Effect of Hearing Device Use on Speech-in-Noise Performance in Children with Severe-to-Profound Unilateral Hearing Loss.

OBJECTIVES: Limited evidence exists for the use of rerouting devices in children with severe-to-profound unilateral sensorineural hearing loss. Many laboratory studies to date have evaluated hearing-in-noise performance in specific target-masker spatial configurations within a small group of participants and with only a subset of available hearing devices. In the present study, the efficacy of all major types of nonsurgical devices was evaluated within a larger group of pediatric subjects on a challenging speech-in-noise recognition task. DESIGN: Children (7-18 years) with unaided severe-to-profound unilateral hearing loss (UHL' n = 36) or bilateral normal hearing (NH, n = 36) participated in the present study. The signal-to-noise ratio (SNR) required for 50% speech understanding (SNR-50) was measured using BKB sentences in the presence of proprietary restaurant noise (R-SPACE BSIN-R) in the R-SPACE Sound System. Subjects listened under 2 target/masker spatial configurations. The target signal was directed toward subjects' NH or hearing-impaired ear (45º azimuth), while the interfering restaurant noise masker was presented from the remaining 7 loudspeakers encircling the subject, spaced every 45º. Head position was fixed during testing. The presentation level of target sentences and masking noise varied over time to estimate the SNR-50 (dB). The following devices were tested in all participants with severe-to-profound UHL: air conduction (AC) contralateral routing of signal (CROS), bone conduction (BC) CROS fitted on a headband with and without the use of remote microphone (RM), and an ear-level RM hearing assistance technology (HAT) system. RESULTS: As a group, participants with severe-to-profound UHL performed best when the target signal was directed toward their NH ear. Across listening conditions, there was an average 8.5 dB improvement in SNR-50 by simply orienting the NH ear toward the target signal. When unaided, participants with severe-to-profound UHL performed as well as participants with NH when the target signal was directed toward the NH ear. Performance was negatively affected by AC CROS when the target signal was directed toward the NH ear, whereas no statistically significant change in performance was observed when using BC CROS. When the target signal was directed toward participants' hearing-impaired ear, all tested devices improved SNR-50 compared with the unaided condition, with small improvements (1-2 dB) observed with CROS devices and the largest improvement (9 dB) gained with the personal ear-level RM HAT system. No added benefit nor decrement was observed when RM was added to BC CROS using a 50/50 mixing ratio when the target was directed toward the impaired ear. CONCLUSIONS: In a challenging listening environment with diffuse restaurant noise, SNR-50 was most improved in the study sample when using a personal ear-level RM HAT system. Although tested rerouting devices offered measurable improvement in performance (1-2 dB in SNR-50) when the target was directed to the impaired ear, benefit may be offset by a detriment in performance in the opposing condition. Findings continue to support use of RM HAT for children with severe-to-profound UHL in adverse listening environments, when there is one primary talker of interest, to ensure advantageous SNRs.

Hearing Aid Use in Children With Unilateral Hearing Loss: A Randomized Crossover Clinical Trial.

OBJECTIVES/HYPOTHESIS: In children with mild to moderately severe unilateral hearing loss (UHL), assess whether subject-reported quality of life (QOL) and teacher- and parent-reported perception of listening difficulty are affected by use of a hearing aid (HA) with baseline accommodations, compared to children receiving only baseline accommodations. STUDY DESIGN: Randomized crossover clinical trial. METHODS: Thirty-seven children 6-12 years of age with mild to moderately severe UHL and ≥80% word recognition scores in the poorer hearing ear were randomized into arm 1, using baseline accommodations (frequency-modulated system and strategic seating) for 12 weeks, followed by addition of a HA for 12 weeks. The other participants were randomized into the reverse methodology: arm 2, using a HA in addition to baseline accommodations for 12 weeks, followed by baseline accommodations alone. Surveys of QOL (Hearing Environments and Reflection on Quality of Life) and listening difficulties or challenges with hearing amplification (CHILD and LIFE-R questionnaires) were administered at 6-week intervals. Differences in mean survey scores, percent change, and improvement over time were computed between the two arms and inter-arm intervals. Per-protocol analysis was used. RESULTS: Of the 37 children enrolled, 34 children underwent the study interventions and were included in the analysis, (arm 1 = 20, arm 2 = 14) (mean [standard deviation] age = 8 [1.5] years; 21 boys [61.8%]). Survey scores averaged across both arms during the HA interval (77.79 [15.13]) were significantly higher than during the baseline-only interval (69.67 [14.69], P = .036). There was no significant difference between trial arms in mean scores between the two HA intervals (P = .450) and two baseline-only intervals (P = .539). CONCLUSIONS: Hearing-related QOL and listening ability improved in children who met eligibility criteria with mild to moderately severe UHL with HA use compared with baseline accommodations alone. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02269124. LEVEL OF EVIDENCE: 1 Laryngoscope, 132:881-888, 2022.

