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9/12/2014
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Audiological Management of Children with Hearing
Loss and Auditory Listening Differences
UNIVERSITY OF NORTH TEXASDepartment of Speech and Hearing Sciences
•Data from 5 studies:1. Speech‐in‐noise thresholds14 Cochlear Freedom Users
Compared CI alone to CI plus Oticon Arc
2. Speech‐in‐noise thresholds:9 users: Nucleus 5, Harmony, & OPUS
Compared: CI alone, Oticon R2, and Oticon Arc
3. Electroacoustic testing with CIs
4. Adaptive digital wireless systems
5. Effect of adaptive signal processing: Nucleus 6
• 14 Cochlear Freedom Users with Oticon Arc
Schafer et al., AJA, 2012
6.0 5.9
-6.5 -5.9
-10
-5
0
5
10
15
Session 1 Session 2
SN
R a
t 50
% C
orr
ect
(dB
)
Test Session
No FM
FM
12 dB improvement with Arc Significant effect of FM
No significant effect of session
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•9 users of various sound processors
0.7
-10.8-6.1
-20
-15
-10
-5
0
5
10
1
BK
B-S
IN S
NR
-50
Condition
No FM
Arc
R2
Both FM better than no FM Arc better than R2
WHY???
Schafer et al., JAAA, 2013a
• Adjusted FM gain to most closely simulate processor output
Measurement Steps 750 Hz 1000 Hz 2000 Hz
1. Processor in Test Box: 65 dB SPL Speech-Std1
2. Transmitter Microphone in Test Box: 65 dB SPL Speech-Std1
Difference Between Two Conditions
Average of Difference Scores (should be + 3 dB)
Schafer et al, 2013b, JAAA
•Step 1: Measure the output of the CI through the monitor earphones using speechinput
•Nucleus 5 in test box
•Coupler & earphone out
Nucleus 5
Earphone & HA-1 Coupler
Schafer et al., 2013b, JAAA
Step 2: Transmitter mic in Test Box:Measure Output of R2 Receiver
Transmitter Microphone
Oticon T30 Transmitter
Nucleus 5
Earphone & HA-1 Coupler
Oticon R2 FM Receiver plugged into earphone cord
Schafer et al., 2013b, JAAA
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Oticon T30 Transmitter
Nucleus 5 withearphone cord
Transmitter Microphone
OticonArc
Why the difference between FMs in Study 3??
0102030405060708090
750 Hz 1000 Hz 2000 Hz
Out
put i
n dB
SPL
Frequency
CI Alone
Arc +8
R2 +16
•We want transparency:•Same output with same inputs to CI and FM mics
•But…..•When we compared the measurements from the CI alone, R2, and Arc, we got….
Schafer et al., JAAA, 2013b
0102030405060708090
750 Hz 1000 Hz 2000 Hz
Out
put i
n dB
SPL
Frequency
Arc +8
R2 +16
R2 +8
Study 3: Electroacoustic Results Cochlear & MED‐EL
Schafer et al., 2013b, JAAA
But…does this approach result in good behavioral results??
•Speech recognition with 2 list‐pairs of BKB‐SIN: speech at 0; Babble at 180 degrees
• Loudness ratings (in parenthesis below)
Subject: CI CI Alone R2 Arc
1: Nucleus 5 1.0 (2.7) ‐11.0 (4.3) ‐12.3 (3.7)
2: Nucleus 5 ‐2.5 (3.3) ‐11.3 (4.0) ‐12.2 (3.7)
Schafer et al., 2013b, JAAA
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• Evaluated speech recognition in quiet and in noise with speech (HINT) at 64 dB at participant (85 dBA at transmitter )and classroom noise at 50, 55, 60, 65, 70, 75, 80 dBA
• Evaluated 3 RF remote microphone systems in Advanced Bionics and Cochlear users:–Fixed‐gain FM – MLxS–Adaptive FM – MLxi–Digital RF – Roger
Study 4 Results: AB (n = 16)
Wolfe et al., 2013, JAAA
Adults with normal hearing score 95% correct here!
Study 4 Results: Cochlear (n = 21)
Wolfe et al., in press, JAAA
Study 4: Summary
Adaptive Digital technology significantly better than fixed‐gain and adaptive FM at 70, 75, and 80 dBA
Adaptive FM technology better than fixed gain FM at 70, 75, and 80 dBA noise levels
No differences were found between CI manufacturers.
