Introdução: A atresia aural congênita refere-se a um espectro de deformidades da orelha presentes ao nascimento que envolve algum grau de falha no desenvolvimento do canal auditivo externo, e, muitas vezes, da membrana timpânica e dos ossículos da orelha média. Uma das consequências da atresia aural congênita é a perda auditiva condutiva que deve ser tratada precocemente a fim de evitar complicações. O uso do Vibrant soundbridge no tratamento da perda auditiva tem propiciado a melhora da audição destes pacientes em serviços de todo o mundo. Objetivo: Sistematizar e descrever a técnica cirúrgica do Vibrant soundbridge em pacientes com atresia aural congênita bilateral e descrever os resultados das avaliações audiológicas após a realização da cirurgia. Método: Doze pacientes com atresia aural congênita bilateral realizaram a cirurgia do Vibrant soundbridge e foram submetidos às avaliações audiológicas em dois momentos: antes e após seis meses da realização da cirurgia. As avaliações realizadas foram: audiometria tonal limiar, audiometria em campo livre, reconhecimento auditivo de palavras no silêncio (lista de monossílabos) e limiar de reconhecimento de sentença, e relação sinal/ruído (HINT - Brasil). Foi feita a análise dos dados por meio das estatísticas descritivas e inferenciais. Resultados: O protocolo cirúrgico utilizado para implantação do dispositivo Vibrant soundbridge em pacientes com atresia aural congênita bilateral foi descrito. Não ocorreram complicações intra ou pós-operatórias. Os limiares auditivos em campo livre melhoraram de 53,5 dB para 27,2 dB após seis meses de uso do Vibrant soundbridge (p < 0,001). O reconhecimento auditivo de palavras monossílabas melhorou significantemente após a cirurgia (de 61,0% para 91,3%). No HINT, também foi encontrada melhora estatisticamente significante (p < 0,001) do limiar de reconhecimento de sentenças que passou de 67,1dB para 45,9 dB e a média da relação sinal/ruído (S/R) melhorou de 5,6 dB para 1,4 dB (p=0,009). Conclusões: Sistematizar a técnica cirúrgica do Vibrant soundbridge em pacientes com atresia aural congênita bilateral permitiu a realização de uma cirurgia segura, sem complicações pós-operatórias, resultando na obtenção de resultados audiológicos positivos nesta população / Introduction: Congenital aural atresia refers to a spectrum of ear deformities present at birth that involve some degree of failure in the development of the external auditory canal, and often the tympanic membrane and middle ear ossicles as well. One of the consequences of congenital aural atresia is conductive hearing loss that must be treated early to avoid complications. The use of Vibrant soundbridge(TM) for treating hearing loss has improved the hearing of these patients in practices worldwide. Objective: To systematize and describe the surgical technique for implanting the Vibrant soundbridge(TM) in patients with bilateral congenital aural atresia and to describe the results of postoperative audiological evaluations. Method: Twelve patients with bilateral congenital aural atresia underwent Vibrant soundbridge(TM) implantation surgery and audiological evaluations at two instances: before and 6 months after surgery. The evaluations included threshold tonal audiometry, free field audiometry, auditory word recognition in silence (list of monosyllables), sentence recognition threshold, and signal to noise ratio (HINT - Brazil). Data were analyzed through descriptive and inferential statistical methods. Results: The surgical protocol used for implantation of the Vibrant soundbridge(TM) device in patients with bilateral congenital aural atresia was described. There were no intraoperative or postoperative complications. The free-field auditory thresholds improved from 53.5 dB to 27.2 dB after 6 months of Vibrant soundbridge(TM) use (p < 0.001). The auditory recognition of monosyllable words improved significantly after surgery (from 61.0% to 91.3%). In HINT, we also found a statistically significant improvement (p < 0.001) in the sentence recommencement threshold from 67.1 dB to 45.9 dB and the mean S/R ratio improved from 5.6 dB to 1.4 dB (p = 0.009). Conclusions: Systematization of the Vibrant soundbridge(TM) surgical technique in patients with bilateral congenital aural atresia allowed safe surgery without postoperative complications and resulted in positive audiological results in the test population

