FITTING AND VERIFICATION OF REMOTE- MICROPHONE TECHNOLOGY IN CHILDREN WITH NORMAL HEARING, HEARING AIDS, AND COCHLEAR IMPLANTS Erin C. Schafer, Ph.D. University of North Texas Dept. of Speech & Hearing Sciences REMOTE-MICROPHONE TECHNOLOGY!! 1. Cochlear implants 2. Hearing aids 3. Normal Hearing with auditory disorders Data from 5 studies: 1. Speech-in-noise thresholds 14 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. Remote mic streaming accessory 1
14 Cochlear Freedom Users with Oticon Arc SNR at 5% Correct (db) 15 1 5-5 12 db improvement with Arc Significant effect of FM 6. 5.9-6.5-5.9 No FM FM No significant effect of session -1 Session 1 Session 2 Test Session Schafer et al., AJA, 212 9 users of various sound processors 1 5 BKB-SIN SNR-5-5 -1-15.7-1.8-6.1 WHY??? No FM Arc R2-2 Condition 1 Both FM better than no FM Arc better than R2 Schafer et al., JAAA, 213a Measurement Steps 75 Hz 1 Hz 2 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) Adjusted FM gain to most closely simulate processor output Schafer et al, 213b, JAAA 2
Step 1: Measure the output of the CI through the monitor earphones using speech input Nucleus 5 in test box Coupler & earphone out Nucleus 5 Earphone & HA-1 Coupler Schafer et al., 213b, JAAA Transmitter Microphone Earphone & HA-1 Coupler Nucleus 5 Oticon T3 Transmitter Oticon R2 FM Receiver plugged into earphone cord Schafer et al., 213b, JAAA Nucleus 5 with earphone cord Oticon Arc Transmitter Microphone Oticon T3 Transmitter 3
WHY THE DIFFERENCE BETWEEN FM IN STUDY 3?? We want transparency: Same output = same inputs to CI and FM mics But..When we compared the measurements from the CI alone, R2, and Arc, we got. 9 Output (db SPL) 8 7 6 5 75 Hz 1 Hz 2 Hz Frequency (Hz) CI Alone Arc FM +8 1 R2 FM +16 2 R2 FM +8 3 Schafer et al., JAAA, 213b STUDY 3: ELECTROACOUSTIC RESULTS COCHLEAR & MED-EL Schafer et al., 213b, JAAA BUT DOES THIS APPROACH RESULT IN GOOD BEHAVIORAL RESULTS?? Speech recognition with 2 list-pairs of BKB-SIN: speech at ; Babble at 18 degrees Loudness ratings (in parenthesis below) Subject: CI CI Alone R2 Arc 1: Nucleus 5 1. (2.7) -11. (4.3) -12.3 (3.7) 2: Nucleus 5-2.5 (3.3) -11.3 (4.) -12.2 (3.7) Schafer et al., 213b, JAAA 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 5, 55, 6, 65, 7, 75, 8 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) Adults with normal hearing score 95% correct here! Wolfe et al., 213, JAAA STUDY 4 RESULTS: COCHLEAR (N = 21) Wolfe et al., 213, JAAA 5
STUDY 4: SUMMARY Adaptive Digital technology significantly better than fixed-gain and adaptive FM at 7, 75, and 8 dba Adaptive FM technology better than fixed gain FM at 7, 75, and 8 dba noise levels No differences were found between CI manufacturers. STUDY 5: WIRELESS AUDIO STREAMING FOR COCHLEAR IMPLANTS Partnered with GN Resound to provide wireless audio streaming via proprietary digital radio frequency transmission (2.4 GHz) STUDY 5: EQUIPMENT HAT Research at Hearts for Hearing: Jace Wolfe, Mila Duke, & Sara Neumann 6
STUDY 5: COCHLEAR MINI MIC 16 Adults: ages 16 to 81 with unilateral or bilateral Nucleus CIs with ACE Evaluated AzBio sentence recognition in quiet and in noise Used participants everyday MAPs with default 2:1 accessory mixing ratio 6 db attenuation of Nucleus 6 microphone Cochlear Mini Mic left at default setting STUDY 5: AZBIO IN QUIET Percent Correct Sentence Recognition 1 8 81% 6 4 2 In press, JAAA Nucleus 6 Alone 91% Significant Improvement n = 16 Nucleus 6/Mini Mic STUDY 5: AZBIO IN NOISE Percent Correct Sentence Recognition 1 8 6 4 2 Significant Improvements +5 db SNR dba Nucleus 6 Alone Nucleus 6/Mini Mic In press, JAAA 5 55 6 65 7 n = 16 75 Speech at 65 db 7
