Spatial Release From Masking in 2-Year-Olds With Normal Hearing and With Bilateral Cochlear Implants

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.

Spatial Release From Masking With Bilateral Bone Conduction Stimulation at Mastoid for Normal Hearing Subjects

This study investigates the effect of spatial release from masking (SRM) in bilateral bone conduction (BC) stimulation at the mastoid. Nine adults with normal hearing were tested to determine SRM based on speech recognition thresholds (SRTs) in simulated spatial configurations ranging from 0 to 180 degrees. These configurations were based on nonindividualized head-related transfer functions. The participants were subjected to sound stimulation through either air conduction (AC) via headphones or BC. The results indicated that both the angular separation between the target and the masker, and the modality of sound stimulation, significantly influenced speech recognition performance. As the angular separation between the target and the masker increased up to 150°, both BC and AC SRTs decreased, indicating improved performance. However, performance slightly deteriorated when the angular separation exceeded 150°. For spatial separations less than 75°, BC stimulation provided greater spatial benefits than AC, although this difference was not statistically significant. For separations greater than 75°, AC stimulation offered significantly more spatial benefits than BC. When speech and noise originated from the same side of the head, the "better ear effect" did not significantly contribute to SRM. However, when speech and noise were located on opposite sides of the head, this effect became dominant in SRM.

Hearing Preservation and Spatial Hearing Outcomes After Cochlear Implantation in Children With TMPRSS3 Mutations

OBJECTIVE

Investigate hearing preservation and spatial hearing outcomes in children with TMPRSS3 mutations who received bilateral cochlear implantation.

STUDY DESIGN AND METHODS

Longitudinal case series report. Two siblings (ages, 7 and 4 yr) with TMPRSS3 mutations with down-sloping audiograms received sequential bilateral cochlear implantation with hearing preservation with low-frequency acoustic amplification and high-frequency electrical stimulation. Spatial hearing, including speech perception and localization, was assessed at three time points: preoperative, postoperative of first and second cochlear implant (CI).

RESULTS

Both children showed low-frequency hearing preservation in unaided, acoustic-only audiograms. Both children demonstrated improvements in speech perception in both quiet and noise after CI activations. The emergence of spatial hearing was observed. Each child's overall speech perception and spatial hearing when listening with bilateral CIs were within the range or better than published group data from children with bilateral CIs of other etiology.

CONCLUSION

Bilateral cochlear implantation with hearing preservation is a viable option for managing hearing loss for pediatric patients with TMPRSS3 mutations.

Spatial release of masking in children and adults in non-individualized virtual environments

The spatial release of masking (SRM) is often measured in virtual auditory environments created from head-related transfer functions (HRTFs) of a standardized adult head. Adults and children, however, differ in head dimensions and mismatched HRTFs are known to affect some aspects of binaural hearing. So far, there has been little research on HRTFs in children and it is unclear whether a large mismatch of spatial cues can degrade speech perception in complex environments. In two studies, the effect of non-individualized virtual environments on SRM accuracy in adults and children was examined. The SRMs were measured in virtual environments created from individual and non-individualized HRTFs and the equivalent real anechoic environment. Speech reception thresholds (SRTs) were measured for frontal target sentences and symmetrical speech maskers at 0° or ±90° azimuth. No significant difference between environments was observed for adults. In 7 to 12-year-old children, SRTs and SRMs improved with age, with SRMs approaching adult levels. SRTs differed slightly between environments and were significantly worse in a virtual environment based on HRTFs from a spherical head. Adult HRTFs seem sufficient to accurately measure SRTs in children even in complex listening conditions.

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.

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.

The Role of Interaural Differences, Head Shadow, and Binaural Redundancy in Binaural Intelligibility Benefits Among School-Aged Children

In complex listening environments, children can benefit from auditory spatial cues to understand speech in noise. When a spatial separation is introduced between the target and masker and/or listening with two ears versus one ear, children can gain intelligibility benefits with access to one or more auditory cues for unmasking: monaural head shadow, binaural redundancy, and interaural differences. This study systematically quantified the contribution of individual auditory cues in providing binaural speech intelligibility benefits for children with normal hearing between 6 and 15 years old. In virtual auditory space, target speech was presented from  + 90° azimuth (i.e., listener's right), and two-talker babble maskers were either co-located (+ 90° azimuth) or separated by 180° (-90° azimuth, listener's left). Testing was conducted over headphones in monaural (i.e., right ear) or binaural (i.e., both ears) conditions. Results showed continuous improvement of speech reception threshold (SRT) between 6 and 15 years old and immature performance at 15 years of age for both SRTs and intelligibility benefits from more than one auditory cue. With early maturation of head shadow, the prolonged maturation of unmasking was likely driven by children's poorer ability to gain full benefits from interaural difference cues. In addition, children demonstrated a trade-off between the benefits from head shadow versus interaural differences, suggesting an important aspect of individual differences in accessing auditory cues for binaural intelligibility benefits during development.

