Objective Universal newborn hearing screening (UNHS) test outcomes can be influenced by conditions affecting the sound-conduction pathway including ear-canal and/or middle-ear function. The purpose of this study was to evaluate the test performance of wideband (WB) acoustic transfer functions (ATFs) and 1-kHz tympanometry in terms of their ability to predict the status of the sound-conduction pathway for ears that passed or were referred in a UNHS program. Design A distortion-product otoacoustic emission (DPOAE) test was used to determine the UNHS status of 455 infant ears (375 passed and 80 referred). WB and 1-kHz tests were performed immediately following the infant s first DPOAE test (Day 1). Of the 80 infants referred on Day 1, 67 infants were evaluated again following a second UNHS DPOAE test the next day (Day 2). WB data were acquired under ambient and tympanometric (pressurized) ear-canal conditions. Clinical decision theory analysis was used to assess the test performance of WB and 1-kHz tests in terms of their ability to classify ears that passed or referred, using DPOAE UNHS test outcomes as the “gold standard”. Specifically, for 1-kHz tympanometry, performance was assessed using previously published measurement criteria and for WB measurements, performance was assessed using a maximum-likelihood procedure. Results For measurements from Day 1, the highest area under the receiver operating characteristic (AROC) curve was 0.87 for an ambient WB test predictor. The highest AROC among several variables derived from 1-kHz tympanometry was 0.75. In general, ears that passed the DPOAE UNHS test had higher energy absorbance compared to those that referred, indicating that infants who passed the DPOAE UNHS had a more acoustically efficient conductive pathway. Conclusions Results showed that: 1) WB tests had better performance in classifying UNHS DPOAE outcomes than 1-kHz tympanometry, 2) WB tests provide data to suggest that many UNHS referrals are a consequence of transient conditions affecting the sound-conduction pathway, 3) WB data reveal changes in sound conduction during the first 2 days of life, and 4) WB measurements used in the present study are objective and quick, making these tests feasible for potential use in conjunction with UNHS programs.

Objectives Progress has been made in recent years in the provision of amplification and early intervention for children who are hard of hearing. However, children who use hearing aids (HA) may have inconsistent access to their auditory environment due to limitations in speech audibility through their HAs or limited HA use. The effects of variability in children’s auditory experience on parent-report auditory skills questionnaires and on speech recognition in quiet and in noise were examined for a large group of children who were followed as part of the Outcomes of Children with Hearing Loss study. Design Parent ratings on auditory development questionnaires and children’s speech recognition were assessed for 306 children who are hard of hearing. Children ranged in age from 12 months to 9 years of age. Three questionnaires involving parent ratings of auditory skill development and behavior were used, including the LittlEARS Auditory Questionnaire, Parents Evaluation of Oral/Aural Performance in Children Rating Scale, and an adaptation of the Speech, Spatial and Qualities of Hearing scale. Speech recognition in quiet was assessed using the Open and Closed set task, Early Speech Perception Test, Lexical Neighborhood Test, and Phonetically-balanced Kindergarten word lists. Speech recognition in noise was assessed using the Computer-Assisted Speech Perception Assessment. Children who are hard of hearing were compared to peers with normal hearing matched for age, maternal educational level and nonverbal intelligence. The effects of aided audibility, HA use and language ability on parent responses to auditory development questionnaires and on children’s speech recognition were also examined. Results Children who are hard of hearing had poorer performance than peers with normal hearing on parent ratings of auditory skills and had poorer speech recognition. Significant individual variability among children who are hard of hearing was observed. Children with greater aided audibility through their HAs, more hours of HA use and better language abilities generally had higher parent ratings of auditory skills and better speech recognition abilities in quiet and in noise than peers with less audibility, more limited HA use or poorer language abilities. In addition to the auditory and language factors that were predictive for speech recognition in quiet, phonological working memory was also a positive predictor for word recognition abilities in noise. Conclusions Children who are hard of hearing continue to experience delays in auditory skill development and speech recognition abilities compared to peers with normal hearing. However, significant improvements in these domains have occurred in comparison to similar data reported prior to the adoption of universal newborn hearing screening and early intervention programs for children who are hard of hearing. Increasing the audibility of speech has a direct positive effect on auditory skill development and speech recognition abilities, and may also enhance these skills by im...

