Voice gender and the segregation of competing talkers: Perceptual learning in cochlear implant simulations.

Two experiments explored the role of differences in voice gender in the recognition of speech masked by a competing talker in cochlear implant simulations. Experiment 1 confirmed that listeners with normal hearing receive little benefit from differences in voice gender between a target and masker sentence in four- and eight-channel simulations, consistent with previous findings that cochlear implants deliver an impoverished representation of the cues for voice gender. However, gender differences led to small but significant improvements in word recognition with 16 and 32 channels. Experiment 2 assessed the benefits of perceptual training on the use of voice gender cues in an eight-channel simulation. Listeners were assigned to one of four groups: (1) word recognition training with target and masker differing in gender; (2) word recognition training with same-gender target and masker; (3) gender recognition training; or (4) control with no training. Significant improvements in word recognition were observed from pre- to post-test sessions for all three training groups compared to the control group. These improvements were maintained at the late session (one week following the last training session) for all three groups. There was an overall improvement in masked word recognition performance provided by gender mismatch following training, but the amount of benefit did not differ as a function of the type of training. The training effects observed here are consistent with a form of rapid perceptual learning that contributes to the segregation of competing voices but does not specifically enhance the benefits provided by voice gender cues.

Preliminary evaluation of a novel non-linear frequency compression scheme for use in children.

OBJECTIVE: The primary goal of this study was to evaluate a new form of non-linear frequency compression (NLFC) in children. The new NLFC processing scheme is adaptive and potentially allows for a better preservation of the spectral characteristics of the input sounds when compared to conventional NLFC processing. DESIGN: A repeated-measures design was utilised to compare the speech perception of the participants with two configurations of the new adaptive NLFC processing to their performance with the existing NLFC. The outcome measures included the University of Western Ontario Plurals test, the Consonant-Nucleus-Consonant word recognition test, and the Phonak Phoneme Perception test. STUDY SAMPLE: Study participants included 14 children, aged 6-17 years, with mild-to-severe low-frequency hearing loss and severe-to-profound high-frequency hearing loss. RESULTS: The results indicated that the use of the new adaptive NLFC processing resulted in significantly better average word recognition and plural detection relative to the conventional NLFC processing. CONCLUSION: Overall, the adaptive NLFC processing evaluated in this study has the potential to significantly improve speech perception relative to conventional NLFC processing.

Speech-in-Noise and Dichotic Auditory Training Students With Autism Spectrum Disorder.

PURPOSE: Individuals diagnosed with autism spectrum disorder (ASD) often exhibit auditory processing issues, including poor speech recognition in background noise and dichotic processing (integration of different stimuli presented to the two ears). Auditory training could mitigate these auditory difficulties. However, few auditory training programs have been designed to target specific listening deficits for students with ASD. The present study summarizes the development of an innovative, one-on-one, clinician-developed speech-in-noise (SIN) training program that has not been previously described and an existing dichotic auditory training program to address common auditory processing deficits in students with ASD. METHOD: Twenty verbal students with ASD, ages 7-17 years, completed a one-on-one, clinician-developed SIN training program and a commercially available dichotic training program 2-3 times a week (30-45 min per session) for 12 weeks. Maximum and minimum training levels from the SIN and dichotic training programs were analyzed statistically to document changes in training level over the training period. RESULTS: Analyses of the pre- and posttraining data revealed significant improvements in training level for both the SIN and dichotic training programs. CONCLUSIONS: Overall, the proposed SIN training resulted in significant improvements in training level and may be used along with dichotic training to improve some of the most common auditory processing issues documented in verbal individuals with ASD requiring minimal support. Both types of auditory training may be implemented in one-on-one therapy in clinics and in the schools.

Developmental effects and spatial hearing in young children with normal-hearing sensitivity.

