Speech discrimination and word identification with a consumer-level bone-conduction headset and remote microphone for children with normal hearing.

OBJECTIVE: This study investigated the use of bone-conduction headsets paired to a wireless, remote microphone on speech discrimination and word identification for children with normal hearing. DESIGN: Children were tested with and without the headset, using the McCormick speech discrimination test in quiet and in speech-shaped noise to measure word-discrimination thresholds. Additionally, open-set word identification in noise was assessed while children were simultaneously engaged in a visual-monitoring task. STUDY SAMPLE: Twenty normal-hearing children, aged 4-11 years. RESULTS: Median word-discrimination threshold in quiet (n = 20) was 20.5 dB(A) without a headset and 11.5 dB(A) with a headset (Z = -3.826, p = 0.0001). In noise, the median word-discrimination threshold (n = 20) was 52 dB(A) without a headset and 40.5 dB(A) with a headset (Z = -3.926, p< 0.0001). For open-set word identification (n = 11), children performed significantly better with a headset than without it, with an average improvement of 23 percentage points (t(10) = -5.227, p = 0.0004, two tailed). CONCLUSIONS: A bone-conduction headset paired to a Bluetooth microphone improved discrimination of distant speech in quiet and in noise and open-set word identification in noise.

Validating Four Hmong Word Recognition Tests With Normal-Hearing Bilingual Hmong Individuals.

PURPOSE: The purpose of this study was to validate four digitally recorded and phonetically balanced 50-word recognition lists in the White Hmong dialect with normal-hearing bilingual Hmong adults. METHOD: Using a randomized, incomplete-block design, each participant listened to and repeated four unique Hmong lists delivered by a female and a male talker. Participants were also tested with an English word list-List 1A of the Northwestern University Auditory Test No. 6. Participants' correct pronunciation of each word was scored. A nonparametric Mann-Whitney U Location Difference Test for Equivalence using two one-sided tests equivalence hypothesis: -0.02 < [(List_1) - (List_2)] < 0.02 was conducted to assess equivalence among all four Hmong and the English lists. RESULTS: Seventy Hmong speakers participated in this study (35 women, 35 men; M age = 29.5 years, SD = 7.1). In all four Hmong lists, 93.5% (187/200) words met the validation criteria for ≥ 92% correct pronunciation. The 13 difficult words were deemed adequate by a Hmong panel and, therefore, were included to maintain four unique, balanced word lists. The test revealed that the Hmong and English word lists were considered equivalent at the 2% bound. CONCLUSION: The four Hmong word lists were validated to ensure an equal range of word difficulty across the lists.

Evaluation of binomial distribution estimates of confidence intervals of speech-recognition test scores.

Speech-recognition tests are a routine component of the clinical hearing evaluation. The most common type of test uses recorded monosyllabic words presented in quiet. The interpretation of test scores relies on an understanding of the variance of repeated tests. Confidence intervals are useful for determining if two scores are significantly different or if the difference is due to the variability of test scores. Because the response to each test item is binary, either correct or incorrect, the binomial distribution has been used to estimate confidence intervals. This method requires that test scores be independent. If the scores are not independent, the binomial distribution will not accurately estimate the variance of repeated scores. A previously published dataset with repeated scores from normal-hearing and hearing-impaired listeners was used to derive confidence intervals from actual test scores in contrast to the predicted confidence intervals in earlier reports. This analysis indicates that confidence intervals predicted by the binomial distribution substantially overestimate the variance of repeated scores resulting in erroneously broad confidence intervals. High correlations were found for repeated scores, indicating that scores are not independent. The interdependence of repeated scores invalidates confidence intervals predicted by the binomial distribution. Confidence intervals and confidence levels for repeated measures were determined empirically from measured test scores to assist in interpreting differences between repeat scores.

AzBio Sentence test in Hebrew (HeBio): development, preliminary validation, and the effect of noise.

