1. Assessing Hearing Capacity and HearingSkill in Children aged 6 months to 3 years Misura delludito e delle abilit uditive neibambini da 6 mesi a 3 anniArthur BoothroydPresented to short course onChildhood Deafness and LanguageAmplifon Center for Research and Study Milan, October 2012 Director: Edoardo ArslanUniversity of Padua

2. AcknowledgementsLaurie Eisenberg, House Research Institute Amy Martinez, House Research InstituteNIDCD grant numbers: DC 006238 and DC 004433 3. Pediatric Aural Habilitation1. Best hearing capacity2. Best hearing skill3. Best use of hearing for:Cognitive developmentSocial developmentLanguage development 4. HearingCAPACITY SKILLCentralConductiveSensorineuralmechanismmechanismmechanism(brain)Deliverers Translators Analysts,decision makers,and responders 5. Best capacity + Best skill??Hearing Capacity Perception = Perception Discrimination Hearing Skill HearingSensitivity &AssociationDetection x CapacityResolution x--------------- = Hearing Attention x Transmission CognitionCognitionRecognition Skill Space-timeLocalization ObjectsInterpretation Events PropertiesCause/effect Audiologic Habilitative managementmanagement 6. Assessment?Hearing Capacity Percep-Hearing Skill ? ? = HearingSensitivity tion Detection x CapacityResolution x&= HearingAttention xRecognition TransmissionCognitionSkillLocalization InterpretationNeeded for Needed forPlanning assistancePlanning habilitationMeasuring outcomeMeasuring outcomePlanning habilitationAudiologic feedback 7. Behavioral assessmentHearing Capacity PerceptionHearing Skill = HearingSensitivity & Detection x CapacityResolution x Cognition= Hearing Attention x Recognition TransmissionSkill LocalizationInterpretation BehaviorAlertingSpeech Actingoutput ImitatingAnswering 8. Behavioral assessmentHearing Capacity PerceptionHearing Skill = HearingSensitivity & Arousal x CapacityResolution x Cognition= Hearing Attention x Recognition TransmissionSkill LocalizationInterpretation BehaviorAlerting Acting ImitatingAnswering 9. Behavioral assessmentHearing CapacityPerceptionHearing Skill = HearingSensitivity& Arousal x CapacityResolutionx Cognition= HearingAttention xRecognition Transmission SkillLocalization InterpretationBehavior Speech Alerting outputActingImitating Answering 10. Operational definitionsSkill = current performanceCapacity = maximum possible performancePerformanceCapacity012 34 5 6 7Hearing Age in years 11. ImitationSensitivity ResolutionTransmission RecognitionSpeechoutput 12. IMSPAC (on-line)Primary computer Secondary monitorVisualVideo VisualMask MaskSpeechNoiseTester Imita- ChildMixer/tionAuditory maskamplifier 13. Tester 14. Performance of 31 hearing childrenon an imitative task involving 5phonetic contrasts3/9 co-operatedand passed2/9 co-operated22/22 co-operated but failed and passed4/9 did not co- operate 15. Rate of learning depends on the taskPerformance Capacity01 2345 6 7 Age in years 16. Visual Response AudiometryStimulus = Sound ChangeSilence Sound (Sensitivity)Sound A Sound B (Resolution)Response =Head turn 17. Video here 18. Behavioral assessment: the idealStimulus Sensorydevice AidedChildsspeechhearing perception system capacityResponse 19. Behavioral assessment: realityStimulus State: Task-related Sensory - comfort, interest, variablesdevice attention, motivation Aided speechAuditory Knowledge: perceptionsystem - world (cognition) capacity- people (social cognition)- language - phonology- vocabulary- syntax Processing skills:- auditory, linguistic Motor skills:- gross, fine, speechResponse? 20. Behavioral tests of capacityCapacity inferred from performancePositive results confidenceNegative results uncertaintyAfter training:Negative results less uncertainty 21. Electrophysiological Assessment? Hearing Capacity Percep-Hearing Skill=Hearing Sensitivity tion DetectionxCapacity Resolutionxx&=Attention RecognitionTransmissionCognitionLocalizationInterpretationResponseABR Brain stemN1P2 Cortex (onset)ACC cortex (change) 22. Electrophysiological Assessment? Hearing Capacity Percep-Hearing Skill=Hearing Sensitivity tion DetectionxCapacity Resolutionxx&=Attention RecognitionTransmissionCognitionLocalizationInterpretationResponseABR Brain stemN1P2 Cortex (onset)ACC cortex (change) 23. Electrophysiological Assessment? Hearing Capacity Percep-Hearing Skill=Hearing Sensitivity tion DetectionxCapacity Resolutionxx&=Attention RecognitionTransmissionCognitionLocalizationInterpretationResponseABR Brain stemN1P2 Cortex (onset)ACC cortex (change) 24. Can electrophysiology fill the gap, and avoid learning, and behavioral effects?Onset The Acoustic ChangeComplex (ACC)Offsetooee ooee ooee ooee ooee ooee ooee ooee... 25. Group mean waveforms Adult data (n=7)xx?////From:Ostroff (1999)PhDDissertationCUNY 26. 32 Hz 27. 77%32 Hz 28. Acoustic Change Complex in children Data courtesy of Dr. Laurie Eisenberg of the House Research Institute 29. ACC in response to ooee 5 normally hearing children.Mean age 2y11mAmplitude (V) P1 N2 Time re change onset (msec) 30. ACC in response to ooee6 hearing-impaired children.Aged 2y3m to 6y3mAmplitude (V) 5 normally hearing children.Mean age 2y11mTime re change onset (msec) 31. ACC in response to ooee 2y7mAmplitude (V) 2y3m P1?5 normally hearing children. Mean age 2y11m Time re change onset (msec) 32. 5 year old hearing aid user ooaa aided ooee aided ooee unaidedAmplitude (V) Time re change onset (msec) 33. Acoustic Change Complex Objective indicator of resolution Obtainable between 2 and 3 years Possibly lower Responds to amplification Still under development 34. In summaryHearing Capacity + Skill PerformanceAssess performance infer skill/capacityResponse to sound sensitivity Response to change resolution ?Imitation sensitivity, and resolutionElectrophysiology: ABR sensitivity ACC resolution ? 35. Thank you