Teachers' and Children's Experiences after an Acoustic Intervention and a Noise-Controlling Workshop in Two Elementary Classrooms.

INTRODUCTION: Treating sources of noise is a novel aspect of voice ergonomics intended to enhance the preconditions for good voice production and easy listening. OBJECTIVE: To improve experiences of listening and voice ergonomics in classrooms. METHODS: Participants were two female elementary school teachers with voice symptoms and their pupils (n = 50). Two interventions were performed: the acoustic intervention and then the workshop intervention where the teachers and pupils were active. Teachers' voice symptoms and pupils' and teachers' experiences of the interventions were elicited by questionnaire. RESULTS: The teacher with many voice symptoms experienced more annoyance from sounds and benefitted more from the interventions. After the interventions both teachers suffered fewer voice breaks and voice symptoms such as lump and mucus in the throat. The pupils reported improvement in the teachers' voice clarity and audibility (p = 0.001). Pupils aged 12-13 years were more annoyed by sounds than those aged 8-9 years (p = 0.003). The older pupils experienced less sound annoyance after both interventions and the younger ones after the workshop intervention. CONCLUSIONS: The importance of good acoustics and individuals' ability to improve voice ergonomics and listening conditions was demonstrated.

Long-term influence of recurrent acute otitis media on neural involuntary attention switching in 2-year-old children.

BACKGROUND: A large group of young children are exposed to repetitive middle ear infections but the effects of the fluctuating hearing sensations on immature central auditory system are not fully understood. The present study investigated the consequences of early childhood recurrent acute otitis media (RAOM) on involuntary auditory attention switching. METHODS: By utilizing auditory event-related potentials, neural mechanisms of involuntary attention were studied in 22-26 month-old children (N = 18) who had had an early childhood RAOM and healthy controls (N = 19). The earlier and later phase of the P3a (eP3a and lP3a) and the late negativity (LN) were measured for embedded novel sounds in the passive multi-feature paradigm with repeating standard and deviant syllable stimuli. The children with RAOM had tympanostomy tubes inserted and all the children in both study groups had to have clinically healthy ears at the time of the measurement assessed by an otolaryngologist. RESULTS: The results showed that lP3a amplitude diminished less from frontal to central and parietal areas in the children with RAOM than the controls. This might reflect an immature control of involuntary attention switch. Furthermore, the LN latency was longer in children with RAOM than in the controls, which suggests delayed reorientation of attention in RAOM. CONCLUSIONS: The lP3a and LN responses are affected in toddlers who have had a RAOM even when their ears are healthy. This suggests detrimental long-term effects of RAOM on the neural mechanisms of involuntary attention.

Background Noise Degrades Central Auditory Processing in Toddlers.

OBJECTIVES: Noise, as an unwanted sound, has become one of modern society's environmental conundrums, and many children are exposed to higher noise levels than previously assumed. However, the effects of background noise on central auditory processing of toddlers, who are still acquiring language skills, have so far not been determined. The authors evaluated the effects of background noise on toddlers' speech-sound processing by recording event-related brain potentials. The hypothesis was that background noise modulates neural speech-sound encoding and degrades speech-sound discrimination. DESIGN: Obligatory P1 and N2 responses for standard syllables and the mismatch negativity (MMN) response for five different syllable deviants presented in a linguistic multifeature paradigm were recorded in silent and background noise conditions. The participants were 18 typically developing 22- to 26-month-old monolingual children with healthy ears. RESULTS: The results showed that the P1 amplitude was smaller and the N2 amplitude larger in the noisy conditions compared with the silent conditions. In the noisy condition, the MMN was absent for the intensity and vowel changes and diminished for the consonant, frequency, and vowel duration changes embedded in speech syllables. Furthermore, the frontal MMN component was attenuated in the noisy condition. However, noise had no effect on P1, N2, or MMN latencies. CONCLUSIONS: The results from this study suggest multiple effects of background noise on the central auditory processing of toddlers. It modulates the early stages of sound encoding and dampens neural discrimination vital for accurate speech perception. These results imply that speech processing of toddlers, who may spend long periods of daytime in noisy conditions, is vulnerable to background noise. In noisy conditions, toddlers' neural representations of some speech sounds might be weakened. Thus, special attention should be paid to acoustic conditions and background noise levels in children's daily environments, like day-care centers, to ensure a propitious setting for linguistic development. In addition, the evaluation and improvement of daily listening conditions should be an ordinary part of clinical intervention of children with linguistic problems.

Effects of recurrent acute otitis media on cortical speech-sound processing in 2-year old children.

