1. Harvey Dillon Carolyn Mee Testing hearing is child’s play John SeymourJesus Cuauhtemoc

2. Each year approximately 250 000 children start school

4. Hearing loss in those first fitted with hearing aids at 5 or 6 years of age.

6. What can interrupt understanding the teacher clearly at school? Permanent hearing loss Middle ear infections Auditory processing disorder Specific language impairment English as a second language Attention deficit disorder Asperger’s / autism spectrum disorder Poor classroom acoustics

7. Problems in combination Aboriginal children all too often have – Middle ear infection  “temporary” hearing loss Spatial processing disorder Learning in a second language Noisy classroom

8. Aim 1: develop a game to test for hearing issues in preschool and school-aged children Sensorineural hearing loss Middle ear disorders Auditory processing disorders Aim 2: differentiate these conditions !

9. cmee4 Productions COLLABORATION

11. TRIALS

12. Basis of the test algorithm 1.Test of word recognition threshold in quiet  used to set level of rest of test  comparison with threshold for adult useful itself 2.Test of speech recognition in spatially separated noise 3.Test of tone perception in noise

13. Bird calls in noise

14. Expected results GroupCalibration testSpeech in noise test Tone in noise test Normal√√√ Conductivex√√ Sensorineuralxxx CAPD√x? ESL, language impairment ?x√

15. PASS: Speech-in-noise average; tone-in-noise good

16. FAIL: speech-in-noise and tone-in-noise both poor Sensorineural loss

17. FAIL: Speech-in-noise poor, tone-in-noise good CAPD or language disorder

18. PASS: Speech-in-noise average; tone-in-noise good

19. Adjustment of items

20. Validity checking Standard error of Cal, Speech-in-noise and Tone-in-noise Number of false positives to tone Excessive linear trend during adaptive track Adult hearing poorer than child

21. Normative data: 4 to 12 years Speech in noise Z scores 1.4 dB per year of age

22. Normative data: Speech in quiet 0.9 dB per year of age Tone in noise

23. Deriving results Normal hearing children Obtain scores Regress against age Express scores as z- scores Combine z- scores for calibration, speech and tone Compare z- scores for calibration, speech and tone Overall pass, uncertain, or fail Probable cause of fail Test unknown child

24. How well does Sound Scouts detect that there is a problem?

25. Is there a hearing loss? – worse ear

26. Overall results GroupPassInconclusiveFailIncompleteTotal Norm hear78721097 Conductive3221026 Sensori4325537 TOTAL85124815160 Wrong results for 9 out of 160 cases. All 7 incorrect passes had <30 dB 4FA HL in poorer ear.

27. Calibration (speech in quiet) results

28. Speech- in-noise results

29. Tone-in- noise results Unilateral losses

30. How accurately does Sound Scouts diagnose the type of problem?

31. Which is this child closest to? Speech in quiet z-score Tone in noise z-score Speech in noise z-score

32. Ability to diagnose problem Number of diagnoses for those with a “Fail” 012 Conductive (n=21)110 Sensorineural (n=25)5164 Total 62614

33. Correctness of single diagnosis SensorineuralCondCAPD/Lang Sensorineural (n=16)1222 Conductive (n=10)370 TOTAL1592

34. Do anywhere – monitor anywhere Audiologist portal

36. Status Available on app store - $14.99 per test Evaluated for conductive loss and sensorineural loss Still to be evaluated for auditory processing disorders (spatial processing disorder) Audiologist portal available ~ August International applications

37. Thanks for listening www.NAL.gov.au www.SoundScouts.com.au Thanks to: Australian Department of Health Sanna Hou, Taegan Young, Kiri Mealings, Trish Van Buynder, Lauren Burns, Lyndal Carter