1

Can You Hear Me Now?

Speech Perception Testing With Children Who Have Hearing Aids

and Cochlear Implants

Amy Lynn Birath, AuD, CCC-A/SLP, FAAA, LSLS Cert. AVEdBoard Certified in Audiology

THE MOOG CENTER FOR DEAF EDUCATION

Disclosures

� Financial:

� I am employed by the Moog Center for Deaf Education

� I am a (re)habilitation and special projects consultant for Advanced Bionics, LLC.

� Non-financial:

� I received my AuD from the University of Memphis

Can You Hear Me Now?

2

Aided Speech Perception Testing

�Administration of evaluation measures

to determine a child’s ability to detect,

recognize, identify, and comprehend what is heard using his hearing aid(s) or

cochlear implant(s)

Goal of Amplification

��To ensure audibility of To ensure audibility of softsoft and and

averageaverage level speech across the level speech across the

broadest frequency rangebroadest frequency range

possible, while maintaining comfort possible, while maintaining comfort

for for loudloud sounds, in a sounds, in a variety of variety of

listening environmentslistening environments

3

How do we know if we met our goal?

Speech

Perception

Testing

Speech Perception Testing Utility

�Validation of device fitting/programming

�Comparison of programs/settings/devices

�Fitting FM/DM systems

�Determining CI candidacy

�Evaluating auditory skills development

�Guiding auditory skills therapy / (re)hab

Aided Audiogram

� Detection ≠

Recognition

� Detection ≠

Identification

� Detection ≠

Comprehension

A A A A AA AA AAA AAAA AAAAA AAAAA

4

Johnny & Jenny

AAAAA AA AA A AA A A AA A A A AA A A A A

Johnny & Jenny

Johnny Jenny

LNT-E: 18/25 (72%) 22/25 (88%)

LNT-H: 11/25 (44%) 22/25 (88%)

Ped AZ Bio: 89/147 (61%) 144/147 (98%)

Iowa Medial: 43/70 (61%) 60/70 (86%)

BKB-SIN: 5.7dB SNR Loss -1.0dB SNR Loss

Madell, et. al. 2011

Excellent: 90-100%

Good: 80-89%

Fair: 70-79%

Poor: <70%

Perception Influences Production

We speak the way that we hear

or

G.I.G.O

We speak the way that we hear

or

G.I.G.O

5

Time

�Start with one test

�Collaborate with the child’s

therapist/teacher

�Have an assistant in the booth

�Use CPT codes 92626 & 92627

The Test Battery

� Needed to measure specific aspects of speech perception, as no single variable can assess or

represent speech perception as a whole

� Required to accommodate a variety of children:

�of different ages

�chronological, developmental, linguistic

�using different communication modes

�oral, cued speech, total, or manual

�with different auditory skills

Eisenberg, et.al., 2005

Lucks Mendel, 2008

Testing Parameters

Easy Hard

Response Formats

closed-set open-set

Presentation Delivery

monitored live voice

recorded

Condition auditory-visual auditory-only

Level of

Presentation average soft

Presentation Environment

quiet noise

6

Response Format

�Closed-set�Typically easier

�Limits response choices

�Good for young children & children with poor speech production

�Open-set�Typically harder

�Unlimited response choices

�Generally more typical of real life

Presentation Delivery

�Monitored Live Voice�Typically easier

�Generally poorer reliability

�May be good for very young children &/or introduction of new test materials

�Recorded�Typically harder

�Best reliability

�Goal for all tests

Condition

�Auditory-visual�Typically easier

�Allows access to the speakers face during stimulus presentation

�Good for introduction of test materials & determination of the impact of visual access

�Auditory-only�Typically harder

�Provides information about performance without visual access

�Most tests are completed in this condition

7

Level of Presentation

�Average

�Typically easier

�60 dB SPL

�Normal conversational level

�Soft

�Typically harder

�50 dB SPL

�Soft conversational level

Presentation Environment

�Quiet

�Typically easier

�Results indicate best possible performance

�Noise

�Typically harder

�Results indicate more realistic performance

�Most tests can be given in background noise & some were developed specifically to evaluate performance in background noise

�Multi-talker babble is preferable

The Moog Center Battery

� Ling 6 Sound Check

� ESP Low Verbal & Standard� WIPI

� Minimal Pairs� GASP Words

� MLNT (easy & hard)

� LNT (easy & hard)� PBK

� CNC

� Iowa Medial Consonant Test� California Consonant Test

� Plurals Test

� Common Phrases

� GASP Sentences

� BKB Sentences

� HINT-C Sentences� CID Everyday Sentences

� MLST-C Sentences

� Pediatric AzBio Sentences� AzBio Sentences

� Phrases in Noise (PINT)

