Amplification Preferences of Children
in Different Listening Environments
Richard Seewald, Joseph Corcoran, Susan Scollie
National Centre for Audiology, London, ON, Canada
Teresa Ching and Harvey Dillon
National Acoustics Laboratories, Sydney, NSW, Australia
Background
Ching et al. (1996)
– The children’s preferred gain was not
significantly different from the NAL-RP
prescribed characteristics.
– The children’s preferred gain & slope were
significantly different (less than) the DSL
prescribed characteristics .
Background
Scollie et al. (2000)
– The children’s preferred gain was not
significantly different from the DSL
prescribed gain.
– The children’s preferred gain was
significantly different (more than) the NAL
prescribed gain.
Background
• Factors not addressed:
– Acclimatization
– Multidimensional nature of outcomes from
amplification
Aims of project
1. To compare the performance and preferences
of children who were fitted with the DSL[i/o]
v4.1 and NAL-NL1 procedures.
2. To determine whether prior experience with a
particular prescription determines what children
subsequently prefer and/or perform better with.
Methods: Subjects
– 48 children (24 children each site)
– Mean Age - 11y : 9m
– Mild to severe bilateral SNHL
– Full-time hearing aid users
– No known central auditory processing deficits
Audiometric Profile
Threshold
(dB HL)
Slope (dB/octave)
Mean
Range
Mean
Range
Canada
48
22-72
6
-13/+22
Australia
46
28-67
5
-12/+17
Hearing Instruments:
• BTEs with several important features:
– Programmable - volume control disabled
– Wide-dynamic-range compression
• 2 and 3 channel instruments used
– Acoustically filtered ear hooks
– FM system compatibility
– Two memories
• One for DSL and one for NAL
Hearing instruments:
Note:
•No Directional Microphones used
•No ‘noise reduction’ employed
Experimental Design
• Double-blind!!
– The audiologists who were evaluating the fittings
did not know whether the child was currently using
DSL or NAL.
– The parents and children did not know whether
the current settings were from their “home country”
or whether they could expect them to be similar to
their old hearing aid settings.
Experimental Design: Trial 1
Trial 1
DSL
Baseline
Measures
or
NAL
8 weeks
Laboratory
Measures
Self-report
Measures
Experimental Design: Trial 2
Trial 2
Laboratory
Measures
Self-Report
Measures
NAL
DSL
8 weeks
Experimental Design: Trial 3
Trial 3
Laboratory
Measures
DSL and NAL
Child Diary
8 weeks
Measures
• Speech Perception (quiet and in noise)
• Loudness Perception
• Paired Comparisons
• Self-reported Performance
• Self-reported Preference
Sample items for comparison of program
effectiveness:
1) Talking to parents, brothers, sisters at home.
2) Listening to TV or a movie at home.
Program 1 is…….than program 2 (Please circle)
A lot
better
A bit
better
Same
+ The children were asked to comment on
their preference
So
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fr o
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TV ne
Fr
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Pa
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Re
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Ca
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bu
Sh
s,
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(DSL Preference)
Rating
(NAL Preference)
Preferences by environment and site
2
Australia
Canada
0
A
1
C
C
C
C,A
C,A
-1
-2
Situation
Qualitative Data
Comments for the 12 situations
+ Overall Preference
13 sets of comments
x 48 subjects
Total of 624 comments analyzed
Results
Question 1
Which program do you prefer when
talking to your parents at home ?
Question 1: Themes
Talking with parents at home
• Some children preferred the program that was
“clearer” and/or “louder”
• Some children did not prefer the program that was
louder
• Some children preferred the program that cut out
the background noise
• Some children preferred having a choice of both
programs
Sample statements Talking with parents at home
Theme 1 – Louder and clearer:
“On program 1 – straining to hear sometimes,
family needs to repeat. On program 2 – clear,
crisp sound.”
“Because I can hear the person more louder.
On Program 1, I won’t be able to really hear it.”
Sample statements Talking with parents at home
Theme 2 – did not prefer Louder:
“Because my brother talks too loud and
sometimes Mum yells at Peter so it is
pleasanter on Program 2.”
Sample statements Talking with parents at home
Theme 3 – cut out background noise:
“Mum, Dad and brother are clearer on Program 1
because they have loud voices. On Program 2, I
could hear extra background sounds which
interfered with the speech.”
Theme 4 – choice of both programs:
“Program 1 is good for normal talking. Program 2
good to hear Ian because he speaks softly.”
Question 2
Which program do you prefer
when watching TV or a movie ?