OBJECTIVES: Previous research suggests that young children have significant difficulty recognizing speech in the presence of background noise as compared with older children and adults. However, limited research exists that examines the developmental effects of speech recognition in noise in separate age groups of young children, especially in a classroom setting. The lack of research may relate to the limited number of tests with multiple, equally intelligible lists in noise that are also appropriate for young children. As a result, the goals of the present study include investigating (1) effects of age and (2) benefits of spatial separation of speech and noise sources on the speech recognition in noise performance of young children with normal-hearing sensitivity. A secondary goal of the study was to establish the validity and reliability of the Phrases in Noise Test (PINT) for assessing the 50% correct speech-in-noise threshold of young children. DESIGN: The investigators used a two-way repeated measures design to examine the main effects of age and spatial separation. Sixty-eight children in separate groups of 3-, 4-, 5-, and 6-year-olds and 17 adults completed two speech-recognition conditions with (1) speech and noise from the same loudspeaker at 0-degree azimuth (S0/N0) and (2) speech and noise from separate loudspeakers at 0- and 180-degree azimuth (S0/N180). Recruiting sites included local preschools and school districts for children and a university for adults. RESULTS: The results of this investigation suggest that younger children (<4 years of age) have significantly poorer speech-in-noise thresholds than older children and adults, and 4- and 5-year-old children also have significantly poorer performance than adults when speech and noise are presented from the same spatial location. All participants obtained significant spatial release from masking. On a parent and teacher screening questionnaire to assess educational risk, five of 12 children with at-risk behaviors had poor speech-in-noise thresholds relative to their peers. When two lists of the PINT are used, the test seems to be a valid and reliable measure for assessing young children's speech-in-noise thresholds. CONCLUSIONS: Young children exhibit significantly poorer speech recognition than do older children and adults in a classroom, especially when speech and noise are presented from the same location. Given the poor acoustics of typical classrooms, and the earlier age at which many children are educated, special modifications to classrooms may be necessary to improve listening through acoustic modifications or classroom amplification. A combination of a parent or teacher questionnaire and the PINT may be helpful in identifying children who are at risk for educational delays and listening difficulties in classrooms with typically poor acoustics.

List equivalency of the AzBio sentence test in noise for listeners with normal-hearing sensitivity or cochlear implants.

BACKGROUND: Speech recognition abilities of adults and children using cochlear implants (CIs) are significantly degraded in the presence of background noise, making this an important area of study and assessment by CI manufacturers, researchers, and audiologists. However, at this time there are a limited number of fixed-intensity sentence recognition tests available that also have multiple, equally intelligible lists in noise. One measure of speech recognition, the AzBio Sentence Test, provides 10-talker babble on the commercially available compact disc; however, there is no published evidence to support equivalency of the 15-sentence lists in noise for listeners with normal hearing (NH) or CIs. Furthermore, there is limited or no published data on the reliability, validity, and normative data for this test in noise for listeners with CIs or NH. PURPOSE: The primary goals of this study were to examine the equivalency of the AzBio Sentence Test lists at two signal-to-noise ratios (SNRs) in participants with NH and at one SNR for participants with CIs. Analyses were also conducted to establish the reliability, validity, and preliminary normative data for the AzBio Sentence Test for listeners with NH and CIs. RESEARCH DESIGN: A cross-sectional, repeated measures design was used to assess speech recognition in noise for participants with NH or CIs. STUDY SAMPLE: The sample included 14 adults with NH and 12 adults or adolescents with Cochlear Freedom CI sound processors. Participants were recruited from the University of North Texas clinic population or from local CI centers. DATA COLLECTION AND ANALYSIS: Speech recognition was assessed using the 15 lists of the AzBio Sentence Test and the 10-talker babble. With the intensity of the sentences fixed at 73 dB SPL, listeners with NH were tested at 0 and -3 dB SNRs, and participants with CIs were tested at a +10 dB SNR. Repeated measures analysis of variance (ANOVA) was used to analyze the data. RESULTS: The primary analyses revealed significant differences in performance across the 15 lists on the AzBio Sentence Test for listeners with NH and CIs. However, a follow-up analysis revealed no significant differences in performance across 10 of the 15 lists. Using the 10, equally-intelligible lists, a comparison of speech recognition performance across the two groups suggested similar performance between NH participants at a -3 dB SNR and the CI users at a +10 SNR. Several additional analyses were conducted to support the reliability and validity of the 10 equally intelligible AzBio sentence lists in noise, and preliminary normative data were provided. CONCLUSIONS: Ten lists of the commercial version of the AzBio Sentence Test may be used as a reliable and valid measure of speech recognition in noise in listeners with NH or CIs. The equivalent lists may be used for a variety of purposes including audiological evaluations, determination of CI candidacy, hearing aid and CI programming considerations, research, and recommendations for hearing assistive technology. In addition, the preliminary normative data provided in this study establishes a starting point for the creation of comprehensive normative data for the AzBio Sentence Test.

