Evaluating New Technologies

Transcription

1 Evaluating New Technologies RUTH BENTLER UNIVERSITY OF IOWA Levels of Evidence* APFs (Catherine Palmer, 29) What does the algorithm do? What are the parameters that impact the doing? Efficacy of the design In a well-controlled (contrived?) environment, do we get an effect? Or, what is the effect of the feature in the lab? Effectiveness of the design In the real-world use of this design, do we get an effect? Or, what is the effect of the feature in the real world? 1 *Ala Bentler 1

2 Levels of Evidence* APFs (Catherine Palmer, 29) What does the algorithm do? What are the parameters that impact the doing? Efficacy of the design In a well-controlled (contrived?) environment, do we get an effect? Or, what is the effect of the feature in the lab? Effectiveness of the design In the real-world use of this design, do we get an effect? Or, what is the effect of the feature in the real world? Efficiency (not studied in my lab) Directional Microphones *Ala Bentler 8 APFs THE FIRST STEP IS TO UNDERSTANDING THE BLACK BOX

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8 43 44 Theoretical FF (BTE) KEMAR (BTE) Cardioid Hypercardioid Supercardioid Cardioid Hypercardioid Theoretical FF (ITE) KEMAR (ITE) Supercardioid

9 And so Polargram owe are able to measure the acoustic and physical facts (APFs) for all possible scenarios of test; osuch APF testing is necessary to develop our hypotheses; onewer technique for quantifying polar response patterns and directivity indices (DI) helps us understand static function in a dynamic world of noise Wu & Bentler, 29, 21, 212)! 5 Data? 1 Test Booth Field Ratings 1 Very Good Plenty of efficacy data for all designs depending upon Baseline used Speaker arrangement Noise type Etc Effectiveness data a bit harder to come by Percent Correct p <.1 p <.1 OMNI DIR Very Poor 6 / 75 / +2 Speech CST Test Condition Understanding in Noise Walden, Surr, & Cord, 23 9

10 Research Question of Study #1 How do visual cues affect DIR benefit? Laboratory Real world Speech recognition test Speech Recognition Performance 1 Speech Recognition (%) DIR OMNI Auditory-Only OMNI-AO OMNI-AV DIR-AO DIR-AV SNR (db) Wu & Bentler, 21, Ear Hear 1

11 Speech Recognition Performance Summary of Study 1 Speech Recognition (%) Audiovisual Auditory-Only OMNI-AO OMNI-AV DIR-AO DIR-AV The advantage (benefit) of visual cues can overshadow the measured benefit of directional mic schemes in real world environments SNR (db) Wu & Bentler, 21, Ear Hear Research Question of Study #2 How does age impact DIR benefit? Laboratory Real world Laboratory DIR Benefit (%) F(1, 21) = 1.21 p = Age Wu, 21, JAAA Real World DIR Preference (%) F(1, 21) = p =.3 Summary of Study #2 Listeners of different ages obtain comparable benefits from DIR in the laboratory. Older users tend to perceive less DIR benefit than do younger users in the real world. Due to lifestyle differences, primarily The focus of future efforts in the lab Age Wu, 21, JAAA 11

12 Example of unexpected function Forward DIR Front Forward DIR Backward DIR Back Backward DIR 7 Directional Benefit (db) p =.17 p <.5 Backward DIR Front Back Backward DIR Wu, Stangl & Bentler, 213 Conversation Our Data Manufacturer s Listening Condition Data Big dogs can be dangerous. Forward DIR Front Big dogs can be dangerous. Forward DIR Forward DIR Front Forward DIR Backward DIR Back Backward DIR Back The boy fell from the window. 12

13 Directional Benefit (db) Wu, Stangl & Bentler, 213 p <.5 p =.17 Conversation Our Data Manufacturer s Listening Data Condition Briefly, for DIR APFs are clear as to expected impact Efficacy has been demonstrated repeatedly; newer algorithms take special consideration Effectiveness depends on many factors Environment, age, etc crud Digital Noise Reduction Analog NR (198-9s) Early spectral approaches Switch ASP (means low frequency compression) Adaptive filtering Frequency dependant input compression Adaptive compression TM Zeta Noise Blocker TM 75 Today s versions omost are modulation-based with some algorithm for where and how much gain reduction should occur; oat least one other (Oticon) first introduced a strategy called synchronous morphology treating harminic inputs like speech; omany are now implementing Wiener filters as well; omany are now implementing impulse noise reduction; omany also use some mic noise reduction, expansion, wind noise reduction, and even directional mics as part of the strategy they promote. APFs THE FIRST STEP IS TO UNDERSTANDING THE BLACK BOX

