Warble Tone Research Articles

Piezoelectric Bone Conduction Hearing Implant: A Case Series of Audiological, Surgical and Patient-Reported Outcomes.

Objective: To examine the surgical, audiological and patient-reported outcomes of the Osia 2 implant. Methods: Data from 14 consecutive subjects undergoing implantation between April 2022 and November 2023 were reviewed. Ten subjects had conductive hearing loss, three had mixed hearing loss and one had single-sided deafness (SSD). Warble tone thresholds, Pure Tone Average (PTA4) and Speech Discrimination Score (SDS) in quiet and in noise were determined unaided and aided. The subjective outcome was determined from two standardized questionnaires: (1) International Outcome Inventory for Hearing Aids (IOI-HA) and (2) Speech, Spatial and Qualities of Hearing Scale 12 (SSQ12b). Results: Unexpected postoperative pain was found in four cases. The warble tone thresholds exhibited a consistent reduction across all frequencies, contributing to a mean decrease of 27 dB in the aided PTA4. SDS demonstrated notable improvements, with a 57.3% increase at 50 dB and a 55.6% increase at 65 dB. In noise, SDS exhibited a 43.9% improvement. The mean IOI-HA Score was 3.8, and the mean overall score for SSQ12b was 6.6, with consistent findings across the subgroups. Conclusions: The Osia device emerges as a promising recommendation for individuals with conductive or mixed hearing loss, possibly also for those with SSD. Its safety and efficacy profile aligns with the broader category of active transcutaneous devices, demonstrating a reduced risk of wound infection compared to percutaneous alternatives. Both audiological assessments and subjective evaluations revealed positive outcomes.

White noise use among children undergoing sound field audiometry: A preliminary study

ObjectiveTo describe the prevalence of routine white noise exposure in children who undergo sound field audiometry. MethodsA retrospective cohort study was conducted at a pediatric otolaryngology clinic affiliated with an academic tertiary care hospital. The medical records of children who underwent sound field audiometry were reviewed and data was collected regarding demographics and audiogram results. The group was divided into two cohorts based on routine exposure to white noise. Children exposed to white noise were tested with warble tones, while those not exposed were tested with narrow-band noise. Results127 patients underwent sound field audiometry testing, of which 96 (75.6%) were reported by their parents to use white noise for sleep. The mean age at time of testing was 1.6 years (95% Confidence Interval [CI] 1.5–1.7). 104 (81.9%) children were able to respond to at least four of the sound field thresholds, and there was no significant difference between the children exposed to white noise and those who were not (P = 0.459). Mean pure tone average (PTA) was 26.2 dB (95% CI 25.2–27.2) and mean speech reception threshold (SRT) was 19.2 dB (95% CI 18.2–20.2). The sound field response rate, PTA, and SRT were similar between these two groups. ConclusionsThe routine use of white noise therapy was extremely common in this pediatric population. The use of warble tones as the audiometric stimuli for children exposed to white noise resulted in similar testing success compared to the use of narrow-band noise in children not exposed to white noise.

Objective verification of audibility in bone conduction devices

Objective To objectively measure audibility in patients wearing bone conduction devices (BCDs) with a new approach using a skin microphone at the patient’s forehead. Design The skin microphone was attached by a softband and shielded by an earmuff. This set-up was confirmed not to be influenced by neither noise floor nor sound bypassing the BCD. Sound field warble tones were used for measuring aided hearing thresholds and maximum power output (MPO) whereas an international speech test signal (ISTS) was presented at different speech levels. Study sample 29 patients were tested (two were bilateral), 19 used percutaneous, eight used active transcutaneous and two used passive transcutaneous devices. Results The skin microphone responses at ISTS levels, hearing threshold and MPO, could be obtained in all patients. Two patients with poor audibility are highlighted in this article as examples. After adjusting the gain of the BCD, they were retested with the skin microphone (for verification) and with speech-in-noise tests (for validation). Both tests confirmed an improved audibility after the adjustments. Conclusion In summary, the proposed measurement of audibility of speech using a skin microphone is a promising method that can be used in a clinical setting for all types of BCDs.