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Study 5: Adaptive Signal Processing: Nucleus 6
•Wolfe et al. evaluated potential benefit of acoustic scene analysis, fully adaptive directional processing, and digital noise reduction/ speech enhancement in Nucleus 6
• 3. Dyslexia• 4. Friedreich Ataxia (FRDA)• 5. Language Disorders
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Goals of This Section
•1. Review literature related to several normal hearing populations that need HAT
•2. Briefly review procedures to determine the need for HAT
•3. Recommend objective fitting procedures for these populations
1. Auditory Processing Disorders (APD)
•Johnston, John, Kreisman, Hall & Crandall (2009)•10 children with APD•13 children in control group•Test measures:
•Speech recognition in quiet & noise: HINT‐C
•Academic performance: SIFTER & LIFE
1. APD: Speech Recognition
Quiet (dB) Noise (dB SNR)
1. APD: Academic Performance‐‐ SIFTER
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1. APD: Academic Performance‐‐ LIFE 2. Autism Spectrum Disorders (ASD)
•Rance, Saunders, Carew, Johansson, & Tan (2014)• 20 children with ASD
• 20 matched controls• Test measures:
• Speech recognition in noise
• APHAB• Temporal processing• Spatial processing
2. ASD: Comparison of Groups—ASD vs. Controls
2. ASD: Speech Recognition in Noise
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2. ASD: Speech Recognition in Noise 2. ASD & ADHD
•Schafer, Mathews, Mehta, Hill, Munoz, Bishop, & Moloney (2012)• 11 children with ASD:
• 7 had ASD: APD (2), anxiety disorder (1), ADHD (2)• 4 had ADHD: APD (1), SLI (1)
• 11 age‐matched peers• Test measures:
• Speech recognition in noise• Classroom observations• Teacher questionnaires
2. ASD & ADHD: Speech Recognition in NoiseLower scores are better!
-14
-12
-10
-8
-6
-4
-2
0
No FM: ASD & ADHD No FM: Typical FM: ASD & ADHD
BK
B-S
IN T
hre
sho
ld i
n d
B S
NR
Condition: Group
Significantly poorer than typical peers
Same as peers when using FM
p < .001 p > .05
-5.4
-10.7
-4.2
-11.2
-14
-12
-10
-8
-6
-4
-2
0
No-FM 1 FM 1 No-FM 2 FM 2
BK
B-S
IN T
hre
sho
ld i
n d
B S
NR
Condition
2. ASD & ADHD: Speech Recognition in Noise
Lower scores are better!
Significantly better performance in FM conditions No effect of session
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63.8%
84.4%
62.9%
71.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FM Off 1 FM On 1 FM Off 2 FM On 2
Per
cen
tag
e o
f O
n-T
ask
Beh
avio
rs
Experimental Phase
2. ASD & ADHD: On‐Task Behaviors
Significantly more on-task behaviors with FM during both trial periods
Both FM conditions significantly better than both no-FM conditions
2. ASD & ADHD: C.H.A.P.S. Results
-35
-30
-25
-20
-15
-10
-5
0
Noise Quiet Ideal MultipleInputs
AuditoryMemory
AuditoryAttention
Teac
her
Rat
ing
C.H.A.P.S. Listening Condition
No FM
FM
Significant improvements in most areas*
* * * * *
3. Dyslexia
•Hornickel et al. (2012)•38 normal hearing children, ages 8‐14 years, with dyslexia
• 19 used FM system (Phonak EduLink) for 1 year
• 19 wore no device (control group)
•Test Measures:• Reading Ability
• Phonological Awareness
• Auditory Brainstem
Response to Speech (cABR)
Significant improvement in FM group; no change for control group
Significant improvement; no change for control group
Significant difference relative to control group
II. New FM Research
• Hornickel et al. (2012)
BaDaGa
stimuli
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3. Dyslexia
•Hornickel et al. (2012)• Subset of participants showed even greater improvements on phonological awareness
• Coined the “learners”
4. Friedreich ataxia (FRDA)
•Rance et al. (2010)• Neurodegenerative disease affecting motor and sensory systems due to mutations in the FXN gene, results in auditory neuropathy spectrum disorder (ANSD)
