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9/12/2014
1
Audiological Management of Children with Hearing
Loss and Auditory Listening Differences
UNIVERSITY OF NORTH TEXASDepartment of Speech and Hearing Sciences
Cochlear Implants, Hearing Aids, & Hearing Assistance Technology (HAT)!!
1. Cochlear implants
2. Hearing aids
3. HAT for children with normal hearing &
auditory difficulties
4. Fitting procedures for children with normal
hearing
•Data from 5 studies:1. Speech‐in‐noise thresholds14 Cochlear Freedom Users
Compared CI alone to CI plus Oticon Arc
2. Speech‐in‐noise thresholds:9 users: Nucleus 5, Harmony, & OPUS
Compared: CI alone, Oticon R2, and Oticon Arc
3. Electroacoustic testing with CIs
4. Adaptive digital wireless systems
5. Effect of adaptive signal processing: Nucleus 6
• 14 Cochlear Freedom Users with Oticon Arc
Schafer et al., AJA, 2012
6.0 5.9
-6.5 -5.9
-10
-5
0
5
10
15
Session 1 Session 2
SN
R a
t 50
% C
orr
ect
(dB
)
Test Session
No FM
FM
12 dB improvement with Arc Significant effect of FM
No significant effect of session
9/12/2014
2
•9 users of various sound processors
0.7
-10.8-6.1
-20
-15
-10
-5
0
5
10
1
BK
B-S
IN S
NR
-50
Condition
No FM
Arc
R2
Both FM better than no FM Arc better than R2
WHY???
Schafer et al., JAAA, 2013a
• Adjusted FM gain to most closely simulate processor output
Measurement Steps 750 Hz 1000 Hz 2000 Hz
1. Processor in Test Box: 65 dB SPL Speech-Std1
2. Transmitter Microphone in Test Box: 65 dB SPL Speech-Std1
Difference Between Two Conditions
Average of Difference Scores (should be + 3 dB)
Schafer et al, 2013b, JAAA
•Step 1: Measure the output of the CI through the monitor earphones using speechinput
•Nucleus 5 in test box
•Coupler & earphone out
Nucleus 5
Earphone & HA-1 Coupler
Schafer et al., 2013b, JAAA
Step 2: Transmitter mic in Test Box:Measure Output of R2 Receiver
Transmitter Microphone
Oticon T30 Transmitter
Nucleus 5
Earphone & HA-1 Coupler
Oticon R2 FM Receiver plugged into earphone cord
Schafer et al., 2013b, JAAA
9/12/2014
3
Oticon T30 Transmitter
Nucleus 5 withearphone cord
Transmitter Microphone
OticonArc
Why the difference between FMs in Study 3??
0102030405060708090
750 Hz 1000 Hz 2000 Hz
Out
put i
n dB
SPL
Frequency
CI Alone
Arc +8
R2 +16
•We want transparency:•Same output with same inputs to CI and FM mics
•But…..•When we compared the measurements from the CI alone, R2, and Arc, we got….
Schafer et al., JAAA, 2013b
0102030405060708090
750 Hz 1000 Hz 2000 Hz
Out
put i
n dB
SPL
Frequency
Arc +8
R2 +16
R2 +8
Study 3: Electroacoustic Results Cochlear & MED‐EL
Schafer et al., 2013b, JAAA
But…does this approach result in good behavioral results??
•Speech recognition with 2 list‐pairs of BKB‐SIN: speech at 0; Babble at 180 degrees
• Loudness ratings (in parenthesis below)
Subject: CI CI Alone R2 Arc
1: Nucleus 5 1.0 (2.7) ‐11.0 (4.3) ‐12.3 (3.7)
2: Nucleus 5 ‐2.5 (3.3) ‐11.3 (4.0) ‐12.2 (3.7)
Schafer et al., 2013b, JAAA
9/12/2014
4
• Evaluated speech recognition in quiet and in noise with speech (HINT) at 64 dB at participant (85 dBA at transmitter )and classroom noise at 50, 55, 60, 65, 70, 75, 80 dBA
• Evaluated 3 RF remote microphone systems in Advanced Bionics and Cochlear users:–Fixed‐gain FM – MLxS–Adaptive FM – MLxi–Digital RF – Roger
Study 4 Results: AB (n = 16)
Wolfe et al., 2013, JAAA
Adults with normal hearing score 95% correct here!
Study 4 Results: Cochlear (n = 21)
Wolfe et al., in press, JAAA
Study 4: Summary
Adaptive Digital technology significantly better than fixed‐gain and adaptive FM at 70, 75, and 80 dBA
Adaptive FM technology better than fixed gain FM at 70, 75, and 80 dBA noise levels
No differences were found between CI manufacturers.
9/12/2014
5
Study 5: Adaptive Signal Processing: Nucleus 6
•Wolfe et al. evaluated potential benefit of acoustic scene analysis, fully adaptive directional processing, and digital noise reduction/ speech enhancement in Nucleus 6
• Ninety‐three participants with Nucleus Freedom, Nucleus CI512, & Nnucleus 422 internal devices
•Conditions: • ADRO + ASC: standard microphone directionality
• ADRO + ASC + SNR‐NR (standard microphone directionality)
• ADRO + ASC + SNR‐NR + SCAN: (automatic microphone directionality)
45.7 46.0
54.5
72.3
0
10
20
30
40
50
60
70
80
N5: ASC+ADRO N6: ASC+ADRO N6: ASC+ADRO+SNR
N6: SCAN+ASC+ADRO+SNR
Per
cent
Cor
rect
Sco
re
Conditions
Best!
Significantly Worse
Cochlear Implants, Hearing Aids, & Hearing Assistance Technology (HAT)!!
1. Cochlear implants
2. Hearing aids
3. HAT for children with normal hearing &
auditory difficulties
4. Fitting procedures for children with normal
hearing
Hearing Aids
•Data from 3 pediatric studies & 1 adult study:
1. Potential benefit of VoicePriorityi in Oticon FM
2. Soundfield/Personal systems: NH and HA• Comparison of soundfield systems
• Comparison of soundfield to personal
•3. Phonak Lyric for children
•4. Resound Unite Mic vs. Phonak Roger
9/12/2014
6
Goal of Oticon Voice Priority i (VPi)
•Automatic and adaptive adjustment of FM emphasis in Sensei:
•When using Amigo R2 or R12 receiver and T30 transmitter, Sensei monitors the noise level around child
•When noise exceeds 58 dBA (65 dB SPL), FM emphasis systematically increased
VPi vs. Other Products
•VPi determines necessary FM emphasis at the location of the child’s HA
•Other products adjust FM gain based on noise level measured at the teacher’s FM transmitter
Determining FM Emphasis at HA: Why does it matter?
•1. DISTANCE• Intensity of talker’s voice & SNR vary based on location
Determining FM Emphasis at HA: Why does it matter?