O esforço auditivo é definido como o esforço cognitivo e de atenção necessários para compreender a fala em ambiente ruidoso. Este estudo teve como objetivo analisar o esforço auditivo e fadiga em adolescentes com deficiência auditiva, usuários de aparelho de amplificação sonora individual (AASI), sem e com sistema de frequência modulada (FM), e comparar com adolescentes com audição normal, por meio do desenvolvimento de uma plataforma para execução da tarefa secundária em teste de dupla tarefa; analisar o impacto do ruído na aprendizagem pela perspectiva dos participantes; e investigar a opinião dos usuários sobre o impacto do uso do sistema FM na sala de aula. Participaram 18 adolescentes com audição normal e 13 adolescentes com deficiência auditiva sensorioneural, bilateralmente, de grau moderado e severo usuários de AASI e sistema FM, com média de idade de 14 anos. O esforço auditivo foi avaliado por meio do paradigma da dupla tarefa, a fadiga por meio de escala, o impacto do ruído na aprendizagem por meio de uma questão e foi aplicado um questionário sobre o uso do sistema FM em ambiente educacional. Foram utilizados para análise dos resultados o teste T (p< 0,01), Anova, qui-quadrado de Pearson (p<0,05) e análise descritiva. Foi elaborada uma plataforma para auxiliar a execução do teste de dupla tarefa, denominada PALETA, com um teste de memória de reconhecimento de cores. A diferença do esforço auditivo com base no número de respostas corretas foi estatisticamente significativa entre os participantes do grupo com audição normal e os participantes do grupo com deficiência auditiva na condição apenas com AASI, o que não ocorreu quando analisado o tempo de resposta. Os resultados sugerem que o desempenho do grupo com audição normal foi próximo ao do grupo com deficiência auditiva na condição com AASI e sistema FM, sendo que na condição de uso apenas do AASI apresentou um esforço auditivo maior. Os resultados obtidos na escala de avaliação da fadiga não revelaram diferenças estatisticamente significativas entre nenhum dos grupos. Sobre o impacto no ruído na sala de aula, os resultados revelaram que o grupo usuário de AASI e sistema FM relataram menor queixa quanto ao ruído interferir na aprendizagem do que seus pares ouvintes e na condição apenas com seus AASI. O questionário aplicado forneceu informações sobre as perspectivas do usuário de sistema FM, que em sua maioria encontravam-se satisfeitos e faziam o uso efetivo de seus dispositivos em sala de aula. Conclui-se que a PALETA é considerada uma ferramenta efetiva para auxiliar na cução de teste de dupla tarefa quando considerado o número de respostas corretas; o uso do sistema FM foi efetivo para reduzir o esforço auditivo; não foram encontradas diferenças significativas entre os grupos quanto à fadiga; a queixa dos adolescentes com deficiência auditiva quanto ao impacto do ruído na aprendizagem diminui significativamente com o uso do sistema FM, e a maioria dos adolescentes usuários de sistema FM encontravam-se satisfeitos e faziam o uso efetivo de seus dispositivos em sala de aula. / Listening effort is defined as the cognitive effort and the attention required to understand speech in a noisy environment. This study aims to analyze listening effort and fatigue in hearing impaired adolescents, users of HA, with and without a FM system, and to compare them with adolescents with normal hearing, through development of a platform for performing the secondary task in a dual-task test; analyze the impact of noise on learning from the participants perspective; and investigate users\' opinions on the impact of using the FM system in the classroom. A total of 31 adolescents participated in this study: 18 with normal hearing and 13 with moderate to severe bilateral sensorineural hearing loss, users of HA and FM system. The mean age of the adolescents was 14 years. Listening effort was evaluated using dual task paradigm; fatigue, using a scale; the impact of noise on learning, using a question; and the use of the FM system in an educational environment, using a questionnaire. The results were statistically analyzed using t-test (p<0.01), Anova, chisquare of Pearson (p<0.05) and descriptive analysis. A platform was developed to assist in the execution of the dual task test. The platform was named PALETA and consisted of color recognition memory test. Based on the number of correct responses, the difference in listening effort was statistically significant between the participants of the normal hearing group and the participants of the hearing-impaired group when these participants were using HA; but