•10 participants, ages 8‐42 years, normal hearing but abnormal ABR with evidence of ANSD & control group
• Used FM system (Phonak iSense) for 6‐week trial
•Test Measures:• Auditory processing testing
• Word recognition in noise: 0 dB SNR
• Abbreviated Profile of Hearing Aid Benefit (APHAB)
4. Friedreich ataxia (FRDA)
•Word recognition with no FM:• FRDA: 43% (SD= 26)• Control: 80% (SD=1.8)
•FRDA with FM:
4. Friedreich ataxia (FRDA)
•APHAB Results:
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5. Language Disorders
•Will discuss after the section on fitting because we did some validation of our fitting procedure on this group
•First, we will briefly discuss (or review) identifying educational need
Determining Educational Need…
•1. Cite literature and assess classroom acoustics using an app to see if it meets ASHA/ANSI criteria (AudioTools from Studio Six Digital)
• Examined validity of AAA protocol & clearly define procedures for fitting ear‐level, open ear, FM‐only devices to 26 NH children
•Meet prescribed targets: DSL
•Measure RESR
•We also evaluated REOR to determine potential changes in REUR due to receiver placement iSense micro with smaller
xStandard receivers
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Specific Goals & Fitting Procedures
•1. Meet DSL targets at 1, 2, 3, & 4 kHz •FM mic in the test box; real‐ear mic in child’s ear•Verifit: select ‘FM’; ‘On‐ear’; Speech‐std[1]; FM volume adjusted, if necessary
•2. Do not exceed estimated UCL•Same settings, but MPO selected as the stimulus•Compared MPO to the estimated UCL on screen
•3‐4. Examine difference between REOR & REUR•Transmitter turned off•Verifit: ‘Open’ instrument; Speech‐std[1] at 65 dB SPL.
1. DSL Targets vs. Output
30
40
50
60
70
80
90
100
110
1000 2000 3000 4000
Target Output
No significant effect of output type
Significant interaction effect
Output 2-3 dBlower than target
2. MPO vs. UCL
Schafer et al., in press-c, JAAA
30
40
50
60
70
80
90
100
110
250 500 1000 2000 3000 4000 6000
dB SPL
Frequency (Hz)
UCL
OutputMPO output significantly lower than estimated UCL
3. REOR vs. REUR
0
10
20
30
40
50
60
70
1000 2000 3000 4000
dB SPL
Frequency (Hz)
iSense
Unaided
Significant difference: average= 3 dB
9/12/2014
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Behavioral Validation:Speech Recognition in Noise
0
10
20
30
40
50
60
70
80
90
100
110
Left FM Right FM Bilateral FM No FM
Percen
t Correct Speech Recogn
ition
Listening Condition
5‐8 yrs
9‐12 yrs
Behavioral Validation:
Loudness Ratings in Noise
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Left FM Right FM Bilateral FM No FM
Loudness Rating
Listening Condition
5‐8 yrs
9‐12 yrs
4. Language Disorders (LD) & Various Disabilities
Table 1. Overview of Subject Demographics and Frequency Modulation (FM) System Volume
Subject # Age Disorder FM Volume: Right FM Volume: Left
1 8; 10 APD ‐2 ‐2
2 10; 7 APD 8 8
3 8; 0 Teacher reported
listening problems
6 6
4 11; 11 ADHD, LD 6 8
5 9; 6 ASD, SLI 8 8
6 9; 3 ASD, APD, SLI 6 6
7 10; 5 ASD, APD, SLI 8 8
8 9; 5 ASD, ID, ADHD, SLI 2 0
9 8; 11 SLI 0 0
10 6; 4 SLI, APD, ADHD 2 2
11 10; 2 SLI 8 6
12 11; 3 SLI 6 6
4. LD & Other Disabilities
•Test Measures:
•Same procedure as the previous fitting study
•Same speech recognition measures
• Listening Comprehension Test 2 (recorded in noise)
Typical Classroom Acoustics Arnold, P., & Canning, D. (1999). Does classroom amplification aid comprehension? British Journal of
Audiology, 33(3), 171-178. Bess, F. H., Sinclair, J. S., & Riggs, D. E. (1984). Group amplification in schools for the hearing impaired. Ear
& Hearing, 5(3), 138-144. Crandell, C. & Smaldino J. (1996). An update of classroom acoustics for children with hearing impairment.