•2. NOISE•Noise may be diffuse or localized
9/12/2014
7
Determining FM Emphasisat HA: Why does it matter?
•Cruckley et al. (2011)
•Noise levels varyacross & within children’s listening environments
Dosimeter measurements
71 73
6163
75% of the day sound levels between 60 to 80 dBA
Participants
20 children with hearing loss Ages 5-18 years 10 male; 10 female 18 sensorineural 1 mixed 1 unilateral (bilateral ANs)
• All but 2 wearing hearing aids
0
10
20
30
40
50
60
70
80
90
250 500 1000 2000 4000
Th
resh
old
(d
B H
L)
Frequency (Hz)
Children using Phonak, Unitron, Oticon, and Starkey HAs or no aids (2)
Methods: Session 1
• Fit bilateral Oticon Sensei Pro BTE or RITE• Real ear measures: met DSL v5 targets
• Fit R12 Amigo receiver and T30 transmitter• Electroacoustic measures: confirmed transparency
•Asked to use the hearing aid & FM system with VPi 4‐week trial, 2 hrs/day, Sensei remainder of day
•Children/parents given an orientation
Schafer et al., 2013JEA
Methods: Session 2
•3 Behavioral Measures• Speech recognition in noise• Acceptable Noise Levels (ANL)• Speech Intelligibility Ratings (SIR)
•3 Questionnaires• Children’s Home Inventory for Listening Difficulty (C.H.I.L.D.) – Parent & Child versions
• Auditory Performance Scale for FM systems (APS‐FM)
9/12/2014
8
Methods: Speech Recognition
•Conducted in classroom • HINT‐C sentences & 4‐classroom noise
• FM conditions: • 1. Traditional FM
• 2. FM with VPi
• Signal levels: • 1. S65/N55
• 2. S70/N63
• 3. S74/N70
• 2 loudspeaker arrangements:• 1. Localized noise
• 2. Diffuse noise
Speech
Noise
Noise
FM
Speech
FM
CD
CD
CD
CD
CD
CD
Diffuse noise
Localized noise
0
20
40
60
80
100
120
Loc 65/55 Loc 70/63 Loc 74/70 Dif 65/55 Dif 70/63 Dif 74/70
% Correct
Loudspeaker Arrangement & SNR
Traditional FM
Voice Priority FM
Methods: ANL
•Conducted in booth: presented running speech at 0◦ and multi‐talker babble at 180◦
•Conditions:• 1. Sensei alone• 2. Sensei plus traditional, fixed‐gain FM• 3. Sensei plus FM with VPi enabled
•Procedure:• 1. Measure MCL with speech only
• 2. Measure BNL with speech set to MCL
• 3. Calculate ANL: MCL – BNL = ANL
9/12/2014
9
Results: ANL
‐10
0
10
20
30
40
50
60
70
MCL BNL ANL
Intensity in
dBHL
Listening Condition
Study HA
Traditional FM
Voice PriorityFM
• 15 items, which can be separated into five categories: hearing in quiet, media, social situations, noise, and at a distance
• Children & Parents completed three times:
• 1. Before the study about personal aids
• 2. After the study about Sensei plus FM
• 3. After the study about Sensei alone
•Participant Version •Parent Version
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10
Results: Participant Questionnaires
0
1
2
3
4
5
6
7
8
9
Quiet Media Social Noise Distance
Participant Ratings
C.H.I.L.D. Listening Situations
Personal HA Study HA Study HA+FM
Schafer et al., in submission
0
1
2
3
4
5
6
7
8
9
Quiet Media Social Noise Distance
Parent Ratings
C.H.I.L.D. Listening Situations
Personal HA Study HA Study HA+FM
•17 items separated into two categories: hearing at home and hearing in social situations related to hearing difficulty
•Children completed three times:
• 1. Before the study about personal aids
• 2. After the study about Sensei plus FM
• 3. After the study about Sensei alone 0
0.5
1
1.5
2
2.5
3
3.5
Home Social
Level of Difficulty Communicating
APS‐FM. Listening Situations
Personal HA
Study HA
Study HA+FM
9/12/2014
11
Results: APS‐FM Questionnaire
•Also included12 questions about the functionality of the FM system•Average ratings: 0.57 ‐ 1.67
• ‘liked it very much’ or ‘it was pretty good’.
•FM receiver: comfortable, easy to use, reliable, clear, cosmetically appealing, & helped them hear.
•FM transmitter: comfortable, cosmetically appealing, good sized, easy to use, & worked well.
Results: APS‐FMAvg FM
Use
(hrs)
Where Most Helpful? Liked Most About FM?
2 At mall & in car Long range; could hear whispers
2 Voices far away and didn’t carry Multiple uses, use as headphones
1‐2 Car, getting attention from another
room
Automatic frequency connection, small FM
6‐10 Coaching, presentations, school Portable
6‐10 Coaching, presentations, school Easy to use, portable, hear clearly at
distance and background noise
1‐2 When person was in different room,
TV
Worked well, reliable
8‐10 In car, TV Could hear much better, easy to use
2 In car, TV Easier to understand people, TV
connection
1 Restaurant, another room Could hear from different room, when it
was loud
1 Restaurant, another room Heard much better without needing to be
loud or yell
Results: APS‐FMAvg FM
Use (hrs)
Where Most Helpful? Liked Most About FM?
8 School, shopping Very easy to use, small
3 Happy to hear better Helps a lot, proud of it
2 Event outside with large group;
grocery shopping
Child could hear all words said and
didn’t ask ‘huh?’, heard better outside
the home
4 Classroom, large noisy rooms Simplicity, size
6‐7 Noisy places Small, easy to use
5 Hear better, gets attention more Music player, mic was sensitive
3‐4 iTouch, classroom, teacher
instructions
Clarity
4‐5 Classroom Clarity when there was no static
1‐2 Hear from different room, in
noise
Mom doesn’t have to yell
3 Noise Distance, directly to ears
Results: APS‐FM
Liked Least About FM? Interference? Recommen
d to
Others?
Charging No Yes
Mic clip not durable, too
big
No Yes
Flashing light, batteries No Yes
* * *
Feedback Yes, when out of range and randomly Yes
Look, size No Yes
Bulky transmitter, mic
detached easily
Not too much Yes
Feedback If far from receiver Yes
* No Yes
Makes some unwanted noise Yes Yes
9/12/2014
12
Results: APS‐FMLiked Least About FM? Interference? Recommend
to Others?
