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Speech Testing Wave 4 EJB 17/05/04 Modernising Children’s Hearing Aid Services Speech Testing Wave 4 EJB 17/05/04 Modernising Children’s Hearing Aid Services

Speech tests Ø To inform on quality of hearing aid fitting Ø Tradition of Speech tests Ø To inform on quality of hearing aid fitting Ø Tradition of neglect ØFalls between audiology and habilitation ØParticularly in Pre School HA User Ø Used more by CI teams Modernising Children’s Hearing Aid Services

Areas of Interest Ø Detection Ø Discrimination Ø Word recognition Ø Speech understanding Modernising Areas of Interest Ø Detection Ø Discrimination Ø Word recognition Ø Speech understanding Modernising Children’s Hearing Aid Services

Sound Detection Ø One example is the Ling 5 (or 6!!) sounds oo - Sound Detection Ø One example is the Ling 5 (or 6!!) sounds oo - ah - ee - (mm) - sh – ss Ø Gives information across the speech frequency range Ø Auditory Speech Sound Evaluation (ASSE) Modernising Children’s Hearing Aid Services

Sound Discrimination Ø These tests should provide information useful for hearing aid fitting and Sound Discrimination Ø These tests should provide information useful for hearing aid fitting and possibly fine tuning Ø But no research to suggest exactly how fittings might be altered by speech test scores Ø Examples (Closed set tests) Ø Ø Ø Mc. Cormick Automated Toy Test CCT (Consonant Cluster Task) Maltby Speech Perception Test Manchester Picture Test FAAF Modernising Children’s Hearing Aid Services

Word Recognition Examples Open set word tests Ø Manchester Junior words Ø Cambridge junior Word Recognition Examples Open set word tests Ø Manchester Junior words Ø Cambridge junior words Ø AB word lists Modernising Children’s Hearing Aid Services

Speech Understanding Examples Sentence Tests Ø BKB sentence lists Ø? Familiarity Modernising Children’s Hearing Speech Understanding Examples Sentence Tests Ø BKB sentence lists Ø? Familiarity Modernising Children’s Hearing Aid Services

First Wave Evaluation Ø First wave evaluation study 3 (mildmoderate-severe, age 7 -15) used First Wave Evaluation Ø First wave evaluation study 3 (mildmoderate-severe, age 7 -15) used FAAF (Four Alternative Auditory Feature Test developed by Haggard and Foster 1987) Ø In study 7 (severe/profoundly deaf group) if child was unable to perform on FAAF at above chance levels, The CCT (Consonant Cluster Task further developed by Marriage) was used. Ø “Standardised” test conditions through a calibrated system were important Modernising Children’s Hearing Aid Services

Difference between analogue and DSP p>0. 0001 Modernising Children’s Hearing Aid Services Difference between analogue and DSP p>0. 0001 Modernising Children’s Hearing Aid Services

Speech Testing Issues Ø Acclimatisation Ø Familiarity of material Ø Degree of Hearing Loss Speech Testing Issues Ø Acclimatisation Ø Familiarity of material Ø Degree of Hearing Loss (esp Severe/Profound) Ø Uses – Counselling ? Ø Uses - Fine tuning ? Ø Uses – Changes to HA Provision ? Ø Further work required (esp Pre School) Ø Calibration/Test Parameters Ø First wave – ambivalent Modernising Children’s Hearing Aid Services

Auditory Speech Sound Evaluation (ASSE) Test Modernising Children’s Hearing Aid Services Auditory Speech Sound Evaluation (ASSE) Test Modernising Children’s Hearing Aid Services

Auditory Speech Sound Evaluation ØGovaerts PJ, Belgium www. deoorgroep. net ØASSE is a set Auditory Speech Sound Evaluation ØGovaerts PJ, Belgium www. deoorgroep. net ØASSE is a set of supraliminal auditory tests ØTest children with no or very limited speech ØPart of Paediatric Auditory Performance Test ØA speech and language independent test to measure the supraliminal auditory capacity ØAll sounds that are used are balanced speech sounds common in many languages Modernising Children’s Hearing Aid Services

Consonant Cluster Task (CCT) Test (Demo) Modernising Children’s Hearing Aid Services Consonant Cluster Task (CCT) Test (Demo) Modernising Children’s Hearing Aid Services

Consonant Cluster Task (CCT) Ø Further developed by Marriage Ø The test involves 4 Consonant Cluster Task (CCT) Ø Further developed by Marriage Ø The test involves 4 alternative monosyllabic real words represented by pictures. They have the same vowel but different consonants e. g. “hen, peg, bed, egg” Ø There are 9 blocks of 6 presentations Ø The test can be given in quiet or competing noise conditions, and input level can be changed. Ø There were no significant differences using this or FAAF in Study 7, the children did score better on the DSP hearing aids, but numbers were small so not significant. Modernising Children’s Hearing Aid Services

CCT Application Ø Closed Set, 4 Alternative Picture Based Test Ø Familiar Material from CCT Application Ø Closed Set, 4 Alternative Picture Based Test Ø Familiar Material from Reed Test Ø Nonsense/Non Words excluded Ø All 4 items have same vowel sound Ø E. g. “Owl”, “House”, “Cow”, “Mouse” Ø Easier contrasts than APT 1 Ø CCT from ? age 3 years Modernising Children’s Hearing Aid Services

