A new tool for the assessment of speech understanding and spatial hearing difficulties in children: the Kid-SSQ questionnaire.

PURPOSE: To develop and validate a new questionnaire, the Kid-SSQ, for the rapid screening of hearing abilities in children with hearing impairment, aged 7-17 years. METHODS: The questionnaire was constructed from two existing, validated versions of the 'Speech, Spatial and Qualities of Hearing' - (SSQ) questionnaire (pediatric form and adult short-form). The 12 selected items included auditory aspects from three subscales: speech perception, spatial hearing, and qualities of hearing. This new short form was then validated in 154 children with cochlear implants (100 bilaterally, and 54 unilaterally implanted children). Construct validity was assessed by testing relationships between Kid-SSQ scores and objective clinical parameters (e.g., age at test, pure-tone audiometry-PTA threshold, speech reception threshold-SRT, duration of binaural experience). RESULTS: Completion time was acceptable for use with children (less than 10 min) and the non-response rate was less than 1%. Good internal consistency was obtained (Cronbach's α = 0.78), with a stable internal structure corresponding to the 3 intended subscales. External validity showed the specificity of each subscale: speech subscale scores were significantly predicted (r = 0.32, p < 0.001) by both 2 kHz PTA threshold (ß = 0.33, p < 0.001) and SRT (ß = - 0.23, p < 0.001). Children with more binaural experience showed significantly higher scores on the spatial subscale than children with less binaural experience (F(1,98) = 5.1, p < 0.03) and the qualities of hearing subscale scores significantly depended on both age and SRT (r = 0.32, p < 0.001). CONCLUSIONS: The Kid-SSQ questionnaire is a robust and clinically useful questionnaire for self-assessment of difficulties in various auditory domains.

Age-related differences in bottom-up and top-down attention: Insights from EEG and MEG.

Attention operates through top-down and bottom-up processes, and a balance between these processes is crucial for daily tasks. Imperilling such balance could explain ageing-associated attentional problems such as exacerbated distractibility. In this study, we aimed to characterize this enhanced distractibility by investigating the impact of ageing upon event-related components associated with top-down and bottom-up attentional processes. MEG and EEG data were acquired from 14 older and 14 younger healthy adults while performing a task that conjointly evaluates top-down and bottom-up attention. Event-related components were analysed on sensor and source levels. In comparison with the younger group, the older mainly displayed (1) reduced target anticipation processes (reduced CMV), (2) increased early target processing (larger P50 but smaller N1) and (3) increased processing of early distracting sounds (larger N1 but reduced P3a), followed by a (4) prolonged reorientation towards the main task (larger RON). Taken together, our results suggest that the enhanced distractibility in ageing could stem from top-down deficits, in particular from reduced inhibitory and reorientation processes.

Development of auditory cognition in 5- to 10-year-old children: Focus on musical and verbal short-term memory.

Developmental aspects of auditory cognition were investigated in 5-to-10-year-old children (n = 100). Musical and verbal short-term memory (STM) were assessed by means of delayed matching-to-sample tasks (DMST) (comparison of two four-item sequences separated by a silent retention delay), with two levels of difficulty. For musical and verbal materials, children's performance increased from 5 years to about 7 years of age, then remained stable up to 10 years of age, with performance remaining inferior to performance of young adults. Children and adults performed better with verbal material than with musical material. To investigate auditory cognition beyond STM, we assessed speech-in-noise perception with a four-alternative forced-choice task with two conditions of phonological difficulty and two levels of cocktail-party noise intensity. Partial correlations, factoring out the effect of age, showed a significant link between musical STM and speech-in-noise perception in the condition with increased noise intensity. Our findings reveal that auditory STM improves over development with a critical phase around 6-7 years of age, yet these abilities appear to be still immature at 10 years. Musical and verbal STM might in particular share procedural and serial order processes. Furthermore, musical STM and the ability to perceive relevant speech signals in cocktail-party noise might rely on shared cognitive resources, possibly related to pitch encoding. To the best of our knowledge, this is the first time that auditory STM is assessed with the same paradigm for musical and verbal material during childhood, providing perspectives regarding diagnosis and remediation in developmental learning disorders.

