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Functional Assessment of Children with Hearing Loss and Auditory
Listening Differences
Erin C. Schafer, Ph.D.Associate Professor, Audiology
UNIVERSITY OF NORTH TEXASDepartment of Speech and Hearing Sciences
UNT Speech and Hearing Center
•Hearing services:•Audiol. evaluations•Hearing aids•Cochlear implant programming
•Vestibular testing•Educational consulting:
• 2 large school districts
UNT Speech Perception Laboratory
•Mission: Improve communication abilities of children and adults with hearing loss!•Assessment:
• Speech recognition: noise
•Amplification:• FM Systems/DM
• Hearing Aids• Cochlear Implants
Opening Considerations
www.handsandvoices.org
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Please share…..
• How do you define an evaluation in the child’s customary environment?
• Classroom observation?
• Speech recognition in noise?
• Teacher questionnaires?
• AAA Remote Guidelines: http://www.audiology.org/resources/documentlibrary/documents/hatguideline.pdf
Evidence‐Based Practice + Educational Hearing Services
Should we develop ongoing evidence‐based protocols in the provision of
hearing services?
II. Validation of HAT efficacy &
effectiveness
I. Functional evaluation protocol for assessing educ. need for HATa. specific to various populationsb. supported by up-to-date
research evidence
EBP + Ed. hearing services
Current Best Evidence
Student Characteristics
& Preferences
Clinical Expertise &
Savvy
EBP + Educational Hearing Services = Awesomeness
Determining Educational Need
• IDEA: an evaluation in the child’s customary environment• 1. Cite acoustics research & measure classroom acoustics
• 2. Perform classroom observation
• 3. Measure speech recognition & comprehension
• 4. Utilize teacher questionnaires
• 5. Other informal assessments: interviews, academic standing, review file, & trial period
• 6. Cite research on the population you are assessing
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EB Component #1: Cite Literature on Classroom Acoustics
•1a. Begin with Guidelines:•ASHA
–Acoustics in Educational Settings (2005)
•ANSI S12.60‐2010–Acoustical Performance Criteria, Design Requirements and Guidelines for Schools
•Offer guidelines for:–1. Unoccupied noise levels: 35 dBA–2. Reverberation times: .6 to .7 seconds
–3. Signal‐to‐noise ratio: +15 dB
1a. Noise Criteria Ratings
Noise Criteria (NC) Rating
› Single number to describe noise level based on series of frequency‐intensity curves›Derived from equal loudness curves consistent with human hearing
›Suggested ratings given for various facilities (e.g. worship centers, performance halls)
1a. AAA Guideline 1b. What are the acoustics of typical classrooms?
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1b. Study One: Classroom Acoustics
•Knecht, Nelson, & Whitelaw (2002)• 32 classrooms selected randomly from 3 school districts
• Included 12 newer schools in suburban areas, 12 in older in suburban areas, 8 in rural areas
• Averaged sound level meter measurements at 5 points in each classroom
1b. Unoccupied Noise in Typical Classrooms
Range:34 to 66 dBA
4 met level
Fish Tank
* HVAC on
1b. Reverberation in Typical Classrooms
Knecht, Nelson, & Whitelaw (2002)
Range:0.2 to 1.27 sec
10 met level
1b. Reverberation in Typical Classrooms
Knecht, Nelson, & Whitelaw (2002)
• Larger roomshad longerreverberationtimes
• Rooms with lowerceilings (< 10 ft.)were more likely to meet RT criteria
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1b. Effects of Reverberation
Reverberation masks direct sound energy by reflected energyReflected signals are temporally delayed and reach child’s ear same time as a direct signal
Words may overlap causing alterations to temporal aspects of speech
Causes prolongation of spectral energy (no gaps)Primarily vowel energy in low‐frequency region
These low‐freq intense vowels then mask consonants (particularly consonants in the final position)
1b. Study Two: Classroom Acoustics
• Nelson, Smaldino, Erler, & Garstecki (2007/2008)• 36 classrooms including urban and suburban
• 16 were built after 2002: “new”• 20 built prior to 1960: “old”• Averaged 5head‐level sound level meter measurements in each room
• Determined noisecriteria (NC) rating
• Measured reverb.
1b. Unoccupied Noise (dBA)
“New” Range: 31 - 53 dBA“Old” Range: 34 - 54 dBA
Rooms for DHH
Significant Difference
Mostly window unit HVAC Central HVAC
1b. Noise Criteria Ratings
Rooms for DHH
Only 2 classrooms met the recommended NC Rating
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1b. Reverberation Times
“New” Range: .4 - .6 s“Old” Range: .5 - .6 s
All met except 1
Most rooms carpeted and had ceiling tiles; absorptive materials were covering
almost all wall space
1b. Studies on Signal‐to‐Noise Ratio
Typical occupied classrooms:
Sanders (1965) reports average SNRs from 47 classrooms
17 Kindergarten: ‐1 dB
12 Elementary: +5
12 High school: +5
Arnold & Canning (1999 ) report typical occupied classrooms as loud as 73 dB
With typical conversational speech is around 55 dB, this could result in a ‐18 SNR
1b. Study Three: Occupied Classroom Acoustics
• Cruckley et al. (2011)
• Noise levels varyacross & within children’s listening environments
Dosimeter measurements
71 73
61 63
75% of the day sound levels between 60 to 80 dBA
1b. Occupied Classroom Acoustics
• Cruckley et al. (2011)
•Dosimeter measurement throughout the day in various children’s listening environments
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1b. Occupied Classroom Acoustics
• Cruckley et al. (2011)
Dosimeter measurements Toddler Room at Daycare
1b. Occupied Classroom Acoustics
• Cruckley et al. (2011)
Dosimeter measurementsPre-school Room at Daycare
1b. Occupied Classroom Acoustics
• Cruckley et al. (2011)
Dosimeter measurementsElementary School
1. Occupied Classroom Acoustics
• Cruckley et al. (2011)
Dosimeter measurementsHigh School
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1b. What’s missing from ASHA & ANSI
recommendations?
• Issues related to distance from the teacher:
• Not every seat provides a high‐quality speech signal from teacher
• These effects examined by Leavitt & Flexer (1991)
• Used Rapid Speech Transmission Index (RASTI) to examine fidelity of speech at various locations in a typical classroom
• Incorporates perception of sound and speech intelligibility of normal‐hearing listeners
Ear & Hearing, 12
1b. Issues Related to Distance
• Leavitt & Flexer (1991)–Combines effects of
unoccupied noise,
reverberation, & SNR
–Less critical speech
information as
distance increases
–Perfect RASTI
transmission = 1.0
Transmitter
Best
Worst!
Ear & Hearing, 12
1b. Issues Related to Distance
•Crandall & Smaldino (2000)• Measured children’s speech perception at various distances from teacher
• Room with RT of .45 s• 6 ft: 89% • 12 ft: 55%• 24 ft: 36%
1b. OK…so what do I do with this info?
•1. Use it in your reports!•I use citations in my reports (see reference list provided)
• Yes…I will admit this is dorky, but it seems to get attention, and it is EVIDENCE‐BASED PRACTICE
• Since I started doing this, teachers, parents, administrators, deaf educators, etc. request the articles
•See sample report in handouts
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1c. Measure Classroom Acoustics
•Anyone can easily assess classroom acoustics with a smartphone and an app!•ASHA & ANSI:
• Unoccupied noise: 35 dBA
• Reverberation: 0.7 seconds
• Estimate SNR
1c. Measuring Classroom Acoustics
•Ostergren & Smaldino: Journal of Educational Audiology (2012)
Figure 1. AudioToolsApp from Studio Six Digital.
1c. AudioTools: Studio Six Digital
Figure 2. iPhone with Analog Sound Level Meter App running.
1c. AudioTools: Studio Six Digital
Figure 3. Sound study graph of an unoccupied classroom.
This can also be done in
an occupiedclassroom
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1c. AudioTools: Studio Six Digital
Figure 5. RT60 measures displayed in octave bands.
.45 seconds
Determining Educational Need
• IDEA: an evaluation in the child’s customary environment• 1. Cite acoustics research & measure classroom acoustics
• 2. Perform classroom observation
• 3. Measure speech recognition & comprehension
• 4. Utilize teacher questionnaires
• 5. Other informal assessments: interviews, academic standing, review file, & trial period
• 6. Cite research on the population you are assessing
EB Component #2: Perform a Classroom Observation
•Assess the child’s listening behaviors during direct instruction:
• Where is child seated?
• Unusual ambient noise in room?• On/off‐task behavior relative to other children?
