A validation and normative study of the Parents' Evaluation of Aural/Oral Performance of Children plus (PEACH+) rating scale in Malaysia.

OBJECTIVE: The purpose of the present study was to (1) translate and validate the PEACH + Rating Scale in Malay and (2) establish normative curves as a function of age and examine test-retest reliability for the Malay and English versions of PEACH+. DESIGN: This is a cross-sectional study that used a convenient sampling technique. STUDY SAMPLE: One hundred and fifty-seven parents of typically developing children aged between 4 months and 7 years participated in the study. Forty-nine completed the Malay PEACH + in a pen-to-paper format (Aim 1). One hundred and eight parents completed PEACH + online (69 completed the Malay version and 39 the English version), and 20 of them completed the questionnaire twice (Aim 2). RESULTS: The PEACH + in Malay showed high internal consistency and item-total correlation. The normative data revealed that scores for frequency of auditory behaviour increased rapidly with age until about 20 months and reached an asymptote of around 90% by about 40 months of age. A similar trend was observed for ease of listening scores, which asymptoted around 85%. CONCLUSIONS: The validated Malay PEACH + Rating Scale can be used as a guide to monitor auditory functional performance and listening efforts of Malaysian children in real-world environments.

Impact of the COVID-19 Pandemic on Individuals With Hearing Loss and Audiology Practice in a Developing Country.

OBJECTIVE: This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic. DESIGN: A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services. STUDY SAMPLE: One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey. RESULTS: Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important. CONCLUSIONS: Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.

Optimising hearing aid output to paediatric prescriptive targets improves outcomes in children.

OBJECTIVE: This study examined the accuracy of hearing aid output to DSL v5.0 Child targets in a group of children who wear hearing aids, and the impact on their auditory outcomes. DESIGN: For each participant, the output of the initial hearing aid fitting was compared to DSL v5.0 Child prescriptive targets and again after the fitting was adjusted using coupler-based verification and RECD measures. Outcomes for initial and adjusted fittings were examined using the Speech Intelligibility Index (SII), Parent's Evaluation of Aural/Oral Performance of Children (PEACH) rating scale, and speech perception tests in quiet and noise. STUDY SAMPLE: Sixty-eight children aged 3 months to 17 years with moderate to profound hearing loss participated in the study. RESULTS: Fit-to-targets improved significantly after hearing aids were adjusted to match targets to within 5 dB RMSE. Adjusted hearing aids provided increased aided audibility compared to initial fittings and resulted in improved speech perception scores and parent-reported hearing performance. Fifty percent of the children aged 6 to 17 years preferred their adjusted fitting compared to 10% who preferred their initial fitting. CONCLUSIONS: Improvement in fit-to-target to a validated paediatric prescriptive formula using best practice procedures can result in improved auditory outcomes and possible self-reported satisfaction.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions.

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight (N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23-48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Development and evaluation of a hearing aid manual in the Malay language.

OBJECTIVE: This study aimed to (a) translate a hearing aid (HA) manual into Malay language and revise the translated manual based on best practice guidelines; (b) compare the effectiveness of the translated and the revised Malay HA manuals in helping individuals to perform HA management tasks. DESIGN: Cross-sectional, randomised, single-blinded study. STUDY SAMPLE: An Oticon-Dynamo HA manual was translated and revised based on best practice guidelines. Ninety participants aged 55 years and above participated in this study. They were randomly assigned into the control group (received translated manual) and the experimental group (received the revised translated manual). The Hearing Aid Management (HAM) test, which was developed in a previous study, was conducted to evaluate participant's ability to perform HA management tasks using the translated and the revised version of Malay HA manual. RESULTS: The revised Malay HA manual had a lower reading grade level relative to the initial translated Malay HA manual. The ability to perform HA management tasks was better in the experimental group (mean = 12.2, SD = 1.15) versus the control group (mean = 8.7, SD = 2.11). CONCLUSION: Further revision of existing HA manuals based on best practice guidelines is recommended to help individuals better manage their HAs.

The Effects of Manufacturer's Prefit and Real-Ear Fitting on the Predicted Speech Perception of Children with Severe to Profound Hearing Loss.