Correction to: A case of verbal and emotional prosody processing dissociation after a right temporal venous infarct.

The above article was published online with missing authors.

A New Speech, Spatial, and Qualities of Hearing Scale Short-Form: Factor, Cluster, and Comparative Analyses.

OBJECTIVES: The objective of this work was to build a 15-item short-form of the Speech Spatial and Qualities of Hearing Scale (SSQ) that maintains the three-factor structure of the full form, using a data-driven approach consistent with internationally recognized procedures for short-form building. This included the validation of the new short-form on an independent sample and an in-depth, comparative analysis of all existing, full and short SSQ forms. DESIGN: Data from a previous study involving 98 normal-hearing (NH) individuals and 196 people with hearing impairments (HI), non hearing aid wearers, along with results from several other published SSQ studies, were used for developing the short-form. Data from a new and independent sample of 35 NH and 88 HI hearing aid wearers were used to validate the new short-form. Factor and hierarchical cluster analyses were used to check the factor structure and internal consistency of the new short-form. In addition, the new short-form was compared with all other SSQ forms, including the full SSQ, the German SSQ15, the SSQ12, and the SSQ5. Construct validity was further assessed by testing statistical relationships between scores and audiometric factors, including pure-tone threshold averages (PTAs) and left/right PTA asymmetry. Receiver-operating characteristic analyses were used to compare the ability of different SSQ forms to discriminate between NH and HI (HI non hearing aid wearers and HI hearing aid wearers) individuals. RESULTS: Compared all other SSQ forms, including the full SSQ, the new short-form showed negligible cross-loading across the three main subscales and greater discriminatory power between NH and HI subjects (as indicated by a larger area under the receiver-operating characteristic curve), as well as between the main subscales (especially Speech and Qualities). Moreover, the new, 5-item Spatial subscale showed increased sensitivity to left/right PTA asymmetry. Very good internal consistency and homogeneity and high correlations with the SSQ were obtained for all short-forms. CONCLUSIONS: While maintaining the three-factor structure of the full SSQ, and exceeding the latter in terms of construct validity and sensitivity to audiometric variables, the new 15-item SSQ affords a substantial reduction in the number of items and, thus, in test time. Based on overall scores, Speech subscores, or Spatial subscores, but not Qualities subscores, the 15-item SSQ appears to be more sensitive to differences in self-evaluated hearing abilities between NH and HI subjects than the full SSQ.

Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss.

Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

Validation of a French-Language Version of the Spatial Hearing Questionnaire, Cluster Analysis and Comparison with the Speech, Spatial, and Qualities of Hearing Scale.