Need more than one
transmitter: for each parent
No Yes
* 2‐3 times; fixed after battery reinserted Yes
Little buzzing, clip Yes, like a noisy waterfall Yes
Yes, when talking or a lot of
noise
* *
Static, size When cord touched another part of the
cord
Yes
Size Yes, static many times Yes
* Static when close to computer speakers Yes
Teachers would not mute,
interfered with participation in
class
Yes, nearly all the time Not in the
classroom
setting
Transmitter didn’t clip well, too
heavy on shirt
No Yes
Transmitter was too heavy to
clip on shirts without pockets
No Yes
Study 1 Summary
•VPi FM significantly improved speech recognition in noise, particularly in high level, localized noise over traditional FM
•VPi FM significantly improved ANL over HA & FM
•Both FM significantly improved SIR over HA
•Children ratings: significant benefit of FM over both study HA or personal HA
•Parent rating: significant benefit of FM over Sensei andpersonal HA.
• Sensei over personal aid
Hearing Aid: Study Two
•Wolfe et al., 2013:
• Participants: 10 NH adults; 15 NH children; 15 children with moderate hearing loss and bilateral hearing aids
• Children ages 6‐13; Losses 35‐75 dB for 4 frequency PTA (most mod)
• Phonak or Oticon hearing aids
• Stimuli: HINT sentences in 4‐classroom noise
• Signal Levels: Quiet 65 dBA; Noise at 50, 55, 60, 65, 70, and 75 dBA
• 3 Conditions: No FM, Phonak Dynamic Soundfield, Audio Enhancement Traditional Soundfield
Study Two Results
Wolfe et al., 2013, JEA
0
0.2
0.4
0.6
0.8
1
Q 50 55 60 65 70 75 Q 50 55 60 65 70 75 Q 50 55 60 65 70 75
HI Child
NH Child
NHA Adult
Phonak SoundfieldNo FM Audio EnhancementSoundfield
Significant effect of
signal level
Significant effect of
group
Significant effect ofcondition
9/12/2014
13
Hearing Aid: Study Two
•Wolfe et al., 2013:•Participants: 13 children with mild‐sev hearing loss & HAs•Stimuli: HINT sentences in 4‐classroom noise
•Signal Levels: Quiet 65 dBA; Noise at 50, 55, 60, 65, 70, and 75 dBA
•6 Conditions: • No FM• Phonak Dynamic Soundfield (SF)
• Audio Enhancement Traditional SF• Phonak Dynamic SF + Personal• Audio Enhancement Traditional SF + Personal• Personal
Study Two Results
Not much to see here; good performance everywhere
0%
20%
40%
60%
80%
100%
120%
Quiet 50 55
No FM
Phonak Soundfield
Audio Enhancement Soundfield
Phonak Soundfield/ Personal FM
Audio Enhancement Soundfield/Personal FM
Personal FM
More Study Two Results
0%
20%
40%
60%
80%
100%
120%
60 65 70 75
No FM
Phonak Soundfield
Audio EnhancementSoundfield
PhonakSoundfield/Personal FM
Audio EnhancementSoundfield/Personal FM
Personal FM
Significant effect of
signal level
Significant effect of condition
Personalsystems
best
Plugginginspiro
into AE systemeliminated Dynamic
Study Three Phonak Lyric
•Children, ages 10‐17with mild to moderate hearing loss, currently using bilateral aids, & 60% on CNC words while aided
•Attempted to meet DSL v5 real ear targets + 5 dB for 55, 65, and 75 dB SPL
• Overall, neither the daily wear (personal) or Lyric were meeting target, but daily wear had higher output
(both a better fit to NAL‐NL1 targets)
Analog device
9/12/2014
14
Table 1. Personal Hearing Aids Used by Participants Prior to the Study
Subject # Age
(years)
Old HA Make/Model SR (kHz) CR Datalogging
(hours/day)
1 12.3 Phonak Nios S H20 III 3.4 2.5 4
2 17.7 Phonak Nios S H20 V 6.0 1.5 14
3 13.1 Oticon Safari 300 BTE NA NA 0
4 15.8 Phonak Nios Micro III 4.5 2.8 0
5 17.3 Phonak Nios Micro III 2.5 3.5 0
6 17.3 Phonak Nios Micro III 2.8 3.1 1
7 16.8 Phonak Certéna Art CIC 4.4 2.7 11
8 12.8 Phonak Naida Q50 RIC 3.0 3.6 14
9 17.4 Phonak Nios Micro V 3.2 2.4 NA
10 10.4 Phonak Versáta M NA . 4
11 12.3 Phonak Nios S H20 III 4.3 2.7 9
12 11.3 Phonak Nios S H20 III 3.4 2.7 4
13 14.8 Phonak Nios S H20 III 4.3 2.7 12
14 11.3 Phonak Nios S H20 III NA 2.3 2
15 12.6 Phonak Nios Micro III 3.2 2.4 NA
16 17.2 Phonak Audéo S Small V 4.6 2.8 NA
AVG:5.8
Study 3 ResultsThresholds: Own Aid vs. Lyric
0
10
20
30
40
50
60
250 500 1000 2000 3000 4000 6000
Th
resh
old
(d
B H
L)
Frequency (Hz)
Own Aid
Lyric
Only significant difference
Study 3 ResultsWord Recognition: Quiet
0
20
40
60
80
100
120
50 dBA 60 dBA
Sp
eech
Rec
ogn
itio
n (
% c
orre
ct)
Condition
Own Aid
Lyric
No significant differences
Study Two ResultsWord Recognition: Noise
0
0.5
1
1.5
2
2.5
3
3.5
4
1 2
Th
resh
old
in n
oise
(d
B S
NR
)
ConditionOwn Aid Lyric
Lyric resulted in significantly better performance on BKB‐SIN
9/12/2014
15
Study Two ResultsAPHAB Questionnaire
0
5
10
15
20
25
30
35
40
45
EC BN RV Global
Lev
el o
f D
iffi
cult
y
APHAB Subscales
Own Aid
Lyric
Significantly lower difficultywith Lyric
Study 3 ResultsSSQ Questionnaire
-0.5
0.5
1.5
2.5
3.5
4.5
5.5
Speech Hearing Spatial Hearing Qualities of Hearing
Ch
ange
Rat
ing
SSQ-C Subscale
Greater perceived benefit with Lyric vs. Daily Wear Aid
Study 3 Summary
•Most kids do not wear regular aids all day
•Did not meet target with Lyric
•Thresholds similar with the exception of 6k
•Word recognition in quiet similar
• Lyric significantly better than daily wear aid in noise•Greater perceived benefit and less difficulty reported in noisy situations with Lyric
•What do you think????
