Electrophysiological Measures of Listening-in-Noise With and Without Remote Microphone System Use in Autistic and Non-Autistic Youth.

OBJECTIVES: This study examined the neural mechanisms by which remote microphone (RM) systems might lead to improved behavioral performance on listening-in-noise tasks in autistic and non-autistic youth. DESIGN: Cortical auditory evoked potentials (CAEPs) were recorded in autistic (n = 25) and non-autistic (n = 22) youth who were matched at the group level on chronological age ( M = 14.21 ± 3.39 years) and biological sex. Potentials were recorded during an active syllable identification task completed in quiet and in multi-talker babble noise with and without the use of an RM system. The effects of noise and RM system use on speech-sound-evoked P1-N1-P2 responses and the associations between the cortical responses and behavioral performance on syllable identification were examined. RESULTS: No group differences were observed for behavioral or CAEP measures of speech processing in quiet or in noise. In the combined sample, syllable identification in noise was less accurate and slower than in the quiet condition. The addition of the RM system to the noise condition restored accuracy, but not the response speed, to the levels observed in quiet. The CAEP analyses noted amplitude reductions and latency delays in the noise compared with the quiet condition. The RM system use increased the N1 amplitude as well as reduced and delayed the P2 response relative to the quiet and noise conditions. Exploratory brain-behavior correlations revealed that larger N1 amplitudes in the RM condition were associated with greater behavioral accuracy of syllable identification. Reduced N1 amplitude and accelerated P2 response were associated with shorter syllable identification response times when listening with the RM system. CONCLUSIONS: Findings suggest that although listening-in-noise with an RM system might remain effortful, the improved signal to noise ratio facilitates attention to the sensory features of the stimuli and increases speech sound identification accuracy.

Remote Microphone Systems for Autistic and Nonautistic Youth: Effects on Audiovisual Task Engagement.

OBJECTIVES: A recent study has provided empirical support for the use of remote microphone (RM) systems to improve listening-in-noise performance of autistic youth. It has been proposed that RM system effects might be achieved by boosting engagement in this population. The present study used behavioral coding to test this hypothesis in autistic and nonautistic youth listening in an ecologically valid, noisy environment. DESIGN: We drew on extant data from a recent experimental study in which 56 youth (32 autistic, 24 nonautistic) matched at the group level on age and biological sex completed listening-in-noise tasks wherein they reported their perception of audiovisual syllables, words, sentences, and passages with and without an RM system; conditions were counter-balanced across participants. As previously reported, perceptual accuracy varied with stimulus complexity and overall improved with the RM system, with improvements not significantly different between groups. Video recordings of participants completing listening-in-noise tasks in both conditions were coded via a 5-second, partial-interval coding system by naive coders for (a) engagement in the task (indexed via proportion of intervals in which participants displayed on-task behaviors) and (b) verbal, stimulus-specific protesting in the task (indexed via proportion of intervals in which participants displayed verbal, stimulus-specific protesting behaviors). Examples of on-task behaviors included attending to the screen and completing task activities. Examples of protesting behaviors included complaining about stimuli volume or the inability to hear. Chronological age, autism features, language ability, audiovisual speech integration as measured by psychophysical tasks, tactile responsiveness, and nonverbal intelligence quotient were evaluated as putative predictors and/or moderators of effects on behaviors of interest. RESULTS: In general, participants were highly engaged in the task, and there were few protests, reflecting more than 90% and fewer than 0.5% of coded intervals, respectively. We did not detect any statistically significant effects of group or RM system use on task engagement. Nonautistic youth were engaged in the listening-in-noise task for an average of 97.45% of intervals, whereas autistic youth were engaged in the listening-in-noise task for an average of 94.25% of intervals. In contrast, verbal, stimulus-specific protesting in the listening-in-noise task was significantly reduced, on average, in the RM (0.04% of intervals) versus the No RM (0.2% of intervals) conditions. There were no effects related to group for this behaviorally coded outcome. In addition, select participant characteristics predicted engagement within conditions across participants. Greater language ability and nonverbal intelligence quotient predicted increased engagement when not using an RM system. Increased features of autism and wider temporal binding windows for audiovisual speech predicted reduced engagement while using an RM system, and greater audiovisual integration predicted increased engagement while using an RM system. CONCLUSIONS: The results of this study suggest that RM system use reduces verbal, stimulus-specific protesting, which likely reflects difficulty engaging when listening in noise. The present study extends our previous study to provide additional empirical support for RM system use in autistic and nonautistic youth.

