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Unilateral hearing loss (UHL) is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties. This indicates that the majority of people today who are fit monaurally with hearing aids are those with unilateral hearing loss (UHL).  UHL is defined as a loss in one ear of any degree (mild to profound) regardless of the type of hearing loss. Recent research indicates school-aged children with UHL demonstrate worse oral language scores (worse language comprehension, oral expression, and oral composite) compared with siblings and normal-hearing age peers.5 Academically, children with UHL have been found to perform more poorly than their normal-hearing counterparts.
Although the choice to fit infants with moderate or greater degrees of bilateral hearing loss has become standard practice, the decision of whether to fit amplification to children with UHL is less clear.
With the introduction of universal newborn hearing screening, UHL can be diagnosed within the first 3 months of life.
The treatment of UHL can include sound field systems, FM systems, traditional hearing aids, CROS hearing aids, bone-anchored hearing aids (BAHA), and even a cochlear implant depending on the type, configuration, and degree of hearing loss.
The benefits of hearing aids include increased audibility, minimizing of auditory deprivation, as well as ease of listening in both quiet and noisy listening conditions. Johnstone and her colleagues10 investigated the sound localization acuity of children with mild-to-severe UHL ages 6 to 14 years who wore a hearing aid in the impaired ear. Fitting of hearing aid amplification is indicated for some people with unilateral hearing losses.
Regarding timing, older children and adults with UHL who are identified as candidates should be fit with amplification as soon as possible. Should hearing aids be fit differently for patients with UHL than for those with bilateral hearing losses? It should be noted that current prescriptive methods are specifically studied and designed for people with bilateral hearing loss.
When doing the initial fitting, be aware that some software will default to a monaural fitting prescription when only one hearing aid is connected if the fitting rule incorporates a binaural correction.
As mentioned, the literature on fitting of asymmetric hearing loss can inform how to fit UHL. One technique12 to achieve the goal of binaural fusion or balance for fitting an asymmetric hearing loss can easily be applied to fitting UHL. Whether hearing aids should be fit differently for those with UHL also extends beyond the gain-frequency response prescription to features of the hearing aids. Children’s limited experience with receptive speech and the importance of overhearing will limit the use of directional microphones.
One important consideration when using wireless accessories is that the fitting should be considered open regardless of how the impaired ear is fit. Frequency lowering (frequency compression, frequency translation, or frequency transposition) algorithms are another common feature in hearing aids today. UHL is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties.
Asymmetric and unilateral hearing losses in children have traditionally been underappreciated, but health care practitioners are now beginning to understand their effect on development and the underlying pathophysiologic mechanisms. This work was supported by a T32 Training Grant #T32DC000022 from the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (NIH) and the St. ReferencesAgterberg MJ, Frenzel H, Wollenberg B, Somers T, Cremers CW, Snik AF (2014) Amplification options in unilateral aural atresia: an active middle ear implant or a bone conduction device? Bamiou DE, Savy L, O’Mahoney C, Phelps P, Sirimanna T (1999) Unilateral sensorineural hearing loss and its aetiology in childhood: the contribution of computerised tomography in aetiological diagnosis and management.
PubMedBuchman CA, Roush PA, Teagle HF, Brown CJ, Zdanski CJ, Grose JH (2006) Auditory neuropathy characteristics in children with cochlear nerve deficiency.
PubMedJiang ZD, Liu XY, Wu YY, Zheng MS, Liu HC (1990) Long-term impairments of brain and auditory functions of children recovered from purulent meningitis. Department of Otolaryngology - Head & Neck Surgery, Washington University School of Medicine, St. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. The terms deaf or hard of hearing cover a wide range of conditions and all affect a child’s listening ability and interfere with their language, social and educational development.
First, below are facts to stimulate your thinking in order to begin by asking the right questions. According to The Alexander Graham Academy for Listening and Spoken Language,  “Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. The AG Bell Academy governs the certification of Certified Auditory-Verbal Therapists (LSLSCert.
If you have the opportunity to see a child who has graduated from AVT or an auditory-oral preschool first and foremost take advantage of theparents’ knowledge. Classrooms are auditory – verbal environments where LISTENING serves as the basis for learning.
There are many specific and purposeful auditory strategies and techniques used to teach a child who is deaf or hard of hearing to learn spoken language through listening. In summary, I have included numerous references, important videos, printable handouts and a wealth of resource materials. This first step is to view the TED Talks video, Establishing a Sound Foundation for Children who are Deaf or Hard of Hearing. Next, watch a series of short videos of my friend and mentor, Carol Flexer, PhD, CCC-A, LSLS Cert. Investigate the Listening and Spoken Language Knowledge Center a vast site for children and adults with hearing loss, their families and the professionals who support them. So if you’re ready to dig in, order your own copy of  101 FAQs about Auditory-Verbal Practice. ASL is a beautiful language and doesnt put deaf children at risks for language delays or deficients like oralism does.
