Validating models of clinical word recognition tests for spanish/english bilinguals

Cochlear Implant Referral Criteria for the Spanish-Speaking Adult Population

OBJECTIVE

To evaluate the effectiveness of the "60/60 Guideline" in a diverse patient population.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary referral center.

PATIENTS

Data were collected for adult patients (18 years and older) who underwent a cochlear implant evaluation (CIE) between January 2016 and March 2021.

MAIN OUTCOME MEASURES

Development of the "60/60 Guideline" has provided better clarity on when to refer English-speaking patients for a CIE. Our study evaluated the effectiveness of this referral tool in the Spanish-speaking population.

RESULTS

In our group of patients who underwent a traditional CIE (n = 402), 209 met unaided and aided traditional cochlear implant (CI) candidacy criteria. Of the 193 individuals who did not meet both components of traditional candidacy criteria, a majority met the aided component (86%) but only 4.6% met the unaided component. When applying the 60/60 Guideline to patients who met traditional criteria, there is a sensitivity rating of 84.7% and a specificity index of 50.3%. For English and Spanish speakers who met traditional criteria but did not meet the 60/60 Guideline, a majority (83.3% English, 87.5% Spanish) had a better ear word recognition score (WRS) greater than 60%, suggesting the unaided WRS is the more restrictive component of the "60/60 Guideline."

CONCLUSION

Application of the "60/60 Guideline" is an effective method to identify potential CI candidates in the English-speaking population; however, it was less effective in the Spanish-speaking population. Spanish-speaking adults should be referred for a CIE when better ear pure tone average is greater than 60 dB hearing loss, regardless of their unaided WRS. This study highlights the need for inclusion of nonlinguistic test measures in the CI referral criteria and test battery to reduce CI access barriers for patients who speak a language other than English.

Investigating Socioeconomic Barriers to Cochlear Implantation

OBJECTIVE

To explore socioeconomic disparities in cochlear implant evaluation (CIE) referrals and cochlear implantation.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral academic center.

METHODS

Adult patients (n = 271) with an audiogram performed between 2015 and 2019 with a pure-tone average of at least 60 dB and word recognition score of 60% or less in the better-hearing ear or no word recognition score performed were included to determine if socioeconomic factors influenced the rate of referral to CIE and cochlear implantation.

RESULTS

There were 122 insured patients referred to CIE where 84 were considered cochlear implant (CI) candidates and 73 were implanted. In multivariate regression analysis, non-English-speaking patients were referred to CIE at lower rates ( p < 0.01) than English-speaking patients. Patients who met the CI candidacy criteria with private insurance ( p = 0.03) or Medicare with private insurance supplement ( p = 0.03) had higher rates of cochlear implantation than those with Medicare or Medicaid. Of the uninsured patients (n = 22), 3 were referred to CIE and 2 were considered CI candidates. No uninsured patients received a CI.

CONCLUSIONS

Primary language spoken was associated with a disparity in rates of CIE referral. Insurance type did influence rate of cochlear implantation once patients completed CIE and were considered CI candidates. Additional research is needed to implement strategies for more inclusive treatment.

The Involvement of Listening Effort in Explaining Bilingual Listening Under Adverse Listening Conditions

The current review examines listening effort to uncover how it is implicated in bilingual performance under adverse listening conditions. Various measures of listening effort, including physiological, behavioral, and subjective measures, have been employed to examine listening effort in bilingual children and adults. Adverse listening conditions, stemming from environmental factors, as well as factors related to the speaker or listener, have been examined. The existing literature, although relatively limited to date, points to increased listening effort among bilinguals in their nondominant second language (L2) compared to their dominant first language (L1) and relative to monolinguals. Interestingly, increased effort is often observed even when speech intelligibility remains unaffected. These findings emphasize the importance of considering listening effort alongside speech intelligibility. Building upon the insights gained from the current review, we propose that various factors may modulate the observed effects. These include the particular measure selected to examine listening effort, the characteristics of the adverse condition, as well as factors related to the particular linguistic background of the bilingual speaker. Critically, further research is needed to better understand the impact of these factors on listening effort. The review outlines avenues for future research that would promote a comprehensive understanding of listening effort in bilingual individuals.

Masked-Speech Recognition for Linguistically Diverse Populations: A Focused Review and Suggestions for the Future

PURPOSE

Twenty years ago, von Hapsburg and Peña (2002) wrote a tutorial that reviewed the literature on speech audiometry and bilingualism and outlined valuable recommendations to increase the rigor of the evidence base. This review article returns to that seminal tutorial to reflect on how that advice was applied over the last 20 years and to provide updated recommendations for future inquiry.

METHOD

We conducted a focused review of the literature on masked-speech recognition for bilingual children and adults. First, we evaluated how studies published since 2002 described bilingual participants. Second, we reviewed the literature on native language masked-speech recognition. Third, we discussed theoretically motivated experimental work. Fourth, we outlined how recent research in bilingual speech recognition can be used to improve clinical practice.