the difference was not statistically significant when comparing response times. The results suggest that the performance of the normal hearing group was similar to the hearing-impaired group when these participants were using a HA and a FM system. When the participants of the hearingimpaired group were using only the HA, the results showed a greater listening effort. The results obtained in the fatigue assessment scale did not reveal statistically significant differences in any of the groups. On the impact of noise in the classroom, the results revealed that the hearing-impaired group users of hearing aid and FM system reported less complaints about noise interfering in learning than their normal hearing peers and in the condition only with their HA. The questionnaire applied provided information on the user\'s perspectives of FM system, which showed that the users were mostly satisfied and made effective use of their devices in the classroom. It is concluded that PALETA is considered an effective tool to assist in the execution of dual task test when considering the number of correct answers; the use of the FM system was effective in reducing listening effort; no significant differences were found between the groups regarding fatigue; the complaint of adolescents with hearing loss about the impact of noise on learning diminishes significantly with the use of the FM system; and the majority of adolescents using FM systems were satisfied and made effective use of their devices in the classroom.

O ruído é um fator que contribui negativamente para a habilidade de compreensão da fala, o que pode prejudicar o desenvolvimento da criança com deficiência auditiva. Nas salas de aula, a fala raramente é transmitida a criança sem que haja interferência do ruído de fundo. Ao mesmo tempo, a efetiva transmissão da informação auditiva é imprescindível para um melhor desempenho acadêmico. Na maioria dos ambientes de aprendizagem, o que mais interfere para que haja uma boa percepção da fala é a relação sinal/ruído (S/R). O Sistema de Frequência Modulada (FM) funciona como o meio mais efetivo para melhorar a captação do sinal da fala e eliminar os efeitos da distância, ruído e reverberação em ambiente educacional. Objetivo: Avaliar a relação S/R a que crianças com deficiência auditiva estão expostas em ambiente escolar e comparar com o limiar de recepção da fala no ruído. Métodos: O trabalho foi realizado com crianças com deficiência auditiva e com linguagem oral estabelecida, usuárias de aparelho de amplificação sonora individual (AASI) e/ou implante coclear (IC) acoplados ao Sistema FM. A mensuração da relação sinal ruído foi realizada através da utilização de um gravador digital portátil e um programa de processamento de áudio para computador. Para avaliação da percepção da fala no ruído, foi aplicada a versão brasileira do teste Hearing in Noise Test (HINT), em campo livre em dois momentos: primeiramente com a criança utilizando apenas seus AASIs e/ou IC e em um segundo momento com o Sistema FM acoplado ao dispositivo individual. Resultados: Todas as crianças apresentaram melhor percepção da fala no ruído com o uso do Sistema FM. Apenas em uma sala de aula a relação sinal/ruído está adequada. Observou-se que a posição do aluno na sala de aula realmente influencia na qualidade da relação S/R a qual o mesmo está exposto. Também foi comprovado que, quanto maior o número de alunos, mais baixa é a relação S/R da sala de aula. Conclusão: A relação S/R da sala de aula em situação real de ensino mostrou-se com um valor mais próximo à relação S/R em que o paciente consegue compreender o discurso com o uso do Sistema FM, demonstrando que o uso do dispositivo é essencial para melhor compreensão da fala nesse ambiente. / Noise is a factor that contributes negatively to the ability to understand speech, which can harm the development of children with hearing impairment. In classrooms, speech is rarely transmitted to children without interference from background noise. At the same time, the effective transmission of auditory information is essential for better academic performance. In most learning environments, which further interferes so there is a good speech perception is the signal/noise ratio (S/N). The Personal Frequency Modulation (FM) Systems serves as the most effective way to improve the uptake of speech signal and eliminate the effects of distance, noise and reverberation in the educational environment. Objective: To evaluate the S/N ratio that hearing impaired