Masked Sentence Recognition in Children, Young Adults, and Older Adults: Age-Dependent Effects of Semantic Context and Masker Type

Taking the Extra Listening Mile: Processing Spoken Semantic Context Is More Effortful for Older Than Young Adults

OBJECTIVES

Older adults use semantic context to generate predictions in speech processing, compensating for aging-related sensory and cognitive changes. This study aimed to gauge aging-related changes in effort exertion related to context use.

DESIGN

The study revisited data from Harel-Arbeli et al. (2023) that used a "visual-world" eye-tracking paradigm. Data on efficiency of context use (response latency and the probability to gaze at the target before hearing it) and effort exertion (pupil dilation) were extracted from a subset of 14 young adults (21 to 27 years old) and 13 older adults (65 to 79 years old).

RESULTS

Both age groups showed a similar pattern of context benefits for response latency and target word predictions, however only the older adults group showed overall increased pupil dilation when listening to context sentences.

CONCLUSIONS

Older adults' efficient use of spoken semantic context appears to come at a cost of increased effort exertion.

Role of the medial olivocochlear efferent auditory system in speech perception in noise: a systematic review and meta-analyses

OBJECTIVE

The study investigated the relationship between the strength of the medial olivocochlear reflex (measured via contralateral inhibition of otoacoustic emissions) and speech perception in noise (obtained from behavioural identification task) through meta-analyses.

DESIGN

A systematic review and random-effects meta-analysis of studies investigating the relationship in neurotypical adults was performed.

STUDY SAMPLE

The systematic search (in PubMed, Scopus, Science Direct and Google Scholar databases) revealed 21 eligible studies, which were critically appraised using the NIH tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed on 17 studies (374 participants) with fair to good quality.

RESULTS

The results revealed that the medial olivocochlear reflex accounts for less than 1% of the variations in speech perception in noise in neurotypical individuals. Sub-group analyses conducted to address a few methodological differences also revealed no discernible association between the two variables.

CONCLUSIONS

The results reveal no modulatory effect of the medial olivocochlear reflex assessed using contralateral inhibition of otoacoustic emission on the ability to perceive speech in noise. However, more data utilising alternative measures of medial olivocochlear reflex strength is necessary before drawing any conclusions about the role of the medial olivocochlear bundle in speech perception in noise.

The role of long-term target and masker talker familiarity in children's speech-in-speech recognition

Objectives

This study investigated the influence of long-term talker familiarity on speech-in-speech recognition in school-age children, with a specific emphasis on the role of familiarity with the mother's voice as either the target or masker speech.

Design

Open-set sentence recognition was measured adaptively in a two-talker masker. Target and masker sentences were recorded by the adult mothers of the child participants. Each child heard sentences spoken by three adult female voices during testing; their own mother's voice (familiar voice) and two unfamiliar adult female voices.

Study sample

Twenty-four school age children (8-13 years) with normal hearing.

Results

When the target speech was spoken by a familiar talker (the mother), speech recognition was significantly better compared to when the target was unfamiliar. When the masker was spoken by the familiar talker, there was no difference in performance relative to the unfamiliar masker condition. Across all conditions, younger children required a more favorable signal-to-noise ratio than older children.

Conclusion

Implicit long-term familiarity with a talker consistently improves children's speech-in-speech recognition across the age range tested, specifically when the target talker is familiar. However, performance remains unaffected by masker talker familiarity. Additionally, while target familiarity is advantageous, it does not entirely eliminate children's increased susceptibility to competing speech.

Developmental Effects in the "Vocale Rapide dans le Bruit" Speech-in-Noise Identification Test: Reference Performances of Normal-Hearing Children and Adolescents

PURPOSE

The main objective of this study was to assess the existence of developmental effects on the performance of the Vocale Rapide dans le Bruit (VRB) speech-in-noise (SIN) identification test that was recently developed for the French language and to collect reference scores for children and adolescents.

METHOD

Seventy-two native French speakers, aged 10-20 years, participated in the study. Each participant listened and repeated four lists of eight sentences, each containing three key words to be scored. The sentences were presented in free field at different signal-to-noise ratios (SNRs) using a four-talker babble noise. The SNR yielding 50% of correct repetitions of key words (SNR50) was recorded for each list.

RESULTS

A strong relationship between age and SNR50 was found, better performance occurring with increasing age (average drop in SNR50 per year: 0.34 dB). Large differences (Cohen's d ≥ 1.2) were observed between the SNR50 achieved by 10- to 13-year-old participants and those of adults. For participants aged 14-15 years, the difference fell just above the 5% level of significance. No effects of hearing thresholds or level of education were observed.

CONCLUSIONS

The study confirms the existence of developmental effects on SIN identification performance as measured using the VRB test and provides reference data for taking into account these effects during clinical practice. Explanations as to why age effects perdure during adolescence are discussed.

Children's use of spatial and visual cues for release from perceptual masking

This study examined the role of visual speech in providing release from perceptual masking in children by comparing visual speech benefit across conditions with and without a spatial separation cue. Auditory-only and audiovisual speech recognition thresholds in a two-talker speech masker were obtained from 21 children with typical hearing (7-9 years of age) using a color-number identification task. The target was presented from a loudspeaker at 0° azimuth. Masker source location varied across conditions. In the spatially collocated condition, the masker was also presented from the loudspeaker at 0° azimuth. In the spatially separated condition, the masker was presented from the loudspeaker at 0° azimuth and a loudspeaker at -90° azimuth, with the signal from the -90° loudspeaker leading the signal from the 0° loudspeaker by 4 ms. The visual stimulus (static image or video of the target talker) was presented at 0° azimuth. Children achieved better thresholds when the spatial cue was provided and when the visual cue was provided. Visual and spatial cue benefit did not differ significantly depending on the presence of the other cue. Additional studies are needed to characterize how children's preferential use of visual and spatial cues varies depending on the strength of each cue.