Study Four: Resound Unite Mic vs. Phonak Roger
•17 adults with mod‐severe SNHL• Fit Phonak Bolero 90 with Roger system• Fit ReSound Verso with Unite Mic
•Tested speech recognition with each aid and with each wireless system in:
• Quiet• Noise: 55, 65, 75, and 80 dBA
9/12/2014
16
Study 4 Results
-10
10
30
50
70
90
110
Quiet 55 dBA 65 dB 75 dBA 80 dBA
Per
cent
Cor
rect
Signal Levels
Resound Verso
Phonak Bolero90
Resound Versowith Unite Mic
Phonak Bolero90 with Roger
Bolero+Rogerbest
Both wireless better than both aids alone
Study 4 Summary
•Phonak Bolero and ReSound Verso resulted in similar speech recognition in quiet and in noise
•Phonak Bolero + Roger best in high noise levels•Both wireless systems helpful in lower noise
•Wireless mics certainly an option for children at homeand at school when the child does not receive special edsupport
Cochlear Implants, Hearing Aids, & Hearing Assistance Technology (HAT)!!
1. Cochlear implants
2. Hearing aids
3. HAT for children with normal hearing &auditory difficulties
4. Fitting procedures for children with normal hearing
No surprise!
•Remote‐microphone technology improves hearing & educational performance in most children
•May be surprising: strong evidence to support FM systems in FM in several underserved populations‐‐
• 1. Auditory Processing Disorder (APD)• 2. Autism Spectrum Disorders (ASD) & Attention‐Deficit Hyperactivity Disorder (ADHD)
• 3. Dyslexia• 4. Friedreich Ataxia (FRDA)• 5. Language Disorders
9/12/2014
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Goals of This Section
•1. Review literature related to several normal hearing populations that need HAT
•2. Briefly review procedures to determine the need for HAT
•3. Recommend objective fitting procedures for these populations
1. Auditory Processing Disorders (APD)
•Johnston, John, Kreisman, Hall & Crandall (2009)•10 children with APD•13 children in control group•Test measures:
•Speech recognition in quiet & noise: HINT‐C
•Academic performance: SIFTER & LIFE
1. APD: Speech Recognition
Quiet (dB) Noise (dB SNR)
1. APD: Academic Performance‐‐ SIFTER
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1. APD: Academic Performance‐‐ LIFE 2. Autism Spectrum Disorders (ASD)
•Rance, Saunders, Carew, Johansson, & Tan (2014)• 20 children with ASD
• 20 matched controls• Test measures:
• Speech recognition in noise
• APHAB• Temporal processing• Spatial processing
2. ASD: Comparison of Groups—ASD vs. Controls
2. ASD: Speech Recognition in Noise
9/12/2014
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2. ASD: Speech Recognition in Noise 2. ASD & ADHD
•Schafer, Mathews, Mehta, Hill, Munoz, Bishop, & Moloney (2012)• 11 children with ASD:
• 7 had ASD: APD (2), anxiety disorder (1), ADHD (2)• 4 had ADHD: APD (1), SLI (1)
• 11 age‐matched peers• Test measures:
• Speech recognition in noise• Classroom observations• Teacher questionnaires
2. ASD & ADHD: Speech Recognition in NoiseLower scores are better!
-14
-12
-10
-8
-6
-4
-2
0
No FM: ASD & ADHD No FM: Typical FM: ASD & ADHD
BK
B-S
IN T
hre
sho
ld i
n d
B S
NR
Condition: Group
Significantly poorer than typical peers
Same as peers when using FM
p < .001 p > .05
-5.4
-10.7
-4.2
-11.2
-14
-12
-10
-8
-6
-4
-2
0
No-FM 1 FM 1 No-FM 2 FM 2
BK
B-S
IN T
hre
sho
ld i
n d
B S
NR
Condition
2. ASD & ADHD: Speech Recognition in Noise
Lower scores are better!
Significantly better performance in FM conditions No effect of session
9/12/2014
20
63.8%
84.4%
62.9%
71.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FM Off 1 FM On 1 FM Off 2 FM On 2
Per
cen
tag
e o
f O
n-T
ask
Beh
avio
rs
Experimental Phase
2. ASD & ADHD: On‐Task Behaviors
Significantly more on-task behaviors with FM during both trial periods
Both FM conditions significantly better than both no-FM conditions
2. ASD & ADHD: C.H.A.P.S. Results
-35
-30
-25
-20
-15
-10
-5
0
Noise Quiet Ideal MultipleInputs
AuditoryMemory
AuditoryAttention
Teac
her
Rat
ing
C.H.A.P.S. Listening Condition
No FM
FM
Significant improvements in most areas*
* * * * *
3. Dyslexia
•Hornickel et al. (2012)•38 normal hearing children, ages 8‐14 years, with dyslexia
• 19 used FM system (Phonak EduLink) for 1 year
• 19 wore no device (control group)
•Test Measures:• Reading Ability
• Phonological Awareness
• Auditory Brainstem
Response to Speech (cABR)
Significant improvement in FM group; no change for control group
Significant improvement; no change for control group
Significant difference relative to control group
II. New FM Research
• Hornickel et al. (2012)
BaDaGa
stimuli
9/12/2014
21
3. Dyslexia
•Hornickel et al. (2012)• Subset of participants showed even greater improvements on phonological awareness
• Coined the “learners”
4. Friedreich ataxia (FRDA)
•Rance et al. (2010)• Neurodegenerative disease affecting motor and sensory systems due to mutations in the FXN gene, results in auditory neuropathy spectrum disorder (ANSD)
•10 participants, ages 8‐42 years, normal hearing but abnormal ABR with evidence of ANSD & control group
• Used FM system (Phonak iSense) for 6‐week trial
•Test Measures:• Auditory processing testing
• Word recognition in noise: 0 dB SNR
• Abbreviated Profile of Hearing Aid Benefit (APHAB)
4. Friedreich ataxia (FRDA)
•Word recognition with no FM:• FRDA: 43% (SD= 26)• Control: 80% (SD=1.8)
•FRDA with FM:
4. Friedreich ataxia (FRDA)
•APHAB Results:
9/12/2014
22
5. Language Disorders
•Will discuss after the section on fitting because we did some validation of our fitting procedure on this group
•First, we will briefly discuss (or review) identifying educational need
Determining Educational Need…
•1. Cite literature and assess classroom acoustics using an app to see if it meets ASHA/ANSI criteria (AudioTools from Studio Six Digital)
• Measure unoccupied noise, occupied noise, estimated SNR, RT
•2. Perform classroom observation:• Seating, on/off task behaviors, participating, ambient noise
•3. Speech recognition in noise: BKB‐SIN & PINT•4. Student & teacher questionnaires•5. Other informal assessments: Interviews with parent &
student; grades, review of special education file or previous testing
•6. Cite Literature on that population
Fitting HAT on Children with Normal Hearing Fitting HAT: NH
• Schafer, Bryant, Sanders, Baldus, Algier, Lewis, Traber, Layden, Amin (in press, JAAA)
• Examined validity of AAA protocol & clearly define procedures for fitting ear‐level, open ear, FM‐only devices to 26 NH children
•Meet prescribed targets: DSL
•Measure RESR
•We also evaluated REOR to determine potential changes in REUR due to receiver placement iSense micro with smaller
xStandard receivers
9/12/2014
23
Specific Goals & Fitting Procedures
•1. Meet DSL targets at 1, 2, 3, & 4 kHz •FM mic in the test box; real‐ear mic in child’s ear•Verifit: select ‘FM’; ‘On‐ear’; Speech‐std[1]; FM volume adjusted, if necessary
•2. Do not exceed estimated UCL•Same settings, but MPO selected as the stimulus•Compared MPO to the estimated UCL on screen
•3‐4. Examine difference between REOR & REUR•Transmitter turned off•Verifit: ‘Open’ instrument; Speech‐std[1] at 65 dB SPL.