A Novel Performance-Based Paradigm of Care for Cochlear Implant Follow-Up.

OBJECTIVES: Utilize a multi-institutional outcomes database to determine expected performance for adult cochlear implant (CI) users. Estimate the percentage of patients who are high performers and achieve performance plateau. STUDY DESIGN: Retrospective database study. METHODS: Outcomes from 9,448 implantations were mined to identify 804 adult, unilateral recipients who had one preoperative and at least one postoperative consonant-nucleus-consonant (CNC) word score. Results were examined to determine percent-correct CNC word recognition preoperatively and at 1, 3, 6, 12, and 24 months after activation. Outcomes from 318 similar patients who also had at least three postoperative CNC word scores were examined. Linear mixed-effects regression was used to examine CNC word performance over time. The time when each patient achieved maximum performance was recorded as a surrogate for time of performance plateau. Patients were assigned as candidates for less intense follow-up if they were high performers and achieved performance plateau. RESULTS: Among 804 patients with at least one postoperative score, CNC score improved at all time intervals. Average performance after the 3-month time interval was 47.2% to 51.5%, indicating a CNC ≥ 50% cutoff for high performers. Among 318 patients with at least three postoperative scores, performance improved from 1 to 3 (P = .001), 3 to 6 (P = .001), and 6 to 12 (P = .01) months. Scores from the 12- and 24-month intervals did not significantly differ (P = .09). By 12 months after activation, 59.7% of patients were considered candidates for less intense follow-up. CONCLUSION: Findings suggest that CNC ≥ 50% is a reasonable cutoff to separate high performers from low performers. Within 12 months after activation, 59.7% of patients were good candidates for less intense follow-up. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:S1-S10, 2022.

Remote Microphone Systems for Cochlear Implant Recipients in Small Group Settings.

PURPOSE: Cochlear implant (CI) recipients often experience speech recognition difficulty in noise in small group settings with multiple talkers. In traditional remote microphones systems, one talker wears a remote microphone that wirelessly delivers speech to the CI processor. This system will not transmit signals from multiple talkers in a small group. However, remote microphone systems with multiple microphones allowing for adaptive beamforming may be beneficial for small group situations with multiple talkers. Specifically, a remote microphone with an adaptive multiple-microphone beamformer may be placed in the center of the small group, and the beam (i.e., polar lobe) may be automatically steered toward the direction associated with the most favorable speech-to-noise ratio. The signal from the remote microphone can then be wirelessly delivered to the CI sound processor. Alternately, each of the talkers in a small group may use a remote microphone that is part of a multi-talker network that wirelessly delivers the remote microphone signal to the CI sound processor. The purpose of this study was to compare the potential benefit of an adaptive multiple-microphone beamformer remote microphone system and a multi-talker network remote microphone system. METHOD: Twenty recipients, ages 12 to 84 years, with Advanced Bionics CIs completed sentence-recognition-in-noise tasks while seated at a desk surrounded by three loudspeakers at 0, 90, and 270 degrees. These speakers randomly presented the target speech while competing noise was presented from four loudspeakers located in the corners of the room. Testing was completed in three conditions: 1) CI alone, 2) Remote microphone system with an adaptive multiple-microphone beamformer, and 3) and a multi-talker network remote microphone system each with five different signal levels (15 total conditions). RESULTS: Significant differences were found across all signal levels and technology conditions. Relative to the CI alone, sentence recognition improvements ranged from 14-23 percentage points with the adaptive multiple-microphone beamformer and 27-47 percentage points with the multi-talker network with superior performance for the latter remote microphone system. CONCLUSIONS: Both remote microphone systems significantly improved speech recognition in noise of CI recipients when listening in small group settings, but the multi-talker network provided superior performance.

A meta-analysis to compare speech recognition in noise with bilateral cochlear implants and bimodal stimulation.

