Development and validation of the FrBio, an international French adaptation of the AzBio sentence lists

Integrating Emotion Perception in Rehabilitation Programs for Cochlear Implant Users: A Call for a More Comprehensive Approach

PURPOSE

Postoperative rehabilitation programs for cochlear implant (CI) recipients primarily emphasize enhancing speech perception. However, effective communication in everyday social interactions necessitates consideration of diverse verbal social cues to facilitate language comprehension. Failure to discern emotional expressions may lead to maladjusted social behavior, underscoring the importance of integrating social cues perception into rehabilitation initiatives to enhance CI users' well-being. After conventional rehabilitation, CI users demonstrate varying levels of emotion perception abilities. This disparity notably impacts young CI users, whose emotion perception deficit can extend to social functioning, encompassing coping strategies and social competence, even when relying on nonauditory cues such as facial expressions. Knowing that emotion perception abilities generally decrease with age, acknowledging emotion perception impairments in aging CI users is crucial, especially since a direct correlation between quality-of-life scores and vocal emotion recognition abilities has been observed in adult CI users. After briefly reviewing the scope of CI rehabilitation programs and summarizing the mounting evidence on CI users' emotion perception deficits and their impact, we will present our recommendations for embedding emotional training as part of enriched and standardized evaluation/rehabilitation programs that can improve CI users' social integration and quality of life.

CONCLUSIONS

Evaluating all aspects, including emotion perception, in CI rehabilitation programs is crucial because it ensures a comprehensive approach that enhances speech comprehension and the emotional dimension of communication, potentially improving CI users' social interaction and overall well-being. The development of emotion perception training holds promises for CI users and individuals grappling with various forms of hearing loss and sensory deficits. Ultimately, adopting such a comprehensive approach has the potential to significantly elevate the overall quality of life for a broad spectrum of patients.

Pediatric normative data for a novel and fast speech perception test in noise

OBJECTIVES

Communicating in noisy settings can be difficult due to interference and environmental noise, which can impact intelligibility for those with hearing impairments and those with normal hearing threshold. Speech intelligibility is commonly assessed in audiology through speech audiometry in quiet environments. Nevertheless, this test may not effectively assess hearing challenges in noisy environments, as total silence is rare in daily activities. A recently patented method, known as the SRT50 FAST, has been developed for conducting speech audiometry in noise. This new method enables the acceleration and simplification of free field speech audiometry tests involving competition noise. This study aims to establish normative scores and standardize the SRT50 FAST method as a test for evaluating speech perception in noise in pediatric patients.

METHODS

The study included 30 participants with normal hearing, consisting of 11 females and 19 males, ranging in age from 6 to 11 years. A series of speech audiometry tests were conducted to determine the speech reception threshold 50% (SRT50) in competing conditions. This included testing both the fast mode (SRT50 FAST) currently being studied and the traditional method (SRT50 CLASSIC). The SRT50, or Signal to Noise Ratio (SNR) at which 50% of speech recognition occurred, was investigated for both methods.

RESULTS

The mean SRT50 FAST test score was -2.69 (SD = 3.15). The dataset exhibited a normal distribution with values ranging from 3.60 to -8.60. Since the scores are expressed in SRT, higher scores indicate poorer performance. We have established a threshold of 3.60 as the upper limit of the normal range, therefore, patients with scores above this threshold are considered to have abnormal results.

CONCLUSIONS

This study aimed to establish normative data for the evaluation of free field speech in noise recognition using the SRT50 FAST method in the pediatric population. This method accurately investigates the necessary signal-to-noise ratio for achieving 50% recognition scores with bisyllabic words in a quick manner. The ultimate objective is to employ this test to identify the optimal configuration of hearing rehabilitation devices, particularly for pediatric patients with hearing aids and/or cochlear implants. Additionally, it can be used to assess pediatric patients with unilateral hearing loss.

Preliminary evaluation of computer-assisted home training for French cochlear implant recipients

For French cochlear implant (CI) recipients, in-person clinical auditory rehabilitation is typically provided during the first few years post-implantation. However, this is often inconvenient, it requires substantial time resources and can be problematic when appointments are unavailable. In response, we developed a computer-based home training software ("French AngelSound™") for French CI recipients. We recently conducted a pilot study to evaluate the newly developed French AngelSound™ in 15 CI recipients (5 unilateral, 5 bilateral, 5 bimodal). Outcome measures included phoneme recognition in quiet and sentence recognition in noise. Unilateral CI users were tested with the CI alone. Bilateral CI users were tested with each CI ear alone to determine the poorer ear to be trained, as well as with both ears (binaural performance). Bimodal CI users were tested with the CI ear alone, and with the contralateral hearing aid (binaural performance). Participants trained at home over a one-month period (10 hours total). Phonemic contrast training was used; the level of difficulty ranged from phoneme discrimination in quiet to phoneme identification in multi-talker babble. Unilateral and bimodal CI users trained with the CI alone; bilateral CI users trained with the poorer ear alone. Outcomes were measured before training (pre-training), immediately after training was completed (post-training), and one month after training was stopped (follow-up). For all participants, post-training CI-only vowel and consonant recognition scores significantly improved after phoneme training with the CI ear alone. For bilateral and bimodal CI users, binaural vowel and consonant recognition scores also significantly improved after training with a single CI ear. Follow-up measures showed that training benefits were largely retained. These preliminary data suggest that the phonemic contrast training in French AngelSound™ may significantly benefit French CI recipients and may complement clinical auditory rehabilitation, especially when in-person visits are not possible.