Predictors of Susceptibility to Noise and Speech Masking Among School-Age Children With Hearing Loss or Typical Hearing

OBJECTIVES

The purpose of this study was to evaluate effects of masker type and hearing group on the relationship between school-age children's speech recognition and age, vocabulary, working memory, and selective attention. This study also explored effects of masker type and hearing group on the time course of maturation of masked speech recognition.

DESIGN

Participants included 31 children with normal hearing (CNH) and 41 children with mild to severe bilateral sensorineural hearing loss (CHL), between 6.7 and 13 years of age. Children with hearing aids used their personal hearing aids throughout testing. Audiometric thresholds and standardized measures of vocabulary, working memory, and selective attention were obtained from each child, along with masked sentence recognition thresholds in a steady state, speech-spectrum noise (SSN) and in a two-talker speech masker (TTS). Aided audibility through children's hearing aids was calculated based on the Speech Intelligibility Index (SII) for all children wearing hearing aids. Linear mixed effects models were used to examine the contribution of group, age, vocabulary, working memory, and attention to individual differences in speech recognition thresholds in each masker. Additional models were constructed to examine the role of aided audibility on masked speech recognition in CHL. Finally, to explore the time course of maturation of masked speech perception, linear mixed effects models were used to examine interactions between age, masker type, and hearing group as predictors of masked speech recognition.

RESULTS

Children's thresholds were higher in TTS than in SSN. There was no interaction of hearing group and masker type. CHL had higher thresholds than CNH in both maskers. In both hearing groups and masker types, children with better vocabularies had lower thresholds. An interaction of hearing group and attention was observed only in the TTS. Among CNH, attention predicted thresholds in TTS. Among CHL, vocabulary and aided audibility predicted thresholds in TTS. In both maskers, thresholds decreased as a function of age at a similar rate in CNH and CHL.

CONCLUSIONS

The factors contributing to individual differences in speech recognition differed as a function of masker type. In TTS, the factors contributing to individual difference in speech recognition further differed as a function of hearing group. Whereas attention predicted variance for CNH in TTS, vocabulary and aided audibility predicted variance in CHL. CHL required a more favorable signal to noise ratio (SNR) to recognize speech in TTS than in SSN (mean = +1 dB in TTS, -3 dB in SSN). We posit that failures in auditory stream segregation limit the extent to which CHL can recognize speech in a speech masker. Larger sample sizes or longitudinal data are needed to characterize the time course of maturation of masked speech perception in CHL.

Can Playing a Game Improve Children's Speech Recognition? A Preliminary Study of Implicit Talker Familiarity Effects

PURPOSE

The goal was to evaluate whether implicit talker familiarization via an interactive computer game, designed for this study, could improve children's word recognition in classroom noise. It was hypothesized that, regardless of age, children would perform better when recognizing words spoken by the talker who was heard during the game they played.

METHOD

Using a one-group pretest-posttest experimental design, this study examined the impact of short-term implicit voice exposure on children's word recognition in classroom noise. Implicit voice familiarization occurred via an interactive computer game, played at home for 10 min a day for 5 days. In the game, children (8-12 years) heard one voice, intended to become the "familiar talker." Pre- and postfamiliarization, children identified words in prerecorded classroom noise. Four conditions were tested to evaluate talker familiarity and generalization effects.

RESULTS

Results demonstrated an 11% improvement when recognizing words spoken by the voice heard in the game ("familiar talker"). This was observed only for words that were heard in the game and did not generalize to unfamiliarized words. Before familiarization, younger children had poorer recognition than older children in all conditions; however, after familiarization, there was no effect of age on performance for familiarized stimuli.

CONCLUSIONS

Implicit short-term exposure to a talker has the potential to improve children's speech recognition. Therefore, leveraging talker familiarity through gameplay shows promise as a viable method for improving children's speech-in-noise recognition. However, given that improvements did not generalize to unfamiliarized words, careful consideration of exposure stimuli is necessary to optimize this approach.

The effects of face masks on speech-in-speech recognition for children and adults

OBJECTIVES

This study explored the effects of different face masks on school-age children's and young adults' word recognition.

DESIGN

Speech recognition thresholds were measured adaptively in a two-talker speech masker using a closed-set picture pointing task. Target words were recorded by a female talker in five conditions: no mask, transparent mask, face shield, N95 mask and surgical mask.

STUDY SAMPLES

Thirty children (8-12 years) and 25 adults (18-25 years) with normal hearing.

RESULTS

Both children's and adults' word recognition was most negatively impacted by the face shield. Children's recognition was also impaired by the transparent mask. No negative effects were observed for the N95 or surgical mask for either age group.

CONCLUSION

School-age children, like young adults, are negatively affected by face masks when recognising speech in a two-talker speech masker, but the effects depend on the type of face mask being worn. Acoustic analyses suggest that the reflective materials used for masks impact speech signal quality and impair word recognition.

Development of Mandarin Lexical Tone Identification in Noise and Its Relation With Working Memory

PURPOSE

This study aimed to examine the developmental trajectory of Mandarin tone identification in quiet and two noisy conditions: speech-shaped noise (SSN) and multitalker babble noise. In addition, we evaluated the relationship between tonal identification development and working memory capacity.

METHOD

Ninety-three typically developing children aged 5-8 years and 23 young adults completed categorical identification of two tonal continua (Tone 1-4 and Tone 2-3) in quiet, SSN, and babble noise. Their working memory was additionally measured using auditory digit span tests. Correlation analyses between digit span scores and boundary widths were performed.

RESULTS

Six-year-old children have achieved the adultlike ability of categorical identification of Tone 1-4 continuum under both types of noise. Moreover, 6-year-old children could identify Tone 2-3 continuum as well as adults in SSN. Nonetheless, the child participants, even 8-year-olds, performed worse when tokens from Tone 2-3 continuum were masked by babble noise. Greater working memory capacity was associated with better tone identification in noise for preschoolers aged 5-6 years; however, for school-age children aged 7-8 years, such correlation only existed in Tone 2-3 continuum in SSN.