OBJECTIVE: This investigation quantified the relative benefits of binaural CI arrangements (i.e., bilateral, bimodal) for three binaural phenomena (i.e., binaural squelch, binaural summation, head-shadow effect) and sensitivity of two speech-recognition test paradigms (i.e., adaptive and fixed). DESIGN: A repeated-measures meta-analytical approach was used to compare effect sizes between binaural CI arrangements for each of the three binaural-listening phenomena and between the two test paradigms. STUDY SAMPLE: A total of 95 effect sizes were calculated and analyzed from 42 peer-reviewed studies published between January 2000 and April 2011. RESULTS: Findings revealed significant effect sizes for both CI arrangements for the binaural phenomena of summation and head-shadow effect. A significant effect size for binaural squelch was determined only for bilateral CI users. Further, the two paradigms resulted in similar effect sizes for bilateral and bimodal users, with the exception of binaural squelch. Here, significant effect sizes were significant only in the fixed-testing paradigm. CONCLUSIONS: The average user of binaural CI arrangements realizes the binaural phenomena of summation and the head-shadow effect, but only the bilateral CI arrangement is afforded the advantage of binaural squelch. Statistically, listeners fit with bilateral CIs have a slight advantage in binaural performance over those using bimodal stimulation.

Educational Challenges During the Pandemic for Students Who Have Hearing Loss.

Purpose The COVID-19 pandemic introduced new educational challenges for students, teachers, and caregivers due to the changed and varied learning environments, use of face masks, and social distancing requirements. These challenges are particularly pronounced for students with hearing loss who often require specific accommodations to allow for equal access to the curriculum. The purpose of this study was to document the potential difficulties that students with hearing loss faced during the pandemic and to generate recommendations to promote learning and engagement based on findings. Method A qualitative survey was designed to document the frequency of various learning situations (i.e., in person, remote virtual, and blended), examine the accessibility of technology and course content, and quantify hearing issues associated with safety measures and technology use in school-age students with hearing loss. Survey questions were informed from key educational issues reported in published articles and guidelines. The survey was completed by 416 educational personnel who work with students with hearing loss. Results Respondents indicated that most of their schools were providing remote or blended (in-person and remote) learning consisting of synchronous and asynchronous learning. Common accommodations for students with hearing loss were only provided some of the time with the exception of sign language interpreters, which were provided for almost all students who required them. According to the respondents, both students and caregivers reported issues or discomfort with the technology required for remote learning. Conclusion To ensure that students with hearing loss are provided equal access to the curriculum, additional accommodations should be considered to address issues arising from pandemic-related changes to school and learning practices including closed captioning, transcripts/notes, recordings of lectures, sign language interpreters, student check-ins, and family-directed resources to assist with technology issues.

Characteristic Deviations of Auditory Evoked Potentials in Individuals with Autism Spectrum Disorder.

BACKGROUND: Neurological, structural, and behavioral abnormalities are widely reported in individuals with autism spectrum disorder (ASD); yet there are no objective markers to date. We postulated that by using dominant and nondominant ear data, underlying differences in auditory evoked potentials (AEPs) between ASD and control groups can be recognized. PURPOSE: The primary purpose was to identify if significant differences exist in AEPs recorded from dominant and nondominant ear stimulation in (1) children with ASD and their matched controls, (2) adults with ASD and their matched controls, and (3) a combined child and adult ASD group and control group. The secondary purpose was to explore the association between the significant findings of this study with those obtained in our previous study that evaluated the effects of auditory training on AEPs in individuals with ASD. RESEARCH DESIGN: Factorial analysis of variance with interaction was performed. STUDY SAMPLE: Forty subjects with normal hearing between the ages of 9 and 25 years were included. Eleven children and 9 adults with ASD were age- and gender-matched with neurotypical peers. DATA COLLECTION AND ANALYSIS: Auditory brainstem responses (ABRs) and auditory late responses (ALRs) were recorded. Adult and child ASD subjects were compared with non-ASD adult and child control subjects, respectively. The combined child and adult ASD group was compared with the combined child and adult control group. RESULTS: No significant differences in ABR latency or amplitude were observed between ASD and control groups. ALR N1 amplitude in the dominant ear was significantly smaller for the ASD adult group compared with their control group. Combined child and adult data showed significantly smaller amplitude for ALR N1 and longer ALR P2 latency in the dominant ear for the ASD group compared with the control group. In our earlier study, the top predictor of behavioral improvement following auditory training was ALR N1 amplitude in the dominant ear. Correspondingly, the ALR N1 amplitude in the dominant ear yielded group differences in the current study. CONCLUSIONS: ALR peak N1 amplitude is proposed as the most feasible AEP marker in the evaluation of ASD.