children are exposed in a school environment and compare with the speech reception threshold in noise. Methods: The study was conducted with children with hearing impaired and spoken language established, users of a hearing aids and/or cochlear implant (CI) coupled to FM system. The measurement of signal to noise ratio was achieved by the use of a portable digital recorder and an audio processing program for computer. To assess speech perception in noise was applied the Brazilian version of the Hearing in Noise Test (HINT), in two stages: first with the child using only their hearing aid\'s and/or CI and a second time with FM system coupled to individual device. Results: All children had better speech perception in noise using the FM system. Only in a one classroom the S/N ratio is adequate. It was observed that the position of the student in the classroom really affect the quality of the S/N ratio to which it is exposed. It was also proven that the higher the number of students, the lower the S/N ratio of the classroom. The S/N ratio of the classroom in a real school showed up with a value closer to the S/N ratio in which the patient can understand speech using the FM system, demonstrating that the use of this device is essential to better understand speech in these environments.

Introdução: Plasticidade auditiva refere-se a mudanças que ocorrem no sistema sensorial responsável pela transmissão da informação acústica. A plasticidade do sistema nervoso auditivo central está relacionada a capacidade de adaptação através da reintrodução de estímulos por meio de aparelhos de amplificação sonora ou implante coclear. Essas mudanças são observadas a partir do desempenho de pacientes com o uso do aparelho de amplificação sonora, e podem ser verificadas por meio dos potenciais evocados auditivos de longa latência. Objetivo: caracterizar os Potenciais Evocados Auditivos de Longa Latência (PEALL) em adultos e idosos com perda auditiva neurossensorial, verificando os efeitos da estimulação auditiva por meio da comparação destes potenciais pré e pós adaptação do Aparelho de Amplificação Sonora Individual (AASI). Metodologia: Participaram deste estudo 15 indivíduos adultos e idosos, de ambos os gêneros, de 55 a 85 anos de idade, com perda auditiva neurossensorial de grau leve a moderado com simetria entre as orelhas, sem experiência prévia com qualquer tipo de dispositivo de amplificação sonora. Os indivíduos foram encaminhados pelas empresas de aparelho auditivo WIDEX, Audibel e o Espaço Reouvir, tratando-se de novos usuários de AASI. Os PEALL foram realizados nas condições com e sem AASI, a 60 e 75 dBnNA em campo sonoro, em dois momentos: primeira avaliação realizada até uma semana após a adaptação do AASI e a segunda avaliação realizada após 6 meses da adaptação do AASI. Resultados: Na comparação da primeira avaliação com a segunda avaliação, na condição sem AASI a 60 dBnNA, observou-se diferença estatisticamente significante na latência do componente P1 (p-valor= 0,034). Na condição sem AASI a 75 dBnNA, observou-se diferença estatisticamente significante para a latência do componente P300 (p-valor 0,031) e para a amplitude P2N2 (p-valor 0,024), com diminuição da latência e aumento da amplitude na segunda avaliação. Por sua vez, na comparação da primeira avaliação com a segunda avaliação, na condição com AASI a 75 dBnNA, obteve-se uma diferença estatisticamente significante na latência do componente N2 (p-valor 0,009) e na amplitude P2N2 (p-valor 0,024), com aumento da amplitude na segunda avaliação. Evidenciou-se, também, diferença significante na amplitude P1N1 (p-valor 0,024) na condição com AASI a 60 dBnNA. Conclusão: Os PEALL com estímulo de fala demonstraram ser um importante procedimento para ser utilizado na prática clínica, visando monitorar a plasticidade neuronal do Sistema Nervoso Auditivo Central frente à estimulação auditiva (uso de AASI), em adultos e idosos com perda auditiva neurossensorial de grau leve a moderado / Introduction: Auditory plasticity refers to changes that occur in the sensory system responsible for the transmission of acoustic information. The plasticity of the central auditory nervous system is related to the capacity of adaptation through the reintroduction of stimuli of sound amplification devices or cochlear implants. These changes are observed from the performance of patients with the use of the sound amplification apparatus, and can be verified by long-latency auditory evoked potentials. Purpose: To characterize