CONCLUSIONS

Lexical tone perception might take a prolonged time to achieve adultlike competence in babble noise relative to SSN. Moreover, a significant interaction between masking type and stimulus difficulty was found, as indicated by Tone 2-3 being more susceptible to interference from babble noise than Tone 1-4. Furthermore, correlations between working memory capacity and tone perception in noise varied with developmental stage, stimulus difficulty, and masking type.

Two-Year Outcomes of Cochlear Implant Use for Children With Unilateral Hearing Loss: Benefits and Comparison to Children With Normal Hearing

OBJECTIVES

Children with severe-to-profound unilateral hearing loss, including cases of single-sided deafness (SSD), lack access to binaural cues that support spatial hearing, such as recognizing speech in complex multisource environments and sound source localization. Listening in a monaural condition negatively impacts communication, learning, and quality of life for children with SSD. Cochlear implant (CI) use may restore binaural hearing abilities and improve outcomes as compared to alternative treatments or no treatment. This study investigated performance over 24 months of CI use in young children with SSD as compared to the better hearing ear alone and to children with bilateral normal hearing (NH).

DESIGN

Eighteen children with SSD who received a CI between the ages of 3.5 and 6.5 years as part of a prospective clinical trial completed assessments of word recognition in quiet, masked sentence recognition, and sound source localization at regular intervals out to 24-month postactivation. Eighteen peers with bilateral NH, matched by age at the group level, completed the same test battery. Performance at 24-month postactivation for the SSD group was compared to the performance of the NH group.

RESULTS

Children with SSD have significantly poorer speech recognition in quiet, masked sentence recognition, and localization both with and without the use of the CI than their peers with NH. The SSD group experienced significant benefits with the CI+NH versus the NH ear alone on measures of isolated word recognition, masked sentence recognition, and localization. These benefits were realized within the first 3 months of use and were maintained through the 24-month postactivation interval.

CONCLUSIONS

Young children with SSD who use a CI experience significant isolated word recognition and bilateral spatial hearing benefits, although their performance remains poorer than their peers with NH.

Speech-in-noise perception in autistic adolescents with and without early language delay

Speech-in-noise perception seems aberrant in individuals with autism spectrum disorder (ASD). Potential aggravating factors are the level of linguistic skills and impairments in auditory temporal processing. Here, we investigated autistic adolescents with and without language delay as compared to non-autistic peers, and we assessed speech perception in steady-state noise, temporally modulated noise, and concurrent speech. We found that autistic adolescents with intact language capabilities and not those with language delay performed worse than NT peers on words-in-stationary-noise perception. For the perception of sentences in stationary noise, we did not observe significant group differences, although autistic adolescents with language delay tend to perform worse in comparison to their TD peers. We also found evidence for a robust deficit in speech-in-concurrent-speech processing in ASD independent of language ability, as well as an association between early language delay in ASD and inadequate temporal speech processing. We propose that reduced voice stream segregation and inadequate social attentional orienting in ASD result in disproportional informational masking of the speech signal. These findings indicate a speech-in-speech processing deficit in autistic adolescents with broad implications for the quality of social communication.

Differential benefits of unmasking extended high-frequency content of target or background speech

Current evidence supports the contribution of extended high frequencies (EHFs; >8 kHz) to speech recognition, especially for speech-in-speech scenarios. However, it is unclear whether the benefit of EHFs is due to phonetic information in the EHF band, EHF cues to access phonetic information at lower frequencies, talker segregation cues, or some other mechanism. This study investigated the mechanisms of benefit derived from a mismatch in EHF content between target and masker talkers for speech-in-speech recognition. EHF mismatches were generated using full band (FB) speech and speech low-pass filtered at 8 kHz. Four filtering combinations with independently filtered target and masker speech were used to create two EHF-matched and two EHF-mismatched conditions for one- and two-talker maskers. Performance was best with the FB target and the low-pass masker in both one- and two-talker masker conditions, but the effect was larger for the two-talker masker. No benefit of an EHF mismatch was observed for the low-pass filtered target. A word-by-word analysis indicated higher recognition odds with increasing EHF energy level in the target word. These findings suggest that the audibility of target EHFs provides target phonetic information or target segregation and selective attention cues, but that the audibility of masker EHFs does not confer any segregation benefit.

Strength of target source segregation cues affects the outcome of speech-on-speech masking experiments

In speech-on-speech listening experiments, some means for designating which talker is the "target" must be provided for the listener to perform better than chance. However, the relative strength of the segregation variables designating the target could affect the results of the experiment. Here, we examine the interaction of two source segregation variables-spatial separation and talker gender differences-and demonstrate that the relative strengths of these cues may affect the interpretation of the results. Participants listened to sentence pairs spoken by different-gender target and masker talkers, presented naturally or vocoded (degrading gender cues), either colocated or spatially separated. Target and masker words were temporally interleaved to eliminate energetic masking in either an every-other-word or randomized order of presentation. Results showed that the order of interleaving had no effect on recall performance. For natural speech with strong talker gender cues, spatial separation of sources yielded no improvement in performance. For vocoded speech with degraded talker gender cues, performance improved significantly with spatial separation of sources. These findings reveal that listeners may shift among target source segregation cues contingent on cue viability. Finally, performance was poor when the target was designated after stimulus presentation, indicating strong reliance on the cues.

Are musical activities associated with enhanced speech perception in noise in adults? A systematic review and meta-analysis

The ability to process speech in noise (SPiN) declines with age, with a detrimental impact on life quality. Music-making activities such as singing and playing a musical instrument have raised interest as potential prevention strategies for SPiN perception decline because of their positive impact on several brain system, especially the auditory system, which is critical for SPiN. However, the literature on the effect of musicianship on SPiN performance has yielded mixed results. By critically assessing the existing literature with a systematic review and a meta-analysis, we aim to provide a comprehensive portrait of the relationship between music-making activities and SPiN in different experimental conditions. 38/49 articles, most focusing on young adults, were included in the quantitative analysis. The results show a positive relationship between music-making activities and SPiN, with the strongest effects found in the most challenging listening conditions, and little to no effect in less challenging situations. This pattern of results supports the notion of a relative advantage for musicians on SPiN performance and clarify the scope of this effect. However, further studies, especially with older adults, using adequate randomization methods, are needed to extend the present conclusions and assess the potential for musical activities to be used to mitigate SPiN decline in seniors.

