Audiology: [beyond the fluffy
bits!] Boldly into the Future.
Wendy McCracken
Opportunities….
• More opportunity now than ever before
Challenges:
• Amplification is managed by people
• Non specialists have more contact time
than ToDs
• Rigor is vital to ensure all deaf children
have optimum access
Cutting edge…………………
State of the art, the highest level of
development, as of a device, technique, or
scientific field
• Lots about Audiological assessment being
cutting edge-equipment led or multidisciplinary team
• For front line practitioners and managers of
services what does this mean?
Dynamic …..now new platform
• Goodbye FM hello ‘wireless’
• Need to be able to actively manage all systems
on behalf of deaf children
Interconnectivity…..
Children experience this from a very early age
Children expect it
Potentially opens up a
new range of
Possibilities BUT do we
‘get it’?
Bluetooth
Named after a Viking
who united warring tribes
Technology turns h.aids
into wireless headsets:
used with mobiles, MP3
devices, TV etc
Oticon Connectline
Phonak Smartlink+
Danalogic Unite
Power drain
Potential for interference
from local
wifi networks
Tube lighting (low frequency
inductive interference
GMS networks
Streaming
Frequency hopping: ‘Roger’
PhonaK: Insight Roger
MCHAS advice Aud to ToD
Detailed information on how the hearing aids
have been programmed to include;
• prescription procedure;
• type of compression and output limiting circuits –
linear, non-linear, WDRC or other;
• setting of compression time constants if known
(slow/fast)
• real ear measures
• volume control setting or status
• feedback management
• noise reduction
• the number of programs activated and the features
of each one
details of any changes, response curve 50,60,80
Audiological information
• What do you do with this information?
• Note click and fit is inapproriate
• Does it inform your practice?
Which programmes and is volume
control active?
• Does it effect use of assistive devices
Note kneepoint set as this will limit FM
Why restrict opportunities?
If you currently do not get this
information…….
• Can you use your test box to
• Check if the volume control is active and the
range?
• Check how many programmes are active and
what they are eg T setting?
• Check if there is active feedback management
or noise reduction?
Education to Audiology
• A summary of a child’s general use of a hearing aid based
on feedback and observations from the parents/carers,
child and teacher or questionnaire
• A summary report based on the Common
Monitoring Protocol, PEACH, LIFE, LSQ or similar
questionnaires, detailing the child’s listening
abilities and use of the aids
• Results of speech tests
• Observations on any perceived changes in the child’s hearing levels
• Use of FM system
A simple reminder
Sharing information
• Audiological Scientists have training in what
CMP can provide?
• Mapping babble/jargon to provide a window
on hearing aid use
• Young children, children with ANSD, children
with complex needs all rely on ToDs to collect
this information
Life style
• When you map emergent babble you need to
place this within a framework the Audiologist
understands
• All waking hours or at school use? Need to
know implications of such choices
• Electro-acoustic flexibility is seldom fully
exploited- need to know about child’s choices
Radio aids
Oticon foundation study
•
To investigate “real world” FM use and its
benefit (2 year study)
– Quantitative
• Audit
• Classroom measures
• Speech in noise testing (dual-task paradigm)
– Qualitative
• Questionnaires, focus groups
• Children recruited through educational
audiologists
– 82 children recruited
– Bolton, Cheshire, Dorset, Hertfordshire,
Oxfordshire, Salford, Somerset, Staffordshire,
Surrey, Warwickshire
• Subset of 46 children (36 classrooms) had
further detailed investigation
Recommended standards
• Unoccupied noise level 35 dBA
• 400 ms 125 Hz to 4 kHz
• +20 dB SNR 125 Hz – 750 Hz
• +15 dB SNR 750 Hz – 4 kHz
British Association of Teachers of the Deaf (2001). Classroom Acoustics – Recommended standards
• Detailed SNR analysis of 9 (of 36)
• Recorded in classroom near to child and
recorded from teacher microphone
SNR methods
• How do you measure SNR a classroom?
• SLM not suitable for “active” classrooms
• Digital sound recorders and offline analysis
• How to analyse the recordings?
– Automated distribution method
– Manual method
Classroom Results
• SNR
– Sections of > 10 dB but also < 0 dB
– Manual method,
-0.5 dB, 6.6 dB
– Teacher Mic. improvement,17.5 dB, 16.1 dB
• Reverberation
– 0 classroom met the 400 ms requirement
– 4 classrooms <400ms except 125 Hz
• (2 special primary, 1 special secondary, 1 secondary)
• Occupied (reduces RT)
Room acoustics
Regular classrooms do not
have to meet BATOD standards
but children have to learn in them
Classroom observations
• Valued the input of ToDs “ we had fantastic
INSET it was amazing really useful”
• Failed to mute Tx in session, did not repeat
back class contributions in plenary
• Of all classrooms observed……………4
mainstream teachers remembered to mute.
