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Early vs. Late Onset Hearing Loss: How Children Differ from Adults Andrea Pittman, PhD Arizona State University Heterogeneity of Children with Hearing Loss Chronological age Age at onset Age at identification Age at amplification Age at intervention Duration of intervention Quality of intervention Degree of hearing loss Configuration of hearing loss Etiology of hearing loss Type of amplification Consistency of hearing aid use Use of supplemental devices (FM system) Other handicapping conditions Parental involvement Socioeconomic status Mono vs. Bilingual language learner IQ The big difference between adults and children… Adults use their residual hearing to continue to communicate… children use their residual hearing to learn to communicate. HI Children vs. HI Adults Audiologic differences Configuration of hearing loss Perceptual differences Perceptual weighting functions Perceptual coherence Perceptual management differences Multitasking Hearing Loss in Children and Adults: Audiometric Configuration, Asymmetry, and Progression Pittman & Stelmachowicz (2003) Ear & Hearing Methods Groups 6-year-old children 60-year-old adults Audiogram Selection Criteria Right ear thresholds Pure-tone thresholds at octave frequencies (250-8000 Hz) At least one threshold > 30 dB HL Confirmed sensorineural hearing losses (air-bone gaps < 10 dB) Methods Core Set of Audiograms 227 children 248 adults Analyses Configuration Asymmetry Progression All Audiograms Children (n=227) Adults (n=248) Frequency (Hz) Hearing Level (dB HL) 250 Frequency (Hz) 500 1000 2000 4000 8000 250 -20 -20 0 0 20 20 40 40 60 60 80 80 100 100 120 120 140 140 500 1000 2000 4000 8000 All Audiograms Children (n=227) Adults (n=248) Frequency (Hz) Hearing Level (dB HL) 250 Frequency (Hz) 500 1000 2000 4000 8000 250 -20 -20 0 0 20 20 40 40 60 60 80 80 100 100 120 120 140 140 500 1000 2000 4000 8000 Audiometric Classification Frequency (Hz) Hearing Level (dB) 250 250 500 1000 2000 4000 8000 250 500 1000 2000 4000 8000 0 0 0 20 20 20 40 40 40 60 60 60 80 80 80 Sloping Rising 250 500 1000 2000 4000 8000 250 500 1000 2000 4000 8000 250 0 0 0 20 20 20 40 40 40 60 60 60 80 80 80 U-Shaped 100 Tent-Shaped 100 Flat 100 100 100 500 1000 2000 4000 8000 500 1000 2000 4000 8000 Other 100 Results - Distribution Percent of Audiograms 50 Adults Children 40 30 20 10 0 Sloping U-Shaped TentShaped Category Flat Other Rising Results - Configuration Adults Children Frequency (Hz) Hearing Level (dB) 250 250 500 1000 2000 4000 8000 250 500 1000 2000 4000 8000 0 0 0 20 20 20 40 40 40 60 60 60 80 80 80 Sloping Rising 250 500 1000 2000 4000 8000 250 500 1000 2000 4000 8000 250 0 0 0 20 20 20 40 40 40 60 60 60 80 80 80 U-Shaped 100 Tent-Shaped 100 Flat 100 100 100 500 1000 2000 4000 8000 500 1000 2000 4000 8000 Other 100 All Audiograms Children (n=227) Adults (n=248) Frequency (Hz) Hearing Level (dB HL) 250 Frequency (Hz) 500 1000 2000 4000 8000 250 -20 -20 0 0 20 20 40 40 60 60 80 80 100 100 120 120 140 140 500 1000 2000 4000 8000 Sloping Losses Adults 73% Children % OF AUDIOGRAMS 50 Children 40 30 20 10 0 33% Adults Sloping U-Shaped TentShaped Flat Other Rising Summary The children had a wider variety of audiometric configurations. The hearing losses in adults were typically sloping in configuration accounting for 3-in-4 audiograms. The same sloping configurations occurred in only 1-in-3 of the children. Influence of Hearing loss on the Perceptual Strategies of Children and Adults Pittman, Stelmachowicz, Lewis & Hoover (2002) Jr of Sp Lang & Hear Res Pittman & Stelmachowicz (2000) Jr of Sp Lang & Hear Res Subjects Frequency (Hz) 250 -20 Normal Hearing 10 Adults 20 Children (mean = 6:8 yrs, 5-7) Hearing Impaired 10 Adults (mean = 59 yrs, 49-66) 10 Children (mean = 7:8 yrs, 5-10) 0 Hearing Level (dB HL) (mean = 28 yrs, 20-44) 20 40 60 80 100 120 500 1000 2000 4000 8000 Stimuli 4 words Sack Sock CVC 2 vowels 2 fricatives 2 conditions w/ transition w/o transition Shack Shock Stimuli 4 words Sack Sock CVC 2 vowels 2 fricatives 2 conditions w/ transition w/o transition Shack Shock Stimuli 4 words w/ transition CVC 2 vowels 2 fricatives 2 conditions w/ transition w/o transition w/o transition Presentation 5 levels 80 Level (dB SPL) vowel 60 40 20 0 -20 500 2000 Frequency (Hz) 8000 Performance 80 100 60 80 % Correct Level (dB SPL) Short-Term Audibility 40 20 60 40 0 20 -20 0 500 2000 Frequency (Hz) 8000 0 0.2 0.4 0.6 0.8 Short-Term Audibility 1 Performance 100 80 60 40 20 0 0 0.2 