The AzBio sentence test is widely used to assess speech perception pre- and post-cochlear implantation. This study created and validated a Hebrew version of AzBio (HeBio) and tested its intelligibility amidst background noise.In Experiment 1, 1,000 recorded Hebrew sentences were presented via five-channel vocoder to 10 normal hearing (NH) listeners for intelligibility testing. In Experiment 2, HeBio lists were presented to 25 post-lingual cochlear implant (CI) users amidst four-talker babble noise (4TBN) or in quiet, along with one-syllable word test. In Experiment 3, 20 NH listeners were presented with eight HeBio lists in two noise conditions [4TBN, speech shaped noise (SSN)] and four SNRs (+3, 0 dB, -3 dB, -6 dB).HeBio lists (33) produced 82% average understanding, no inter-list intelligibility differences among NH, and equal intelligibility for CI users. One-syllable words predicted 67% of the variance in HeBio among CI users. Higher intelligibility was found for SSN than for 4TBN, and the mean speech receptive threshold (SRT) was more negative for SSN than for 4TBN.HeBio results were similar to AzBio. Results obtained with two noise types were as expected. HeBio is recommended for evaluation of different populations in quiet and noise.

Is It Okay to Use Compressed NU-6 Files for Clinical Word Recognition Testing?

PURPOSE: The purpose of this study was to evaluate the impact of file compression on clinically measured word recognition scores obtained using the Northwestern University Test Number Six (NU-6; Auditec recording) materials. METHOD: Participants were 86 adults (N = 170 ears; M age = 65.5). The 25 most difficult words from each of four NU-6 test lists were used to measure word recognition. Two lists were compressed using a freely available Advanced Audio Coding compression algorithm and two were not. Word recognition was measured in each ear using one compressed file and one uncompressed file. Percent correct scores were calculated in each test condition and log transformed for analyses. Clinically meaningful differences between uncompressed and compressed scores were examined using 95% critical difference ranges. The effects of file compression on word recognition scores were examined in the context of multiple potential confounding effects, including age and degree of hearing loss, using linear mixed-effects models (LMMs). RESULTS: Differences between compressed and uncompressed scores in a given ear exceeded the 95% critical difference range in about 7% of cases, approximating the 5% of expected cases occurring due to chance. Likewise, LMM results revealed no significant effect of file compression on clinically measured NU-6 word recognition scores and no significant interactions between compression effects and age or degree of hearing loss. CONCLUSIONS: While the original uncompressed audio files are clearly the most appropriate stimuli for clinical purposes, our study results suggest that file compression, even at an aggressive 64 kilobits per second, does not have a statistically significant, or clinically meaningful, effect on word recognition scores when measured using these Auditec materials.

Updating sentences lists for assessment speech perception. / Adaptação de listas de sentenças para avaliação da percepção da fala.

PURPOSE: Adapt a list of sentences for a speech intelligibility test. METHODS: A speech material data base consisting of 200 phonetically balanced sentences was analyzed and partially updated. In the first stage, 60 reviewers, specialists in linguistics and speech and hearing science, analyzed the sentences in relation to the parameters of familiarity, meaning and predictability using an on-line questionnaire. Cronbach's Alpha coefficient was used to analyze the internal consistency of the questionnaire. In the second stage, the reviewers analyzed whether they were in accordance with the criteria indicated by the literature for the construction of sentences. RESULTS: In the first stage, the responses of 15 reviewers who completed the entire questionnaire were analyzed. Agreement between reviewers was high for all criteria. 71 sentences were recommended for modification in the first stage, with predictability being the most indicated parameter as requiring change. In the second stage, 28 more sentences were selected for adjustment, with the presence of a proper name in the sentence being the most frequently cited criterion. CONCLUSION: It was possible to adapt a list of sentences in order to provide speech language therapists with a free of charge speech perception protocol. It is hoped that this new test can assist in standardizing assessment for normal hearing adults and individuals with hearing loss in Brazilian Portuguese.

