Modernising Childrens Hearing Aid Services Speech Testing Wave 4 EJB 17/05/04

Modernising Childrens Hearing Aid Services Speech tests To inform on quality of hearing aid fitting To inform on quality of hearing aid fitting Tradition of neglect Tradition of neglect Falls between audiology and habilitation Particularly in Pre School HA User Used more by CI teams Used more by CI teams

Modernising Childrens Hearing Aid Services Detection Detection Discrimination Discrimination Word recognition Word recognition Speech understanding Speech understanding Areas of Interest

Modernising Childrens Hearing Aid Services One example is the Ling 5 (or 6!!) sounds One example is the Ling 5 (or 6!!) sounds oo - ah - ee - (mm) - sh – ss Gives information across the speech frequency range Gives information across the speech frequency range Auditory Speech Sound Evaluation (ASSE) Auditory Speech Sound Evaluation (ASSE) Sound Detection

Modernising Childrens Hearing Aid Services These tests should provide information useful for hearing aid fitting and possibly fine tuning These tests should provide information useful for hearing aid fitting and possibly fine tuning But no research to suggest exactly how fittings might be altered by speech test scores But no research to suggest exactly how fittings might be altered by speech test scores Examples (Closed set tests) Examples (Closed set tests) McCormick Automated Toy Test CCT (Consonant Cluster Task) Maltby Speech Perception Test Manchester Picture Test FAAF Sound Discrimination

Modernising Childrens Hearing Aid Services Examples Open set word tests Manchester Junior words Manchester Junior words Cambridge junior words Cambridge junior words AB word lists AB word lists Word Recognition

Modernising Childrens Hearing Aid Services Examples Sentence Tests BKB sentence lists BKB sentence lists ?Familiarity Speech Understanding

Modernising Childrens Hearing Aid Services First wave evaluation study 3 (mild- moderate-severe, age 7-15) used FAAF (Four Alternative Auditory Feature Test developed by Haggard and Foster 1987) First wave evaluation study 3 (mild- moderate-severe, age 7-15) used FAAF (Four Alternative Auditory Feature Test developed by Haggard and Foster 1987) In study 7 (severe/profoundly deaf group) if child was unable to perform on FAAF at above chance levels, The CCT (Consonant Cluster Task further developed by Marriage) was used. In study 7 (severe/profoundly deaf group) if child was unable to perform on FAAF at above chance levels, The CCT (Consonant Cluster Task further developed by Marriage) was used. Standardised test conditions through a calibrated system were important Standardised test conditions through a calibrated system were important First Wave Evaluation

Modernising Childrens Hearing Aid Services Difference between analogue and DSP p>0.0001

Modernising Childrens Hearing Aid Services Speech Testing Issues Acclimatisation Acclimatisation Familiarity of material Familiarity of material Degree of Hearing Loss (esp Severe/Profound) Degree of Hearing Loss (esp Severe/Profound) Uses – Counselling ? Uses – Counselling ? Uses - Fine tuning ? Uses - Fine tuning ? Uses – Changes to HA Provision ? Uses – Changes to HA Provision ? Further work required (esp Pre School) Further work required (esp Pre School) Calibration/Test Parameters Calibration/Test Parameters First wave – ambivalent First wave – ambivalent

Modernising Childrens Hearing Aid Services Auditory Speech Sound Evaluation (ASSE) Test

Modernising Childrens Hearing Aid Services Belgium Govaerts PJ, Belgium ASSE is a set of supraliminal auditory tests Test children with no or very limited speech Part of Paediatric Auditory Performance Test A speech and language independent test to measure the supraliminal auditory capacity All sounds that are used are balanced speech sounds common in many languages Auditory Speech Sound Evaluation

Modernising Childrens Hearing Aid Services Fifteen speech sounds that can be selected Selected speech sound presented 3 times Loudness can be set by the audiometer routine evaluation ca 70 dB SPL Patient is asked to tell whether sound heard Scoring is binary Correct(+) sound heard False (-) sound not heard ASSE Detection Test

Modernising Childrens Hearing Aid Services Other ASSE Tests Discrimination Discrimination Identification Identification

Modernising Childrens Hearing Aid Services Consonant Cluster Task (CCT) Test (Demo)

Modernising Childrens Hearing Aid Services Further developed by Marriage Further developed by Marriage The test involves 4 alternative monosyllabic real words represented by pictures. They have the same vowel but different consonants e.g. hen, peg, bed, egg The test involves 4 alternative monosyllabic real words represented by pictures. They have the same vowel but different consonants e.g. hen, peg, bed, egg There are 9 blocks of 6 presentations There are 9 blocks of 6 presentations The test can be given in quiet or competing noise conditions, and input level can be changed. The test can be given in quiet or competing noise conditions, and input level can be changed. There were no significant differences using this or FAAF in Study 7, the children did score better on the DSP hearing aids, but numbers were small so not significant. There were no significant differences using this or FAAF in Study 7, the children did score better on the DSP hearing aids, but numbers were small so not significant. Consonant Cluster Task (CCT)