Objectives Hearing aids provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported hearing aid fitting outcomes for a large group of children. The current study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided hearing aids for the children in the current study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. Additionally, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and improved audibility than cohorts fitted without these measures. Design Hearing aid fitting data from 195 children with mild to severe hearing losses were analyzed as part of a multicenter study evaluating outcomes in children with hearing loss. Proximity of fitting to prescriptive targets was quantified by calculating the average RMS error of the fitting compared to Desired Sensation Level prescriptive targets for 500, 1000, 2000 and 4000 Hz. Aided audibility was quantified using the speech intelligibility index (SII). Survey data from the pediatric audiologists who fit amplification for children in the current study were collected to evaluate trends in fitting practices and relate those patterns to proximity of the fitting to prescriptive targets and aided audibility. Results More than half (55%) of the children in the study had at least one ear that deviated from prescriptive targets by more than 5 dB RMS on average. Deviation from prescriptive target was not predicted by pure tone average (PTA), assessment method or reliability of assessment. Study location was a significant predictor of proximity to prescriptive target with locations who recruited subjects who were fit at multiple clinical locations (University of Iowa and Boys Town National Research Hospital) having larger deviations from target than the location where the subjects were recruited primarily from a single, large pediatric audiology clinic (University of North Carolina). Fittings based on average real-ear to coupler differences (RECD) resulted in larger deviations from prescriptive targets than fittings based on individually-measured RECD. Approximately 26% of the children in the study had aided audibility less than .65. Aided audibility was significantly predicted by the proximity to prescriptive targets and PTA, but not age in months. Conclusions Children in the study had a wide range of fitting outcomes in terms of proximity to prescriptive targets (RMS error) and aided speech audibility (SII). Even when recommended hearing aid verification strategies were reported, fittings often exceeded the criteria for both proximity to the prescriptive target and aided audibility. The implications for optimizing amplificatio...

This study investigated the relationship between audibility and predictions of speech recognition for children and adults with normal hearing. The Speech Intelligibility Index (SII) is used to quantify the audibility of speech signals and can be applied to transfer functions to predict speech recognition scores. Although the SII is used clinically with children, relatively few studies have evaluated SII predictions of children's speech recognition directly. Children have required more audibility than adults to reach maximum levels of speech understanding in previous studies. Furthermore, children may require greater bandwidth than adults for optimal speech understanding, which could influence frequency-importance functions used to calculate the SII. Speech recognition was measured for 116 children and 19 adults with normal hearing. Stimulus bandwidth and background noise level were varied systematically in order to evaluate speech recognition as predicted by the SII and derive frequency-importance functions for children and adults. Results suggested that children required greater audibility to reach the same level of speech understanding as adults. However, differences in performance between adults and children did not vary across frequency bands.

Purpose: This study examined the effects of consistent hearing aid (HA) use on outcomes in children with mild hearing loss (HL). Method: Five-or 7-year-old children with mild HL were separated into 3 groups on the basis of patterns of daily HA use. Using analyses of variance, we compared outcomes between groups on speech and language tests and a speech perception in noise task. Regression models were used to investigate the influence of cumulative auditory experience (audibility, early intervention, HA use) on outcomes. Results: Full-time HA users demonstrated significantly higher scores on vocabulary and grammar measures compared with nonusers. There were no significant differences between the 3 groups on articulation or speech perception measures. After controlling for the variance in age at confirmation of HL, level of audibility, and enrollment in early intervention, only amount of daily HA use was a significant predictor of grammar and vocabulary. Conclusions: The current results provide evidence that children's language development benefits from consistent HA use. Nonusers are at risk in areas such as vocabulary and grammar compared with other children with mild HL who wear HAs regularly. Service providers should work collaboratively to encourage consistent HA use.