Volta Review, 1, 4-12. Cruckley, J., Scollie, S., & Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of
Educational Audiology, 17, 23-35. Knecht, H. A., Nelson, P. B., Whitelaw, G. M., & Feth, L. L. (2002). Background noise levels and reverberation
times in unoccupied classrooms: predictions and measurements. American Journal of Audiology, 11, 65-71.
Leavitt, R., & Flexer, C. (1991). Speech degradation as measured by the Rapid Speech Transmission Index (RASTI). Ear Hear, 12(2), 115-118.
Markides, A. (1986). Speech levels and speech-to-noise ratios. British Journal of Audiology, 20, 115-120. Nelson, E. L.., Smaldino, J., Erler, S., Garsteki, D. (2007/2008). Background Noise Levels and Reverberation
Times in Old and New Elementary School Classrooms Journal of Educational Audiology, 14, 12-18. Sanders, D. A. (1965). Noise Conditions in Normal School Classrooms. Except Child, 31, 344-353.
Recommended Classroom Acoustics & Measuring Acoustics American National Standards Institute. (2010). American National Standard Acoustical Performance Criteria,
Design Requirements, and Guidelines for Schools, Part 1: Permanent Schools (No. ANSI S12.60-2010). Melville, NY.
American Speech-Language-Hearing Association. (2005). Acoustics in educational settings: Position statement. [Position Statement]. Available from www.asha.org/policy.
Ostergren, D., & Smaldino, J. (2013). Technology in educational settings: It may already be in your pocket or purse! Journal of Educational Audiology, 18, 10-13.
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with reduced spectral cues as a function of age. Journal of the Acoustical Society of America, 107(5 Pt 1), 2704-2710.
Elliott, L. L. (1979). Performance of children aged 9 to 17 years on a test of speech intelligibility in noise using sentence material with controlled word predictability. Journal of the Acoustical Society of America, 66(3), 651-653.
Elliott, L. L., Connors, S., Kille, E., Levin, S., Ball, K., & Katz, D. (1979). Children's understanding of monosyllabic nouns in quiet and in noise. Journal of the Acoustical Society of America, 66(1), 12-21.
Gravel, J. S., Fausel, N., Liskow, C., & Chobot, J. (1999). Children's speech recognition in noise using omni- directional and dual-microphone hearing aid technology. Ear and Hearing, 20(1), 1-11.
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Stelmachowicz, P. G., Hoover, B. M., Lewis, D. E., Kortekaas, R. W., & Pittman, A. L. (2000). The relation between stimulus context, speech audibility, and perception for normal-hearing and hearing-impaired children. Journal of Speech, Language, and Hearing Research, 43(4), 902-914.
Effects of Noise: Normal Hearing Listeners Dubno, J. R., Dirks, D. D., & Morgan, D. E. (1984). Effects of age and mild hearing loss on speech recognition
in noise. Journal of the Acoustical Society of America, 76(1), 87-96.
Duqesnoy, A. J., & Plomp, R. (1983). The effect of hearing aid on the speech-reception threshold of hearing- impaired listeners in quiet and noise. Journal of the Acoustical Society of America, 73(2166-2173).
Erber, N. P. (1971). Auditory and audiovisual reception of words in low-frequency noise by children with normal hearing and by children with impaired hearing. Journal of Speech and Hearing Research, 14, 496-512.
Finitzo-Hieber, T., & Tillman, T. (1978). Room acoustics effects on monosyllabic word discrimination ability for normal and hearing impaired children. Journal of Speech and Hearing Research, 21, 440-458.
Valente, D. L., Plevinsky, H. M., Franco, J. M., Heinrichs-Graham, E. C., & Lewis, D. E. (2012). Experimental investigation of the effects of the acoustical conditions in a simulated classroom on speech recognition and learning in children. J Acoust Soc Am, 131(1), 232-246.
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and American listeners. Journal of the Acoustical Society of America, 88, 663-666.
