J Am Acad Audiol
DOI: 10.1055/s-0042-1755319
Research Article

Remote-Microphone Benefit in Noise and Reverberation for Children Who are Hard of Hearing

Dawna Lewis
1   Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, Nebraska
Meredith Spratford
1   Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, Nebraska
George Christopher Stecker
2   Spatial Hearing Laboratory, Boys Town National Research Hospital, Omaha, Nebraska
Ryan W. McCreery
1   Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, Nebraska
› Author Affiliations
Funding The Centre for Applied Audiology Research, Oticon A/S provided financial support and amplification devices for this study. This work also was supported by grants from the National Institutes of Health—National Institute for Deafness and Communication Disorders, National Institute of General Medical Sciences (R01 DC013591, P20 GM109023). Author George Christopher Stecker received additional funding from NIH (R01DC016643, R01DC018166) and is a member of Auditory Space, LLC—a provider of research software and consulting, not involved in the current study. Author Dawna Lewis is a member of the Phonak Pediatric Advisory Board. The content of this project is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Background Remote-microphone (RM) systems are designed to reduce the impact of poor acoustics on speech understanding. However, there is limited research examining the effects of adding reverberation to noise on speech understanding when using hearing aids (HAs) and RM systems. Given the significant challenges posed by environments with poor acoustics for children who are hard of hearing, we evaluated the ability of a novel RM system to address the effects of noise and reverberation.

Purpose We assessed the effect of a recently developed RM system on aided speech perception of children who were hard of hearing in noise and reverberation and how their performance compared to peers with “normal” hearing. The effect of aided speech audibility on sentence recognition when using an RM system also was assessed.

Study Sample Twenty-two children with mild to severe hearing loss and 17 children with normal “hearing” (7–18 years) participated.

Data Collection and Analysis An adaptive procedure was used to determine the signal-to-noise ratio for 50 and 95% correct sentence recognition in noise and noise plus reverberation (RT 300 ms). Linear mixed models were used to examine the effect of listening conditions on speech recognition with RMs for children who were hard of hearing compared to children with “normal” hearing and the effects of aided audibility on performance across all listening conditions for children who were hard of hearing.

Results Children who were hard of hearing had poorer speech recognition for HAs alone than for HAs plus RM. Regardless of hearing status, children had poorer speech recognition in noise plus reverberation than in noise alone. Children who were hard of hearing had poorer speech recognition than peers with “normal” hearing when using HAs alone but comparable or better speech recognition with HAs plus RM. Children with better-aided audibility with the HAs showed better speech recognition with the HAs alone and with HAs plus RM.

Conclusions Providing HAs that maximize speech audibility and coupling them with RM systems has the potential to improve communication access and outcomes for children who are hard of hearing in environments with noise and reverberation.

