The long-term average speech spectrum (LTASS) and some dynamic characteristics of speech were determined for 12 languages: English (several dialects), Swedish, Danish, German, French (Canadian), Japanese, Cantonese, Mandarin, Russian, Welsh, Singhalese, and Vietnamese. The LTASS only was also measured for Arabic. Speech samples (18) were recorded, using standardized equipment and procedures, in 15 localities for (usually) ten male and ten female talkers. All analyses were conducted at the National Acoustic Laboratories, Sydney. The LTASS was similar for all languages although there were many statistically significant differences. Such differences were small and not always consistent for male and female samples of the same language. For one-third octave bands of speech, the maximum short-term rms level was 10 dB above the maximum long-term rms level, consistent across languages and frequency. A ‘‘universal’’ LTASS is suggested as being applicable, across languages, for many purposes including use in hearing aid prescription procedures and in the Articulation Index.

Two experiments were conducted to examine the relationship between audibility and speech recognition for individuals with sensorineural hearing losses ranging from mild to profound degrees. Speech scores measured using filtered sentences were compared to predictions based on the Speech Intelligibility Index (SII). The SII greatly overpredicted performance at high sensation levels, and for many listeners, it underpredicted performance at low sensation levels. To improve predictive accuracy, the SII needed to be modified. Scaling the index by a multiplicative proficiency factor was found to be inappropriate, and alternative modifications were explored. The data were best fitted using a method that combined the standard level distortion factor (which accounted for decrease in speech intelligibility at high presentation levels based on measurements of normal-hearing people) with individual frequency-dependent proficiency. This method was evaluated using broadband sentences and nonsense syllables tests. Results indicate that audibility cannot adequately explain speech recognition of many hearing-impaired listeners. Considerable variations from audibility-based predictions remained, especially for people with severe losses listening at high sensation levels. The data suggest that, contrary to the basis of the SII, information contained in each frequency band is not strictly additive. The data also suggest that for people with severe or profound losses at the high frequencies, amplification should only achieve a low or zero sensation level at this region, contrary to the implications of the unmodified SII.

OBJECTIVES: Universal newborn hearing screening has been implemented to detect permanent childhood hearing loss (PCHL) early, with the ultimate goal of improving outcomes through early treatment. However, there is disagreement between studies on the size of this benefit and in some cases whether it is significantly different from 0. There have been no studies of sufficient size in which researchers have determined reliably whether the effect varies with degree of PCHL. We aimed to explore how intervention timing influences 5-year language in children with PCHL. METHODS: Via a prospective study of 350 children, we used standard multiple regression analyses to investigate the effect of age at intervention or hearing screening on language outcomes after allowing for the effects of nonverbal IQ, degree of PCHL, sex, birth weight, maternal education, additional disabilities, and communication mode. RESULTS: The benefit of early intervention for language development increased as hearing loss increased. Children whose amplification started at age 24 months had poorer language than those whose amplification started at 3 months. The difference was larger for 70-dB HL (−11.8 score points; 95% confidence interval [95% CI]: −18.7 to −4.8) than for 50-dB HL (−6.8; 95% CI: −10.8 to −2.8). Children who received cochlear implants at 24 months had poorer language than those implanted at 6 months (−21.4; 95% CI: −33.8 to −9.0). There was no significant effect of screening on outcomes. CONCLUSIONS: Early intervention improves language outcomes, thereby lending support to streamlining clinical pathways to ensure early amplification and cochlear implantation after diagnosis.

