A randomized controlled comparison of NAL and DSL prescriptions for young children: Hearing-aid characteristics and performance outcomes at three years of age

Ching, Teresa Y. C.; Dillon, Harvey; Hou, Sanna; Zhang, Vicky; Day, Julia; Crowe, Kathryn; Marnane, Vivienne; Street, Laura; Burns, Lauren; Buynder, Patricia Van; Flynn, Christopher; Thomson, Jessica L.

doi:10.3109/14992027.2012.705903

Cited by 20 publications

(23 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This value exceeded the 5 dB criterion set forth in previous adult studies of proximity related to prescriptive target (Byrne & Cotton, 1988; Cox & Alexander, 1990; Baumfield & Dillon, 2001; Polonenko et al 2010). The current cohort of hearing-aid fittings also deviated from prescriptive target to a greater degree than published reports evaluating the relationship between prescriptive approaches and developmental outcomes in children (Ching et al 2012). For children with mild to severe hearing loss, fitting the hearing aid within 5 dB of prescriptive targets represents a reasonable and achievable standard if appropriate verification methods are used.…”

Section: Discussionmentioning

confidence: 56%

“…The vast majority of service providers reported using the DSL prescriptive method (98%; 123/125), while the remaining two service providers reported using NAL-NL1. Recent studies suggested that although there are differences between DSL v. 4 and NAL-NL1 in both gain and output, speech recognition and audibility outcomes are similar between the two prescriptions(Scollie et al, 2010; Ching et al, 2010; Ching et al 2012). Comparisons are further complicated by the fact that updated versions of each algorithm (DSL v.5 and NAL-NL2) have been developed and are used clinically by pediatric audiologists.…”

Section: Discussionmentioning

confidence: 99%

“…However, degree of hearing loss was a significant predictor of outcomes with greater degrees of hearing loss associated with greater developmental delays. In another investigation, over 200 children with hearing loss were randomly assigned to either DSL 4.1 or NAL-NL1 prescriptions (Ching et al 2012). Results indicated no significant differences between prescriptions on average across language, speech production, and functional auditory skills at age 3.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Characteristics of Hearing Aid Fittings in Infants and Young Children

2013

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics of Hearing Aid Fittings in Infants and Young Children

2013

View full text Add to dashboard Cite

show abstract

“…For children with ANSD, the audiogram for fitting was estimated on the basis of the minimum response levels obtained during behavioral observation audiometry (BOA) assessments, together with measurements of cortical auditory evoked potentials (CAEP) using speech-sound stimuli developed in a previous study (Golding et al, 2009), as well as parental reports (Ching & Hill, 2007). Children who enrolled in the study prior to initial amplification were randomly assigned to being fitted with either the National Acoustic Laboratories prescription for non-linear hearing aids, version 1 (NAL), or the desired sensation level, version 4.1 (DSL) prescription (Ching et al, 2013a). Those who enrolled after initial fitting were fitted with hearing aids using the NAL prescription.…”

Section: Methodsmentioning

confidence: 99%

Impact of the presence of auditory neuropathy spectrum disorder (ANSD) on outcomes of children at three years of age

Ching

Day

Dillon

et al. 2013

International Journal of Audiology

Self Cite

View full text Add to dashboard Cite

Objective To determine the influence of the presence of auditory neuropathy spectrum disorder (ANSD) on speech, language, and psycho-social development of children at three years of age. Design A population-based, longitudinal study was performed on outcomes of children with hearing impairment (LOCHI) in Australia. The demographic characteristics of the children were described, and their developmental outcomes were evaluated at three years of age. Performance of children with ANSD was compared with that of children without ANSD in the LOCHI study. Study sample There were 47 children with ANSD in the study sample. Results Sixty-four percent of children with ANSD have hearing sensitivity loss ranging from mild to severe degree, and the remaining have profound hearing loss. At three years, 27 children used hearing aids, 19 used cochlear implants, and one child did not use any hearing device. Thirty percent of children have disabilities in addition to hearing loss. On average, there were no significant differences in performance level between children with and without ANSD. Also, the variability of scores was not significantly different between the two groups. Conclusions There was no significant difference in performance levels or variability between children with and without ANSD, both for children who use hearing aids, and children who use cochlear implants.

show abstract

“…Two prescriptive methods have been widely validated for children who wear HAs: the National Acoustics Laboratories Nonlinear Formula, Version 2 (NAL-NL2; Keidser et al, 2011) and the Desired Sensation Level multistage input/output, Version 5 (DSL m i/o; Scollie et al, 2005). Both formulae have been validated for use with children, including a randomized controlled trial where equivocal results were observed among children fitted with each formula (Ching et al, 2013a). Hearing aid fittings that more closely approximate prescriptive targets have been shown to provide more consistent speech audibility across a range of degrees of hearing loss than fittings with significant deviations (McCreery et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

A randomized controlled comparison of NAL and DSL prescriptions for young children: Hearing-aid characteristics and performance outcomes at three years of age

Cited by 20 publications

References 46 publications

Characteristics of Hearing Aid Fittings in Infants and Young Children

Characteristics of Hearing Aid Fittings in Infants and Young Children

Impact of the presence of auditory neuropathy spectrum disorder (ANSD) on outcomes of children at three years of age

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

Contact Info

Product

Resources

About