Outreach Sept 2018: Lorna Halliday main talk

Childhood hearing & hearing loss
https://lornafhalliday.com/
https://www.ucl.ac.uk/pals/people/lorna-halliday
@lornafhalliday

Auditory processing (AP)
in children with
sensorineural hearing loss
(SNHL)

Taxi driver test…
A bit
deaf…
They wear those
things… Like
glasses for ears
You have
to shout
They can’t
hear things as
well, right?

…Those aspects of hearing that are
affected by factors other than, or in
addition to, how audible something is...

…Those aspects of hearing that are
affected by factors other than, or in
addition to, how audible something is...
temporal
fine
structure
temporal
processing
frequency
selectivityabsolute
threshold
broader
auditory
filters
envelope
pitch
perception
phase
locking
speech
perception
speech in
noise
binaural
hearing
Loudness
recruitment

perception
output
cognition
language
auditory
input
The importance of AP

Sensorineural hearing loss (SNHL)
mild
21-40 dB HL
moderate
41-70 dB HL
severe
71-90 dB HL
profound
91+ dB HL
difficulty
following
speech in noise
difficulty
following
speech without
hearing aid(s)
unable to follow
speech without
amplification
mainstream schools
hearing aids, FM systems
Powerful hearing aids +/or cochlear
implants
(speech reading;
sign language;
specialist schools)
severity
little/no access
to speech
without cochlear
implants

Mild to moderate SNHL (MMHL)
mild
21-40 dB HL
moderate
41-70 dB HL
difficulty
following
speech in noise
difficulty
following
speech without
hearing aid(s)
mainstream schools
hearing aids, FM systems
severity

Questions
Do children
with MMHL
have poorer
AP (than NH
children)?
If so,
why?
Does it
matter?

Participants
Information sent to 900
children with MMHL across
London and SE England
Inclusion criteria:
Aged 8 – 16 years
Native English-only
speakers
No additional diagnoses
Information sent to 2000
normally hearing (NH)
children across London
and SE England
Consent
n = 59
Consent
n > 70
Age-match to MMHL
Did not consent/
no reply
Exclusions:
High-frequency HL
Auditory Neuropathy
Spectrum Disorder
(ANSD)
Additional diagnoses
n = 2
Screen:
Pure tone audiometry
NVIQ
n = 57
Screen:
Pure tone audiometry
NVIQ
n = 44
n = 46 n = 44
Exclusions:
PTA < 20 >70 dB HL
NVIQ < 85
n = 5
Exclusions:
PTA > 20 dB HL
NVIQ < 85
n = 0
Test sessions 1 and 2
n = 52
Test sessions 1 and 2
n = 44
Drop out
n = 6

Variable
MM group
n = 46
Control (NH) group
n = 44
Age (years) 11.4 (8.5 - 16.4) 11.5 (8.0 - 15.9)
Gender (girls: boys) 19:27 25:19
PTA threshold (dB HL) 46.0 (27.5 - 69.2) 8.9 (0 - 15.8)
HL confirmed (months) 53 (2 - 179)
Hearing aids (n) 43 0
Nonverbal IQ (T score) 55.6 (40 - 78) 60.6 (40 - 78)
Participants

Child-friendly computer games
Halliday, Tuomainen, & Rosen (2017). Cognition, 166, 139-151;
Halliday & Rosen (in prep)

A (brief) lesson about AP…
Envelope (E)
Temporal Fine Structure (TFS)

Auditory processing tasks
Frequency
discrimination
(FD)
Frequency
modulation
detection
(FMD)
Rise time
(RT)
Fundamental
frequency
(F0)
2nd formant
(F2)
Amplitude
modulation
detection
(AMD)
/ba/-/da/
Halliday, Tuomainen, & Rosen (2017). Cognition, 166, 139-151;
Timescale
Complexity
EnvelopeTFS

Results
Do children
with MMHL
have poorer
AP (than NH
children)?

Unaided
NH
MM unaided
better

Envelope
TFS,
frequency
selectivity
Summary
Do children
with MMHL
have poorer
AP?

Aided vs. unaided
NH
MM unaided
MM aided
better

Aided vs. NH
NH
MM unaided
MM aided
better

Probably
not….
Is poorer AP
(just) due to
poorer audibility
in children with
MMHL?
Summary

Response variability
Trial #
Stimulus#
Good AP
Good listening
Poor AP
Good listening
? AP
Poor listening

Response variability
Trial #
Stimulus#
Good AP
Good listening
Poor AP
Good listening
? AP
Poor listening
Poorer AP not
due to poorer
attention

Links to language Do
deficits in
AP
matter?

Relationship between AP and language
NH
MMHL
Good AP
Good language
Halliday, Tuomainen, & Rosen (2017). Cognition, 166, 139-151
Poor AP
Poor language
Good AP
Poor language
Poor AP
Good language

Relationship between AP and language
NH
MMHL
Good AP
Good language
Poor AP
Poor language
Good AP
Poor language
Poor AP
Good language
General AP deficits
are often linked to
language
difficulties, but not
always

Relationship between E and language
Good E
Poor language
E processing
deficits not usually
linked to language
difficulties, but if a
child has them, they
are likely to also
have language
difficulties
Good E
Good language
Poor E
Good
language
Poor E
Poor
language
NH
MMHL

Auditory processing tasks
Frequency
discrimination
(FD)
Frequency
modulation
detection
(FMD)
Rise time
(RT)
Fundamental
frequency
(F0)
2nd formant
(F2)
Amplitude
modulation
detection
(AMD)
/ba/-/da/
Timescale
Complexity
EnvelopeTFS
Cabrera, Rosen, & Halliday (in prep).

Predictors of vocabulary
Estimate SE t P -2 LL p
Intercept 32.2 22.0 1.5 .150 ----
Age 0.5 0.9 0.6 .578 ----
Hearing loss 0.4 0.2 2.0 .056 ----
Maternal education 0.3 0.7 0.4 .684 ----
Nonverbal IQ 0.7 0.2 3.4 .002 <.05
Family history 9.5 4.1 2.3 .024 <.05
TFS -4.0 1.5 -2.6 .012 <.05
Cabrera, Rosen, & Halliday (in prep).
• Mixed models analysis predicting BPVS scores MM group only
Do
deficits
in AP
matter?

Is poor AP
linked to
difficulties with
language in
children with
MMHL?
Yes…
Summary
In particular,
TFS seems
to be
especially
important for
language

Take home messages
Children with
MMHL have
poorer AP
than those
with NH
Particular
difficulties
with TFS (but
not E)
processing
Not only due
to difficulty
hearing
(audibility)
Not due to
poorer
nonverbal IQ
or attention
Associated
with poorer
language
outcomes

The future…
Language Development and Disorder in Children with SNHL: A UK Cohort Study
Year 1
Background Auditory Cognitive Language Academic
SES Audiometry Nonverbal IQ Phonology EYFSP
Questionnaires Auditory processing Working memory Vocabulary KS1
Communication Grammar KS2
Social, emotional, Reading
behavioural
longitudinal
Early-confirmed
mild-profound
SNHL
(N = 126)
Late-confirmed
mild SNHL
(N ≥ 43)
DLD and DRD
(N ~ 50)
Unilateral SNHL
(N = 86)
ANSD
(N = 17)
Year 2
Year 3 Years 6-7 Years 6-7
participantsdesign
Year 4
prospective
Year 5
Year 6
battery
retrospective
Years 6-7

Questions..?
l.halliday@ucl.ac.uk
https://lornafhalliday.com/
@lornafhalliday

Outreach Sept 2018: Lorna Halliday main talk

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