Plasticity Changes in Central Auditory Systems of School-Age Children Following a Brief Training With a Remote Microphone System.

OBJECTIVES: The objective of this study was to investigate whether a brief speech-in-noise training with a remote microphone (RM) system (favorable listening condition) would contribute to enhanced post-training plasticity changes in the auditory system of school-age children. DESIGN: Before training, event-related potentials (ERPs) were recorded from 49 typically developing children, who actively identified two syllables in quiet and in noise (+5 dB signal-to-noise ratio [SNR]). During training, children completed the same syllable identification task as in the pre-training noise condition, but received feedback on their performance. Following random assignment, half of the sample used an RM system during training (experimental group), while the other half did not (control group). That is, during training' children in the experimental group listened to a more favorable speech signal (+15 dB SNR) than children from the control group (+5 dB SNR). ERPs were collected after training at +5 dB SNR to evaluate the effects of training with and without the RM system. Electrical neuroimaging analyses quantified the effects of training in each group on ERP global field power (GFP) and topography, indexing response strength and network changes, respectively. Behavioral speech-perception-in-noise skills of children were also evaluated and compared before and after training. We hypothesized that training with the RM system (experimental group) would lead to greater enhancement of GFP and greater topographical changes post-training than training without the RM system (control group). We also expected greater behavioral improvement on the speech-perception-in-noise task when training with than without the RM system. RESULTS: GFP was enhanced after training only in the experimental group. These effects were observed on early time-windows corresponding to traditional P1-N1 (100 to 200 msec) and P2-N2 (200 to 400 msec) ERP components. No training effects were observed on response topography. Finally, both groups increased their speech-perception-in-noise skills post-training. CONCLUSIONS: Enhanced GFP after training with the RM system indicates plasticity changes in the neural representation of sound resulting from listening to an enriched auditory signal. Further investigation of longer training or auditory experiences with favorable listening conditions is needed to determine if that results in long-term speech-perception-in-noise benefits.

An evaluation of newborn hearing screening brochures and parental understanding of screening result terminology.

OBJECTIVE: To assess the suitability of newborn hearing screening brochures by evaluating current state-level brochures and pregnant people's understanding of screening result terminology. DESIGN: In Study 1, state-level brochures were evaluated based on readability, design, picture appropriateness, and use of the word "refer." In Study 2, pregnant people completed a questionnaire that queried their understanding of and expected anxiety about three newborn hearing screening outcomes ("refer," "did not pass," and "pass"). STUDY SAMPLE: In Study 1, 59 newborn hearing screening brochures were analysed. In Study 2, 43 pregnant people completed surveys during a prenatal appointment. RESULTS: Most of the brochures were found deficient on at least one element. Thirty percent of brochures used the word "refer" to indicate a hearing screening failure; yet, fewer than half of participants understood its meaning. Ratings of expected anxiety were highest in response to the term "did not pass." CONCLUSIONS: Based on four study criteria of brochure suitability, 88% of available state-level newborn hearing screening brochures should be modified to make them readily understandable by a broad educational demographic. Discretion in use of the term "refer" should be made when indicating screening results, because the term is not readily understood.

Remote Microphone Systems Can Improve Listening-in-Noise Accuracy and Listening Effort for Youth With Autism.