RESULTS

Research conducted since 2002 commonly describes bilingual samples in terms of their language status, competency, and history. Bilingualism was not consistently associated with poor masked-speech recognition. For example, bilinguals who were exposed to English prior to age 7 years and who were dominant in English performed comparably to monolinguals for masked-sentence recognition tasks. To the best of our knowledge, there are no data to document the masked-speech recognition ability of these bilinguals in their other language compared to a second monolingual group, which is an important next step. Nonetheless, individual factors that commonly vary within bilingual populations were associated with masked-speech recognition and included language dominance, competency, and age of acquisition. We identified methodological issues in sampling strategies that could, in part, be responsible for inconsistent findings between studies. For instance, disparities in socioeconomic status (SES) between recruited bilingual and monolingual groups could cause confounding bias within the research design.

CONCLUSIONS

Dimensions of the bilingual linguistic profile should be considered in clinical practice to inform counseling and (re)habilitation strategies since susceptibility to masking is elevated in at least one language for most bilinguals. Future research should continue to report language status, competency, and history but should also report language stability and demand for use data. In addition, potential confounds (e.g., SES, educational attainment) when making group comparisons between monolinguals and bilinguals must be considered.

The effect of background noise on speech perception in monolingual and bilingual adults with normal hearing

Background

Previous studies have highlighted that bilingual listeners have a deficit in speech perception in their second language compared with monolingual listeners in noisy listening environments. This deficit may give rise to educational and occupational implications for bilingual speakers who are studying or working in non-native language environments in poor acoustic conditions.

Objectives

To compare the speech perception performance of monolingual English speakers and English as a second language (ESL) bilinguals within environments with various levels of background noise and to examine whether bilinguals with an early age of second language acquisition would perform better than those with a late age of acquisition.

Study sample

Two groups of adult listeners with normal hearing participated: monolingual British English listeners (N = 15) and bilingual Arabic listeners for whom English was their second language and who were proficient in English (N = 15). The quick speech-in-noise (QuickSIN) test was used to assess signal-to-noise ratio (SNR) loss and SNR-50 for both groups.

Results

The QuickSIN test results indicated that bilingual Arabic listeners with normal hearing displayed a mild SNR loss comparable to that observed for a person with hearing loss, indicating a higher SNR needed for this population to achieve a comparable level of comprehension to their monolingual English peers.

Conclusion

Results highlight the importance of measuring SNR loss to obtain accurate diagnosis and potential rehabilitative information that is not available from audiogram studies.

Effects of Language History on Sentence Recognition in Noise or Two-Talker Speech: Monolingual, Early Bilingual, and Late Bilingual Speakers of English

Purpose Language history is an important factor in masked speech recognition. Listeners who acquire the target language later in life perform more poorly than native speakers. However, there are inconsistencies in the literature regarding performance of bilingual speakers who begin learning the target language early in life. The purpose of this experiment was to evaluate speech-in-noise and speech-in-speech recognition for highly proficient early bilingual listeners compared to monolingual and late bilingual listeners. Method Three groups of young adults participated: native monolingual English speakers, bilingual Mandarin-English speakers who learned English from birth (early bilinguals), and native Mandarin speakers who learned English later in life (late bilinguals). All participants had normal hearing and were full-time college students. Recognition was assessed for English sentences in speech-shaped noise and two-talker English speech. Participants provided linguistic and demographic information, and late bilinguals completed the Versant test of spoken English abilities. Results All listeners performed better in speech-shaped noise than two-talker speech. Performance was similar for monolingual and early bilinguals. Late bilinguals performed more poorly overall. There was evidence for a stronger association between masked speech recognition and English dominance for late bilinguals compared to early bilinguals. Conclusion These results support the conclusion that bilingualism itself does not necessarily result in a disadvantage when recognizing masked speech in noise and speech in speech. For populations similar to those studied here (highly proficient early bilinguals), it would be appropriate to evaluate masked speech recognition using the same simple stimuli and normative data used for monolingual speakers of English.

Speech audiometry and Spanish-English bilinguals: challenges in clinical practice

PURPOSE

The Spanish-English bilingual population has been on a steady rise in the United States and is projected to continue to grow. Speech audiometry, a key component of hearing care, must be customized for this linguistically unique and diverse population.

METHOD

The tutorial summarizes recent findings concerning Spanish-English bilinguals' performance on English and Spanish speech audiometric tests in the context of the psychometric properties of the tests and the language and dialect profile of the individual (language status, history, stability, competency, and use). The tutorial also provides arguments for evaluating bilingual clients in Spanish, in English, or in both languages, which may serve as rationales in support of varied bilingual clinical practices. Last, the tutorial provides information regarding Spanish speech audiometry, including available tests, issues that clinicians may encounter when administering them, and dialectal consideration.

CONCLUSIONS

It is a challenge as well as an opportunity for clinicians to expand service to the Spanish-English bilingual community. Understanding the characteristics of the individual and the test is essential for ensuring quality services to the bilingual client.