14 2 Siemens (TRIANO 3) GN ReSound (CANTA 77-D) Difference (db, 1/3 Octave) SIREN -1 TRAFFIC DINING Frequency (Hz) Difference (db,1/3octave) a Frequency (Hz) Starkey (AXENT II AV MM) 7dB 5 2 Difference (db,1/3octave) b Frequency (Hz) ICRA Speech Random Noise Babble ON versus OFF (output change) Frequency (Hz) SNR SNR5 SNR1 SNR15 85dB 5 Starkey J13 Axent AV 75 db --SPEECH,RANDOM, MUSIC-- 2 ON versus OFF (output change) SNR SNR5 DIFFERENCE (db,1/3octave) SNR1 SNR Frequency (Hz) Frequency(Hz) Guitar Piano Saxophone with background music Random Noise Plain Speech 14

15 Output SNR (re: Linear) What happens in the time domain? Siemens (Triano) APFs 1 years later Starkey (Axent) 88 Any reason to expect SNR-5 would change? Miller et al

16 Data? Still, plenty of efficacy and effectiveness data for all designs if you are asking the right question: Walden et al (2) Boymans and Dreschler (2) Alcantara et al (23) Ricketts & Hornsby (25) Marcoux et al (26) Mueller et al (28) Bentler et al (29) Sarampalis et al (29) Bentler et al (21) Stelmachowicz et al (21) Pittman et al (211): And those are good outcomes Briefly, for DNR APFs are clear as to expected impact Efficacy and Effectiveness have been demonstrated if you are asking the right question Not really a new concept Frequency Lowering Four (sort of) choices on the market: Frequency compression Frequency transposition Frequency cueing Combination of above Concept makes sense Providing the widest input bandwidth possible Data suggest this may be most important for children re: speech and language development 93 What is happening here? APFs THE FIRST STEP IS TO UNDERSTANDING THE BLACK BOX. Frequency compression hearing aid Default settings Steeply sloping loss Freq compression: OFF Assessed on 11/23/9 SN:96H19W Input: 1s pure tones 1 Hz spaced with 5ms intervals (~75dB SPL) Upper graph: output of Hearing aid

17 1 st peak: 3468 Hz, 2 nd peak: 491 Hz, 3 rd peak: 47 Hz Input: 491 Hz 1 st peak: 3661 Hz, 2 nd peak: 436 Hz, 3 rd peak: 4927 Hz Input: 436 Hz st peak: 3765 Hz, 2 nd peak: 4392 Hz Input 4392 Hz 1 st peak: 47 Hz, 2 nd peak: 4694 Hz, 3 rd peak: 5336 Hz Input 4694 Hz st peak: 549 Hz Input 549 Hz 1 st peak: 5598 Hz Input 5598 Hz

18 1 st peak: 5457 Hz, 2 nd peak: 693 Hz Input: 693 Hz 1 st peak: 5553 Hz, 2 nd peak: 621 Hz Input: 621 Hz st peak: 5665 Hz, 2 nd peak: 563 Hz Input 639 Hz 1 st peak: 1937 Hz, 2 nd peak: 2562 Hz Input 6395 Hz What is happening here? 1 st peak: 171 Hz, 2 nd peak: 171 Hz, 3 rd peak: 2346 Hz Input: 491 Hz Frequency compression hearing aid Default settings Steeply sloping loss Freq compression: ON Assessed on 11/23/9 SN:96H19W Input: 1s pure tones 1 Hz spaced with 5ms intervals (~75dB SPL) Upper graph: output of Hearing aid

19 1 st peak: 1894 Hz, 2 nd peak: 1538 Hz Input: 436 Hz 1 st peak: 127 Hz, 2 nd peak: 1359 Hz, 3 rd peak: 2851 Hz, 4 th peak: 21 Hz, 5 th peak: 2482 Hz Input 4392 Hz st peak: 1343 Hz, 2 nd peak: 1656 Hz, 3 rd peak: 1981 Hz, 4 th peak: 2626 Hz Input 4694 Hz 1 st peak: 1351 Hz, 2 nd peak: 1672 Hz, 3 rd peak: 1981 Hz, 4 th peak: 2626 Hz Input 549 Hz st peak: 1287 Hz, 2 nd peak: 1916 Hz, 3 rd peak: 241 Hz, 4 th peak: 2562 Input 5598 Hz 1 st peak: 1624 Hz, 2 nd peak: 226 Hz, 3 rd peak: 297 Hz Input: 693 Hz