Comparison of the Ling-6 Sound Test with Warble Tone Stimuli in Audiometry of Hearing-Impaired Children Using Hearing Aids Considering Different Prescriptions and Normal-Hearing Children

Background and Aim: Speech is a vital stimulus and the ultimate goal of hearing aid fitting to make the speech an audible signal. The purpose of this research was to investigate whether it is possible to track the threshold with speech phonemes and which of the two fitting methods of Desired Sensation Level version 5.0 (DSL v5.0) and National Acoustic Laboratories-Nonlinear 2 (NAL-NL2) provide better audibility for the phonemes. Methods: In this cross-sectional study, the unaided thresholds of 18 normal-hearing children and the aided thresholds of 15 hearing-impaired children aged 5-8 years were evaluated with two types of stimuli. DSL v5.0 and NAL-NL2 methods were used for hearing aid fitting in hearing-impaired children. Results: There was a significant relationship between the unaided and aided thresholds of each phoneme and the warble tone threshold at the corresponding frequency (p<0.01), except for the phoneme /s/. The results showed a significant difference between the aided thresholds of each phoneme and the upper limit of the speech banana in the corresponding frequency for each method (Z=–4.99, p≤0.001). Conclusion: The results showed that phonemes could be used to assess unaided and aided thresholds. In the first fit, both methods estimated the amount of amplification that caused the average aided thresholds for these six phonemes for moderate to severe hearing loss to be positioned within the speech banana range, except for the average aided thresholds for the /s/ phoneme in the NAL-NL2 method that was placed outside the range. Keywords: Ling-6 sound test; pediatric audiometry; desired sensation level version 5.0; national acoustic laboratories-nonlinear 2

Optimal Choice for Improving the Hearing in Children with Unilateral Microtia and Atresia: Softband or Adhesive Adapter?

Introduction: A nonsurgical bone conduction hearing aid (BCHA) is a well-established treatment for children with congenital unilateral microtia and atresia (UMA). To date, limited studies have evaluated the audiological characteristics of the different wearing modes in the same nonsurgical BCHA. Methods: Eighteen patients with UMA aged 5–24 years were included. Warble tones at frequencies of 0.5, 1, 2, and 4 kHz were presented to determine functional hearing gain (FHG) of hearing thresholds (in dB HL) in the sound field. The speech perception abilities were assessed by the speech discrimination score (SDS, in %) of monosyllables, disyllables, and sentences in quiet and noise using the Chinese Mandarin speech test materials. Hearing outcomes were evaluated with the ADHEAR™ worn on a softband and with an adhesive adapter. A correlational analysis was conducted to analyze the correlations between variables (e.g., age, height, weight, body mass index [BMI], bone conduction pure-tone threshold, and air conduction pure-tone threshold) and the differences in the two wearing modes. Results: The mean FHG (standard deviation, SD) at 0.5–4 kHz was 20.63 (3.94) dB HL with the adhesive adapter and 26.39 (3.15) dB HL with the softband. When aided with the BCHA, significant improvements in SDS were revealed in all Mandarin speech test material lists either in quiet or noise for both wearing modes. Compared with the adapter mode, the softband provided higher aided SDS values. Correctional analyses revealed that higher BMI values were positively associated with larger delta outcomes between the two coupling methods of the softband and adhesive adapter in patients with UMA. Furthermore, a larger delta average FHG of 0.5–4 kHz was consistently associated with larger delta monosyllabic SDS in quiet, disyllabic SDS in quiet, and disyllabic SDS in noise. Discussion: To the best of our knowledge, this is the first study to compare the hearing benefits of coupling methods using novel adhesive adapters and conventional softbands with the same audio processor (ADHEAR™). Under uniform internal settings, softband integration provided more hearing benefits than adhesive adapter integration, and the differences were more obvious in patients with higher BMI values. Besides, a brief measurement of FHG can be utilized to predict individualized speech perception levels.

