Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Auditory processing disorder wikipedia , lookup
Telecommunications relay service wikipedia , lookup
Speech perception wikipedia , lookup
Olivocochlear system wikipedia , lookup
Auditory system wikipedia , lookup
Soundscape ecology wikipedia , lookup
Hearing loss wikipedia , lookup
Hearing aid wikipedia , lookup
Noise-induced hearing loss wikipedia , lookup
Sensorineural hearing loss wikipedia , lookup
Audiology and hearing health professionals in developed and developing countries wikipedia , lookup
Hearing Aid Technologies Perry C. Hanavan, Au.D. HA Developments • Nanotechnology providing water resistant hearing aids HA Directional Microphones • Most HA have directional microphones • Proven beneficial technology • Data support use of directional hearing aids in some noisy school environments • Suggest use of directional mode should be limited to situations in which all talkers of interest are located in front of the student. (Ricketts & Galster 2007) Digital Feedback Reduction (DFR) • Technology has dramatically improved the reduction of acoustic feedback • Helps increase HA gain without “whistle” Digital Noise Reduction (DNR) • Significant increase in “ease of listening” with DNR (Bentler, Wu, Kettel & Hurtig 2008) • Spectral changes from noise suppression ALWAYS improve speech. – Therefore, we tentatively recommend DNR systems be routinely enabled for children of all ages…just like adults. (Dillon, Ching & Golding 2008) • DNR does NOT have negative effect on perception of nonsense syllables, words or sentences – Stelmachowicz et al 2010) Extended HF Frequency Bandwidth Stelmochowitz found bandwidth beyond 5 kHz (Stelmachowicz et al 2004) (Stelmachowicz 2010) Pittman found that children with HL require 3X the exposure to learn each new word and concepts due to reduced acoustic bandwidth caused by HL (Pittman 2008) • Most modern HA have bandwidth from 6 to 10 plus kHz • However telecoil use may only amplify to 4 kHz • Thus FM technology for speech and language develop may be better than telecoil-induction loop technology • However telecoil option remains critically import for: – Phone – More public facilities (churches, theaters, sports arenas, etc.) are getting looped (Get in the Loop initiative) AAA, HLAA, Sertoma 10,000 kHz Bandwidth Bandwidth & Phoneme ID in Students CAM2 • CAM2 software prescribes the amount of amplification of high-frequency sounds above 6000 Hz-required to restore audibility • Most HA software only prescribes amount of amplification to 6000 Hz • Higher frequencies help distinguish sounds such as “sh”, “ch” and “f” • Listening situations, such as in a room where several people are speaking at once—higher frequencies make it much easier to understand the person you want to listen/hear. • Higher frequencies can improve sound localization Get in the Hearing Loop • American Academy of Audiology • Hearing Loss Association of America • Sertoma Foundation grants available for looping • 2nd Annual Loop Conference held in Washington, DC, June 19-20, 2011 Loops &Telecoils-What Is It? Telecoil--Advantages • Universal • Convenient--no additional apparatus, special equipment , streamers, remotes, etc. • No battery drain • No pairing – universal signal worldwide/standardized • Most HA have T/TM/M options for classroom use • Inexpensive (little or no cost to parents) • No time delay from microphone to HA • Can accommodate hundreds of listeners in the loop • Most HA and all CI have telecoil • Used with all landline phones, many cell phones with T3/T4 ratings HA with Telecoils • • • • • • 7 of 28 CIC 8 of 10 ITC 20 of 42 RIC/RITE 24 of 35 “Slim- & Thin-Tube” HA 38 of 38 ITE 29 of 30 BTE (Oct 2010) (May/Jun 2009) (Jan 2010) (Feb 2010) (Sep 2010) (Jan 2009) Telecoil Mode Options • Paper investigated the preference of classroom assistive listening devices (ALDs) based on induction loop systems. Comparing the assessments of T-mode (telecoil mode) and M-mode (microphone mode) • M-mode and T-mode give two advantages to choose from: better audibility or better awareness. Less effort is required to hear using T-mode. M-mode gives a better recognition of the environment around