OBJECTIVES: To investigate at the age of 2 years the effects of childhood recurrent acute otitis media (RAOM) on central auditory processing by using cortical event-related potentials elicited by syllable stimuli. DESIGN: During a 1-year period, 22- to 26-month-old children fulfilling the criteria for tympanostomy tube insertion in Oulu University Hospital, Oulu, Finland, were recruited to the RAOM group (N = 20). The control group (N = 19) was matched by age, sex, and mother's educational level. In both groups, children were typically developing and had no family history of language disorder or developmental language problems. Finnish syllables /ke:/ and /pi:/ as standards and their variants with changes in frequency, intensity, vowel, consonant, and vowel duration as deviants were used to record P1, N2, and mismatch negativity (MMN) responses in the multifeature paradigm. The clinically healthy ears at the time of registration were a prerequisite for the participation. RESULTS: Children with RAOM and their controls showed the age-typical P1 and N2 responses with no differences in the amplitudes or latencies between the groups, which suggests unaffected basic encoding of sound features and sound representation formation. However, the groups showed different auditory discrimination profiles. In children with RAOM, frequency and vowel MMN amplitudes were increased. Furthermore, the MMN latency for the frequency change was shorter and the frequency MMN amplitude lateralized to the left hemisphere in the RAOM group instead of an adult-like right-hemispheric lateralization observed in the controls. The children with RAOM had a more anterior MMN amplitude scalp distribution for the intensity change than control children. In addition, the MMN amplitude elicited by consonant change was evenly distributed unlike in controls, who had a left-side preponderant lateralization. Taken together, these results suggest an elevated responsiveness for frequency, vowel, and intensity changes, and an immature pattern of discriminating small speech sound contrasts in children with RAOM. CONCLUSIONS: The results suggest that childhood RAOM does not affect the central auditory pathway integrity or sound encoding. However, RAOM may lead to aberrant preattentive discrimination of sound features even when the peripheral auditory input is normal. These results are clinically significant because even transient problems with auditory processing may delay language development.

A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies?

PURPOSE: We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). METHOD: A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f0, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). RESULTS: No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f0 increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f0 decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls' eight-week non-therapy period (P = 0.003). CONCLUSION: The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group's voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.

Noise Equally Degrades Central Auditory Processing in 2- and 4-Year-Old Children.

Purpose: The aim of this study was to investigate developmental and noise-induced changes in central auditory processing indexed by event-related potentials in typically developing children. Method: P1, N2, and N4 responses as well as mismatch negativities (MMNs) were recorded for standard syllables and consonants, frequency, intensity, vowel, and vowel duration changes in silent and noisy conditions in the same 14 children at the ages of 2 and 4 years. Results: The P1 and N2 latencies decreased and the N2, N4, and MMN amplitudes increased with development of the children. The amplitude changes were strongest at frontal electrodes. At both ages, background noise decreased the P1 amplitude, increased the N2 amplitude, and shortened the N4 latency. The noise-induced amplitude changes of P1, N2, and N4 were strongest frontally. Furthermore, background noise degraded the MMN. At both ages, MMN was significantly elicited only by the consonant change, and at the age of 4 years, also by the vowel duration change during noise. Conclusions: Developmental changes indexing maturation of central auditory processing were found from every response studied. Noise degraded sound encoding and echoic memory and impaired auditory discrimination at both ages. The older children were as vulnerable to the impact of noise as the younger children. Supplemental materials: https://doi.org/10.23641/asha.5233939.

Linguistic multi-feature paradigm as an eligible measure of central auditory processing and novelty detection in 2-year-old children.

This study evaluated whether the linguistic multi-feature paradigm with five types of speech-sound changes and novel sounds is an eligible neurophysiologic measure of central auditory processing in toddlers. Participants were 18 typically developing 2-year-old children. Syllable stimuli elicited significant obligatory responses and syllable changes significant MMN (mismatch negativity) which suggests that toddlers can discriminate auditory features from alternating speech-sound stream. The MMNs were lateralized similarly as found earlier in adults. Furthermore, novel sounds elicited a significant novelty P3 response. Thus, the linguistic multi-feature paradigm with novel sounds is feasible for the concurrent investigation of the different stages of central auditory processing in 2-year-old children, ranging from pre-attentive encoding and discrimination of stimuli to attentional mechanisms in speech-like research compositions. As a conclusion, this time-efficient paradigm can be applied to investigating central auditory development and impairments in toddlers in whom developmental changes of speech-related cortical functions and language are rapid.