Hearing Loss, Hearing Devices, and the Business of Childhood
Andrea Pittman, PhD CCC-AArizona State University Pediatric Amplification Labpedamp.asu.edu/presentations We Give Kids Volume
DisclosuresAnd the help of research assistants (The Pitt Crew):Current: Previous:Elizabeth Rainy Ian Odgear Elizabeth StewartLauren Meadows Amanda Willman Ashley WrightNicole Marzan Madalyn Rash Amy Stahl Beatriz Lazaro Brittany Schuett (and many more)
This work was supported by grants from:
And collaborators:
Rachel Krupa – Mesa Public Schools, AZJudy Attaway – Casa Colina Hospital, CADan Duran – Valley Children’s Hospital, CAKari Morgenstein – Miami Univ Hospital, FLKristy Winters – Michigan Univ Hospital, MI
Arizona CommunityFoundation
Hearing Industry Research Consortium
Leadership Fund
The kids we’re talking about
The kids we’re talking about
Profound
Mild
AGE (years)
HEA
RIN
G L
OSS
(d
egr
ee)
0 5 10 15 18
The business of childhood
Vocabulary Development
2
4
6
8
10
12
14
16
18
20
22
24
4 6 8 10 12 14 16
PP
VT
Vo
cab
ula
ry A
ge (
Yrs)
Chronological Age (Yrs)
NHC
HIC
AGE (years)
HEA
RIN
G L
OSS
(d
egre
e)
81 HI Children 110 NH Children
Pittman & Latto (1998-2008)
Secretly Awesome
Vocabulary Development
AGE (years)
HEA
RIN
G L
OSS
(d
egre
e)
40 HA Children 47 CI Children
Blamey et al (2001) Relationships among speech perception, production, language, hearing loss, and age in children with impaired hearing, JSLRH, 44, 264-285.
Secretly Awesome
Vocabulary Knowledge - College Students
106
82
0
20
40
60
80
100
120
NH HL
PP
VT
Stan
dar
d S
core
7.7
15.5
0
5
10
15
20
25
30
NH HL
PP
VT
Ove
rest
imat
e (1
20
item
s)
Vocabulary Knowledge
Overestimate of Vocabulary
Knowledge
Sarchet et al (2014), Vocabulary knowledge of deaf and hearing postsecondary students, J Postsecond Educ Disabil, 27(2), 161-178.
93 Hearing loss97 Normal hearing
AGE (years)
HEA
RIN
G L
OSS
(d
egre
e)
What does it take to learn a new word?
To learn a new word a child needs to be able to:
1) Perceive speech
2) Detect that a word is new (unknown)
3) Learn what the new word means
4) Remember the new word
Auditory Lexical Decision Task
“Swim”Repeat Categorize
Swim Real
Swim Not Real
Srim Real
Srim Not Real
Whim Real
Whim Not Real
pedamp1.asu.edu/presentations
Repeat Categorize
Glat Not Real
Glat Real
Glad Not Real
Glad Real
Grat Not Real
Grat Real
“Glat”
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Leve
l (d
B H
L)
Frequency (kHz)
UNAIDED
AIDED
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
Wid
eban
d (
Porp
. Co
rrec
t)
Narrowband (Prop. Correct)
Wideband
NLFC
Amplification Bandwidth (Wide vs Narrow)
Pittman, Stewart, Odgear & Willman (2017) Detecting and learning new words: The impact of advancing age and hearing loss. American Journal of Audiology.
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Leve
l (d
B H
L)Frequency (kHz)
UNAIDED
AIDED OFF
AIDED ON
Digital Noise Reduction (On vs Off)
Pittman, Stewart, Willman & Odgear (2017) Word recognition and learning: Effects of hearing loss and amplification feature, Trends in Hearing.