students and the possibility of hearing other students not using an ALD • Students with severe hearing loss benefit more using T-mode compared to the better hearing students • Loss of bilateral advantage using an ALD results in a decrease in localization and segregation of sounds • Students use different choices between M-mode and T-mode are made depending on the listening situation • Students noted they solve the choice between audibility and awareness by using one hearing aid in M-mode and the other in T-mode, or by using one or both HA in a M+Tmode • Pedagogical paradigm changes the auditory scenario and consequently also the quality specifications of ALDs. Evaluation of these systems in terms both audibility and awareness requires an approach where several attributes to hearing and disability are assessed. A questionnaire in the dimensions of speech hearing, spatial hearing, and other qualities is a promising tool for this evaluation. Open-ended questions as well as additional notes add to the understanding of the result. (Odelius & Johansson 2010) Telecoil Available for CI Telecoil—Frequency Response • Currently, frequency response characteristics limited in low and high frequencies (decreased bandwidth) Telecoil—Orientation • Telecoil situated perpendicular to installed loop wire or telephone • Incorrect orientation of telecoil results in attenuated signal • Head orientation and tilting head may result in poor signal reception • Placement not ideal for landline phone Orientation & Frequency Response CI Telecoil Orientation • • • • MED-EL Opus 2: Advanced Bionics Harmony: Cochlear Nucleus 5: Cochlear Nucleus Freedom: Vertical 45 deg angle Horizontal Vertical Calibrated to International Standard? • Field Strength Meter assesses electromagnetic interference and is used to calibrate loop installations • Loop induction installations need to be electromagnetic free and calibrated for uniform signal strength Looping Options Beyond the Classroom • School – Auditorium – School secretary office – Librarian desk • Community – – – – – – Church Grocery store checkout Library checkout Transportation Ticket booths Drive-up windows Frequency Lowering HAs • Studies show that frequency lowering aids improve speech recognition with severe to profound high frequency SNHL – – – – – Simpson et al, 2005 Glista et al, 2009 Nyffeler 2008 Wolfe et al, 2010 Wolfe et al 2011 • “Non-linear frequency compression algorithm is the most important development in pediatric amplification in over a decade.” (Richard Seewald) Non-Linear Frequency Lowering High Frequency Loss • Phonak (Naida) and Widex (Inteo) hearing aids • Frequency lowering (frequency transposition) hearing aids for persons with un-aidable high frequency hearing loss. • Creates new acoustic cues for hearing /s/ sound important in plurals (e.g., books, it’s) • Speech recognition cues improve over time from initial fit • Students function better in classroom and in various communication situations (Glista et al 2009) High Frequency Lowering Compression • NLFC improves speech recognition and speech production for children with moderate to profound hearing loss • NLFC should be considered for all children moderate to profound high-frequency hearing loss • Verification is essential for success of these children • Kids with essentially no hearing above 1500 Hz should be referred for CI evaluation (Wolfe et al 2010) Hearing Tests for High Frequency • • • • University of Western Ontario Plurals Test Phonak Logatome Test BKB-SIN Recorded /sh/ and /s/, University Western Ontario UWO Plural Test • • • • Recorded test Open set test Female speaker 15 words familiar to school-aged children in both singular and plural form (/s/ or /z/ in final position) – – – – Skunk/skunks Book/books Fly/flies Crayon/crayons • Presented at 50 dB SPL from loudspeaker 1 meter directly in front of child UWO /s/--/sh/ Video Game Phonak Logatom Test • Adaptive, computer controlled test • Developed by Phonak • Female speaker: “My name is…” – – – – – – – ASA ASA (filter to 6 kHz) ADA AKA AFA ASHA ATA • Software track level in dB SPL that corresponds to 50% correct performance BKB-SIN BKB-SIN • 10 sentences presented twice • Increasing