Effects of Target and Masker Fundamental Frequency Contour Depth on School-Age Children's Speech Recognition in a Two-Talker Masker

PURPOSE

Maturation of the ability to recognize target speech in the presence of a two-talker speech masker extends into early adolescence. This study evaluated whether children benefit from differences in fundamental frequency (f _o) contour depth between the target and masker speech, a cue that has been shown to improve recognition in adults.

METHOD

Speech stimuli were recorded from talkers using three speaking styles, with f _o contour depths that were Flat, Normal, or Exaggerated. Targets were open-set, declarative sentences produced by a female talker, and maskers were two streams of concatenated sentences produced by a second female talker. Listeners were children (ages 5-17 years) and adults (ages 18-24 years) with normal hearing. Each listener was tested in one of the three masker styles paired with all three target styles. Speech recognition thresholds (SRTs) corresponding to 50% correct were estimated by fitting psychometric functions to adaptive track data.

RESULTS

For adults, performance did not differ significantly across conditions with matched speaking styles. A mismatch benefit was observed when combining Flat targets with the Exaggerated masker and Exaggerated targets with the Flat masker, and for both Flat and Exaggerated targets paired with the Normal masker. For children, there was a significant effect of age in all conditions. Flat targets in the Flat masker were associated with lower SRTs than the other two matched conditions, and a mismatch benefit was observed for young children only when the target f _o contour was less variable than the masker f _o contour.

CONCLUSIONS

Whereas child-directed speech often has exaggerated pitch contours, young children were better able to recognize speech with less variable f _o. Age effects were observed in the benefit of mismatched speaking styles for some conditions, which could be related to differences in baseline SRTs rather than differences in segregation abilities.

Predicting speech-in-speech recognition: Short-term audibility, talker sex, and listener factors

Speech-in-speech recognition can be challenging, and listeners vary considerably in their ability to accomplish this complex auditory-cognitive task. Variability in performance can be related to intrinsic listener factors as well as stimulus factors associated with energetic and informational masking. The current experiments characterized the effects of short-term audibility of the target, differences in target and masker talker sex, and intrinsic listener variables on sentence recognition in two-talker speech and speech-shaped noise. Participants were young adults with normal hearing. Each condition included the adaptive measurement of speech reception thresholds, followed by testing at a fixed signal-to-noise ratio (SNR). Short-term audibility for each keyword was quantified using a computational glimpsing model for target+masker mixtures. Scores on a psychophysical task of auditory stream segregation predicted speech recognition, with stronger effects for speech-in-speech than speech-in-noise. Both speech-in-speech and speech-in-noise recognition depended on the proportion of audible glimpses available in the target+masker mixture, even across stimuli presented at the same global SNR. Short-term audibility requirements varied systematically across stimuli, providing an estimate of the greater informational masking for speech-in-speech than speech-in-noise recognition and quantifying informational masking for matched and mismatched talker sex.

Can Closed-Set Word Recognition Differentially Assess Vowel and Consonant Perception for School-Age Children With and Without Hearing Loss?

PURPOSE

Vowels and consonants play different roles in language acquisition and speech recognition, yet standard clinical tests do not assess vowel and consonant perception separately. As a result, opportunities for targeted intervention may be lost. This study evaluated closed-set word recognition tests designed to rely predominantly on either vowel or consonant perception and compared results with sentence recognition scores.

METHOD

Participants were children (5-17 years of age) and adults (18-38 years of age) with normal hearing and children with sensorineural hearing loss (7-17 years of age). Speech reception thresholds (SRTs) were measured in speech-shaped noise. Children with hearing loss were tested with their hearing aids. Word recognition was evaluated using a three-alternative forced-choice procedure, with a picture-pointing response; monosyllabic target words varied with respect to either consonant or vowel content. Sentence recognition was evaluated for low- and high-probability sentences. In a subset of conditions, stimuli were low-pass filtered to simulate a steeply sloping hearing loss in participants with normal hearing.

RESULTS

Children's SRTs improved with increasing age for words and sentences. Low-pass filtering had a larger effect for consonant-variable words than vowel-variable words for both children and adults with normal hearing, consistent with the greater high-frequency content of consonants. Children with hearing loss tested with hearing aids tended to perform more poorly than age-matched children with normal hearing, particularly for sentence recognition, but consonant- and vowel-variable word recognition did not appear to be differentially affected by the amount of high- and low-frequency hearing loss.

CONCLUSIONS

Closed-set recognition of consonant- and vowel-variable words appeared to differentially evaluate vowel and consonant perception but did not vary by configuration of hearing loss in this group of pediatric hearing aid users. Word scores obtained in this manner do not fully characterize the auditory abilities necessary for open-set sentence recognition, but they do provide a general estimate.

Effect of Age on Informational Masking: Differential Effects of Phonetic and Semantic Information in the Masker

PURPOSE

Speech recognition in noise is a ubiquitous problem in older listeners. Speech, the most commonly encountered noise in the real world, causes greater masking than noise maskers, a phenomenon called informational masking (IM). This is due to the lexical-semantic and/or acoustic-phonetic information present in speech maskers. In this study, we aimed to observe the age-related differences in speech recognition and the magnitudes of IM when the maskers varied in the type of linguistic information.

METHOD

In 30 young and 30 older individuals, we measured the signal-to-noise ratio required to obtain 50% correct identification under four-talker babble (lexical-semantic and acoustic-phonetic information), four-talker reverse babble (predominantly acoustic-phonetic information), and speech-shaped noise (SSN; energetic).

RESULTS

In both groups, the four-talker babble caused the greatest masking effect (worst performances), whereas the SSN resulted in the least masking effect (best performances). The effectiveness of IM due to the lexical-semantic information was comparable between the two groups. However, the effectiveness of IM due to the acoustic-phonetic information was significantly higher in the older listeners, causing worse performances.