Development and Validation of a Mandarin Chinese Adaptation of AzBio Sentence Test (CMnBio)

A new sentence recognition test in Mandarin Chinese was developed and validated following the principles and procedures of development of the English AzBio sentence materials. The study was conducted in two stages. In the first stage, 1,020 sentences spoken by 4 talkers (2 males and 2 females) were processed through a 5-channel noise vocoder and presented to 17 normal-hearing Mandarin-speaking adults for recognition. A total of 600 sentences (150 from each talker) in the range of approximately 62 to 92% correct (mean = 78.0% correct) were subsequently selected to compile 30, 20-sentence lists. In the second stage, 30 adult CI users were recruited to verify the list equivalency. A repeated-measures analysis of variance followed by the post hoc Tukey's test revealed that 26 of the 30 lists were equivalent. Finally, a binomial distribution model was adopted to account for the inherent variability in the lists. It was found that the inter-list variability could be best accounted for with a 65-item binomial distribution model. The lower and upper limits of the 95% critical differences for one- and two-list recognition scores were then generated to provide guidance for detection of a significant difference in recognition scores in clinical settings. The final set of 26 equivalent lists contains sentence materials more difficult than those found in other speech audiometry materials in Mandarin Chinese. This test should help minimize the ceiling effects when testing sentence recognition in Mandarin-speaking CI users.

The Effect of Age, Type of Noise, and Cochlear Implants on Adaptive Sentence-in-Noise Task

Adaptive tests of sentences in noise mimic the challenge of daily listening situations. The aims of the present study were to validate an adaptive version of the HeBio sentence test on normal hearing (NH) adults; to evaluate the effect of age and type of noise on speech reception threshold in noise (SRTn); and to test it on prelingual adults with cochlear implants (CI). In Experiment 1, 45 NH young adults listened to two lists accompanied by four-talker babble noise (4TBN). Experiment 2 presented the sentences amidst 4TBN or speech-shaped noise (SSN) to 80 participants in four age groups. In Experiment 3, 18 CI adult users with prelingual bilateral profound hearing loss performed the test amidst SSN, along with HeBio sentences and monosyllabic words in quiet and forward digits span. The main findings were as follows: SRTn for NH participants was normally distributed and had high test–retest reliability; SRTn was lower among adolescents and young adults than middle-aged and older adults, and were better for SSN than 4TBN; SRTn for CI users was higher and more variant than for NH and correlated with speech perception tests in quiet, digits span, and age at first CI. This suggests that the adaptive HeBio can be implemented in clinical and research settings with various populations.

Adult Normative Data for the Adaptation of the Hearing in Noise Test in European French (HINT-5 Min)

Decreased speech-in-noise (SpIN) understanding is an early marker not only of presbycusis but also of auditory processing disorder. Previous research has shown a strong relationship between hearing disorders and cognitive limitations. It is therefore crucial to allow SpIN testing in subjects who cannot sustain prolonged diagnostic procedures. The objectives of this study were to develop a rapid and reproducible version of the Hearing in Noise Test (HINT-5 min), and to determine its adult normative values in free-field and monaural or binaural headphone conditions. Following an adaptive signal-to-noise ratio (SNR) protocol, the test used a fixed noise level, while the signal level varied to reach the 50% speech reception threshold (SRT50). The speech material consisted of five lists of 20 sentences each, all recorded in European French. The whole semi-automated procedure lasted 5 min and was administered to 83 subjects aged 19 to 49 years with no reported listening difficulties. Fifty-two subjects were retested between 7 and 8 days later. For the binaural free-field condition, the mean SRT50 was −1.0 dB SNR with a standard deviation of 1.3 dB SNR. There was no significant difference between the results obtained at test and retest, nor was there any effect of listening condition, sex, or age on SRT50. The results indicate that the procedure is robust and not affected by any learning phenomenon. The HINT-5 min was found to be both a fast and reliable marker of the ability to understand speech in background noise.

The French MBAA2 sentence recognition in noise test for cochlear implant users

OBJECTIVE

The "Marginal benefit from acoustic amplification" version 2 (MBAA2) sentence test has been used in France in the routine evaluation of cochlear implant (CI) users for 20 years. Here we present four studies that characterise and validate the test, and compare it with the French matrix sentence test.

DESIGN AND SAMPLE

An analytic method was developed to obtain speech recognition threshold in noise (SNR50) from testing at a fixed signal to noise ratios (SNRs). Speech recognition was measured at several fixed SNRs in 18 normal-hearing listeners and 15 CI listeners. Then, the test-retest reliability of the MBAA2 was measured in an additional 15 CI listeners. Finally, list equivalence was evaluated in eight CI listeners.

RESULTS

The MBAA2 test produced lower SNR50s and SNR50s were obtained in more CI listeners than with the French matrix test. For the MBAA2, the standard deviation of test-retest differences in CI listeners was around 1 dB SNR. Three lists had deviant difficulty and nine low item-to-total correlations.

CONCLUSIONS

We propose to reduce the number of MBAA2 test lists to reduce variability. The MBAA2 test has high test-retest reliability for percent correct and SNR50, and is suitable for the assessment of cochlear implant patients.

Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) and the French Society of Audiology (SFA) for Speech-in-Noise Testing in Adults

OBJECTIVES

This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs.

MATERIAL AND METHODS

The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence.

RESULTS

Eight tests of speech audiometry in noise can be used in France.

CONCLUSION

To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers

<b><i>Background:</i></b> Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population. <b><i>Summary:</i></b> A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus databases were searched. Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit. <b><i>Key Messages:</i></b> As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling.