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Purpose: This article describes DigiSpan, a new computer-controlled auditory test of forward and reverse digit span, designed to be administered by clinicians, and presents normative and test-retest reliability data for adults. Method: DigiSpan mimics conventional live-voice tests in that it commences with trials that ascend in length until a stopping criterion is met, giving rise to a conventional scaled score. It then administers five additional adaptive trials, the length of which depends on the correctness of the response to the previous trial. Each of these two segments of the measurement gives rise to a scaled score. The ascending and adaptive scores are averaged to give an overall score and subtracted to produce an internal measure of consistency, and hence reliability. Young adults with an Mage of 25 years (N = 163) were tested, of whom 65 were retested on a separate day. Results: The scaled scores from the conventional ascending trials were highly consistent with existing normative data based on live-voice tests. Combination of the conventional scaled score with a scaled score based on the adaptive trials led to 44% reduction in error variance for forward memory span and 20% reduction for reverse memory span. The average of these (32%) is similar to but (insignificantly) less than the 42% reduction in error variance that can be predicted based on adding the five adaptive trials. Conclusions: Replacing live-voice production of digits by a clinician with recorded, computer-controlled production has not affected the difficulty of the test. Adding five additional trials around the sequence length that a test participant can just remember has produced a decrease in measurement error. In addition, the availability of separate scaled scores for the ascending and adaptive phases enables the reliability of the combined score to be checked, for both forward and reverse measurements. The combination of standardized delivery, increased accuracy, internal reliability check, and fast automated scoring makes the test highly suitable for clinical use. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the speech recognition equivalence of Mandarin Bamford-Kowal-Bench (BKB) sentence lists with adults and children with normal hearing. Method: A total of 32 lists, each of nine sentences, were compiled from a corpus of BKB-like sentences with paired babble in Mandarin. Interlist equivalence, critical differences, and sensitivity of performance to signal-to-noise ratio (SNR) were examined. Experiment 1 included 64 native Mandarin-speaking adults with normal hearing. Experiment 2 included 54 native Mandarin-speaking children with normal hearing aged 4-6 years. Results: Among the 32 sentence lists, 28 lists were confirmed to be equivalent in adults, with a mean SNR required for 50% correct (SNR50) of -5.9 ± 0.1 dB, a mean slope of 22.3%/dB ± 1.5%/dB, and a grand 95% critical difference subsequently calculated as 27.2% for score. From the 28 equivalent lists, 27 lists were selected and observed to be equivalent in children, with a mean SNR50 threshold of -2.0 ± 0.2 dB, a mean slope of 15.8%/dB ± 1.1%/dB, and a grand 95% critical difference of 24.6% for score. Conclusions: The Mandarin BKB sentences in babble noise test offers an opportunity for clinicians and researchers to assess speech understanding in adults and preschool children in an efficient manner. For comparisons of performance in different test conditions, 28 equivalent lists are available for adults and 27 equivalent lists for preschool children. The 95% critical difference values can be used for total percentage correct or SNR for 50% performance. Future work will examine the clinical utility for school-age children and children who are deaf and hard of hearing. Supplemental Material: https://doi.org/10.23641/asha.24400066 [ABSTRACT FROM AUTHOR]

Hearing aid verification with real-ear measurement (REM) is recommended in clinical practice. Improvements, over time, in accuracy of manufacturers' initial fit mean the benefit of routine REM for new adult users is unclear. This registered, double-blinded, randomized, mixed-methods clinical trial aimed to (i) determine whether new adult hearing aid users prefer initial or real-ear fit and (ii) investigate the reasons for preferences. New adult hearing aid users (n = 45) were each fitted with two programs: the initial fit and real-ear fit, both with adjustments based on immediate feedback from the patient. Participants were asked to complete daily paired-comparisons of the two programs with a magnitude estimation of the preference, one for each of clarity/comfort in quiet/noise as well as overall preference. The results revealed gain adjustment requests were low in number and small in magnitude. Deviation from NAL-NL2 targets (after adjustment for a 65 dB SPL input) was close to zero, except at high frequencies where real-ear fits were around 3 dB closer to target. There was no difference in clarity ratings between programs, but comfort ratings favored initial fit. Overall, 10 participants (22%) expressed a preference for real-ear fit. Reasons for preference were primarily based on comfort with the initial fit and clarity with real-ear fit. It may be acceptable to fit new adult users with mild-to-moderate hearing loss without the need for REMs, if the primary outcome of interest is user preference. It remains to be seen if the findings generalize to other fitting software, other outcome measures and more severe hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: Open-plan classroom styles are increasingly being adopted in Australia despite evidence that their high intrusive noise levels adversely affect learning. The aim of this study was to develop a new Australian speech perception task (the Mealings, Demuth, Dillon, and Buchholz Classroom Speech Perception Test) and use it in an open-plan classroom to assess how intrusive noise affects speech perception. Method: The first part of this article describes how the online 4-picture choice speech perception task materials were created. The second part focuses on the study involving twenty-two 5- to 6-year-old children in an openplan classroom who completed the task while other classes engaged in quiet and noisy activities. Results: Children's performance accuracy, number of responses, and speed were lower in the noisy condition compared with the quiet condition. In addition, children's speech perception scores decreased the farther away they were seated from the loudspeaker. Overall, the children understood and were engaged in the task, demonstrating that it is an appropriate tool for assessing speech perception live in the classroom with 5- to 6- year-old children. Conclusions: The results suggest that the Mealings, Demuth, Dillon, and Buchholz Classroom Speech Perception Test is a helpful tool for assessing speech perception in classrooms and that it would be beneficial to use in future research investigating how classroom design and noise affect speech perception.

