Modernising Children’s Hearing Aid Services
Speech TestingSpeech Testing
Wave 4 EJB 17/05/04
Modernising Children’s Hearing Aid Services
Speech testsSpeech tests
To inform on quality of hearing aid fittingTo inform on quality of hearing aid fittingTradition of neglectTradition of neglect
Falls between audiology and habilitationParticularly in Pre School HA User
Used more by CI teamsUsed more by CI teams
Modernising Children’s Hearing Aid Services
DetectionDetectionDiscrimination Discrimination Word recognitionWord recognitionSpeech understandingSpeech understanding
Areas of InterestAreas of Interest
Modernising Children’s Hearing Aid Services
One example is the Ling 5 (or 6!!) sounds One example is the Ling 5 (or 6!!) sounds
oo - ah - ee - (mm) - sh – ssoo - ah - ee - (mm) - sh – ssGives information across the speech Gives information across the speech
frequency rangefrequency rangeAuditory Speech Sound Evaluation (ASSE)Auditory Speech Sound Evaluation (ASSE)
Sound DetectionSound Detection
Modernising Children’s Hearing Aid Services
These tests should provide information useful These tests should provide information useful for hearing aid fitting and possibly fine tuningfor hearing aid fitting and possibly fine tuning
But no research to suggest exactly how But no research to suggest exactly how fittings might be altered by speech test fittings might be altered by speech test scoresscores
Examples (Closed set tests)Examples (Closed set tests) McCormick Automated Toy Test CCT (Consonant Cluster Task) Maltby Speech Perception Test Manchester Picture Test FAAF
Sound DiscriminationSound Discrimination
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ExamplesExamples
Open set word testsOpen set word testsManchester Junior wordsManchester Junior wordsCambridge junior wordsCambridge junior wordsAB word listsAB word lists
Word RecognitionWord Recognition
Modernising Children’s Hearing Aid Services
ExamplesExamplesSentence TestsSentence TestsBKB sentence listsBKB sentence lists
?Familiarity
Speech UnderstandingSpeech Understanding
Modernising Children’s Hearing Aid Services
First wave evaluation study 3 (mild-moderate-First wave evaluation study 3 (mild-moderate-severe, age 7-15) used severe, age 7-15) used FAAFFAAF ( (Four Alternative Four Alternative Auditory FeatureAuditory Feature Test developed by Haggard Test developed by Haggard and Foster 1987)and Foster 1987)
In study 7 (severe/profoundly deaf group) if In study 7 (severe/profoundly deaf group) if child was unable to perform on FAAF at above child was unable to perform on FAAF at above chance levels, The chance levels, The CCT CCT ((Consonant Cluster Consonant Cluster Task further Task further developed by Marriage) was used. developed by Marriage) was used.
““Standardised” test conditions through a Standardised” test conditions through a calibrated system were importantcalibrated system were important
First Wave EvaluationFirst Wave Evaluation
Modernising Children’s Hearing Aid Services
Difference between analogue and DSP p>0.0001
Modernising Children’s Hearing Aid Services
Speech Testing IssuesSpeech Testing Issues
AcclimatisationAcclimatisation Familiarity of materialFamiliarity of material Degree of Hearing Loss (esp Severe/Profound)Degree of Hearing Loss (esp Severe/Profound) Uses – Counselling ?Uses – Counselling ? Uses - Fine tuning ? Uses - Fine tuning ? Uses – Changes to HA Provision ?Uses – Changes to HA Provision ? Further work required (esp Pre School)Further work required (esp Pre School) Calibration/Test ParametersCalibration/Test Parameters First wave – ambivalentFirst wave – ambivalent
Modernising Children’s Hearing Aid Services
Auditory Speech Sound EvaluationAuditory Speech Sound Evaluation(ASSE) Test(ASSE) Test
Modernising Children’s Hearing Aid Services
Govaerts PJ, Belgium www.deoorgroep.netBelgium www.deoorgroep.net
ASSE is a set of supraliminal auditory tests
Test children with no or very limited speech
Part of Paediatric Auditory Performance Test
A speech and language independent test to measure the supraliminal auditory capacity
All sounds that are used are balanced speech sounds common in many languages
Auditory Speech Sound EvaluationAuditory Speech Sound Evaluation
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Consonant Cluster Task (CCT) Consonant Cluster Task (CCT) TestTest
(Demo)(Demo)
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Further developed by Marriage Further developed by Marriage The test involves 4 alternative monosyllabic The test involves 4 alternative monosyllabic
real words represented by pictures. They real words represented by pictures. They have the same vowel but different consonants have the same vowel but different consonants e.g. “hen, peg, bed, egg”e.g. “hen, peg, bed, egg”
There are 9 blocks of 6 presentationsThere are 9 blocks of 6 presentations The test can be given in quiet or competing The test can be given in quiet or competing
noise conditions, and input level can be noise conditions, and input level can be changed.changed.