1. DSL Targets vs. Output
30
40
50
60
70
80
90
100
110
1000 2000 3000 4000
Target Output
No significant effect of output type
Significant interaction effect
Output 2-3 dBlower than target
2. MPO vs. UCL
Schafer et al., in press-c, JAAA
30
40
50
60
70
80
90
100
110
250 500 1000 2000 3000 4000 6000
dB SPL
Frequency (Hz)
UCL
OutputMPO output significantly lower than estimated UCL
3. REOR vs. REUR
0
10
20
30
40
50
60
70
1000 2000 3000 4000
dB SPL
Frequency (Hz)
iSense
Unaided
Significant difference: average= 3 dB
9/12/2014
24
Behavioral Validation:Speech Recognition in Noise
0
10
20
30
40
50
60
70
80
90
100
110
Left FM Right FM Bilateral FM No FM
Percen
t Correct Speech Recogn
ition
Listening Condition
5‐8 yrs
9‐12 yrs
Behavioral Validation:
Loudness Ratings in Noise
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Left FM Right FM Bilateral FM No FM
Loudness Rating
Listening Condition
5‐8 yrs
9‐12 yrs
4. Language Disorders (LD) & Various Disabilities
Table 1. Overview of Subject Demographics and Frequency Modulation (FM) System Volume
Subject # Age Disorder FM Volume: Right FM Volume: Left
1 8; 10 APD ‐2 ‐2
2 10; 7 APD 8 8
3 8; 0 Teacher reported
listening problems
6 6
4 11; 11 ADHD, LD 6 8
5 9; 6 ASD, SLI 8 8
6 9; 3 ASD, APD, SLI 6 6
7 10; 5 ASD, APD, SLI 8 8
8 9; 5 ASD, ID, ADHD, SLI 2 0
9 8; 11 SLI 0 0
10 6; 4 SLI, APD, ADHD 2 2
11 10; 2 SLI 8 6
12 11; 3 SLI 6 6
4. LD & Other Disabilities
•Test Measures:
•Same procedure as the previous fitting study
•Same speech recognition measures
• Listening Comprehension Test 2 (recorded in noise)
•Trial period: child, parent, & teacher questionnaires
9/12/2014
25
4. LD: Fitting Results
60
65
70
75
80
85
1000 2000 3000 4000
Out
pu
t (d
B S
PL
)
Frequency (Hz)
Targret
FM Output
DSL output was met or slightly exceeded (by 3 dB) for all 24 ears
4. LD: Speech Recognition Results (n=10)
‐10
0
10
20
30
40
50
60
70
80
90
100
110
FM Left FM Right Bilateral FM Unaided
Speech Recogn
ition Score (%)
Condition
We recommend bilateral FM!
All loudness ratings “Comfortable” or “Loud, but OK”
4. LD: Listening Comprehension(n=8)
0
2
4
6
8
10
12
14
16
18
Main Idea Details Reasoning Vocabulary Underst.Messages
Listening Test Score
Subtest
Unaided FM
4. LD: Participant C.H.I.L.D. (n=7)
0
10
20
30
40
Quiet Noise Distance Social Media
Subject C.H.I.L.D. Rating
Listening Condition
Baseline With FM
9/12/2014
26
4. LD: Parent C.H.I.L.D. (n=10)
0
5
10
15
20
25
30
35
Quiet Noise Distance Social Media
Paren
t C.H.I.L.D. Rating
Listening Condition
Baseline With FM
All Conditions Better with FM!
Cochlear Implants, Hearing Aids, & Hearing Assistance Technology (HAT)!!
1. Cochlear implants
2. Hearing aids
3. HAT for children with normal hearing &
auditory difficulties
4. Fitting procedures for children with normal
hearing
Questions??
•Thank you!• Erin.Schafer@unt.edu
Helpful References! Erin C. Schafer, Ph.D.
Typical Classroom Acoustics Arnold, P., & Canning, D. (1999). Does classroom amplification aid comprehension? British Journal of
Audiology, 33(3), 171-178. Bess, F. H., Sinclair, J. S., & Riggs, D. E. (1984). Group amplification in schools for the hearing impaired. Ear
& Hearing, 5(3), 138-144. Crandell, C. & Smaldino J. (1996). An update of classroom acoustics for children with hearing impairment.
Volta Review, 1, 4-12. Cruckley, J., Scollie, S., & Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of
Educational Audiology, 17, 23-35. Knecht, H. A., Nelson, P. B., Whitelaw, G. M., & Feth, L. L. (2002). Background noise levels and reverberation
times in unoccupied classrooms: predictions and measurements. American Journal of Audiology, 11, 65-71.
Leavitt, R., & Flexer, C. (1991). Speech degradation as measured by the Rapid Speech Transmission Index (RASTI). Ear Hear, 12(2), 115-118.
Markides, A. (1986). Speech levels and speech-to-noise ratios. British Journal of Audiology, 20, 115-120. Nelson, E. L.., Smaldino, J., Erler, S., Garsteki, D. (2007/2008). Background Noise Levels and Reverberation
Times in Old and New Elementary School Classrooms Journal of Educational Audiology, 14, 12-18. Sanders, D. A. (1965). Noise Conditions in Normal School Classrooms. Except Child, 31, 344-353.
Recommended Classroom Acoustics & Measuring Acoustics American National Standards Institute. (2010). American National Standard Acoustical Performance Criteria,
Design Requirements, and Guidelines for Schools, Part 1: Permanent Schools (No. ANSI S12.60-2010). Melville, NY.
American Speech-Language-Hearing Association. (2005). Acoustics in educational settings: Position statement. [Position Statement]. Available from www.asha.org/policy.
Ostergren, D., & Smaldino, J. (2013). Technology in educational settings: It may already be in your pocket or purse! Journal of Educational Audiology, 18, 10-13.
Effects of Noise on Younger Listeners Eisenberg, L. S., Shannon, R. V., Martinez, A. S., Wygonski, J., & Boothroyd, A. (2000). Speech recognition
with reduced spectral cues as a function of age. Journal of the Acoustical Society of America, 107(5 Pt 1), 2704-2710.