• Independent worker?• Need help from other students?• Class participation? • Student interview: ask about hearing specific teachers
See sample observationform in digital handouts
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EB Component #3: Assess speech recognition and comprehension
•Speech Recognition in Noise•Recommended by HAT guideline
• Please note the importance of using materials with list equivalency in noise (equal difficulty)
• If they are not equal, you cannot use them to compare conditions: FM vs. no FM
3. Assessing Speech Recognition in Noise
•Adolescent/Adult tests designed for use in noise:•HINT‐C: Starkey Pro•Connected Speech Test (CST): Robyn Cox, http://www.memphis.edu/ausp/harl/ ($50)
•BKB‐SIN: Etymotic ($195)•Quick‐SIN: Etymotic ($160)
3. Assessing Speech Recognition in Noise
•Pediatric Tests Designed for Use in Noise:• BKB‐SIN: Ages 6+• HINT‐C: Ages 5+
Schafer, J Ed Aud, 2010
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3. Assessing Speech Recognition in Noise Pediatric Tests Designed for Use in Noise:
›PSI: Ages 3+›LiSN‐S:
Problems:›Limited number of tests›Cannot use standard clinical tests because of vocabulary level and lists not equivalent in noise: WIPI, PBK, NU‐CHIPS, NU‐6, W‐22
›Only test for young children, requires fixed intensities: longer test time, multiple lists, what SNR?, ceiling/floor effects
3. Speech Recognition
• Stimuli:– Phrases in Noise Test (PINT): children 3+
– BKB‐SIN: children 6 years+ and adults
• Conditions:– No FM
– FM 1– FM 2 (if applicable)
• Test Environment:– Soundbooth: speakers at 0 and 180°azimuth, transmitter placed 3 to 6” from signal speaker
– Classroom
3. Speech Recognition: BKB‐SIN
•18 list pairs equated for difficulty•Each pair has 8‐10 sentences and takes approximately 3 minutes to administer and score
•Score based on number of key words repeated correctly, then use formula to calculate SNRloss
•Recorded Split track or Standard CD
3. Speech Recognition: PINT
Lab Goal: Create or assess reliability and validity of new speech recognition tests:
›Phrases in Noise Test (PINT) Initial stimuli used in Schafer & Thibodeau, 2006
New version: Schafer et al., 2012 Available via email: [email protected]
•AzBio Sentence Lists in Noise (> 9 years)• Sphar & Dorman, Arizona State, $155
• http://auditorypotential.com/
• Listening Comprehension Test 2• Recorded existing test in background noise
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3. Phrases in Noise Test (PINT) Is it needed?
›1. There is no sensitive speech recognition test in noise for young children Current tests are not designed for testing in noise (NU‐CHIPS, WIPI, PBK) or they are subject to ceiling effects (PSI)
›2. We need a reliable, valid, and portable speech‐in‐noise test for young children to: Examine those who are at‐risk for listening difficulties in the classroom
Assess “educational need” for assistive technology Measure the benefit from assistive technology (i.e., FM systems)
Schafer et al., 2012, Ear & Hearing
3. PINT Goals
•Goals of study:•1. Create a reliable and valid
test for 3‐6 year olds•2. Equipment & set‐up for real
classrooms or soundbooth•3. Normative data on 3‐6 year
olds: NH & CIs•4. Assess effects of spatial
separation of speech and noise sources
Schafer et al., 2012, Ear & Hearing
3. PINT: Stimuli
• PINT consists of 12 phrases–May be acted out with a doll & objects–Sample phrases:
• Phrases are of equal duration & equal intelligibility in 4‐classroom noise
–Pilot data with 20 adults established that the phrases were equally‐intelligible in noise
Brush his teeth Comb his hair Pull his toes
Find his shoe Blow his nose Hide his face
Schafer et al., 2012, Ear & Hearing
3. PINT Scoring
• Estimates 50% correct speech‐in‐noise thresholds (e.g., BKB‐SIN)
–Conditions:–1. Speech/noise: same loudspeaker (S0/N0)
–Speech/noise: separate loudspeakers (S0/N180)
HARDER EASIERTHRESHOLD = -1.5 dB
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3. PINT Equipment/Set‐up
Desk with Signal/Noise Speaker
Desk with Noise Speaker
Boom Box
Examiner
Child
SpeakerWire
1. Attached speaker wire to boom box speakers
2. Placed speakers on desksequidistant to child’s seat (3 feet)
4. Verified output of eachspeaker using calibrationtrack on CD and radio shack SLM
3. PINT Results: Normal Hearing
• Good test‐retest reliability (each child repeated 2 lists)
• Significant effect of spatial separation (S0/N0 and S0/N180)
• 3‐year‐old children perform significantly worse in noise than children ages 4 ‐6 years and adults
-16.0
-14.0
-12.0
-10.0
-8.0
-6.0
-4.0
-2.0
0.0
3 4 5 6 Adult
Th
res
ho
ld i
n N
ois
e (d
B S
NR
)
Age Group
S0/N0
S0/N180
Schafer et al., 2012, Ear & Hearing
3. PINT Results: Hearing Loss
No group comparisons because of small samples Significant effect of spatial separation (S0/N0 and S0/N180)
-6
-4
-2
0
2
4
6
8
Bilateral CI Bilateral HA Bimodal
PIN
T T
hre
sho
ld i
n d
B S
NR
Group
S0/N0
S0/N180
n=13 n=10 n=6
3. PINT Results: NH vs. Hearing Loss
-16-14-12-10
-8-6-4-2024
Th
resh
old
in
No
ise
(dB
SN
R)
Group
S0/N0
S0/N180
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3. PINT vs. Teacher S.I.F.T.E.R.
•Significant medium to large correlations for all Preschool S.I.F.T.E.R. areas
• Poorer PINT performance related to poorer teacher ratings
R² = 0.5595
0
2
4
6
8
10
12
14
‐2 0 2 4 6 8
Average S.I.F.T.E.R. Rating:
Attention
S0/N0 Threshold in Noise (dB SNR)
3. AzBio Sentence Lists
•Used in several CI research studies: Spahr & Dorman, 2004; Gifford et al, 2008; Spahr et al, 2011, 2012
•CD version: • 15 lists: Channel 1 • 10‐talker babble: Channel 2• Four talkers: 2 male; 2 female
3. AzBio Sentence Lists
•No clear evidence: list equivalency in noise
•Our Method: •Assessed equivalency of all 15 lists in noise‐‐
• 14 adults with normal‐hearing sensitivity at 0 SNRand ‐3 SNR
• 12 adults and adolescents with CIs +10 SNR
Schafer et al., 2012, JAAA
3. AzBio List Equivalency: NH
Not equivalent: 1, 6, 7, 12, & 14 different from more than one other list
0102030405060708090
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Ave
rage
% C
orre
ct S
core
List Number
0 SNR-3 SNR
Schafer et al., 2012, JAAA
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3. AzBio List Equivalency: CI
0102030405060708090
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Ave
rage
% C
orre
ct S
core
List Number
Not equivalent Deleted 1, 6, 7, 12, & 14: now equivalent
Schafer et al., 2012, JAAA
3. Group Comparison
•Significant difference between 0 vs. +10•Same for ‐3 vs. +10: 13 dB difference!!!
Schafer et al., 2012, JAAA
NH: 0NH: -3
CI: +10
3. Listening Comprehension
• Valente et al. (2012)
• Examined speech recognition & comprehension of NH students for two tasks: discussion and lecture
• Tested at +5 and +10 SNR and at two reverberation times:.6 and 1.5 seconds
• Performance compared to adults and to sentence recognition in the same conditions
3. Listening Comprehension
• Speech recognition ≠ comprehension
• Valente et al., 2012
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3. Listening Comprehension
Significant effect of age
Significant effect of SNR condition
Significant effect of RT condition
3. Listening Comprehension
• What specific areas of comprehension most affected? • Tested listening comprehension in 18, 6‐10 yr olds
• Listening Comprehension Test 2 (Linguisystems):• 1. main idea
• 2. details
• 3. reasoning
• 4. vocabulary
• 5. understanding messages
Schafer et al., 2013, J Educ Audiol
Compared performance to 95% confidenceintervals in quiet from test manual
3. ListeningComp.Results
0
2
4
6
8
10
12
14
16
6;9
6;10
6;11
7;6
8;2
8;5
8;11
8;11
9;0
9;1
9;11
10;1
10;3
10;4
10;7
10;8
10;11
10;9
DetailsRaw
Scores
Age (yrs;mo)
Score
CI 95%
0
2
4
6
8
10
12
14
16
6;9
6;10
6;11
7;6
8;2
8;5
8;11
8;11
9;0
9;1
9;11
10;1
10;3
10;4
10;7
10;8
10;11
10;9
Main Idea
Raw
Scores
Age (yrs;mo)
Score
CI 95%
Main Idea: 9 above; 9 below
Details: 2 above; 14 below
3. ListeningComp.Results
0
2
4
6
8
10
12
14
6;9
6;10
6;11
7;6
8;2
8;5
8;11
8;11
9;0
9;1
9;11
10;1
10;3
10;4
10;7
10;8
10;11
10;9
Rea
soningRaw
Scores
Age (yrs;mo)
Score
CI 95%0
Reasoning: 1 above; 17 below
0
2
4
6
8
10
12
14
16
6;9
6;10
6;11
7;6
8;2
8;5
8;11
8;11
9;0
9;1
9;11
10;1
10;3
10;4
10;7
10;8
10;11
10;9
Vocabulary Raw
Scores
Age (yrs;mo)
Score
CI 95%0
Vocabulary: 8 above; 10 below
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3. Listening Comp. Results
• Overall:
• Children have
poorer comp. in
background noise
• Most difficulty:
details, reasoning,
& unders. messages
• New research suggests that these findings relate to working memory
• Although we cannot sell the stimuli, you could do this test live voice with background
noise
0
2
4
6
8
10
12
14
16
6;9
6;10
6;11
7;6
8;2
8;5
8;11
8;11
9;0
9;1
9;11
10;1
10;3
10;4
10;7
10;8
10;11
10;9
Understanding M
essages Raw
Scores
Age (yrs;mo)