Sound Localization in Unilateral Cochlear Implant Users

Purpose: Sound is localized by two ears. People with bilaterally severe-to-profound hearing loss may struggle to identify the direction of a sound if their hearing device delivers sound only one ear due to the loss of binaural advantage. The purpose of this study was to systematically investigate the sound localization performance of people with unilateral cochlear implant users. Methods: Ten unilateral cochlear implant users and 10 normal hearing adults participated in this study. Sound localization tests were conducted using five stimuli (speech, speech with noise, 500 Hz warble tone, 1 kHz warble tone, and 4 kHz warble tone) presented from eight loud-speakers. Correct responses and root- mean-square errors were obtained to investigate the localization performances and error patterns. Additional factors including the Korean-Speech Spatial and Qualities of Hearing Questionnaire were also analyzed. Results: Localization performance was significantly poor in the unilateral cochlear implant group showing polar patterns toward their hearing side. While the normal hearing group showed better localization for speech in quiet conditions compared to 500 Hz warble tone, the cochlear implant group did not show any statistical difference in performance across the stimuli due to their very poor performance. The Korean-Speech Spatial and Qualities of Hearing Questionnaire was associated with localization performance in limited conditions. Conclusion: The present study revealed that unilateral cochlear implant users correctly localize a sound at nearly chance levels. The Korean-Speech Spatial and Qualities of Hearing Questionnaire predict localization performance for unilateral cochlear implant users only for particular conditions.

Perceptual Loudness Growth in Cochlear Implant Users

Purpose: Despite a growing number of cochlear implant (CI) studies, little attention has been given to loudness perception. The overall purpose of this study is to obtain the perceptual loudness growth from CI users and systematically investigate it with other relevant variables.Methods: Fourteen CI users and 14 normal hearing (NH) adults participated in this study. Loudness growth functions were obtained using three warble tones presented at 500 Hz, 1 kHz, and 4 kHz. Sentence recognition tests were implemented under favorable and adverse noise conditions. Mapping parameters including T-level, C-level, and electrical dynamic range were analyzed in conjunction with outcomes from the loudness growth.Results: The loudness growth curves for CI group were sharper than those for NH group. CI group showed a narrower acoustic dynamic range than NH group. There was no significant relationship between acoustic dynamic range and electrical dynamic range for CI users. Sentence recognition scores in adverse noise conditions were associated with electrical dynamic range in CI users. In NH group, a significant positive relationship was found between sentence recognition scores in adverse condition and acoustic dynamic range.Conclusion: This study showed that the perceptual loudness growth of CI users is not identical to that of NH adults, due to the unique way of signal processing mechanisms. Acoustic dynamic range for CI users seems affected by gain control algorithms. The adjusting mapping parameters associated with loudness may improve speech perception performance regardless of the dynamic range of CIs.

Detection thresholds with active hearing protection devices in quiet and noise

The Real-Ear Attenuation at Threshold (REAT) method is a standardized (ANSI/ASA S12.6) method of assessing the passive attenuation of hearing protection devices (HPD), including electronic HPDs with the electronics turned off. Characterizing HPDs with electronics turned on is performed with the Microphone in Real Ear (MIRE) method, or with an acoustic test fixture, as described in ANSI/ASA S12.42. It has been proposed that the REAT method may be useful for characterizing the effect of HPDs on detection of ambient sounds for HPDs with hear-through microphones, including the effects of electronics noise from the HPD. In this study, detection thresholds were measured with three electronic earmuff-type HPDs using a method similar to the REAT method. Detection thresholds were obtained for warble tones presented from a loudspeaker placed in front of the subject in a sound treated room. Thresholds were measured with unoccluded ears and with three HPDs with hear-through capability in quiet and in noise. In addition, thresholds were measured with one of the HPDs with foam earplugs inserted into both ears to simulate a conductive hearing loss. The results point to the interaction between device noise, ambient noise, and human absolute thresholds as limitations on the detectability of ambient sounds.

Hearing and Language Outcomes of Cochlear Implant Users in Zagazig University Program

Introduction: The most common congenital sensory deficit is sensory neural hearing loss (SNHL), with a 1:3 occurrences per 1000 live births, this incidence increases to 4-5% in neonates with risk factors for SNHL. For severe to profound deaf persons, cochlear implantation has been used as a successful method to regain partial hearing. Children with CIs are now able to communicate and understand speech, learn spoken language, and attend regular schools. Objectives: The aim of this study was to assess auditory perception threshold of cochlear implant users in Zagazig University Hospitals and evaluate their speech and language outcomes.Patients and methods: This study included 62 participants operated in zagazig university hospital and follow the candidacy criteria for cochlear implantation of Zagazig University CI program. All patients were subjected to postoperative audiological and phonological assessment including Warble tone response thresholds in sound field, aided speech discrimination, language test and speech analysis.Results: The results of this study revealed a statistically significant improvement in hearing thresholds and increase in speech intelligibility in the studied group. By comparing total language age with CI age there was 56.5% of cases have total language age less than CI age and 43.3% of cases have total language age equal and more than CI age.