noise with each sentence • Indicates ability to understand speech in noise • Helps audiologist select appropriate hearing aid and hearing assistance technologies RITA, RIC & MARIC • RITA Receiver in the aid • RIC Receiver in canal • MARIC Mike and receiver in canal HA Streamers • Bluetooth streamers/Remote controls • System that allows HA to connect with virtually any audio device – cell phones, IPods, PDAs, TV, etc. • Short distance wireless communication • Can be worn around neck or held in hand • Battery drain increase • No standardization between various HA manufacturers Personal FM • FM/Radio Frequency Devices • The benefits of FM systems are well documented and include: – Eliminating negative effects of noise and reverberation on speech perception, and – maintaining constant speech input regardless of distance between the speaker and listener • (Boothroyd, 2004; Chisholm et al, 2007). – FM use specifically with cochlear implants, the overwhelming majority of these studies pertain to children in educational setting (Davies et al, 2001; Schafer & Thibodeau, 2006). – Research with children has shown significant improvement in speech understanding in noise when an FM system is used in conjunction with a cochlear implant (Davies et al, 2001; Schafer & Thibodeau, 2006). Personal Adaptive (Dynamic) FM • On the objective measures, Phonak adaptive FM processing resulted in significantly better speech recognition in noise compared to fixed FM processing for 68- and 73dBA noise levels. • On the subjective measures, all individuals preferred adaptive over fixed processing for half of the activities. • Adaptive processing was also preferred by most (8–9) individuals for the remaining 4 activities. (Thibodeau 2010) Phonak FM Recievers IDEA 2004 & CI • (2) Nothing in paragraph (b)(1) of this section-- (i) Limits the right of a child with a surgically implanted device (e.g., cochlear implant) to receive related services (as listed in paragraph (a) of this section) that are determined by the IEP Team to be necessary for the child to receive FAPE. • (ii) Limits the responsibility of a public agency to appropriately monitor and maintain medical devices that are needed to maintain the health and safety of the child, including breathing, nutrition, or operation of other bodily functions, while the child is transported to and from school or is at school; or • (iii) Prevents the routine checking of an external component of a surgically-implanted device to make sure it is functioning properly, as required in Sec. 300.113(b). Binaural CI Advantages Infrared Light Pulses Could Make Better Bionics for Deafness • Optical signals could be used instead of electrical signals to stimulate cells in the body CIs and FM Systems • Remote Microphone • Bilateral Wireless Systems • Includes HA for non-CI ear if aidable with remote microphone • Meta-analysis: – Classroom amplification systems (3% improvement — not significant improvement) – Desktop amplification systems (17% improvement— significant improvement) – Personal FM systems—38% improvement—significant improvement over the other two) (Schafer & Wolfe 2010) Note FM component on CI MLxi Universal Receiver • Phonak’s universal Dynamic FM receiver. • When attached to the user’s hearing instrument, MLxi provides all the benefits of Phonak’s Dynamic FM technology. • Dynamic Speech Extractor - an algorithm that improves signal-to-noise ratios by up to 15 dB and speech scores in noise by dozens of percentage points. • Fully automated product; the user just needs to switch it on; child-proof and backwards compatible • Compatible with virtually all BTEs and cochlear implants • Compatible with all Phonak transmitters CI Performance in Noise w/o FM CI plus Personal FM • Personal FM system have been used to assist HA users for improving hearing in difficult listening environments • Personal FM systems are the most effective means to assist CI users to hear better in noise (Wolfe & Schafer, 2008; Wolfe et al, 2009) • Audiologists have been reluctant to consider personal FM because: – Multiple parameters that must be adjusted with some FM systems including: • Ratio of the FM input to the processor mic input (i.e., Mixing