OBJECTIVES: This study examined whether remote microphone (RM) systems improved listening-in-noise performance in youth with autism. We explored effects of RM system use on both listening-in-noise accuracy and listening effort in a well-characterized sample of participants with autism. We hypothesized that listening-in-noise accuracy would be enhanced and listening effort reduced, on average, when participants used the RM system. Furthermore, we predicted that effects of RM system use on listening-in-noise accuracy and listening effort would vary according to participant characteristics. Specifically, we hypothesized that participants who were chronologically older, had greater nonverbal cognitive and language ability, displayed fewer features of autism, and presented with more typical sensory and multisensory profiles might exhibit greater benefits of RM system use than participants who were younger, had less nonverbal cognitive or language ability, displayed more features of autism, and presented with greater sensory and multisensory disruptions. DESIGN: We implemented a within-subjects design to investigate our hypotheses, wherein 32 youth with autism completed listening-in-noise testing with and without an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in complexity (i.e., syllable-, word-, sentence-, and passage-level). In addition, several putative moderators of RM system effects (i.e., sensory and multisensory function, language, nonverbal cognition, and broader features of autism) on outcomes of interest were evaluated. RESULTS: Overall, RM system use resulted in higher listening-in-noise accuracy in youth with autism compared with no RM system use. The observed benefits were all large in magnitude, although the benefits on average were greater for more complex stimuli (e.g., key words embedded in sentences) and relatively smaller for less complex stimuli (e.g., syllables). Notably, none of the putative moderators significantly influenced the effects of the RM system on listening-in-noise accuracy, indicating that RM system benefits did not vary according to any of the participant characteristics assessed. On average, RM system use did not have an effect on listening effort across all youth with autism compared with no RM system use but instead yielded effects that varied according to participant profile. Specifically, moderated effects indicated that RM system use was associated with increased listening effort for youth who had (a) average to below-average nonverbal cognitive ability, (b) below-average language ability, and (c) reduced audiovisual integration. RM system use was also associated with decreased listening effort for youth with very high nonverbal cognitive ability. CONCLUSIONS: This study extends prior work by showing that RM systems have the potential to boost listening-in-noise accuracy for youth with autism. However, this boost in accuracy was coupled with increased listening effort, as indexed by longer reaction times while using an RM system, for some youth with autism, perhaps suggesting greater engagement in the listening-in-noise tasks when using the RM system for youth who had lower cognitive abilities, were less linguistically able, and/or have difficulty integrating seen and heard speech. These findings have important implications for clinical practice, suggesting RM system use in classrooms could potentially improve listening-in-noise performance for some youth with autism.

Rerouting Hearing Aid Systems for Overcoming Simulated Unilateral Hearing in Dynamic Listening Situations.

OBJECTIVES: Unilateral hearing loss increases the risk of academic and behavioral challenges for school-aged children. Previous research suggests that remote microphone (RM) systems offer the most consistent benefits for children with unilateral hearing loss in classroom environments relative to other nonsurgical interventions. However, generalizability of previous laboratory work is limited because of the specific listening situations evaluated, which often included speech and noise signals originating from the side. In addition, early studies focused on speech recognition tasks requiring limited cognitive engagement. However, those laboratory conditions do not reflect characteristics of contemporary classrooms, which are cognitively demanding and typically include multiple talkers of interest in relatively diffuse background noise. The purpose of this study was to evaluate the potential effects of rerouting amplification systems, specifically a RM system and a contralateral routing of signal (CROS) system, on speech recognition and comprehension of school-age children in a laboratory environment designed to emulate the dynamic characteristics of contemporary classrooms. It was expected that listeners would benefit from the CROS system when the head shadow limits audibility (e.g., monaural indirect listening). It was also expected that listeners would benefit from the RM system only when the RM was near the talker of interest. DESIGN: Twenty-one children (10 to 14 years, M = 11.86) with normal hearing participated in laboratory tests of speech recognition and comprehension. Unilateral hearing loss was simulated by presenting speech-shaped masking noise to one ear via an insert earphone. Speech stimuli were presented from 1 of 4 loudspeakers located at either 0°, +45°, -90°, and -135° or 0°, -45°, +90°, and +135°. Cafeteria noise was presented from separate loudspeakers surrounding the listener. Participants repeated sentences (sentence recognition) and also answered questions after listening to an unfamiliar story (comprehension). They were tested unaided, with a RM system (microphone near the front loudspeaker), and with a CROS system (ear-level microphone on the ear with simulated hearing loss). RESULTS: Relative to unaided listening, both rerouting systems reduced sentence recognition performance for most signals originating near the ear with normal hearing (monaural direct loudspeakers). Only the RM system improved speech recognition for midline signals, which were near the RM. Only the CROS system significantly improved speech recognition for signals originating near the ear with simulated hearing loss (monaural indirect loudspeakers). Although the benefits were generally small (approximately 6.5 percentage points), the CROS system also improved comprehension scores, which reflect overall listening across all four loudspeakers. Conversely, the RM system did not improve comprehension scores relative to unaided listening. CONCLUSIONS: Benefits of the CROS system in this study were small, specific to situations where speech is directed toward the ear with hearing loss, and relative only to a RM system utilizing one microphone. Although future study is warranted to evaluate the generalizability of the findings, the data demonstrate both CROS and RM systems are nonsurgical interventions that have the potential to improve speech recognition and comprehension for children with limited useable unilateral hearing in dynamic, noisy classroom situations.