OBJETIVO: Adaptar listas de sentenças para avaliar o reconhecimento de fala em adultos. MÉTODO: Foram atualizadas 200 sentenças balanceadas foneticamente que passaram por duas etapas de revisão. Na primeira etapa, foi enviado um questionário on-line para 60 juízes analisarem as sentenças em relação aos critérios de familiaridade, significado e previsibilidade. Para análise da consistência interna do questionário foi aplicado coeficiente Alfa de Cronbach. Na segunda etapa, três juízes especialistas analisaram se as mesmas estavam de acordo com os parâmetros indicados pela literatura para a construção de sentenças e organizaram em 10 listas de 20 sentenças cada, a fim de facilitar a avaliação clínica do reconhecimento de fala. Foi realizado um estudo piloto com três indivíduos jovens e normo-ouvintes. RESULTADOS: Na primeira etapa foram analisadas as respostas de 15 juízes que preencheram todo o questionário. Verificou-se que a concordância entre os juízes foi alta para todos os critérios. Foram indicadas 71 sentenças para serem modificadas na primeira etapa, sendo a previsibilidade o critério que teve maior ocorrência de modificação. Na segunda etapa foram identificadas mais 28 sentenças passíveis de ajustes, sendo a presença de nome próprio o critério mais frequente. No estudo piloto os jovens apresentaram alto índice de reconhecimento de fala. CONCLUSÃO: Concluiu-se que a maioria das modificações realizadas nas sentenças deste estudo possibilitou a criação de um material fidedigno para a prática clínica fonoaudiológica que contribuirá na padronização da avaliação da percepção da fala de indivíduos normo-ouvintes e com perda auditiva.

Lists of monosyllables for logoaudiometric tests: elaboration, content validation and search for equivalence. / Listas de monossílabos para testes logoaudiométricos: elaboração, validação de conteúdo e pesquisa de equivalência.

PURPOSE: Develop new lists of monosyllables for conducting logoaudiometric tests in Portuguese, perform content validation, considering ear side and education and check the equivalence between the lists. METHODS: Were selected 125 monosyllables with different syllabic structures, which were submitted to the content validation process, which included judgment on familiarity, organization of lists, recording of material and auditory recognition. After content validation, the monosyllable lists were subjected to equivalence research, in order to obtain evidence of reliability for the proposed test instrument. RESULTS: Five lists with 25 monosyllables were elaborated and analyzed for content, of these, four lists were validated. There was no statistically significant difference between the responses obtained in the right and left ears. The education of the subjects did not influence the recognition of words. As for the equivalence search, it was found that two lists were equivalent, one not equivalent, but similar and one list was different from the others, and then excluded. CONCLUSION: Two monosyllable lists were validated for content and considered equivalent, with the same level of difficulty between them, and one list was considered similar, which can be used as training to apply the test on the audiological battery. The validated lists were not influenced by ear and education.

OBJETIVO: Elaborar novas listas de monossílabos para realização de testes logoaudiométricos na Língua Portuguesa, realizar a validação de conteúdo, considerando lado da orelha e escolaridade e verificar a equivalência entre as listas. MÉTODO: Foram selecionados 125 monossílabos com diferentes estruturas silábicas, os quais foram submetidos ao processo de validação de conteúdo, que incluiu o julgamento quanto à familiaridade, organização das listas, gravação do material e reconhecimento auditivo. Após a validação de conteúdo, as listas de monossílabos foram submetidas à pesquisa de equivalência, a fim de obter evidências de fidedignidade para o instrumento de teste proposto. RESULTADOS: Cinco listas com 25 monossílabos foram elaboradas e analisadas quanto ao conteúdo, destas, quatro listas foram validadas. Não houve diferença estatisticamente significante entre as respostas obtidas nas orelhas direitas e esquerdas. A escolaridade dos sujeitos não influenciou o reconhecimento das palavras. Quanto à pesquisa de equivalência, verificou-se que duas listas foram equivalentes, uma não equivalente, porém semelhante e uma lista foi diferente das demais, e então excluída. CONCLUSÃO: Duas listas de monossílabos foram validadas quanto ao conteúdo e consideradas equivalentes, com igual nível de dificuldade entre si e uma lista foi considerada semelhante, podendo ser utilizada como treino para aplicação do teste na bateria audiológica. As listas validadas não sofreram influência segundo o lado da orelha e escolaridade.