Ratio) • Gain of the FM receiver • Input Dynamic Range (IDR) CIs and FM Systems • Meta-analysis – HA or CI on 2nd ear (bilateral)—1.1 dB improvement on average – CI with FM on one side—13.3 dB improvement – 2nd CI or HA on second side— – Binaural FM—best signal option (Dynamic FM will improve listening in noise, social situations, restaurants, etc.) • Recommendation: – If family/school can afford, best option is binaural Dynamic FM with binaural CI or CI and HA – Next best option is Dynamic FM on 1st cochlear implant side (Wolfe 2010) Dynamic FM • Advanced Bionics Cochlear implants improve dramatically with Phonak’s Dynamic FM and ASC activated in noise • Cochlear with ASC activated improves in noise • No difference between Advanced Bionics and Cochlear when ASC activated • Even with the FM off, ASC provided the best performance in noise! • ADRO plus ASC program activation provides best option for listening in noise • No data on MEDEL (Wolfe 2010) Dynamic FM (Phonak) Dynamic SoundField Take Home Message • Consider Phonak’s Dynamic FM for all children • Know the parameters for optimizing performance of the CI and personal FM – Work with audiologist – Refer audiologists to Jace Wolfe, audiologist at Hearts for Hearing in Oklahoma, JAAA 2008, 2009, 2010, 2011, Audiology Online #18191 • Consider simultaneous use of Phonak Dynamic FM Soundfield classroom amplification with personal FM + CI Neckloop Receivers • Not recommended by AAA for HA or CI for children • Head movement, head orientation, and telecoil orientation in HA affect signal quality • However, Oticon Arc neckloop shows improvement and is helpful • Nucleus 5 – Use manual t-coil, not audio t-coil to see benefit Auditory Neuropathy/Dyssynchrony Classroom Soundfield Amplification • Benefits – – – – – – – Children with temporary HL Improve S/N ratio Reduce teacher vocal fatigue Children with APD and ADHD (hearing in noise) Improves academic achievement and behavior Increased word and sentence recognition Improves literacy growth • Disadvantages – – – – – Do not use in place of Dynamic FM for HA and CI users Will not compensate for poor classroom acoustics Poor installation/systems may not be helpful Poor microphone management by teacher not helpful Unclear speech by teacher not helpful Classroom Amplification Systems Self install systems: • LightSpeed REDCAT • Phonak Dynamic SoundField Phonak Dynamic Soundfield • Inspiro Dynamic microphone • Compatible with Dynamic FM receivers, BAHA, other HA • Software updatable • Remote computer access • Monitors classroom environment and adjusts volume and frequency • Provides optima S/N ratio • Connects to Smartboard Dynamic SoundField BAHA (unisensory conductive loss) Bone Anchored Hearing Aid: • Surgically embedded titanium "post" into skull with a small abutment • A sound processor sits on abutment • The implant vibrates the skull and stimulates the cochlea via bone conduction bypassing outer & middle ear • Can utilize FM receiver • Treatment for: – Conductive loss – Mixed hearing losses – Unilateral sensorineural hearing loss – Chronic ear infections – Congenital external auditory canal atresia Alpha 1 (M) Bone Conduction Hearing System • • • • • Sophono, Inc. Surgical procedure video Abutment free Up to a 45 dB HL conductive loss Available with telecoil & FM interface Envoy Implant • Middle Ear Implant • Envoy Medical Envoy ESTEEM Implant Criteria • At least 18 years of age • Stable, moderate-to-severe, bilateral sensorineural hearing loss (Range = 40 dB to 70 dB, defined as the average of pure tone thresholds at .5, 1, 2 KHz) • Speech recognition test score (WRS) greater than, or equal to, 40% in the worst hearing ear • Normal tympanic membrane & middle ear anatomy • Normally functioning Eustachian tubes • Worn properly fit hearing aids for at least one month • No history of immune compromise or chronic staphylococcal skin infections • Room in their mastoid cavity to accept the ESTEEM components • Able to undergo a 3-4 hours general anesthetic VIBRANT SOUNDBRIDGE Middle Ear Implant System (Medel) Placement Options: Ossicular Round Window Smartphones ($1.99) App • Variety of apps that may be beneficial to students • Music ID, lyrics • Phone IP Relay, etc. • Google Voice … can listen or read text • Many have M4 and T4 ratings to interface with HA or CI telecoil Assessment Tools • A variety of assessment tools that identify and support the need for assistive technologies include: – Observation of student functioning in classroom and other environments – Questionnaires and checklists for teachers, parents, students and peers (where age appropriate) – Functional listening evaluation which attempts to replicate how the student functions with listening in the classroom – Diagnostic evaluations to assess clinically how students hear in noise Questionnaire/Inventory/Survey • Adolescent SAC / SOAC Questionnaire • SSQ • Listening Inventories For Educators (L.I.F.E.) • Children’s Auditory Performance Scale (CHAPS) • SIFTER • CHILD • ELF Go to www.hear2learn.com for additional surveys PARC • Placement And Readiness Checklists • PARC is a set of placement and readiness checklists designed to assist IEP teams, including students, teachers, specialists, parents and school administrators, when making decisions about programming and placement for individuals who are deaf and hard of hearing (DHH). • http://www.handsandvoices.org/pdf/PARC_2011.pdf Ling 6 Sound Check • Evaluate student at variety of distances to determine maximum distance Ling sounds heard • Ling 6 Sound Check Chart • Ling 6 Behavioral Daily Checklist • Ling 6 Recording Chart Functional Listening Evaluation • Determine how listening abilities are affected by noise, distance, and visual input in an individual’s natural listening environment • Designed to simulate listening ability in situations that represent actual listening conditions in student’s classroom– not sound booth • Administration of the evaluation, the student’s teachers, parents, and others gain understanding affects of adverse listening conditions encountered by the student. • The evaluation results are also useful in justifying accommodations, such as assistive listening devices, sign language or oral interpreters, notetakers, captioning, special seating, and room acoustic modifications. • Functional Listening Evaluation (Ying , 1990), (Ross, Bracken & Maxon, 1992) FLE (cont.) • Test administration takes approximately 30 minutes, including set up, with sentences and 20 minutes with words. 1. Auditory-Visual Close Quiet 2. Auditory Close Quiet 3. Auditory-Visual Close Noise 4. Auditory Close Noise 5. Auditory-Visual Distant Noise 6. Auditory Distant Noise 7. Auditory Distant Quiet 8. Auditory-Visual Distant Quiet FLE (cont.) FLE (Example) BKB SIN Test • 10 sentences presented twice • Increasing noise with each sentence • SNR loss is the increased S/N ratio required by a listener to understand speech in noise • BKB-SIN Test scores are reported in SNR • Age normative data • Allows audiologist to recommend appropriate assistive technology (e.g., omni-directional microphones, directional microphones, array microphones, FM systems, etc.) for students with HL to function in noisy situations • Rich in semantic context, thus individuals with HL may be using top-down processing to improve their performance—does not tax bottom-up processing (Niquette et al 2003) Words in Noise (WIN) Test • Uses monosyllabic words in seven signal-to-noise ratios of multitalker babble to evaluate the ability of individuals to understand speech in background noise • Developed with the Northwestern University Auditory Test No. 6 (NU-6) monosyllabic words • Female speaker • Age normative data • Test scores are reported in SNR • Can test down to age 6 • WIN is sensitive to bottom-up processing (Wilson et al 2010) Practical Hearing Aid Skill Tasks (PHAST) • Can student and parents pass the PHAST? • Perhaps modify this for use with assistive devices? (Desjardins & Doherty 2009) HA Functioning in Preschool Setting • Over half of the HA tested were determined to have at least one or more problems • Problems detected using listening and visual checks • Failure rates based on basic listening and visual checks among the HA examined in this study demonstrate no improvement over those reported in the 1970''s • The results re-emphasize the need for a national dialogue on this topic (Burkhalter