Obesity as a Possible Risk Factor for Pediatric Sensorineural Hearing Loss.

OBJECTIVES/HYPOTHESIS: Childhood hearing loss impacts linguistic, academic, social, and psychologic development, and may have lasting implications for future workforce performance. Current evidence for obesity as a pediatric sensorineural hearing loss (SNHL) risk factor is intriguing but equivocal. We hypothesized that obesity is associated with a higher risk of SNHL. We additionally examined whether underweight is associated with a higher risk of SNHL. STUDY DESIGN: Retrospective database review. METHODS: A single-institution audiologic database from 2015 to 2020 was queried for audiograms with type-A tympanograms from children aged 5 to 18 years old. Comorbidities known to be associated with hearing loss were excluded. We then examined both for sub-clinical (≥15 dB) high- or low-frequency hearing loss, and for clinical (≥21 dB) hearing loss, with the aim of examining the association between obesity and SNHL. Multivariable logistic regression was performed to adjust for age, gender, diabetes mellitus, attention deficit hyperactivity disorder, and autism. RESULTS: A total of 3,142 children were included. Obesity was not associated with risk of SNHL (adjusted OR 0.82; 95% CI: 0.60, 1.12). Underweight children had a higher risk of SNHL than normal weight children (adjusted OR 1.78; 95% CI: 1.08, 2.95). Autism was significantly associated with increased risk of sub-clinical SNHL only (adjusted OR 2.00; 95% CI 1.34, 2.98). CONCLUSIONS: No association was found between obesity and pediatric SNHL. Underweight children may represent a higher-risk population for SNHL. There appears to be an increasing risk of SNHL as children approach adolescence. Further study of systemic risk factors for SNHL is indicated. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1416-1419, 2021.

Audibility-Based Hearing Aid Fitting Criteria for Children With Mild Bilateral Hearing Loss.

Purpose Because of uncertainty about the level of hearing where hearing aids should be provided to children, the goal of the current study was to develop audibility-based hearing aid candidacy criteria based on the relationship between unaided hearing and language outcomes in a group of children with hearing loss who did not wear hearing aids. Method Unaided hearing and language outcomes were examined for 52 children with mild-to-severe hearing losses. A group of 52 children with typical hearing matched for age, nonverbal intelligence, and socioeconomic status was included as a comparison group representing the range of optimal language outcomes. Two audibility-based criteria were considered: (a) the level of unaided hearing where unaided children with hearing loss fell below the median for children with typical hearing and (b) the level of unaided hearing where the slope of language outcomes changed significantly based on an iterative, piecewise regression modeling approach. Results The level of unaided audibility for children with hearing loss that was associated with differences in language development from children with typical hearing or based on the modeling approach varied across outcomes and criteria but converged at an unaided speech intelligibility index of 80. Conclusions Children with hearing loss who have unaided speech intelligibility index values less than 80 may be at risk for delays in language development without hearing aids. The unaided speech intelligibility index potentially could be used as a clinical criterion for hearing aid fitting candidacy for children with hearing loss.

Perspective on the Development of a Large-Scale Clinical Data Repository for Pediatric Hearing Research.

