Boys Town National Research Hospital Research Articles

Inclusion of individuals with Down syndrome in auditory research

This talk will provide an overview of the procedures, challenges, and key findings of Project INCLUDE at Boys Town National Research Hospital. Funded by a trans-NIH initiative to investigate health conditions that affect individuals living with Down syndrome, the goal of Project INCLUDE at Boys Town National Research Hospital is to characterize how speech, language, and hearing develop across the lifespan. Individuals living with Down syndrome have been inadequately represented in auditory research, which has likely contributed to health care disparities. The exclusion of individuals with Down syndrome in prior research is particularly concerning given the high prevalence of hearing loss and otologic disease observed in this population. Results from an ongoing experiment investigating masked speech recognition outcomes will be presented. Participants are school-age children and young adults with Down syndrome and age-matched participants who are neurotypical. Data collection includes clinical audiological measures and standardized assessments of speech, language, and executive function, facilitating comparisons with other cohorts affiliated with the NIH-wide initiative. Recommendations for recruitment, details on the formation of a community advisory board, and community-based testing initiatives will be discussed.

Honoring the Contributions of Pat Stelmachowicz to the Field of Pediatric Audiology

My first encounter with Dr. Pat Stelmachowicz was during my first week in an audiology clinical placement at Boys Town National Research Hospital (BTNRH) during my graduate program over 20 years ago. I was sitting at the lunch table with much of the audiology staff, still trying to figure out how I had managed to land a clinical placement at such an amazing place with so many people who cared about pediatric audiology. Pat came into the room and started asking the clinical audiologists questions about how they were fitting hearing aids for children who were coming into the clinic. I assumed from the interaction that Pat was another audiologist on staff that I had yet to meet, as there were nearly 20 on staff at the time. I had no idea that I was having lunch with a leading scientist in pediatric audiology who had created an environment that would allow clinical audiologists to actively engage in research to support our patients. This very first interaction with Pat exemplified the qualities that made her a great mentor to many audiologists and scientists.

Metabolic and Sensory Components of Age-Related Hearing Loss: Associations With Distortion- and Reflection-Based Otoacoustic Emissions.

Age-related hearing loss is difficult to study in humans because multiple genetic and environmental risk factors may contribute to pathology and cochlear function declines in older adults. These pathologies, including degeneration of the stria vascularis, are hypothesized to affect outer hair cells responsible for active cochlear amplification of low-level sounds. Otoacoustic emission (OAE) measures are used to quantify the energy added to the traveling wave in cochlear amplification, which typically weakens with increased pure-tone thresholds and for older individuals. Thus, the current study evaluated two OAE measures for individuals with different components of age-related hearing loss. We examined two retrospective adult lifespan datasets (18 to 89+ years of age) from independent sites (Medical University of South Carolina and Boys Town National Research Hospital), which included demographics, noise history questionnaires, distortion-product otoacoustic emissions (DPOAE), and cochlear reflectance (CR). Metabolic and sensory estimates of age-related hearing loss were derived from the audiograms in each dataset, and then tested for associations with DPOAE and CR. The results showed that metabolic estimates increased for older participants and were associated with lower overall DPOAE and CR magnitudes across frequency (i.e., lower fitted intercepts). Sensory estimates were significantly higher for males, who reported more positive noise histories compared to females and were associated with steeper negative across-frequency slopes for DPOAEs. Although significant associations were observed between OAE configurations, DPOAEs appeared uniquely sensitive to metabolic estimates. The current findings suggest that distortion-based measures may provide greater sensitivity than reflection-based measures to the components of age-related hearing loss.

Graduate studies in acoustics at the University of Nebraska – Lincoln within the College of Engineering

Those interested in pursuing graduate studies and conducting research in acoustics are invited to learn more about opportunities at the University of Nebraska – Lincoln (UNL) within the College of Engineering. Dr. Lily Wang and Dr. Erica Ryherd work on architectural acoustics and noise control topics (http://nebraskaacousticsgroup.org ) within the Durham School of Architectural Engineering and Construction, based at UNL's Scott Campus in Omaha. Dr. Jinying Zhu in Civil and Environmental Engineering (also based on UNL’s Scott Campus in Omaha) is active in structural acoustics, using ultrasonic waves for concrete evaluation (https://engineering.unl.edu/cee/faculty/jinying-zhu/). Dr. Joseph Turner in Mechanical and Materials Engineering (based at UNL’s City Campus in Lincoln) focuses on ultrasound propagation through complex media for quantitative characterization of materials/microstructure (http://quisp.unl.edu ). This poster presents the graduate-level acoustics courses and lab facilities at UNL within the College of Engineering, and highlights the research interests and achievements of our faculty, graduates, and students. Extracurricular experiences are available through an Acoustical Society of America student chapter based on the Scott Campus and collaborations with Boys Town National Research Hospital.