Consensus practice parameter: audiological assessment and management of unilateral hearing loss in children.

Objective: Provide recommendations to audiologists for the management of children with unilateral hearing loss (UHL) and for needed research that can lend further insight into important unanswered questions.Design: An international panel of experts on children with UHL was convened following a day and a half of presentations on the same. The evidence reviewed for this parameter was gathered through web-based literature searches specifically designed for academic and health care resources, recent systematic reviews of literature, and new research presented at the conference that underwent peer review for publication by the time of this writing.Study sample: Expert opinions and electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Education Resources Information Centre (ERIC), Google Scholar, PsycINFO, PubMed, ScienceDirect, and Turning Research into Practice (TRIP) Database.Results: The resulting practice parameter requires a personalised, family-centred process: (1) routine surveillance of speech-language, psychosocial, auditory, and academic or pre-academic development; (2) medical assessments for determination of aetiology of hearing loss; (3) assessment of hearing technologies; and (4) considerations for family-centred counselling.Conclusions: This practice parameter provides guidance to clinical audiologists on individualising the management of children with UHL. In addition, the paper concludes with recommendations for research priorities.

Monitoring neonates for ototoxicity.

OBJECTIVES: Neonates admitted to the neonatal intensive care unit (NICU) are at greater risk of permanent hearing loss compared to infants in well mother and baby units. Several factors have been associated with this increased prevalence of hearing loss, including congenital infections (e.g. cytomegalovirus or syphilis), ototoxic drugs (such as aminoglycoside or glycopeptide antibiotics), low birth weight, hypoxia and length of stay. The aetiology of this increased prevalence of hearing loss remains poorly understood. DESIGN: Here we review current practice and discuss the feasibility of designing improved ototoxicity screening and monitoring protocols to better identify acquired, drug-induced hearing loss in NICU neonates. STUDY SAMPLE: A review of published literature. CONCLUSIONS: We conclude that current audiological screening or monitoring protocols for neonates are not designed to adequately detect early onset of ototoxicity. This paper offers a detailed review of evidence-based research, and offers recommendations for developing and implementing an ototoxicity monitoring protocol for young infants, before and after discharge from the hospital.

Binaural masking release in children with Down syndrome.