OBJECTIVES: To validate a French-language version of the spatial hearing questionnaire (SHQ), including investigating its internal structure using cluster analysis and exploring its construct validity on a large population of hearing-impaired (HI) and normal-hearing (NH) subjects, and to compare the SHQ with the speech, spatial, and qualities of hearing scale (SSQ) in the same population. DESIGN: The SHQ was translated in accordance with the principles of the Universalist Model of cross-cultural adaptation of patient-reported outcome instruments. The SSQ and SHQ were then presented in a counterbalanced order, in a self-report mode, in a population of 230 HI subjects (mean age = 54 years and pure-tone audiometry [PTA] on the better ear = 28 dB HL) and 100 NH subjects (mean age = 21 years). The SHQ feasibility, readability, and psychometric properties were systematically investigated using reliability indices, cluster, and factor analyses and multiregression analyses. SHQ characteristics were compared both to different literature data obtained with different language versions and to the SSQ scores obtained in the same population. RESULTS: Internal validity was high and very good reproducibility of scores and intersubject variability were obtained across the 24 items between the English and French SHQ for NH subjects. Factor and cluster analyses concurred in identifying five correlated factors, corresponding to several SHQ subscales: (1) speech in noise (corresponding to SHQ subscales 7 and 8), (2) localization of voice sounds from behind, (3) speech in quiet (corresponding to SHQ subscale 1), (4) localization of everyday sounds, and (5) localization of voices and music (corresponding to parts of the SHQ localization subscale). Correlations between SSQ subscales and SHQ factors identified the greatest correlations between SHQ factors 2, 4, and 5 and SSQ spatial subscales, whereas SHQ factor 1 had the greatest correlation with SSQ_speech. SHQ and SSQ scores were similar, whether in NH subjects (8.5 versus 8.4) or in HI subjects (6.6 for both), sharing more than 80% of variance. The SHQ localization subscale gave similar scores as the SSQ spatial subscale, sharing more than 75% of variance. Construct validity identified better ear PTA and PTA asymmetry as the two main predictors of SHQ scores, to a degree similar to that seen for the SSQ. The SHQ was shorter, easier to read and less sensitive to the number of years of formal education than the SSQ, but this came at a cost of ecological validity, which was rated higher for the SSQ than for the SHQ. CONCLUSIONS: A comparison of factor analysis outcomes among the English, Dutch, and French versions of the SHQ confirmed good conceptual equivalence across languages and robustness of the SHQ for use in international settings. In addition, SHQ and SSQ scores showed remarkable similarities, suggesting the possibility of extrapolating the results from one questionnaire to the other. Although the SHQ was originally designed in a population of cochlear implant patients, the present results show that its usefulness could easily be extended to noncochlear-implanted, HI subjects.

Sources of variability of speech, spatial, and qualities of hearing scale (SSQ) scores in normal-hearing and hearing-impaired populations.

OBJECTIVE: To identify and quantify sources of variability in scores on the speech, spatial, and qualities of hearing scale (SSQ) and its short forms among normal-hearing and hearing-impaired subjects using a French-language version of the SSQ. DESIGN: Multi-regression analyses of SSQ scores were performed using age, gender, years of education, hearing loss, and hearing-loss asymmetry as predictors. Similar analyses were performed for each subscale (Speech, Spatial, and Qualities), for several SSQ short forms, and for differences in subscale scores. STUDY SAMPLE: One hundred normal-hearing subjects (NHS) and 230 hearing-impaired subjects (HIS). RESULTS: Hearing loss in the better ear and hearing-loss asymmetry were the two main predictors of scores on the overall SSQ, the three main subscales, and the SSQ short forms. The greatest difference between the NHS and HIS was observed for the Speech subscale, and the NHS showed scores well below the maximum of 10. An age effect was observed mostly on the Speech subscale items, and the number of years of education had a significant influence on several Spatial and Qualities subscale items. CONCLUSION: Strong similarities between SSQ scores obtained across different populations and languages, and between SSQ and short forms, underline their potential international use.

Validation of a French translation of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) and comparison with other language versions.

OBJECTIVE: To validate a French version of the speech, spatial, and qualities of hearing scale (SSQ), a subjective evaluation of patients' hearing disability, and to assess SSQ reproducibility across different language versions. DESIGN: The SSQ was translated in accordance with the principles of the 'Universalist approach' of cross-cultural adaptation of patient-reported outcome instruments. Scores from a normal-hearing and a hearing-impaired population were compiled and compared, whenever possible, with data from the literature, collected using other language versions. STUDY SAMPLE: One hundred normal-hearing subjects and 230 hearing-impaired subjects. RESULTS: Good reproducibility of scores and inter-subject variability were obtained between several language versions, even if scores found using the French version were slightly lower than those obtained using Dutch or English versions. A comparison of factor analysis outcomes between the English and French versions confirmed good conceptual equivalence across languages and robustness of the SSQ for use in international settings. The three main subscales (speech, spatial, and qualities) confirmed their usefulness in assessing different aspects of hearing disability. CONCLUSION: This study validated a French-language version of the SSQ, and assessed the reproducibility of the SSQ across subject groups, administration modes, and different countries/languages, confirming its potential as an international standard for hearing disability evaluation.

Predictors of Speech-in-Noise Understanding in a Population of Occupationally Noise-Exposed Individuals.