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Hearing, l7, 210-217. Crandell, C. & Flannagan, R. (1999). Effects of conductive hearing loss on speech recognition in quiet and
noise. Journal of Educational Audiology, 8, 5-14. Dubno, J. R., Dirks, D. D., & Morgan, D. E. (1984). Effects of age and mild hearing loss on speech recognition
in noise. Journal of the Acoustical Society of America, 76(1), 87-96. Duqesnoy, A. J., & Plomp, R. (1983). The effect of hearing aid on the speech-reception threshold of hearing-
impaired listeners in quiet and noise. Journal of the Acoustical Society of America, 73(2166-2173). Erber, N. P. (1971). Auditory and audiovisual reception of words in low-frequency noise by children with normal
hearing and by children with impaired hearing. Journal of Speech and Hearing Research, 14, 496-512. Finitzo-Hieber, T., & Tillman, T. (1978). Room acoustics effects on monosyllabic word discrimination ability for
normal and hearing impaired children. Journal of Speech and Hearing Research, 21, 440-458. Nabelek, A., & Pickett, J. M. (1974). Monaural and binaural speech perception through hearing aids under noise
and reverberation with normal and hearing-impaired listeners. Journal of Speech and Hearing Research, 17, 724-739.
Nabelek, A., & Pickett, J. M. (1974). Reception of consonants in a classroom as affected by monaural and binaural listening, noise, reverberation, and hearing aids. Journal of the Acoustical Society of America, 56, 628-639.
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in background noise in children with normal hearing. Journal of Educational Audiology, 19(58-64). Working Memory Osman, H. & Sullivan, J. (2013). Children’s auditory working memory performance in degraded listening
conditions. Journal of Speech, Language, and Hearing Research, 57(4), 1503-1511. Listening Effort (see pubmed.com for more studies on this): Picou, E. M., & Rickets, T. A. (in press). The effect of changing the secondary task in dual-task paradigms for
measuring listening effort. Ear & Hearing. Ross, M. (1992). Room acoustics and speech perception. In M. Ross (ed.), FM Auditory Training Systems:
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Audiology, 33,171-178. Crandell, C.C., Charlton, M., Kinder, M., and Kreisman, B.M. Effects of portable sound field systems on speech
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behaviors of learning-disabled children. Language, Speech, and Hearing Services in the Schools, 22, 111-114.
Clarke-Klein, S.M., Roush, J., Davis, K. & Medley, L. (1995). FM amplification for enhancement of conversational discourse skills: case study. Journal of American Academy of Audiology, 6, 230-234.
Flexer, C., Millin, J.P. & Brown, L. (1990). Children with developmental disabilities: the effect of sound field amplification on word identification. Language, Speech and Hearing Services in the Schools, 21, 177- 182.
Flexer, C. & Savage, H. (1993). Use of mild gain amplifier with preschoolers with language delay. Language, Speech, and Hearing Services in the Schools, 24, 151-155.
Friederichs, E. & Friederichs, P. (2005). Electrophysiologic and psycho-acoustic findings following one-year
5 application of personal ear-level FM device in children with attention deficit and suspected central auditory processing disorder, Journal of Educational Audiology, 12, 29-34.
Hornickel, J., Zecker, S. G., Bradlow, A. R., & Kraus, N. Assistive listening devices drive neuroplasticity in
children with dyslexia. Proc Natl Acad Sci U S A, 109(41), 16731-16736. Johnston, K.N., John, A.B., Kreisman, N.V., Hall, J.W. 3rd, Crandell, C.C. (2009). Multiple benefits of personal
FM system use by children with auditory processing disorder (APD). International Journal of Audiology, 48(6), 371-383.
Rance, G., Corben, L. A., Du Bourg, E., King, A., & Delatycki, M. B. (2010). Successful treatment of auditory perceptual disorder in individuals with Friedreich ataxia. Neuroscience, 171(2), 552-555.
Rance, G., Saunders, K., Carew, P., Johansson, M., & Tan, J. (2014). The use of listening devices to ameliorate auditory deficit in children with autism. J Pediatr, 164(2), 352-357.
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Schafer, E. C., Mathews, L., Mehta, S., Hill, M., Munoz, A., Bishop, R., & Maloney, M. (2012). Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): An initial investigation. Journal of Communication Disorders, 46, 40-52.
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Stach, B.A., Loiselle, L.H., Jerger, J.F., Mintz, S.L. & Taylor, C.D. (1987). Clinical experience with personal FM assistive listening devices. The Hearing Journal, May, 24-30.
FM/DM System Research: Minimal and Mild Hearing Loss Ross, M. & Giolas, T.G. (1971). Effect of three classroom listening conditions on speech intelligibility.