et al 2011) ReSound (iOS, Android) free Bibliography Anderson KL, Goldstein H, Colodzin L, Inglehart 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. J Educ Audiol, 12, 14–28. Anderson K & Smaldino J. (1999). Listening Inventories for Education: A classroom measurement tool. Hear Journal, 52(10), 74–76. Bentler R, Wu, Kettel & Hurtig. (2008). Digital noise reduction: outcomes from laboratory and field studies. International Journal of Audiology Vol 47): (Boothroyd, 2004; Burkhalter, C. L., Blalock, L., Herring, H., & Skaar, D. (2011). Hearing aid functioning in the preschool setting: Stepping back in time?. International Journal of Pediatric Otorhinolaryngology, 75(6), 801-804. doi:10.1016/j.ijporl.2011.03.011 Ching TYC, Hill M, & Dillon H. (2008). Effect of variations in hearing-aid frequency response on real-life functional performance of children with severe or profound hearing loss. Int J Audiol, 47(8), 461–475 Ching TYC & Hill M. (2007). The Parents’ evaluation of aural/oral performance of children (PEACH) scale: Normative data. J Am Acad Audiol, 18(3), 221–237. Chisholm et al, 2007. Ching TYC, Hill M and Dillon H. (2008). Effect of variations in hearing-aid frequency response on real-life functional performance of children with severe or profound hearing loss. Int J Audiol, 47(8), 461–475. Bibliography Ching TYC, Hill M, Dillon H, van Wanrooy E. (2004). Fitting and evaluating a hearing aid for recipients of unilateral cochlear implants: the NAL approach. Part 1. Hearing Review, 11(7), 14–22, 58. Ching TYC, O’Brien A, Dillon H, Chalupper J, Hartley L. (2009). Directional effects on infants and young children in real life: Implications for amplification. J Speech Lang Hear Res, 52, 1241– 1254. (Dillon H, Ching T & Golding M. (2008). in PEDIATRIC AUDIOLGY Davies et al, 2001 Desjardins JL & Doherty KA. (2009). Correct use of hearing aids. American Journal of Audiology; 18, 69–76. Niquette, P, Arcaroli, J, Revit, L, Parkinson, A, Staller, S, Skinner, M, & Killion, M. (2003, March). Development of the BKB-SIN Test. Paper presented at the annual meeting of the American Auditory Society, Scottsdale, AZ. Odelius J and Johansson Ö. (2010). Self-assessment of classroom assistive listening devices. International Journal of Audiology; 49, 7: 508–517. Pittman, AL. (2008). Short-term word-learning rate in children with normal hearing and children with hearing loss in limited and extended high-frequency bandwidths. J Speech Lang Hear Res 51: 785-797. Ricketts T and Galster J. (2007). Directional benefit in simulated classroom environments. American Journal of Audiology;16,130–144. Bibliography Ross, M., Brackett, D. & Maxon, A. (1991). Communication Assessment. In Assessment and management of mainstreamed hearing-impaired children (pp 113.127). Austin , Tx : Pro-Ed. Schafer EC & Thibodeau LM. (2006). Speech recognition in noise in children with cochlear implants while listening in bilateral, bimodal, and FM-system arrangements. Am J Audiol, 15, 114–126. Sheehan JP, Griffiths SK. (2010). vA survey of awareness of ALDs and hearing difficulty in places of worship. Hearing Review;17(2):18-19. Stelmachowicz PG et al (2004) Arch Otolaryngol Head Neck Surg.; 130:556-562 Stelmachowicz PG et al (2010). Effects of digital noise reduction on speech perception for children with hearing loss. Ear and Hearing, Vol 31, No 3. . Stelmachowicz, P, Lewis, D, Hoover, B, Nishi, K, McCreery, R, & Woods, W. (2010). Effects of digital noise reduction on speech perception for children with hearing loss. Ear and Hearing. 31, 345-355 Stelmachowicz, P. G. (2010). Extending hearing aid bandwidth: Effects, challenges, and solutions. Widex Press, 24, 1-4. Thibodeau, L. (2010). Benefits of adaptive FM systems on speech recognition in noise for listeners who use hearing aids. American Journal of Audiology 19: 36-45. Wilson, RH, Farmer, NM, Gandhi, A, Shelburne, E, Weaver, J. (2010). Normative data for the words-in-noise test for 6- to 12-year-old children. J Speech Lang Hear Res 53: 1111-1121. Ying E. (1990). Speech and Language Assessment: Communication Evaluation. In M. Ross (Ed.), Hearing- impaired children in the mainstream (pp 45.60). Parkton , MD : York Press.