Score
CI 95%0
Unders. Mess.: 5 above; 13 below
3. What does this mean??
•1. Recogni on ≠ Comprehension
•2. We can do better than recognition
•3. This is critical for determining educational need
in children
•4. Specific areas of comprehension affected by
noise:
•Details, reasoning, vocabulary, understanding messages
•½ are able to identify the main idea, which is similar to
recognition
3. Listening Comprehension & Working Memory
•Sullivan, Homira, & Schafer, submitted• Examined relationship between two skills in quiet and in noise: 20 NH children
• Sections of Listening Comprehension Test 2• Backward digit recall and listening recall: subsets from the Working Memory TestBattery for Children (WMTB‐C)
3. Working Memory
29.9
20.6
0
5
10
15
20
25
30
35
40
Quiet Noise
AUDITORY WORKING M
EMORY TO
TAL
CONDITION
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3. Listening Comprehension
1.0 1.0
0.8
1.0 1.01.0
0.7
0.1
0.5
0.6
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
Main Idea Details Reasoning Vocabulary Und. Mess.
Listening Comprehension Score
Listening Test2 SubtestQuiet Noise
3. Listening Comprehension vs. Working Memory: Quiet
0
1
2
3
4
5
6
20 22 24 26 28 30 32 34 36 38 40
Listening Comprehension Total: Quiet
Auditory Working Memory Total: Quiet
r = .50
3. Listening Comprehension vs. Working Memory: Noise
0
1
2
3
4
5
6
10 15 20 25 30 35
Lis
ten
ing
Com
pre
hen
sion
Tot
al:
Noi
se
Auditory Working Memory Total: Noise
r = .75
3. Listening Comprehension vs. Working Memory: Noise
0.0
1.0
2.0
3.0
4.0
5.0
10 12 14 16 18 20 22 24 26 28 30
Vocabulary Sbbtest: Noise
Backward Digit Recall in Noise
r = .71
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EB Component #4: Teacher & Student Questionnaires
•Almost all of our research includes questionnaires, which correlate to behavioral results
• SIFTER: Screening Instrument for Targeting Educational Risk
• CHAPS: Children’s Auditory Performance Scale
• LIFE: Listening Inventory for Education
• www.successforkidswithhearingloss.com
Incorporates classroom acoustics
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Determining Educational Need
• IDEA: an evaluation in the child’s customary environment• 1. Cite acoustics research & measure classroom acoustics
• 2. Perform classroom observation
• 3. Measure speech recognition & comprehension
• 4. Utilize teacher questionnaires
• 5. Other informal assessments: interviews, academic standing, review file, & trial period
• 6. Cite research on the population you are assessing
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EB Component #5: Other Informal Evaluations
•Parent/Student Interview:
–Ask about listening problems in
specific classes (e.g., science)
–Ask student/parent about grades
–Ask parent about concerns
–Ask student about hearing different
teachers
–Ask parent about hearing aid use/
problems with hearing aids
5. Other Informal Evaluations
•Review of Sp Ed File:• Audiological evaluations
• Noted teacher concerns
• Other evaluations (OT, PT, Autism, Medical, etc.)
• Review communication assessment from AI evaluation
• Review speech‐language evaluation & goals from SLP
• Oral/reading comprehension tests given in classroom
•Neale Analysis of Reading Ability (NARA), Oral and Written Language Scales (OWLS)
5. Other Informal Evaluations
•Academic standing• Should not be a major contributing factor• BIG difference between academic need and educational need
• Jake’s story
5. Other Informal Evaluations
•Trial with device• AT Specialist will train school staff on use and maintenance of equipment followed by 6 week trial
• Pre‐post measures:
• Classroom observation
• Teacher questionnaires• Teacher, parent, student interview
• Summary report created; Schedule IEP meeting/ARD meeting
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EB Component #6: Cite Research
• All children are affected: classroom noise,
reverberation, signal‐to‐noise ratios, and distance
from the teacher
Teachers suffer from significant vocal fatigue!
Data for several populations:
Normal hearing Mild to moderate SNHL
Younger students Cochlear implants
English language learners Autism spectrum disorders
Otitis Media ADHD
Unilateral hearing loss
Mild or minimal hearing loss
6. Children with Normal Hearing•Finitzo‐Heiber & Tillman (1978)
• Examined word recognition of 12 children with normal hearing
• Tested in noise and reverberation conditions
Scores decrease asreverberation and
noise increase
Even in a quiet room, scores in the presence of long
RTs declined to 80%
In a typical classroom with+6 SNR and 0.8 RT,
scores declined to 60%
6. Younger Listeners • Jamieson, Kranjc, Yu, Hodgetts (2004)
• Speech recognition in noise of 40 children in Kindergarten, 1st, 2nd, and 3rd grades
Similar
Significantly different
Older can toleratehigher levels of
classroom noise, butyounger cannot
UnfortunatelyKindergarten rooms
are the noisiest Sanders (1965)
JAAA, 15(7)
•Nelson, Kohnert, Sabur, & Shaw (2005)
• Examined speech recognition of 7 English only speakers and 15 Spanish speakers
6. English Language Learners
Similar performance in quiet
Significantly poorer performance in noise
Lang., Speech, Hearing Services in Schools, 36
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6. Children with OM
•Gravel & Wallace (1992)
• Speech recognition using adaptive stimuli: 13 children with OM‐ and 10 children with OM+
Better
High Risk
Full Term
Significantlypoorer
6. Children with Unilateral Loss
•Bess, Tharpe, & Gibler(1986)• Speech perception of 25 children with mild to severe unilateral hearing loss; 25 with normal hearing
Similar performance in quiet
Dark Bars = NH, White Bars = HI speech at betterGray Bars = HI speech at worse ear
Significantly worse in noise
6. Children with Mild/Minimal SNHL
•Alarming number of children,
many not be identified
• Niskar et al. (1998) [JAMA 279(14)]
• 14.9% of 6166 children, ages 6 to 19, hadlow‐frequency or high‐frequency hearing
loss of 16‐dB HL or greater
• Bess, Dodd‐Murphy, & Parker (1998)
• 11.3% of 1218 3rd through 9th grade students had hearing loss > 20 dB HL
6. Children with Minimal SNHL
•Children mild/ minimal SNHL:• Crandell, Smaldino, & Flexer (1995)
• Compared speech perception of normal‐hearing to children with minimal degrees of SNHL
Consistently poorer performancein noise for children with hearing loss
Similar performance in quiet
In Book: Sound-field FM Amplification Theory and Practical Applications
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6. Children with Mild‐Mod SNHL
•Finitzo‐Heiber & Tillman (1978)• Word recognition: 12 normal‐hearing children vs. 12 with hearing impairment
• Tested in noise and reverberation conditions
In a quiet room, scores in the presence of long
RTs declined to below 70%
In a typical classroom with+6 SNR and 0.8 RT,
scores declined to 50%
Scores decrease as noise andreverberation increase, significantlyWorse performance than NH children
in previous slide
6. Children with Cochlear Implants
•Schafer & Thibodeau (2004)• 10 normal‐hearing adults; 8 with CIs
• Speech recognition significantly poorer for CI group
Similar decrement noted for children between quiet and noise conditions(Davies et al, 2001; Schafer & Thibodeau, 2003, 2006)
6. Children with ASD & ADHDLower scores are better!
-14
-12
-10
-8
-6
-4
-2
0
No FM: ASD & ADHD No FM: Typical FM: ASD & ADHD
BK
B-S
IN T
hre
sho
ld i
n d
B S
NR
Condition: Group
Significantly poorer than typical peers
Same as peers when using FM
p < .001 p > .05
Schafer et al., 2012, J Comm Dis
6. Teachers
•Roy et al. (2004)• Prevalence of teachers who had voice disorders
• During lifetime, teachers had significantly more voice disorders versus non‐teachers
• More likely to consult physician or SLP
• Woman higher prevalence than men
Average: 58%
Average: 29%
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Determining Educational Need
• IDEA: an evaluation in the child’s customary environment• 1. Measure classroom acoustics
• 2. Perform classroom observation
• 3. Measure speech recognition & comprehension
• 4. Utilize teacher questionnaires
• 5. Other informal assessments: interviews, academic standing, review file, & trial period
• 6. Cite research on the population you are assessing
Summary .…Yay!!