OBJECTIVES: Binaural hearing results in a number of listening advantages relative to monaural hearing, including enhanced hearing sensitivity and better speech understanding in adverse listening conditions. These advantages are facilitated in part by the ability to detect and use interaural cues within the central auditory system. Binaural hearing for children with Down syndrome could be impacted by multiple factors including, structural anomalies within the peripheral and central auditory system, alterations in synaptic communication, and chronic otitis media with effusion. However, binaural hearing capabilities have not been investigated in these children. This study tested the hypothesis that children with Down syndrome experience less binaural benefit than typically developing peers. DESIGN: Participants included children with Down syndrome aged 6 to 16 years (n = 11), typically developing children aged 3 to 12 years (n = 46), adults with Down syndrome (n = 3), and adults with no known neurological delays (n = 6). Inclusionary criteria included normal to near-normal hearing sensitivity. Two tasks were used to assess binaural ability. Masking level difference (MLD) was calculated by comparing threshold for a 500-Hz pure-tone signal in 300-Hz wide Gaussian noise for N0S0 and N0Sπ signal configurations. Binaural intelligibility level difference was calculated using simulated free-field conditions. Speech recognition threshold was measured for closed-set spondees presented from 0-degree azimuth in speech-shaped noise presented from 0-, 45- and 90-degree azimuth, respectively. The developmental ability of children with Down syndrome was estimated and information regarding history of otitis media was obtained for all child participants via parent survey. RESULTS: Individuals with Down syndrome had higher masked thresholds for pure-tone and speech stimuli than typically developing individuals. Children with Down syndrome had significantly smaller MLDs than typically developing children. Adults with Down syndrome and control adults had similar MLDs. Similarities in simulated spatial release from masking were observed for all groups for the experimental parameters used in this study. No association was observed for any measure of binaural ability and developmental age for children with Down syndrome. Similar group psychometric functions were observed for children with Down syndrome and typically developing children in most instances, suggesting that attentiveness and motivation contributed equally to performance for both groups on most tasks. CONCLUSIONS: The binaural advantages afforded to typically developing children, such as enhanced hearing sensitivity in noise, were not as robust for children with Down syndrome in this study. Children with Down syndrome experienced less binaural benefit than typically developing peers for some stimuli, suggesting that they could require more favorable signal-to-noise ratios to achieve optimal performance in some adverse listening conditions. The reduced release from masking observed for children with Down syndrome could represent a delay in ability rather than a deficit that persists into adulthood. This could have implications for the planning of interventions for individuals with Down syndrome.

The Use of Electronic Health Records for Behavioral Phenotyping of School-Age Children With Unilateral Hearing Loss: A Methodological Approach.

PURPOSE: This methodological study describes a technique for extracting information from de-identified electronic health records (EHRs) to identify occurrences of permanent unilateral hearing loss (UHL) and associated educational comorbidities. METHOD: This was an exploratory methodological study utilizing approximately 3.3 million de-identified medical records. Structured and unstructured data were extracted using both automated and manual methods. When both methods were available, positive and negative predictive values were calculated to evaluate the utility of using automated methods. RESULTS: We defined a cohort of 471 records that met our criteria of school-age children with permanent UHL and no additional significant disabilities/diagnoses. Fifty-one percent of the children reflected in this cohort had indicators of adverse educational progress, defined as documentation of receiving educational services, speech-language therapy, and/or parental/teacher concern, with 12% of records reflecting overlapping services/concerns. Negative predictive values were generally high and positive predictive values were generally low, suggesting automated searches are useful for excluding factors of interest, but not finding them. CONCLUSIONS: This study demonstrates the feasibility of using EHRs in examining UHL in school-age children. By restricting our cohort to individuals who were seen in audiology clinic, we were able to capture variables such as educational difficulty that are not routinely ascertained in medical contexts. The proportion of children in this cohort demonstrating a marker of adverse educational progress is consistent with numerous prior observational studies, thus providing validity to this ascertainment approach. We describe challenges encountered in creating this cohort and detail our hybrid approach to ascertaining key variables accurately.

Pediatric Hearing Aid Daily Wear Time Is Significantly Impacted by Clinician-Family Language Discordance.