The use of "big data" for pediatric hearing research requires new approaches to both data collection and research methods. The widespread deployment of electronic health record systems creates new opportunities and corresponding challenges in the secondary use of large volumes of audiological and medical data. Opportunities include cost-effective hypothesis generation, rapid cohort expansion for rare conditions, and observational studies based on sample sizes in the thousands to tens of thousands. Challenges include finding and forming appropriately skilled teams, access to data, data quality assessment, and engagement with a research community new to big data. The authors share their experience and perspective on the work required to build and validate a pediatric hearing research database that integrates clinical data for over 185,000 patients from the electronic health record systems of three major academic medical centers.

Validation of a portable hearing assessment tool: Agilis Health Mobile Audiogram.

OBJECTIVES: To examine if the tablet-based Agilis Health Mobile Audiogram (Agilis Audiogram) is an effective and valid measure of hearing thresholds compared to a pure-tone audiogram in an adult and pediatric population. METHODS: Participants underwent an otologic exam, conventional audiometric evaluation and the self-administered Agilis Audiogram. We examined whether the difference of pure-tone average (PTA) between the two measurement techniques fell within the equivalence range of ±8 dB. The Agilis Audiogram was administered twice for each subject to assess test-retest reliability of the application. RESULTS: A total of 54 ears from 27 participants were evaluated. The average time to complete the self-administered Agilis Audiogram was 10 min. Among participants with normal hearing, the average PTA from conventional audiometric evaluation was 8.9 dB (±3.8) and the average PTA from the Agilis Audiogram was 8.5 dB (±4.5), with mean difference of 0.4 dB (±4.2; 95% CI -1.0 to 1.7 dB) falling within the equivalence range (-8 to 8 dB). Among participants with confirmed hearing loss, the average PTA was 22.5 dB (±17.1) from conventional audiometric evaluation and 24.3 dB (±16.6) from the Agilis Audiogram, with mean difference of -1.8 dB (±5.4; 95% CI -4.9 to 1.3 dB), falling within the equivalence range. Overall, there was a significant correlation between conventional audiometric evaluation and the Agilis Audiogram (Pearson correlation = 0.93; p < 0.001). CONCLUSION: Thresholds obtained by the Agilis Audiogram were found to be a valid measure of hearing among adults with normal hearing and children with hearing loss in the mild-moderate range.

Does Clarithromycin Cause Hearing Loss? A 12-Year Review of Clarithromycin Therapy for Nontuberculous Mycobacterial Lymphadenitis in Children.

OBJECTIVE(S): The objective was to describe the characteristics of hearing losses documented in patients treated with clarithromycin alone for nontuberculous mycobacterial NTM lymphadenitis in a pediatric tertiary care center over a 12-year period. METHODS: An institutional review board (IRB) approval was obtained. A database search was performed using the ICD-10 diagnosis codes 31.0, 31.1, and 31.8 between January 2004 and January 2017. A REDCap database was created to record variables. Patients were included if they received clarithromycin alone and had, at the minimum, a baseline audiology assessment, and 1 further evaluation during treatment. Fisher's exact test was used to analyze categorical variables, and Wilcoxon rank sum test was used to analyze continuous variables. RESULTS: A total of 167 patients with cervicofacial NTM were identified. Of them, 42 patients fulfilled inclusion criteria. Three children (7%) developed a hearing loss (HL) between 25 and 63 days after starting treatment. HL was unilateral in 2 children. HL persisted in 1 child following cessation of treatment. However, this patient had Rubinstein Taybi syndrome, limiting our ability to attribute the HL solely to clarithromycin. CONCLUSION: We noted a 7% hearing loss rate in our series. Confounding issues, such as 1 patient with a syndrome potentially contributing to HL, and limitations to this study, including retrospective design and loss to follow-up, temper our ability to conclude that clarithromycin was the sole cause of these HL. However, enough supporting data for a role in clarithromycin causing HL exist that testing should be considered for patients undergoing long-term clarithromycin treatment.

Enlarged Vestibular Aqueduct and Cochlear Implants: The Effect of Early Counseling on the Length of Time Between Candidacy and Implantation.