Understanding speech in noise is particularly difficult for individuals occupationally exposed to noise due to a mix of noise-induced auditory lesions and the energetic masking of speech signals. For years, the monitoring of conventional audiometric thresholds has been the usual method to check and preserve auditory function. Recently, suprathreshold deficits, notably, difficulties in understanding speech in noise, has pointed out the need for new monitoring tools. The present study aims to identify the most important variables that predict speech in noise understanding in order to suggest a new method of hearing status monitoring. Physiological (distortion products of otoacoustic emissions, electrocochleography) and behavioral (amplitude and frequency modulation detection thresholds, conventional and extended high-frequency audiometric thresholds) variables were collected in a population of individuals presenting a relatively homogeneous occupational noise exposure. Those variables were used as predictors in a statistical model (random forest) to predict the scores of three different speech-in-noise tests and a self-report of speech-in-noise ability. The extended high-frequency threshold appears to be the best predictor and therefore an interesting candidate for a new way of monitoring noise-exposed professionals.

Listening Effort in Quiet and Noisy Environments in the Daily Life of Adults With Hearing Aids: An Extended Version of the Effort Assessment Scale (EEAS).

This study was aimed at assessing listening effort (LE) in quiet and in noisy daily life situations, in 481 adults with hearing aids (HAs) and 62 adults with normal hearing, using an Extended version of the Effort Assessment Scale (EEAS). Participants were invited to self-assess their LE in daily life, on a visual analog scale graded from 0 (no effort) to 10. The EEAS's internal structure identified two separate constructs pertaining to LE in quiet and LE in noise, each with good consistency (Cronbach's α > 0.83). A three-factor model explained 12% of the variance of the EEAS scores, with HA experience the most important one, and better ear hearing threshold (averaged across 0.5-4 kHz) and ear asymmetry as the other two factors. The EEAS subscales differed in behavior, with the LE in noise being the most dependent on HA experience, whereas LE in quiet depended more on better ear hearing threshold. In a subgroup of people with 6 months to less than 24 months HA experience, a significant decrease in LE in noise was observed with increasing HA experience (0.26 points decrease per year of HA experience), whereas in a group of people with at least 24 months of HA experience, a small increase in LE in noise was observed. This effect was not mediated by age, nor hearing threshold. The extended Effort Assessment Scale is therefore offering an assessment of both LE in quiet and LE in noise, with different dependence on HA experience and hearing thresholds.

Auditory efferents facilitate sound localization in noise in humans.

The mammalian auditory system contains descending neural pathways, some of which project onto the cochlea via the medial olivocochlear (MOC) system. The function of this efferent auditory system is not entirely clear. Behavioral studies in animals with olivocochlear (OC) lesions suggest that the MOC serves to facilitate sound localization in noise. In the current work, noise-induced OC activity (the OC reflex) and sound-localization performance in noise were measured in normal-hearing humans. Consistent with earlier studies, both measures were found to vary substantially across individuals. Importantly, significant correlations were observed between OC-reflex strength and the effect of noise on sound-localization performance; the stronger the OC reflex, the less marked the effect of noise. These results suggest that MOC activation by noise helps to counteract the detrimental effects of background noise on neural representations of direction-dependent spectral features, which are especially important for accurate localization in the up/down and front/back dimensions.

Ear Asymmetry and Contextual Influences on Speech Perception in Hearing-Impaired Patients.