long latency auditory evoked potentials (LLAEP) in adults with sensorineural hearing loss, verifying the effects of auditory stimulation by comparing these before and after adaptation potentials of the Individual Sound Amplification (AASI). Methodology: Fifteen adult and elderly individuals of both genders, aged 55 to 85 years, with mild to moderate sensorineural hearing loss with symmetry between the ears, without prior experience with any type of sound amplification device. The subjects were referred by hearing aid companies WIDEX, Audibel and Espaço Reouvir, in the case of new hearing aids users. The LLAEP were performed in the conditions with and without AASI, at 60 and 75 dBnNA in sound field, in two moments: first evaluation performed up to one week after AASI adaptation and the second evaluation performed after 6 months of AASI adaptation. Results: In the comparison of the first evaluation with the second evaluation, in the condition without AASI at 60 dBnNA, a statistically significant difference was observed in the latency of the P1 component (p-value = 0.034). In the condition without AASI at 75 dBnNA, a statistically significant difference was observed for the latency of the P300 component (p-value 0.031) and for the P2N2 amplitude (p-value 0.024), with latency decrease and amplitude increase in the second evaluation. In the comparison of the first evaluation with the second evaluation, in the condition with AASI at 75 dBnNA, there was a statistically significant difference in the latency of the N2 component (p-value 0.009) and in the P2N2 amplitude (p-value 0.024) , With amplitude increase in the second evaluation. There was also a significant difference in P1N1 amplitude (p-value 0.024) in the condition with AASI at 60 dBnNA. Conclusion: The LLAEP was an important procedure to be used in clinical practice, aiming to monitor the neural plasticity of the Central Auditory Nervous System in front of auditory stimulation (hearing aids use) in adults and elderly patients with mild to moderate sensorineural hearing loss of amplification and the importance of neural plasticity of the Central Auditory Nervous System

Introdução: Plasticidade auditiva refere-se a mudanças que ocorrem no sistema sensorial responsável pela transmissão da informação acústica. A plasticidade do sistema nervoso auditivo central está relacionada a capacidade de adaptação através da reintrodução de estímulos por meio de aparelhos de amplificação sonora ou implante coclear. Essas mudanças são observadas a partir do desempenho de pacientes com o uso do aparelho de amplificação sonora, e podem ser verificadas por meio dos potenciais evocados auditivos de longa latência. Objetivo: caracterizar os Potenciais Evocados Auditivos de Longa Latência (PEALL) em adultos e idosos com perda auditiva neurossensorial, verificando os efeitos da estimulação auditiva por meio da comparação destes potenciais pré e pós adaptação do Aparelho de Amplificação Sonora Individual (AASI). Metodologia: Participaram deste estudo 15 indivíduos adultos e idosos, de ambos os gêneros, de 55 a 85 anos de idade, com perda auditiva neurossensorial de grau leve a moderado com simetria entre as orelhas, sem experiência prévia com qualquer tipo de dispositivo de amplificação sonora. Os indivíduos foram encaminhados pelas empresas de aparelho auditivo WIDEX, Audibel e o Espaço Reouvir, tratando-se de novos usuários de AASI. Os PEALL foram realizados nas condições com e sem AASI, a 60 e 75 dBnNA em campo sonoro, em dois momentos: primeira avaliação realizada até uma semana após a adaptação do AASI e a segunda avaliação realizada após 6 meses da adaptação do AASI. Resultados: Na comparação da primeira avaliação com a segunda avaliação, na condição sem AASI a 60 dBnNA, observou-se diferença estatisticamente significante na latência do componente P1 (p-valor= 0,034). Na condição sem AASI a 75 dBnNA, observou-se diferença estatisticamente significante para a latência do componente P300 (p-valor 0,031) e para a amplitude P2N2 (p-valor 0,024), com diminuição da latência e aumento da amplitude na segunda avaliação. Por sua vez, na comparação da primeira avaliação com a segunda avaliação, na condição com AASI a 75 dBnNA, obteve-se uma diferença estatisticamente significante na latência do componente N2 (p-valor 0,009) e na amplitude P2N2 (p-valor 0,024), com aumento da amplitude na segunda avaliação. Evidenciou-se, também, diferença significante na amplitude P1N1 (p-valor 0,024) na condição com AASI a 60 