Modernising Childrens Hearing Aid Services CCT Application Closed Set, 4 Alternative Picture Based Test Closed Set, 4 Alternative Picture Based Test Familiar Material from Reed Test Familiar Material from Reed Test Nonsense/Non Words excluded Nonsense/Non Words excluded All 4 items have same vowel sound All 4 items have same vowel sound E.g. Owl, House, Cow, Mouse E.g. Owl, House, Cow, Mouse Easier contrasts than APT1 Easier contrasts than APT1 CCT from ? age 3 years CCT from ? age 3 years

Modernising Childrens Hearing Aid Services CCT Presentation Level should avoid floor (score 95%) effects Level should avoid floor (score 95%) effects Performance/intensity function may be steep Performance/intensity function may be steep Useful to test at conversation (e.g. 65 dB) quiet (e.g. 50 dB) and loud (e.g. 80 dB) levels Useful to test at conversation (e.g. 65 dB) quiet (e.g. 50 dB) and loud (e.g. 80 dB) levels Pre-recorded better than live presentation for comparison (? not viable for young children) Pre-recorded better than live presentation for comparison (? not viable for young children) Can be presented in speech shaped noise at an appropriate speech/noise ratio Can be presented in speech shaped noise at an appropriate speech/noise ratio

Modernising Childrens Hearing Aid Services CCT Test Procedure CD Player & 2 Channel Audiometer + Loudspeaker CD Player & 2 Channel Audiometer + Loudspeaker Speech Channel 1 & Noise Channel 2 Calibrate using Track 1 Picture Card 1- familiarise with live voice Picture Card 1- familiarise with live voice Start CD Start CD Each Picture Card 6 presentation each picture card Score on confusion matrix score sheet

Modernising Childrens Hearing Aid Services CCT Interpretation Total number of correct responses Total number of correct responses Observation of errors in confusion matrix Observation of errors in confusion matrix Assess difficulty child has discrimination Assess difficulty child has discrimination

Modernising Childrens Hearing Aid Services APT1 Application Closed Set, 4 Alternative Picture Based Test Closed Set, 4 Alternative Picture Based Test All 4 items have same vowel sound All 4 items have same vowel sound E.g. Boat, Coat, Goat, Note E.g. Boat, Coat, Goat, Note More difficult contrasts than CCT More difficult contrasts than CCT 2 Sets Vowel & 8 Consonant confusion contrast 2 Sets Vowel & 8 Consonant confusion contrast APT1 from ? age 5 years APT1 from ? age 5 years

Modernising Childrens Hearing Aid Services Four Alternative Auditory Feature (FAAF) Test (Demo & Practical)

Modernising Childrens Hearing Aid Services FAAF Test A speech in noise test to measure speech intelligibility, and benefit from a hearing aid. A speech in noise test to measure speech intelligibility, and benefit from a hearing aid. Different speech levels and speech:noise ratios Different speech levels and speech:noise ratios The test is presented in a sound field room, from a loudspeaker 1.5m in front of the patient. The test is presented in a sound field room, from a loudspeaker 1.5m in front of the patient. The test can be carried out unaided in two interleaved conditions, and aided in four interleaved conditions. The test can be carried out unaided in two interleaved conditions, and aided in four interleaved conditions. Responses can be via a touch screen Responses can be via a touch screen

Modernising Childrens Hearing Aid Services FAAF Equipment FAAF Software (available from IHR) Laptop computer Compatible Sound Card (internal or USB) Suitable loudspeaker (and external amplifier) Child-friendly mouse or... Touch Screen hardware/software (e.g. KeyTech ca £150)

Modernising Childrens Hearing Aid Services FAAF Parameters Parameters for test can be changed May reduce test time Exercise caution Effect of noise reduction systems on DSP aids

Modernising Childrens Hearing Aid Services FAAF Parameters Can edit.ini file in program directory 4 is default, 0 will mean no feedback for incorrect answer (shorten test, less negative for child) Time (ms) that noise is on before speech (default is 500)

Modernising Childrens Hearing Aid Services FAAF Calibration SLM on a tripod, mic 1.5m away from speaker Set the SLM to A weighting; slow Click on File, then select Calibrate Check the output level bar is set to 50 dB Click on Play to play noise Adjust the volume so SLM reads 50 dBA (+/- 1dB) Quit by clicking on File, then Exit

Modernising Childrens Hearing Aid Services FAAF Suggested Instructions Four words will appear on the screen You will hear Can you hear X clearly? where X is a simple word Touch / use the mouse to indicate the word you think you heard This will be repeated but with a different word If you are not sure, try and choose the word you think was said There will be noise in the background most of the time, try to ignore it Touch here to continue will appear after each set of 4 sentences When you see this, it means that the speech and/or noise will get quieter or louder so be prepared for this This isnt a test and it can be difficult even for someone with good hearing

Modernising Childrens Hearing Aid Services Typical FAAF Screen Grey item is childs response Green item is correct answer

Modernising Childrens Hearing Aid Services FAAF Aided Test This test contains 80 sentences 20 Sentences in each condition Condition 1S:N=+10S=60N=50 Condition 2S:N=+5S=60N=55 Condition 3S:N=+10S=70N=60 Condition 4S:N=+5S=70N=65 Note scores on test form / PMS

Modernising Childrens Hearing Aid Services FAAF Typical Data Log File Summarise test parameters (.ini file) used Records test items,levels,responses for each presentation