Didactic/Contructivist?
Findings from classroom recordings, pupil comments and
questionnaires all confirm the significant impact of class
teacher use on benefit.
Establishing optimum use in modern classrooms is
challenging for a specialist, and even more so for
mainstream teachers.
Classroom use of transmitter
SPIN/SART
• Background date of ID, degree and type of h.
loss, fitting protocol, aid[s], FM system, SPIN
• Used child’s aids and FM system only psychoacoustic checks
• Used FM working guidelines to set up SART
Test setup for SART
SART
• A pseudo randomised sequence of single
numerical digits one at a time. In between
each digit presentation a visual fixation (a
circle with a cross in it) is displayed.
SART
• Each test block consisted of 238 digits
• Yellow Arial font on a black background:
random font size of 48, 72, 94, 100 or 120
points.
• Each digit was presented for 250 ms,
followed by the fixation for 1800 ms.
• The target digit for this study was“3
SART
• Results on SPIN and SART [AB component] were
highly correlated 0.63 (p < 0.001)
• Dual-task word scores were significantly lower
(n= 33, t=4.261, p < 0.001), with a mean
difference of 11% (SD 17), compared to SPIN
scores in QUIET
• ?The effect of cognitive load in the dual task, and
the possiblity that SPIN is too simplistic an
assessment of children’s listening in noise
LIFE-UK
 LIFE-UK is a useful start, but details of when, how and
why pupils find FM beneficial are very diverse.
 Pupils report specific and common difficulties :
•
•
•
especially problematic where children don’t have
frequent specialist support
pupils lacked confidence that complaining would
effect change
Possibly an interactive database into which pupils
could record their experiences (and possiby share
solutions) on a regular basis, accessible by ToDs/Ed
Auds to support remotely
LIFE-R
• FM Benefit is established in quiet testing rooms.
• All pupils recorded benefit in quiet classroom with
teacher at the front (mean implied benefit 0.97)
5
4
3
2
1
1 Ease of Listening without
FM
1 Ease of Listening with FM
Variation over other scenarios
Most difficulty/most benefit
Classroom use of FM
Challenging in all settings…
Frequency of occurance of key unhelpful FM use types in minutes
between occurances
13
12
11
10
9
Individual signal to
all
Lead speaker not
'transmitted'
8
7
6
5
4
3
2
1
0
1mary
1mary special
2ndary
Setting type
2ndary special
All
‘Real life’ use of FM amplification
• Teenagers don’t like wearing FM
systems
• Teachers of the Deaf provide INSET
training
• For many Education = School
Real life use of FM amplification
• Mainstream settings
• MUTE facility
• Responsibility without choice
• Options to use with Ipads, Tablets, Smart
phones, TV, DVD, Ipods and MP3 players
• In the car, shopping, Brownies, Scouts, dance
class, music lessons
WHY SCHOOL AGE?
ToD in audiological management
• Agreed proforma for reports to
Audiology/Education
• Always look at whole child and lifestyle
choices
• Enable child to make choices and take
responsibility
• Listen to child’s views and experiences
Children in the driving seat
• Need vocabulary to describe listening environment
and functioning of equipment
• Need to understand perceptual features of hearing
loss
• Room acoustics
• Aids -acoustic and electrical
• Earmoulds, retubing
• Assistive technology
NVQ or similar in understanding hearing loss for deaf
children and all staff with daily responsibility for
management
ALL equipment
• Needs to be checked daily or more often for
younger children- psycho-acoustic checks
• Checked regularly via test box
• MUST be rigorous and real
• Clear management responsibility with “bite”
• Time needs to be allocated to allow ToDs to
actively manage and to cascade training
Does INSET work?
• Reflect how long did it take YOU to learn to
make effective use of a radio aid?
• You chose the training, were motivated, had
the ‘back story’, had time and access to
expertise
• Statutory does not mean mainstream staff ‘get
it’
• Checks, on going support
Responsibility
• “The future is already here – it's just not
evenly distributed,” William Gibson, 2003
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Ensuring we keep up to date
All equipment needs to be verified
All equipment needs to be well used
Children need to be actively involved
Listening is all waking hours