Interrater Reliability for a Two-Interval, Observer-Based Procedure for Measuring Hearing in Young Children.

Purpose To overcome methodology limitations for studying auditory development in young children, we have recently developed an observer-based procedure that uses a conditioned, play-based, motor response (see Bonino & Leibold, 2017). The purpose of this article was to examine interrater reliability for the method. Method Video recordings of test sessions of 2- to 4-year-old children (n = 17) were examined. Detection of a 1000-Hz warble tone was measured with the Play Observer-Based, Two-Interval (PlayO2I) method in each of two conditions: for a fixed intensity level (30 dB SPL) or for a variable intensity level signal (0-30 dB SPL). All test sessions were scored independently by three observers (one real-time, two offline). Observer consensus was evaluated with Fleiss' kappa statistic. To determine if summary data were similar across the observers of each test session, the proportion of correct trials (fixed-level condition) or threshold (variable-level condition) were computed. Results The strength of observer consensus was classified as "almost perfect" and "substantial" for the fixed-level and variable-level conditions, respectively. Follow-up analysis of the variable-level data indicated that differences in observer consensus were seen based on the signal level, the type of response behavior provided by the child, and the confidence level of the real-time observer. Resulting summary data were similar across the three observers of each test session: no significant differences for estimates of the proportion of correct trials or threshold. Conclusions Results from this study confirm strong interrater reliability for the method. The PlayO2I method is a powerful tool for measuring detection and discrimination abilities in young children. Supplemental Material https://doi.org/10.23641/asha.12978197.

Comparison of Pure-Tone Thresholds and Cochlear Microphonics Thresholds in Pediatric Cochlear Implant Patients.

In adult cochlear implant patients, conventional audiometry is used to measure postoperative residual hearing which requires active listening and patient feedback. However, audiological measurements in pediatric cochlear implant patients are both challenging as well as time consuming. Intracochlear electrocochleography (ECOG) offers an objective and a time-efficient method to measure frequency-specific cochlear microphonic or difference thresholds (CM/DIF) thresholds that closely approximate auditory thresholds in adult cochlear implant patients. The correlation between CM/DIF and behavioral thresholds has not been established in pediatric cochlear implant patients. In the present study, CM/DIF thresholds were compared with audiometric thresholds in pediatric cochlear implant patients with postoperative residual hearing. Thirteen (11 unilateral and 2 bilateral) pediatric cochlear implant patients (mean age = 9.2 years ± 5.1) participated in this study. Audiometric thresholds were estimated using conventional, condition play, or visual reinforcement audiometry. A warble tone stimulus was used to measure audiometric thresholds at 125, 250, 500, 1000, and 2000 Hz. ECOG waveforms were elicited using 50-msec acoustic tone-bursts. The most apical intracochlear electrode was used as the recording electrode with an extra-cochlear ground electrode. The ECOG waveforms were analyzed to determine CM/DIF thresholds that were compared with pediatric cochlear implant patients' audiometric thresholds. The results show a significant correlation (r = 0.77, p < 0.01) between audiometric and CM/DIF thresholds over a frequency range of 125 to 2000 Hz in pediatric cochlear implant patients. Frequency-specific comparisons revealed a correlation of 0.82, 0.74, 0.69, 0.41, and 0.32 between the audiometric thresholds and CM/DIF thresholds measured at 125, 250, 500, 1000, and 2000 Hz, respectively. An average difference of 0.4 dB (±14 dB) was measured between the audiometric and CM/DIF thresholds. Intracochlear ECOG can be used to measure CM/DIF thresholds in pediatric cochlear implant patients with residual hearing in the implanted ear. The CM/DIF thresholds are similar to the audiometric thresholds at lower test frequencies and offer an objective method to monitor residual hearing in difficult-to-test pediatric cochlear implant patients.