•Classroom acoustics does not have to be boring.•OK…maybe the guidelines are boring, but…assessing acoustics with an app is FUN!
•Observing children in their customary environment is INTERESTING!
•Assessing speech recognition and comprehension in noise out in a child’s classroom is pretty EXCITING!
•Teacher questionnaires are super NEAT!•Other assessments are extremely HELPFUL!
•Don’t be afraid to use research on populations!
What do you do once you find educational need?
1. Classroom modifications
2. Behavioral management
3. Amplification & Wireless Tech
1. Classroom Modifications
http://www.allnoisecontrol.com/
III. Modifications
Lower ceilings are better, install ceiling tiles, baffles,
banners
Using carpet and rugs, or adding tennis balls or rubber tips to legs of chairs, desks,
and tables
Drapes, panels, corkboard, or
acoustical fabrics on windows and walls
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2. Behavior Management: Occupied Noise Management Techniques
Non‐verbal cues to get attention:1. Light switch or hand signals
to gain attention
2. Hands up, mouths closed3. Noise Thermometer4. Monkey Meter
5. Chatter Tracker6. Talk Light: $7507. Yacker Tracker:
$40–100
33 44
55
66 77
2. Calmness Counter
• http://www.ictgames.com/resources.html
2. Occupied Noise Management Techniques
•Get the entire school involved to reduce noise in hallways:
• Line leader reviews hallway rules before leaving classroom
• Line leader carries a quiet sign in the halls
• Whole school implements a quiet hand signal
NECKLOOP
PhonakML 12i
PhonakMLxi
PhonakMyLink+
OticonAmigoR2
OticonAmigo
R7
OticonArc
DEDICATEDUNIVERSAL
PhonakML14i for Nucleus 5
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3. Amplification: Personal DevicesNormal Hearing
Phonak DynamicSoundfield
Oticon Amigo Star Phonak iSense Micro
If you have questions…
• Email:• [email protected]
Helpful References! Erin C. Schafer, Ph.D.
Typical Classroom Acoustics Arnold, P., & Canning, D. (1999). Does classroom amplification aid comprehension? British Journal of
Audiology, 33(3), 171-178. Bess, F. H., Sinclair, J. S., & Riggs, D. E. (1984). Group amplification in schools for the hearing impaired. Ear
& Hearing, 5(3), 138-144. Crandell, C. & Smaldino J. (1996). An update of classroom acoustics for children with hearing impairment.
Volta Review, 1, 4-12. Cruckley, J., Scollie, S., & Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of
Educational Audiology, 17, 23-35. Knecht, H. A., Nelson, P. B., Whitelaw, G. M., & Feth, L. L. (2002). Background noise levels and reverberation
times in unoccupied classrooms: predictions and measurements. American Journal of Audiology, 11, 65-71.
Leavitt, R., & Flexer, C. (1991). Speech degradation as measured by the Rapid Speech Transmission Index (RASTI). Ear Hear, 12(2), 115-118.
Markides, A. (1986). Speech levels and speech-to-noise ratios. British Journal of Audiology, 20, 115-120. Nelson, E. L.., Smaldino, J., Erler, S., Garsteki, D. (2007/2008). Background Noise Levels and Reverberation
Times in Old and New Elementary School Classrooms Journal of Educational Audiology, 14, 12-18. Sanders, D. A. (1965). Noise Conditions in Normal School Classrooms. Except Child, 31, 344-353.
Recommended Classroom Acoustics & Measuring Acoustics American National Standards Institute. (2010). American National Standard Acoustical Performance Criteria,
Design Requirements, and Guidelines for Schools, Part 1: Permanent Schools (No. ANSI S12.60-2010). Melville, NY.
American Speech-Language-Hearing Association. (2005). Acoustics in educational settings: Position statement. [Position Statement]. Available from www.asha.org/policy.
Ostergren, D., & Smaldino, J. (2013). Technology in educational settings: It may already be in your pocket or purse! Journal of Educational Audiology, 18, 10-13.
Effects of Noise on Younger Listeners Eisenberg, L. S., Shannon, R. V., Martinez, A. S., Wygonski, J., & Boothroyd, A. (2000). Speech recognition
with reduced spectral cues as a function of age. Journal of the Acoustical Society of America, 107(5 Pt 1), 2704-2710.
Elliott, L. L. (1979). Performance of children aged 9 to 17 years on a test of speech intelligibility in noise using sentence material with controlled word predictability. Journal of the Acoustical Society of America, 66(3), 651-653.
Elliott, L. L., Connors, S., Kille, E., Levin, S., Ball, K., & Katz, D. (1979). Children's understanding of monosyllabic nouns in quiet and in noise. Journal of the Acoustical Society of America, 66(1), 12-21.
Gravel, J. S., Fausel, N., Liskow, C., & Chobot, J. (1999). Children's speech recognition in noise using omni- directional and dual-microphone hearing aid technology. Ear and Hearing, 20(1), 1-11.
Jamieson, D. G., Kranjc, G., Yu, K., & Hodgetts, W. E. (2004). Speech intelligibility of young school- aged children in the presence of real-life classroom noise. J Am Acad Audiol, 15, 508-517.
Schafer, E. C., Beeler, S., Ramos, H., Morais, M., Monzingo, J., & Algier, K. Developmental effects and spatial hearing in young children with normal-hearing sensitivity. Ear Hear, 33(6), e32-43.
Soli, S. D., & Sullivan, J. A. (1997). Factors affecting children's speech communication in classrooms. Journal of the Acoustical Society of America, 101, S3070.
Stelmachowicz, P. G., Hoover, B. M., Lewis, D. E., Kortekaas, R. W., & Pittman, A. L. (2000). The relation between stimulus context, speech audibility, and perception for normal-hearing and hearing-impaired children. Journal of Speech, Language, and Hearing Research, 43(4), 902-914.
Effects of Noise: Normal Hearing Listeners Dubno, J. R., Dirks, D. D., & Morgan, D. E. (1984). Effects of age and mild hearing loss on speech recognition
in noise. Journal of the Acoustical Society of America, 76(1), 87-96. Duqesnoy, A. J., & Plomp, R. (1983). The effect of hearing aid on the speech-reception threshold of hearing-
impaired listeners in quiet and noise. Journal of the Acoustical Society of America, 73(2166-2173). Erber, N. P. (1971). Auditory and audiovisual reception of words in low-frequency noise by children with normal
hearing and by children with impaired hearing. Journal of Speech and Hearing Research, 14, 496-512.
Finitzo-Hieber, T., & Tillman, T. (1978). Room acoustics effects on monosyllabic word discrimination ability for normal and hearing impaired children. Journal of Speech and Hearing Research, 21, 440-458.
Valente, D. L., Plevinsky, H. M., Franco, J. M., Heinrichs-Graham, E. C., & Lewis, D. E. (2012). Experimental investigation of the effects of the acoustical conditions in a simulated classroom on speech recognition and learning in children. J Acoust Soc Am, 131(1), 232-246.
Nabelek, A., & Pickett, J. M. (1974). Monaural and binaural speech perception through hearing aids under noise and reverberation with normal and hearing-impaired listeners. Journal of Speech and Hearing Research, 17, 724-739.
Nabelek, A., & Pickett, J. M. (1974). Reception of consonants in a classroom as affected by monaural and binaural listening, noise, reverberation, and hearing aids. Journal of the Acoustical Society of America, 56, 628-639.
Effects of Noise: English Language Learners Crandell, C.C. & Smaldino, J.J. (1996). Speech perception in noise by children for whom English is a second
language. American Journal of Audiology, 5, 47-51. Hasegawa, M., Carpenter, P. A., & Just, M. A. (2002). An fMRI study of bilingual sentence comprehension and
workload. Neuroimage, 15(3), 647-660. Nabelek, A.K. & Donahue, A.M. (1984). Perception of consonants in reverberation by native and non-native
listeners. Journal of the Acoustical Society of America, 75, 632-634. Nelson, P., Kohnert, K., Sabur, S., & Shaw, D. (2005). Classroom noise and children learning through a
second language: double jeopardy? Lang Speech Hear Serv Sch, 36(3), 219-229. Takata, Y. & Nabelek, A.K. (1990). English consonant recognition in noise and in reverberation by Japanese
and American listeners. Journal of the Acoustical Society of America, 88, 663-666.
