were divided into two age groups: older children (10-16 yr) and younger children (6-9 yr). DATA COLLECTION AND ANALYSIS: All testing was done in a sound-treated booth with a horizontal array of 15 loudspeakers (radius of 1 m). The stimulus was a spondee word, "baseball": the level averaged 60 dB SPL and randomly roved (±8 dB). Each child was asked to identify the location of a sound source. Localization error was calculated across the loudspeaker array for each listening condition. RESULTS: A significant interaction was found between immediate benefit from OFD and duration of CE usage. Longer CE usage was associated with degraded localization accuracy using OFDs. Regardless of chronological age, children who had used CEs for <6 yr showed immediate localization benefit using OFDs, whereas children who had used CEs for >6 yr showed immediate localization interference using OFDs. Development, however, may play a role in SLA in children with BHFL. When unaided, older children had significantly better localization acuity than younger children with BHFL. When compared to age-matched controls, children with BHFL of all ages showed greater localization error. Nearly all (94% [17/18]) children with BHFL spontaneously reported immediate own-voice improvement when using OFDs. CONCLUSIONS: OFDs can provide sound localization benefit to younger children with BHFL. However, immediate benefit from OFDs is reduced by prolonged use of CEs. Although developmental factors may play a role in improving localization abilities over time, children with BHFL will rarely equal that of peers without early use of minimally disruptive hearing aid technology. Also, the occlusion effect likely impacts children far more than currently thought.

Relationship among the physiologic channel interactions, spectral-ripple discrimination, and vowel identification in cochlear implant users.

The hypothesis of this study was that broader patterns of physiological channel interactions in the local region of the cochlea are associated with poorer spectral resolution in the same region. Electrically evoked compound action potentials (ECAPs) were measured for three to six probe electrodes per subject to examine the channel interactions in different regions across the electrode array. To evaluate spectral resolution at a confined location within the cochlea, spectral-ripple discrimination (SRD) was measured using narrowband ripple stimuli with the bandwidth spanning five electrodes: Two electrodes apical and basal to the ECAP probe electrode. The relationship between the physiological channel interactions, spectral resolution in the local cochlear region, and vowel identification was evaluated. Results showed that (1) there was within- and across-subject variability in the widths of ECAP channel interaction functions and in narrowband SRD performance, (2) significant correlations were found between the widths of the ECAP functions and narrowband SRD thresholds, and between mean bandwidths of ECAP functions averaged across multiple probe electrodes and broadband SRD performance across subjects, and (3) the global spectral resolution reflecting the entire electrode array, not the local region, predicts vowel identification.

Spatial hearing in a child with auditory neuropathy spectrum disorder and bilateral cochlear implants.

OBJECTIVE: The neural dys-synchrony associated with auditory neuropathy spectrum disorder (ANSD) causes a temporal impairment that could degrade spatial hearing, particularly sound localization accuracy (SLA) and spatial release from masking (SRM). Unilateral cochlear implantation has become an accepted treatment for ANSD but treatment options for the contralateral ear remain controversial. We report spatial hearing measures in a child with ANSD before and after receiving a second cochlear implant (CI). STUDY SAMPLE: An 11-year-7-month old boy with ANSD and expressive and receptive language delay received a second CI eight years after his first implant. DESIGN: The SLA and SRM were measured four months before sequential bilateral CIs (with the contralateral ear plugged and unplugged), and after nine months using both CIs. RESULTS: Testing done before the second CI, with the first CI alone, suggested that residual hearing in the contralateral ear contributed to sound localization accuracy, but not word recognition in quiet or noise. Nine-months after receiving a second CI, SLA improved by 12.76° and SRM increased to 3.8-4.2 dB relative to pre-operative performance. Results were compared to published outcomes for children with bilateral CIs. CONCLUSIONS: The addition of a second CI in this child with ANSD improved spatial hearing.