Objective The primary goal of nonlinear frequency compression (NFC) and other frequency lowering strategies is to increase the audibility of high-frequency sounds that are not otherwise audible with conventional hearing-aid processing due to the degree of hearing loss, limited hearing aid bandwidth or a combination of both factors. The aim of the current study was to compare estimates of speech audibility processed by NFC to improvements in speech recognition for a group of children and adults with high-frequency hearing loss. Design Monosyllabic word recognition was measured in noise for twenty-four adults and twelve children with mild to severe sensorineural hearing loss. Stimuli were amplified based on each listener’s audiogram with conventional processing (CP) with amplitude compression or with NFC and presented under headphones using a software-based hearing aid simulator. A modification of the speech intelligibility index (SII) was used to estimate audibility of information in frequency-lowered bands. The mean improvement in SII was compared to the mean improvement in speech recognition. Results All but two listeners experienced improvements in speech recognition with NFC compared to CP, consistent with the small increase in audibility that was estimated using the modification of the SII. Children and adults had similar improvements in speech recognition with NFC. Conclusion Word recognition with NFC was higher than CP for children and adults with mild to severe hearing loss. The average improvement in speech recognition with NFC (7%) was consistent with the modified SII, which indicated that listeners experienced an increase in audibility with NFC compared to CP. Further studies are necessary to determine if changes in audibility with NFC are related to speech recognition with NFC for listeners with greater degrees of hearing loss, with a greater variety of compression settings, and using auditory training.

Objectives-Children who are hard of hearing (CHH) have restricted access to acoustic and linguistic information. Increased audibility provided by hearing aids (HAs) influences language outcomes, but the advantages of appropriately-fit HAs can only be realized if children wear their devices on a consistent basis. The purpose of the current paper was to characterize long-term HA use in CHH, based on parent report measures, and identify factors that influence longitudinal trends in HA use.Design-Participants were parents of 290 children with mild to severe hearing loss. At every visit, parents estimated the average amount of time the child used HAs per day during the week and on the weekends. Parent reports of daily HA use were analyzed to determine if different patterns of HA use were observed longitudinally during the study. Independent predictor variables were then related to longitudinal trends in HA use within three age groups (infant, preschool, school-age).Results-On average across multiple visits, parents reported that their children wore their HAs for 10.63 hours per day (SD = 3.29). Data logging values were lower than parent report measures (M = 8.44, SD = 4.06), suggesting that parents overestimated daily HA use. The majority of children in each age group wore HAs at least 8 hours per day from their first research testing interval to their last, based on parent-report measures. Maternal education level predicted longitudinal trends in HA use for infants and school-age CHH. Degree of hearing loss was related to trends in school-age children only. Conclusions-The current results indicated that the majority of CHH increased HA use over time, but a sizable minority demonstrated a low level of use or decreased use in the time period studied. Maternal education level influenced longitudinal trends in daily HA use. Degree of

Objectives Amplification is a core component of early intervention for children who are hard of hearing (CHH), but hearing aids (HAs) have unique effects that may be independent from other components of the early intervention process, such as caregiver training or speech and language intervention. The specific effects of amplification are rarely described in studies of developmental outcomes. The primary purpose of this manuscript is to quantify aided speech audibility during the early childhood years and examine the factors that influence audibility with amplification for children in the Outcomes of Children with Hearing Loss (OCHL) study. Design Participants were 288 children with permanent hearing loss who were followed as part of the OCHL study. All of the children in this analysis had bilateral hearing loss and wore air-conduction behind-the-ear HAs. At every study visit, hearing thresholds were measured using developmentally-appropriate behavioral methods. Data were obtained for a total of 1043 audiometric evaluations across all subjects for the first four study visits. In addition, the aided audibility of speech through the HA was assessed using probe microphone measures. Hearing thresholds and aided audibility were analyzed. Repeated-measures analyses of variance were conducted to determine if patterns of thresholds and aided audibility were significantly different between ears (left vs. right) or across the first four study visits. Furthermore, a cluster analysis was performed based on the aided audibility at entry into the study, aided audibility at the child’s final visit, and change in aided audibility between these two intervals to determine if there were different patterns of longitudinal aided audibility within the sample. Results Eighty-four percent of children in the study had stable audiometric thresholds during the study, defined as threshold changes <10 dB for any single study visit. There were no significant differences in hearing thresholds, aided audibility, or deviation of the HA fitting from prescriptive targets between ears or across test intervals for the first four visits. Approximately 35% of the children in the study had aided audibility that was below the average for the normative range for the Speech Intelligibility Index (SII) based on degree of hearing loss. The cluster analysis of longitudinal aided audibility revealed three distinct groups of children: a group with consistently high aided audibility throughout the study, a group with decreasing audibility during the study, and a group with consistently low aided audibility. Conclusions The current results indicated that approximately 65% of children in the study had adequate aided audibility of speech and stable hearing during the study period. Limited audibility was associated with greater degrees of hearing loss and larger deviations from prescriptive targets. Studies of developmental outcomes will help to determine how aided audibility is necessary to affects developmental outcomes in CHH.