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Leve
l (d
B H
L)
Frequency (kHz)
BINAURAL FF UNAIDEDBINAURAL FF OFFBINAURAL FF ON
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
DN
R O
n (
Pro
p. C
orr
ect)
DNR Off (Prop. Correct)
Bone Conduction (Softband vs Direct)
20
40
60
80
100
120
0.125 0.25 0.5 1 2 4 8
Forc
e (µ
N)
SoftbandDirect
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
In-s
itu
Th
resh
old
s (d
B H
L)
Frequency (kHz)
Softband
Direct
Pittman (in progress)
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
Dir
ect
Co
up
ling
(Pro
p C
orr
ect)
Softband Coupling (Prop Correct)
Non-Word Detection 2.0
# of
nonsense
words
Example phrase
0 Clocks tick on time.
1 Birds rike long worms
2 Dats catch slow bice.
3 -
4 -
0 1 2 42 31 NEXT
Amplification (Unaided vs Aided)
Pittman & Daliri (in progress)
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
Aid
ed (
Pro
p. C
orr
ect)
Unaided (Prop. Correct)
RealNonsense
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Hea
rin
g Le
vel (
dB
HL)
Frequency (kHz)
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
Dir
ect
Co
up
ling
(Pro
p. C
orr
ect)
Softband Coupling (Prop. Correct)
Real
Nonsense
Bone Conduction (Softband vs Direct)
Pittman (in progress)
Rapid Word Learning
0
10
20
30
40
50
60
70
80
90
100
5 25 45 65 85 105 125 145
PER
FOR
MA
NC
E (%
Co
rrec
t)
TRIALS
𝑃𝑐 = 1 − 0.80𝑒−𝑛/𝑐
Learning Speed:3 = 1 trial (perfect learning)2 = 10 trials1 = 100 trials0 = 1000 trials (no learning)
Rapid Word Learning
115 correct/150 trials
=77%
High-Frequency AmplificationNLFC
WB
Pittman, Stewart, Odgear & Willman (2017) Detecting and learning new words: The impact of advancing age and hearing loss. American Journal of Audiology.
0
1
2
3
0 1 2 3
Wid
eb
and
(le
arn
ing
spee
d)
Narrowband (learning speed)
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Leve
l (d
B H
L)
Frequency (kHz)
UNAIDED
AIDED-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Leve
l (d
B H
L)Frequency (kHz)
UNAIDED
AIDED OFF
AIDED ON
Digital Noise Reduction (on vs off)
0
1
2
3
0 1 2 3
DN
R O
n (
Lear
nin
g Sp
eed
)
DNR Off (Learning Speed)
-20
0
20
40
60
80
100
120
0.25 0.5 1 2 4 8
Leve
l (d
B H
L)
Frequency (kHz)
BINAURAL FF UNAIDEDBINAURAL FF OFFBINAURAL FF ON
Pittman, Stewart, Willman & Odgear (2017) Word recognition and learning: Effects of hearing loss and amplification feature, Trends in Hearing.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
0.0 0.5 1.0 1.5 2.0 2.5 3.0
Dir
ect
Co
up
ling
(lea
rnin
g sp
eed
)
Softband Coupling (learning speed)
Bone Conduction (direct vs softband)
pedamp1.asu.edu/presentationsPittman (in progress)
.59
.66
0.0
0.2
0.4
0.6
0.8
1.0
.71
.84
0.0
0.2
0.4
0.6
0.8
1.0
.73
.87
0.0
0.2
0.4
0.6
0.8
1.0NB
WB
.89
1.79
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Group Results – Amplification Bandwidth
NWD 1.0 WORD LEARNINGLEXICAL DECISIONWORD RECOGNITION
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
LEA
RN
ING
SP
EED
(LO
G N
/10
00
)
Pittman, Stewart, Willman & Odgear (2017) Word recognition and learning: Effects of hearing loss and amplification feature, Trends in Hearing.
.46 .46
0.0
0.2
0.4
0.6
0.8
1.0
.48 .47
0.0
0.2
0.4
0.6
0.8
1.0
.54 .55
0.0
0.2
0.4
0.6
0.8
1.0DNR OFFDNR ON
.46 .46
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Group Results – Digital Noise Reduction
NWD 1.0 WORD LEARNINGLEXICAL DECISIONWORD RECOGNITION
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
LEA
RN
ING
SP
EED
(LO
G N
/10
00
)
Pittman, Stewart, Willman & Odgear (2017) Word recognition and learning: Effects of hearing loss and amplification feature, Trends in Hearing.