If you would like to know what your child or adult loved one is experiencing with their hearing loss, the first step is to understand more about their hearing loss. The audiogram below contains drawings depicting typical sounds and where they fall on the audiogram.  Jet planes, for instance, are loud, high decibel, high frequency, sounds while wind rustling leaves is a much lower decibel sound.
Show your friends and family what sounds you have difficulty distinguishing between and hearing on the below audiogram with the speech banana.  This can help them learn to say certain sounds a little louder, or speak into your better hearing ear or to speak directly in front of you so that you can help determine what they are saying.
This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you.
1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Effects of early abnormal auditory experience and later recovery have been reported in several animal studies. Congenital conductive hearing loss may occur for reasons of atresia or middle ear anomalies such as a fused malleus and incus, or fixation of the stapes.
In the current case study, we investigated the effects of long-term congenital, unilateral mixed (conductive and sensorineural) hearing loss on sound localization, speech understanding, and cortical organization, both before and after the conductive component of the hearing loss was corrected in adulthood. Written informed consent was obtained from the participant in accordance with the Declaration of Helsinki and guidelines approved by the Human Research Protection Office at Washington University School of Medicine (WUSM). The participant (P1) was a 41 year old female who had a history of unilateral hearing loss in the right ear that had been present since early childhood (probably since birth). Pre-operative, high resolution CT scanning revealed a slightly thickened stapes footplate with no other abnormalities suggestive of otosclerosis. All testing occurred in double-walled sound booths with the participant comfortably seated. An adaptive speech reception threshold (SRT) psychoacoustic task resulted in speech thresholds for quiet and nine competing noise conditions (modified from the task described in Litovsky (2005) and Johnstone and Litovsky (2006)). A psychoacoustic measure determined the random spectrogram sound (RSS) that was most different from two others during each trial.
Previously described protocols (Burton et al., 2012, 2013) were used to perform functional magnetic resonance imaging (fMRI), preprocess the images, and analyze blood oxygen level-dependent (BOLD) responses to auditory stimulation of the unaffected left ear.
The distribution of volume-based F-Zstats from each imaging session was superimposed on coronal slices through the patient’s brain.
Figure 3 displays results for R-Space sentence understanding in the presence of restaurant noise. Vivienne has been working on the Outcomes project since late 2007, after graduating from the University of Sydney with a Bachelor of Applied Science in Speech Pathology and spending some time working as a speech pathologist in both the public and private sectors. After graduating from the University of Newcastle with a Bachelor of Speech Pathology, Jessica has worked in both the community and clinical setting providing both assessments and intervention to children with speech, language, fluency, voice and swallowing difficulties. Vicky joined the LOCHI Study in early 2009 after completing her PhD in Audiology from the University of Hong Kong. Jess joined the team in 2009 as a research assistant after working for a few years with children and young adults with mental disabilities.
Since graduating from the University of Sydney, Miriam has worked as a Speech Pathologist in schools in both NSW and QLD, as well as a busy Private Practice on Sydneya€™s North Shore.
Research shows sound localization test scores were significantly poorer for the children with UHL than for the children with normal hearing.
In a study of 60 children with UHL, Bess and Tharpe6 found that 35% of the children had repeated at least one grade in school, and an additional 13.3% required resource assistance, such as academic tutoring. It has been shown that fitting of aids soon after identification can minimize language delay; however, there can be a delay of up to 7 months in provision of amplification for children with mild and UHL.
In this article, we will only discuss the fitting of conventional hearing aid amplification. Their results showed that a hearing aid can provide bilateral localization benefit to some children with UHL. The decision to fit a patient with unilateral hearing loss should be made on an individual basis, taking into consideration the person’s or family’s preferences, as well as audiologic, developmental, educational, and communication needs.
Those with moderately severe or better UHL are likely to accept the use of a hearing aid, whereas those with a severe or profound UHL may not comply with hearing aid usage at all. For infants, there is still debate whether they should be fit before or after 18 months of age.
Although the prescription may provide targets for a monaural versus binaural fitting, it might not specifically address the needs of people with UHL.
NAL-NL2 is an example of a prescription that provides binaural correction for both pediatric and adult patients, while DSL 5.0 only has a binaural correction for adults. Directional microphones can be fitted according to the patient’s communication needs for adults with UHL.