Elliott, L. L. (1979). Performance of children aged 9 to 17 years on a test of speech intelligibility in noise using sentence material with controlled word predictability. Journal of the Acoustical Society of America, 66(3), 651-653.
Elliott, L. L., Connors, S., Kille, E., Levin, S., Ball, K., & Katz, D. (1979). Children's understanding of monosyllabic nouns in quiet and in noise. Journal of the Acoustical Society of America, 66(1), 12-21.
Gravel, J. S., Fausel, N., Liskow, C., & Chobot, J. (1999). Children's speech recognition in noise using omni- directional and dual-microphone hearing aid technology. Ear and Hearing, 20(1), 1-11.
Jamieson, D. G., Kranjc, G., Yu, K., & Hodgetts, W. E. (2004). Speech intelligibility of young school- aged children in the presence of real-life classroom noise. J Am Acad Audiol, 15, 508-517.
Schafer, E. C., Beeler, S., Ramos, H., Morais, M., Monzingo, J., & Algier, K. Developmental effects and spatial hearing in young children with normal-hearing sensitivity. Ear Hear, 33(6), e32-43.
Soli, S. D., & Sullivan, J. A. (1997). Factors affecting children's speech communication in classrooms. Journal of the Acoustical Society of America, 101, S3070.
Stelmachowicz, P. G., Hoover, B. M., Lewis, D. E., Kortekaas, R. W., & Pittman, A. L. (2000). The relation between stimulus context, speech audibility, and perception for normal-hearing and hearing-impaired children. Journal of Speech, Language, and Hearing Research, 43(4), 902-914.
Effects of Noise: Normal Hearing Listeners Dubno, J. R., Dirks, D. D., & Morgan, D. E. (1984). Effects of age and mild hearing loss on speech recognition
in noise. Journal of the Acoustical Society of America, 76(1), 87-96.
Duqesnoy, A. J., & Plomp, R. (1983). The effect of hearing aid on the speech-reception threshold of hearing- impaired listeners in quiet and noise. Journal of the Acoustical Society of America, 73(2166-2173).
Erber, N. P. (1971). Auditory and audiovisual reception of words in low-frequency noise by children with normal hearing and by children with impaired hearing. Journal of Speech and Hearing Research, 14, 496-512.
Finitzo-Hieber, T., & Tillman, T. (1978). Room acoustics effects on monosyllabic word discrimination ability for normal and hearing impaired children. Journal of Speech and Hearing Research, 21, 440-458.
Valente, D. L., Plevinsky, H. M., Franco, J. M., Heinrichs-Graham, E. C., & Lewis, D. E. (2012). Experimental investigation of the effects of the acoustical conditions in a simulated classroom on speech recognition and learning in children. J Acoust Soc Am, 131(1), 232-246.
Nabelek, A., & Pickett, J. M. (1974). Monaural and binaural speech perception through hearing aids under noise and reverberation with normal and hearing-impaired listeners. Journal of Speech and Hearing Research, 17, 724-739.
Nabelek, A., & Pickett, J. M. (1974). Reception of consonants in a classroom as affected by monaural and binaural listening, noise, reverberation, and hearing aids. Journal of the Acoustical Society of America, 56, 628-639.
Effects of Noise: English Language Learners Crandell, C.C. & Smaldino, J.J. (1996). Speech perception in noise by children for whom English is a second
language. American Journal of Audiology, 5, 47-51. Hasegawa, M., Carpenter, P. A., & Just, M. A. (2002). An fMRI study of bilingual sentence comprehension and
workload. Neuroimage, 15(3), 647-660. Nabelek, A.K. & Donahue, A.M. (1984). Perception of consonants in reverberation by native and non-native
listeners. Journal of the Acoustical Society of America, 75, 632-634. Nelson, P., Kohnert, K., Sabur, S., & Shaw, D. (2005). Classroom noise and children learning through a
second language: double jeopardy? Lang Speech Hear Serv Sch, 36(3), 219-229. Takata, Y. & Nabelek, A.K. (1990). English consonant recognition in noise and in reverberation by Japanese
and American listeners. Journal of the Acoustical Society of America, 88, 663-666.
Effects of Noise: Hearing Loss and Hearing Aids Crandell, C. (1992). Noise effects on the speech recognition of children with minimal hearing loss. Ear and
Hearing, l7, 210-217. Crandell, C. & Flannagan, R. (1999). Effects of conductive hearing loss on speech recognition in quiet and
noise. Journal of Educational Audiology, 8, 5-14. Dubno, J. R., Dirks, D. D., & Morgan, D. E. (1984). Effects of age and mild hearing loss on speech recognition
in noise. Journal of the Acoustical Society of America, 76(1), 87-96. Duqesnoy, A. J., & Plomp, R. (1983). The effect of hearing aid on the speech-reception threshold of hearing-
impaired listeners in quiet and noise. Journal of the Acoustical Society of America, 73(2166-2173). Erber, N. P. (1971). Auditory and audiovisual reception of words in low-frequency noise by children with normal
hearing and by children with impaired hearing. Journal of Speech and Hearing Research, 14, 496-512. Finitzo-Hieber, T., & Tillman, T. (1978). Room acoustics effects on monosyllabic word discrimination ability for
normal and hearing impaired children. Journal of Speech and Hearing Research, 21, 440-458. Nabelek, A., & Pickett, J. M. (1974). Monaural and binaural speech perception through hearing aids under noise
and reverberation with normal and hearing-impaired listeners. Journal of Speech and Hearing Research, 17, 724-739.
Nabelek, A., & Pickett, J. M. (1974). Reception of consonants in a classroom as affected by monaural and binaural listening, noise, reverberation, and hearing aids. Journal of the Acoustical Society of America, 56, 628-639.
Effects of Noise: Unilateral Hearing Loss Bess, F.H. & Tharpe, A.M. (1986). Case history data on unilaterally hearing-impaired children. Ear and
Hearing, 7, 14-17. Bess, F.H. & Tharpe, A.M. (1986). An introduction to unilateral sensorineural hearing loss in children. Ear
and Hearing, 7, 3-13.
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hearing loss. Ear and Hearing, 7, 20-26. Culbertson, J.L. & Gilbert, L.E. (1986). Children with unilateral sensorineural hearing loss: cognitive, academic,
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sensorineural hearing loss as a function of amplification, speech stimuli and listening condition. Ear and Hearing, 11, 264-270.
Effects of Noise: Cochlear Implants Fetterman, B. L., & Domico, E. H. (2002). Speech recognition in background noise of cochlear implant patients.
