Background: Limited access of oral language caused by hearing loss poses a risk for the development of reading problems. A functional overlap in outcomes between children fit with hearing aids (HAs) and children provided with cochlear implants (CIs) results in a gray area in pediatric CI candidacy criteria. This gray area makes it more difficult to determine which device will provide the best developmental outcomes for children with borderline CI eligibility. Objective: In an effort to gain outcome data that could inform decision-making regarding CI versus HA candidacy, the question posed in this study concerned the speech intelligibility index (SII) levels of children with HAs that were comparable to children with CIs based upon reading outcomes of both groups. Methods: The study sample comprised of 77 children between the ages of 6;10 and 9;6 with hearing loss: 58 children with HAs and 19 children with CIs. Reading performance data was obtained using the Word Attack and Passage Comprehension subtests of the Woodcock Reading Mastery Tests. SII information was obtained for the HA group. To allow a comparison of reading performance relative to SII between children with CIs and children with HAs, multiple imputation was used to estimate a functional SII for the CI group based off the available reading information. Results: Children in the HA and CI groups demonstrated overall similar reading performance. The relationship between aided SII and reading in the HA group was found to be three times as large as that found for unaided PTA and reading. Children in the CI group were found to have reading abilities similar to children in the HA group with known SIIs of 0.73. Functional SII was imputed for the CI group with strong relative efficiency, but because confidence intervals were rather large, more data is needed in order to make statements with greater levels of confidence regarding implications for CI candidacy criteria.

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The speech of a person speaking in a noisy environment can be enhanced through electronic beamforming using spatially distributed microphones. As this approach demands precise information about the microphone locations, its application is limited in places where microphones must be placed quickly or changed on a regular basis. Highly precise calibration or measurement process can be tedious and time consuming. In order to understand tolerable limits on the calibration process, the impact of microphone position error on the intelligibility is examined. Analytical expressions are derived by modeling the microphone position errors as a zero mean uniform distribution. Experiments and simulations were performed to show relationships between precision of the microphone location measurement and loss in intelligibility. A variety of microphone array configurations and distracting sources (other interfering speech and white noise) are considered. For speech near the threshold of intelligibility, the results show that microphone position errors with standard deviations less than 1.5cm can limit losses in intelligibility to within 10% of the maximum (perfect microphone placement) for all the microphone distributions examined. Of different array distributions experimented, the linear array tends to be more vulnerable whereas the non-uniform 3D array showed a robust performance to positional errors.

Background: An important goal of providing amplification to children with hearing loss is to ensure that hearing aids are adjusted to match targets of prescriptive procedures as closely as possible. The Desired Sensation Level (DSL) v5 and the National Acoustic Laboratories’ prescription for nonlinear hearing aids, version 1 (NAL-NL1) procedures are widely used in fitting hearing aids to children. Little is known about hearing aid fitting outcomes for children with severe or profound hearing loss. Purpose: The purpose of this study was to investigate the prescribed and measured gain of hearing aids fit according to the NAL-NL1 and the DSL v5 procedure for children with moderately severe to profound hearing loss; and to examine the impact of choice of prescription on predicted speech intelligibility and loudness. Research Design: Participants were fit with Phonak Naida V SP hearing aids according to the NAL-NL1 and DSL v5 procedures. The Speech Intelligibility Index (SII) and estimated loudness were calculated using published models. Study Sample: The sample consisted of 16 children (30 ears) aged between 7 and 17 yr old. Data Collection and Analysis: The measured hearing aid gains were compared with the prescribed gains at 50 (low), 65 (medium), and 80 dB SPL (high) input levels. The goodness of fit-to-targets was quantified by calculating the average root-mean-square (RMS) error of the measured gain compared with prescriptive gain targets for 0.5, 1, 2, and 4 kHz. The significance of difference between prescriptions for hearing aid gains, SII, and loudness was examined by performing analyses of variance. Correlation analyses were used to examine the relationship between measures. Results: The DSL v5 prescribed significantly higher overall gain than the NAL-NL1 procedure for the same audiograms. For low and medium input levels, the hearing aids of all children fit with NAL-NL1 were within 5 dB RMS of prescribed targets, but 33% (10 ears) deviated from the DSL v5 targets by more than 5 dB RMS on average. For high input level, the hearing aid fittings of 60% and 43% of ears deviated by more than 5 dB RMS from targets of NAL-NL1 and DSL v5, respectively. Greater deviations from targets were associated with more severe hearing loss. On average, the SII was higher for DSL v5 than for NAL-NL1 at low input level. No significant difference in SII was found between prescriptions at medium or high input level, despite greater loudness for DSL v5 than for NAL-NL1. Conclusions: Although targets between 0.25 and 2 kHz were well matched for both prescriptions in commercial hearing aids, gain targets at 4 kHz were matched for NAL-NL1 only. Although the two prescriptions differ markedly in estimated loudness, they resulted in comparable predicted speech intelligibility for medium and high input levels.

The hearing and understanding problems of the people with high frequency hearing loss are covered within the scope of this thesis. For overcoming these problems, two main studies, developing hearing loss simulation (HLS) and applying new frequency lowering methods (FLMs) were carried out. HLS was developed with the suprathreshold effects and new FLMs were applied with different combinations of the FLMs. For evaluating the studies, modified rhyme test (MRT) and speech intelligibility index (SII) were used as subjective and objective measures, respectively. Before both of the studies, offline studies were carried out for specifying the significant parameters and values for using in MRT. For the HLS study, twelve hearing impaired subjects listened to unprocessed sounds and thirty six normal hearing subjects listened to simulated sounds. In the evaluation of the HLS, both measures gave similar and consistent results for both unprocessed and simulated sounds. In FLMs study, hearing impaired subjects were simulated and normal hearing subjects listened to frequency lowered sounds with the specified methods, parameters and values. All FLMs were compared with the standard method of hearing aids (amplification) for five different noisy environments. FLMs satisfied 83% success of higher speech intelligibility improvement than amplification in all cases. As a conclusion, the necessity of using subject-specific FLMs was shown to achieve higher intelligibility than with amplification only. Accordingly, a methodology for selection of the values of parameters for different noisy environments and for different audiograms was developed.