INTRODUCTIONCochlear implantation has become a common recommendation for parents of children with severe to profound hearing loss. This surgical intervention has numerous reported benefits including improved speech and language skills as well as higher academic achievement. (1)(2)(3) In fact, there is evidence that some children receiving cochlear implants before 24 months have attained some aspects of language comparable to their normal hearing peers, but we currently have no indication that implantation between 6 and 12 months results in significantly better language development than those implanted between 12 and 24 months of age. (4)(5)(6)(7) Regardless of early implantation, this population of children maintains a substantial amount of variability in language outcomes. (8) Some known predictors of language outcomes include parent level of education and non-verbal cognitive development. (9) The socio-economic levels of many families in cochlear implant research articles are often quite high with a typical average of college education or above (16 years or greater) which may contribute to an upward bias in outcomes or an indication of how family characteristics may relate to treatment choices.Advances in CI technology and surgical procedures have closely coincided with early intervention initiatives and advances in hearing aid technology as well. In this technological age, it should be noted that many families still choose hearing aids rather than implantation for their child with severe or profound hearing loss. As such, this paper aims to compare the language developmental trends as well as the background characteristics of children with hearing aids (HA) and children with cochlear implants (CI) with severe to profound hearing loss under the establishment of universal newborn screening in the state of Colorado. One aspect of our study population that is unusual compared to other states is that Colorado represents a state-wide population with children who have been implanted in various programs. At the time of data collection for the current study, there were seven cochlear implant programs in the state, three of the seven programs implanted the majority of the children in the Denver metropolitan area but some of the children were implanted in other areas of the state. The parents of these children chose to enroll their children in the Colorado Home Intervention Program, a public program that provides early intervention services to over 90% of the children identified with hearing loss from birth through three years of age.In addition, almost all children who received cochlear implants also received services through a clinic-based program after implantation and were seen by speech/language pathologists who were certified auditory verbal specialists or auditory-oral specialists with extensive experience.It is not uncommon for Colorado families to participate in sign language instruction. Over 80 percent of the families in our data source engage in sign language instruction from an individual who was deaf or ha...
Objectives Hearing aids use complex processing intended to improve speech recognition. While many listeners benefit from such processing, it can also introduce distortion that offsets or cancels intended benefits for some individuals. The purpose of the present study was to determine the effects of cognitive ability (working memory) on individual listeners’ responses to distortion caused by frequency compression applied to noisy speech. Design The present study analyzed a large dataset of intelligibility scores for frequency-compressed speech presented in quiet and at a range of signal-to-babble ratios. The intelligibility dataset was based on scores from 26 adults with hearing loss with ages ranging from 62 to 92 years. The listeners were grouped based on working memory ability. The amount of signal modification (distortion) due to frequency compression and noise was measured using a sound quality metric. Analysis of variance and hierarchical linear modeling were used to identify meaningful differences between subject groups as a function of signal distortion caused by frequency compression and noise. Results Working memory was a significant factor in listeners’ intelligibility of sentences presented in babble noise and processed with frequency compression based on sinusoidal modeling. At maximum signal modification (caused by both frequency compression and babble noise), the factor of working memory (when controlling for age and hearing loss) accounted for 29.3% of the variance in intelligibility scores. Combining working memory, age, and hearing loss accounted for a total of 47.5% of the variability in intelligibility scores. Furthermore, as the total amount of signal distortion increased, listeners with higher working memory performed better on the intelligibility task than listeners with lower working memory. Conclusions Working memory is a significant factor in listeners’ responses to total signal distortion caused by cumulative effects of babble noise and frequency compression implemented with sinusoidal modeling. These results, together with other studies focused on wide-dynamic range compression (WDRC), suggest that older listeners with hearing loss and poor working memory are more susceptible to distortions caused by at least some types of hearing aid signal processing algorithms and by noise, and that this increased susceptibility should be considered in the hearing-aid fitting process.
This article will provide information about the Pragmatics Checklist, which consists of 45 items and is scored as: (1) not present, (2) present but preverbal, (3) present with one to three words, and (4) present with complex language. Information for both children who are deaf or hard of hearing and those with normal hearing are presented. Children who are deaf or hard of hearing are significantly older when demonstrating skill with complex language than their normal hearing peers. In general, even at the age of 7 years, there are several items that are not mastered by 75% of the deaf or hard of hearing children. Additionally, the article will provide some suggestions of strategies that can be considered as a means to facilitate the development of these pragmatic language skills for children who are deaf or hard of hearing. KEYWORDS: Deaf, hard of hearing, pragmatic language developmentLearning Outcomes: As a result of this activity, the reader will be able to (1) identify the pragmatic language skills that children who are deaf or hard of hearing have the most difficulty mastering by 7 years of age; (2) identify the pragmatic language skills that are the latest developed with complex language for children with normal hearing; (3) differentiate the rate of pragmatic language development by age and degree of hearing loss; (4) compare and contrast the pragmatic language skills of children with normal hearing and children who are deaf or hard of hearing by age; and (5) develop teaching strategies for preschool-aged children who are deaf or hard of hearing to develop specific pragmatic language skills that are typically developed significantly later than children with normal hearing.
Background Speech perception measures have long been considered an integral piece of the audiological assessment battery. Currently, a prelinguistic, standardized measure of speech perception is missing in the clinical assessment battery for infants and young toddlers. Such a measure would allow systematic assessment of speech perception abilities of infants as well as the potential to investigate the impact early identification of hearing loss and early fitting of amplification have on the auditory pathways. Purpose To investigate the impact of sensation level (SL) on the ability of infants with NH to discriminate /a-i/ and /ba-da/ and to determine if performance on the two contrasts are significantly different in predicting the discrimination criterion. Research Design The design was based on a survival analysis model for event occurrence and a repeated measures logistic model for binary outcomes. The outcome for survival analysis was the minimum SL for criterion and the outcome for the logistic regression model was the presence/absence of achieving the criterion. Criterion achievement was designated when an infant’s proportion correct score was ≥0.75 on the discrimination performance task. Study Sample Twenty-two infants with NH sensitivity participated in this study. There were 9 males and 13 females, aged 6–14 months. Data Collection and Analysis Testing took place over two to three sessions. The first session consisted of a hearing test, threshold assessment of the two speech sounds (/a/ and /i/), and if time and attention allowed, Visual Reinforcement Infant Speech Discrimination (VRISD). The second session consisted of VRISD assessment for the two test contrasts (/a-i/ and /ba-da/). The presentation level started at 50 dBA. If the infant was unable to successfully achieve criterion (≥0.75) at 50 dBA, the presentation level was increased to 70 dBA followed by 60 dBA. Data examination included an event analysis, which provided the probability of criterion distribution across SL. The second stage of the analysis was a repeated measures logistic regression where SL and contrast were used to predict the likelihood of speech discrimination criterion. Results Infants were able to reach criterion for the /a-i/ contrast at statistically lower SLs when compared to /ba-da/. There were six infants who never reached criterion for /ba-da/ and one never reached criterion for /a-i/. The conditional probability of not reaching criterion by 70 dB SL was 0% for /a-i/ and 21% for /ba-da/. The predictive logistic regression model showed that children were more likely to discriminate the /a-i/ even when controlling for SL. Conclusions Nearly all normal-hearing infants can demonstrate discrimination criterion of a vowel contrast at 60 dB SL, while a level of 70 dB SL may be needed to allow all infants to demonstrate discrimination criterion of a difficult consonant contrast.
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