CONCLUSIONS

The greater effectiveness of IM due to the acoustic-phonetic information (worse performance) could be due to the minimal-to-mild high-frequency hearing loss and the consequent temporal processing deficits observed in the older listeners. However, it is possible that the older listeners can employ compensatory mechanisms (such as life experiences, contextual cues, employing higher listening efforts, among many possible other mechanisms) to overcome some of these deficits.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20405730.

Lilliput: speech perception in speech-weighted noise and in quiet in young children

OBJECTIVE

The aim of this study was to develop an open-set word recognition task in speech-weighted noise and in quiet for young children and examine age effects for open versus closed response formats.

DESIGN

Dutch monosyllabic words were presented in quiet and in stationary speech-weighted noise to 4- and 5-year-old children as well as to young adults in an open-set response format. Additionally, performance in open and closed context was assessed, as well as in a picture-pointing paradigm.

STUDY SAMPLE

More than 200 children and 50 adults with normal hearing participated in the various validation phases.

RESULTS

Average fitted speech reception thresholds (50%) yielded an age effect between 4-year and 5-year olds (and adults), both in speech-weighted noise and in quiet. The closed-set format yielded lower (better) SNRs than the open-set format, and children benefitted to the same extent as adults from phonetically similar words in speech-weighted noise. Additionally, the 4 AFC picture-pointing paradigm can be used to assess word recognition in quiet from 3 years of age.

CONCLUSIONS

The same materials reveal performance differences between 4 and 5 years of age (and adults), both in quiet and speech-weighted noise using an open-set response format. This relatively small yet significant difference in SRT for a gap of only 1 year shows a developmental change for word recognition in speech-weighted noise and in quiet in the first decade of life.The study is part of the protocol registered on ClinicalTrials.gov (ID = NCT04063748).

Remote-Microphone Benefit in Noise and Reverberation for Children Who are Hard of Hearing

BACKGROUND

 Remote-microphone (RM) systems are designed to reduce the impact of poor acoustics on speech understanding. However, there is limited research examining the effects of adding reverberation to noise on speech understanding when using hearing aids (HAs) and RM systems. Given the significant challenges posed by environments with poor acoustics for children who are hard of hearing, we evaluated the ability of a novel RM system to address the effects of noise and reverberation.

PURPOSE

 We assessed the effect of a recently developed RM system on aided speech perception of children who were hard of hearing in noise and reverberation and how their performance compared to peers who are not hard of hearing (i.e., who have hearing thresholds no greater than 15 dB HL). The effect of aided speech audibility on sentence recognition when using an RM system also was assessed.

STUDY SAMPLE

 Twenty-two children with mild to severe hearing loss and 17 children who were not hard of hearing (i.e., with hearing thresholds no greater than 15 dB HL) (7-18 years) participated.

DATA COLLECTION AND ANALYSIS

 An adaptive procedure was used to determine the signal-to-noise ratio for 50 and 95% correct sentence recognition in noise and noise plus reverberation (RT 300 ms). Linear mixed models were used to examine the effect of listening conditions on speech recognition with RMs for both groups of children and the effects of aided audibility on performance across all listening conditions for children who were hard of hearing.

RESULTS

 Children who were hard of hearing had poorer speech recognition for HAs alone than for HAs plus RM. Regardless of hearing status, children had poorer speech recognition in noise plus reverberation than in noise alone. Children who were hard of hearing had poorer speech recognition than peers with thresholds no greater than 15 dB HL when using HAs alone but comparable or better speech recognition with HAs plus RM. Children with better-aided audibility with the HAs showed better speech recognition with the HAs alone and with HAs plus RM.

CONCLUSION

 Providing HAs that maximize speech audibility and coupling them with RM systems has the potential to improve communication access and outcomes for children who are hard of hearing in environments with noise and reverberation.

Effect of Masker Head Orientation, Listener Age, and Extended High-Frequency Sensitivity on Speech Recognition in Spatially Separated Speech

OBJECTIVES

Masked speech recognition is typically assessed as though the target and background talkers are all directly facing the listener. However, background speech in natural environments is often produced by talkers facing other directions, and talker head orientation affects the spectral content of speech, particularly at the extended high frequencies (EHFs; >8 kHz). This study investigated the effect of masker head orientation and listeners' EHF sensitivity on speech-in-speech recognition and spatial release from masking in children and adults.

DESIGN

Participants were 5- to 7-year-olds (n = 15) and adults (n = 34), all with normal hearing up to 8 kHz and a range of EHF hearing thresholds. Speech reception thresholds (SRTs) were measured for target sentences recorded from a microphone directly in front of the talker's mouth and presented from a loudspeaker directly in front of the listener, simulating a target directly in front of and facing the listener. The maskers were two streams of concatenated words recorded from a microphone located at either 0° or 60° azimuth, simulating masker talkers facing the listener or facing away from the listener, respectively. Maskers were presented in one of three spatial conditions: co-located with the target, symmetrically separated on either side of the target (+54° and -54° on the horizontal plane), or asymmetrically separated to the right of the target (both +54° on the horizontal plane).

RESULTS

Performance was poorer for the facing than for the nonfacing masker head orientation. This benefit of the nonfacing masker head orientation, or head orientation release from masking (HORM), was largest under the co-located condition, but it was also observed for the symmetric and asymmetric masker spatial separation conditions. SRTs were positively correlated with the mean 16-kHz threshold across ears in adults for the nonfacing conditions but not for the facing masker conditions. In adults with normal EHF thresholds, the HORM was comparable in magnitude to the benefit of a symmetric spatial separation of the target and maskers. Although children benefited from the nonfacing masker head orientation, their HORM was reduced compared to adults with normal EHF thresholds. Spatial release from masking was comparable across age groups for symmetric masker placement, but it was larger in adults than children for the asymmetric masker.

CONCLUSIONS

Masker head orientation affects speech-in-speech recognition in children and adults, particularly those with normal EHF thresholds. This is important because masker talkers do not all face the listener under most natural listening conditions, and assuming a midline orientation would tend to overestimate the effect of spatial separation. The benefits associated with EHF audibility for speech-in-speech recognition may warrant clinical evaluation of thresholds above 8 kHz.