Remote hearing screening and assessment may improve access to, and uptake of, hearing care. This review, the most comprehensive to date, aimed to (i) identify and assess functionality of remote hearing assessment tools on smartphones and online platforms, (ii) determine if assessed tools were also evaluated in peer-reviewed publications and (iii) report accuracy of existing validation data. Protocol was registered in INPLASY and reported according to PRISMA-Extension for Scoping Reviews. In total, 187 remote hearing assessment tools (using tones, speech, self-report or a combination) and 101 validation studies met the inclusion criteria. Quality, functionality, bias and applicability of each app were assessed by at least two authors. Assessed tools showed considerable variability in functionality. Twenty-two (12%) tools were peer-reviewed and 14 had acceptable functionality. The validation results and their quality varied greatly, largely depending on the category of the tool. The accuracy and reliability of most tools are unknown. Tone-producing tools provide approximate hearing thresholds but have calibration and background noise issues. Speech and self-report tools are less affected by these issues but mostly do not provide an estimated pure tone audiogram. Predicting audiograms using filtered language-independent materials could be a universal solution. [ABSTRACT FROM AUTHOR]

Create a language-independent, ecologically valid auditory processing assessment and evaluate relative stimuli intelligibility in native and non-native English speakers. The Language-Independent Speech in Noise and Reverberation Test (LISiNaR) targets comprised consonant-vowel (CVCV) pseudo-words. Distractors comprised CVCVCVCV pseudo-words. Stimuli were presented over headphones using an iPad either face-to-face or remotely. Scoring occurred adaptively to establish a participant's speech reception threshold in noise (SRT). The listening environment was simulated using reverberant and anechoic head-related transfer functions. In four test conditions, targets originated from 0°. Distractors originated from either ±90°, ±67.5° and ±45° (spatially separated) or 0° azimuth (co-located). Reverberation impact (RI) was calculated as the difference in SRTs between the anechoic and reverberant conditions and spatial advantage (SA) as the difference between the spatially separated and co-located conditions. Young adult native speakers of Australian (n = 24) and Canadian (25) and non-native English speakers (34). No significant effects of language occurred for the test conditions, RI or SA. A small but significant effect of delivery mode occurred for RI. Reverberation impacted SRT by 5 dB relative to anechoic conditions. Performance on LISiNaR is not affected by the native language or accent of groups tested in this study. [ABSTRACT FROM AUTHOR]

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services. [ABSTRACT FROM AUTHOR]

Remote microphones (RMs) enable clearer reception of speech than would be normally achievable when relying on the acoustic sound field at the listener's ear (Hawkins, J Sp Hear Disord 49, 409–418, 1984). They are used in a wide range of environments, with one example being for children in educational settings. The international standards defining the assessment methods of the technical performance of RMs rely on free-field (anechoic) delivery, a rarely met acoustic scenario. Although some work has been offered on more real-world testing (Husstedt et al., Int J Audiol 61, 34–45. 2022), the area remains under-investigated. The electroacoustic performance of five RMs in a low-reverberation room was compared in order to assess just the RM link, rather than measurements at the end of the signal chain, for example, speech intelligibility in human observers. It pilots physical- and electro-acoustic measures to characterize the performance of RMs. The measures are based on those found in the IEC 60118 standards relating to hearing aids, but modified for diffuse-field delivery, as well as adaptive signal processing. Speech intelligibility and quality are assessed by computer models. Noise bands were often processed into irrelevance by adaptive systems that could not be deactivated. Speech-related signals were more successful. The five RMs achieved similar levels of good predicted intelligibility, for each of two background noise levels. The main difference observed was in the transmission delay between microphone and ear. This ranged between 40 and 50 ms in two of the systems, on the upper edge of acceptability necessary for audio-visual synchrony. [ABSTRACT FROM AUTHOR]