American Annals of the Deaf, 116, 580-584. Sariff, L.S. (1981). An innovative use of free field amplification in regular classrooms. In R. Roeser & M.
Downs (Eds.) Auditory Disorders in School Children (p. 263-272). New York: Thieme Stratton, Inc. Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013).
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FM System Research: Unilateral Hearing Loss Bess, F.H., Klee, T. & Culbertson, J.L. (1986). Identification, assessment, and management of children with
hearing loss. Ear and Hearing, 7, 43-51. Updike, C.D. (1994). Comparison of FM auditory trainers, CROS aids, and personal amplification in
unilaterally hearing-impaired children. Journal of American Academy of Audiology, 5, 204-209.
FM System & Digital Transmission Research: Moderate to Profound Hearing Loss and Hearing Aids Anderson, K.L. & Goldstein, H. (2004). Speech perception benefits of FM and infrared devices to children with
hearing aids in a typical classroom. Journal of Speech, Language, and Hearing Services in the Schools, 35(2), 169-184.
Anderson, K. L., Goldstein, H., Colodzin, L., & Iglehart, F. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12, 14-28.
Boothroyd, A. & Iglehart, F. (1998). Experiments with classroom amplification. Ear and Hearing, 19, 207-217. Flynn, T.S. & Gregory, M. (2005). The FM advantage in the real classroom. Journal of Educational Audiology,
12, 35-42. Lewis, M. S., Crandell, C. C., Valente, M., & Horn, J. E. (2004). Speech perception in noise: directional
microphones versus frequency modulation (FM) systems. Journal of the American Academy of Audiology, 15, 426-439.
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Nabelek, A.K., Donahue, A.M. & Letowski, T.R. (1986). Comparison of amplification systems in a classroom.
Journal of Rehabilitation Research and Development, 23, 41-52.
Noe, C.M., Davidson, S.A. & Mishler, P.J. (1997). The use of large group assistive listening devices with and without hearing aids in an adult classroom setting. American Journal of Audiology, 6, 48-63.
Pittman, A.L., Lewis, D.E., Hoover, B.M. & Stelmachowicz, P.G. (1999). Recognition performance for four combinations of FM system and hearing aid microphone signals in adverse listening conditions. Ear and Hearing, 20, 279-289.
Ross, M., Giolas, T. & Carver, P. (1973). Effect of classroom listening conditions of speech intelligibility. Language, Speech, and Hearing Services in the Schools, 4, 72-76.
Schafer, E. C., Sanders, K., Bryant, D., Keeney, K., & Baldus, N. (2013). Effects of Voice Priority in FM systems for children with hearing aids. Journal of Educational Audiology, 19, 12-24.
Toe, D. (1999). Impact of FM aid use on the classroom behavior of profoundly deaf secondary students. Seminars in Hearing, 20, 223-234.
Wolfe, J.,Morais, M., Neumann, S., Schafer, E. C., Wells, N., Mülder, H. E., John, A., & Hudson, M. (2013). Evaluation of speech recognition with personal FM and classroom audio distribution systems. Journal of Educational Audiology, 19, 65-79.
FM System/Digital Transmission Research: Cochlear Implants Aaron, R., Sonneveldt, V., Arcaroli, J., & Holstad, B. (2003, November). Optimizing microphone sensitivity
settings of pediatric Nucleus 24 cochlear implant patients using Phonak MicroLink CI+ FM system. Poster presented at ACCESS: Achieving Clear Communication Employing Sound Solutions - Proceedings of the First International Conference, Chicago, IL.
Acoustical Society of America, (n.d.). Position on the Use of Sound Amplification in the Classroom. Retrieved October 12, 2006 from http://asa.aip.org
Anderson, K. L., Goldstein, H., Colodzin, L., & Iglehart, F. (2005). Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a cochlear implant. Journal of Educational Audiology, 12, 14-28.
Catlett, D. & Brown, C.J. (2003, November). Optimal audio mix settings for pediatric Clarion cochlear implant patient using a Phonak MicroLink CI-S FM system. Poster presented at ACCESS: Achieving Clear Communication Employing Sound Solutions - Proceedings of the First International Conference, Chicago, IL.
Crandell, C. C., Holmes, A. E., Flexer, C., & Payne, M. (1998). Effects of soundfield FM amplification on the speech recognition of listeners with cochlear implants. Journal of Educational Audiology, 6, 21-27.