Factors Associated with Speech-Recognition Performance in School-Aged Children with Cochlear Implants and Early Auditory-Verbal Intervention.

BACKGROUND: Considerable variability exists in the speech recognition abilities achieved by children with cochlear implants (CIs) due to varying demographic and performance variables including language abilities. PURPOSE: This article examines the factors associated with speech recognition performance of school-aged children with CIs who were grouped by language ability. RESEARCH DESIGN: This is a single-center cross-sectional study with repeated measures for subjects across two language groups. STUDY SAMPLE: Participants included two groups of school-aged children, ages 7 to 17 years, who received unilateral or bilateral CIs by 4 years of age. The High Language group (N = 26) had age-appropriate spoken-language abilities, and the Low Language group (N = 24) had delays in their spoken-language abilities. DATA COLLECTION AND ANALYSIS: Group comparisons were conducted to examine the impact of demographic characteristics on word recognition in quiet and sentence recognition in quiet and noise. RESULTS: Speech recognition in quiet and noise was significantly poorer in the Low Language compared with the High Language group. Greater hours of implant use and better adherence to auditory-verbal (AV) therapy appointments were associated with higher speech recognition in quiet and noise. CONCLUSION: To ensure maximal speech recognition in children with low-language outcomes, professionals should develop strategies to ensure that families support full-time CI use and have the means to consistently attend AV appointments.

Meta-Analysis of Speech Recognition Outcomes in Younger and Older Adults With Cochlear Implants.

Purpose Meta-analyses were conducted to compare pre- to postoperative speech recognition improvements and postoperative scores after cochlear implantation in younger (< 60 years) and older (> 60 years) adults. Method Studies were identified with electronic databases and through manual search of the literature. In the primary analyses, effect sizes between pre- and postoperative scores for each age group were calculated using a formula appropriate for repeated-measures designs. Using the effect sizes, two separate meta-analyses using a random-effects restricted maximum likelihood model were conducted for experiments using word and sentence recognition stimuli in quiet. Secondary meta-analyses were conducted to examine average postimplant, percent correct word recognition, sentence recognition, and speech recognition in noise in studies that included both older and younger age groups. Traditional Hedges's g effect sizes were calculated between the two groups. Results For the primary analyses, experiments using word and sentence recognition stimuli yielded significant, large effect sizes for the younger and older adult cochlear implant recipients with no significant differences between the older and younger age groups. However, the secondary meta-analyses of postoperative scores suggested significant differences between age groups for stimuli in quiet and noise. Conclusions Although older and younger adults with implants achieve the same magnitude of pre- to postimplant speech recognition benefit in quiet, the overall postoperative speech recognition outcomes in quiet and noise are superior in younger over older adults. Strategies to mitigate these group differences are critical for ensuring optimal outcomes in elderly individuals who are candidates for cochlear implants.

Remote Microphone Technology for Children with Hearing Loss or Auditory Processing Issues.

School classrooms are noisy and reverberant environments, and the poor acoustics can be a barrier to successful learning in children, particularly those with multiple disabilities, auditory processing issues, and hearing loss. A new set of listening challenges have been imposed by the recent global pandemic and subsequent online learning requirements. The goal of this article is to review the impact of poor acoustics on the performance of children with auditory processing issues, mild hearing loss, and unilateral hearing loss. In addition, we will summarize the evidence in support of remote microphone technology by these populations.

Effects of Auditory Training on Electrophysiological Measures in Individuals with Autism Spectrum Disorder.