Hearing aids are typically programmed using the individual's audiometric thresholds and verified using real-ear measures. Developments in technology have resulted in a new category of direct-to-consumer devices, which are not necessarily programmed using the individual's audiometric thresholds. This review aimed to identify whether programming hearing aids using the individual's validated audiogram-based prescription, and verified using real-ear measures, results in better outcomes for adults with hearing loss. The review was registered in PROSPERO and reported in accordance with PRISMA guidelines. After screening more than 1370 records, seven experimental studies met the eligibility criteria. Studies were categorised under three methods of fitting: (i) comparative fitting evaluating different settings based on the beliefs of the audiologist; (ii) client choice of preset responses; and (iii) self-fit by adjustment. The findings suggest that using a prescription based on the individual's audiogram improves outcomes relative to the comparative and client choice fitting approaches. Self-adjustment during daily use may produce equivalent (or better) outcomes than an audiogram-based prescription. The quality of evidence for the outcomes ranged from low to very low. This review has highlighted the dearth of high-quality studies on which to make evidence-based decisions on hearing aid fitting methods. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the head orientation of young children in naturalistic settings and the acoustics of their everyday environments for quantifying the potential effects of directionality. Method: Twenty-seven children (11 with normal hearing, 16 with impaired hearing) between 11 and 78 months of age were video recorded in naturalistic settings for analyses of head orientation. Reports on daily activities were obtained from caregivers. The effect of directionality in different environments was quantified by measuring the Speech Transmission Index (STI; H. J. M. Steeneken & T. Houtgast, 1980). Results: Averaged across 4 scenarios, children looked in the direction of a talker for 40% of the time when speech was present. Head orientation was not affected by age or hearing status. The STI measurements revealed a directional advantage of 3 dB when a child looked at a talker but a deficit of 2.8 dB when the talker was sideways or behind the child. The overall directional effect in real life was between -0.4 and 0.2 dB. Conclusions: The findings suggest that directional microphones in personal hearing devices for young children are not detrimental and have much potential for benefits in real life. The benefits may be enhanced by fitting directionality early and by counseling caregivers on ways to maximize benefits in everyday situations.

The aim of this study was to examine the effects of sound-field amplification intervention on the acquisition of specific educational goals for children in mainstream cross-cultural classrooms. Twelve classes of Year 2 children participated in the project. For classes 1 to 8, the listening environments were alternated between amplified and unamplified conditions, each condition being for two terms (one semester) of the school year. Beneficial effects of amplification were obtained in all three skill areas of reading, writing and numeracy. The beneficial effects occurred irrespective of whether the children had English as a native language or as a second language. Classes 9 to 12 were alternated between single-channel and dual-channel transmission options, each condition being for one semester of the school year. The results indicated that using different numbers of microphones did not affect the rate of acquisition of educational outcomes. (Contains 2 tables and 4 figures.)

This article presents teachers' and children's views of the effectiveness of sound-field amplification intervention. The rating scale, Teacher Opinions re Performance in Classrooms (TOPIC) provided information on teacher perceptions regarding changes in student performance in unamplified "OFF" and amplified "ON" listening conditions. The teachers observed improvement in attention, communication strategies and classroom behaviour when the amplification systems were operating. The answers from questionnaires indicated a high level of satisfaction from both teachers and students following use of the systems. Less vocal strain was identified by the teachers to be a major benefit. The children reported that they could hear better, clearer or louder. [For Part 1, see EJ983296.] (Contains 9 tables and 2 figures.)

Purpose: Open-plan classroom styles are increasingly being adopted in Australia despite evidence that their high intrusive noise levels adversely affect learning. The aim of this study was to develop a new Australian speech perception task (the Mealings, Demuth, Dillon, and Buchholz Classroom Speech Perception Test) and use it in an open-plan classroom to assess how intrusive noise affects speech perception. Method: The first part of this article describes how the online 4-picture choice speech perception task materials were created. The second part focuses on the study involving twenty-two 5- to 6-year-old children in an open-plan classroom who completed the task while other classes engaged in quiet and noisy activities. Results: Children's performance accuracy, number of responses, and speed were lower in the noisy condition compared with the quiet condition. In addition, children's speech perception scores decreased the farther away they were seated from the loudspeaker. Overall, the children understood and were engaged in the task, demonstrating that it is an appropriate tool for assessing speech perception live in the classroom with 5- to 6-year-old children. Conclusions: The results suggest that the Mealings, Demuth, Dillon, and Buchholz Classroom Speech Perception Test is a helpful tool for assessing speech perception in classrooms and that it would be beneficial to use in future research investigating how classroom design and noise affect speech perception., Primary school provides children's first experience of formal education, preparing them for higher levels of literacy, numeracy, and other academic skills. The primary modes of communication in the educational setting [...]