Randomized Trial to Increase Speech Sound Differentiation in Infants Born Preterm.

OBJECTIVE: To test whether infant-directed foreign language active learning would specifically increase speech sound differentiation to the intervention language while not decreasing differentiation in response to English. STUDY DESIGN: Pilot randomized controlled trial of stable infants born preterm in the newborn intensive care unit with normal auditory brainstem responses, whose parents spoke only English and had no musical training or familial hearing abnormality. Assignment was to 1 of 3 groups: passive exposure to English infant-directed lullabies and readings (English-enrichment, control group) and contingent exposure by active sucking on a sensor-equipped pacifier to either infant-directed French lullabies and readings (English environment, French-contingent learning group) or infant-directed Mandarin lullabies and readings (English environment, Chinese-contingent learning group). The main outcome measures were preintervention and postintervention event-related potentials (ERPs) in response to standardized speech syllables in each language. RESULTS: Forty-one subjects completed the study, including 15 in the English-enrichment control group and 13 each in the French-contingent and Chinese-contingent groups. The median gestational age at birth was 34 weeks (IQR, 8.75 weeks); postmenstrual age at intervention ranged from 36 to 46 weeks and was similar across the 3 groups. Postintervention mean ERP amplitude to pairs of English speech sounds did not differ across the 3 groups; however, ERP amplitude in French sound differentiation was greater in the French-contingent group than in the Chinese-contingent or English-enrichment groups, and ERP amplitude greater in Chinese sound differentiation was greater in the Chinese-contingent group compared with the other 2 groups. CONCLUSION: Contingent infant-directed foreign language exposure increased speech sound differentiation specific to the intervention language and did not decrease differentiation in response to English. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03232931.

Cochlear Implant Outcomes in Prelingually Deafened Adults with and without Sound Deprivation: Are There Differences in Quality of Life?

BACKGROUND Indications for cochlear implantation (CI) are constantly being updated, and with them, the audiometric results achieved by patients. Patient satisfaction should always be considered, even in patients with lower audiological results. The aim of the present study was to compare quality of life (QoL), self-perceived hearing benefit, and audiometric results between prelingually and postlingually deafened patients, with and without sound deprivation, after CI. MATERIAL AND METHODS The sample included 46 patients with bilateral sensorineural hearing loss: 22 postlingually deafened and 24 prelingually deafened, further subdivided into sound-deprived (n=10) and non-sound-deprived (n=14). Auditory performance was evaluated with pure tone audiometry, speech recognition scores (SRS), and self-perceived hearing benefit, whereas QoL was evaluated with 2 self-reported questionnaires (Comprehensive Cochlear Implant Questionnaire and World Health Organization Quality of Life-BREF). RESULTS Audiometric results were worse in the prelingually deafened than in the postlingually deafened group, and worse in the prelingually deafened patients with sound deprivation. There was no marked difference in perceived CI benefit or QoL between the 2 groups or within the 2 prelingually deafened subgroups. No correlation was found between SRS and duration of CI use or between QoL and SRS in the prelingually and postlingually deafened groups. CONCLUSIONS Our findings demonstrate better auditory performance for the postlingually deafened group and no differences in perceived QoL or benefit of CI between the groups. The sound-deprived patients had equal scores on the perceived QoL questionnaire. These analyses suggest that sound-deprived, prelingually deafened patients may benefit from CI.

Bilateral cochlear implantation.