dBnNA. Conclusão: Os PEALL com estímulo de fala demonstraram ser um importante procedimento para ser utilizado na prática clínica, visando monitorar a plasticidade neuronal do Sistema Nervoso Auditivo Central frente à estimulação auditiva (uso de AASI), em adultos e idosos com perda auditiva neurossensorial de grau leve a moderado / Introduction: Auditory plasticity refers to changes that occur in the sensory system responsible for the transmission of acoustic information. The plasticity of the central auditory nervous system is related to the capacity of adaptation through the reintroduction of stimuli of sound amplification devices or cochlear implants. These changes are observed from the performance of patients with the use of the sound amplification apparatus, and can be verified by long-latency auditory evoked potentials. Purpose: To characterize long latency auditory evoked potentials (LLAEP) in adults with sensorineural hearing loss, verifying the effects of auditory stimulation by comparing these before and after adaptation potentials of the Individual Sound Amplification (AASI). Methodology: Fifteen adult and elderly individuals of both genders, aged 55 to 85 years, with mild to moderate sensorineural hearing loss with symmetry between the ears, without prior experience with any type of sound amplification device. The subjects were referred by hearing aid companies WIDEX, Audibel and Espaço Reouvir, in the case of new hearing aids users. The LLAEP were performed in the conditions with and without AASI, at 60 and 75 dBnNA in sound field, in two moments: first evaluation performed up to one week after AASI adaptation and the second evaluation performed after 6 months of AASI adaptation. Results: In the comparison of the first evaluation with the second evaluation, in the condition without AASI at 60 dBnNA, a statistically significant difference was observed in the latency of the P1 component (p-value = 0.034). In the condition without AASI at 75 dBnNA, a statistically significant difference was observed for the latency of the P300 component (p-value 0.031) and for the P2N2 amplitude (p-value 0.024), with latency decrease and amplitude increase in the second evaluation. In the comparison of the first evaluation with the second evaluation, in the condition with AASI at 75 dBnNA, there was a statistically significant difference in the latency of the N2 component (p-value 0.009) and in the P2N2 amplitude (p-value 0.024) , With amplitude increase in the second evaluation. There was also a significant difference in P1N1 amplitude (p-value 0.024) in the condition with AASI at 60 dBnNA. Conclusion: The LLAEP was an important procedure to be used in clinical practice, aiming to monitor the neural plasticity of the Central Auditory Nervous System in front of auditory stimulation (hearing aids use) in adults and elderly patients with mild to moderate sensorineural hearing loss of amplification and the importance of neural plasticity of the Central Auditory Nervous System

Background: Hearing aid prescriptive recommendations for hearing losses having a conductive component have received less clinical and research interest than for losses of a sensorineural nature; as a result, much variation remains among current prescriptive methods in their recommendations for conductive and mixed hearing losses (Johnson and Dillon, 2011). Purpose: The primary intent of this brief clinical note is to demonstrate differences between two algebraically equivalent expressions of hearing loss, which have been approaches used historically to generate a prescription for hearing losses with a conductive component. When air and bone conduction thresholds are entered into hearing aid prescriptions designed for nonlinear hearing aids, it was hypothesized that that two expressions would not yield equivalent amounts of prescribed insertion gain and output. These differences are examined for their impact on the maximum power output (MPO) requirements of the hearing aid. Subsequently, the MPO capabilities of two common behind-the-ear (BTE) receiver placement alternatives, receiver-in-aid (RIA) and receiver-in-canal (RIC), are examined. Study Samples: The two expressions of hearing losses examined were the 25% ABG + AC approach and the 75% ABG + BC approach, where ABG refers to air-bone gap, AC refers to air-conduction threshold, and BC refers to bone-conduction threshold. Example hearing loss cases with a conductive component are sampled for calculations. The MPO capabilities of