Glomerular basement membrane deposition of collagen α1(III) in Alport glomeruli by mesangial filopodia injures podocytes via aberrant signaling through DDR1 and integrin α2β1.

In Alport mice, activation of the endothelin A receptor (ETAR) in mesangial cells results in sub‐endothelial invasion of glomerular capillaries by mesangial filopodia. Filopodia deposit mesangial matrix in the glomerular basement membrane (GBM), including laminin 211 which activates NF‐κB, resulting in induction of inflammatory cytokines. Herein we show that collagen α1(III) is also deposited in the GBM. Collagen α1(III) localized to the mesangium in wild‐type mice and was found in both the mesangium and the GBM in Alport mice. We show that collagen α1(III) activates discoidin domain receptor family, member 1 (DDR1) receptors both in vitro and in vivo. To elucidate whether collagen α1(III) might cause podocyte injury, cultured murine Alport podocytes were overlaid with recombinant collagen α1(III), or not, for 24 h and RNA was analyzed by RNA sequencing (RNA‐seq). These same cells were subjected to siRNA knockdown for integrin α2 or DDR1 and the RNA was analyzed by RNA‐seq. Results were validated in vivo using RNA‐seq from RNA isolated from wild‐type and Alport mouse glomeruli. Numerous genes associated with podocyte injury were up‐ or down‐regulated in both Alport glomeruli and cultured podocytes treated with collagen α1(III), 18 of which have been associated previously with podocyte injury or glomerulonephritis. The data indicate α2β1 integrin/DDR1 co‐receptor signaling as the dominant regulatory mechanism. This may explain earlier studies where deletion of either DDR1 or α2β1 integrin in Alport mice ameliorates renal pathology. © 2022 Boys Town National Research Hospital. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Toward an adaptive procedure for multi-frequency categorical loudness scaling: A Monte Carlo simulation study

To capture a listener’s loudness perception profile, categorical loudness scaling (CLS) is typically repeated at various frequencies. The current study aims to develop psychophysical procedures that enable simultaneous estimation of loudness growth across frequencies. For these procedures, the listener hears a pure-tone stimulus provides a categorical rating (“Soft,” “Loud,” etc.) on each trial. After a response is collected, the procedures update a model of the loudness profile and leverage the model to optimize the stimulus (i.e., level and frequency) for the next trial. The modified slope-adaptive procedure selects the stimulus from a uniform distribution spanning the model-predicted dynamic range, while the modified maximum expected information (MEI) procedure optimizes the stimulus based on an entropy metric. Monte Carlo simulations were conducted to evaluate the two procedures using a database that consists of CLS data collected from 148 listeners at Boys Town National Research Hospital. For each listener, the two procedures were run based on responses simulated using their known loudness profiles (i.e., the ground truth). Both procedures were able to estimate the loudness profile close to the ground truth, with a root-mean-square error (RMSE) of about 6 dB after 100 trials. Below 100 trials, the modified MEI procedure showed a lower RMSE.

Audibility and Spectral-Ripple Discrimination Thresholds as Predictors of Word Recognition with Nonlinear Frequency Compression.