There were no significant differences using There were no significant differences using this or FAAF in Study 7, the children did score this or FAAF in Study 7, the children did score better on the DSP hearing aids, but numbers better on the DSP hearing aids, but numbers were small so not significant.were small so not significant.
Consonant Cluster Task (CCT)Consonant Cluster Task (CCT)
Modernising Children’s Hearing Aid Services
CCT ApplicationCCT Application Closed Set, 4 Alternative Picture Based TestClosed Set, 4 Alternative Picture Based Test
Familiar Material from Reed TestFamiliar Material from Reed Test
Nonsense/Non Words excludedNonsense/Non Words excluded
All 4 items have same vowel soundAll 4 items have same vowel sound
E.g. “Owl”, “House”, “Cow”, “Mouse”E.g. “Owl”, “House”, “Cow”, “Mouse”
Easier contrasts than APT1Easier contrasts than APT1
CCT from ? age 3 yearsCCT from ? age 3 years
Modernising Children’s Hearing Aid Services
CCT PresentationCCT Presentation Level should avoid floor (score < 25%) or ceiling (score > Level should avoid floor (score < 25%) or ceiling (score >
95%) effects95%) effects
Performance/intensity function may be steepPerformance/intensity function may be steep
Useful to test at conversation (e.g. 65 dB) quiet (e.g. 50 Useful to test at conversation (e.g. 65 dB) quiet (e.g. 50 dB) and loud (e.g. 80 dB) levelsdB) and loud (e.g. 80 dB) levels
Pre-recorded better than live presentation for comparison Pre-recorded better than live presentation for comparison (? not viable for young children)(? not viable for young children)
Can be presented in speech shaped noise at an Can be presented in speech shaped noise at an appropriate speech/noise ratioappropriate speech/noise ratio
Modernising Children’s Hearing Aid Services
CCT Test ProcedureCCT Test Procedure CD Player & 2 Channel Audiometer + LoudspeakerCD Player & 2 Channel Audiometer + Loudspeaker
Speech Channel 1 & Noise Channel 2
Calibrate using Track 1
Picture Card 1- familiarise with live voicePicture Card 1- familiarise with live voice
Start CDStart CD
Each Picture Card
6 presentation each picture card
Score on confusion matrix score sheet
Modernising Children’s Hearing Aid Services
CCT InterpretationCCT Interpretation
Total number of correct responsesTotal number of correct responses
Observation of errors in confusion matrixObservation of errors in confusion matrix
Assess difficulty child has discriminationAssess difficulty child has discrimination
Modernising Children’s Hearing Aid Services
APT1 ApplicationAPT1 Application
Closed Set, 4 Alternative Picture Based TestClosed Set, 4 Alternative Picture Based Test
All 4 items have same vowel soundAll 4 items have same vowel sound
E.g. “Boat”, “Coat”, “Goat”, “Note”E.g. “Boat”, “Coat”, “Goat”, “Note”
More difficult contrasts than CCTMore difficult contrasts than CCT
2 Sets Vowel & 8 Consonant confusion contrast2 Sets Vowel & 8 Consonant confusion contrast
APT1 from ? age 5 yearsAPT1 from ? age 5 years
Modernising Children’s Hearing Aid Services
Four Alternative Auditory Feature Four Alternative Auditory Feature (FAAF) Test(FAAF) Test
(Demo & Practical)(Demo & Practical)
Modernising Children’s Hearing Aid Services
FAAF TestFAAF Test A speech in noise test to measure speech intelligibility, A speech in noise test to measure speech intelligibility,
and benefit from a hearing aid.and benefit from a hearing aid.