PURPOSE: The purpose of this study was to evaluate the potential contribution of limited English proficiency on daily hearing aid wear time for children with hearing loss. METHOD: A retrospective chart review was completed to evaluate hearing aid wear time based on data logging information available at the time of a follow-up visit following an initial hearing aid fitting. Children were included in the study if they had permanent bilateral hearing loss and were less than 60 months of age at the time of their first follow-up visit. Wear time was compared between children who attended an interpreter-mediated appointment and those who did not have an interpreter present. The presence of an interpreter at the appointment was the study indicator that the family had limited English proficiency. RESULTS: Children from families with limited English proficiency exhibited significantly shorter daily wear time (M = 1.3 hr) than their peers whose families were English-proficient speakers, thus, having a shared language with their audiologists (M = 5.2 hr). CONCLUSIONS: Results of this study suggest that family-clinician language discordance might put children at greater risk of shorter hearing aid wear time than children whose caregivers share a common language with their child's audiologist. There can be many linguistic, cultural, and educational factors that contribute to hearing aid wear time in children whose families have limited English proficiency as well as different approaches to improving that wear time. Efforts should ensure that hearing and hearing aid-related information is accessible to all families, especially those with clinician-family language discordance. Such efforts can include, among others, training that improves clinicians' cultural and linguistic responsiveness to the diverse families they serve.

A Comparison of Listening Skills of Autistic and Non-Autistic Youth While Using and Not Using Remote Microphone Systems.

OBJECTIVES: The purposes of this study were to compare (a) listening-in-noise (accuracy and effort) and (b) remote microphone (RM) system benefits between autistic and non-autistic youth. DESIGN: Groups of autistic and non-autistic youth that were matched on chronological age and biological sex completed listening-in-noise testing when wearing and not wearing an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in type (syllables, words, sentences, and passages). Several putative moderators of RM system effects on outcomes of interest were also evaluated. RESULTS: Autistic youth outperformed non-autistic youth in some conditions on listening-in-noise accuracy; listening effort between the two groups was not significantly different. RM system use resulted in listening-in-noise accuracy improvements that were nonsignificantly different across groups. Benefits of listening-in-noise accuracy were all large in magnitude. RM system use did not have an effect on listening effort for either group. None of the putative moderators yielded effects of the RM system on listening-in-noise accuracy or effort for non-autistic youth that were significant and interpretable, indicating that RM system benefits did not vary according to any of the participant characteristics assessed. CONCLUSIONS: Contrary to expectations, autistic youth did not demonstrate listening-in-noise deficits compared to non-autistic youth. Both autistic and non-autistic youth appear to experience RM system benefits marked by large gains in listening-in-noise performance. Thus, the use of this technology in educational and other noisy settings where speech perception needs enhancement might be beneficial for both groups of children.

Evidence for a Musician Speech-Perception-in-Noise Advantage in School-Age Children.

PURPOSE: The objective of this study was to evaluate whether child musicians are better at listening to speech in noise (SPIN) than nonmusicians of the same age. In addition, we aimed to explore whether the musician SPIN advantage in children was related to general intelligence (IQ). METHOD: Fifty-one children aged 8.2-11.8 years and with different levels of music training participated in the study. A between-group design and correlational analyses were used to determine differences in SPIN skills as they relate to music training. IQ was used as a covariate to explore the relationship between intelligence and SPIN ability. RESULTS: More years of music training were associated with better SPIN skills than fewer years of music training. Furthermore, this difference in SPIN skills remained even when accounting for IQ. These results were found at the group level and also when years of instrument training was treated as a continuous variable (i.e., correlational analyses). CONCLUSIONS: We confirmed results from previous studies in which child musicians outperformed nonmusicians in SPIN skills. We also showed that this effect was not related to differences in IQ between the musicians and nonmusicians for this cohort of children. However, confirmation of this finding with a cohort of children from more diverse socioeconomic statuses and cognitive profiles is warranted.

Remote Microphone System Use in Preschool Children With Autism Spectrum Disorder and Language Disorder in the Classroom: A Pilot Efficacy Study.

