1. Hearing problems in school – causes and solutions
Harvey Dillon
With thanks to:
Sharon Cameron
Robyn Massie
Helen Glyde

2. Presentation Overview
Causes of not hearing clearly in class Solutions Sound field amplification Auditory training for Spatial Processing Disorder (SPD)

3. Why don’t some children seem to hear and understand easily in class?

4. Children may not understand speech easily in the classroom because of:
Hearing loss
Sensorineural hearing loss – permanent
Conductive hearing loss
Language impairment (including ESL)
Cognitive deficit
Attention
Verbal working memory IQ
Auditory processing disorder
Spatial processing disorder
Other types
Poor classroom acoustics

5. Differentiating these problems based on symptoms
Acts (inappropriately) based on what was heard
Asks for repetition of instruction
Does nothing
Misbehaves
Response by child
Interpretation by observer
Daydreams
Badly behaved
Can’t follow instructions
Is not very smart
Poor concentration
Child fails to understand an instruction
Event
Cognition
Language
Auditory processing
Hearing loss

6. What solutions exist?

7. Solutions to help hear more clearly:
Language intervention
Hearing aids
Wireless remote microphones
Sound field amplification
Auditory training
Memory training

8. Matching treatment to condition
Language intervention
Hearing aids
Wireless remote microphone
Sound-field amplification
Auditory training
Memory training
Attention disorder
Language impairment √
Sensorineural hearing loss
Conductive hearing loss
(√ )
CAPD - general
CAPD – spatial processing disorder
Working memory deficit

9. THE IMPACT OF SOUND-FIELD AMPLIFICATION IN MAINSTREAM CLASSROOMs
Robyn Massie
Harvey Dillon

10. FACTORS AFFECTING CLASSROOM COMMUNICATION

11. Direct and reverberant fields in a room
Total
Noise
Reverberant
Direct

12. SOUND-FIELD AMPLIFICATION

13. PREVIOUS STUDY FINDINGS
INCREASED:
verbal communication
children’s response to teacher verbal instruction
child proactiveness in classroom discussion
children’s confidence
DECREASED:
disruptive behaviours
teacher voice fatigue

14. Aim of our study To investigate the effects of sound field amplification intervention on specific educational goals

15. METHOD Eight Grade 2 classes, in Queensland
242 children
43% Vietnamese, Samoan, Spanish, Aboriginal
Dual-channel sound-field amplification
Four classes started with amplification, four without. Change-over at mid year.
Educational attainment rated by teacher at year start, mid-year, and start of next year (Diagnostic Net)

16. PROCEDURE Teacher in-service training Audiological assessment
Classroom acoustic measurements

17. Hearing and acoustic results
Mean Hearing level
Overall effect
Mean noise
Mean Reverberation
Mean Signal-to-noise
15 dB
+ 7 dB
Actual Recommended
50 dB dB
1.5 secs secs
- 3 dB dB

18. Overall “ON” / “OFF”
Bars show 95% confidence intervals

19. Results by skill area and language at homeOn
Off

20. SUMMARY Positive effect on literacy and numeracy
Urgent need to improve classroom and acoustic environment

21. Spatial Processing Disorder: Overview
Diagnosis, cause, remediation

22. The Australian Broadcasting Commission
Catalyst
The Australian Broadcasting Commission

23. Link between SPD and
Chronic Otitis Media (middle ear infections)

24. SPD and chronic otitis media (COM)
50% of children (24/49) diagnosed with SPD at NAL reported a history of COM. (Dillon et al., 2012).
30% of children (15/50) previously diagnosed with COM at University of Melbourne were diagnosed with SPD. (Graydon & Rance, ongoing).
Spatial processing deficit worse for early onset age and longer duration of COM (n=35; Tomlin & Rance, under review).
6 yo children with history of COM have below average spatial advantage (n=17; z= -1.0) (Kapadia et al, 2012).
13-17 yo adolescents with history of COM have below average spatial advantage (n=20; z= -0.75) (Kapadia et al, 2014).
10% of a population sample (9/90) of Aboriginal children from remote Australia diagnosed with SPD. (Unpublished data).
7% of a population sample (10/144) of Aboriginal children from regional Australia diagnosed with SPD. (Cameron et al., in review).
Indigenous Australian children experience, on average, 2.6 years of conductive hearing loss (vs. 3 months for non-Indigenous children).