The effects of behind-the-ear and off-the-ear sound processors on speech understanding performance in cochlear implant users

ObjectiveThe first aim of this study was to compare speech understanding performance in adult cochlear implant users using behind-the-ear and off-the-ear sound processors in quiet and noise. Second, the impact of sound processor microphone location on speech understanding performance was compared. MethodsParticipants were tested with both types of sound processors in the free field with warble tones, and speech discrimination scores in quiet were obtained. Turkish Matrix Test was used to measure speech understanding in noise with five different loudspeaker settings. Twenty-seven participants of cochlear implants between 16 and 67 years-of-age using behind-the-ear or off-the-ear sound processors were included in the study. The results obtained with two types of sound processors were compared. ResultsAided free field thresholds were significantly better for the behind-the-ear vs. off-the-ear sound processor. The mean difference was 3.3 dB HL. There was no significant difference in speech discrimination scores in quite between the two processors (p > 0.05). Statistically significant differences were not seen for speech intelligibility in five spatial settings in the Turkish Matrix Test (p > 0.05). ConclusionAlthough both types of sound processors had different microphone locations, the outcomes were found to be consistent with previous results in adult users off-the-ear sound processors, demonstrating equivalent speech understanding in quiet and noise.

Three-Year Follow-Up with the Bone Conduction Implant

Background: The bone conduction implant (BCI) is an active transcutaneous bone conduction device where the transducer has direct contact to the bone, and the skin is intact. Sixteen patients have been implanted with the BCI with a planned follow-up of 5 years. This study reports on hearing, quality of life, and objective measures up to 36 months of follow-up in 10 patients. Method: Repeated measures were performed at fitting and after 1, 3, 6, 12, and 36 months including sound field warble tone thresholds, speech recognition thresholds in quiet, speech recognition score in noise, and speech-to-noise thresholds for 50% correct words with adaptive noise. Three quality of life questionnaires were used to capture the benefit from the intervention, appreciation from different listening situations, and the ability to interact with other people when using the BCI. The results were compared to the unaided situation and a Ponto Pro Power on a soft band. The implant functionality was measured by nasal sound pressure, and the retention force from the audio processor against the skin was measured using a specially designed audio processor and a force gauge. Results: Audiometry and quality of life questionnaires using the BCI or the Ponto Pro Power on a soft band were significantly improved compared to the unaided situation and the results were statistically supported. There was generally no significant difference between the two devices. The nasal sound pressure remained stable over the study period and the force on the skin from the audio processor was 0.71 ± 0.22 N (mean ± 1 SD). Conclusion: The BCI improves the hearing ability for tones and speech perception in quiet and in noise for the indicated patients. The results are stable over a 3-year period, and the patients subjectively report a beneficial experience from using the BCI. The transducer performance and contact to the bone is unchanged over time, and the skin area under the audio processor remains without complications during the 3-year follow-up.

Cochlear Implant Mapping Through Telemedicine—A Feasibility Study

Access to postoperative aural rehabilitation limits cochlear implant (CI) penetration to the candidate population. The purpose of this study was to evaluate the effectiveness of remote CI programming and aural rehabilitation via telehealth. Retrospective study of one cochlear implant center. Patients undergoing cochlear implantation from 2015 to 2018 undergoing remote programming as part of routine audiologic follow up. AzBio scores, impedances, comfort and threshold levels, and responses to the International Outcome Inventory for Hearing Aids questionnaire modified for CIs (IOI-CI). A total of 22 CIs in 20 patients were included during the study period. Threshold, comfort, and impedance levels were readily obtained via telehealth and were not significantly different between telehealth and live sessions. AzBio scores and warble tone pure tone averages were also similar and acceptable in both session modalities. Based on IOI-CI scores, patients were very satisfied with their hearing outcomes. Using telemedicine, reliable measurements were readily obtained and hearing outcomes after remote programming were comparable to those expected after in-person programming sessions. Patients were overall satisfied with their remote programming sessions. Telehealth is a cost-effective and safe way to deliver post-CI audiologic care, particularly to patients with limited mobility or those in remote locations.

Comparison of Intensity Discrimination between Children Using Cochlear Implants and Typically Developing Children.