0.4 0.6 0.8 Short-Term Audibility 1 Results Normal-Hearing Adults Performance 100 80 60 40 w/ transition w/o transition 20 0 0 0.2 0.4 0.6 0.8 Short-Term Audibility 1 Normal-Hearing Adults Normal-Hearing Children 80 80 Performance 100 Performance 100 60 40 60 40 20 20 0 0 0 0.2 0.4 0.6 0.8 1 0 Short-Term Audibility 80 Performance 80 Performance 100 60 40 0 0 0.6 0.8 1 40 20 0.4 0.8 60 20 Short-Term Audibility 0.6 Hearing-Impaired Children 100 0.2 0.4 Short-Term Audibility Hearing-Impaired Adults 0 0.2 1 0 0.2 0.4 0.6 0.8 Short-Term Audibility 1 HIA 100 NHC HIC 80 Performance NHA HIC 60 40 20 0 0 0.2 0.4 0.6 0.8 Short-Term Audibility 1 Conclusions Relative to the normal-hearing adults… The normal-hearing children demonstrated typical development of speech perception. The hearing-impaired adults demonstrated the typical effects of hearing loss for the perception of soft speech. The hearing-impaired children demonstrated a combination of speech perception development and hearing loss effects. The whole was greater than the sum of the parts. Perceptual coherence in listeners with childhood hearing losses, adultonset hearing losses, and normal hearing Pittman (January, 2008) Jr Acoust Society Amer Perceptual Coherence Subjects 10 Normal hearing (mean age 25 years) 10 Acquired hearing losses (mean age 64 years) 10 Congenital hearing losses (mean age 35 years) Frequency (Hz Hearing Level (dB SPL) 0.25 0.5 1 2 4 0.25 0.5 8 -10 10 10 10 30 30 50 50 70 70 90 90 110 10 130 Acquired 30 1 Congenital 2 4 8 Stimuli Speech 9 naturally produced words (sonorants) Produced by a male, female and child. Paradigm Yes/No Yes trial F2 in the word No trial F2 not in the word Results Conclusions Perceptual coherence was not affected by hearing loss. Perceptual coherence was affected by the presence of hearing loss early in life. Practical consequences of poor perceptual coherence are largely unknown. Results suggest long-term effects of hearing loss. Effect of minimal hearing loss on children’s ability to multitask in quiet and in noise McFadden & Pittman (submitted) J Lang Sp Hear Ser Schls How do children allocate their cognitive resources? How do children allocate their cognitive resources? Downs & Crum (1978) Normal-Hearing Adults Paired Association Task & Probe Reaction Time 35 dB SL Quite and +6dB SNR SECONDARY TASK PRIMARY TASK 400 12 11 350 300 Reaction Time (ms) # of Learning Trials 9 8 7 6 5 4 3 Worse Better Better Worse 10 250 200 150 100 2 50 1 0 0 Quiet Noise Quiet Noise Downs (1982) Hearing-Impaired Adults Word Recognition Task & Probe Reaction Time 58 dB SPL 0 dB SNR SECONDARY TASK PRIMARY TASK 125 80 Reaction Time (ms) Word Recognition (% correct) 150 60 40 20 Worse Better Worse Better 100 100 75 50 25 0 0 Aided Unaided Aided Unaided Hicks & Tharpe (2002) Normal-Hearing & Hearing-Impaired Children Word Recognition Task & Probe Reaction Time 70 dB SPL Quiet, +20, +15 & +10 dB SNR NHC HIC SECONDARY TASK 250 90 200 Reaction Time (ms) Word Categorization (% correct) 100 80 70 Worse Better Worse Better PRIMARY TASK 150 100 50 60 0 50 Quiet +10 dB SNR Quiet +10 dB SNR Method NH children N=11 Age = 8-12 years HI children N=10 Age = 8-12 years Minimal Hearing Losses Unilateral Mild High-frequency Method Primary Task: Word categorization Animal, Person, Food Example: Dog, Mother, Pizza Presented binaurally via earphones at 65 dB SPL Listening conditions: Quiet, +6 dB SNR, and 0 dB SNR Secondary Task: Dot to dot puzzles 18 puzzles Dot rate (dots/minute) Method Word Categorization PERSON FOOD ANIMAL Dot-to-dot Games Results NHC HIC PRIMARY TASK SECONDARY TASK 100 100 90 Dot Rate (dots/min) Word Categorization 80 80 70 Better Worse Worse Better 90 70 60 50 40 30 20 60 10 0 50 Quiet 0dB SNR Quiet 0dB SNR Conclusions Hearing loss did not alter the way these children approached multiple tasks. Children did not appear to redirect their cognitive resources from one task to accommodate the listening task. May be unwilling to redirect May be unable to redirect May be unaware of the need to redirect How does the difficulty of the competing task affect their ability to attend to speech? Summary Children’s hearing loss configurations differ from those of adults The presence of hearing loss early in life has immediate and long-term effects on auditory perception Children do not (or are not able to) approach listening tasks in the same way as adults. In the future… Configuration specific amplification strategies Life-long effects of hearing loss Management of perceptual resources