Nonlinear frequency compression (NFC) lowers high-frequency sounds to a lower frequency and is used to improve high-frequency audibility. However, the efficacy of NFC varies widely-while some individuals benefit from NFC, many do not. Spectral resolution is one factor that might explain individual benefit from NFC. Because individuals with better spectral resolution understand more speech than those with poorer spectral resolution, it was hypothesized that individual benefit from NFC could be predicted from the change in spectral resolution measured with NFC relative to a condition without NFC. This study aimed to determine the impact of NFC on access to spectral information and whether these changes predict individual benefit from NFC for adults with sensorineural hearing loss (SNHL). Present study is a quasi-experimental cohort study. Participants used a pair of hearing aids set to the Desired Sensation Level algorithm (DSL m[i/o]). Participants were 19 adults with SNHL, recruited from the Boys Town National Research Hospital Participant Registry. Participants were seated in a sound-attenuating booth and then percent-correct recognition of words, and spectral-ripple discrimination thresholds were measured for two different conditions, with and without NFC. Because audibility is known to influence spectral-ripple thresholds and benefit from NFC, audibility was quantified using the aided speech intelligibility index (SII). Linear mixed models were generated to predict word recognition using the aided SII and spectral-ripple discrimination thresholds. While NFC did not influence percent-correct word recognition, participants with higher (better) aided SII and spectral-ripple discrimination thresholds understood more words than those with either a lower aided SII or spectral-ripple discrimination threshold. Benefit from NFC was not predictable from a participant's aided SII or spectral-ripple discrimination threshold. We have extended previous work on the effect of audibility on benefit from NFC to include a measure of spectral resolution, the spectral-ripple discrimination threshold. Clinically, these results suggest that patients with better audibility and spectral resolution will understand speech better than those with poorer audibility or spectral resolution; however, these results are inconsistent with the notion that individual benefit from NFC is predictable from aided audibility or spectral resolution.

Simultaneous Superiorly Based Pharyngeal Flap and Tonsillectomy: Evaluation of Speech and Pain Outcomes.

Controversy remains whether to perform a pharyngeal flap simultaneously with a tonsillectomy in patients with velopharyngeal insufficiency. The aim of this study is to revisit the speech outcomes and complications associated with the combined superiorly based pharyngeal flap and tonsillectomy procedure, while comparing pain outcomes. We hypothesize that the combined procedure will improve speech outcomes with minimal complications, but patients will experience more pain in the combined procedure.A 5-year retrospective review of registry data from Boys Town National Research Hospital was conducted from 2014 to 2019. Data collection included age, surgeries performed, length of stay, pain medication administration occurrences, immediate postoperative complications, postoperative speech outcomes specifically related to articulation (audible nasal airway emissions) and resonance (hypernasality).Eighty-eight patients had a superiorly based pharyngeal flap over this 5-year period. Eighteen patients (20%) had a simultaneous procedure performed. There were no patients who had immediate postoperative complications such as upper airway obstruction or bleeding complications that necessitated a reoperation. One of the patients had a pharyngeal flap dehiscence that required a revision pharyngeal flap in the combined group. Nasal airway emissions and hypernasality were eliminated in 58.3% and 75%of the combined patients, respectively. The total number of narcotic administration occurrences were significantly higher in the combined group than the pharyngeal flap only group (9.0 versus 7.0; P = 0.03).A number of velopharyngeal patients will present with hypertrophied tonsils. We believe that it is safe and beneficial to perform the combined procedure in the same setting.

Otoacoustic emissions: Laboratory studies and clinical applications

Historically, the clinical potential of otoacoustic emissions (OAEs) to diagnosis hearing status was recognized prior to any consensus regarding their cochlear origin. In retrospect, we now understand refection-generated emissions as being closely aligned with Kemp’s (1980) concept of “cochlear echoes,” while distortion-generated emissions are necessarily tied to nonlinearities in cochlear mechanics. Research at the Boys Town National Research Hospital provided evidence supporting the cochlear origin of OAEs by demonstrating an approximate two-times relationship between an estimate of forward-latency derived from auditory brainstem responses and the round-trip latency of OAEs for tone-burst stimuli. Our application of clinical decision theory to distortion-product OAE levels, based on a large number of both normal-hearing and hearing-impaired ears, helped to establish (1) the validity of using DPOAEs to identify the presence of hearing loss and (2) guidelines for the interpretation of DPOAE levels in the clinic. Our exploration of reflection-generated emissions that we call cochlear reflectance is a continuation of our efforts to further extend the clinical potential of OAEs.Historically, the clinical potential of otoacoustic emissions (OAEs) to diagnosis hearing status was recognized prior to any consensus regarding their cochlear origin. In retrospect, we now understand refection-generated emissions as being closely aligned with Kemp’s (1980) concept of “cochlear echoes,” while distortion-generated emissions are necessarily tied to nonlinearities in cochlear mechanics. Research at the Boys Town National Research Hospital provided evidence supporting the cochlear origin of OAEs by demonstrating an approximate two-times relationship between an estimate of forward-latency derived from auditory brainstem responses and the round-trip latency of OAEs for tone-burst stimuli. Our application of clinical decision theory to distortion-product OAE levels, based on a large number of both normal-hearing and hearing-impaired ears, helped to establish (1) the validity of using DPOAEs to identify the presence of hearing loss and (2) guidelines for the interpretation of DPOAE levels in the ...