Otolaryngology Head and Neck Surgery, 126(3), 257-263. Garnham, C., O'Driscoll, M., Ramsden, & Saeed, S. (2002). Speech understanding in noise with a Med-El
COMBI 40+ cochlear implant using reduced channel sets. Ear and Hearing, 23(6), 540-552. Gantz, B. J., Tyler, R. S., Rubinstein, J. T., Wolaver, A., Lowder, M. W., Abbas, P., et al. (2002). Binaural
cochlear implants placed during the same operation. Otology & Neurotology, 23(2), 169-180. Hamzavi, J., Franz, P., Baumgartner, W. D., & Gstoettner, W. (2001). Hearing performance in noise of
cochlear implant patients versus severely-profoundly hearing-impaired patients with hearing aids. Audiology, 40(1), 26-31.
Nelson, P. B., Jin, S. H., Carney, A. E., & Nelson, D. A. (2003). Understanding speech in modulated interference: cochlear implant users and normal-hearing listeners. Journal of the Acoustical Society of America, 113(2), 961-968.
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first two years of life. Journal of Speech and Hearing Research, 33, 188-194. Gravel, J.S. & Wallace, I.F. (1992). Listening and language at 4 years of age: effects of early otitis media.
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Zumach, A., Gerrits, E., Chenault, M. N., & Anteunis, L. J. (2009). Otitis media and speech-in-noise recognition in school-aged children. Audiol Neurootol, 14(2), 121-129.
Other Effects: Listening Comprehension Schafer, E. C., Bryant, D., Sanders, K., Baldus, N., Lewis, A., Traber, J., et al. (2013). Listening comprehension
in background noise in children with normal hearing. Journal of Educational Audiology, 19(58-64). Working Memory Osman, H. & Sullivan, J. (2013). Children’s auditory working memory performance in degraded listening
conditions. Journal of Speech, Language, and Hearing Research, 57(4), 1503-1511. Listening Effort (see pubmed.com for more studies on this): Picou, E. M., & Rickets, T. A. (in press). The effect of changing the secondary task in dual-task paradigms for
measuring listening effort. Ear & Hearing. Ross, M. (1992). Room acoustics and speech perception. In M. Ross (ed.), FM Auditory Training Systems:
Characteristics, Selection, and Use, 40-41. Timonium, MD: York Press. Processing Time: Downs, D., & Crum, M. (1978). Processing demands during auditory learning under degraded listening
conditions. Journal of Speech and Hearing Research, 21, 702-714. Teacher Vocal Fatigue Rogerson, J. & Dodd, B. (2005). Is there an effect of dysphonic teachers’ voices on children’s processing of
spoken language? Journal of Voice, 19(1), 47-60.
Roy, N., Merrill, R.M., Thibeault, S., Parsa, R.A., Gray, S.D., & Smith, E.M. Prevalence of voice disorders in
teachers and the general population. Journal of Speech, Language, and Hearing Research, 47(2), 281- 293.
Remote-Microphone Technology Guidelines American Academy of Audiology Clinical Practice Guidelines. (2008, April). Remote Microphone Hearing
Assistance Technologies for Children and Youth from Birth to 21 Years.
FM System Research: Young Children American Speech-Language-Hearing Association. (1991). The use of FM amplification instruments for infants
and preschool children with hearing impairment, ASHA, 33, (suppl.5). 1-2.
Benoit, R. (1989). Home use of FM amplification systems during the early childhood years. Hearing Instruments, 40, 8-10.
Moeller, M.P., Donagy, K.F., Beauchaine, K.L., Lewis, D.E. & Stelmachowicz, P.G. (1996). Longitudinal study of FM system use in non-academic settings: effects on language development. Ear and Hearing, 17, 28- 40.
FM/DM System Research: Normal Hearing Arnold, P. & Canning, D. (1999). Does classroom amplification aid comprehension?. British Journal of
Audiology, 33,171-178. Crandell, C.C., Charlton, M., Kinder, M., and Kreisman, B.M. Effects of portable sound field systems on speech
perception in noise. Journal of Educational Audiology, 9, 8-12. Mendel, L.L., Roberts, R.A., & Walton, J.H. (2003). Speech perception benefits from sound field FM
amplification. American Journal of Audiology, 12(2), 114-124. Picard, M. & Lefrancois, J. (1986). Speech perception through FM auditory trainers in noise and
reverberation. Journal of Rehabilitation Research and Development, 23, 53-62. Rosenberg, G.G., Blake-Rahter, P., Heavner, J., Allen, L., Redmond, B.M., Phillips, J. & Stigers, K. (1999).
Improving classroom acoustics (ICA): a three-year FM sound field classroom amplification study. Journal of Educational Audiology, 7, 8-21.
Schafer, E.C., Bryant, D., Sanders, K., Baldus, N., Algier, K., Lewis, A., Traber, J., Layden, P., Amin, A. (in press). Fitting and verification of frequency modulation (FM) systems on children with normal hearing Journal of the American Academy of Audiology.
Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013). Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System Research: English Language Learners Lederman, N., DeConde Johnson, C., Crandell, C.C. & Smaldino, J.J. (2000). The development and
validation of an "intelligent classroom sound field frequency modulation (FM) system. Journal of Educational Audiology, 8, 37-42.
Nabelek, A.K. & Donahue, A.M. (1986). Comparison of amplification systems in an auditorium. Journal of Acoustical Society of America, 79, 2078-2082.
FM System Research: Auditory Processing Disorder, Autism Spectrum Disorders, ANSD, AD HD, & Other Needs Blake, R., Field, B., Foster, C., Platt, F. & Wertz, P. (1991). Effect of FM auditory trainers on attending
behaviors of learning-disabled children. Language, Speech, and Hearing Services in the Schools, 22, 111-114.
Clarke-Klein, S.M., Roush, J., Davis, K. & Medley, L. (1995). FM amplification for enhancement of conversational discourse skills: case study. Journal of American Academy of Audiology, 6, 230-234.
Flexer, C., Millin, J.P. & Brown, L. (1990). Children with developmental disabilities: the effect of sound field amplification on word identification. Language, Speech and Hearing Services in the Schools, 21, 177- 182.
Flexer, C. & Savage, H. (1993). Use of mild gain amplifier with preschoolers with language delay. Language, Speech, and Hearing Services in the Schools, 24, 151-155.
Friederichs, E. & Friederichs, P. (2005). Electrophysiologic and psycho-acoustic findings following one-year
5 application of personal ear-level FM device in children with attention deficit and suspected central auditory processing disorder, Journal of Educational Audiology, 12, 29-34.
Hornickel, J., Zecker, S. G., Bradlow, A. R., & Kraus, N. Assistive listening devices drive neuroplasticity in
children with dyslexia. Proc Natl Acad Sci U S A, 109(41), 16731-16736. Johnston, K.N., John, A.B., Kreisman, N.V., Hall, J.W. 3rd, Crandell, C.C. (2009). Multiple benefits of personal
FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48(6), 371-383.
Rance, G., Corben, L. A., Du Bourg, E., King, A., & Delatycki, M. B. (2010). Successful treatment of auditory perceptual disorder in individuals with Friedreich ataxia. Neuroscience, 171(2), 552-555.