Effects of Noise: Hearing Loss and Hearing Aids Crandell, C. (1992). Noise effects on the speech recognition of children with minimal hearing loss. Ear and
Hearing, l7, 210-217. Crandell, C. & Flannagan, R. (1999). Effects of conductive hearing loss on speech recognition in quiet and
noise. Journal of Educational Audiology, 8, 5-14. Dubno, J. R., Dirks, D. D., & Morgan, D. E. (1984). Effects of age and mild hearing loss on speech recognition
in noise. Journal of the Acoustical Society of America, 76(1), 87-96. Duqesnoy, A. J., & Plomp, R. (1983). The effect of hearing aid on the speech-reception threshold of hearing-
impaired listeners in quiet and noise. Journal of the Acoustical Society of America, 73(2166-2173). Erber, N. P. (1971). Auditory and audiovisual reception of words in low-frequency noise by children with normal
hearing and by children with impaired hearing. Journal of Speech and Hearing Research, 14, 496-512. Finitzo-Hieber, T., & Tillman, T. (1978). Room acoustics effects on monosyllabic word discrimination ability for
normal and hearing impaired children. Journal of Speech and Hearing Research, 21, 440-458. Nabelek, A., & Pickett, J. M. (1974). Monaural and binaural speech perception through hearing aids under noise
and reverberation with normal and hearing-impaired listeners. Journal of Speech and Hearing Research, 17, 724-739.
Nabelek, A., & Pickett, J. M. (1974). Reception of consonants in a classroom as affected by monaural and binaural listening, noise, reverberation, and hearing aids. Journal of the Acoustical Society of America, 56, 628-639.
Effects of Noise: Unilateral Hearing Loss Bess, F.H. & Tharpe, A.M. (1986). Case history data on unilaterally hearing-impaired children. Ear and
Hearing, 7, 14-17. Bess, F.H. & Tharpe, A.M. (1986). An introduction to unilateral sensorineural hearing loss in children. Ear
and Hearing, 7, 3-13.
3 Bess, F.H., Tharpe, A.M. & Gibler, A.M. (1986). Auditory performance of children with unilateral sensorineural
hearing loss. Ear and Hearing, 7, 20-26. Culbertson, J.L. & Gilbert, L.E. (1986). Children with unilateral sensorineural hearing loss: cognitive, academic,
and social development. Ear and Hearing, 7, 38-42. Kenworthy, O.T., Klee, T. & Tharpe, A.M. (1990). Speech recognition ability of children with unilateral
sensorineural hearing loss as a function of amplification, speech stimuli and listening condition. Ear and Hearing, 11, 264-270.
Effects of Noise: Cochlear Implants Fetterman, B. L., & Domico, E. H. (2002). Speech recognition in background noise of cochlear implant patients.
Otolaryngology Head and Neck Surgery, 126(3), 257-263. Garnham, C., O'Driscoll, M., Ramsden, & Saeed, S. (2002). Speech understanding in noise with a Med-El
COMBI 40+ cochlear implant using reduced channel sets. Ear and Hearing, 23(6), 540-552. Gantz, B. J., Tyler, R. S., Rubinstein, J. T., Wolaver, A., Lowder, M. W., Abbas, P., et al. (2002). Binaural
cochlear implants placed during the same operation. Otology & Neurotology, 23(2), 169-180. Hamzavi, J., Franz, P., Baumgartner, W. D., & Gstoettner, W. (2001). Hearing performance in noise of
cochlear implant patients versus severely-profoundly hearing-impaired patients with hearing aids. Audiology, 40(1), 26-31.
Nelson, P. B., Jin, S. H., Carney, A. E., & Nelson, D. A. (2003). Understanding speech in modulated interference: cochlear implant users and normal-hearing listeners. Journal of the Acoustical Society of America, 113(2), 961-968.
Schafer, E. C., Pogue, J., & Milrany, T. List equivalency of the AzBio sentence test in noise for listeners with normal-hearing sensitivity or cochlear implants. J Am Acad Audiol, 23(7), 501- 509.
Wolfe, J., Schafer E. C., John, A., Hudson, M. (2011). The effect of front-end processing on cochlear implant performance of children. Otology & Neurotology, 32(4), 533-538.
Effects of Noise: Otitis Media Friel-Patti, S. & Finitzo, T. (1990). Language learning in a prospective study of otitis media with effusion in the
first two years of life. Journal of Speech and Hearing Research, 33, 188-194. Gravel, J.S. & Wallace, I.F. (1992). Listening and language at 4 years of age: effects of early otitis media.
Journal of Speech and Hearing Research, 35, 588-595. Silva, P.A., Kirkland, C., Simpson, A., Stewart, I.A. & Williams, S.M. (1982). Some developmental and
behavioral problems associated with bilateral otitis media with effusion. Journal of Learning Disabilities, 15, 417-421.
Zumach, A., Gerrits, E., Chenault, M. N., & Anteunis, L. J. (2009). Otitis media and speech-in-noise recognition in school-aged children. Audiol Neurootol, 14(2), 121-129.
Other Effects: Listening Comprehension Schafer, E. C., Bryant, D., Sanders, K., Baldus, N., Lewis, A., Traber, J., et al. (2013). Listening comprehension
in background noise in children with normal hearing. Journal of Educational Audiology, 19(58-64). Working Memory Osman, H. & Sullivan, J. (2013). Children’s auditory working memory performance in degraded listening
conditions. Journal of Speech, Language, and Hearing Research, 57(4), 1503-1511. Listening Effort (see pubmed.com for more studies on this): Picou, E. M., & Rickets, T. A. (in press). The effect of changing the secondary task in dual-task paradigms for
measuring listening effort. Ear & Hearing. Ross, M. (1992). Room acoustics and speech perception. In M. Ross (ed.), FM Auditory Training Systems:
Characteristics, Selection, and Use, 40-41. Timonium, MD: York Press. Processing Time: Downs, D., & Crum, M. (1978). Processing demands during auditory learning under degraded listening
conditions. Journal of Speech and Hearing Research, 21, 702-714. Teacher Vocal Fatigue Rogerson, J. & Dodd, B. (2005). Is there an effect of dysphonic teachers’ voices on children’s processing of
spoken language? Journal of Voice, 19(1), 47-60.
Roy, N., Merrill, R.M., Thibeault, S., Parsa, R.A., Gray, S.D., & Smith, E.M. Prevalence of voice disorders in teachers and the general population. Journal of Speech, Language, and Hearing Research, 47(2), 281- 293.
Remote-Microphone Technology Guidelines American Academy of Audiology Clinical Practice Guidelines. (2008, April). Remote Microphone Hearing
Assistance Technologies for Children and Youth from Birth to 21 Years.
FM System Research: Young Children American Speech-Language-Hearing Association. (1991). The use of FM amplification instruments for infants
and preschool children with hearing impairment, ASHA, 33, (suppl.5). 1-2.
Benoit, R. (1989). Home use of FM amplification systems during the early childhood years. Hearing Instruments, 40, 8-10.
Moeller, M.P., Donagy, K.F., Beauchaine, K.L., Lewis, D.E. & Stelmachowicz, P.G. (1996). Longitudinal study of FM system use in non-academic settings: effects on language development. Ear and Hearing, 17, 28- 40.
FM/DM System Research: Normal Hearing Arnold, P. & Canning, D. (1999). Does classroom amplification aid comprehension?. British Journal of
Audiology, 33,171-178. Crandell, C.C., Charlton, M., Kinder, M., and Kreisman, B.M. Effects of portable sound field systems on speech
perception in noise. Journal of Educational Audiology, 9, 8-12. Mendel, L.L., Roberts, R.A., & Walton, J.H. (2003). Speech perception benefits from sound field FM
amplification. American Journal of Audiology, 12(2), 114-124. Picard, M. & Lefrancois, J. (1986). Speech perception through FM auditory trainers in noise and
reverberation. Journal of Rehabilitation Research and Development, 23, 53-62. Rosenberg, G.G., Blake-Rahter, P., Heavner, J., Allen, L., Redmond, B.M., Phillips, J. & Stigers, K. (1999).
Improving classroom acoustics (ICA): a three-year FM sound field classroom amplification study. Journal of Educational Audiology, 7, 8-21.
Schafer, E.C., Bryant, D., Sanders, K., Baldus, N., Algier, K., Lewis, A., Traber, J., Layden, P., Amin, A. (in press). Fitting and verification of frequency modulation (FM) systems on children with normal hearing Journal of the American Academy of Audiology.
Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013). Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System Research: English Language Learners Lederman, N., DeConde Johnson, C., Crandell, C.C. & Smaldino, J.J. (2000). The development and
validation of an "intelligent classroom sound field frequency modulation (FM) system. Journal of Educational Audiology, 8, 37-42.
Nabelek, A.K. & Donahue, A.M. (1986). Comparison of amplification systems in an auditorium. Journal of Acoustical Society of America, 79, 2078-2082.
FM System Research: Auditory Processing Disorder, Autism Spectrum Disorders, ANSD, AD HD, & Other Needs Blake, R., Field, B., Foster, C., Platt, F. & Wertz, P. (1991). Effect of FM auditory trainers on attending
behaviors of learning-disabled children. Language, Speech, and Hearing Services in the Schools, 22, 111-114.
Clarke-Klein, S.M., Roush, J., Davis, K. & Medley, L. (1995). FM amplification for enhancement of conversational discourse skills: case study. Journal of American Academy of Audiology, 6, 230-234.
Flexer, C., Millin, J.P. & Brown, L. (1990). Children with developmental disabilities: the effect of sound field amplification on word identification. Language, Speech and Hearing Services in the Schools, 21, 177- 182.
Flexer, C. & Savage, H. (1993). Use of mild gain amplifier with preschoolers with language delay. Language, Speech, and Hearing Services in the Schools, 24, 151-155.
Friederichs, E. & Friederichs, P. (2005). Electrophysiologic and psycho-acoustic findings following one-year
5 application of personal ear-level FM device in children with attention deficit and suspected central auditory processing disorder, Journal of Educational Audiology, 12, 29-34.
Hornickel, J., Zecker, S. G., Bradlow, A. R., & Kraus, N. Assistive listening devices drive neuroplasticity in children with dyslexia. Proc Natl Acad Sci U S A, 109(41), 16731-16736.
Johnston, K.N., John, A.B., Kreisman, N.V., Hall, J.W. 3rd, Crandell, C.C. (2009). Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48(6), 371-383.
Rance, G., Corben, L. A., Du Bourg, E., King, A., & Delatycki, M. B. (2010). Successful treatment of auditory perceptual disorder in individuals with Friedreich ataxia. Neuroscience, 171(2), 552-555.
Rance, G., Saunders, K., Carew, P., Johansson, M., & Tan, J. (2014). The use of listening devices to ameliorate auditory deficit in children with autism. J Pediatr, 164(2), 352-357.
Schafer, E.C., Bryant, D., Sanders, K., Baldus, N., Algier, K., Lewis, A., Traber, J., Layden, P., Amin, A. (in press). Fitting and verification of frequency modulation (FM) systems on children with normal hearing Journal of the American Academy of Audiology.
Schafer, E. C., Mathews, L., Mehta, S., Hill, M., Munoz, A., Bishop, R., & Maloney, M. (2012). Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): An initial investigation. Journal of Communication Disorders, 46, 40-52.
Schafer, E. C., Traber, J., Layden, P., Amin, A., Sanders, K., Bryant, D., & Baldus, N. (in press). Use of wireless technology for children with APD, ADHD, and language disorders. Seminars in Hearing.
Smith, D.E., McConnell, J.V., Walter, T.L. & Miller, S.D. (1985). Effect of using an auditory trainer on the attentional, language, and social behaviors of autistic children. Journal of Autism and Developmental Disorders, 15, 285-302.
Stach, B.A., Loiselle, L.H., Jerger, J.F., Mintz, S.L. & Taylor, C.D. (1987). Clinical experience with personal FM assistive listening devices. The Hearing Journal, May, 24-30.
FM/DM System Research: Minimal and Mild Hearing Loss Ross, M. & Giolas, T.G. (1971). Effect of three classroom listening conditions on speech intelligibility.
American Annals of the Deaf, 116, 580-584. Sariff, L.S. (1981). An innovative use of free field amplification in regular classrooms. In R. Roeser & M.
Downs (Eds.) Auditory Disorders in School Children (p. 263-272). New York: Thieme Stratton, Inc. Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013).
Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System Research: Unilateral Hearing Loss Bess, F.H., Klee, T. & Culbertson, J.L. (1986). Identification, assessment, and management of children with
hearing loss. Ear and Hearing, 7, 43-51. Updike, C.D. (1994). Comparison of FM auditory trainers, CROS aids, and personal amplification in
unilaterally hearing-impaired children. Journal of American Academy of Audiology, 5, 204-209.
FM System & Digital Transmission Research: Moderate to Profound Hearing Loss and Hearing Aids Anderson, K.L. & Goldstein, H. (2004). Speech perception benefits of FM and infrared devices to children with
hearing aids in a typical classroom. Journal of Speech, Language, and Hearing Services in the Schools, 35(2), 169-184.
Anderson, K. L., Goldstein, H., Colodzin, L., & Iglehart, F. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12, 14-28.
Boothroyd, A. & Iglehart, F. (1998). Experiments with classroom amplification. Ear and Hearing, 19, 207-217. Flynn, T.S. & Gregory, M. (2005). The FM advantage in the real classroom. Journal of Educational Audiology,
12, 35-42. Lewis, M. S., Crandell, C. C., Valente, M., & Horn, J. E. (2004). Speech perception in noise: directional
microphones versus frequency modulation (FM) systems. Journal of the American Academy of Audiology, 15, 426-439.
Nabelek, A.K. & Donahue, A.M. (1986). Comparison of amplification systems in an auditorium. Journal of Acoustical Society of America, 79, 2078-2082.
Nabelek, A.K., Donahue, A.M. & Letowski, T.R. (1986). Comparison of amplification systems in a classroom.
Journal of Rehabilitation Research and Development, 23, 41-52. Noe, C.M., Davidson, S.A. & Mishler, P.J. (1997). The use of large group assistive listening devices with and
without hearing aids in an adult classroom setting. American Journal of Audiology, 6, 48-63. Pittman, A.L., Lewis, D.E., Hoover, B.M. & Stelmachowicz, P.G. (1999). Recognition performance for four
combinations of FM system and hearing aid microphone signals in adverse listening conditions. Ear and Hearing, 20, 279-289.
Ross, M., Giolas, T. & Carver, P. (1973). Effect of classroom listening conditions of speech intelligibility. Language, Speech, and Hearing Services in the Schools, 4, 72-76.
Schafer, E. C., Sanders, K., Bryant, D., Keeney, K., & Baldus, N. (2013). Effects of Voice Priority in FM systems for children with hearing aids. Journal of Educational Audiology, 19, 12-24.
Toe, D. (1999). Impact of FM aid use on the classroom behavior of profoundly deaf secondary students. Seminars in Hearing, 20, 223-234.
Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013). Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System/Digital Transmission Research: Cochlear Implants Aaron, R., Sonneveldt, V., Arcaroli, J., & Holstad, B. (2003, November). Optimizing microphone sensitivity
settings of pediatric Nucleus 24 cochlear implant patients using Phonak MicroLink CI+ FM system. Poster presented at ACCESS: Achieving Clear Communication Employing Sound Solutions - Proceedings of the First International Conference, Chicago, IL.
Acoustical Society of America, (n.d.). Position on the Use of Sound Amplification in the Classroom. Retrieved October 12, 2006 from http://asa.aip.org
Anderson, K. L., Goldstein, H., Colodzin, L., & Iglehart, F. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12, 14-28.
Catlett, D. & Brown, C.J. (2003, November). Optimal audio mix settings for pediatric Clarion cochlear implant patient using a Phonak MicroLink CI-S FM system. Poster presented at ACCESS: Achieving Clear Communication Employing Sound Solutions - Proceedings of the First International Conference, Chicago, IL.
Crandell, C. C., Holmes, A. E., Flexer, C., & Payne, M. (1998). Effects of soundfield FM amplification on the speech recognition of listeners with cochlear implants. Journal of Educational Audiology, 6, 21-27.
Davies, M. G., Yellon, L., & Purdy, S. C. (2001). Speech-in-noise perception of children using cochlear implants and FM systems. Australian and New Zealand Journal of Audiology, 23, 52-62.
Iglehart, F. (2004). Speech perception by students with cochlear implants using sound-field systems in classrooms. American Journal of Audiology, 13, 62-72.
Schafer, E. C., Huynh, C., Romine, D., Jimenez, R. (2012). Speech recognition in noise and subjective perceptions of neckloop FM receivers with cochlear implants. American Journal of Audiology, 22(1), 53-64.
Schafer, E.C. & Kleineck, M.P. (2009). Improvements in speech-recognition performance using cochlear implants and three types of FM systems: A meta-analytic approach. Journal of Educational Audiology, 15, 4-14
Schafer, E. C., Musgrave, E., Momin, S., Sandrock, C., & Romine, D. (2013). A proposed electroacoustic test protocol for personal FM receivers coupled to cochlear implant sound processors. Journal of the American Academy of Audiology, 24(10), 941-954.