20 1 st peak: 172 Hz, 2 nd peak: 2368 Hz Input: 621 Hz 1 st peak: 183 Hz, 2 nd peak: 2466 Hz Input 639 Hz st peak: 1937 Hz, 2 nd peak: 2562 Hz Input 6395 Hz 75 Output (frequency in Hz) Uncompressed CF6.; CR1.5 CF5.9; CR2.1 CF4.7; CR2. CF3.8; CR1.9 CF3.2; CR1.8 CF2.6; CR1.7 CF2.2; CR1.7 CF1.9; CR1.5 CF1.7; CR1.6 CF1.5; CR1.5 CF1.5; CR2. CF1.5; CR2.5 CF1.5; CR3.2 CF1.5; CR Input (frequency in Hz) 117 Graph from A Perreau dissertation, Output of frequency-lowering hearing aids as a function of input frequency High-pass filter Processing of data blocks Output (frequency in Hz) * *N=7/11: Lowered Output <15Hz Microphone Cutoff Frequency FFT Bin 1 Bin 2 Bin 3... Bin 24 Σ Oscillators Bin 1 Bin 2 Bin 3... Bin 24 Σ Receiver Input (frequency in Hz) Low-pass filter delay = 9 ms Graph from A Perreau dissertation, Graph from A Perreau dissertation,

21 Sound quality Guitar Original Guitar Max Comp Piano Original Piano Compressed Singer Original Singer Compressed Evidence (efficacy here): Better speech-sound perception Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test Evidence: Evidence: Better speech perception/satisfaction Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test Better speech perception/satisfaction Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test Evidence: Better speech perception/satisfaction Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test Evidence: Better speech perception/satisfaction Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test 21

22 Evidence: Better speech perception/satisfaction Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test Evidence: Better speech perception/satisfaction Simpson et al (25) 8/17 improvement phoneme recognition Simpson et al (26) 1/7 (words) 1/5 (sentences) improved speech perception; 1/6 better APHAB Kuk et al (27; 29) improved consonant recognition (group) Gifford et al (27): 2/6 improved sentence recognition in Q and N; more (group) benefit on EC, BN and RV subscales of APHAB Robinson et al (27) 4/7 improved affricates; 5/7 improved /s and /z/ Nyffeler (28) improved (group) satisfaction (11 adults) Robinson et al (29) 1/5 improved affricates; 1/5 improved /s and /z/ Glista et al (29) 5/11 children, 5/13 adults benefit for /s/ and /z/ detection O Brien et al (21) initial improvement in speech perception (23 adults) Wolfe at al (21) group improvement for tokens /asa/ and /ada/ in quiet (15 children) Wolfe et al (211) group improvement for tokens /asa/, /ata/ and /ada/ in quiet; after 6 mo. of use improvement on nonsense syllable SRT in quiet, 13/15 improved on plural test And now for the conflicting evidence: Worse performance or no change Simpson et al (25) 8/17 no improvement phoneme recognition; 1/17 poorer Simpson et al (26) 4/7 (words) 4/5 (sentences) no improvement speech perception; 2/7 (words) poorer; 4/6 APHAB preference for conventional amplification, 1/6 APHAB no preference Kuk et al (27; 29): no change in vowel recognition (group data; n=13, 8) Gifford et al (27): 4/6 no diff in sentence recognition in Q and N; more (group) aversiveness on APHAB Robinson et al (27) 3/7 no effect affricates; 2/7 no improvement /s and /z/ Nyffeler (28) no improvement (group) in sentence recognition in noise Robinson et al (29) 2/5 decreases performance affricates; 4/5 no improvement /s/ and /z/; 4/5 preferred control (no compression) condition 1/5 had no clear preference Glista et al (29) 5/11 children, 6/13 adults no benefit for /s/ and /z/ detection; 1/11, 1/13 showed poorer performance O Brien et al (21) initial improvement in speech perception (23 adults) disappeared after 8 weeks. No difference/improvement on SSQ. Wolfe at al (21) no improvement (group) for sentence recognition in noise or for tokens /afa/, /aka/, /asha/ or /ata/ in quiet Wolfe et al (211) no improvement (group) for sentence recognition in noise or for tokens /afa/, /aka/, or /asha/, no effect for 2/15 who performed at ceiling on plural test More recent data (still efficacy) Mussoi pre-dissertation project: Less is more Musical training makes the distortion more negative % Preference No compression NH-NT NH-T HL-NT HL-T Moderate compression NH-NT NH-T HL-NT HL-T Group Max. compression Slight preference Moderate preference Strong preference NH-NT NH-T HL-NT HL-T More recent data (still efficacy) Perreau dissertation Adults tend to opt for conventional technology as the bimodal option to CI No objective evidence of better localization More recent data (still efficacy) Perreau dissertation Adults tend to opt for conventional technology as the bimodal option to CI No objective evidence of improved speech perception Perreau, Bentler & Tyler, 213 Perreau, Bentler & Tyler,