Different speech levels and speech:noise ratios Different speech levels and speech:noise ratios
The test is presented in a sound field room, from a The test is presented in a sound field room, from a loudspeaker 1.5m in front of the patient. loudspeaker 1.5m in front of the patient.
The test can be carried out unaided in two interleaved The test can be carried out unaided in two interleaved conditions, and aided in four interleaved conditions.conditions, and aided in four interleaved conditions.
Responses can be via a touch screenResponses can be via a touch screen
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FAAF EquipmentFAAF Equipment FAAF Software (available from IHR)
Laptop computer
Compatible Sound Card (internal or USB)
Suitable loudspeaker (and external amplifier)
Child-friendly mouse or...
Touch Screen hardware/software (e.g. KeyTech ca £150)
Modernising Children’s Hearing Aid Services
FAAF ParametersFAAF Parameters
Parameters for test can be changed
May reduce test time
Exercise caution
Effect of noise reduction systems on DSP aids
Modernising Children’s Hearing Aid Services
[Feedback] Flashes=0 Flash_Time=100 Flash_Colour=50,100,50 [Sound_Output] Presentation=Speakers Noise_file_1=c:\faaf\waves\faafspn.wav Noise_file_2=c:\faaf\waves\faafspn.wav hardware_switch=off Max_Speech_Level=80 Max_Noise_Level=100 Ramp_time=100 Pre_stimulus_noise_time=200 Post_stimulus_noise_time=100
FAAF ParametersFAAF Parameters
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 InstructionsFAAF Suggested Instructions Four words will appear on the screen
You will hear “Can you hear X clearly?” where X is a simple word
Touch / use the mouse to indicate the word you think you heard
This will be repeated but with a different word
If you are not sure, try and choose the word you think was said
There will be noise in the background most of the time, try to ignore it
“Touch here to continue” will appear after each set of 4 sentences
When you see this, it means that the speech and/or noise will get quieter or louder so be prepared for this
This isn’t a “test” and it can be difficult even for someone with good hearing
Modernising Children’s Hearing Aid Services
Typical FAAF ScreenTypical FAAF Screen Grey item is child’s response Green item is correct answer
Modernising Children’s Hearing Aid Services
FAAF Aided TestFAAF Aided Test
This test contains 80 sentences
20 Sentences in each condition
Condition 1 S:N=+10 S=60 N=50
Condition 2 S:N=+5 S=60 N=55
Condition 3 S:N=+10 S=70 N=60
Condition 4 S:N=+5 S=70 N=65
Note scores on test form / PMS
Modernising Children’s Hearing Aid Services
name: ed Patient number: a Date: Sat Dec 13 11:27:21 2003 ---------------------------------------------------------------------- 1. Aided FAAF in noise test using "acdtest.ini" on Sat Dec 13 11:30:29 2003 1,bang,bad,bag,ban,3,3,1,1,60,50,2,2 2,lad,land,lands,lads,3,3,1,1,60,50,2,2 3,how,hang,ham,high,2,2,1,1,60,50,2,2 ... 19,cab,tab,dab,gab,1,1,1,1,60,50,2,2 20,bag,back,bat,bad,3,3,1,1,60,50,2,2
FAAF Typical Data Log FileFAAF Typical Data Log File Summarise test parameters (.ini file) usedRecords test items,levels,responses for each presentation