The left hemisphere preference for verbal stimuli is well known, with a right ear (RE) advantage obtained when competing verbal stimuli are presented simultaneously, at comfortable intensities, to both ears. Speech perception involves not only the processing of acoustic peripheral information but also top-down contextual influences, filling the gaps in the incoming information that is particularly degraded in hearing-impaired individuals. This study aimed to analyze the potential asymmetry of those contextual influences on a simple speech perception task in hearing-impaired patients in light of hemispheric asymmetry. Contextual influences on disyllabic word perception scores of 60 hearing-impaired patients were compared between left ear (LE) and RE, in a balanced design, involving two repetitions of the same task. Results showed a significantly greater contextual influence on the RE versus the LE and, for the second repetition versus the first one, without any interaction between the two. Furthermore, the difference in contextual influences between RE and LE increased significantly with the RE advantage measured by a dichotic listening test in the absence of any significant correlation with hearing threshold asymmetry. Lastly, the contextual influence asymmetry decreased significantly as age increased, which was mainly due to a greater increase, with age, of contextual influences on the LE versus the RE. Those results agree with the literature reporting a relative right-shift of hemispheric asymmetry observed with age in speech in noise perception tasks in normal hearing subjects and the clinical reports of generally better audiometric speech scores obtained in RE versus LE.

Comparing methods of analysis in pupillometry: application to the assessment of listening effort in hearing-impaired patients.

Numerous studies showed that task-evoked pupil dilation is an objective marker of cognitive activity and listening effort. However, these studies differ in their experimental and analysis methods. Whereas most studies focus on a single method, the present study sought to compare different pupil-dilation data analysis methods, including different normalization techniques, baseline periods, and baseline durations, in order to assess their influence on the outcomes of pupillometry results obtained in an auditory task. To that purpose, we used pupillometry data recorded in response to words in noise in hearing-impaired individuals. The start-time of the baseline relative to stimulus timing turned out to have a significant influence on conclusions. In particular, a significant interaction in the effects of signal-to-noise ratio and hearing-aid use on pupil dilation was observed when the baseline period used started early relative to the word-an effect likely related to anticipatory, pre-stimulus cognitive processes, such as attention mobilization. This was the case even with only correct-response trials included in analyses, so that any confounding effect of performance in the word-repetition task was eliminated. Different normalization methods and baseline durations showed similar results, however the use of z-score transformation homogenized variability across conditions without affecting the qualitative aspect of the results. The consistency of results regardless of normalization methods, and the fact that differences in pupil dilation and subjective measures of listening effort could be observed despite perfect performance in the task, underlines the relevance of pupillometry as an objective measure of listening effort.

Rapid Assessment of Non-Verbal Auditory Perception in Normal-Hearing Participants and Cochlear Implant Users.

In the case of hearing loss, cochlear implants (CI) allow for the restoration of hearing. Despite the advantages of CIs for speech perception, CI users still complain about their poor perception of their auditory environment. Aiming to assess non-verbal auditory perception in CI users, we developed five listening tests. These tests measure pitch change detection, pitch direction identification, pitch short-term memory, auditory stream segregation, and emotional prosody recognition, along with perceived intensity ratings. In order to test the potential benefit of visual cues for pitch processing, the three pitch tests included half of the trials with visual indications to perform the task. We tested 10 normal-hearing (NH) participants with material being presented as original and vocoded sounds, and 10 post-lingually deaf CI users. With the vocoded sounds, the NH participants had reduced scores for the detection of small pitch differences, and reduced emotion recognition and streaming abilities compared to the original sounds. Similarly, the CI users had deficits for small differences in the pitch change detection task and emotion recognition, as well as a decreased streaming capacity. Overall, this assessment allows for the rapid detection of specific patterns of non-verbal auditory perception deficits. The current findings also open new perspectives about how to enhance pitch perception capacities using visual cues.

Music processing deficits in Landau-Kleffner syndrome: Four case studies in adulthood.

Verbal-auditory agnosia and aphasia are the most prominent symptoms in Landau-Kleffner syndrome (LKS), a childhood epilepsy that can have sustained long-term effects on language processing. The present study provides the first objective investigation of music perception skills in four adult patients with a diagnosis of LKS during childhood, covering the spectrum of severity of the syndrome from mild to severe. Pitch discrimination, short-term memory for melodic, rhythmic and verbal information, as well as emotion recognition in music and speech prosody were assessed with listening tests, and subjective attitude to music with a questionnaire. We observed amusia in 3 out of 4 patients, with elevated pitch discrimination thresholds and poor short-term memory for melody and rhythm. The two patients with the most severe LKS had impairments in music and prosody emotion recognition, but normal perception of emotional intensity of music. Overall, performance in music processing tasks was proportional to the severity of the syndrome. Nonetheless, the four patients reported that they enjoyed music, felt musical emotions, and used music in their daily life. These new data support the hypothesis that, beyond verbal impairments, cerebral networks involved in sound processing and encoding are deeply altered by the epileptic activity in LKS, well after electrophysiological normalization.

