Assessing Growth of Loudness in Children by Cross-Modality Matching

Abstract

This study examined the clinical feasibility, validity, and reliability of loudness growth assessment using cross-modality matching (CMM) between line length and loudness in 16 children 4 to 12 years old with normal hearing or bilateral sensorineural hearing losses ranging from moderate to severe in degree. Eight adult listeners with normal hearing were used as a comparison group. Loudness growth functions and real-ear measures were obtained for 500–Hz and 2000-Hz narrowband noise stimuli for each individual. No significant differences were found between the loudness slope values for the adults and children with normal hearing. Loudness growth functions of the children with sensorineural hearing loss were significantly steeper (larger) than the slopes obtained from children with normal hearing. The numeric slope value of the loudness growth function became larger and more variable as children's hearing threshold increased and differed for children with similar thresholds. The loudness functions obtained for retested participants at two different test sessions were highly correlated. Real-ear measurements revealed that for equivalent input stimulus levels, significantly higher stimulus levels were present in the ear canals of children versus adults. Although adults and children with normal hearing had similar overall rates of loudness growth, discrete points along the loudness growth function were judged to be louder by the children. This preliminary study suggests that measures of loudness growth using CMM between line length and loudness are feasible, valid, and reliable in children with normal hearing or sensorineural hearing loss. The individual variability noted in slope values for children with hearing loss attests to the importance of subjective assessments of loudness. The protocol used in this study may have potential as a clinical tool for selecting and fitting amplification technology for children with hearing loss as young as 6 years. Abbreviations: CMM = cross-modality matching, HI = hearing impairment, LDL = loudness discomfort level, MCL = most comfortable loudness, NBN = narrowband noise, NH = normal hearing

Narrative Review of Loudness Perception Measures in Children

“…Studies reporting variability across children of similar ages show that this variability is substantial but similar to that which has been reported with adult listeners (Dorfman & Megling 1966; Bond & Stevens 1969; Teghtsoonian 1980; Collins & Gescheider 1989; Baruch et al 1993; Fucci et al 1999; Davidson et al 2000, 2009; Serpanos & Gravel 2000, 2004; Khalfa et al 2004; Serpanos 2004; Scollie et al 2010; Crukley & Scollie 2012, 2014; Wolfe et al 2015; Van Eeckhoutte et al 2020). Despite this across-child variability, children were highly consistent in their loudness growth reports across tests (O’Loughlin 1978; Collins & Gescheider 1989; Serpanos & Gravel 2000, 2004; Serpanos 2004; Wolfe et al 2015). Considering that both adults and children demonstrate broad across-listener variability, audiologists should consider measuring loudness growth rather than estimating based on average data.…”

“…That is, perhaps the real ear sound pressure level (SPL) of the LDL signal is greater for children, who have smaller ear canals than adults. Although their primary purpose was to explore developmental differences in loudness growth, not LDL, Serpanos and Gravel (2000) accounted for variations in real ear SPL across child and adult participants. They found that, although loudness seemed to grow at the same rate as adults for children when real ear SPL was the same, children perceived the stimulus to be louder than it was perceived to be by adult listeners.…”

“…Consistent with Bentler and Cooley (2001), most studies measuring LDLs in children reported considerable variability across children in the same age range (Holmes & Woodford 1977;Kawell et al 1988;Macpherson et al 1991;Stuart et al 1991;Israelsson et al 1995;Lucker et al 1996;Ellis & Wynne 1999;Serpanos & Gravel 2000;Khalfa et al 2004;Coelho et al 2007;Aazh et al 2011). This wide range of LDLs measured in studies including children with and without hearing loss suggests that using estimated LDLs could misrepresent a child's actual LDLs.…”

“…Existing literature overwhelmingly shows no significant developmental differences on measures of loudness growth (Dorfman & Megling 1966;Bond & Stevens 1969;O'Loughlin 1978;Teghtsoonian 1980;Collins & Gescheider 1989;Baruch et al 1993;Schneider & Cohen 1997;Fucci et al 1999;Serpanos & Gravel 2000, 2004Serpanos 2004;Scollie et al 2010;Schafer et al 2013). Note that the majority of studies comparing adults with children used magnitude estimation, magnitude production, or cross modality matching.…”