Publication History

Received: 07 October 2021

Accepted: 12 June 2022

Article published online:
28 December 2022

© 2022. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Finitzo-Hieber T, Tillman TW. Room acoustics effects on monosyllabic word discrimination ability for normal and hearing-impaired children. J Speech Hear Res 1978; 21 (03) 440-458
  • 2 Hick CB, Tharpe AM. Listening effort and fatigue in school-age children with and without hearing loss. J Speech Lang Hear Res 2002; 45 (03) 573-584
  • 3 Leibold LJ, Hillock-Dunn A, Duncan N, Roush PA, Buss E. Influence of hearing loss on children's identification of spondee words in a speech-shaped noise or a two-talker masker. Ear Hear 2013; 34 (05) 575-584
  • 4 McCreery RW, Walker EA, Spratford M, Lewis D, Brennan M. Auditory, cognitive, and linguistic factors predict speech recognition in adverse listening conditions for children who are hard of hearing. Front Neurosci 2019; 13: 1093
  • 5 Blair J, Peterson M, Viehwig S. The effects of mild hearing loss on academic performance of young school-age children. Volta Review 1985; 87: 87-93
  • 6 Crandell CC. Speech recognition in noise by children with minimal degrees of sensorineural hearing loss. Ear Hear 1993; 14 (03) 210-216
  • 7 Lewis DE, Valente DL, Spalding JL. Effect of minimal/mild hearing loss on children's speech understanding in a simulated classroom. Ear Hear 2015; 36 (01) 136-144
  • 8 Dockrell J, Shield B. Acoustical barriers in classrooms: the impact of noise on performance in the classroom. Br Educ Res J 2006; 32: 509-525
  • 9 Jamieson DG, Kranjc G, Yu K, Hodgetts WE. Speech intelligibility of young school-aged children in the presence of real-life classroom noise. J Am Acad Audiol 2004; 15 (07) 508-517
  • 10 Klatte M, Hellbrück J, Seidel J, Leistner P. Effects of classroom acoustics on performance and well-being in elementary school children: a field study. Environ Behav 2010; 42: 659-692
  • 11 Klatte M, Lachmann T, Meis M. Effects of noise and reverberation on speech perception and listening comprehension of children and adults in a classroom-like setting. Noise Health 2010; 12 (49) 270-282
  • 12 McKellin W, Shahin K, Hodgson M, Jamieson J, Pichora-Fuller K. Noisy zones of proximal development: conversations in noisy classrooms. J Sociolinguist 2011; 15: 65-93
  • 13 Shield BM, Dockrell JE. The effects of environmental and classroom noise on the academic attainments of primary school children. J Acoust Soc Am 2008; 123 (01) 133-144
  • 14 Valente DL, Plevinsky HM, Franco JM, Heinrichs-Graham EC, Lewis DE. Experimental investigation of the effects of the acoustical conditions in a simulated classroom on speech recognition and learning in children. J Acoust Soc Am 2012; 131 (01) 232-246
  • 15 Yang W, Bradley JS. Effects of room acoustics on the intelligibility of speech in classrooms for young children. J Acoust Soc Am 2009; 125 (02) 922-933
  • 16 American National Standards Institute (ANSI). 12.60–2010/Part 1, Acoustical Performance Criteria, Design Requirements and Guidelines for Schools, Part 1: Permanent Schools. New York: Acoustical Society of America; 2010
  • 17 Iglehart F. Speech perception in classroom acoustics by children with hearing loss and wearing hearing aids. Am J Audiol 2020; 29 (01) 6-17
  • 18 Gremp MA, Easterbrooks SR. A descriptive analysis of noise in classrooms across the US and Canada for children who are deaf and hard of hearing. Volta Review 2018; 117 (1-2): 5-31
  • 19 Ronsse LM, Wang LM. Relationships between unoccupied classroom acoustical conditions and elementary student achievement measured in eastern Nebraska. J Acoust Soc Am 2013; 133 (03) 1480-1495
  • 20 Spratford M, Walker EA, McCreery RW. Use of an application to verify classroom acoustic recommendations for children who are hard of hearing in a general education setting. Am J Audiol 2019; 28 (04) 927-934
  • 21 Crukley J, Scollie S, Parsa V. An exploration of non-quiet listening at school. J Educ Audiol 2011; 17: 23-35
  • 22 Sato H, Bradley JS. Evaluation of acoustical conditions for speech communication in working elementary school classrooms. J Acoust Soc Am 2008; 123 (04) 2064-2077
  • 23 Leavitt R, Flexer C. Speech degradation as measured by the Rapid Speech Transmission Index (RASTI). Ear Hear 1991; 12 (02) 115-118
  • 24 Crukley J, Scollie SD. The effects of digital signal processing features on children's speech recognition and loudness perception. Am J Audiol 2014; 23 (01) 99-115
  • 25 Stelmachowicz PG, Hoover BM, Lewis DE, Kortekaas RW, Pittman AL. The relation between stimulus context, speech audibility, and perception for normal-hearing and hearing-impaired children. J Speech Lang Hear Res 2000; 43 (04) 902-914
  • 26 Stelmachowicz PG, Lewis DE, Choi S, Hoover B. Effect of stimulus bandwidth on auditory skills in normal-hearing and hearing-impaired children. Ear Hear 2007; 28 (04) 483-494
  • 27 Tomblin JB, Oleson JJ, Ambrose SE, Walker E, Moeller MP. The influence of hearing aids on the speech and language development of children with hearing loss. JAMA Otolaryngol Head Neck Surg 2014; 140 (05) 403-409
  • 28 Wolfe J, John A, Schafer E, Nyffeler M, Boretzki M, Caraway T. Evaluation of nonlinear frequency compression for school-age children with moderate to moderately severe hearing loss. J Am Acad Audiol 2010; 21 (10) 618-628
  • 29 Anderson KL, Goldstein H. Speech perception benefits of FM and infrared devices to children with hearing aids in a typical classroom. Lang Speech Hear Serv Sch 2004; 35 (02) 169-184