Interrater Reliability for a Two-Interval, Observer-Based Procedure for Measuring Hearing in Young Children

Purpose To overcome methodology limitations for studying auditory development in young children, we have recently developed an observer-based procedure that uses a conditioned, play-based, motor response (see Bonino & Leibold, 2017). The purpose of this article was to examine interrater reliability for the method. Method Video recordings of test sessions of 2- to 4-year-old children (n = 17) were examined. Detection of a 1000-Hz warble tone was measured with the Play Observer-Based, Two-Interval (PlayO2I) method in each of two conditions: for a fixed intensity level (30 dB SPL) or for a variable intensity level signal (0-30 dB SPL). All test sessions were scored independently by three observers (one real-time, two offline). Observer consensus was evaluated with Fleiss' kappa statistic. To determine if summary data were similar across the observers of each test session, the proportion of correct trials (fixed-level condition) or threshold (variable-level condition) were computed. Results The strength of observer consensus was classified as "almost perfect" and "substantial" for the fixed-level and variable-level conditions, respectively. Follow-up analysis of the variable-level data indicated that differences in observer consensus were seen based on the signal level, the type of response behavior provided by the child, and the confidence level of the real-time observer. Resulting summary data were similar across the three observers of each test session: no significant differences for estimates of the proportion of correct trials or threshold. Conclusions Results from this study confirm strong interrater reliability for the method. The PlayO2I method is a powerful tool for measuring detection and discrimination abilities in young children. Supplemental Material https://doi.org/10.23641/asha.12978197.

Auditory Attention and Spatial Unmasking in Children With Cochlear Implants

The ability to attend to target speech in background noise is an important skill, particularly for children who spend many hours in noisy environments. Intelligibility improves as a result of spatial or binaural unmasking in the free-field for normal-hearing children; however, children who use bilateral cochlear implants (BiCIs) demonstrate little benefit in similar situations. It was hypothesized that poor auditory attention abilities might explain the lack of unmasking observed in children with BiCIs. Target and interferer speech stimuli were presented to either or both ears of BiCI participants via their clinical processors. Speech reception thresholds remained low when the target and interferer were in opposite ears, but they did not show binaural unmasking when the interferer was presented to both ears and the target only to one ear. These results demonstrate that, in the most extreme cases of stimulus separation, children with BiCIs can ignore an interferer and attend to target speech, but there is weak or absent binaural unmasking. It appears that children with BiCIs mostly experience poor encoding of binaural cues rather than deficits in ability to selectively attend to target speech.

Behavioral Assessment of Hearing in 2- to 7-Year-Old Children: Evaluation of a Two-Interval, Observer-Based Procedure Using Conditioned Play-Based Responses

Purpose It is challenging to collect reliable behavioral data from toddlers and preschoolers. Consequently, we have significant gaps in our understanding of how auditory development unfolds during this time period. One method that appears to be promising is an observer-based procedure that uses conditioned, play-based responses (Bonino & Leibold, 2017). In order to evaluate the quality of data obtained with this method, this study presented a suprathreshold signal to determine the number of trials 2- to 7-year-old children could complete, as well as the associated hit rate and observer confidence. Method Participants were 23 children (2-7 years old). Children were taught to perform a play-based motor response when they detected the 1000-Hz warble tone signal (at 30 dB SPL). An observer evaluated children's behavior using a 2-interval, 2-alternative testing paradigm. Testing was terminated after 100 trials or earlier, if signs of habituation were observed. Results Data were successfully collected from 22 of the 23 children. Of the 22 children, all but 1 child completed 100 trials. Overall hit rate was high (0.88-1.0; M = 0.94) and improved with listener age. Hit rate was stable across the test session. Strong agreement was seen between the correctness of the response and the observer's confidence in the judgment. Conclusion Results of this study confirm that the 2-interval, observer-based procedure described in this article is a powerful tool for measuring detection and discrimination abilities in young children. Future research will (a) evaluate coder reliability and (b) examine stability of performance across a test session when the signal intensity is manipulated. Supplemental Material https://doi.org/10.23641/asha.8309273.

Sound Localization in Toddlers with Normal Hearing and with Bilateral Cochlear Implants Revealed Through a Novel "Reaching for Sound" Task

BACKGROUND

Spatial hearing abilities in children with bilateral cochlear implants (BiCIs) are typically improved when two implants are used compared with a single implant. However, even with BiCIs, spatial hearing is still worse compared to normal-hearing (NH) age-matched children. Here, we focused on children who were younger than three years, hence in their toddler years. Prior research with this age focused on measuring discrimination of sounds from the right versus left.

PURPOSE

This study measured both discrimination and sound location identification in a nine-alternative forced-choice paradigm using the "reaching for sound" method, whereby children reached for sounding objects as a means of capturing their spatial hearing abilities.

RESEARCH DESIGN

Discrimination was measured with sounds randomly presented to the left versus right, and loudspeakers at fixed angles ranging from ±60° to ±15°. On a separate task, sound location identification was measured for locations ranging from ±60° in 15° increments.

STUDY SAMPLE

Thirteen children with BiCIs (27-42 months old) and fifteen age-matched (NH).

DATA COLLECTION AND ANALYSIS

Discrimination and sound localization were completed for all subjects. For the left-right discrimination task, participants were required to reach a criterion of 4/5 correct trials (80%) at each angular separation prior to beginning the localization task. For sound localization, data was analyzed in two ways. First, percent correct scores were tallied for each participant. Second, for each participant, the root-mean-square-error was calculated to determine the average distance between the response and stimulus, indicative of localization accuracy.

RESULTS

All BiCI users were able to discriminate left versus right at angles as small as ±15° when listening with two implants; however, performance was significantly worse when listening with a single implant. All NH toddlers also had >80% correct at ±15°. Sound localization results revealed root-mean-square errors averaging 11.15° in NH toddlers. Children in the BiCI group were generally unable to identify source location on this complex task (average error 37.03°).

CONCLUSIONS

Although some toddlers with BiCIs are able to localize sound in a manner consistent with NH toddlers, for the majority of toddlers with BiCIs, sound localization abilities are still emerging.