Development of Masked Speech Detection Thresholds in 2- to 15-year-old Children: Speech-Shaped Noise and Two-Talker Speech Maskers

OBJECTIVES

On the basis of the data from school-aged children, there is consistent evidence that there is a prolonged course of auditory development for perceiving speech embedded in competing background sounds. Furthermore, age-related differences are prolonged and pronounced for a two-talker speech masker compared to a speech-shaped noise masker. However, little is known about the course of development during the toddler and preschool years because it is difficult to collect reliable behavioral data from this age range. The goal of this study was to extend our lower age limit to include toddlers and preschoolers to characterize the developmental trajectory for masked speech detection thresholds across childhood.

DESIGN

Participants were 2- to 15-year-old children (n = 67) and adults (n = 17), all with normal hearing. Thresholds (71%) were measured for detecting a two-syllable word embedded in one of two maskers: speech-shaped noise or two-talker speech. The masker was presented at 55 dB SPL throughout testing. Stimuli were presented to the left ear via a lightweight headphone. Data were collected using an observer-based testing method in which the participant's behavior was judged by an experimenter using a two-interval, two-alternative testing paradigm. The participant's response to the stimulus was shaped by training him/her to perform a conditioned play-based response to the sound. For children, receptive vocabulary and working memory were measured. Data were fitted with a linear regression model to establish the course of development for each masker condition. Appropriateness of the test method was also evaluated by determining if there were age-related differences in training data, inter-rater reliability, or slope or upper asymptote estimates from pooled psychometric functions across different age groups.

RESULTS

Child and adult speech detection thresholds were poorer in the two-talker masker than in the speech-shaped noise masker, but different developmental trajectories were seen for the two masker conditions. For the speech-shaped noise masker, threshold improved by about 5 dB across the age span tested, with adult-like performance being reached around 10 years of age. For the two-talker masker condition, thresholds improved by about 7 dB between 2.5 and 15 years. However, the linear fit for this condition failed to achieve adult-like performance because of limited data from teenagers. No significant age-related differences were seen in training data, probe hit rate, or inter-rater reliability. Furthermore, slope and upper asymptote estimates from pooled psychometric functions were similar across different child age groups.

CONCLUSIONS

Different developmental patterns were seen across the two maskers, with more pronounced child-adult differences and prolonged immaturity during childhood for the two-talker masker relative to the speech-shaped noise masker. Our data do not support the idea that there is rapid improvement of masked speech detection thresholds between 2.5 and 5 years of age. This study also highlights that our observer-based method can be used to collect reliable behavioral data from toddlers and preschoolers-a time period where we know little about auditory development.

Speech Understanding in Modulated Noise and Speech Maskers as a Function of Cognitive Status in Older Adults

Objectives The purpose of this study was to investigate the impact of different types of maskers on speech understanding as a function of cognitive status in older adults. The hypothesis tested was that individuals with a diagnosis of mild cognitive impairment (MCI) or mild dementia would perform like their age- and hearing status-matched control counterparts in modulated noise but would perform more poorly in the presence of competing speech. Design Participants (n = 39; age range: 55-77 years old) performed a speech-in-noise task and completed two cognitive screening tests and a measure of working memory. Sentences were presented in the presence of two types of maskers (i.e., speech envelope-modulated noise and two-talker, same-sex competing speech). Two analyses were undertaken: (a) a between-groups comparison of individuals diagnosed with MCI/dementia, individuals who failed both cognitive screeners (possible MCI), and age- and hearing status-matched neurologically healthy control individuals and (b) a mixed-model analysis of variance of speech perception performance as a function of working memory capacity. Results The between-groups comparison yielded significant group differences for speech understanding in both masking conditions, with the MCI/dementia group performing more poorly than the neurologically healthy controls and possible MCI groups. A single measure of working memory (Size Comparison Span [SICSPAN]) was correlated with performance on the speech perception task in the competing speech conditions. Conclusions Adults with a diagnosis of MCI or mild dementia performed more poorly on a speech perception task than their age- and hearing status-matched control counterparts in the presence of both maskers, with larger group mean differences when the target speech was presented in a two-talker masker. This suggests increased difficulty understanding speech in the presence of distracting backgrounds for people with MCI/dementia. Future studies should consider how to target this potentially vulnerable population as they may be experiencing increased difficulty communicating in challenging environments.

Comparing the Speech Perception of Cochlear Implant Users with Three Different Finnish Speech Intelligibility Tests in Noise

Background: A large number of different speech-in-noise (SIN) tests are available for testing cochlear implant (CI) recipients, but few studies have compared the different tests in the same patient population to assess how well their results correlate. Methods: A clinically representative group of 80 CI users conducted the Finnish versions of the matrix sentence test, the simplified matrix sentence test, and the digit triplet test. The results were analyzed for correlations between the different tests and for differences among the participants, including age and device modality. Results: Strong and statistically significant correlations were observed between all of the tests. No floor or ceiling effects were observed with any of the tests when using the adaptive test procedure. Age or the length of device use showed no correlation to SIN perception, but bilateral CI users showed slightly better results in comparison to unilateral or bimodal users. Conclusions: Three SIN tests that differ in length and complexity of the test material provided comparable results in a diverse CI user group.

Speech Recognition in Noise Using Binaural Diotic and Antiphasic Digits-in-Noise in Children: Maturation and Self-Test Validity

BACKGROUND

 Digits-in-noise (DIN) tests have become popular for hearing screening over the past 15 years. Several recent studies have highlighted the potential utility of DIN as a school-aged hearing test. However, age may influence test performance in children due to maturation. In addition, a new antiphasic stimulus paradigm has been introduced, allowing binaural intelligibility level difference (BILD) to be measured by using a combination of conventional diotic and antiphasic DIN.

PURPOSE

 This study determined age-specific normative data for diotic and antiphasic DIN, and a derived measure, BILD, in children. A secondary aim evaluated the validity of DIN as a smartphone self-test in a subgroup of young children.

