BAA, Manchester, 2013 Does amplification improve speech in noise perception and localisation accuracy of children with unilateral hearing loss? A.Jauncey, C. Munro, J. Benne and D. Vickers UCL Ear Institute, 332 Gray s Inn Road, London. RNTNE, 336 Gray s Inn Road, London
Clinical Motivation for Research Congenital Unilateral Hearing Loss (UHL) is now identified at birth under Newborn Hearing Screening (NHSP). Also identified later in childhood. Children with UHL struggle in complex listening environments e.g. The classroom (Bess and Tharpe, 1984 and Dancer et al, 1995). What? Speech in noise perception (SPIN) (Ruscetta et al, 2005) and Localisation (LOC) (Humes et al, 1980) accuracy is effected. What is the most effective management and rehabilitation for children with UHL? (Sutton et al, 2012) 2
Objectives / Hypotheses NHS Audit / Service Evaluation Does the hearing aid (HA) actually improve SPIN perception and LOC? Using objective and subjective measures Null Hypotheses 1) There is no difference in LOC with or without the HA. 2) There is no difference in SPIN perception with or without the HA. 3
Participants 10 initially recruited. 1 cancelled and 1 technical error prevented testing. VARIABLES: age range 4 17 years / usage 2 months to 2 years / 4 Conductive hearing loss (CHL) 3 sensori neural hearing loss (SNHL) and 1 mixed hearing loss. 4
Objective Assessments -2 Assessments: LOC and SPIN -2 conditions: with HA and without (randomised) Task 1 : LOC Completed by 7 children 5 toys displayed on screens 15 degrees apart Hello, what s this? Child matches image on touch screen to where they think the sound came from. 5
LOC Results Wilcoxon, z = -2.37 p = 0.02 Non- parametric statistical tests. All reported at the 0.05 significance level. Significant decline in localisation accuracy with amplification, across the group. All of the children s localisation accuracy was worse when in the aided condition. 6
Objective Task 2: SPIN Closed set IHR - McCormick Automated Toy Discrimination Test (10 toy version) (Summerfield, 1994). 7
SPIN Results worse better Huge variation in Spatial Release from Masking (SRM) change as a result of amplification. No significant difference between the aided and unaided scores to either the better or worse ear across the group. No relationship between time with hearing aids or level of hearing loss. 8
Subjective Assessments -2 Assessments: Speech, Spatial and Qualities of Hearing scale for parents of children with impaired hearing (SSQ-P) and a Unilateral Hearing Loss Questionnaire (UHL Q) -2 conditions: pre and post amplification Task 1: SSQ P (Galvin et al, 2007) -Parents only -Retrospective -3 Sub sections: speech; spatial and quality of hearing e.g. Completed by 8 children 9
SSQ P Results 3 5 Close to sig. dif. on pre HA score between children with R or L HL (Mann-Whitney, Z = -1.94, p=0.05). Total: Wilcoxon, z= -2.830, p = 0.017 Speech: Wilcoxon, z= -2.37, p = 0.02 Spatial: Wilcoxon, z= -2.20, p = 0.028 Qualities: Wilcoxon, z= -1.820, p = 0.069 Sig. dif. Between pre and post HA scores in right HL group (Z = -2.02, p = 0.043 but not in those with left HL (Wilcoxon, Z= -1.60, p = 0.11). 10
Subjective Task 2: UHL Q - Child and parent sections - Pre and post HA fitting - E.g.s Parent Question: Your child s ability to accurately localise a sound source BEFORE Hearing Aid 1 2 3 4 5 WITH Hearing Aid 1 2 3 4 5 Child Question: being able to tell where sound is coming from BEFORE Hearing Aid 1 2 3 4 5 WITH Hearing Aid 1 2 3 4 5 11
UHL Q Results All parents record improvement with amplification 6/8 children report improvement with amplification Parents perception did not always match the child's. Sig. dif. In pre and post child scores (Wilcoxon, z = -2.207, p = 0.027). Sig dif. In pre and post parent scores (Wilcoxon, (z = - 2.527, p = 0.012) 12
Conclusions Subjective Benefit but no Objective Benefit WHY? More participants needed! Thoughts for clinical practice Consider the hearing loss, not just that it is unilateral. Consider the Hearing Aid (Johnstone et al, 2010 a and b, Van de Boggaert, 2011). Auditory Training (Irving and Moore, 2011). Counselling 13
