Children perform more poorly than adults on a wide range of masked speech perception paradigms, but this effect is particularly pronounced when the masker itself is also composed of speech. The present study evaluated two factors that might contribute to this effect: the ability to perceptually isolate the target from masker speech, and the ability to recognize target speech based on sparse cues (glimpsing). Speech reception thresholds (SRTs) were estimated for closed-set, disyllabic word recognition in children (5-16 years) and adults in a one-or two-talker masker. Speech maskers were 60 dB sound pressure level (SPL), and they were either presented alone or in combination with a 50-dB-SPL speech-shaped noise masker. There was an age effect overall, but performance was adult-like at a younger age for the one-talker than the two-talker masker. Noise tended to elevate SRTs, particularly for older children and adults, and when summed with the one-talker masker. Removing timefrequency epochs associated with a poor target-to-masker ratio markedly improved SRTs, with larger effects for younger listeners; the age effect was not eliminated, however. Results were interpreted as indicating that development of speech-in-speech recognition is likely impacted by development of both perceptual masking and the ability recognize speech based on sparse cues.

Classroom attention abilities should be monitored for early school-age CMHL. Late-identified CMHL and CMHL with low maternal education levels may be in particular need of academic and social support. Continued efforts for early identification of CMHL should be made to improve outcomes for these children.

Purpose The present study evaluated the effects of inherent envelope modulation and the availability of cues across frequency on behavioral gap detection with noise-band stimuli in school-age children. Methods Listeners were normal-hearing adults and 5.2- to 15.6-year-olds. Stimuli were continuous bands of noise centered on 2000 Hz, either 1000 or 25 Hz wide. In addition to Gaussian noise at these bandwidths, there were conditions using 25-Hz-wide noise bands modified to either accentuate or minimize inherent envelope modulation (staccato and low-fluctuation noise, respectively). Results Within the 25-Hz-wide conditions, adults’ gap detection thresholds were highest in the staccato, lower in the Gaussian, and lowest in the low-fluctuation noise. Similar trends were evident in children’s thresholds, although inherent envelope modulation had a smaller effect on children than adults. Whereas adults’ thresholds were comparable for the 1000-Hz-wide Gaussian and 25-Hz-wide low-fluctuation stimulus, children’s performance converged on adults’ at a younger age for the 1000-Hz-wide Gaussian stimulus. Conclusions Results are consistent with the idea that children are less susceptible to the disruptive effects of inherent envelope modulation than adults when detecting a gap in a narrowband noise. Further, the ability to use spectrally distributed gap detection cues appears to mature relatively early in childhood.

Objective The purpose of this study was to assess age-related changes in temporal resolution in listeners with relatively normal audiograms. The hypothesis was that increased susceptibility to non-simultaneous masking contributes to the hearing difficulties experienced by older listeners in complex fluctuating backgrounds. Design Participants included younger (n = 11), middle-aged (n = 12), and older (n = 11) listeners with relatively normal audiograms. The first phase of the study measured masking period patterns for speech-shaped noise maskers and signals. From these data, temporal window shapes were derived. The second phase measured forward-masking functions, and assessed how well the temporal window fits accounted for these data. Results The masking period patterns demonstrated increased susceptibility to backward masking in the older listeners, compatible with a more symmetric temporal window in this group. The forward-masking functions exhibited an age-related decline in recovery to baseline thresholds, and there was also an increase in the variability of the temporal window fits to these data. Conclusions This study demonstrated an age-related increase in susceptibility to non-simultaneous masking, supporting the hypothesis that exacerbated non-simultaneous masking contributes to age-related difficulties understanding speech in fluctuating noise. Further support for this hypothesis comes from limited speech-in-noise data suggesting an association between susceptibility to forward masking and speech understanding in modulated noise.

Objectives Current protocols presumably use criteria that are chosen on the basis of the sensitivity and specificity rates they produce. Such an approach emphasizes test performance, but does not include societal implications of the benefit of early identification. The purpose of the present analysis was to evaluate an approach to selecting criteria for use in UNHS programs that utilizes BCR to demonstrate an alternative method to audiologists, administrators, and others involved in UNHS protocol decisions. Design Existing data from over 1200 ears were used to analyze benefit-cost ratio (BCR) as a function of DPOAE level. These data were selected because both audiometric and DPOAE data were available on every ear. Although these data were not obtained in newborns, this compromise was necessary because audiometric outcomes (especially in infants with congenital hearing loss) in neonates are either lacking or limited in number. As such, it is important to note that the characteristics of responses from the group of subjects that formed the bases of the present analyses are different from those for neonates. This limits the extent to which actual criterion levels can be selected but should not affect the general approach of using BCR as a framework for considering UNHS criteria. Estimates of the prevalence of congenital hearing loss identified through UNHS in 37 states and U.S. territories in 2004 were used to calculate BCR. A range of estimates for the lifetime monetary benefits and yearly costs for UNHS were used, based on data available in the literature. Still, exact benefits and costs are difficult to know. Both one-step (DPOAE alone) and two-step (DPOAE followed by AABR) screening paradigms were considered in the calculation of BCR. The influence of middle-ear effusion was simulated by incorporating a range of expected DPOAE level reductions into an additional BCR analyses. Results Our calculations indicate that for a range of proposed benefit and cost estimates, the monetary benefits of both one-step (DPOAE alone) and two-step (DPOAE followed by AABR) NHS programs outweigh programmatic costs. Our calculations indicate that BCR is robust in that it can be applied regardless of the values that are assigned to benefit and cost. Maximum BCR was identified and remained stable regardless of these values; however, it was recognized that use of maximum BCR could result in reduced test sensitivity and may not be optimal for use in UNHS programs. The inclusion of secondary AABR screening increases BCR, but does not alter the DPOAE criterion level at which maximum BCR occurs. The model of middle-ear effusion reduces overall DPOAE level, subsequently lowering the DPOAE criterion level at which maximum BCR was obtained. Conclusion BCR is one of several alternative methods for choosing UNHS criteria, in which the evaluation of costs and benefits allows clinical and societal considerations to be incorporated into the pass/refer decision a meaningful way. Though some of the benefits of early identification of hearing...