25. Interpretation Based on These and Other Studies
Chronic otitis media
Fluctuating access to binaural cues
reduced effectiveness in better-ear glimpsing

26. Remediation of SPD:
The LiSN & Learn Auditory Training Software

27. Target: The horse kicked six wet shoes

28. LiSN-S Results - Pre- vs. Post-Training
LC SRT p = 0.158
Talker Advantage p = 0.981
HC SRT p =
Spatial Advantage p =
Total Advantage p = 0.001
Vertical bars denote 0.95 confidence intervals
F(8, 64)=5.3847, p=.00003
Cameron & Dillon (2011)

29. LiSN & Learn – Preliminary Study
9 children with SPD (6 to 11 years)
LiSN & Learn – 2 games/day, 5 days/week, 12 weeks
10 dB
Better
Average SRT
First vs Last 30 Days
p =
LiSN & Learn SRT (dB)
Game Number
Cameron & Dillon (2011)

30. Self-Report Questionnaire - Pre- vs. Post-Training
Very Hard
Hard OK
Easy
Very Easy
SSQ –
Listening in Noise:
Pre vs Post - p = *
Post vs 3MP - p = 0.397
SSQ –
Listening in Quiet:
Pre vs Post - p = 0.103
Post vs 3MP - p = 0.529
Cameron & Dillon (2011)

31. Blinded Randomized Control Study
10 children (aged 6 yrs 0 mths to 9 yrs, 9 mths) diagnosed with LiSN-S as having SPD:
5 x LiSN & Learn (experimental group)
5 x Earobics (control group)
Questionnaires
Participant (LIFE)
Parent (Fishers)
Teacher (LIFE)
LiSN & Learn or Earobics training – 15 minutes daily x 60 sessions
Re-evaluate LiSN-S and questionnaires post-training
SSQ = Speech, Spatial and Qualities of Hearing Scale
LISN-S one-sided critical difference was calculated as (Mean Test-Retest Difference) - (1.64 x SD of Mean Test-Retest Difference).
This represents the decrease in dB needed to infer that there has been a genuine improvement in auditory performance on retest, taking into account mean practice effects and day-to-day fluctuations in performance.
Mean difference between test and retest was 0.5 dB for Low-cue SRT, 1.1 dB for High-cue SRT, 0.9 dB for talker advantage, 0.1 dB for spatial advantage, and 0.7 for total advantage.
A critical difference on the spatial advantage measure is 2.8 dB, and on the Low-cue SRT it is 2.5 dB 31 31

32. LiSN-S Results – Pre vs. Post Training
Earobics (n = 5)
Lisn & Learn (n = 5)
p = 0.03 to
p = 0.5 to 0.7
Cameron, Glyde & Dillon (2012)

33. Questionnaires – Post Training Improvements
L&L = 16 pts;
Earobics = 7 pts;
where 0 pts = “no improvement”
Teachers
Parents
Children
p = 0.028
L&L = 31%; Earobics = 9%
L&L = 22%; Earobics = 9%

34. Spatial Processing Disorder: Prevalence in a clinical population

35. Australian Hearing’s CAPD Service
Operating in 42 Australian Hearing centers around Australia since May 2012.
Diagnosis, assessment and management of specific aspects of CAPD.
Recruitment targets children experiencing difficulty hearing in background noise.
Tests are chosen which:
Have been shown to be associated with difficulties in real life.
Are reliable, repeatable and relatively quick to administer.
Lead to remediation that is backed by research evidence.

36. Test structure LiSN-S Auditory memory (digits forward and reverse)
Remediate
(L&L)
LiSN-S
Auditory memory
(digits forward and reverse)
Remediate
(Memory booster)
Remediate
(wireless remote microphone)
Dichotic digits

37. Age Distribution
N=618

38. Minimal Sensorineural
Passes and Fails
666 23 4
Mild Conductive
Hearing screening
Minimal Sensorineural 3
Pass
636
Unknown
Z <
Fail
120
LiSN - HC
LiSN
SPD
19%
Z ≥ -1
307
Auditory memory
Fail
167
Pass (not SPD)
209
Memory
26%
Pass 349
< 7 years 76
Age
Testing discontinued
≥ 7 yrs 273
Dichotic deficit
DDT
Fail
100
20%
Pass 173
27%

39. National CAPD service results: LiSN & Learn effects

40. LiSN & Learn training: COSI results

41. Effect of Memory Booster training

42. COSI scores for Memory Booster training

43. Take-home messages Children need to hear their teacher easily
Many deficits in children prevent this
Many classroom prevent this
Acoustics can be improved
Classroom amplification helps everyone
Spatial Processing Disorder (SPD) is common but can be diagnosed and cured

44. Disclosure
The National Acoustic Laboratories, is an Australian government laboratory
NAL licences the LiSN-S test to Phonak, and is paid a royalty on sales.
NAL directly sells the LiSN & Learn training package through its web site.

45. CAPD.NAL.gov.au - TV news story
Thanks for listening
The support of the Commonwealth Department of Health is greatly appreciated
CAPD.NAL.gov.au - TV news story
- science TV show 45