With Thanks to Participating children and their families Staff at the RNTNE, Nuffield Centre Project Supervisor: Dr Deborah Vickers 14
Thank you amy.jauncey.09@ucl.ac.uk 07791855862
References Bess, F.H., & Tharpe, A.M. (1984). Case history data on unilateral hearing-impaired children. Ear and Hearing. 7: 14-18. Briggs, L., Davidson, L., Lieu, J.E. (2011). Outcomes of Conventional Amplification for Pediatric Unilateral Hearing Loss. Ann Otol Rhinol Laryngol. 120(7): 448 454. Dancer, J., Burl, N., & Waters, S. (1995). Effects of unilateral hearing loss on teacher responses to the SIFTER. American Annals of the Deaf. 140: 291-294. Galvin, K.L, Mok, M., Dowell, R.C. (2007). Perceptual benefit and functional outcomes for children using sequential bilateral cochlear implants. Ear Hear. 28: 470 82. Holstrum, W.J., Gaffney, M., Gravel, J.S., Oyler, R.F. & Ross, D.S. (2008). Early Intervention for Children with Unilateral and Mild Bilateral Degrees of Hearing Loss Trends in Amplification; 12: 35-41. Humes, L. E., Allen, S. K., Bess, F. H. (1980)Horizontal sound localization skills of unilaterally hearing- impaired children. Audiology. 19(6):508 18. Irving, S. & Moore, D.R. (2011). Training sound localization in normal hearing listeners with and without a unilateral ear plug. Hearing Research, 280: 100 108. Johnstone, P.M., Nábe lek, A.K. & Robertson, V.S. (2010a). Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. Journal of the American Academy of Audiology 21: 522 34. 16
Johnstone, P.M. & Robertson, V.S. (2010b). Chapter 7. Earmould considerations optimal spatial hearing in children with unilateral hearing loss. Phonak, A sound foundation through early amplification. Chicago, USA. Available at: http://www.phonakpro.com/content/dam/phonak/gc_hq/b2b/en/events/2010/proceedings/pho_c hap_07_johnstone_final.pdf [Accessed on: 27th February 2013]. Kitterick, P. T., Lovett, R. E. S., Goman, A. M., Summerfield, A. Q. 2011. The AB-York Crescent of Sound: an apparatus for assessing spatial-listening skills in children and adults. Cochlear Implants Int, 12, 164-9. Mc Cormick, B. (1977) The toy discrimination test: an aid for screening the hearing of children above a mental age of two years. Public Health, 91, 67-73. Ruscetta, M.N., Arjmand, E.M, & Pratt, S.R. (2005). Speech recognition abilities in noise for children with severe-to-profound unilateral hearing impairment. Int J Pediatr Otorhinolaryngol. 69(6):771-9. Sutton, G., Pattison, E & Carr, G. (2012). Clinicans views on how to manage unilateral hearing loss in infants. Britich Academy of Audiology Annual Conference, Manchester. Van den Bogaert, T., Carette, E. & Wouters, J. (2011). Sound source localization using hearing aids with microphones placed behind-the-ear, in-the-canal, and in-the-pinna. 50(3): 164-176. Wendorf, L.A. (2010). Outcomes of conventional amplification for pediatric unilateral hearing loss. Independent Studies and Capstones. Paper 591. Program in Audiology and Communication Sciences, Washington University School of Medicine. Available at: http://digitalcommons.wustl.edu/pacs_capstones/591 [Accessed on 26 February 2013]. 17
Images Professional Audiology (2013) Available at: http://www.proaudiology.net/pages_%20folder/links.htm (Accessed on 31 August 2013) Little Raz (2011) Available at: http://www.littleraz.org/?cat=3 (Accessed on 31 August 2013) NHS Newborn Hearing Screening programme (2013) http://hearing.screening.nhs.uk/audiology (Accessed on 31 August 2013) Allergy and Nose Clinic London (2013) http://www.allergyandnoseclinic.co.uk/contact.aspx (Accessed on 30 October 2013) Plural Publishing (2010) http://www.pluralpublishing.com/wp/?p=358 (Accessed on 31 August 2013) NHS Local (2010) http://www.nhslocal.nhs.uk/story/news/health-chief-says-nhs-reform-has-alreadybegun (Accessed on 31 August 2013) Grace Ponte Conversations (2011) http://www.gracepointe.net/conversations/2011/04/17/originalthought/ (Accessed on 1 September 2013) 18