Purpose: Perceived sound quality was variously compared between either no aiding or aiding with three models of hearing aid that varied the microphone position around the pinna, depth of the receiver in the auditory meatus, degree of meatal occlusion, and processing sophistication. The hearing aids were modern designs and commercially available at the time of testing. Method: Binaural recordings of multichannel spatially separated speech and music excerpts were made in a manikin, either open ear or aided. Recordings were presented offline over wide-bandwidth, high-quality insert earphones. Participants listened to pairs of the recordings and made preference ratings both by clarity and externality (a proxy for "spaciousness"). Two separate groups of adults were tested, 20 with audiometrically normal hearing (Nh) and 20 with mild-to-moderate sensorineural hearing loss (hearing impaired [HI]). Results: For ratings of speech clarity, the NH group expressed no preference between the open ear and a deeply inserted occluding aid, both of which were preferred to a low-pass filtered output of the same aid. For the music signal, a small preference emerged for the open-ear recording over that of the aid. For the HI group, clarity of the deeply inserted aid was similar to in-the-ear and behind-the-ear devices for speech, but worse for music. Ratings of spaciousness produced no clear result in either group, which can be attributed to study limitations and/or participant factors. Conclusion: Based on clarity, a wide bandwidth, particularly to beyond 5 kHz generally and below 300 Hz for music, is desirable, independent of hearing aid design. [ABSTRACT FROM AUTHOR]

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This study, involving 11 older males with mild or moderate sensorineural loss, tested whether speech gain that results from a hearing aid fitting is predictable on the basis of unaided performance intensity curve, unaided narrow-band sound field thresholds, hearing aid insertion gain as a function of frequency, ambient noise, and internal hearing aid noise. (JDD)

The one-up one-down adaptive (staircase or up-down) procedure is often used to estimate the speech recognition threshold (SRT) in speech-in-noise testing. This article provides a brief historical overview of the one-up one-down procedure in psychophysics, discussing the groundbreaking early work that is still relevant to clinical audiology and scientific research. Next, this article focuses on two aspects of the one-up one-down adaptive procedure: first, the standard error of measurement (SEM) and, second, the fluctuations in the track [i.e., the standard deviation of the signal-to-noise ratios of the stimuli within the track (SDtrack)]. Simulations of ideal and non-ideal listeners and experimental data are used to determine and evaluate different relationships between the parameters slope of the speech recognition function, SRT, SEM, and SDtrack. Hearing loss and non-ideal behavior (inattentiveness, fatigue, and giving up when the task becomes too difficult) slightly increase the average value of SDtrack. SDtrack, however, poorly discriminates between reliable and unreliable SRT estimates. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the head orientation of young children in naturalistic settings and the acoustics of their everyday environments for quantifying the potential effects of directionality. Method: Twenty-seven children (11 with normal hearing, 16 with impaired hearing) between 11 and 78 months of age were video recorded in naturalistic settings for analyses of head orientation. Reports on daily activities were obtained from caregivers. The effect of directionality in different environments was quantified by measuring the Speech Transmission Index (STI; H. J. M. Steeneken & T. Houtgast, 1980). Results: Averaged across 4 scenarios, children looked in the direction of a talker for 40% of the time when speech was present. Head orientation was not affected by age or hearing status. The STI measurements revealed a directional advantage of 3 dB when a child looked at a talker but a deficit of 2.8 dB when the talker was sideways or behind the child. The overall directional effect in real life was between -0.4 and 0.2 dB. Conclusions: The findings suggest that directional microphones in personal hearing devices for young children are not detrimental and have much potential for benefits in real life. The benefits may be enhanced by fitting directionality early and by counseling caregivers on ways to maximize benefits in everyday situations. KEY WORDS: directional microphones, infants, young children, hearing aids, pediatric amplification, naturalistic settings, Children acquire knowledge and develop communication skills through their experiences in everyday environments (Akhtar, 2005). Extracting speech information in these environments is challenging not only for children with impaired hearing [...]

This article presents teachers' and children's views of the effectiveness of sound-field amplification intervention. The rating scale, Teacher Opinions re Performance in Classrooms (TOPIC) provided information on teacher perceptions regarding [...]

The aim of this study was to examine the effects of sound-field amplification intervention on the acquisition of specific educational goals for children in mainstream cross-cultural classrooms. Twelve classes of [...]