Purpose The present pilot study aimed to provide estimates of the feasibility and efficacy of a remote microphone (RM) system as an augmentative intervention to improve the functional listening performance of preschool children with autism spectrum disorder (ASD) and language disorder. Method Eight children with ASD and language disorder participated. Efficacy of the RM system was determined by evaluating participants' functional listening performance, as measured by an observational measure in RM-off and RM-on conditions. Responses were evaluated at the individual level using an alternating conditions design. Results Adequate feasibility was demonstrated as all participants were able to complete tasks in the RM-on condition. A subset of participants showed significant improvements in their functional listening performance in the RM-on condition, as demonstrated by visual inspection and effect sizes (nonoverlapping data points and percentage of data points exceeding the mean), indicating that there may be important sources of individual differences in responses to RM use in children with ASD. Conclusion The results of this pilot study provide support for future research on RM systems to target functional listening performance in children with ASD and language disorder.

Central auditory system responses from children while listening to speech in noise.

Cortical auditory evoked potentials (CAEPs) have been successfully used to explore the effects of noise on speech processing at the cortical level in adults and children. The purpose of this study was to determine whether +15 dB signal-to-noise ratios (SNRs), often recommended for optimal speech perception in children, elicit higher amplitude CAEPs than more realistic SNRs encountered by children during their daily lives (+10 dB SNR). Moreover, we aimed to investigate whether cortical speech categorization is observable in children in quiet and in noise and whether CAEPs to speech in noise are related to behavioral speech perception in noise performance in children. CAEPs were measured during a passive speech-syllable task in 51 normal hearing children aged 8 to 11 years. The speech syllables /da/ and /ga/ were presented in quiet and in the presence of a 4-talker-babble noise at +15 dB and +10 dB SNR. N1 latencies and P2 amplitudes and latencies varied as a function of SNR, with poorer SNRs (+10 dB) eliciting significantly smaller P2 amplitudes and delayed N1 and P2 latencies relative to the higher SNR (+15 dB). Finally, speech categorization was present at the cortical level in this group of children in quiet and at both SNRs; however, N1 and P2 amplitudes and latencies were not related to behavioral speech-in-noise perception of children.

Young Children's Attitudes Toward Peers Who Wear Hearing Aids.

Purpose This study examined whether young children with normal hearing demonstrated negative attitudes toward peers wearing hearing aids, often described as the "hearing aid effect." The effect of age on these attitudes was also examined. Method Forty-five typically developing children with normal hearing, aged 6-11 years, were recruited to answer questions about and rate photos of children with and without hearing aids in areas of peer acceptance as well as physical and cognitive competence. Participants completed a forced-choice task, a perceived competence rating task, and a sociometric rating task. Results Children in this study perceived their peers who wore hearing aids as having less physical competence and less peer acceptance than peers without hearing aids, thus confirming a hearing aid effect in children as young as 6 years of age. Both younger and older children were more likely to choose pictures of children wearing hearing aids as having less peer acceptance than pictures of children who were not wearing hearing aids. Older children were also more likely to choose a picture of a child with hearing aids as having less physical competence than a picture of a child without hearing aids. Conclusion These findings should serve to alert professionals who work with children who have hearing loss that additional support and education might be warranted for these children and their peers with normal hearing.

Considerations for Choosing Microphone Technologies for Students With Limited Useable Hearing Unilaterally.

Purpose Current recommendations for clinical management of school-aged children with limited useable hearing unilaterally primarily focus on remote microphone systems and preferential seating. The purpose of this narrative review is to examine the existing evidence supporting these recommendations. Method A narrative review was conducted, focused on nonsurgical interventions for children with limited useable hearing unilaterally. Results Six articles were identified. Three survey studies suggest high use rates and improved academic performance with contralateral routing of signal systems. One laboratory study suggests students with hearing loss need to sit closer to the desired signal (e.g., teacher) than their peers with normal hearing to achieve similar speech recognition. Two laboratory studies suggest remote microphone systems provide consistent benefits when the microphone is located near the talker of interest, whereas contralateral routing of signal systems impairs performance in noise. Conclusions The discrepancy between survey studies and laboratory studies could be explained partly due to the difference between listening situations in the laboratory and in classrooms. Everyone in the classroom is a potential talker of interest, and the listening environments are often dynamic. Thus, contralateral routing of signal systems might have more potential to improve classroom communication than was suggested by the laboratory studies. Recommendations for microphone technologies should be based on the extent to which a student is struggling, where the student sits in the classroom, and where the important talkers are located. There is not one optimal recommendation for all students, but a combination of remote microphone and contralateral routing of signal systems could work for most students. Supplemental Material https://doi.org/10.23641/asha.9956663.