23 Effectiveness data Perreau dissertation Adults tend to opt for conventional technology as the bimodal option to CI.. OCHL Study (real effectiveness data) NIH/NIDCD R1 DC956 Outcomes of Children with Hearing Loss Co-PIs Mary Pat Moeller, J Bruce Tomblin Multi-site (UIowa, UNC, Boys Town) Using accelerated longitudinal design Recruited children 6 mos-7 years of age Follow same children for 3+ years Lengthy burden tables resulting in many data points! Perreau, Bentler & Tyler, Recruitment Sampling Regions Iowa, Nebraska, Eastern Kansas/Northern Missouri, Illinois, Southern Virginia, North Carolina, Minnesota Sampling Method Referral from Newborn Hearing Screening Children identified in EHDI via follow up clinics Children identified via audiology or medical service providers Children identified through school screening Sample 321 children with hearing loss 182 children with normal hearing Ages 6 months to 7 years, 3 months Speaks English in the home No major secondary disabilities Permanent Bilateral Mild to Severe Hearing Loss PTA of db HL (5, 1k, 2k, 4 khz) 137 Domains of Study Opportunity to observe: Hearing & Speech Perception Speech Production Language Skills Academic Abilities Psychosoci al and Behavioral What hearing aids children wear; How they are fit; How long they wear them (i.e., use time); What kind of audibility is provided; If any of the above impact outcomes in speech and language. Background characteristics of child/family Child and Family Outcomes Interventions (clinical, educational, audiological) 23

24 This Data Set Three age levels (3-, 4- and 5-yr olds) All children had 1+ yrs. experience with aids and ~equal number in each group: Nonlinear Frequency Compression (NLFC) Conventional signal processing Data from one site only since that site fit majority of subjects using NLFC, using best-practice verification protocol. Questions Are children using nonlinear frequency compression (NLFC) in their hearing aids getting better access to the speech signal than children using conventional processing schemes? Questions Are children using nonlinear frequency compression (NLFC) in their hearing aids getting better access to the speech signal than children using conventional processing schemes? We hypothesized that children whose hearing aids provided wider input bandwidth would have more access to the speech signal, as measured by an adaptation of the Speech Intelligibility Index (SII, ANSI S , R27) Questions Are speech and language skills different for children who have been fit with the two different technologies; if so, in what areas? Questions Are speech and language skills different for children who have been fit with the two different technologies; if so, in what areas? We hypothesized that if the children were getting increased access to the speech signal as a result of their NLFC hearing aids (Question 1), we would see improved performance in areas of speech production, morphosyntax, and speech perception compared to the group with conventional processing. Demographics No significant differences between groups (NLFC and conventional processing) at any age (3, 4, 5): Age loss confirmed Age began intervention Months using hearing aids Reported daily use time Datalogged use time Mother s education Family income All children wore current hearing aids > 1 year 24

