Download PDF
J Am Acad Audiol 2017; 28(09): 861-875
DOI: 10.3766/jaaa.17014
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perceptual Implications of Level- and Frequency-Specific Deviations from Hearing Aid Prescription in Children

Ryan W. McCreery
*   Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
,
Marc Brennan
*   Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
,
Elizabeth A. Walker
†   Departments of Communication Sciences and Disorders, University of Iowa, Iowa City, IA
,
Meredith Spratford
*   Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
› Author Affiliations
Further Information

Publication History

Publication Date:
26 June 2020 (online)

Also available at
   Permissions and Reprints

Abstract

Background:

The purpose of providing amplification for children with hearing loss is to make speech audible across a range of frequencies and intensities. Children with hearing aids (HAs) that closely approximate prescriptive targets have better audibility than peers with HA output below prescriptive targets. Poor aided audibility puts children with hearing loss at risk for delays in communication, social, and academic development.

Purpose:

The goals of this study were to determine how well HAs match prescriptive targets across ranges of frequency and intensity of speech and to determine how level- and frequency-dependent deviations from prescriptive target affect speech recognition in quiet and in background noise.

Study Sample:

One-hundred sixty-six children with permanent mild to severe hearing loss who were between 6 months and 8 years of age and who wore HAs participated in the study.

Data Collection and Analysis:

Hearing aid verification and speech recognition data were collected as part of a longitudinal study of communication development in children with HAs. Hearing aid output at levels of soft and average speech and maximum power output were compared with each child’s prescriptive targets. The deviations from prescriptive target were quantified based on the root-mean-square (RMS) error and absolute deviation from target for octave frequencies. Children were classified into groups based on the number of level-dependent deviations from prescriptive target. Frequency-specific deviations from prescriptive target and sensation levels (SLs) were used to estimate the proximity of fittings across the frequency range. Lexical Neighborhood Test (LNT) word recognition in quiet and Computer-Assisted Speech Perception Assessment (CASPA) phoneme recognition in noise were compared across level-dependent error groups and as a function of SL at 4 kHz.

Results:

Children who had deviations from prescriptive target at all three input levels had poorer LNT word recognition in quiet than children who had fittings that matched prescriptive target within 5 dB RMS at all three input levels. Children with lower 4 kHz SLs through their HAs had poorer LNT recognition in quiet and CASPA phoneme recognition in noise than children with higher aided SLs.

Conclusions:

Children with HAs fitted to provide audibility for speech across a range of inputs and frequencies had better speech recognition outcomes than peers with HAs that were not optimally fitted to prescriptive targets.

Key Words

amplification - children - hearing aids - hearing aid prescription - hearing loss - pediatric audiology - speech perception

This work was supported by grants from the National Institutes of Health—National Institute for Deafness and Communication Disorders (R01 DC013591; R01 DC009560; P20 GM109023, and P30 DC004662).


The content of this project is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Deafness and Other Communication Disorders or the National Institutes of Health.


 