the BTE receiver placements in commercially-available products were obtained from hearing aids on the U.S. federal purchasing contract. Results: Prescribed gain and the required MPO differs markedly between the two approaches. The 75% ABG + BC approach prescribes a compression ratio that is reflective of the amount of sensorineural hearing loss. Not all hearing aids will have the MPO capabilities to support the output requirements for fitting hearing losses with a large conductive component particularly when combined with significant sensorineural hearing loss. Generally, current RIA BTE products have greater output capabilities than RIC BTE products. Conclusions: The 75% ABG + BC approach is more appropriate than the 25% ABG + AC approach because the latter approach inappropriately uses AC thresholds as the basis for determining the compression ratio. That is, for hearing losses with a conductive component, the AC thresholds are not a measure of sensorineural hearing loss and cannot serve as the basis for determining the amount of desired compression. The Australian National Acoustic Laboratories has been using the 75% ABG + BC approach in lieu of the 25% ABG + AC approach since its release of the National Acoustic Laboratories—Non-linear 1 (NAL-NL1) prescriptive method in 1999. Future research may examine whether individuals with conductive hearing loss benefit or prefer more than 75% restoration of the conductive component provided adequate MPO capabilities to support such restoration.

Purpose: To evaluate sound quality preferences of participants wearing hearing aids with different strengths of nonlinear frequency compression (NFC) processing versus no NFC processing. Two analysis methods, one without and one with a qualifier as to the magnitude of preferences, were compared for their percent agreement to differentiate a small difference in perceived sound quality as a result of applied NFC processing. Research Design: A single-blind design was used with participants unaware of the presence or strength of NFC processing (independent variable). The National Acoustic Laboratories-Nonlinear 2 (NAL-NL2) prescription of amplification was chosen because audibility is intentionally not prescribed in the presence of larger sensorineural hearing loss thresholds. A lack of prescribed audibility, when present, was deemed an objective qualifier for NFC. NFC is known to improve the input bandwidth available to listeners when high-frequency audibility is not otherwise available and increasing strengths of NFC were examined. Experimental condition 3 (EC3) was stronger than the manufacturer default (EC2). More aggressive strengths (e.g., EC4 and EC5), however, were expected to include excessive distortion and even reduce the output bandwidth that had been prescribed as audible by NAL-NL2 (EC1). Study Sample: A total of 14 male Veterans with severe high-frequency sensorineural hearing loss. Data Collection and Analysis: Participant sound quality preference ratings (dependent variable) without a qualifier as to the magnitude of preference were analyzed based on binomial probability theory, as is traditional with paired comparison data. The ratings with a qualifier as to the magnitude of preference were analyzed based on the nonparametric statistic of the Wilcoxon signed rank test. Results: The binomial probability analysis method identified a sound quality preference as well as the nonparametric probability test method. As the strength of NFC increased, more participants preferred the EC with less NFC. Fourteen of 14 participants showed equal preference between EC1 and EC2 perhaps, in part, because EC2 showed no objective improvement in audibility for six of the 14 participants (42%). Thirteen of the 14 participants showed no preference between NAL-NL2 and EC3, but all participants had an objective improvement in audibility. With more NFC than EC3, more and more participants preferred the other EC with less NFC in the paired comparison. Conclusions: By referencing the recommended sensation levels of amplitude compression (e.g., NAL-NL2) in the ear canal of hearing aid wearers, the targeting of NFC parameters can likely be optimized with respect to improvements in effective audibility that may contribute to speech recognition without adversely impacting sound quality. After targeting of NFC parameters, providers can facilitate decisions about the use of NFC parameters (strengths of processing) via sound quality preference judgments using paired comparisons.