Differential sensitivity of intensity is known to be important for the perception of the relative distance of sounds in the environment, emotions of speakers, and localize sounds. However, a few features in listening devices, such as cochlear implants, used by individuals with hearing loss alter the output intensity heard by them. This makes soft sounds loud and loud sounds soft. Hence, the aim of the present study was to compare the intensity discrimination of children using cochlear implants with that of typically developing children. Intensity discrimination of 30 children (15 using cochlear implants and 15 typically developing children) was obtained for three warble tones (500 Hz, 1000 Hz, and 4000 Hz) and three vowels (/a/, /i/, and /u/). The responses of the two participant groups, obtained using a 3-alternative forced-choice technique, were compared. Children using cochlear implants performed significantly poorer than typically developing children for the 4000 Hz warble tone and for the vowels /a/ and /u/. However, there was no significant difference for the remaining stimuli. The study indicated that the intensity discrimination threshold varies as a function of the frequency of the signals in children using cochlear implants. Intensity discrimination for high-frequency tones was significantly poorer for typically developing children, but not for low-frequency tones. In contrast, children using cochlear implants performed similarly to typically developing children for the high-frequency vowel but not for the mid- and low-frequency vowel.

Speech Perception Outcomes in Transcutaneous Versus Percutaneous Bone Conduction Stimulation in Individuals With Single-sided Deafness.

To investigate the differences in percutaneous versus passive transcutaneous bone-conduction stimulation in individuals with single-sided deafness. Prospective, single-subject. Tertiary academic referral center. Adult bone-anchored implant listeners with single-sided deafness using a percutaneous implant system. Experienced percutaneous bone anchored implant recipients were tested in the percutaneous and transcutaneous conditions using a BAHA 5 (Cochlear Corp., Cochlear Bone-Anchored Solutions, Mölnlycke, Sweden) sound processor on the patient's own abutment and on a softband. Phoneme recognition was assessed using Consonant-Nucleus-Consonant (CNC) words for soft (47 dB SPL) and average (62 dB SPL) speech inputs. Speech perception in noise performance was also assessed for soft (47 dB SPL) and average (62 dB SPL) speech inputs using sentences presented in multi-talker babble. Aided free-field thresholds were obtained in both conditions using warble tone stimuli. Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain for high frequency stimulation. Transcutaneous stimulation required higher signal to noise ratios to achieve comparable performance to the percutaneous condition. Phoneme recognition was poorer in transcutaneous versus percutaneous stimulation with the most significant impact observed for soft speech inputs. A significant performance gap in speech recognition is observed between percutaneous and transcutaneous bone-conduction stimulation in individuals with single-sided deafness at the same signal to noise ratios. Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain, decreased phoneme recognition, word recognition, and performance in noise, with the most significant impact observed for soft speech inputs.

Audiological correlates of cone beam computed tomography (CBCT) in cochlear implant recipients

Objectives: To evaluate the role of Cone beam CT (CBCT) regarding the intracochlear electrode position, the exact localization of the electrode in either the Scala tympani or Scala vestibuli and any accompanying inner ear trauma to the delicate intracochlear structures and furthermore correlate these findings with the hearing thresholds and speech tests in patients with unilateral cochlear implant (CI).Method: A total number of 20 subjects were examined in this study, 6 males and 14 females, their ages ranged from 3 to 10 years who underwent cochlear implantation. CBCT was done to the entire study group 3 months after surgery. After one year, audio logical evaluation was done in the form of aided warble tone response, aided speech reception threshold and early speech perception test (ESP) both in quiet and in noise. The study group was subdivided according to the degree of inner ear trauma into four groups: grade 0 trauma (9 subjects), grade I trauma (3 subjects), grade II trauma (3 subjects), grade III trauma (5 subjects).Results: There was a significant difference among no trauma patients and trauma patients regarding the insertion angle, aided threshold at 250 Hz, percentage of working electrodes and ESP in noise test. Moreover, significant inverse correlation was present between the grade of trauma and both ESP in noise and the percentage of working electrodes.Conclusions: The optimal image quality and the small radiation dose renders CBCT as an optimal and secure imaging tool for the assessment of the CI electrode location and evaluation of inner ear trauma as it affects postoperative programing and hearing perspectives.

A Two-Interval, Forced-Choice, Observer-Based Procedure for Evaluating Hearing Sensitivity in Children With Motor and Developmental Impairments.