Question 2: Themes
When watching TV or movie
• Some children preferred the program that
was louder and clearer therefore allowing
them to ‘hear’ and to ‘understand’ better
• Some children preferred having a choice of
both programs
Sample statements
When watching TV or movie
Theme 1: Louder and clearer –
“Know more what’s going on. It’s louder, understand
better.”
“On Program 1 needed to turn up the TV volume. On
Program 2 – clearer, even with accents.”
Theme 2: choice of both programs –
“Scary parts on Program 2 – you can’t hear them as
much. Program 1 most of the time.”
Question 3
Which program do you prefer when
talking in a car, bus or train ?
Question 3: Themes
When talking in a car, bus or train
• Some children expressed preference for the
program that reduced the background noise
• Some children preferred the program that allowed
them to hear voices better from the back seat of the
car
• Some children expressed preference for the program
that allowed them to hear voices “better” / ”clearer”
Sample statements
When talking in a car, bus or train
Theme 1: reduced the background noise –
“Because it is not as noisy and can hear speech
better on the bus”
“Program 1 is clearer for picking up Mum’s
voice. Program 2 background sounds louder
cutting into speech.”
Sample statements
When talking in a car, bus or train
Theme 2: better from the back seat –
“Program 1 is better in the car because I sit in
the back seat and the sound comes back to me
better.”
“Because I can hear mom speaking when sitting
behind her – clearer.”
Sample statements
When talking in a car, bus or train
Theme 3: hear voices better/clearer –
“Program 1 wanting to look at the person in the
car! Program 2 – I could follow conversations
better.”
Question 5
Which program do you prefer
when talking in a restaurant ?
Question 5: Themes
When talking in a restaurant
• Some children preferred the program that
reduced the background noise
• Some children preferred the program that allowed
them to hear table conversations
• Some children preferred the program that allowed
them to hear the person(s) they wanted to hear
• Some children preferred a choice of programs
depending on the situation
Sample statements
When talking in a restaurant
Theme 1: Reduces background noise –
“It was a bit noisy at McDonalds so I went to
Program 2 and the noise was less and that
was good.”
“It cuts down on the noise. Better to hear at
McDonalds on Program 1.”
Sample statements
When talking in a restaurant
Theme 2: Hearing table conversations –
“On Program 1 – good for talking at the table
because it focused on the person near me.”
“Went to McDonalds and I could hear everyone
at the table on Program 2.”
Sample statements
When talking in a restaurant
Theme 3: To hear persons they wanted to
hear
“Working at McDonalds, struggling on Program
1 – couldn’t hear customers properly.”
“When the lady says how much it is, it’s easier
to hear on Program 1.”
“Waitress asking for something to drink – could
hear her better.”
Question 7
Which program do you prefer when
someone calls you from behind ?
Question 7: Themes
When someone calls you from behind
• Some children preferred the program that enabled
them to hear sounds that were far away better.
• Some children preferred the program that made
sounds louder and clearer.
• Some children preferred the program that made it
easier to localize sounds.
• Some children preferred the program that cut out the
background noise.
Sample Comments
When someone calls you from behind
Theme 1: Hear better from far away
“Couldn’t hear on Program 1, had to look behind.”
“Because I can hear better on Program 2. Because
the sound is brought closer to me.”
Sample Comments
When someone calls you from behind
Theme 2: Made the sounds louder and
clearer
“When at work outside, someone calls for
carryout – can hear from a distance because
it’s louder.”
“When Jessie called me from the back of the
class I hear her better on Program 2. When the
teacher called me from behind it was very
clearly heard on Program 2.”
Question 8
Which program do you prefer
when someone speaks softly ?
Question 8: Themes
When someone speaks softly
• Some children preferred the program that
made speech louder, clearer or easier to
hear.
• Some children expressed preference for the
program that enabled them to hear
whispering and soft voices
Sample Comments
When someone speaks softly
Theme 1: Louder, clearer – easier to hear –
“My sister was telling me a secret. Program 1 –
it’s better, much louder and clearer.”
“Because it’s loud and clear.”
“Program 2 perfect. Makes voices louder.
Program 2 is too soft, couldn’t hear.”
Sample Comments
When someone speaks softly
Theme 2 – to hear whispering and soft voices
“ ‘Cause I can get the full sound - whispering”
“When someone whispers I hear better on
Program 1. When Tara Lee talks I use Program
1 as she speaks quietly.”
“My friends Queenie and Jenny have soft voices
and it’s better on Program 2.”
Question 9
Which program do you prefer when
listening to the teacher in class ?