BACKGROUND: The use of probe microphone measures in hearing aid verification is often neglected or not fully used by practitioners. Some practitioners rely on simulated gain and output provided by manufacturer's fitting software to verify hearing aids. PURPOSE: This study aims to evaluate the effectiveness of manufacturer's prefit procedure in matching the prescribed real-ear targets. It also aims to study its correlated impact on the predicted speech perception in children with severe and profound hearing loss. RESEARCH DESIGN: This cross-sectional experiment was carried out by measuring the output of hearing aids based on prefit versus real-ear at low-, moderate-, and high-input levels. The predicted speech perception for different hearing aid fittings was determined based on the Speech Intelligibility Index (SII). STUDY SAMPLE: Sixteen children (28 ears) aged between 4 and 7 yr, with severe to profound sensorineural hearing loss took part in the study. METHOD: Two different types of hearing aids (Phonak and Unitron) were programmed based on their respective manufacturers' Desired Sensation Levels (DSL) v5 Child procedure. The hearing aids were then verified using coupler-based measurements and individual real-ear-to-coupler differences. The prefit outputs were compared with the DSL v5 Child-prescribed outputs at low-, moderate-, and high-input levels. The hearing aids were then adjusted to closely match the prescribed output. The SIIs were calculated for the fittings before and after adjustment. DATA COLLECTION AND ANALYSIS: Sixty four percent of fittings that were based on the prefit procedure achieved the optimal fit-to-targets, with less than 5-dB RMS deviations from the DSL v5 Child targets. After adjusting the hearing aids to attempt to meet the DSL v5 Child targets, 75% of the ears tested achieved the optimal fit-to-targets. On average, hearing aid outputs generated by the manufacturer's prefit procedure had good and reasonable agreement with the DSL v5 Child-prescribed outputs at low- and mid-frequencies. Nonetheless, at 4000 Hz, the hearing aid output mostly fell below the DSL v5 Child-prescribed outputs. This was still the case even after the hearing aid was adjusted to attempt to match with the targets. At low input level, some prefit outputs were found to be higher than the prescribed outputs. The deviations of prefit outputs from the prescribed outputs were dependent on the type of hearing aid and input levels. There was no significant difference between the SII calculated for fittings based on the prefit and adjusted fit. CONCLUSIONS: Prefit procedure tends to produce outputs that were below the DSL v5 Child-prescribed outputs, with the largest mean difference at 4000 Hz. Even though the hearing aid gains were adjusted to attempt to match with the targets, the outputs were still below the targets. The limitations of hearing aids to match the DSL v5 Child targets at high-frequency region have resulted in no improvement in the children's predicted speech perception.

The effect of non-native and non-regional speech testing on a multi-lingual population.

OBJECTIVE: This study was conducted to evaluate the speech perception of Malaysian Chinese adults using the Taiwanese Mandarin HINT (MHINT-T) and the Malay HINT (MyHINT). DESIGN: The MHINT-T and the MyHINT were presented in quiet and noise (front, right and left) conditions under headphones. Results for the two tests were compared with each other and with the norms for each test. STUDY SAMPLE: Malaysian Chinese native speakers of Mandarin (N = 58), 18-31 years of age with normal hearing. RESULTS: On average, subjects demonstrated poorer speech perception ability than the normative samples for these tests. Repeated measures ANOVA showed that speech reception thresholds (SRTs) were slightly poorer on the MHINT-T than on the MyHINT for all test conditions. However, normalized SRTs were poorer by 0.6 standard deviations for MyHINT as compared with MHINT-T. CONCLUSIONS: MyHINT and MHINT-T can be used as norm-referenced speech perception measures for Mandarin-speaking Chinese in Malaysia.

Auditory Performance of Paediatric Cochlear Implant Users under the National Cochlear Implant Programme / Jurnal Sains Kesihatan Malaysia

Cochlear implant (CI) is the main intervention option for people with severe and profound sensorineural hearing loss. The purpose of this study was to investigate the auditory performance of a group of prelingually deafened paediatric cochlear implant users using direct speech perception measures (objective) and a parental questionnaire (subjective) and to identify significant demographic factors that might contribute to their performance. A total of 48 children from the Cochlear Implant Program under the Malaysian Ministry of Health with hearing age of 12 to 89 months (mean = 42.60 ± 19.46 months) participated in this study. The speech perception test was conducted using selected tests from the Malay version of the Evaluation of Auditory Response to Speech (EARS) while parental views of the children’s performance were collected using the Malay version of the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) questionnaire. The recorded speech stimuli were presented to the children in a free field at approximately 65 dB SPL in a sound treated room. The speech perception test results were then categorized using the Malay version of the Categories of Auditory Performance Index (My-CAPI) with 10 categories ranging from ‘0’ to ‘9’. Results showed that most of the children (N = 20, 41.7%) were performing at category 2 of My-CAPI (limited closed set speech perception) with three children achieved the maximum category 9 (advanced open-set sentences in noise). Communication mode was the only demographic factor that significantly correlated with the My-CAPI and PEACH scores (p < 0.01). Pearson correlation coefficient showed a strong relationship between the PEACH scores and My-CAPI levels (p < 0.01; r = 0.71) suggesting that the PEACH questionnaire can be used as an indicator of the auditory performance if the speech perception tests cannot be performed. The findings suggest that the majority of the CI children tested in this study had not achieved satisfactory auditory performance and that the use of oral communication mode was the main factor associated with better auditory outcomes. Keywords: Speech perception; children; cochlear implant; Parents’ Evaluation of Aural/Oral Performance of Children (PEACH); Categories of Auditory Performance Index (CAPI)

Comparing NAL-NL1 and DSL v5 in Hearing Aids Fit to Children with Severe or Profound Hearing Loss: Goodness of Fit-to-Targets, Impacts on Predicted Loudness and Speech Intelligibility.