BACKGROUND: Identifying objective changes following an auditory training program is central to the assessment of the program's efficacy. PURPOSE: This study aimed (1) to objectively determine the efficacy of a 12-week auditory processing training (APT) program in individuals with autism spectrum disorder using auditory evoked potentials (AEPs) and (2) to identify the top central AEP predictors of the overall score on the Test of Auditory Processing Skills-3 (TAPS-3), the primary behavioral outcome measure of the APT program published in our earlier article. RESEARCH DESIGN: A one-group pretraining, posttraining design was used. STUDY SAMPLE: The sample included 15 children and young adults diagnosed with autism spectrum disorder. Participants underwent the APT program consisting of computerized dichotic training, one-on-one therapist-directed auditory training, and the use of remote microphone technology at home and in the classroom. DATA COLLECTION AND ANALYSIS: All participants underwent pre- and posttraining auditory brain stem responses (ABRs), complex auditory brain stem responses (cABRs), and auditory late responses (ALRs). Test results from ABRs and ALRs were grouped based on scores obtained in their dominant and nondominant ears. Paired t-tests were used to assess the efficacy of the training program, and least absolute shrinkage and selection operator regression was used to assess the relationship between ALRs and the TAPS-3 overall summed raw score reported in our earlier article. RESULTS AND CONCLUSIONS: When compared with pretraining results, posttraining results showed shorter ABR latencies and larger amplitudes. The cABRs showed decreased latencies of the frequency following waves, a reduction in pitch error, and enhancement of pitch strength and phase shift. ALR results indicated shorter latencies and larger amplitudes. Our earlier article showed that the TAPS-3 overall score was significantly higher after training. This study showed that the top three ALR predictors of TAPS-3 outcomes were P1 amplitude in the dominant ear, and N1 amplitude in the dominant and nondominant ears.

Benefits of a Hearing Registry: Cochlear Implant Candidacy in Quiet Versus Noise in 1,611 Patients.

Purpose This retrospective study used a cochlear implant registry to determine how performing speech recognition candidacy testing in quiet versus noise influenced patient selection, speech recognition, and self-report outcomes. Method Database queries identified 1,611 cochlear implant recipients who were divided into three implant candidacy qualifying groups based on preoperative speech perception scores (≤ 40% correct) on the AzBio sentence test: quiet qualifying group, +10 dB SNR qualifying group, and +5 dB SNR qualifying group. These groups were evaluated for demographic and preoperative hearing characteristics. Repeated-measures analysis of variance was used to compare pre- and postoperative performance on the AzBio in quiet and noise with qualifying group as a between-subjects factor. For a subset of recipients, pre- to postoperative changes on the Speech, Spatial and Qualities of Hearing Scale were also evaluated. Results Of the 1,611 patients identified as cochlear implant candidates, 63% of recipients qualified in quiet, 10% qualified in a +10 dB SNR, and 27% qualified in a +5 dB SNR. Postoperative speech perception scores in quiet and noise significantly improved for all qualifying groups. Across qualifying groups, the greatest speech perception improvements were observed when tested in the same qualifying listening condition. For a subset of patients, the total Speech, Spatial and Qualities of Hearing Scale ratings improved significantly as well. Conclusion Patients who qualified for cochlear implantation in quiet or background noise test conditions showed significant improvement in speech perception and quality of life scores, especially when the qualifying noise condition was used to track performance.

Behavioral Auditory Processing in Children and Young Adults with Autism Spectrum Disorder.

BACKGROUND: Auditory-processing deficits are common in children and adults who are diagnosed with autism spectrum disorder (ASD). These deficits are evident across multiple domains as exhibited by the results from subjective questionnaires from parents, teachers, and individuals with ASD and from behavioral auditory-processing testing. PURPOSE: Few studies compare subjective and behavioral performance of adults and children diagnosed with ASD using commercially available tests of auditory processing. The primary goal of the present study is to compare the performance of adults and children with ASD to age-matched, neurotypical peers. The secondary goal is to examine the effect of age on auditory-processing performance in individuals with ASD relative to age-matched peers. RESEARCH DESIGN: A four-group, quasi-experimental design with repeated measures was used in this study. STUDY SAMPLE: Forty-two adults and children were separated into four groups of participants: (1) 10 children with ASD ages 14 years or younger; (2) 10 age-matched, neurotypical children; (3) 11 adolescents and young adults with ASD ages 16 years and older; and (4) 11 age-matched, neurotypical adolescents or young adults. DATA COLLECTION AND ANALYSIS: Data from each participant were collected in one test session. Data were analyzed with analysis of variance (ANOVA), repeated measures ANOVA, or nonparametric analyses. Effect sizes were calculated to compare performance between those with ASD and those who were neurotypical within each age group. RESULTS: Across all the questionnaires and the majority of the behavioral test measures, participants with ASD had significantly poorer ratings or auditory-processing performance than age-matched, neurotypical peers. Adults had more favorable performance than children on several of the test measures. Medium to large effect sizes corroborated the significant results. CONCLUSION: Overall, the questionnaires and behavioral tests used in this study were sensitive to detecting auditory-processing differences between individuals diagnosed with ASD and those who are considered neurotypical. On most test measures, children performed more poorly than adults. The findings in this study support that both children and adults with ASD exhibit auditory-processing difficulties. Appropriate school and work accommodations will be necessary to ensure appropriate access to speech in challenging environments.