� HINT-C Sentences in Noise� Pediatric AzBio Sentences in Noise

� BKB-Sentences in Noise

� AzBio Sentences in Noise

8

Videos

ESP Low Verbal Pattern Perception

ESP Low Verbal Spondees

9

ESP Standard Monosyllables

WIPI

MLNT

10

CNC

Iowa Medial Consonant Test

HINT-C in Quiet

11

Pediatric AzBio

PINT

BKB-SIN

12

Test Selection

�Child Factors:

�Age

�Developmental Level

�Language Skills

Test Selection

�Test Factors�Stimuli

�Phonemes, Patterns, Words, Sentences

�Level of Difficulty

�Easiest to hardest:

1. Monitored Live Voice, Closed-set, Quiet

-Rate, articulation, familiar speaker

-Pictures/toys to choose from – known word

-Easy listing situation

TO

2. Recorded, Open-set, Noise

-Consistent presentation, rate and manner, unfamiliar speaker

-No pictures or toys to choose from – unknown word

-Difficult listening situation

Where To Start

XLNT

XMLNT

X

(familiar words)

GASP

Words

X

(consonants)

Minimal

Pairs

X

(consonants)WIPI

XESP

XXLing 6

Sounds

ComprehensionIdentificationRecognitionDetection

13

X

(answer)

X

(repeat)

GASP

Sentences

\X

(familiar phrases)

Common

Phrases

X

(/s/ & /z/)Plurals

X

(phonemes)

X

(phonemes)

California

Consonant

X

(phonemes)

X

(phonemes)

IA Medial

Consonant

XCNC

XPBK

ComprehensionIdentificationRecognitionDetection

\X

(noise)BKB-SIN

\X

(noise)PINT

X

(non-contextual)AzBio

X

(non-contextual)

Pediatric

AzBio

\X

(contextual) MLST-C

\X

(contextual)

CID

Sentences

\X

(contextual)HINT-C

Sentences

ComprehensionIdentificationRecognitionDetection

Where to Start: Auditory Language Age (ALA)

Adapted from Madell & Flexer, 2008

If ALA < 2,

administer ESP

If ALA ≥ 2 to ≤ 5,

administer WIPI

If ALA is ≥3 to < 6,

administer MLNT &/or LNT

If ALA is ≥ 4 to ≤ 6,

administer PBK

If ALA is > 6, administer CNC

14

What Next?

� If score is < 50%

�Give an easier test

� If score is > 50%

�Give same test at a soft presentation level

�Give a test in background noise

� If score is ≥ 85%

�Give a more difficult test

General Testing Protocol

�At least one single word test�60dB SPL; Right, Left, Both

�50dB SPL; Both

�At least one sentence test�60dB SPL; Right, Left, Both

�50dB SPL; Both

�At least one test in background noise�+5dB SNR

�Per test protocol

General Testing Frequency

�For children with cochlear implants:

�1, 3, 6, 9, 12 months post initial activation

�At least annually (prefer every 6 months)

�Following programming and/or devices changes

�If concerns arise

15

General Testing Frequency

�For children with hearing aids:

�As soon as is developmentally appropriate

�At least annually (every 6 months until age 3)

�Following programming and/or device changes

�If concerns arise

Utility Revisited

�Validation of device fitting/programming

�Comparison of programs/settings/devices

�Fitting FM/DM systems

�Determining CI candidacy

�Evaluating auditory skills development

�Guiding auditory skills therapy / (re)hab

Conclusion

�Aided speech perception testing is of great value for children with hearing aids and

cochlear implants

� It can and should be incorporated into

standard clinical practice to ensure

accurate assessment and optimum outcomes

AAA, 2013

16

Final Thought

Questions?

abirath@moogcenter.org

References

� American Academy of Audiology (2013). Clinical Practice Guidelines: Pediatric Amplification.

� Eisenberg, L., Johnson, K., & Martinez, A. (2005). Clinical assessment of speech perception for infants and toddlers. Audiology Online, September. Retrieved from http://www.audiologyonline.com/articles/clinical-assessment-speech-perception-for-1016

� Lucks Mendel, L. (2008). Current considerations in pediatric speech audiometry. International Journal of Audiology, 47. 546-553.

� Madell, J., & Flexer, C. (2008). Pediatric audiology: Diagnosis, technology, and management. New York: Thieme Medical Publishers.

� Madell, J., Batheja, R., Klemp, E., & Hoffman, R. (2011). Evaluating speech perception performance, Audiology Today, September-October, 52-56.

� Munoz, K., Blaiser, K., & Schofield, H. (2012). Aided speech perception testing practices for three-to-six-year old children with permanent hearing loss. Journal of Educational Audiology, 18, 53-60.

� Roeser, R., & Clark, J. (2008). Live voice speech recognition audiometry –stop the madness! Audiology Today, 2(1), 32-33.