HEARING AID STUDIES HEARING AIDS Data from 3 studies: 1. FM vs. streaming 2. VoicePriorityi 3. Personal FM vs. Soundfield FM STUDY 1: RM VS STREAMING Phonak Bolero Resound Verso Phonak Roger X Resound Unite Mic Phonak Roger Pen Evaluated sentence recognition in 17 adults with hearing loss with and without wireless technology 8
STUDY 1: PROGRAMMING Fitted Resound and Phonak aids to DSL v5. target for adults SII within 2 points for the two hearing instruments Disabled all NR technologies and NLFC; FB cancellation enabled Ensured transparency for each remote mic condition STUDY 1: RESULTS 1 8 Resound Verso Phonak Bolero 9 Resound Verso with Unite Mic Phonak Bolero 9 with Roger 6 4 2 Quiet 55 dba 65 db 75 dba 8 dba n = 17 STUDY 2: VOICE PRIORITY (VP I ) Participants: 2 children with hearing loss, ages 5-18 years Methods: All fit with bilateral Oticon Sensei Pro BTEs or RITEs & FM Used FM system with VPi: 4-week trial Parent & participant questionnaires Tested in lab: speech recognition in noise & ANL 9
Parent Ratings 9 8 7 6 5 4 3 2 1 Quiet Media Social Noise Distance C.H.I.L.D. Listening Situations Personal HA Study HA Study HA+FM C D C D Speech Recognition C D C D FM FM Speech C D Speech a. Diffuse noise b. Localized noise Traditional FM & FM with VPi: 1. S65/N55 2. S7/N63 3. S74/N7 C D 12 1 % Correct 8 6 4 2 Traditional FM Voice Priority FM Loc 65/55 Loc 7/63 Loc 74/7 Dif 65/55 Dif 7/63 Loudspeaker Arrangement & SNR Dif 74/7 1
STUDY 2 RESULTS: ANL Intensity in dbhl 7 6 5 4 3 2 1-1 MCL BNL ANL Listening Condition Study HA Traditional FM Voice Priority FM STUDY 3: PERSONAL VS. SOUNDFIELD FM Participants: 15 children with mild to severe SNHL, ages 6-13 years, all using bilateral hearing aids Tested speech recognition: No FM Phonak Dynamic Soundfield Audio Enhancement Soundfield Phonak Dynamic Soundfield + Personal FM Audio Enhancement Soundfield + Personal FM Personal FM STUDY 3: RESULTS 11
STUDY 3: RESULTS NORMAL HEARING WITH AUDITORY DISORDERS APD, ASD, ADHD, Language Disorders, & Dyslexia AUDITORY PROCESSING DISORDERS (APD) Johnston, John, Kreisman, Hall & Crandall (29) 1 children with APD 13 children in control group Test measures: Speech recognition in quiet & noise: HINT-C Academic Performance: SIFTER & LIFE 12
APD: SPEECH RECOGNITION Quiet (db) Noise (db SNR) APD: ACADEMIC PERFORMANCE-- SIFTER ASD: PREVALENCE 1 in 68 children in the US have ASD (CDC, 21) Prevalence increasing: 2: 1 in 15 26: 1 in 11 28: 1 in 88 5 times more common in boys than girls 8% require special education support 13
ASD: REASONS FOR AUDITORY DEFICITS 1. Abnormal physiological encoding of auditory stimuli in quiet and noise from brainstem to the cortex (Barry et al, 22; Russo et al., 29) P1 correlates to mental, verbal, and receptive language abilities ASD: REASONS FOR AUDITORY DEFICITS Russo et al, 29 Similar P1 and N1 Latencies ASD: REASONS FOR AUDITORY DEFICITS 2. 1 gene mutations linked to ASD 3. As a result, abnormalities in dendritic spines 14
REASONS FOR AUDITORY DEFICITS Tang et al., 214 owhy do we care? opostmortem temporal lobes: children ASD oincreased dendrites in ASD result in increased excitation olikely causes difficulty separating signal from noise Dendritic spine density STUDY MEASURES Behavioral Measures with and without RM Technology: 1. Speech recognition: BKB-SIN with speech at and noise at 18 degrees 2. Listening Comprehension: Ross Information Processing Assessment Primary (RIPA-P) Subjective Measures: 1. Parent: Children s Home Inventory for Listening Difficulties (CHILD); Short Sensory Profile (SSP) 2. Teacher: Listening Inventory for Education-Revised (LIFE); Children s Auditory Performance Scale (CHAPS) 3. Participant: Listening Inventory for Education-Revised (LIFE) SPEECH RECOGNITION BKB-SIN: Speech at & Noise at 18 Speech in Noise Threshold (db SNR) 2 4 6 8 1 12 n = 8.4 6.3 No Device RM Technology Listening Condition Significant average improvement: 5.9 db 15