Binaural hearing has certain benefits while listening in noisy environments. It provides the listeners with access to time, level and spectral differences between sound signals, perceived by the two ears. However, single sided deaf (SSD) or unilateral cochlear implant (CI) users cannot experience these binaural benefits due to the acoustic input coming from a single ear. The translational research on bilateral CIs started in the year 1998, initiated by J. Müller and J. Helms from Würzburg, Germany in association with MED-EL. Since then, several clinical studies were conducted by different research groups from across the world either independently or in collaboration with MED-EL. As a result, the bilateral CI has become the standard of care in many countries along with reimbursement by the health care systems. Recent data shows that children particularly, are given high priority for the bilateral CI implantation, most often performed simultaneously in a single surgery, as the binaural hearing has a positive effect on their language development. This article covers the milestones of translational research from the first concept to the widespread clinical use of bilateral CI.

CI in single-sided deafness.

The cochlear implant (CI) as a treatment option for single-sided deafness (SSD) started with a clinical study looking in to the influence of cochlear implantation with a MED-EL device on incapacitating unilateral tinnitus in SSD. The study began in 2003 and was conducted by P. Van de Heyning and his team in Antwerp, Belgium. The first CI in SSD without tinnitus in Germany was implanted by J. Mueller and R. Jacob in Koblenz in 2005. Translational research activities took place since then to evaluate the CI as a treatment option for SSD not only in adults but also in children. They assessed the hearing performance of SSD patients implanted with CI, importance of long electrode arrays in SSD patients, degree of acceptance of CI by SSD children, importance of early CI implantation in SSD children in developing language skills, music enjoyment by hearing with two ears and evidence on spiral ganglion cell body distribution. In 2013, MED-EL was the first CI manufacturer to receive the CE mark for the indication of SSD and asymmetric hearing loss (AHL) in adults and children. In 2019, MED-EL was the first CI manufacturer to get its CI device approved for patients over the age of five with SSD and AHL, by the FDA in the USA. This article covers the milestones of translational research from the first concept to the widespread clinical use of CI in SSD.

EAS-Combined electric and acoustic stimulation.

Electric-acoustic stimulation (EAS) is a special treatment modality for those patients who are profoundly deaf in the high-frequency (HF) region and retain usable hearing in the low-frequency (LF) region. Combining the electric stimulation with cochlear implant (CI) in the HF and acoustic amplification of residual hearing using a conventional hearing aid (HA) in the LF region defines EAS. The EAS concept was first proposed by C. von Ilberg from Frankfurt, Germany in the year 1997. In association with MED-EL, all the necessary safety studies were performed in non-human subjects before the first patient received it in 1997. In association with MED-EL, all the necessary safety studies were performed in non-human subjects before the first patient received it in 1999. For the patient to successfully use the EAS concept, the residual hearing needs to be preserved to a high extent and for several years. This requires a highly flexible electrode array in safeguarding the intra-cochlear structures during and after the CI electrode array insertion. Combining the HA unit with the audio processor unit of the CI was necessary for the convenient wearing of the unified audio processor. Fitting of the unified audio processor is another important factor that contributes to the overall success of the EAS treatment. The key translational research efforts at MED-EL were on the development of flexible electrodes, a unified audio processor, innovations in the fitting process, intra-operative monitoring of cochlear health during electrode insertion, pre-operative soft-ware tool to evaluate the cochlear size and electrode selection and some new innovations tried within EAS topic. This article covers the milestones of translational research from the first concept to the widespread clinical use of EAS.

Association of In-Ear Device Use With Communication Quality Among Individuals Wearing Personal Protective Equipment in a Simulated Operating Room.