Question 9: Themes
When listening to the teacher in class
• Some children preferred the program that
allowed them to hear the teacher louder and/or
more clearly
• Some children preferred the program that
enabled them to hear the teacher at the back of
the classroom or when the teacher moved
around within the classroom
Question 9: Themes (continued)
When listening to the teacher in class
• Some children preferred the program that
enabled them to better hear what they wanted
to with relative ease
• Some children preferred to use both programs
depending on the listening conditions (i.e.,
distance, vocal loudness, background noise)
Sample Comments
When listening to the teacher in class
Theme 1: Hear the teacher louder and/or
more clearly
“The teacher was louder on Program 2 and I
could hear better and her voice seems strong.”
Sample Comments
When listening to the teacher in class
Theme 2: Hear the teacher when at the back
or moves around the classroom
“Program 2 clearer for following the teacher
when she is behind me – at back of class also
for hearing teacher’s aid.”
“Program 1 increases the volume. Program 1 a
little easier to understand the teacher and
better to follow her as she moves around the
class.”
Sample Comments
When listening to the teacher in class
Theme 3: To hear more easily what they
want to hear
“Program 2 is best. The teachers were talking
about our snow trip and I heard them more
easily on Program 2.”
“I can hear her all the time on Program 2. I got
answers wrong on Program 1.”
Question 11
Which program do you prefer
when in the playground ?
Question 11: Themes
When on the playground
• Some children preferred the program that enabled
them in the presence of noise
• Some children expressed preference for both programs
– with choice of the program dependent on the presence
or absence of noise
• Some children expressed preference for the program
that allowed them to hear sounds from a distance and
from a variety of directions
Sample Comments
When on the playground
Theme 1: to hear in the presence of noise
“Program 1 is much better here because I could
still hear my friends with other noises around.”
“It helps cut out the background noise and allows
me to hear in a small group.”
“I like Program 2 because it’s noisy outside and I
can hear better with it.”
Sample Comments
When on the playground
Theme 2: Prefer having both programs
“Use both Program 1 and 2 – If out on the field,
use Program 2 because not much background
noise. I use Program 1 if there are lots of people
nearby and are making a lot of noise.”
“Program 1 is good for ten pin bowling, net ball.
Program 2 is good for hearing the teacher calling
me.”
Question 12
Which program do you prefer when
listening to sounds in the environment ?
Question 12: Themes
When listening to sounds in the environment
• Some children preferred the program which enabled
them to hear the sounds of nature more clearly
• Some children preferred to have the choice of both
programs – using one program to hear softer sounds of
nature and the other to comfortably hear the louder
environmental sound such as the sounds of traffic
• Some children preferred the program that enabled them
to hear sounds more easily
Sample Comments
When listening to sounds in the environment
Theme 1: To hear the sounds of nature better
“In the bush walking or just walking on footpaths,
Program 1 gives a clarity to sounds, bird calls or
rustle of leaves.”
“Program 1 missing more, not hearing birds,
wind noises – Program 2 seemed to pick up
these sounds more.”
Sample Comments
When listening to sounds in the environment
Theme 2: Prefer having both programs
“I like hearing the rain on Program 2, but louder
sounds like traffic outside or the school yard
sound better on Program 1.”
“Program 1 is good for traffic sounds like sirens
behind me. Program 2 good for hearing birds,
crickets in the yard.”
Question 13
Which program do you prefer overall ?
Question 13: Themes
Which program do you prefer overall ?
• Some children preferred the program that made sound
louder and clearer
• Some children preferred the program that allowed
them to hear better/comfortably in the presence of noise
• Some children preferred having the choice of both
programs available – the choice largely dependent on
whether the situation was noisy or quiet
Sample Comments
Which program do you prefer overall ?
Theme 1: Preferred the program that was
‘louder’ and /or ‘clearer’
“Program 2 louder overall making it easier to
hear things in most situations.”
“Program 2 – I can hear better – clearer and
louder.”
Sample Comments
Which program do you prefer overall ?
Theme 2: To hear in the presence of noise
“Program 1 picks up the human voice better,
especially in noisy situations.”
“Program 2 – it’s softer and it helps me to hear
better, particularly if it’s noisy.”
Sample Comments
Which program do you prefer overall ?
Theme 3: Prefer a choice of both programs
“Preferred Program 2 for quiet situations and
preferred program 1 if in noisy situations.
Program 2 was a bit stronger overall, but I did
change between programs a lot depending on
the situation.”
“Program 2 – because it’s louder – Program 1
good for very noisy situations.”
Some concluding thoughts . . .
• Prior experience
• Electroacoustic performance does matter
• Complexity of acoustical environments
• Multi-memory capability
• Usefulness of qualitative analyses