RIPA-P QUESTIONS Immediate Memory Recent Memory LISTENING COMPREHENSION: RIPA-P 1 8 No Device RM Technology Significant Improvements RIPA-P Scores 6 4 2 Immediate Memory Recent Memory n = 7 PARTICIPANT LIFE n = 9 TEACHER LIFE Listening & Learning Challenge Listening & Learning Challenge 8 7 6 5 4 3 2 1 6 5 4 3 2 1 Less Challenge & Significant Improvement 44 No Device 34 Evidence of Listening Challenges No Device 59 RM Technology 44 Significant Improvement RM Technology 16
TEACHER: CHAPS Level of Difficulty -5-1 -15-2 -25 Significantly Less Difficulty No Device RM Tech -3 Noise Quiet Ideal Mult. InputsAud. Mem. Seq. Listening Condition Aud. Atten. Span PARENT: AUDITORY SECTIONS-SSP We assigned values ranging to 5 (always) to 1 (never) and summed each area SSP PARENT RATING: LEVEL OF DIFFICULTY 3 Level of Difficulty 25 2 15 1 5 21 13 Significant Improvement SSPs from 4 parents: auditory filtering greatest predictor of educational success No Device 12 RM Technology 9 Significant Improvement Auditory Filtering Auditory/Visual Sensitivity SSP Area n = 9 17
PARENT: CHILD Level of Difficulty 35 3 25 2 15 1 5 Significant Improvements No Device RM Technology Quiet Noise Distance Social Media Listening Situation n = 8 REAL-WORLD EXPERIENCES Parent Email #1: #2: I've They just are finished doing so using well with the devices them. The for the teachers first time are today, giving and some my great daughter feedback. and I just had a 3-minute conversation about cocoa. She made eye-contact consistently while we talked We actually back-and-fourth, tried them Sunday and she when responded we went quickly grocery as I've never shopping seen at her Target, do before. and it Afterwards, literally brought we continued me to tears with our cause conversation it's the first some time in more. years we've all been able to go and they listened. I would talk to them and remind them Usually, how we behave a conversation while we with were her in there, requires and a having lot of work my with repeated voice talk requests, them throughout, questions, they etc. (as actually many helped as ten put times) to get things her in to the respond, cart. I'm and just keeping very thankful her engaged we are in able having to be an a ongoing part of this conversation study. with her is taxing. However, the conversation that I had with her just now was super easy. Because of that, I'm so amazed and excited!! ASD & ADHD Schafer, Mathews, Mehta, Hill, Munoz, Bishop, & Moloney (212) 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 with and w/o FM systems: Speech recognition in noise Classroom Observations Teacher questionnaires 18
ASD & ADHD: SPEECH RECOGNITION IN NOISE LOWER SCORES ARE BETTER! BKB-SIN Threshold in db SNR -2-4 -6-8 -1-12 -14 p <.1 p >.5 No FM: ASD & ADHD No FM: Typical FM: ASD & ADHD Condition: Group Significantly poorer than typical peers Same as peers when using FM ASD & ADHD: ON-TASK BEHAVIORS Percentage of On-Task Behaviors 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % 84.4% 71.1% 63.8% 62.9% FM Off 1 FM On 1 FM Off 2 FM On 2 Experimental Phase Significantly more on-task behaviors with FM during both trial periods Both FM conditions significantly better than both no-fm conditions DYSLEXIA Hornickel et al. (212) 38 normal hearing children, ages 8-14 years, with dyslexia 19 used FM system for 1 year 19 wore no device (cntl grp) Test Measures: Reading Ability Phonological Awareness Auditory Brainstem Response to Speech (cabr) Significant improvement in FM grp; no change for control grp Significant Improvement; no change for control group Significant difference relative to control group 19