Effects of UMTS cellular phones on human hearing: results of the European project EMFnEAR.

Abstract The European project EMFnEAR was undertaken to assess potential changes in human auditory function after a short-term exposure to radiofrequency (RF) radiation produced by UMTS (Universal Mobile Telecommunication System) mobile phones. Participants were healthy young adults with no hearing or ear disorders. Auditory function was assessed immediately before and after exposure to radiofrequency radiation, and only the exposed ear was tested. Tests for the assessment of auditory function were hearing threshold level (HTL), distortion product otoacoustic emissions (DPOAE), contralateral suppression of transiently evoked otoacoustic emission (CAS effect on TEOAE), and auditory evoked potentials (AEP). The exposure consisted of speech at a typical conversational level delivered via an earphone to one ear, plus genuine or sham RF-radiation exposure produced by a commercial phone controlled by a personal computer. Results from 134 participants did not show any consistent pattern of effects on the auditory system after a 20-min UMTS exposure at the maximum output of the phone with 69 mW/kg SAR in the cochlea region in a double blind comparison of genuine and sham exposure. An isolated effect on the hearing threshold at high frequencies was identified, but this was statistically nonsignificant after correction for multiple comparisons. It is concluded that UMTS short-term exposure at the maximum output of consumer mobile phones does not cause measurable immediate effects on the human auditory system.

Speech auditory brainstem response (speech ABR) characteristics depending on recording conditions, and hearing status: an experimental parametric study.

Speech elicited auditory brainstem responses (Speech ABR) have been shown to be an objective measurement of speech processing in the brainstem. Given the simultaneous stimulation and recording, and the similarities between the recording and the speech stimulus envelope, there is a great risk of artefactual recordings. This study sought to systematically investigate the source of artefactual contamination in Speech ABR response. In a first part, we measured the sound level thresholds over which artefactual responses were obtained, for different types of transducers and experimental setup parameters. A watermelon model was used to model the human head susceptibility to electromagnetic artefact. It was found that impedances between the electrodes had a great effect on electromagnetic susceptibility and that the most prominent artefact is due to the transducer's electromagnetic leakage. The only artefact-free condition was obtained with insert-earphones shielded in a Faraday cage linked to common ground. In a second part of the study, using the previously defined artefact-free condition, we recorded speech ABR in unilateral deaf subjects and bilateral normal hearing subjects. In an additional control condition, Speech ABR was recorded with the insert-earphones used to deliver the stimulation, unplugged from the ears, so that the subjects did not perceive the stimulus. No responses were obtained from the deaf ear of unilaterally hearing impaired subjects, nor in the insert-out-of-the-ear condition in all the subjects, showing that Speech ABR reflects the functioning of the auditory pathways.

The Glasgow Sensory Questionnaire: Validation of a French Language Version and Refinement of Sensory Profiles of People with High Autism-Spectrum Quotient.

Sensory sensitivity peculiarities represent an important characteristic of Autism Spectrum Disorders (ASD). We first validated a French language version of the Glasgow Sensory Questionnaire (GSQ) (Robertson and Simmons in J Autism Dev Disord 43(4):775-784, 2013). The GSQ score was strongly positively correlated with the Autism-Spectrum Quotient (AQ) (r = 0.81, p < 10-6, n = 245). We further examined sensory profiles of groups with high versus low AQ. The high AQ group scored higher at the GSQ than the low AQ group for every sensory modality. Moreover, the high AQ group showed greater consistency in their patterns of hypersensitivity and hyposensitivity between sensory modalities, and stronger correlations between hyper and hyposensitivity. Results are discussed in the context of theories accounting for atypical sensory perception in ASD.