OBJECTIVE: To determine if discussing cochlear implantation (CI) with patients with enlarged vestibular aqueducts (EVA) and their families before reaching audiological criteria for CI candidacy effects the length of time between reaching audiological candidacy and CI surgery, and to describe the universal newborn hearing screening (UNHS) results and communication modality in this sample. PATIENTS: Forty-two patients (25 females) with confirmed EVA and cochlear implants. INTERVENTION(S): Diagnostic CI visit. MAIN OUTCOME MEASURES: The primary outcome measure is the difference in length of time between reaching audiological candidacy for CI and surgical implantation between those who had preliminary discussions regarding CI with their medical and healthcare providers before reaching audiological candidacy versus who had discussions after reaching candidacy. The secondary outcome measure is the result of the UNHS and primary mode of communication used by each patient. RESULTS: Discussing CI before reaching audiological candidacy was associated with a significantly shorter duration between reaching audiological candidacy and receiving CI (median = 3.1 mo; interquartile range [IQR] = 1.7-5.4) as compared with discussing CI after reaching candidacy (median = 5.8 mo; IQR = 3.2-11.2; p = 0.012). Participants born after the implementation of the UNHS, 16 of 24 patients referred on one or both ears. Communication modalities were evenly divided between utilizing sign-support English and oral/aural communicators only. CONCLUSIONS: Discussion of CI in patients with EVA before reaching audiological candidacy reduces the amount of time the child is without adequate auditory access and contributes to a constructive and interactive preparatory experience.

Why words are hard for adults with developmental language impairments.

PURPOSE: To determine whether word learning problems associated with developmental language impairment (LI) reflect deficits in encoding or subsequent remembering of forms and meanings. METHOD: Sixty-nine 18- to 25-year-olds with LI or without (the normal development [ND] group) took tests to measure learning of 16 word forms and meanings immediately after training (encoding) and 12 hr, 24 hr, and 1 week later (remembering). Half of the participants trained in the morning, and half trained in the evening. RESULTS: At immediate posttest, participants with LI performed more poorly on form and meaning than those with ND. Poor performance was more likely among those with more severe LI. The LI-ND gap for word form recall widened over 1 week. In contrast, the LI and ND groups demonstrated no difference in remembering word meanings over the week. In both groups, participants who trained in the evening, and therefore slept shortly after training, demonstrated greater gains in meaning recall than those who trained in the morning. CONCLUSIONS: Some adults with LI have encoding deficits that limit the addition of word forms and meanings to the lexicon. Similarities and differences in patterns of remembering in the LI and ND groups motivate the hypothesis that consolidation of declarative memory is a strength for adults with LI.

Applying experiential learning to audiology curricula.

In my quest to become a better professor, I have been searching for the instructional paradigms that best facilitate the educational process between me and my students. To support this endeavor, I opted to study learning diversity. The results of my investigation led me to reflect upon whether my teaching strategies inadvertently engaged only a subset of my students. I believe that was the case. In this article, I will describe the experiential learning model, how I used it to measure my students' learning styles, and how I used the model to make my teaching more holistic.

Children with ASD can use gaze in support of word recognition and learning.

BACKGROUND: Many children with autism spectrum disorders (ASD) struggle to understand familiar words and learn unfamiliar words. We explored the extent to which these problems reflect deficient use of probabilistic gaze in the extra-linguistic context. METHOD: Thirty children with ASD and 43 with typical development (TD) participated in a spoken word recognition and mapping task. They viewed photographs of a woman behind three objects and simultaneously heard a word. For word recognition, the objects and words were familiar and the woman gazed ahead (neutral), toward the named object (facilitative), or toward an un-named object (contradictory). For word mapping, the objects and words were unfamiliar and only the neutral and facilitative conditions were employed. The children clicked on the named object, registering accuracy and reaction time. RESULTS: Speed of word recognition did not differ between groups but varied with gaze such that responses were fastest in the facilitative condition and slowest in the contradictory condition. Only the ASD group responded slower to low frequency than high-frequency words. Accuracy of word mapping did not differ between groups, but accuracy varied with gaze with higher performance in the facilitative than neutral condition. Both groups scored above single-trial chance levels in the neutral condition by tracking cross-situational information. Only in the ASD group did mapping vary with receptive vocabulary. CONCLUSIONS: Under laboratory conditions, children with ASD can monitor gaze and judge its reliability as a cue to word meaning as well as typical peers. The use of cross-situational statistics to support word learning may be problematic for those who have weak language abilities.