No description available.

In the present thesis, computer-assisted reading intervention with a phonics approach was examined in deaf and hard of hearing children (DHH) aged 5, 6 or 7 years old using cochlear implants, hearing aids or a combination of both. Children with normal hearing (NH), matched for non-verbal intelligence and age, served as a reference group. Deaf and hard of hearing children constitute a heterogenetic population regarding cognitive and academic achievement. Many of them do not reach age appropriate levels in language and reading ability during their school years, with negative consequences for later training facilities and job opportunities. Finding relevant intervention methods to promote early language learning and literacy development that are easy to implement is therefore of great importance. In this thesis three aspects of cognitive ability (phonological processing skills, lexical access and working memory capacity), and reading ability was examined at three points in time; baseline 1, pre intervention and post intervention. Additionally, computer-assisted training delivered by  means of the Internet in the children’s homes was explored in order to determine whether it would be a useful and efficient method for the DHH population. Overall, the results from the present thesis support the notion that offering a computer-assisted intervention program delivered at home, is an alternative way to support not only NH children with reading difficulties but also to support DHH children’s phonological development and decoding proficiency. / I denna avhandling undersöktes fonologisk lästräning vid datorn för döva och hörselskadade barn 5, 6 och 7 år gamla som använde cochleaimplantat, hörapparat eller en kombination av båda. Barn med normal hörsel som var matchade avseende icke-verbal intelligens och ålder utgjorde jämförelsegrupp. Döva och hörselskadade barn utgör en heterogen grupp avseende kognitiv förmåga och skolframgång. Många av dem når inte kraven för åldern avseende språk och läsförmåga under skoltiden vilket får negativa konsekvenser för senare utbildning och arbete. Att hitta relevanta interventionsmetoder för att främja tidig språkinlärning och läsutveckling som är lätta att genomföra, är därför av stor betydelse. I avhandlingen undersöktes tre aspekter av kognitiv förmåga (fonologisk bearbetningsförmåga, lexikal åtkomst och arbetsminneskapacitet) och läsförmåga vid tre tidpunkter; förtest 1, före intervention och efter intervention. Dessutom undersöktes om datorbaserad intervention som genomförs via Internet i hemmet, skulle vara en användbar och effektiv metod för döva och hörselskadade barn. Resultaten i stort visar att fonologisk lästräning vid datorn i barnens hem är en alternativ metod att stödja inte bara barn i risk att utveckla lässvårigheter, utan även döva och hörselskadade barns fonologi och avkodningsförmåga.

abstract: A dual-channel directional digital hearing aid (DHA) front-end using a fully differential difference amplifier (FDDA) based Microphone interface circuit (MIC) for a capacitive Micro Electro Mechanical Systems (MEMS) microphones and an adaptive-power analog font end (AFE) is presented. The Microphone interface circuit based on FDDA converts the capacitance variations into voltage signal, achieves a noise of 32 dB SPL (sound pressure level) and an SNR of 72 dB, additionally it also performs single to differential conversion allowing for fully differential analog signal chain. The analog front-end consists of 40dB VGA and a power scalable continuous time sigma delta ADC, with 68dB SNR dissipating 67u¬W from a 1.2V supply. The ADC implements a self calibrating feedback DAC, for calibrating the 2nd order non-linearity. The VGA and power scalable ADC is fabricated on 0.25 um CMOS TSMC process. The dual channels of the DHA are precisely matched and achieve about 0.5dB gain mismatch, resulting in greater than 5dB directivity index. This will enable a highly integrated and low power DHA / Dissertation/Thesis / Ph.D. Electrical Engineering 2011