  • 30 Cruz ADD, Gagné JP, Cruz WM, Isotani S, Gauthier-Cossette L, Jacob RTS. The effects of using hearing aids and a frequency modulated system on listening effort among adolescents with hearing loss. Int J Audiol 2020; 59 (02) 117-123
  • 31 Wolfe J, Duke M, Schafer E, Jones C, Rakita L, Battles J. Evaluation of a remote microphone system with tri-microphone beamformer. J Am Acad Audiol 2020; 31 (01) 50-60
  • 32 McCreery RW, Walker EA, Spratford M. et al. Speech recognition and parent ratings from auditory development questionnaires in children who are hard of hearing. Ear Hear 2015; 36 (Suppl. 01) 60S-75S
  • 33 McCreery RW, Spratford M, Kirby B, Brennan M. Individual differences in language and working memory affect children's speech recognition in noise. Int J Audiol 2017; 56 (05) 306-315
  • 34 Stiles DJ, Bentler RA, McGregor KK. The Speech Intelligibility Index and the pure-tone average as predictors of lexical ability in children fit with hearing AIDS. J Speech Lang Hear Res 2012; 55 (03) 764-778
  • 35 Walker EA, Redfern A, Oleson JJ. Linear mixed-model analysis to examine longitudinal trajectories in vocabulary depth and breadth in children who are hard of hearing. J Speech Lang Hear Res 2019; 62 (03) 525-542
  • 36 Pittman AL, Lewis DE, Hoover BM, Stelmachowicz PG. Recognition performance for four combinations of FM system and hearing aid microphone signals in adverse listening conditions. Ear Hear 1999; 20 (04) 279-289
  • 37 Tharpe AM, Ricketts T, Sladen D. FM systems for children with minimal to mild hearing loss. In Fabry D, DeConde Johnson C. eds. ACCESS: Achieving Clear Communication Employing Sound Solutions. Chicago: Phonak AG; 2003: 191-197
  • 38 Thibodeau L. Benefits of adaptive FM systems on speech recognition in noise for listeners who use hearing aids. Am J Audiol 2010; 19 (01) 36-45
  • 39 Thibodeau L. Comparison of speech recognition with adaptive digital and FM remote microphone technology by listeners who use hearing aids. Am J Audiol 2014; 23: 201-210
  • 40 Wolfe J, Morais M, Neumann S. et al. Evaluation of speech recognition with personal FM and classroom audio distribution systems. J Educ Audiol 2013; 19: 65-79
  • 41 Browning JM, Buss E, Flaherty M, Vallier T, Leibold LJ. Effects of adaptive hearing aid directionality and noise reduction on masked speech recognition for children who are hard of hearing. Am J Audiol 2019; 28 (01) 101-113
  • 42 Le Goff N, Jensen J, Pedersen MS, Callaway SL. An introduction to OpenSound Navigator™ (Whitepaper). 2016. Somerset NJ. Oticon Incorporated. HYPERLINK https://urldefense.com/v3/__https:/wdh02.azureedge.net/-/media/oticon-us/main/download-center/white-papers/15555-9950---opnsound-navigator.pdf?rev=5008&la=en__;!!CEjAKCqGPSl6!uAP3R2ui1TQJQqgPqU4n6EFm-MdGkVcmMfcwBXGwH-ThCGN0WWN65CMQWjKE6FATlN5KbkQBzqK7EaIF$
  • 43 American National Standards Institute. Methods for Calculation of the Speech Intelligibility Index. New York: Acoustical Society of America; 1997
  • 44 McCreery RW, Walker EA, Stiles DJ, Spratford M, Oleson JJ, Lewis DE. Audibility-based hearing aid fitting criteria for children with mild bilateral hearing loss. Lang Speech Hear Serv Sch 2020; 51 (01) 55-67
  • 45 Bagatto M, Moodie S, Scollie S. et al. Clinical protocols for hearing instrument fitting in the desired sensation level method. Trends Amplif 2005; 9 (04) 199-226
  • 46 Oticon. EduMic Verification Guide: Verifit1 and Verifit2. 2022
  • 47 American Academy of Audiology. American Academy of Audiology Clinical Practice Guidelines: Remote Microphone Hearing Assistance Technologies for Children and Youth from Birth to 21 years. 2022 Available at HYPERLINK https://www.audiology.org/wp-content/uploads/2021/05/HAT_Guidelines_Supplement_A.pdf_53996ef7758497.54419000.pdf
  • 48 Spahr AJ, Dorman MF, Litvak LM. et al. Development and validation of the pediatric AzBio sentence lists. Ear Hear 2014; 35 (04) 418-422
  • 49 Allen JB, Berkley DA. Image method for efficiently simulating small-room acoustics. J Acoust Soc Am 1979; 65: 943-950
  • 50 Stecker GC, Moore TM. Reverberation enhances onset dominance in sound localization. J Acoust Soc Am 2018; 143 (02) 786-793
  • 51 Pulkki V. Virtual sound source positioning using vector base amplitude panning. J Audio Eng Soc 1997; 45 (06) 456-466
  • 52 Croghan NB, Grantham DW. Binaural interference in the free field. J Acoust Soc Am 2010; 127 (05) 3085-3091
  • 53 Simon L, Wüthrich H, Dillier N. (2017). Comparison of higher-order ambisonics, vector- and distance-based amplitude panning using a hearing device beamformer. 2017 In: Proceedings of the 4th International Conference on Spatial Audio, VDT&IEM, Graz, 7-10 Sept. 2017. 131-137
  • 54 Buss E, Hodge SE, Calandruccio L, Leibold LJ, Grose JH. Masked sentence recognition in children, young adults, and older adults: age-dependent effects of semantic context and masker type. Ear Hear 2019; 40 (05) 1117-1126
  • 55 Bradley JS, Sato H. The intelligibility of speech in elementary school classrooms. J Acoust Soc Am 2008; 123 (04) 2078-2086
  • 56 R Development Core Team. R: A Language and Environment for Statistical Computing. 2018
  • 57 Bates D, Maechler M, Bolker B, Walker S. lme4: Linear mixed-effects models using Eigen and S4. R Package Version 2020
  • 58 Walker EA, Holte L, McCreery RW, Spratford M, Page T, Moeller MP. The influence of hearing aid use on outcomes of children with mild hearing loss. J Speech Lang Hear Res 2015; 58 (05) 1611-1625