Group Results – Bone Conduction
0.74 0.76
0.0
0.2
0.4
0.6
0.8
1.0
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)
SoftbandDirect
0.61
0.71
0.0
0.2
0.4
0.6
0.8
1.0
PER
FOR
MA
NC
E (P
RO
P. C
OR
REC
T)1.18
1.44
0.0
0.5
1.0
1.5
2.0
SEN
SITI
VIT
Y (D
-PR
IME)
0.84
1.19
0.0
0.5
1.0
1.5
2.0
2.5
3.0
LEA
RN
ING
SP
EED
(LO
G N
/10
00
)
NWD 2.0 WORD LEARNINGLEXICAL DECISIONWORD RECOGNITION
Pittman (in progress)
Are the new words remembered?Retention Posttest
Name Name Name
Learning
Pittman, Wright, Latto, Wright (in process)
Are the new words remembered?
0
20
40
60
80
100
50 100 150 200
Perf
orm
ance
(%
Co
rrec
t)
Trials
TrainingRetention
0
20
40
60
80
100
50 100 150 200
Perf
orm
ance
(%
Co
rrec
t)
Trials
NORMAL HEARING
HEARING LOSS
Pittman, Wright, Latto, Wright (in process)
If given enough trials, children with hearing loss can learn as quickly as children with normal hearing but they need more training than children with normal hearing to remember what they’ve learned.
Catching up
Vocabulary Size
The average undergraduate student knows between 15,000 and 200,000 words (D’Anna et al, 1991).
Oxford Dictionary of American English:
1000+ new entries each year
1. new words
2. new definitions to existing words
D’Anna, Zechmeister, and Hall (1991) Toward a meaningful definition of vocabulary size. Journal of Reading Behavior 23.1: 109–22.
Let’s do a little math…
Children:
50,000 word vocabulary
learned over 18 years (3 to 22 years)
= 7 new words everyday
Adults:
1,000 new words per year
= 3 new words every day
Vocabulary Knowledge - Adults
Older adults outperform younger adults on standardized vocabulary tests (Verhaeghen, 2003).
Flynn Effect: Scores increase with age due to a cohort effect that favors the earlier born (Flynn, 1987).
Verhaeghen (2003) Aging and Vocabulary Scores: A Meta- Analysis. Psychology and Aging, 18(2), 332–339.Flynn (1987) Massive IQ gains in 14 nations: What IQ tests really measure. Psychological Bulletin, 101, 171–191.
VocabTest
1960 1970 1980 1990 2000 2010 2020
70 yrs20 yrs
20-50
Word Type # Example
Old Words 15 Aghast: Filled with horror or shock
Old words with a new definition
15Ship: The desire of a fan for two fictional characters to be in a romantic relationship
New words 15Geotag: An electronic tag that assigns a geographical location to a photograph
Nonsense words 5 Desill
Vocabulary Knowledge - Adults
Pittman, Stahl & Marzan (in process)
Vocabulary Knowledge - Adults
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Overall Old Words New Words Nonsense Words
Perf
orm
ance
20-30 yrs
40-50 yrs
60-70 yrs
n=48
n=50
n=16
Pittman, Stahl & Marzan (in process)
Vocabulary Knowledge - Adults
21 Adults 19-88 years
Pittman, Stahl & Marzan (in process)
Old Words: r = -.17, p=.51Partial correlations controlling for age
New Words: r= -.83, p<.001*Partial correlations controlling for age
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0 10 20 30 40 50 60 70 80 90 100
Perf
orm
ance
(P
rop
. Co
rrec
t)
Degree of Hearing Loss (4FPTA, dB HL)
Old Words
New Words
What have we learned today?
We’ve learned that…Perceiving words we already know is easy,
but learning new words is more challenging.
Learning new words is directly related to:
1) the quality of the auditory signal
2) the opportunities to learning
When we optimize amplification for children (and adults), we optimize their opportunities to learn.
pedamp1.asu.edu/presentations
pedamp.asu.edu/presentations
Thank you!