Importance: The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators. Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date. Objective: To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR]) in the operating room. Design, Setting, and Participants: This quality improvement study was conducted in June 2020. Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited. All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital. Exposures: All participants performed the speech intelligibility tasks with and without an in-ear communication device. Main Outcomes and Measures: Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100%) was obtained for each speech intelligibility test. Listening effort was assessed using the NASA Task Load Index. An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained. Results: A total of 12 participants were included (mean [SD] age, 31.2 [1.9] years; 8 women [66.7%]). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8%) without the in-ear device vs 94.3% (7.4%) with the device. While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4%) without the in-ear device vs 90.8% (8.9%) with the device. While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8%) without the in-ear device vs 94.5% (5.5%) with the device. Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3%; 95% CI, 23.8%-40.7%; P < .001) and the PAPR (9.9%; 95% CI, 1.4%-18.3%; P = .01). Furthermore, use of the device was associated with decreased listening effort. The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device. While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device. While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device. Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI, 23.5-53.3; P < .001) and the PAPR (18.4; 95% CI, 0.4-36.4; P = .04). Conclusions and Relevance: This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort. Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.

Aircrew Performance and Safety While Using Protective Masks in Response to Coronavirus Disease.

INTRODUCTION: In response to the urgent need for safe aircrew respiratory protection due to the COVID-19 pandemic, three small descriptive evaluations were conducted with aircrew and air traffic controllers (ATC) that assessed the impact of mask use on safety and performance onboard rotary wing aircraft.METHODS: A series of evaluations assessed aircrew performance using the 3MTM Model 1860 N95 respiratory protection mask, two aviation-specific cloth mask prototypes, and a commercial off-the-shelf aviation-specific cloth mask. The series of evaluations included different sets of subjects consisting of up to five Black Hawk helicopter aircrew members, air traffic control (ATC), and 12 CH-47 aircrew members. The Modified Rhyme Test was used to measure speech intelligibility and was administered in the UH-60 among crewmembers of the same aircraft, between pilots of different aircraft, and between the pilots and ATC. Measures of workload, usability, comfort, and pulse oximetry were also administered.RESULTS: Results from the Modified Rhyme Test indicated that all subjects scored greater than 80% accuracy given the proper microphone positioning relative to the mask. With respect to workload, NASA-TLX total scores for the perform radio communications task was 50.83.DISCUSSION: Despite an elevated perceived degree of workload on the communications flight task, results from the speech intelligibility test indicated that performance was maintained within the acceptable range as defined by MIL-STD-1474E, Design Criteria Standard Noise Limit. This abbreviated evaluation suggests that the face masks tested are safe for use by helicopter aircrew under the conditions tested.Cave KM, Kelley AM, Feltman KA, Gerstner JA, Stewart JL, Crowley JS. Aircrew performance and safety while using protective masks in response to coronavirus disease. Aerosp Med Hum Perform. 2021; 92(4):274280.

Perceived Sound Quality Dimensions Influencing Frequency-Gain Shaping Preferences for Hearing Aid-Amplified Speech and Music.

Hearing aids are typically fitted using speech-based prescriptive formulae to make speech more intelligible. Individual preferences may vary from these prescriptions and may also vary with signal type. It is important to consider what motivates listener preferences and how those preferences can inform hearing aid processing so that assistive listening devices can best be tailored for hearing aid users. Therefore, this study explored preferred frequency-gain shaping relative to prescribed gain for speech and music samples. Preferred gain was determined for 22 listeners with mild sloping to moderately severe hearing loss relative to individually prescribed amplification while listening to samples of male speech, female speech, pop music, and classical music across low-, mid-, and high-frequency bands. Samples were amplified using a fast-acting compression hearing aid simulator. Preferences were determined using an adaptive paired comparison procedure. Listeners then rated speech and music samples processed using prescribed and preferred shaping across different sound quality descriptors. On average, low-frequency gain was significantly increased relative to the prescription for all stimuli and most substantially for pop and classical music. High-frequency gain was decreased significantly for pop music and male speech. Gain adjustments, particularly in the mid- and high-frequency bands, varied considerably between listeners. Music preferences were driven by changes in perceived fullness and sharpness, whereas speech preferences were driven by changes in perceived intelligibility and loudness. The results generally support the use of prescribed amplification to optimize speech intelligibility and alternative amplification for music listening for most listeners.