RESEARCH DESIGN

 A cross-sectional, quantitative design was used. Participants with confirmed normal audiometric hearing were tested with a diotic and antiphasic DIN. During the test, arrangements of three spoken digits were presented in noise via headphones at varying signal-to-noise ratio (SNR). Researchers entered each three-digit spoken sequence repeated by the participant on a smartphone keypad.

STUDY SAMPLE

 Overall, 621 (428 male and 193 female) normal hearing children (bilateral pure tone threshold of ≤ 20 dB hearing level at 1, 2, and 4 kHz) ranging between the ages of 6 and 13 years were recruited. A subgroup of 7-year-olds (n = 30), complying with the same selection criteria, was selected to determine the validity of self-testing.

DATA COLLECTION AND ANALYSIS

 DIN testing was completed via headphones coupled to a smartphone. Diotic and antiphasic DIN speech recognition thresholds (SRTs) were analyzed and compared for each age group. BILD was calculated through subtraction of antiphasic from diotic SRTs. Multiple linear regressions were run to determine the effect of age on SRT and BILD. In addition, piecewise linear regressions were fit across different age groups. Wilcoxon signed-rank tests were used to determine differences between self- and facilitated tests.

RESULTS

 Age was a significant predictor, of both diotic and antiphasic DIN SRTs (p < 0.05). SRTs improved by 0.15 dB and 0.35 dB SNR per year for diotic and antiphasic SRTs, respectively. However, age effects were only significant up to 10 and 12 years for antiphasic and diotic SRTs, respectively. Age significantly (p < 0.001) predicted BILD, which increased by 0.18 dB per year. A small SRT advantage for facilitated over self-testing was seen but was not significant (p > 0.05).

CONCLUSIONS

 Increasing age was significantly associated with improved SRT and BILD using diotic and antiphasic DINs. DIN could be used as a smartphone self-test in young children from 7 years of age with appropriate quality control measures to avoid potential false positives.

Spatial Release From Masking in Pediatric Cochlear Implant Recipients With Single-Sided Deafness

Purpose Children with single-sided deafness (SSD) experience difficulty understanding speech in multisource listening situations. Case reports and retrospective studies have indicated that a cochlear implant (CI) may improve masked speech recognition in children with SSD. This prospective study was conducted to determine whether providing a CI to children with SSD supports spatial release from masking (SRM), an improvement in speech recognition associated with separating the target and masker sources. Method Twenty children with at least a moderate-to-profound hearing loss in one ear and normal hearing in the contralateral ear underwent cochlear implantation. The average age of implantation was 5.5 years (range: 3.5-12.7). After 12 months of CI use, subjects completed a sentence recognition task in multitalker masker with and without the CI. The target was presented from the front, and the masker was either colocated with the target (0°) or from the side (+90° or -90°). A two-way repeated-measures analysis of variance was completed to investigate SRM with and without the CI. Results Pediatric CI recipients experienced significant SRM when the masker was directed to the normal-hearing ear or to the affected ear. Conclusions The results indicate that cochlear implantation in children with SSD supports binaural skills required for speech recognition in noise. These results are consistent with improved functional communication in multisource environments, like classrooms.

Individuals With Mild Cognitive Impairment and Alzheimer's Disease Benefit From Audiovisual Speech Cues and Supportive Sentence Context

Purpose Speech perception in noise becomes difficult with age but can be facilitated by audiovisual (AV) speech cues and sentence context in healthy older adults. However, individuals with Alzheimer's disease (AD) may present with deficits in AV integration, potentially limiting the extent to which they can benefit from AV cues. This study investigated the benefit of these cues in individuals with mild cognitive impairment (MCI), individuals with AD, and healthy older adult controls. Method This study compared auditory-only and AV speech perception of sentences presented in noise. These sentences had one of two levels of context: high (e.g., "Stir your coffee with a spoon") and low (e.g., "Bob didn't think about the spoon"). Fourteen older controls (M _age = 72.71 years, SD = 9.39), 13 individuals with MCI (M _age = 79.92 years, SD = 5.52), and nine individuals with probable Alzheimer's-type dementia (M _age = 79.38 years, SD = 3.40) completed the speech perception task and were asked to repeat the terminal word of each sentence. Results All three groups benefited (i.e., identified more terminal words) from AV and sentence context. Individuals with MCI showed a smaller AV benefit compared to controls in low-context conditions, suggesting difficulties with AV integration. Individuals with AD showed a smaller benefit in high-context conditions compared to controls, indicating difficulties with AV integration and context use in AD. Conclusions Individuals with MCI and individuals with AD do benefit from AV speech and semantic context during speech perception in noise (albeit to a lower extent than healthy older adults). This suggests that engaging in face-to-face communication and providing ample context will likely foster more effective communication between patients and caregivers, professionals, and loved ones.

School-age children benefit from voice gender cue differences for the perception of speech in competing speech

Differences in speakers' voice characteristics, such as mean fundamental frequency (F0) and vocal-tract length (VTL), that primarily define speakers' so-called perceived voice gender facilitate the perception of speech in competing speech. Perceiving speech in competing speech is particularly challenging for children, which may relate to their lower sensitivity to differences in voice characteristics than adults. This study investigated the development of the benefit from F0 and VTL differences in school-age children (4-12 years) for separating two competing speakers while tasked with comprehending one of them and also the relationship between this benefit and their corresponding voice discrimination thresholds. Children benefited from differences in F0, VTL, or both cues at all ages tested. This benefit proportionally remained the same across age, although overall accuracy continued to differ from that of adults. Additionally, children's benefit from F0 and VTL differences and their overall accuracy were not related to their discrimination thresholds. Hence, although children's voice discrimination thresholds and speech in competing speech perception abilities develop throughout the school-age years, children already show a benefit from voice gender cue differences early on. Factors other than children's discrimination thresholds seem to relate more closely to their developing speech in competing speech perception abilities.