  • REFERENCES

  • American Academy of Audiology 2013. Clinical Practice Guidelines: Pediatric Amplification. Reston, VA: American Academy of Audiology;
    Search in Google Scholar
  • American National Standards Institute (ANSI) 1997. Methods for the calculation of the speech intelligibility index. ANSI S3.5–1997 New York, NY: ANSI;
    Search in Google Scholar
  • Bagatto M, Scollie SD, Hyde M, Seewald R. 2010; Protocol for the provision of amplification within the Ontario infant hearing program. Int J Audiol 49 (Suppl 1) S70-S79
    CrossrefPubMedSearch in Google Scholar
  • Bates D, Maechler M, Bolker B. et al. 2014 lme4: Linear mixed-effects models using Eigen and S4. [Computer software] Published 7-19-2014. http://cran.r-project.org/ . Accessed January 6, 2017
    PubMedSearch in Google Scholar
  • Benjamini Y, Hochberg Y. 1995; Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B 57: 289-300
    Search in Google Scholar
  • Boothroyd A. 1999 Computer-Assisted Speech Perception Assessment (CASPA v2. 2). San Diego, CA: Boothroyd
    PubMed
  • Brennan M, Souza P. 2009; Effects of expansion on consonant recognition and consonant audibility. J Am Acad Audiol 20 (02) 119-127
    Thieme ConnectPubMedSearch in Google Scholar
  • Ching TY, Dillon H, Byrne D. 1998; Speech recognition of hearing-impaired listeners: Predictions from audibility and the limited role of high-frequency amplification. J Acoust Soc Am 103 (02) 1128-1140
    CrossrefPubMedSearch in Google Scholar
  • Ching TY, Dillon H, Hou S, Zhang V, Day J, Crowe K, Marnane V, Street L, Burns L, Van Buynder P, Flynn C, Thomson J. 2013; a A randomized controlled comparison of NAL and DSL prescriptions for young children: hearing-aid characteristics and performance outcomes at three years of age. Int J Audiol 52 (Suppl 2) S17-S28
    CrossrefPubMedSearch in Google Scholar
  • Ching TY, Johnson EE, Seeto M, Macrae JH. 2013; b Hearing-aid safety: a comparison of estimated threshold shifts for gains recommended by NAL-NL2 and DSL m[i/o] prescriptions for children. Int J Audiol 52 (Suppl 2) S39-S45
    CrossrefPubMedSearch in Google Scholar
  • Jenstad LM, Pumford J, Seewald RC, Cornelisse LE. 2000; Comparison of linear gain and wide dynamic range compression hearing aid circuits II: Aided loudness measures. Ear Hear 21 (01) 32-44
    CrossrefPubMedSearch in Google Scholar
  • Jenstad LM, Seewald RC, Cornelisse LE, Shantz J. 1999; Comparison of linear gain and wide dynamic range compression hearing aid circuits: Aided speech perception measures. Ear Hear 20 (02) 117-126
    CrossrefPubMedSearch in Google Scholar
  • Jenstad LM, Souza PE. 2007; Temporal envelope changes of compression and speech rate: combined effects on recognition for older adults. J Speech Lang Hear Res 50 (05) 1123-1138
    CrossrefPubMedSearch in Google Scholar
  • Keidser G, Dillon H, Flax M, Ching T, Brewer S. 2011; The NAL-NL2 prescription procedure. Audiology Res 1 (01) e24
    Search in Google Scholar
  • Kimlinger C, McCreery R, Lewis D. 2015; High-frequency audibility: the effects of audiometric configuration, stimulus type, and device. J Am Acad Audiol 26 (02) 128-137
    Thieme ConnectPubMedSearch in Google Scholar
  • Kirk KI, Pisoni DB, Osberger MJ. 1995; Lexical effects on spoken word recognition by pediatric cochlear implant users. Ear Hear 16 (05) 470
    CrossrefPubMedSearch in Google Scholar
  • Koehlinger K, Van Horne AO, Oleson J, McCreery R, Moeller MP. 2015; The role of sentence position, allomorph, and morpheme type on accurate use of s-related morphemes by children who are hard of hearing. J Speech Lang Hear Res 58 (02) 396-409
    CrossrefPubMedSearch in Google Scholar
  • Kuk F, Peeters H, Lau C, Korhonen P. 2011; Effect of maximum power output and noise reduction on speech recognition in noise. J Am Acad Audiol 22 (05) 265-273
    Thieme ConnectPubMedSearch in Google Scholar
  • McCreery RW, Bentler RA, Roush PA. 2013; Characteristics of hearing aid fittings in infants and young children. Ear Hear 34 (06) 701-710
    CrossrefPubMedSearch in Google Scholar
  • McCreery RW, Walker EA, Spratford M, Bentler R, Holte L, Roush P, Oleson J, Van Buren J, Moeller MP. 2015; a Longitudinal predictors of aided speech audibility in infants and children. Ear Hear 36 (Suppl 1) 24S-37S
    CrossrefPubMedSearch in Google Scholar
  • McCreery R, Walker E, Spratford M, Kirby B, Oleson J, Brennan M. 2016; Stability of audiometric thresholds for children with hearing aids applying the American Academy of Audiology Pediatric Amplification Guideline: implications for safety. J Am Acad Audiol 27 (03) 252-263
    Thieme ConnectPubMedSearch in Google Scholar
  • McCreery RW, Walker EA, Spratford M, Oleson J, Bentler R, Holte L, Roush P. 2015; b Speech recognition and parent ratings from auditory development questionnaires in children who are hard of hearing. Ear Hear 36 (Suppl 1) 60S-75S
    CrossrefPubMedSearch in Google Scholar
  • McCreery RW, Venediktov RA, Coleman JJ, Leech HM. 2012; An evidence-based systematic review of amplitude compression in hearing aids for school-age children with hearing loss. Am J Audiol 21 (02) 269-294
    CrossrefPubMedSearch in Google Scholar
  • Moeller MP, Hoover B, Putman C, Arbataitis K, Bohnenkamp G, Peterson B, Wood S, Lewis D, Pittman A, Stelmachowicz P. 2007; Vocalizations of infants with hearing loss compared with infants with normal hearing: Part I--phonetic development. Ear Hear 28 (05) 605-627
    CrossrefPubMedSearch in Google Scholar
  • Moeller MP, Tomblin JB. 2015; An introduction to the Outcomes of Children with Hearing Loss Study. Ear Hear 36 (Suppl 1) 4S-13S
    CrossrefPubMedSearch in Google Scholar
  • Moodie ST, Kothari A, Bagatto MP, Seewald R, Miller LT, Scollie SD. 2011; Knowledge translation in audiology: promoting the clinical application of best evidence. Trends Amplif 15 (01) 5-22
    CrossrefPubMedSearch in Google Scholar
  • Moodie S, Scollie S, Bagatto M, Keene K. Forthcoming Fit-to-targets for the DSL v5.0a hearing aid prescription method for children. Am J Audiol
  • Pittman AL. 2008; Short-term word-learning rate in children with normal hearing and children with hearing loss in limited and extended high-frequency bandwidths. J Speech Lang Hear Res 51 (03) 785-797
    CrossrefPubMedSearch in Google Scholar
  • R Core Development Team 2014 R: A language and environment for statistical computing [Computer software]. www.R-project.org . Accessed January 6, 2017
    PubMed
  • Scollie S, Seewald R, Cornelisse L, Moodie S, Bagatto M, Laurnagaray D, Beaulac S, Pumford J. 2005; The desired sensation level multistage input/output algorithm. Trends Amplif 9 (04) 159-197
    CrossrefPubMedSearch in Google Scholar
  • Stelmachowicz PG, Pittman AL, Hoover BM, Lewis DE. 2001; Effect of stimulus bandwidth on the perception of/s/in normal-and hearing-impaired children and adults. J Acoust Soc Am 110 (04) 2183-2190
    CrossrefPubMedSearch in Google Scholar
  • Stelmachowicz PG, Pittman AL, Hoover BM, Lewis DE, Moeller MP. 2004; The importance of high-frequency audibility in the speech and language development of children with hearing loss. Arch Otolaryngol Head Neck Surg 130 (05) 556-562
    CrossrefPubMedSearch in Google Scholar
  • Strauss S, van Dijk C. 2008; Hearing instrument fittings of pre-school children: Do we meet the prescription goals?. Int J Audiol 47 (Supp 1) S62-S71
    CrossrefPubMedSearch in Google Scholar
  • Tomblin J.B., Harrison M., Ambrose S., Oleson J.J., Walker E.A., Moeller M.P.. 2015; Language outcomes in young children with mild to severe hearing loss. Ear Hear 36 (Suppl 1) 76S-91S
    CrossrefPubMedSearch in Google Scholar
  • Tomblin JB, Oleson JJ, Ambrose SE, Walker E, Moeller MP. 2014; The influence of hearing aids on the speech and language development of children with hearing loss. JAMA Otolaryngol Head Neck Surg 140 (05) 403-409
    CrossrefPubMedSearch in Google Scholar
  • Tomblin JB, Walker EA, McCreery RW, Arenas RM, Harrison M, Moeller MP. 2015; Outcomes of children with hearing loss: data collection and methods. Ear Hear 36 (Suppl 1) 14S-23S
    CrossrefPubMedSearch in Google Scholar
  • Wickham H, Chang W. 2014 ggplot2: An implementation of the Grammar of Graphics. [Computer software] Published 5-21-2014. http://cran.r-project.org/ . Accessed January 6, 2017
    PubMed