How physical versus panned sources in dry or reverberant conditions affect accuracy of localization in sound field synthesis systems

Sound field synthesis systems vary in number and arrangement of loudspeakers and methods used to generate virtual sound environments to study human hearing perception. While previous work has evaluated the accuracy with which these systems physically reproduce room acoustic conditions, less is known on assessing subjective perception of those conditions, such as how well such systems preserve source localization. This work quantifies the accuracy and precision of perceived localization from a multi-channel sound field synthesis system at Boys Town National Research Hospital, which used 24 physical loudspeakers and vector-based amplitude panning to generate sound fields. Short bursts of broadband speech-shaped noise were presented from source locations (either coinciding with a physical loudspeaker location, or panned between loudspeakers) under free-field and modeled reverberant-room conditions. Listeners used a HTC Vive remote laser tracking system to point to the perceived source location. Results on how physical versus panned sources in dry or reverberant conditions impact accuracy and precision of localization are presented. Similar validation tests are recommended for sound field synthesis systems at other labs that are being used to create virtual sound environments for subjective testing. [Work supported by NIH GM109023.]

Determining the accuracy of sound field synthesis systems in reproducing subjective source locations

Sound field synthesis systems developed and applied to study human hearing perception differ in terms of the number and arrangement of loudspeakers in rooms of different sizes, and methods used to generate virtual sound environments. Research has evaluated how well such systems physically reproduce room acoustic conditions, but limited subjective data are available. This paper seeks to develop a method for determining the accuracy of the perceived localization of a virtual sound source generated using a multichannel sound synthesis system. A test method is applied to the sound field synthesis facility at Boys Town National Research Hospital, a room (5.8 m x 5.2 m x 2.7 m) with reverberation time of 0.16 s at 125 Hz and below 0.024 s at 250 Hz and above. Short bursts of broadband speech-shaped noise are presented at a number of virtual source locations under free-field and modeled reverberant-room conditions, and listeners are asked to point to the subjective source location. Subjective localization results are compared as functions of virtual sound location, and parameters of early reflections and reverberation in the modeled sound environment. Results are intended to guide future research on subjective room acoustics relevant to children's’ communication needs. [Work supported by NIH GM109023.]

The Big Screen Difference

The Big Screen Difference

Gender-based comorbidity in benign paroxysmal positional vertigo.

It has been noted that benign paroxysmal positional vertigo (BPPV) may be associated with certain disorders and medical procedures. However, most studies to date were done in Europe, and epidemiological data on the United States (US) population are scarce. Gender-based information is even rarer. Furthermore, it is difficult to assess the relative prevalence of each type of association based solely on literature data, because different comorbidities were reported by various groups from different countries using different patient populations and possibly different inclusion/exclusion criteria. In this study, we surveyed and analyzed a large adult BPPV population (n = 1,360 surveyed, 227 completed, most of which were recurrent BPPV cases) from Omaha, NE, US, and its vicinity, all diagnosed at Boys Town National Research Hospital (BTNRH) over the past decade using established and consistent diagnostic criteria. In addition, we performed a retrospective analysis of patients’ diagnostic records (n = 1,377, with 1,360 adults and 17 children). The following comorbidities were found to be significantly more prevalent in the BPPV population when compared to the age- and gender-matched general population: ear/hearing problems, head injury, thyroid problems, allergies, high cholesterol, headaches, and numbness/paralysis. There were gender differences in the comorbidities. In addition, familial predisposition was fairly common among the participants. Thus, the data confirm some previously reported comorbidities, identify new ones (hearing loss, thyroid problems, high cholesterol, and numbness/paralysis), and suggest possible predisposing and triggering factors and events for BPPV.

Menopause and benign paroxysmal positional vertigo.