Davies, M. G., Yellon, L., & Purdy, S. C. (2001). Speech-in-noise perception of children using cochlear implants and FM systems. Australian and New Zealand Journal of Audiology, 23, 52-62.
Iglehart, F. (2004). Speech perception by students with cochlear implants using sound-field systems in classrooms. American Journal of Audiology, 13, 62-72.
Schafer, E. C., Huynh, C., Romine, D., Jimenez, R. (2012). Speech recognition in noise and subjective perceptions of neckloop FM receivers with cochlear implants. American Journal of Audiology, 22(1), 53-64.
Schafer, E.C. & Kleineck, M.P. (2009). Improvements in speech-recognition performance using cochlear implants and three types of FM systems: A meta-analytic approach. Journal of Educational Audiology, 15, 4-14
Schafer, E. C., Musgrave, E., Momin, S., Sandrock, C., & Romine, D. (2013). A proposed electroacoustic test protocol for personal FM receivers coupled to cochlear implant sound processors. Journal of the American Academy of Audiology, 24(10), 941-954.
Schafer, E. C., Pogue, J., Milrany, T. (2012). Equivalency of the AzBio Sentence Test in noise for listeners with normal-hearing sensitivity or cochlear implants. Journal of the American Academy of Audiology, 23(7), 501-509.
Schafer, E. C., Romine, D., Musgrave, E., Momin, S., & Huynh, C. (2013). Electromagnetic versus electrical coupling of personal frequency modulation (FM) receivers to cochlear implant sound processors. Journal of the American Academy of Audiology, 24(10), 927-940.
Schafer, E. C. & Thibodeau, L.M. (2006). Speech recognition in noise in children with cochlear implants while listening in bilateral, bimodal, and FM-system arrangements. American Journal of Audiology, 15(2), 114-126.
Schafer, E. C. & Thibodeau, L. M. (2004). Speech recognition abilities of adults using cochlear implants interfaced with FM systems. Journal of the American Academy of Audiology, 15(10), 678-691.
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Seminars in Hearing, 31(3), 219-232. Schafer, E. C. & Wolfe, J. (2010). Hearing assistance technology for children: candidacy and selection.
Seminars in Hearing, 31(3), 219-232. Schafer, E. C., Wolfe, J., Algier, K., Morais, M., Price, S., Monzingo, J., et al. (2012). Spatial hearing in
noise of young children with cochlear implants and hearing aids. Journal of Educational Audiology, 18, 38-52.
Schafer, E. C., Wolfe, J., Lawless, T., & Stout, B. (2009). Effects of FM-receiver gain on speech-recognition performance of adults with cochlear implants. International Journal of Audiology, 48(4), 196-203.
Wolfe, J., Morais, M., Schafer, E., Mills, E., Mulder, H. E., Goldbeck, F., et al. Evaluation of speech recognition of cochlear implant recipients using a personal digital adaptive radio frequency system. J Am Acad Audiol, 24(8), 714-724.
Wolfe, J., Morais, M., Schafer, E., Mills, E., Peters, R., Lianos, L., John, A., & Hudson, M. (2013). Better speech recognition with digital RF system in study of cochlear implants. The Hearing Journal, 66(7), 24-26
Wolfe, J. & Schafer E.C. (2008). Optimizing the benefits of Auria® sound processors coupled to personal FM systems with iConnect™ adaptors. Journal of the American Academy of Audiology, 19(8). 585-594.
Wolfe, J., Schafer, E.C., Heldner, B., Mulder, H., Ward, E., & Vincent, B. (2009). Evaluation of speech recognition in noise with cochlear implants and Dynamic FM. Journal of the
American Academy of Audiology, 20(7), 409-421. [Tier 1] Wolfe, J., Schafer, E. C., Parkinson, A., John, A., Hudson, M., Wheeler, J., & Mucci, A. (2013). Effects
of input processing and type of personal FM system on speech recognition performance of adults with cochlear implants. Ear and Hearing, 34(1), 52-62.
Wolfe, J., Thompson, K., Swim, L., Schafer, E.C. (2007/2008). Clinical evaluation of the FM advantage provided by contemporary personal FM systems. Journal of Educational Audiology, 14, 47-57.