Purpose It can be challenging to collect reliable behavioral responses to sound from individuals with significant motor or developmental impairments, the most common types of comorbid disability found in children with hearing loss (e.g., Gallaudet Research Institute, 2011). The purpose of this study was to test the feasibility of using a 2-interval, forced-choice, observer-based method for individuals considered to be difficult-to-test using behavioral audiometric assessments. Method Participants were 5 children with motor and developmental impairments, ages 5-15 years (M = 11.6, SD = 4.6). The functional abilities of all participants were greater than 2 SDs below the mean, as measured by the Vineland-II Parent Caregiver Rating Form. Participants listened to either a male talker saying the word "playground" or a 1000-Hz warble tone, presented via an insert earphone or a sound field speaker. An observer, blind to signal presentation, selected 1 of 2 temporal intervals, determining which contained the signal based only on participant behavior. Criterion was reached when the observer correctly identified the interval containing the signal for 8 of the last 10 trials. Results An 80%-correct criterion was met for all participants, suggesting feasibility for use in children with motor or developmental impairment. Two participants were tested using an adaptive tracking procedure; a reliable threshold estimate was obtained for both children. This method offers promise for children who have difficulty performing behavioral audiometric assessments currently in use clinically.

Development of Sound Field Audiometry System for Small Audiometric Booths and Comparison of Its Equivalence With Traditional System.

ObjectivesSound field (SF) audiometry tests are usually conducted in audiometric booths measuring greater than 2×2 m in size. However, most private ENT clinics carry about 1×1-m-sized audiometric booths, making SF audiometry testing difficult to perform. The aims of this study were to develop an SF audiometry system for use in smaller audiometric booths and compare its performance with traditional system.MethodsThe newly developed SF audiometry system can yield an SF signal at a distance of about 30 cm from the subject’s ears. Its height can be adjusted according to the subject’s head height. We compared SF hearing results between the new SF system and the traditional SF audiometry system in 20 adults with normal hearing (40 ears) and 24 adults with impaired hearing levels (38 ears) who wore hearing aids. Comparative parameters included warble tone audiometry threshold, a speech reception threshold (SRT), and a speech discrimination score (SDS). For statistical analysis, paired t-test was used. The equivalence of both SF systems was tested using two one-sided test (TOST) with a margin of 5 dB (normal hearing participants) and 10 dB (hearing aids wearing participants).ResultsAmong participants with normal hearing, warble tone hearing thresholds of 0.5, 1, 2, and 4 kHz, average values of these four frequencies, and SRT were similar between the two systems (all P>0.05). Participants with hearing aids showed similar warble tone threshold and SRT (P>0.05) in both systems except for threshold of 4 kHz (P=0.033). SDS was significantly higher in the newly developed system (P<0.05). TOST results showed equivalent SF audiometry results using either system.ConclusionAudiometric results of the newly developed SF audiometry system were equivalent to those of a traditional system. Therefore, the small SF audiometry system can be used at small audiometric booths present in most private ENT clinics.

Behavioral Assessment of Hearing in 2- to 7-Year-Old Children: Evaluation of a Two-Interval, Observer-Based Procedure Using Conditioned Play-Based Responses.

Purpose It is challenging to collect reliable behavioral data from toddlers and preschoolers. Consequently, we have significant gaps in our understanding of how auditory development unfolds during this time period. One method that appears to be promising is an observer-based procedure that uses conditioned, play-based responses (Bonino & Leibold, 2017). In order to evaluate the quality of data obtained with this method, this study presented a suprathreshold signal to determine the number of trials 2- to 7-year-old children could complete, as well as the associated hit rate and observer confidence. Method Participants were 23 children (2-7 years old). Children were taught to perform a play-based motor response when they detected the 1000-Hz warble tone signal (at 30 dB SPL). An observer evaluated children's behavior using a 2-interval, 2-alternative testing paradigm. Testing was terminated after 100 trials or earlier, if signs of habituation were observed. Results Data were successfully collected from 22 of the 23 children. Of the 22 children, all but 1 child completed 100 trials. Overall hit rate was high (0.88-1.0; M = 0.94) and improved with listener age. Hit rate was stable across the test session. Strong agreement was seen between the correctness of the response and the observer's confidence in the judgment. Conclusion Results of this study confirm that the 2-interval, observer-based procedure described in this article is a powerful tool for measuring detection and discrimination abilities in young children. Future research will (a) evaluate coder reliability and (b) examine stability of performance across a test session when the signal intensity is manipulated. Supplemental Material https://doi.org/10.23641/asha.8309273.