This study was designed to examine the age and sex distribution and the effects of menopause in a large cohort of participants diagnosed with benign paroxysmal positional vertigo (BPPV). We analyzed 1,377 BPPV patients and surveyed 935 women from this group-all diagnosed at the Boys Town National Research Hospital in the last decade. A detailed age and sex distribution analysis of BPPV onset showed that aging had a profound impact on BPPV occurrence in both sexes, and that perimenopausal women were especially susceptible to BPPV (3.2:1 female-to-male ratio). The latter is a novel finding and was confirmed by a direct survey of female BPPV patients (168 participated). In addition, there was a pronounced female preponderance (6.8:1 female-to-male ratio) in BPPV in the teenage group despite its low prevalence in this age group. Data suggest that hormonal fluctuations (especially during menopause) may increase the tendency to develop BPPV.

Spotlight on Special Interest Division 7, Aural Rehabilitation and Its Instrumentation

You have accessThe ASHA LeaderSIG Spotlight1 Jul 2014Spotlight on Special Interest Division 7, Aural Rehabilitation and Its Instrumentation Kathleen M. CienkowskiPhD, CCC-A Kathleen M. Cienkowski Google Scholar More articles by this author , PhD, CCC-A https://doi.org/10.1044/leader.SIGS.19072014.np SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In How many affiliates does SIG 7 have? As of June 2014, SIG 7 has 313 affiliates. Why did you originally choose to affiliate with SIG 7? I have been an affiliate of SIG 7 for more than five years, and I have found it to be one of the most rewarding benefits of my ASHA membership. I learned about the SIG through its then-coordinator, J. P. Gagne. I was surprised that I knew so little about what the SIG had to offer—educational opportunities, Perspectives, online resources and more. The SIG has been an incredible resource for professional connections and information. What is the most important issue surrounding SIG 7’s subject matter right now? Access to affordable hearing health care is a hotly debated topic among professionals. Hearing aids and personal sound amplification products are available online through big-box stores and wholesale clubs. The question is, how will access to these lower-cost hearing devices affect the numbers of people with hearing loss seeking treatment and the quality of services they receive? SIG 7 notes that a device is only one part of effective hearing health care management. The provision of a range of services—including communication and auditory training, speechreading, assistive devices and counseling—are critical to successful hearing loss management. Audiologic rehabilitation is about understanding the consequences of hearing loss in our patients’ daily lives and working collaboratively to develop a management plan. SIG 7 is an important resource for clinicians seeking to provide this type of comprehensive care. What upcoming events related to or sponsored by SIG 7 should everyone know about? SIG 7 is sponsoring two events at the upcoming ASHA convention in Orlando. Jaclyn Spitzer from Columbia University, along with René Gifford from Vanderbilt University, will present a short course on new developments in implantable hearing devices. In addition, Michelle Hughes from Boys Town National Research Hospital will present a mini-seminar on “telehabilitation.” Both events promise to provide insightful information in these areas of hearing loss management. Which of your recent Perspectives articles is a must-read for CSD professionals, and why? Perspectives on Aural Rehabilitation and Its Instrumentation offers many excellent papers for SIG 7 affiliates. Our December 2013 issue includes a paper by Nerina Scarinci and colleagues, “Using a Family-Centered Care Approach in Audiologic Rehabilitation for Adults with Hearing Impairment,” that is a must-read. In keeping with SIG 7’s emphasis on patient-centered care, the article describes the crucial role of family in audiologic rehabilitation for older adults with hearing loss. The paper thoughtfully provides strategies for increased inclusion of family members in the rehabilitation process to promote the reduction of “third-party disability”—the impact of a person’s hearing loss on his or her family. Author Notes Kathleen M. Cienkowski, PhD, CCC-A, SIG 7 coordinator, is associate professor and audiology program director in the Department of Speech, Language and Hearing Sciences at the University of Connecticut. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 19Issue 7July 2014 Get Permissions Add to your Mendeley library History Published in print: Jul 1, 2014 Metrics Downloaded 76 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2014 American Speech-Language-Hearing AssociationLoading ...