A new procedure for fitting nonlinear hearing aids (National Acoustic Laboratories' nonlinear fitting procedure, version 1 [NAL-NL1]) is described. The rationale is to maximize speech intelligibility while constraining loudness to be normal or less. Speech intelligibility is predicted by the Speech Intelligibility Index (SII), which has been modified to account for the reduction in performance associated with increasing degrees of hearing loss, especially at high frequencies. Prescriptions are compared for the NAL-NL1, desired sensation level [input/output], FIG6, and a threshold version of the Independent Hearing Aid Fitting Forum procedures. For an average speech input level, the NAL-NL1 prescriptions are very similar to those of the well-established NAL-Revised, Profound procedure. Compared with the other procedures, NAL-NL1 prescribes less low-frequency gain for flat and upward sloping audiograms. It prescribes less high-frequency gain for steeply sloping high-frequency hearing losses. NAL-NL1 tends to prescribe less compression than the other procedures. All procedures differ considerably from one another for some audiograms. Abbreviations: Al = Articulation Index, CR = compression ratio, CT = compression threshold; DSL[i/o] = desired sensation level [input/output], IHAFF = Independent Hearing Aid Fitting Forum, LGOB = loudness growth in ¹/₂-octave bands, NAL-NL1 = National Acoustic Laboratories' nonlinear fitting procedure, version 1, NAL-R = NAL Revised, NAL-RP = NAL-Revised, Profound, PLL = preferred listening level, POGO = prescription of gain and maximum output, RAB = Ricketts and Bentler, rms = root mean square, SII = Speech Intelligibility Index, WDRC = wide dynamic range compression Article published online: 28 February 2022 © 2001. American Academy of Audiology. This article is published by Thieme. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Objective: To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment. Design: All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children’s speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes. Results: Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children’s performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age. Conclusions: Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.

Objective: The goals of this research were to develop and evaluate a new version of the Listening in Spatialized Noise Test (LISN®; Cameron, Dillon & Newall, 2006a) by incorporating a simplified and more objective response protocol to make the test suitable for assessing the ability of children as young as 5 yr to understand speech in background noise. The LISN-Sentences test (LISN-S; Cameron & Dillon, Reference Note 1) produces a three-dimensional auditory environment under headphones and is presented by using a personal computer. A simple repetition response protocol is used to determine speech reception thresholds (SRTs) for sentences presented in competing speech under various conditions. In four LISN-S conditions, the maskers are manipulated with respect to location (0° versus ±90° azimuth) and vocal quality of the speaker(s) of the stories (same as, or different than, the speaker of the target sentences). Performance is measured as two SRT measures and three “advantage” measures. These advantage measures represent the benefit in decibels gained when either talker, spatial, or both talker and spatial cues combined, are incorporated in the maskers. This use of difference scores minimizes the effects of between-listener variation in factors such as linguistic skills and general cognitive ability on LISN-S performance. Design: An initial experiment was conducted to determine the relative intelligibility of the sentences used in the test. Up to 30 sentences were presented adaptively to 24 children ages 8 to 9 yr to estimate the SRT (eSRT). Fifty sentences each were then presented at each participant's eSRT, eSRT +2 dB, and eSRT −2 dB. Psychometric functions were fitted and the sentences were adjusted in amplitude for equal intelligibility. After adjustment, intelligibility increased across sentences by approximately 17% for each 1 dB increase in signal-to-noise ratio (SNR). A second experiment was conducted to gather normative data on the LISN-S from 82 children with normal hearing, ages 5 to 11 yr. Results: For the 82 children in the normative data study, regression analysis showed that there was a strong trend of decreasing SRT and increasing advantage as age increased across all LISN-S performance measures. Analysis of variance revealed that significant differences in performance were most pronounced between the 5-yr-olds and the other age groups on the LISN-S measures that assess the ability to use spatial cues to understand speech in background noise, suggesting that binaural processing skills are still developing at age 5 yr. Inter-participant variation in performance on the various SRT and advantage measures was minimal for all groups, including the 5- and 6-yr-olds who exhibited standard deviations ranging from only 1.0 dB to 1.8 dB across measures. The intra-participant standard error ranged from 0.6 dB to 2.0 dB across age groups and conditions. Total time taken to administer all four LISN-S conditions was on average 12 minutes. Conclusions: The LISN-S provides a quick, objective method of measuring a child's ability to understand speech in background noise. The small degree of inter- and intra-participant variation in the 5- and 6-yr-old children suggests that the test is capable of assessing auditory processing in this age group. However, because there appears to be a strong developmental curve in binaural processing skills in the 5-yr-olds, it is suggested that the LISN-S be used clinically with children from 6 yr of age. Cut-off scores, calculated as 2 standard deviations below the mean adjusted for age, were calculated for each performance measure for children ages 6 to 11 yr. These scores, which represent the level below which performance on the LISN-S is considered to be outside normal limits, will be used to in future studies with children with suspected central auditory processing disorder.