Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids

Abstract

Objectives: The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child’s unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child’s hearing technology or intervention plan. Design: The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay. Results: Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals. Conclusions: Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child’s hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation.

Task-Dependent Effects of Signal Audibility for Processing Speech: Comparing Performance With NAL-NL2 and DSL v5 Hearing Aid Prescriptions at Threshold and at Suprathreshold Levels in 9- to 17-Year-Olds With Hearing Loss

“…Our results appear to conflict with those of Wiseman et al (2023), who reported an association between aided SII and language composite scores for a cohort of younger children with hearing loss (4- to 8-year-olds). The authors acknowledged that this association was questionable given the variability in the data and the influence of a small proportion of the children at the lowest SII levels.…”

“…Unaided and aided SRTs and word recognition at levels near threshold could be more sensitive than at higher presentation levels to the benefit that a particular fitting formula or hearing aid feature will provide. Second, although deviations from prescriptive targets are commonly observed in the pediatric population (McCreery et al, 2015), our results and those of Wiseman et al (2023) suggest that the effect of these deviations on language development may be smaller than expected.…”

“…Further, there was no difference in language outcomes between children with well-fit and poorly-fit hearing aids. Together with the substantial and unexplained variability in the data, the Wiseman et al (2023) results suggest a weak relationship between aided audibility and language outcomes. Our results are consistent with those findings and confirm that performance for tasks that support language development is largely insensitive to widely varying levels of audibility.…”

“…Fifth, standardized measures of cognition and language were not included in this study and may explain some of the variance in the data. Finally, a measure of recall following the word learning task may provide a more comprehensive understanding of the relationship between audibility and language learning in this population (Stelmachowicz et al, 2004; Wiseman et al, 2023).…”

EEG Alpha Band Responses Reveal Amplification Benefits in Infants with Hearing Loss

“…Aided SII is a standard clinical tool for measuring how much speech-relevant information is accessible acoustically to children with hearing loss and is a hearing aid variable known to correlate with language outcomes in children [ 49 , 50 ]. For example, recent research suggests that children with aided SII values >0.71, auditory dosage (a measure of amount of time with auditory access), and word recognition in noise, could be used to predict spoken language abilities and guide changes in intervention [ 51 ]. Given the significant effects of alpha for the aided versus unaided responses and a lack of correlation with aided SII, the findings in this study suggest that aided SII alone may be inadequate for predicting hearing aid benefit in infants, especially when aided SII values are above 0.71.…”