Effects of FM-receiver gain on speech-recognition performance of adults with cochlear implants.

The primary aim of this study was to examine the effects of frequency-modulated (FM) settings on speech-recognition performance in noise of listeners using two different cochlear implant speech processors. Participants included eight users of ESPrit 3G speech processors and nine users of Auria speech processors. A modified adaptive-testing paradigm was used to assess speech recognition in noise with the cochlear implant and FM system at four receiver-gain settings: +6, +10, +14, or +20. In the no-FM condition, performance differences were not detected between the two processor groups. In the FM conditions, significantly better performance was found for participants with the Auria processor compared to those using the ESPrit 3G processor. Increases in receiver gain did not significantly improve speech recognition of participants using ESPrit 3G processors, but did significantly influence performance for those using Auria processors. For Auria users, the +6 setting resulted in significantly poorer performance than all other conditions, and optimal FM performance was found in the +14 and +20 gain settings. Clinical recommendations will be provided according to results of the study.

Evaluation of speech recognition in noise with cochlear implants and dynamic FM.

BACKGROUND: Use of personal frequency-modulated (FM) systems significantly improves speech recognition in noise for users of cochlear implants (CIs). Previous studies have shown that the most appropriate gain setting on the FM receiver may vary based on the listening situation and the manufacturer of the CI system. Unlike traditional FM systems with fixed-gain settings, Dynamic FM automatically varies the gain of the FM receiver with changes in the ambient noise level. There are no published reports describing the benefits of Dynamic FM use for CI recipients or how Dynamic FM performance varies as a function of CI manufacturer. PURPOSE: To evaluate speech recognition of Advanced Bionics Corporation or Cochlear Corporation CI recipients using Dynamic FM vs. a traditional FM system and to examine the effects of Autosensitivity on the FM performance of Cochlear Corporation recipients. RESEARCH DESIGN: A two-group repeated-measures design. Participants were assigned to a group according to their type of CI. STUDY SAMPLE: Twenty-five subjects, ranging in age from 8 to 82 years, met the inclusion criteria for one or more of the experiments. Thirteen subjects used Advanced Bionics Corporation, and 12 used Cochlear Corporation implants. INTERVENTION: Speech recognition was assessed while subjects used traditional, fixed-gain FM systems and Dynamic FM systems. DATA COLLECTION AND ANALYSIS: In Experiments 1 and 2, speech recognition was evaluated with a traditional, fixed-gain FM system and a Dynamic FM system using the Hearing in Noise Test sentences in quiet and in classroom noise. A repeated-measures analysis of variance (ANOVA) was used to evaluate effects of CI manufacturer (Advanced Bionics and Cochlear Corporation), type of FM system (traditional and dynamic), noise level, and use of Autosensitivity for users of Cochlear Corporation implants. Experiment 3 determined the effects of Autosensitivity on speech recognition of Cochlear Corporation implant recipients when listening through the speech processor microphone with the FM system muted. A repeated-measures ANOVA was used to examine the effects of signal-to-noise ratio and Autosensitivity. RESULTS: In Experiment 1, use of Dynamic FM resulted in better speech recognition in noise for Advanced Bionics recipients relative to traditional FM at noise levels of 65, 70, and 75 dB SPL. Advanced Bionics recipients obtained better speech recognition in noise with FM use when compared to Cochlear Corporation recipients. When Autosensitivity was enabled in Experiment 2, the performance of Cochlear Corporation recipients was equivalent to that of Advanced Bionics recipients, and Dynamic FM was significantly better than traditional FM. Results of Experiment 3 indicate that use of Autosensitivity improves speech recognition in noise of signals directed to the speech processor relative to no Autosensitivity. CONCLUSIONS: Dynamic FM should be considered for use with persons with CIs to improve speech recognition in noise. At default CI settings, FM performance is better for Advanced Bionics recipients when compared to Cochlear Corporation recipients, but use of Autosensitivity by Cochlear Corporation users results in equivalent group performance.