Influence of Protective Face Coverings on the Speech Recognition of Cochlear Implant Patients.

OBJECTIVES: The objectives were to characterize the effects of wearing face coverings on: 1) acoustic speech cues, and 2) speech recognition of patients with hearing loss who listen with a cochlear implant. METHODS: A prospective cohort study was performed in a tertiary referral center between July and September 2020. A female talker recorded sentences in three conditions: no face covering, N95 mask, and N95 mask plus a face shield. Spectral differences were analyzed between speech produced in each condition. The speech recognition in each condition for twenty-three adult patients with at least 6 months of cochlear implant use was assessed. RESULTS: Spectral analysis demonstrated preferential attenuation of high-frequency speech information with the N95 mask plus face shield condition compared to the other conditions. Speech recognition did not differ significantly between the uncovered (median 90% [IQR 89%-94%]) and N95 mask conditions (91% [IQR 86%-94%]; P = .253); however, speech recognition was significantly worse in the N95 mask plus face shield condition (64% [IQR 48%-75%]) compared to the uncovered (P < .001) or N95 mask (P < .001) conditions. CONCLUSIONS: The type and combination of protective face coverings used have differential effects on attenuation of speech information, influencing speech recognition of patients with hearing loss. In the face of the COVID-19 pandemic, there is a need to protect patients and clinicians from spread of disease while maximizing patient speech recognition. The disruptive effect of wearing a face shield in conjunction with a mask may prompt clinicians to consider alternative eye protection, such as goggles, in appropriate clinical situations. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2038-E2043, 2021.

A review of Mandarin speech recognition test materials for use in Singapore.

OBJECTIVE: This study aimed to evaluate word lists of current Mandarin speech recognition test materials on their adaptability for use on adult Singapore Mandarin speakers. DESIGN: This scoping review involved literature search through electronic databases for studies published in English or Mandarin, detailing the development or validation of Mandarin speech recognition test materials meant to be used in quiet. Word lists of materials were evaluated for phonemic balance (Stage 1) and familiarity to Singapore Mandarin speakers by comparing the test items against a list of 1,000 common Singapore Mandarin words (Stage 2). STUDY SAMPLE: Thirty articles that fulfilled the inclusion and exclusion criteria were reviewed. RESULTS: Nine sets of materials were found and evaluated in Stage 1. Among these, two sets of materials did not contain phonemically balanced word lists. The remaining seven sets of materials were evaluated in Stage 2. The percentage of unfamiliar characters to Singapore Mandarin speakers was found to be between 15% and 41% across the word lists. CONCLUSION: None of the currently available materials contain word lists that can be readily adapted for re-recording with the voice of a Singapore Mandarin speaker. There is a need to develop original Singapore Mandarin speech recognition test materials.

Long-Term Outcomes of Cochlear Implantation in Irradiated Ears of Nasopharyngeal Carcinoma Patients.

OBJECTIVES: To evaluate the safety and feasibility of cochlear implantation (CI) in irradiated ears of nasopharyngeal carcinoma (NPC) patients. STUDY DESIGN: A retrospective study. METHODS: From 2008 to 2017, 10 adults with binaural severe or profound sensorineural hearing loss subsequent to radiotherapy for NPC underwent CI in our center. The mean follow-up was 63.2 months. Hearing and speech performance were evaluated pre- and postoperatively with audiometric and speech discrimination testing, Category of Auditory Performance, Speech Intelligibility Rating, and Chinese version of Nijmegen Cochlear Implant Questionnaire. RESULTS: According to the severity of radioactive osteomyelitis of temporal bone, patients were classified into three categories: mild, moderate, and severe. Patients in mild category underwent routine CI. Patients in moderate category underwent extended radical mastoidectomy and CI simultaneously. Patients in severe category underwent subtotal temporal bone resection, external auditory canal elimination, and CI simultaneously or by stage. There was no massive hemorrhage, facial paralysis, or nonunion of incision after operation. One suffered from radiation encephalopathy 13 months postoperatively; since then, the cochlear implant has been idle. The other nine patients demonstrated encouraging results of hearing and speech performance. CONCLUSION: CI for postirradiated ears of NPC is safe and feasible. Strict control of operative indications and extra care during surgery are required. Individual surgical plan should be made according to the severity of radioactive osteomyelitis. Choose one-stage surgery as much as possible in severe cases to avoid the risk of difficulty in locating round window in second-stage surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:649-655, 2021.