BACKGROUND: An important goal of providing amplification to children with hearing loss is to ensure that hearing aids are adjusted to match targets of prescriptive procedures as closely as possible. The Desired Sensation Level (DSL) v5 and the National Acoustic Laboratories' prescription for nonlinear hearing aids, version 1 (NAL-NL1) procedures are widely used in fitting hearing aids to children. Little is known about hearing aid fitting outcomes for children with severe or profound hearing loss. PURPOSE: The purpose of this study was to investigate the prescribed and measured gain of hearing aids fit according to the NAL-NL1 and the DSL v5 procedure for children with moderately severe to profound hearing loss; and to examine the impact of choice of prescription on predicted speech intelligibility and loudness. RESEARCH DESIGN: Participants were fit with Phonak Naida V SP hearing aids according to the NAL-NL1 and DSL v5 procedures. The Speech Intelligibility Index (SII) and estimated loudness were calculated using published models. STUDY SAMPLE: The sample consisted of 16 children (30 ears) aged between 7 and 17 yr old. DATA COLLECTION AND ANALYSIS: The measured hearing aid gains were compared with the prescribed gains at 50 (low), 65 (medium), and 80 dB SPL (high) input levels. The goodness of fit-to-targets was quantified by calculating the average root-mean-square (RMS) error of the measured gain compared with prescriptive gain targets for 0.5, 1, 2, and 4 kHz. The significance of difference between prescriptions for hearing aid gains, SII, and loudness was examined by performing analyses of variance. Correlation analyses were used to examine the relationship between measures. RESULTS: The DSL v5 prescribed significantly higher overall gain than the NAL-NL1 procedure for the same audiograms. For low and medium input levels, the hearing aids of all children fit with NAL-NL1 were within 5 dB RMS of prescribed targets, but 33% (10 ears) deviated from the DSL v5 targets by more than 5 dB RMS on average. For high input level, the hearing aid fittings of 60% and 43% of ears deviated by more than 5 dB RMS from targets of NAL-NL1 and DSL v5, respectively. Greater deviations from targets were associated with more severe hearing loss. On average, the SII was higher for DSL v5 than for NAL-NL1 at low input level. No significant difference in SII was found between prescriptions at medium or high input level, despite greater loudness for DSL v5 than for NAL-NL1. CONCLUSIONS: Although targets between 0.25 and 2 kHz were well matched for both prescriptions in commercial hearing aids, gain targets at 4 kHz were matched for NAL-NL1 only. Although the two prescriptions differ markedly in estimated loudness, they resulted in comparable predicted speech intelligibility for medium and high input levels.

Evaluation of real-world preferences and performance of hearing aids fitted according to the NAL-NL1 and DSL v5 procedures in children with moderately severe to profound hearing loss.

OBJECTIVE: The study aims to compare the performance of hearing aids fitted according to the NAL-NL1 and DSL v5 prescriptive procedure for children. DESIGN: This is a crossover four period trial. STUDY SAMPLE: Sixteen school-aged children with moderately severe to profound hearing losses participated in the study. The children were fitted with Phonak Naida V SP hearing aids according to the two prescriptive procedures. RESULTS: The results showed that children performed significantly better with DSL v5 than with NAL-NL1 prescription for sentence perception in quiet. The paired-comparison judgments of speech intelligibility showed seven children significantly preferred the DSL v5 prescription while two children preferred the NAL-NL1 prescription. The average scores on functional and ratings by parents and teachers performance of children in real life were significantly better for the DSL v5 prescription. At the end of all trials, nine children preferred the DSL v5 prescription, four preferred the NAL-NL1 prescription, and two had no preference. CONCLUSIONS: Hearing aids fitted based on the DSL v5 procedure would seem to be more appropriate than the NAL-NL1 procedure for children with moderately severe to profound sensorineural hearing loss, at least in quiet listening environments.

Parents' evaluation of aural/oral performance of children (PEACH) scale in the Malay language: data for normal-hearing children.

UNLABELLED: The parents' evaluation of aural/oral performance of children (PEACH) scale was developed to assess the effectiveness of amplification for children, based on a systematic use of parents' observations of children's performance in real-world environments. OBJECTIVE: The purpose of the present study was to adapt the PEACH scale into the Malay language, and to collect normative data on a group of children with normal hearing. STUDY SAMPLE: The participants were parents of 74 children aged between 3 months and 13 years of age. Parents were requested to observe their children's auditory/oral behavior in everyday life and to record their observations in the PEACH booklet. RESULTS: High internal consistency (Cronbach's alpha = 0.93) and item-total correlation were found (0.52-0.85). Similar to the published norms for English-speaking children, near-perfect scores were achieved by Malaysian children around 40 months of age. CONCLUSIONS: The adapted version can be used to evaluate amplification for children in the Malay speaking environment. The normative curve relating age to scores for the Malay PEACH can be used as a reference against which functional aural/oral performance of hearing-impaired Malaysian children can be evaluated.