Extended high-frequency hearing and head orientation cues benefit children during speech-in-speech recognition

While the audible frequency range for humans spans approximately 20 Hz to 20 kHz, children display enhanced sensitivity relative to adults when detecting extended high frequencies (frequencies above 8 kHz; EHFs), as indicated by better pure tone thresholds. The impact that this increased hearing sensitivity to EHFs may have on children's speech recognition has not been established. One context in which EHF hearing may be particularly important for children is when recognizing speech in the presence of competing talkers. In the present study, we examined the extent to which school-age children (ages 5-17 years) with normal hearing were able to benefit from EHF cues when recognizing sentences in a two-talker speech masker. Two filtering conditions were tested: all stimuli were either full band or were low-pass filtered at 8 kHz to remove EHFs. Given that EHF energy emission in speech is highly dependent on head orientation of the talker (i.e., radiation becomes more directional with increasing frequency), two masker head angle conditions were tested: both co-located maskers were facing 45°, or both were facing 60° relative to the listener. The results demonstrated that regardless of age, children performed better when EHFs were present. In addition, a small change in masker head orientation also impacted performance, with better recognition at 60° compared to 45°. These findings suggest that EHF energy in the speech signal above 8 kHz is beneficial for children in complex listening situations. The magnitude of benefit from EHF cues and talker head orientation cues did not differ between children and adults. Therefore, while EHFs were beneficial for children as young as 5 years of age, children's generally better EHF hearing relative to adults did not provide any additional benefit.

Psychometric function for speech-in-noise tests accounts for word-recognition deficits in older listeners

Speech-in-noise (SIN) understanding in older age is affected by hearing loss, impaired central auditory processing, and cognitive deficits. SIN-tests measure these factors' compound effects by a speech reception threshold, defined as the signal-to-noise ratio required for 50% word understanding (SNR50). This study compared two standard SIN tests, QuickSIN (n = 354) in young and older adults and BKB-SIN (n = 139) in older adults (>60 years). The effects of hearing loss and age on SIN understanding were analyzed to identify auditory and nonauditory contributions to SIN loss. Word recognition in noise was modelled with individual psychometric functions using a logistic fit with three parameters: the midpoint (SNRα), slope (β), and asymptotic word-recognition deficit at high SNR (λ). The parameters SNRα and λ formally separate SIN loss into two components. SNRα characterizes the steep slope of the psychometric function at which a slight SNR increase provides a considerable improvement in SIN understanding. SNRα was discussed as being predominantly affected by audibility and low-level central auditory processing. The parameter λ describes a shallow segment of the psychometric function at which a further increase in the SNR provides modest improvement in SIN understanding. Cognitive factors in aging may contribute to the SIN loss indicated by λ.

Cognitive and Linguistic Contributions to Masked Speech Recognition in Children

Purpose The goal of this study was to examine the effects of cognitive and linguistic skills on masked speech recognition for children with normal hearing in three different masking conditions: (a) speech-shaped noise (SSN), (b) amplitude-modulated SSN (AMSSN), and (c) two-talker speech (TTS). We hypothesized that children with better working memory and language skills would have better masked speech recognition than peers with poorer skills in these areas. Selective attention was predicted to affect performance in the TTS masker due to increased cognitive demands from informational masking. Method A group of 60 children in two age groups (5- to 6-year-olds and 9- to 10-year-olds) with normal hearing completed sentence recognition in SSN, AMSSN, and TTS masker conditions. Speech recognition thresholds for 50% correct were measured. Children also completed standardized measures of language, memory, and executive function. Results Children's speech recognition was poorer in the TTS relative to the SSN and AMSSN maskers. Older children had lower speech recognition thresholds than younger children for all masker conditions. Greater language abilities were associated with better sentence recognition for the younger children in all masker conditions, but there was no effect of language for older children. Better working memory and selective attention skills were associated with better masked sentence recognition for both age groups, but only in the TTS masker condition. Conclusions The decreasing influence of vocabulary on masked speech recognition for older children supports the idea that this relationship depends on an interaction between the language level of the stimuli and the listener's vocabulary. Increased cognitive demands associated with perceptually isolating the target talker and two competing masker talkers with a TTS masker may result in the recruitment of working memory and selective attention skills, effects that were not observed in SSN or AMSSN maskers. Future research should evaluate these effects across a broader range of stimuli or with children who have hearing loss.

The Finnish simplified matrix sentence test for the assessment of speech intelligibility in the elderly

Objective: A simplified version of the Finnish matrix sentence test (FMST) was developed to improve the reliability of hearing diagnostic for children and for patients with limited working memory capacity and/or vocabulary.Design: Study 1 evaluated the word matrix of the Finnish simplified matrix sentence test (FINSIMAT) to rule out systematic differences between the new FINSIMAT test lists, and to provide reference values for normal-hearing (NH) young adults (YA). In Study 2, the FINSIMAT and the FMST were evaluated in elderly listeners with mild-to-moderate hearing impairment (HI).Study sample: Twenty NH YAs participated in Study 1, and 16 elderly HI adults participated in Study 2.Results: For NH YAs, the reference speech reception threshold (SRT₅₀) estimate and the slope for the FINSIMAT were -11.2 ± 1.0 dB signal-to-noise ratio (SNR) and 19.4 ± 1.9%/dB SNR. For the elderly HI listeners, the mean SRT₅₀ estimates for the FINSIMAT and FMST were -4.1 and -3.6 dB SNR, respectively. The correlation between the FMST and FINSIMAT results was strong (r² = 0.78, p < 0.001).Conclusion: The FINSIMAT showed comparable characteristics to the FMST and proved feasible for measurements in elderly HI listeners.

Psychometric function slope for speech-in-noise and speech-in-speech: Effects of development and aging

Masked sentence recognition was evaluated in normal-hearing children (8.8-10.5 years), young adults (18-28 years), and older adults (60-71 years). Consistent with published data, speech recognition thresholds were poorer for young children and older adults than for young adults, particularly when the masker was composed of speech. Psychometric function slopes were steeper for young children and older adults than for young adults when the masker was two-talker speech, but not when it was speech-shaped noise. Multiple factors are implicated in the age effects observed for speech-in-speech recognition at low signal-to-noise ratios.