Schafer, E. C., Pogue, J., Milrany, T. (2012). Equivalency of the AzBio Sentence Test in noise for listeners with normal-hearing sensitivity or cochlear implants. Journal of the American Academy of Audiology, 23(7), 501-509.
Schafer, E. C., Romine, D., Musgrave, E., Momin, S., & Huynh, C. (2013). Electromagnetic versus electrical coupling of personal frequency modulation (FM) receivers to cochlear implant sound processors. Journal of the American Academy of Audiology, 24(10), 927-940.
Schafer, E. C. & Thibodeau, L.M. (2006). Speech recognition in noise in children with cochlear implants while listening in bilateral, bimodal, and FM-system arrangements. American Journal of Audiology, 15(2), 114-126.
Schafer, E. C. & Thibodeau, L. M. (2004). Speech recognition abilities of adults using cochlear implants interfaced with FM systems. Journal of the American Academy of Audiology, 15(10), 678-691.
7 Schafer, E. C. & Thibodeau, L. M. (2003). Speech recognition performance of children using cochlear implants
and FM systems. Journal of Educational Audiology, 11, 15-26. Schafer, E. C. & Wolfe, J. (2010). Hearing assistance technology for children: candidacy and selection.
Seminars in Hearing, 31(3), 219-232. Schafer, E. C. & Wolfe, J. (2010). Hearing assistance technology for children: candidacy and selection.
Seminars in Hearing, 31(3), 219-232. Schafer, E. C., Wolfe, J., Algier, K., Morais, M., Price, S., Monzingo, J., et al. (2012). Spatial hearing in
noise of young children with cochlear implants and hearing aids. Journal of Educational Audiology, 18, 38-52.
Schafer, E. C., Wolfe, J., Lawless, T., & Stout, B. (2009). Effects of FM-receiver gain on speech-recognition performance of adults with cochlear implants. International Journal of Audiology, 48(4), 196-203.
Wolfe, J., Morais, M., Schafer, E., Mills, E., Mulder, H. E., Goldbeck, F., et al. Evaluation of speech recognition of cochlear implant recipients using a personal digital adaptive radio frequency system. J Am Acad Audiol, 24(8), 714-724.
Wolfe, J., Morais, M., Schafer, E., Mills, E., Peters, R., Lianos, L., John, A., & Hudson, M. (2013). Better speech recognition with digital RF system in study of cochlear implants. The Hearing Journal, 66(7), 24-26
Wolfe, J. & Schafer E.C. (2008). Optimizing the benefits of Auria® sound processors coupled to personal FM systems with iConnect™ adaptors. Journal of the American Academy of Audiology, 19(8). 585-594.
Wolfe, J., Schafer, E.C., Heldner, B., Mulder, H., Ward, E., & Vincent, B. (2009). Evaluation of speech recognition in noise with cochlear implants and Dynamic FM. Journal of the
American Academy of Audiology, 20(7), 409-421. [Tier 1] Wolfe, J., Schafer, E. C., Parkinson, A., John, A., Hudson, M., Wheeler, J., & Mucci, A. (2013). Effects
of input processing and type of personal FM system on speech recognition performance of adults with cochlear implants. Ear and Hearing, 34(1), 52-62.
Wolfe, J., Thompson, K., Swim, L., Schafer, E.C. (2007/2008). Clinical evaluation of the FM advantage provided by contemporary personal FM systems. Journal of Educational Audiology, 14, 47-57.
Observation of Attending Behaviors
Student:________________________________________ DOB:________ Grade:__________
Parent(s) Name(s):________________________________ Hm Phone:___________________
School: _______________________________ Teacher: _______________________________
Observed By:___________________________________________ Date: _________________
Current amplification in use: RE _____________________________________________________
LE _____________________________________________________
Is he/she a consistent user? Y N
Amplification compatible with telecoil and DAI? RE____________________________________
LE ___________________________________
Are other FM systems used at school? Y N
If yes, please list systems and channels in use: _________________________________________
_________________________________________________________________________________
Will the student be changing classes? Y N If yes, how many? _____________________
Classroom acoustics measurements:_____________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Any unusual ambient noise in the classroom? ____________________________________________
___________________________________________________________________________________
Where is the student seated in room?____________________________________________________
___________________________________________________________________________________
Does he/she follow along with the lesson independently? ___________________________________
___________________________________________________________________________________
Does he/she look to other students to follow activities? _____________________________________
___________________________________________________________________________________
Does he/she do well with transitions? ____________________________________________________
___________________________________________________________________________________
Department of Speech and Hearing Sciences 907 W. Sycamore, Denton, TX 76201
Phone: (940) 565-2262; Fax: (940) 565-4058
Target Student Time: Off Task Repetition Redirection
Comments:
Peer Time: Off Task Repetition Redirection
Comments:
Parent Interview
Parent Preference for FM: ___________________________________________________________
How does the student feel about using hearing aids/CI?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Additional Comments:
Student Interview
Student Preference for FM: ____________________________________________________ Additional Comments:
Functional Measures Erin C. Schafer, Ph.D., University of North Texas
* Developmental questionnaire/checklist~Good for validation of hearing assistance technology (HAT)
• *Auditory Behavior in Everyday Life (ABEL) Purdy, S.C., Farrington, D.R., Moran, C.A., Chard, L.L., & Hodgson, S. (2002). A parental questionnaire to evaluate children’s auditory behavior in everyday life (ABEL).
• *~Children’s Auditory Processing Scale (CHAPS)Smoski, W., Brunt, M., & Tannahill, C. (1998). Children’s Auditory Performance Scale. Available fromEducational Audiology Association, www.edaud.org;https://successforkidswithhearingloss.com/tests
• ~Children’s Abbreviated Profile of Hearing Aid Performance (CA-PHAP)Kopun, J.G., & Stelmachowicz, P.G. (1998, March). Perceived communication difficulties of childrenwith hearing loss. American Journal of Audiology, (1), 7: 30-38.
• ~Parent’s Abbreviated Profile of Hearing Aid Performance (PA-PHAP)Kopun, J.G., & Stelmachowicz, P.G. (1998, March). Perceived communication difficulties of childrenwith hearing loss. American Journal of Audiology, (1), 7: 30-38.