Contralateral Routing of Signal Systems Can Improve Speech Recognition and Comprehension in Dynamic Classrooms.

Objective The purpose of this study was to evaluate the effects of hearing aid-based rerouting systems (remote microphone [RM] and contralateral routing of signals [CROS]) on speech recognition and comprehension for children with limited usable hearing unilaterally. A secondary purpose was to evaluate students' perceptions of CROS benefits in classrooms. Method Twenty children aged 10-16 years with limited useable hearing in one ear completed tasks of sentence recognition and comprehension in a laboratory. For both tasks, speech was presented from one of four loudspeakers in an interleaved fashion. Speech loudspeakers were either midline, monaural direct, or monaural indirect, and noise loudspeakers surrounded the participant. Throughout testing, the RM was always near the midline loudspeaker. Six established users of CROS systems completed a newly developed questionnaire that queried experiences in diverse listening situations. Results There were no effects of RM or CROS use on performance for speech presented from front or monaural direct loudspeakers. However, for monaural indirect loudspeakers, CROS improved sentence recognition and RM impaired recognition. In the comprehension task, CROS improved comprehension by 11 rationalized arcsine units, but RM did not affect comprehension. Questionnaire results demonstrated that students report CROS benefits for talkers in the front and from the side, but not for situations requiring localization. Conclusions The results support CROS benefits without CROS disadvantages in a laboratory environment that reflects a dynamic classroom. Thus, CROS systems have the potential to improve hearing in contemporary classrooms for students, especially if there is only a single microphone.

Remote Microphone System Use in the Homes of Children With Hearing Loss: Impact on Caregiver Communication and Child Vocalizations.

Purpose This study examined the impact of home use of remote microphone systems (RMSs) on caregiver communication and child vocalizations in families of children with hearing loss. Method We drew on data from a prior study in which Language ENvironmental Analysis recorders were used with 9 families during 2 consecutive weekends-1 that involved using an RMS and 1 that did not. Audio samples from Language ENvironmental Analysis recorders were (a) manually coded to quantify the frequency of verbal repetitions and alert phrases caregivers utilized in communicating to children with hearing loss and (b) automatically analyzed to quantify children's vocalization rate, duration, complexity, and reciprocity when using and not using an RMS. Results When using an RMS at home, caregivers did not repeat or clarify their statements as often as when not using an RMS while communicating with their children with hearing loss. However, no between-condition differences were observed in children's vocal characteristics. Conclusions Results provide further support for home RMS use for children with hearing loss. Specifically, findings lend empirical support to prior parental reports suggesting that RMS use eases caregiver communication in the home setting. Studies exploring RMS use over a longer duration of time might provide further insight into potential long-term effects on children's vocal production.

Remote Microphone System Use at Home: Impact on Child-Directed Speech.

Purpose The impact of home use of a remote microphone system (RMS) on the caregiver production of, and child access to, child-directed speech (CDS) in families with a young child with hearing loss was investigated. Method We drew upon extant data that were collected via Language ENvironment Analysis (LENA) recorders used with 9 families during 2 consecutive weekends (RMS weekend and no-RMS weekend). Audio recordings of primary caregivers and their children with hearing loss obtained while wearing and not wearing an RMS were manually coded to estimate the amount of CDS produced. The proportion of CDS that was likely accessible to children with hearing loss under both conditions was determined. Results Caregivers produced the same amount of CDS when using and when not using the RMS. However, it was concluded that children with hearing loss, on average, could potentially access 12% more CDS if caregivers used an RMS because of their distance from their children when talking to them. Conclusion Given our understanding of typical child language development, findings from this investigation suggest that children with hearing loss could receive auditory, speech, and language benefits from the use of an RMS in the home environment.