Wordlikeness and word learning in children with hearing loss.

BACKGROUND: The more a novel word conforms to the phonotactics of the language, the more wordlike it is and the easier it is to learn. It is unknown to what extent children with hearing loss (CHL) take advantage of phonotactic cues to support word learning. AIMS: This study investigated whether CHL had similar sensitivities to wordlikeness during a word-learning task as children with normal hearing (CNH). METHODS & PROCEDURES: Sixteen CHL and 24 CNH participated in a novel word-learning task. Novel words varied by English wordlikeness. Recall was tested using a forced-choice identification task wherein foils for each trial related semantically, lexically or not at all. Receptive vocabulary and working memory were also assessed. OUTCOMES & RESULTS: All children were able to identify high wordlike novel words more accurately than low wordlike novel words. The number of errors on identification of words that were moderate in wordlikeness was inversely correlated to vocabulary size (not working memory) and CHL had smaller vocabularies than CNH. When in error, CHL were more likely than CNH to select a semantically related foil. CONCLUSIONS & IMPLICATIONS: Although they are sensitive to extremes in wordlikeness, compared with their peers with normal hearing, CHL present with subtle differences in word learning. Clinical implications for exploiting wordlikeness in service of word learning assessment and intervention are presented.

The Speech Intelligibility Index and the pure-tone average as predictors of lexical ability in children fit with hearing AIDS.

PURPOSE: To determine whether a clinically obtainable measure of audibility, the aided Speech Intelligibility Index (SII; American National Standards Institute, 2007), is more sensitive than the pure-tone average (PTA) at predicting the lexical abilities of children who wear hearing aids (CHA). METHOD: School-age CHA and age-matched children with normal hearing (CNH) repeated words and nonwords, learned novel words, and completed a standardized receptive vocabulary test. Analyses of covariance allowed comparison of the 2 groups. For CHA, regression analyses determined whether SII held predictive value over and beyond PTA. RESULTS: CHA demonstrated poorer performance than CNH on tests of word and nonword repetition and receptive vocabulary. Groups did not differ on word learning. Aided SII was a stronger predictor of word and nonword repetition and receptive vocabulary than PTA. After accounting for PTA, aided SII remained a significant predictor of nonword repetition and receptive vocabulary. CONCLUSIONS: Despite wearing hearing aids, CHA performed more poorly on 3 of 4 lexical measures. Individual differences among CHA were predicted by aided SII. Unlike PTA, aided SII incorporates hearing aid amplification characteristics and speech-frequency weightings and may provide a more valid estimate of the child's access to and ability to learn from auditory input in real-world environments.

Vocabulary and working memory in children fit with hearing aids.

PURPOSE: To determine whether children with mild-to-moderately severe sensorineural hearing loss (CHL) present with disturbances in working memory and whether these disturbances relate to the size of their receptive vocabularies. METHOD: Children 6 to 9 years of age participated. Aspects of working memory were tapped by articulation rate, forward and backward digit span in the auditory and visual modalities, Corsi span, parent surveys, and a sequential encoding task. Articulation rate, digit spans, and Corsi spans were also administered in low-level broadband noise. RESULTS: CHL and children with normal hearing (CNH) demonstrated auditory advantage in forward serial recall. CHL demonstrated slower articulation rates than CNH, but similar memory spans. CHL with poor executive function presented with poorer performance on the Corsi span task. The presence of background noise had no effect on performance in either group. CHL presented with significantly smaller receptive vocabularies than their CNH peers. Across groups, receptive vocabulary size was positively correlated with digit span in quiet, Corsi span in noise, and articulation rate. CONCLUSIONS: In the presence of mild-to-moderately severe hearing loss, children demonstrated resilient working memory systems. For all children, working memory and vocabulary were related; that is, children with poorer working memory had smaller vocabulary sizes.