25 Outcome Measures, Age 3 Outcome Measures, Age 4 Goldman-Fristoe Test of Articulation-2 (GFTA-2, Goldman & Fristoe, 2) is a standardized measure of speech production; Vineland Adaptive Behavior Scales-II (VABS-II; Sparrow, Cicchetti, & Balla, 25), parent-report questionnaire of personal/social behavior; Comprehensive Assessment of Spoken Language (CASL 3-4; Carrow-Woolfolk, 1999), standardized measure of global language development. VABS-II also administered in the 4-year old protocol; Test of Preschool Early Literacy (TOPEL; Lonigan et al., 27), standardized measure of early literacy, specifically phonological processing and print knowledge; CASL 3-4 also administered in the 4-year old protocol; Wechsler Preschool and Primary Scales of Intelligence-III (WPPSI-III; Wechsler, 22), standardized measure of verbal and nonverbal intelligence Outcome Measures, Age 5 Goldman-Fristoe Test of Articulation-2 also administered in the 5- year old protocol; Peabody Picture Vocabulary Test-4 (PPVT-4; Dunn & Dunn, 27), standardized measure of receptive vocabulary; TOPEL also administered in the 5-year old protocol; CELF-4 Word Structure. Subtest of the Clinical Evaluation of Language Fundamentals-4 (CELF-4; Semel, Wiig, & Secord, 23), assesses morphological development using picture stimuli; Comprehensive Test of Phonological Processing (CTOPP; Wagner, Torgesen, & Rashotte, 1999), standardized measure of phonological processing; Preschool Language Assessment Instrument (PLAI-2; Blank et al, 23), standardized measure of expressive and receptive discourse; PBKs for speech perception Hearing Level (db) Three-year olds Non-Compressed Compressed Frequency (Hz) 3 year olds NLFC Conventional P value GFTA Vineland CASL Better ear PTA Better ear aided SII (5) Better ear aided SII (65) Better ear unaided SII Hearing Level (db) Four-year olds Non-Compressed Compressed Frequency (Hz) 25

26 4-year olds NLFC Conventional P value Vineland CASL TOPEL Phono WPPSI Block WPPSI Reasoning WPPSI Vocab Better Ear PTA Hearing Level (db) Five-year olds Non-Compressed Compressed Frequency (Hz) 5-year olds Limitations NLFC Conventional P value GFTA PPVT TOPEL CELF PLAI PBK Better Ear PTA Not a true comparison of impact of NLFC on bandwidth (i.e., audibility) in that this was a between-groups analysis; Reflects best-case fitting methods, which may not be representative of other clinics; The audiometric data of the subjects did not support assumption that NLFC would be more readily fit to children with more sloping configuration of loss. 156 Summary of OCHL findings OCHL Team Members In this study, audiograms and unaided audibility (ala SII) same for both groups at each age; Aided audibility was not different for the two groups (NLFC and Conventional) for soft or average inputs; As an expected consequence, speech and language outcomes were not different for the two groups. Emerging data suggest that detection may be enhanced for some children, but there is still little evidence of broader advantage for children of this audiometric profile. More longitudinal data of this sort necessary. University of Iowa J. Bruce Tomblin, Ph.D. (Co-PI) Marlea O Brien, Program Coordinator Rick Arenas (IT) Ruth Bentler, Ph.D. Lenore Holte, Ph.D. Elizabeth Walker, Ph.D., CCC-A/SLP Connie Ferguson, M.S., CCC-SLP Marcia St. Clair, SLP Examiner Wendy Fick Jacob Oleson, Ph.D. (biostatistics) BTNRH Mary Pat Moeller, Ph.D. (Co-PI) Patricia Stelmachowicz, Ph.D. Meredith Spratford, Au.D. Lauren Berry, M.S., CCC-SLP Emilie Sweet, M.S., CCC-SLP Sophie Ambrose, Ph.D. (LENA) University of North Carolina-Chapel Hill Melody Harrison, Ph.D. Patricia A. Roush, Au.D. Shana Jacobs, Au.D. M. Thomas Page, M.S., CCC-SLP 26

27 Briefly, for frequency lowering APFs are manageable, but different for different algorithms; Efficacy has been demonstrated repeatedly in terms of sibilant detection & discrimination for adults and children; Little effectiveness data not very encouraging. What can we do? i.e., we as in clinicians, not me as in researcher What can we do? Know the black box (APFs) DIR/DNR: test it! Frequency Lowering: Verify it! Look at efficacy measures: Have high ecological validity Represent individual s listening environments Include a variety of test situations Look at effectiveness COSI, e.g. Self-report measures..and the evidence will have the strength (both in level and grade) to impact decision-making in the clinics. Buzz words Evidence-based design Evidence-based practice Evidence Evidence Evidence So, how does this all go? Three prongs Empirical evidence Clinician experience/evidence Patient needs and characteristics Acknowledgements National Institute on Disability and Rehabilitation Research (NIDRR) National Institute on Health (NIH/NIDCD) ASHFoundation AAA Foundation Starkey laboratories, Inc. Siemens Hearing Instruments, Inc. Research participants 27