Study of the knowledge of Pediatricians and Senior Residents Relating to the Importance of Hearing Impairment and Deafness Screening Among Newborns in Isfahan city in 2012

Introduction: Newborn hearing screening leads to the early detection of hearing impairment. The aim of screening is to decrease or remove the effect of hearing impairment on development of speech and language by timely diagnosis and effective treatment. A number of risk factors lead to delayed start of decreased hearing ability including: 1. Congenital infection with cytomegalovirus (CMV) virus, 2. Meningitis, 3. Mumps, 4. Positive family history, 5. Head trauma, 6. Chemotherapy, 7. Syndrome pertaining to delayed start of decreased hearing. Unfortunately, lack of attention to early diagnosis of hearing impairment is becoming a general health problem. No research has yet been carried out relating to the knowledge of pediatricians on this issue, particularly the importance of hearing impairment and hearing screening. The aim of this study was to determine the attitude to newborn hearing screening among pediatricians. Materials and Methods: This cross-sectional, descriptive-analytic study was conducted in Isfahan in 2012 among 300 pediatricians and final-year pediatric residents. An adjusted 22-question version of the Early Hearing Detection and Intervention (EHDI) questionnaire was used to collect data. The validity and reliability of the EHDI questionnaire was previously demonstrated by Boys Town National Research Hospital and its Farsi translated version was validated by the EDC Center at the Isfahan University of Medical Sciences. Results: In our study, 83% of pediatricians agreed on the importance of hearing impairment screening for all infants. However 65% were not aware of special needs for hearing-impaired patients. Conclusion: Newborn hearing impairment and deafness screening is important, irrespective of the costs, and lack of timely diagnosis results in both individual and social consequences. The majority of physicians use textbooks to gain information about hearing screening, but recognize that this is insufficient. Although it is now one of the most useful tools for gathering and applying new information, the physicians in our study rely very little on the Internet as a source of information.

Counting Down the ‘Tot 10’ Highlights of 2013

Counting Down the ‘Tot 10’ Highlights of 2013

Counting Down the ‘Tot 10’ Highlights of 2013

Counting Down the ‘Tot 10’ Highlights of 2013

Characteristics of Hearing Aid Fittings in Infants and Young Children

Hearing aids (HAs) provide the basis for improving audibility and minimizing developmental delays in children with mild to severe hearing loss. Multiple guidelines exist to recommend methods for optimizing amplification in children, but few previous studies have reported HA fitting outcomes for a large group of children. The present study sought to evaluate the proximity of the fitting to prescriptive targets and aided audibility of speech, as well as survey data from pediatric audiologists who provided HAs for the children in the present study. Deviations from prescriptive target were predicted to have a negative impact on aided audibility. In addition, children who were fitted using verification with probe microphone measurements were expected to have smaller deviations from prescriptive targets and greater audibility than cohorts fitted without these measures. HA fitting data from 195 children with mild to severe hearing losses were analyzed as part of a multicenter study evaluating outcomes in children with hearing loss. Proximity of fitting to prescriptive targets was quantified by calculating the average root-mean-square (RMS) error of the fitting compared with Desired Sensation Level prescriptive targets for 500, 1000, 2000, and 4000 Hz. Aided audibility was quantified using the Speech Intelligibility Index. Survey data from the pediatric audiologists who fit amplification for children in the present study were collected to evaluate trends in fitting practices and relate those patterns to proximity of the fitting to prescriptive targets and aided audibility. More than half (55%) of the children in the study had at least 1 ear that deviated from prescriptive targets by more than 5 dB RMS on average. Deviation from prescriptive target was not predicted by pure-tone average, assessment method, or reliability of assessment. Study location was a significant predictor of proximity to prescriptive target with locations that recruited participants who were fit at multiple clinical locations (University of Iowa and Boys Town National Research Hospital) having larger deviations from target than the location where the participants were recruited primarily from a single, large pediatric audiology clinic (University of North Carolina). Fittings based on average real-ear to coupler differences resulted in larger deviations from prescriptive targets than fittings based on individually measured real-ear to coupler differences. Approximately 26% of the children in the study has aided audibility less than 0.65 on the Speech Intelligibility Index (SII). Aided audibility was significantly predicted by the proximity to prescriptive targets and pure-tone average, but not age in months. Children in the study had a wide range of fitting outcomes in terms of proximity to prescriptive targets (RMS error) and aided speech audibility (SII). Even when recommended HA verification strategies were reported, fittings often exceeded the criteria for both proximity to the prescriptive target and aided audibility. The implications for optimizing amplification for children are also discussed.

Tot 10

Tot 10