Modulation rate and age effect on intermittent speech recognition / Efeito da idade e da taxa de modulação no reconhecimento da fala intermitente

ABSTRACT Purpose: to investigate the auditory recognition of intermittent speech in relation to different modulation rates and ages. Methods: 20 young people, 20 middle-aged adults, and 16 older adults, all of them with auditory thresholds equal to or lower than 25 dB HL up to the frequency of 4000 Hz. The participants were submitted to intermittent speech recognition tests presented in three modulation conditions: 4 Hz, 10 Hz, and 64 Hz. The percentages of correct answers were compared between age groups and modulation rates. ANOVA and post hoc tests were conducted to investigate the modulation rate effect, and the mixed linear regression model (p < 0.001). Results: regarding the age effect, the data showed a significant difference between young people and older adults, and between middle-aged and older adults. As for the modulation rate effect, the indexes of correct answers were significantly lower at the slower rate (4 Hz) in the three age groups. Conclusion: an age effect was verified on intermittent speech recognition: older adults have greater difficulty. A modulation rate effect was also noticed in the three age groups: the higher the rate, the better the performance.

RESUMO Objetivo: investigar o reconhecimento auditivo da fala intermitente em função de diferentes taxas de modulação e em função da idade. Métodos: participaram do estudo vinte jovens, vinte adultos de meia idade, e dezesseis idosos, todos com limiares auditivos iguais ou menores que 25 dB NA até a frequência de 4000 Hz. Os participantes foram submetidos a testes de reconhecimento da fala intermitente apresentada em três condições de modulação: 4 Hz, 10 Hz e 64 Hz. Percentuais de acerto foram comparados entre grupos etários e taxas de modulação. Para a investigação do efeito da taxa de modulação foi realizada ANOVA e testes Post Hoc, enquanto para a investigação do efeito da idade, utilizou-se o modelo de regressão linear misto (p<0,001). Resultados: sobre o efeito da idade, os dados mostram diferença significante entre jovens e idosos, e entre adultos de meia idade e idosos. Sobre o efeito da taxa de modulação, os índices de acerto da taxa mais lenta (4Hz) foram significantemente menores nos três grupos etários. Conclusão: foi verificado um efeito da idade no reconhecimento da fala intermitente: idosos apresentaram maior dificuldade. Percebeu-se também um efeito de taxa de modulação nos três grupos etários: quanto maior a taxa, melhor o desempenho.

Recognition of vocoded words and sentences in quiet and multi-talker babble with children and adults.

A vocoder is used to simulate cochlear-implant sound processing in normal-hearing listeners. Typically, there is rapid improvement in vocoded speech recognition, but it is unclear if the improvement rate differs across age groups and speech materials. Children (8-10 years) and young adults (18-26 years) were trained and tested over 2 days (4 hours) on recognition of eight-channel noise-vocoded words and sentences, in quiet and in the presence of multi-talker babble at signal-to-noise ratios of 0, +5, and +10 dB. Children achieved poorer performance than adults in all conditions, for both word and sentence recognition. With training, vocoded speech recognition improvement rates were not significantly different between children and adults, suggesting that improvement in learning how to process speech cues degraded via vocoding is absent of developmental differences across these age groups and types of speech materials. Furthermore, this result confirms that the acutely measured age difference in vocoded speech recognition persists after extended training.