Ba Da Ga Hornickel et al. (212) stimuli II. NEW FM RESEARCH DYSLEXIA Hornickel et al. (212) Subset of participants showed even greater improvements on phonological awareness Coined the learners LANGUAGE DISORDERS (LD) Will discuss LD after the following section on fitting procedures 2
FITTING HAT ON CHILDREN WITH NORMAL HEARING FITTING HAT: NH Schafer et al., 214 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 DSL TARGETS VS. OUTPUT 11 1 9 8 db SPL 7 6 5 4 3 No significant effect of output type Significant interaction effect 1 2 3 4 Target Output 2-3 db lower than target Output 21
MPO VS. UCL 11 1 9 8 db SPL 7 6 5 MPO output significantly lower than estimated UCL UCL Output 4 3 25 5 1 2 3 4 6 Frequency (Hz) REOR VS. REUR 7 6 5 db SPL 4 3 2 Significant difference: = 3 db isense FM Unaided 1 1 2 3 4 Frequency (Hz) BEHAVIORAL VALIDATION: SPEECH RECOGNITION IN NOISE Percent Correct Speech Recognition 11 1 9 8 7 6 5 4 3 2 1 Left FM Right FM Bilateral FM No FM Listening Condition 5-8 yrs 9-12 yrs 22
7 Uncomfortably Loud BEHAVIORAL VALIDATION: LOUDNESS RATINGS 6 Loud, but okay IN NOISE 6. 5. 5 Comfortable, But Slightly Loud Loudness Rating 4. 3. 2. 1.. 4 Comfortable 3 Comfortable, but Slightly Soft 2 Soft Left FM Right FM Bilateral FM No FM 1 Very Soft Listening Condition 5-8 yrs 9-12 yrs LANGUAGE DISORDERS & VARIOUS DISABILITIES Table 1. Overview of Subject Demographics and Frequency Modulation (FM) System Volume Subject # Age Disorder FM Volume: FM Volume: Left Right 1 8; 1 APD -2-2 2 1; 7 APD 8 8 3 8; 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 1; 5 ASD, APD, SLI 8 8 8 9; 5 ASD, ID, ADHD, SLI 2 9 8; 11 SLI 1 6; 4 SLI, APD, ADHD 2 2 11 1; 2 SLI 8 6 12 11; 3 SLI 6 6 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 Participant and parent C.H.I.L.D. and participant and teacher L.I.F.E.-R 23
LD: FITTING RESULTS 85 8 Output (db SPL) 75 7 65 DSL output was met or slightly exceeded (3 db) for all 24 ears Targret FM Output 6 1 2 3 4 Frequency (Hz) LD: SPEECH RECOGNITION RESULTS N=1 Speech Recognition Score (%) 11 1 9 8 7 6 5 4 3 2 1-1 FM Left FM Right Bilateral FM Unaided Condition All loudness ratings Comfortable or Loud, but OK We recommend bilateral FM/DM! LD: LISTENING COMPREHENSION N=8 Listening Test Score 18 16 14 12 1 8 6 4 2 Main Idea Details Reasoning Vocabulary Underst. Messages Subtest Unaided FM 24
LD: PARTICIPANT C.H.I.L.D. (N=7) 4 Subject C.H.I.L.D. Rating 3 2 1 Quiet Noise Distance Social Media Listening Condition Baseline With FM LD: PARENT C.H.I.L.D. (N=1) Parent C.H.I.L.D. Rating 35 3 25 2 15 1 5 All Conditions Better with FM! Quiet Noise Distance Social Media Listening Condition Baseline With FM REMOTE-MIC SUMMARY 1. Cochlear implants Neckloop systems are beneficial Optimal settings FM/DM systems may vary Streaming accessories are beneficial 2. Hearing aids RM better than streaming devices, but they do help Voice priority i works Personal FM is better than soundfield 3. Normal Hearing with Auditory Dis. Open ear, digital RM and FM technology is extremely beneficial! 25
Thank you for listening! QUESTIONS?? Erin.Schafer@unt.edu https://www.researchgate. net/profile/erin_schafer 26