Effects of Auditory Training and Remote Microphone Technology on the Behavioral Performance of Children and Young Adults Who Have Autism Spectrum Disorder.

BACKGROUND: Individuals who have a normal pure-tone audiogram but are diagnosed with autism spectrum disorder (ASD) often exhibit poorer speech recognition and auditory processing when compared with neurotypical peers with normal pure-tone audiograms. PURPOSE: The purpose of this study was to determine the efficacy and effectiveness of a 12-week auditory processing training (APT) program that was designed to address the deleterious effects of background noise and auditory processing deficits that are common among individuals diagnosed with ASD. RESEARCH DESIGN: A repeated measures design was used. STUDY SAMPLE: The sample consisted of 15 high-functioning children and young adults who had a formal diagnosis of ASD and who were recruited from local clinics and school districts. INTERVENTION: Participants completed the 12-week APT program consisting of computerized dichotic training, one-on-one therapist-directed auditory training, and the use of remote microphone (RM) technology at home and in the classroom. DATA COLLECTION AND ANALYSIS: Participants completed a comprehensive test battery to assess general auditory processing skills, speech recognition in noise, acceptance of background noise, spatial processing, binaural integration abilities, self-perceived difficulties, and observed behaviors. Testing was conducted before (n = 15), immediately after (n = 15), and 12 weeks after (n = 7) the completion of the APT program. Paired t-tests, repeated measures analysis of variance, or nonparametric tests were used to analyze the data. RESULTS: On average, the APT program significantly enhanced general auditory processing abilities, including binaural integration and subjective listening abilities in the classroom. When the RM was used, significantly improved speech recognition and improved acceptance of background noise was measured relative to a condition with no technology. CONCLUSIONS: Following the APT program, the participants exhibited the greatest improvements in testing that required binaural integration and auditory working memory. The use of the RM technology was able to address the deleterious effects of noise on speech recognition in noise and acceptance of noise levels.

Optimizing the benefit of sound processors coupled to personal FM systems.

BACKGROUND: Use of personal frequency modulated (FM) systems significantly improves speech recognition in noise for users of cochlear implants (CI). There are, however, a number of adjustable parameters of the cochlear implant and FM receiver that may affect performance and benefit, and there is limited evidence to guide audiologists in optimizing these parameters. PURPOSE: This study examined the effect of two sound processor audio-mixing ratios (30/70 and 50/50) on speech recognition and functional benefit for adults with CIs using the Advanced Bionics Auria sound processors. RESEARCH DESIGN: Fully-repeated repeated measures experimental design. Each subject participated in every speech-recognition condition in the study, and qualitative data was collected with subject questionnaires. STUDY SAMPLE: Twelve adults using Advanced Bionics Auria sound processors. Participants had greater than 20% correct speech recognition on consonant-nucleus-consonant (CNC) monosyllabic words in quiet and had used their CIs for at least six months. INTERVENTION: Performance was assessed at two audio-mixing ratios (30/70 and 50/50). For the 50/50 mixing ratio, equal emphasis is placed on the signals from the sound processor and the FM system. For the 30/70 mixing ratio, the signal from the microphone of the sound processor is attenuated by 10 dB. DATA COLLECTION AND ANALYSIS: Speech recognition was assessed at two audio-mixing ratios (30/70 and 50/50) in quiet (35 and 50 dB HL) and in noise (+5 signal-to-noise ratio) with and without the personal FM system. After two weeks of using each audio-mixing ratio, the participants completed subjective questionnaires. RESULTS: Study results suggested that use of a personal FM system resulted in significant improvements in speech recognition in quiet at low-presentation levels, speech recognition in noise, and perceived benefit in noise. Use of the 30/70 mixing ratio resulted in significantly poorer speech recognition for low-level speech that was not directed to the FM transmitter. There was no significant difference in speech recognition in noise or functional benefit between the two audio-mixing ratios. CONCLUSIONS: Use of a 50/50 audio-mixing ratio is recommended for optimal performance with an FM system in quiet and noisy listening situations.