Rance, G., Saunders, K., Carew, P., Johansson, M., & Tan, J. (2014). The use of listening devices to ameliorate auditory deficit in children with autism. J Pediatr, 164(2), 352-357.
Schafer, E.C., Bryant, D., Sanders, K., Baldus, N., Algier, K., Lewis, A., Traber, J., Layden, P., Amin, A. (in press). Fitting and verification of frequency modulation (FM) systems on children with normal hearing Journal of the American Academy of Audiology.
Schafer, E. C., Mathews, L., Mehta, S., Hill, M., Munoz, A., Bishop, R., & Maloney, M. (2012). Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): An initial investigation. Journal of Communication Disorders, 46, 40-52.
Schafer, E. C., Traber, J., Layden, P., Amin, A., Sanders, K., Bryant, D., & Baldus, N. (in press). Use of wireless technology for children with APD, ADHD, and language disorders. Seminars in Hearing.
Smith, D.E., McConnell, J.V., Walter, T.L. & Miller, S.D. (1985). Effect of using an auditory trainer on the attentional, language, and social behaviors of autistic children. Journal of Autism and Developmental Disorders, 15, 285-302.
Stach, B.A., Loiselle, L.H., Jerger, J.F., Mintz, S.L. & Taylor, C.D. (1987). Clinical experience with personal FM assistive listening devices. The Hearing Journal, May, 24-30.
FM/DM System Research: Minimal and Mild Hearing Loss Ross, M. & Giolas, T.G. (1971). Effect of three classroom listening conditions on speech intelligibility.
American Annals of the Deaf, 116, 580-584. Sariff, L.S. (1981). An innovative use of free field amplification in regular classrooms. In R. Roeser & M.
Downs (Eds.) Auditory Disorders in School Children (p. 263-272). New York: Thieme Stratton, Inc. Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013).
Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System Research: Unilateral Hearing Loss Bess, F.H., Klee, T. & Culbertson, J.L. (1986). Identification, assessment, and management of children with
hearing loss. Ear and Hearing, 7, 43-51. Updike, C.D. (1994). Comparison of FM auditory trainers, CROS aids, and personal amplification in
unilaterally hearing-impaired children. Journal of American Academy of Audiology, 5, 204-209.
FM System & Digital Transmission Research: Moderate to Profound Hearing Loss and Hearing Aids Anderson, K.L. & Goldstein, H. (2004). Speech perception benefits of FM and infrared devices to children with
hearing aids in a typical classroom. Journal of Speech, Language, and Hearing Services in the Schools, 35(2), 169-184.
Anderson, K. L., Goldstein, H., Colodzin, L., & Iglehart, F. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12, 14-28.
Boothroyd, A. & Iglehart, F. (1998). Experiments with classroom amplification. Ear and Hearing, 19, 207-217. Flynn, T.S. & Gregory, M. (2005). The FM advantage in the real classroom. Journal of Educational Audiology,
12, 35-42. Lewis, M. S., Crandell, C. C., Valente, M., & Horn, J. E. (2004). Speech perception in noise: directional
microphones versus frequency modulation (FM) systems. Journal of the American Academy of Audiology, 15, 426-439.
Nabelek, A.K. & Donahue, A.M. (1986). Comparison of amplification systems in an auditorium. Journal of Acoustical Society of America, 79, 2078-2082.
Nabelek, A.K., Donahue, A.M. & Letowski, T.R. (1986). Comparison of amplification systems in a classroom.
Journal of Rehabilitation Research and Development, 23, 41-52.
Noe, C.M., Davidson, S.A. & Mishler, P.J. (1997). The use of large group assistive listening devices with and without hearing aids in an adult classroom setting. American Journal of Audiology, 6, 48-63.
Pittman, A.L., Lewis, D.E., Hoover, B.M. & Stelmachowicz, P.G. (1999). Recognition performance for four combinations of FM system and hearing aid microphone signals in adverse listening conditions. Ear and Hearing, 20, 279-289.
Ross, M., Giolas, T. & Carver, P. (1973). Effect of classroom listening conditions of speech intelligibility. Language, Speech, and Hearing Services in the Schools, 4, 72-76.
Schafer, E. C., Sanders, K., Bryant, D., Keeney, K., & Baldus, N. (2013). Effects of Voice Priority in FM systems for children with hearing aids. Journal of Educational Audiology, 19, 12-24.
Toe, D. (1999). Impact of FM aid use on the classroom behavior of profoundly deaf secondary students. Seminars in Hearing, 20, 223-234.
Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013). Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System/Digital Transmission Research: Cochlear Implants Aaron, R., Sonneveldt, V., Arcaroli, J., & Holstad, B. (2003, November). Optimizing microphone sensitivity
settings of pediatric Nucleus 24 cochlear implant patients using Phonak MicroLink CI+ FM system. Poster presented at ACCESS: Achieving Clear Communication Employing Sound Solutions - Proceedings of the First International Conference, Chicago, IL.
Acoustical Society of America, (n.d.). Position on the Use of Sound Amplification in the Classroom. Retrieved October 12, 2006 from http://asa.aip.org
Anderson, K. L., Goldstein, H., Colodzin, L., & Iglehart, F. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12, 14-28.
Catlett, D. & Brown, C.J. (2003, November). Optimal audio mix settings for pediatric Clarion cochlear implant patient using a Phonak MicroLink CI-S FM system. Poster presented at ACCESS: Achieving Clear Communication Employing Sound Solutions - Proceedings of the First International Conference, Chicago, IL.
Crandell, C. C., Holmes, A. E., Flexer, C., & Payne, M. (1998). Effects of soundfield FM amplification on the speech recognition of listeners with cochlear implants. Journal of Educational Audiology, 6, 21-27.
Davies, M. G., Yellon, L., & Purdy, S. C. (2001). Speech-in-noise perception of children using cochlear implants and FM systems. Australian and New Zealand Journal of Audiology, 23, 52-62.
Iglehart, F. (2004). Speech perception by students with cochlear implants using sound-field systems in classrooms. American Journal of Audiology, 13, 62-72.
Schafer, E. C., Huynh, C., Romine, D., Jimenez, R. (2012). Speech recognition in noise and subjective perceptions of neckloop FM receivers with cochlear implants. American Journal of Audiology, 22(1), 53-64.
Schafer, E.C. & Kleineck, M.P. (2009). Improvements in speech-recognition performance using cochlear implants and three types of FM systems: A meta-analytic approach. Journal of Educational Audiology, 15, 4-14
Schafer, E. C., Musgrave, E., Momin, S., Sandrock, C., & Romine, D. (2013). A proposed electroacoustic test protocol for personal FM receivers coupled to cochlear implant sound processors. Journal of the American Academy of Audiology, 24(10), 941-954.
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