• *Children’s Home Inventory of Listening Difficulties (CHILD) Anderson K., & Smaldino, J. (2000). Children’s Home Inventory of Listening Difficulties (CHILD). Available from Educational Audiology Association,
• *~The Children’s Outcome Worksheets (COW)Available from Oticon:
https://successforkidswithhearingloss.com/tests
http://otikids.oticon.nl/eprise/main/Oticon/com/SEC_AboutHearing/LearnAboutHearing/Products/SEC_OtiKids/Parents/Networking/91180310cow_counsellingtool.pdf
• ~Developmental Index of Audition and Listening (DIAL)Palmer, C., & Mormer, E. (1999). Goals and expectations of the hearing aid fitting. Trends inAmplification, 4(2), 61–71. Available from Educational Audiology Association, www.edaud.org
• ~Early Listening Function (ELF)Anderson, K. (2002). Early Listening Function (ELF) instrument for infants and toddler with hearingloss. Available from Educational Audiology Association https://successforkidswithhearingloss.com/tests
• *Functional Auditory Performance Indicators (FAPI) Stredler-Brown, A. & Johnson, D. (2004). Functional auditory performance indicators: An integrated approach to auditory development. Retrieved from http://www.csdb.org/Early%20Education/resources/docs/fapi6_23.pdf
• ~The Functional Listening Evaluation (FLE)Johnson, C.D. (2004). The Functional Listening Evaluation. Retrieved March 2, 2007 fromhttp://www.cde.state.co.us/cdesped/download/pdf/s4-FunListEval.pdf Available from EducationalAudiology Association www.edaud.org
• ~Pediatric Hearing Demand, Ability, and Need Profile (HDAN)Palmer CV, Mormer E. (1997) A systematic program for hearing aid orientation and adjustment. HearReview 1:45–52. Available from Educational Audiology Association www.edaud.org
• *Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS)
Zimmerman-Phillips S., Robbins A., & Osberger M. (2000). Assessing cochlear implant benefit in very young children. Ann Otol Rhinol Laryngol. 109(suppl 185, pt 2), 42-44. Available at Advanced Bionics Corporation, (2003): http://www.advancedbionics.com/content/dam/ab/Global/en_ce/documents/libraries/AssessmentTools/3-01015_ITMAIS%20brochure%20Dec12%20FINAL.pdf
• *Meaningful Auditory Integration Scale (MAIS) Robbins, A., Renshaw, J., & Berry, S. (1991). Evaluating meaningful auditory integration in
profoundly hearing-impaired children. American Journal of Otology, 12 (Suppl.); 144–150. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&ved=0CFMQFjAF&url=http%3A %2F%2Fmedicine.iu.edu%2Foto%2Findex.php%2Fdownload_file%2Fview%2F252%2F267%2F&ei=zUAMUbr2F6K5ywHR9YCQBg&usg=AFQjCNHqmmT8NuPVXoCezeHnfNhX4_lXCg&bvm=bv.41867550,d.aWc
• *~Parents’ Evaluation of Aural/oral performance of Children (PEACH)
Ching, T.Y., & Hill, M. (2007) The Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) scale: normative data. J Am Acad Audiol. 18 (3): 220-35. Available at National Acoustic Laboratories http://www.nal.gov.au/hearing-rehabilitation_tab_paediatric-amplification.shtml
• *~Teachers’ Evaluation of Aural/oral performance of Children (TEACH) Developed by Teresa Ching & Mandy Hill, copyright 2005 Australian Hearing Available at National Acoustic Laboratories http://www.nal.gov.au/hearing-rehabilitation_tab_paediatric-amplification.shtml
• *~Screening Instrument For Targeting Educational Risk (SIFTER)
Anderson, K. (1989). Screening Instrument For Targeting Educational Risk (S.I.F.T.E.R.). Austin, TX: Pro-Ed. Available from https://successforkidswithhearingloss.com/testschecklists
• *~Screening Instrument for Targeting Educational Risk in Preschool Children (age 3-Kindergarten) [Preschool SIFTER] Anderson, K., & Matkin, N. (1996). Screening Instrument for Targeting Educational Risk in Preschool Children (Preschool S.I.F.T.E.R.), Available from https://successforkidswithhearingloss.com/testschecklists
• *~Screening Instrument For Targeting Educational Risk in Secondary Students (Secondary SIFTER) Anderson, K. (2004). Screening Inventory For Targeting Educational Risk in Secondary Students (Secondary S.I.F.T.E.R.). Available from https://successforkidswithhearingloss.com/testschecklists
• ~Listening Inventory For Education An Efficacy Tool Student Appraisal of Listening Difficulty (Student LIFE)
Anderson K., & Smaldino, J. (1997). Learning Inventory For Education (L.I.F.E.). Available from https://successforkidswithhearingloss.com/tests
• ~Listening Inventory For Education An Efficacy Tool Teacher Appraisal of Listening Difficulty (Teacher LIFE) Anderson K., & Smaldino, J. (1997). Learning Inventory For Education (L.I.F.E.). Available from https://successforkidswithhearingloss.com/tests
FM System Evaluation and Report ______________________________________________________________________________________________
Name: Joe Date of Report: 1/04/2012 School: Adler Elementary School Contact: Ann Helms Grade: Kindergarten Evaluation Requested By: Parent Eligibility Codes: AI, SI Birthdate: 3/12/2006
________________________________________________________________________________________________
Reason for Evaluation Joe was referred for a FM system evaluation at the request of his mother. She was concerned that he was not receiving adequate benefit from his current FM system, a desktop soundfield system.
Background Information Joe is a six-year old Kindergartner at Alder Elementary. Previous testing shows that he has a bilateral profound hearing loss. Joe uses an Advanced Bionics HiResolution 90K implant with Auria Sound Processor on his right ear and a digital hearing aid in his left ear. When using his implant, he has excellent word-recognition performance in quiet conditions in the sound booth. No speech recognition testing was conducted in a noise condition.
Typical school classrooms do not provide adequate acoustics that meet guidelines recommended by the American National Standards Institute (2010) or the American Speech-Language-Hearing Association (2005) for appropriate levels of unoccupied noise, reverberation, and signal-to-noise ratios (Arnold & Canning, 1999; Knecht et al., 2002). Furthermore, previous research shows that children with cochlear implants experience significant decreases in speech recognition in noise relative to performance in a quiet listening condition; however, personal frequency modulation (FM) systems that are directly coupled to the cochlear implant significantly improve speech recognition performance in noisy test conditions (Schafer & Thibodeau, 2003, 2006). Also according to previous research, personal FM systems provide significantly better speech recognition performance for individuals with cochlear implants than soundfield systems, which consist of wall-mounted or desktop loudspeakers (Schafer & Kleineck, 2009).
Existing Evidence
The functional evaluation to determine the need for the FM system consisted of formal and informal evaluations including speech recognition in noise testing, a teacher questionnaire, a classroom observation of listening behaviors, a parent interview, and a review of current academic performance and educational challenges.
Informal and Formal Evaluation Results
Joe’s speech-recognition performance in noise was evaluated in his classroom with the Phrases in Noise Test (PINT), which measures a 50% correct speech-in-noise threshold for simple, closed-set phrases in classroom noise. During testing, the signal speaker (phrases) was presented directly in front of him while the background noise (classroom noise) was presented directly behind him. Lower scores on this test indicate better performance or the ability to function in a more adverse listening environment. Joe was tested in three conditions: (1) cochlear implant alone, (2) desktop soundfield system, and (3) electrically-coupled personal FM receivers that directly connect to his cochlear implant and hearing aid. Scores for the three conditions were (95% critical difference level=3.2 dB):
1. Cochlear implant alone: +10.5 dB 2. Desktop soundfield system +1.5 dB 3. Electrically-coupled personal FM system -9.0 dB
The cochlear-implant alone condition results suggested that Joe requires the phrases to be at least 10.5 dB more intense than the background noise to hear the speech only half of the time. Both the desktop and electrically-coupled FM system significantly improved his ability to hear the closed-set, simple phrases; however, the electrically-coupled system provides significantly greater gains in speech recognition in noise. Given the substantially more difficult , open-set listening tasks expected of children in a real classroom environment, this simple speech-in-noise test substantially underestimates the
Department of Speech and Hearing Sciences 907 W. Sycamore, Denton, TX 76201
Phone: (940) 565-2262; Fax: (940) 565-4058
difficulties he will face in a real listening situation. As a result, Joe should use the device that provides the greatest benefit.
The teacher questionnaire used for the evaluation was the Screening Instrument for Targeting Educational Risk (SIFTER). Results from both of his general education teachers indicated that he is at risk in the areas of attention, communication, and class participation when compared to his peers with normal hearing. The questionnaire results were validated by the classroom observation conducted by the audiologist. During the observation during center time, the classroom was particularly noisy with occupied noise levels ranging from 67 to 88 dBA across eight measurements throughout his classroom. These noise levels would make it difficult, if not impossible, to achieve the +15 signal-to-noise ratio recommended by the American Speech-Language-Hearing Association (2005) for children with hearing loss, even when the desktop system is in use. Furthermore, it was not feasible for Joe to carry around his desktop system to each center; therefore, he did not use it during center time and other similar periods throughout the day. As a result, during any given school day, it was only used during circle time, snack time, and music. Given the noisy conditions, Joe had substantial difficulty following directions and he relied on peers during transitions. Joe’s mother was concerned that he was not hearing well at school with the desktop soundfield FM system. He was performing well in the classroom in terms of academic performance, but his expressive and receptive language levels were delayed relative to normal-hearing peers.
Recommendation Given the results of the formal and informal evaluations, an electrically-coupled personal FM system is recommended for Joe. This recommendation is further supported by peer-reviewed literature cited above on FM systems for children and adults with cochlear implants. It is also recommended that Joe should be preferentially seated in the classroom away from noise producing equipment. The electrically-coupled system will need to be fit and regularly monitored by a licensed educational audiologist.
Erin C. Schafer, Ph.D., CCC/A Associate Professor [email protected]
References
American National Standards Institute. (2010). American National Standard Acoustical Performance Criteria, Design Requirements, and Guidelines for Schools, Part 1: Permanent Schools (No. ANSI S12.60-2010). Melville, NY.
American Speech-Language-Hearing Association. (2005). Acoustics in educational settings: Position statement. [Position Statement]. Available from www.asha.org/policy.
Arnold, P., & Canning, D. (1999). Does classroom amplification aid comprehension? British Journal of Audiology, 33(3), 171-178.
Knecht, H. A., Nelson, P. B., Whitelaw, G. M., & Feth, L. L. (2002). Background noise levels and reverberation times in unoccupied classrooms: predictions and measurements. American Journal of Audiology, 11, 65-71.
Schafer, E.C. & Kleineck, M.P. (2009). Improvements in speech-recognition performance using cochlear implants and three types of FM systems: A meta-analytic approach. Journal of Educational Audiology, 15, 4-14
Schafer, E.C. & Thibodeau, L.M. (2006). Speech recognition in noise in children with cochlear implants while listening in bilateral, bimodal, and FM-system arrangements. American Journal of Audiology, 15(2), 114-126.
Schafer, E. C. & Thibodeau, L. M. (2003). Speech recognition performance of children using cochlear implants and FM systems. Journal of Educational Audiology, 11, 15-26.