CCT Presentation Ø Level should avoid floor (score < 25%) or ceiling (score > CCT Presentation Ø Level should avoid floor (score < 25%) or ceiling (score > 95%) effects Ø Performance/intensity function may be steep Ø Useful to test at conversation (e. g. 65 d. B) quiet (e. g. 50 d. B) and loud (e. g. 80 d. B) levels Ø Pre-recorded better than live presentation for comparison (? not viable for young children) Ø Can be presented in speech shaped noise at an appropriate speech/noise ratio Modernising Children’s Hearing Aid Services

CCT Test Procedure Ø CD Player & 2 Channel Audiometer + Loudspeaker Ø Speech CCT Test Procedure Ø CD Player & 2 Channel Audiometer + Loudspeaker Ø Speech Channel 1 & Noise Channel 2 Ø Calibrate using Track 1 Ø Picture Card 1 - familiarise with live voice Ø Start CD Ø Each Picture Card Ø 6 presentation each picture card Ø Score on confusion matrix score sheet Modernising Children’s Hearing Aid Services

CCT Interpretation Ø Total number of correct responses Ø Observation of errors in confusion CCT Interpretation Ø Total number of correct responses Ø Observation of errors in confusion matrix Ø Assess difficulty child has discrimination Modernising Children’s Hearing Aid Services

APT 1 Application Ø Closed Set, 4 Alternative Picture Based Test Ø All 4 APT 1 Application Ø Closed Set, 4 Alternative Picture Based Test Ø All 4 items have same vowel sound Ø E. g. “Boat”, “Coat”, “Goat”, “Note” Ø More difficult contrasts than CCT Ø 2 Sets Vowel & 8 Consonant confusion contrast Ø APT 1 from ? age 5 years Modernising Children’s Hearing Aid Services

Four Alternative Auditory Feature (FAAF) Test (Demo & Practical) Modernising Children’s Hearing Aid Services Four Alternative Auditory Feature (FAAF) Test (Demo & Practical) Modernising Children’s Hearing Aid Services

FAAF Test Ø A speech in noise test to measure speech intelligibility, and benefit FAAF Test Ø A speech in noise test to measure speech intelligibility, and benefit from a hearing aid. Ø Different speech levels and speech: noise ratios Ø The test is presented in a sound field room, from a loudspeaker 1. 5 m in front of the patient. Ø The test can be carried out unaided in two interleaved conditions, and aided in four interleaved conditions. Ø Responses can be via a touch screen Modernising Children’s Hearing Aid Services

FAAF Equipment Ø FAAF Software (available from IHR) Ø Laptop computer Ø Compatible Sound FAAF Equipment Ø FAAF Software (available from IHR) Ø Laptop computer Ø Compatible Sound Card (internal or USB) Ø Suitable loudspeaker (and external amplifier) Ø Child-friendly mouse or. . . Ø Touch Screen hardware/software (e. g. Key. Tech ca £ 150) Modernising Children’s Hearing Aid Services

FAAF Parameters Ø Parameters for test can be changed Ø May reduce test time FAAF Parameters Ø Parameters for test can be changed Ø May reduce test time Ø Exercise caution Ø Effect of noise reduction systems on DSP aids Modernising Children’s Hearing Aid Services

FAAF Parameters Ø Can edit. ini file in program directory “ 4” is default, FAAF Parameters Ø Can edit. ini file in program directory “ 4” is default, “ 0” will mean no feedback for incorrect answer (shorten test, less “negative” for child) Time (ms) that noise is on before speech (default is 500) Modernising Children’s Hearing Aid Services

FAAF Suggested Instructions Ø Four words will appear on the screen Ø You will FAAF Suggested Instructions Ø Four words will appear on the screen Ø You will hear “Can you hear X clearly? ” where X is a simple word Ø Touch / use the mouse to indicate the word you think you heard Ø This will be repeated but with a different word Ø If you are not sure, try and choose the word you think was said Ø There will be noise in the background most of the time, try to ignore it Ø “Touch here to continue” will appear after each set of 4 sentences Ø When you see this, it means that the speech and/or noise will get quieter or louder so be prepared for this Ø This isn’t a “test” and it can be difficult even for someone with good hearing Modernising Children’s Hearing Aid Services

Typical FAAF Screen Ø Grey item is child’s response Ø Green item is correct Typical FAAF Screen Ø Grey item is child’s response Ø Green item is correct answer Modernising Children’s Hearing Aid Services

FAAF Aided Test Ø This test contains 80 sentences Ø 20 Sentences in each FAAF Aided Test Ø This test contains 80 sentences Ø 20 Sentences in each condition Ø Condition 1 S: N=+10 S=60 N=50 Ø Condition 2 S: N=+5 S=60 N=55 Ø Condition 3 S: N=+10 S=70 N=60 Ø Condition 4 S: N=+5 S=70 N=65 Ø Note scores on test form / PMS Modernising Children’s Hearing Aid Services

FAAF Typical Data Log File ØSummarise test parameters (. ini file) used ØRecords test FAAF Typical Data Log File ØSummarise test parameters (. ini file) used ØRecords test items, levels, responses for each presentation Modernising Children’s Hearing Aid Services