When a directional microphone is used, it is recommended to keep it in the automatic mode.  There is some evidence that directional microphones in the automatic mode will switch appropriately between a directional and omnidirectional response for the given environment approximately 90% of the time. But there is only limited literature about hearing aid fitting for patients with UHL; some of the ideas have to borrow from asymmetry hearing loss fitting.
Fitting of a hearing aid should be individually based and using your own expertise, taking consideration of patient age, degree of hearing loss, speech development, communication needs, and other morbidities, etc. Monaural hearing aid fitting considerations for Patients with unilateral hearing loss: Who should receive unilateral fittings, and how should you fit them? Hearing Review.
The common wisdom among medical and educational professionals has been that at least one normal-hearing or near-normal-hearing ear was sufficient for typical speech and language development in children.
American Academy Otolaryngology-Head Neck Surgery, Washington, DCAmerican Speech-Language-Hearing Association (2014) Hearing loss. I hope it’s a great starting place if you’re working with hearing impaired students!


The number of children in neighborhood preschools and auditory-oral private schools is ever increasing.
Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Students who use hearing aids may not be able to hear all of the sounds of speech even when it is quiet and the speaker is close by.
This will enable you to further investigate opportunities for supporting children with hearing loss and their families. AVT, as she teaches on auditory brain development, acoustic accessibility, the listening environment, signal to noise ratio and more in her engaging videos. Anderson PhD, an audiologist has a wealth of resources including printable handouts regarding the relationship of types and ranges of hearing loss and the impact on listening and learning, social needs, and the potential school accommodations and therapy needs. It is an excellent resource edited by Warren Estabrooks, the President and CEO of WE Listen International. My entire caseload is deaf and hard-of-hearing students, and I know from personal experience that it is very difficult to find and adapt things specifically for this population. A child may be able to hear certain low frequency sounds such as [m] but not hear higher frequency sounds such as [s] and [sh] even with the use of hearing aids.  Missing those sounds may change their understanding of what is being said. Through this site and linkages to other sites, we provide general information for educational purposes only.
This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience.
Imbalanced input also degrades time-intensity cues for sound localization and signal segregation for listening in noise.
This occurs in cases of unilateral sensorineural hearing loss, where there is sensory (inner ear) or neural dysfunction, as well as losses in the conductive pathway between the outer and inner ear. For example, UCHL created by plugging one ear in young owls initially altered localization abilities but abilities then recovered, that is, the owls made use of abnormal cues to accurately localize (Knudsen et al., 1984a,b).
Degree of hearing loss and the presence or absence of other inner ear deficits varies with the abnormality, but can result in 60 dB of hearing loss from the conductive aspect alone.
Measures included interaural temporal difference limens, MLDs, sound localization and speech recognition in noise. Family history included a father and paternal grandmother with mixed unilateral hearing loss.
The participant underwent a laser stapedotomy procedure with prosthetic reconstruction completed under general anesthesia through an aural speculum.
All test stimuli were from recordings and individually calibrated for the presentation equipment. SRT determinations were for test spondees (two-syllable words with equal stress on both syllables) spoken by a male talker and always presented from a loudspeaker facing the front of the seated participant. BOLD responses to RSS stimuli of 2 s duration were recorded at three times: pre-surgery and at 3 and 9 months post-surgery. Additionally, BOLD response time courses were extracted from regions of interest for peak F-Zstats identified with an automated search (Kerr et al., 2004). For each plot, the location of the loudspeaker source (in degrees azimuth) is indicated along the x-axis and of the reported loudspeaker along the y-axis.
Ching, PhD is a senior research scientist and head of the Rehabilitation Procedures research at the National acoustic laboratories in Australia. More recently Vivienne has completed a Masters degree in Epidemiology with the University of Queensland in 2012, bringing invaluable skills and knowledge to the project. Jessica has also worked in a hearing clinic providing speech and language intervention to children with hearing impairments and auditory processing difficulties. Vicky has over 10 years clinical, training and research experience in the area of hearing assessment and rehabilitation for infants and children. She is tireless in her dedication to her field and has a great passion for the children and families who come under her care. She brings her experience working with children of all ages in the areas of speech, language, fluency, voice and swallowing to the team, as well as her passion for working with children with hearing difficulties. In the ensuing years, as the benefits of binaural hearing aid fittings became apparent, the proportion of monaural-to-binaural fittings did a dramatic flip-flop. Localization acuity in younger children with UHL was significantly improved, but not in the group of older children; time of intervention is also a main factor affecting the localization benefit.
On the one hand, it is unknown what degree of UHL may result in auditory deprivation and what is the critical time to provide amplification thereby avoiding these effects.
That is, we do not yet know if people with UHL prefer the gain generated by a prescriptive method designed for monaural fitting of a bilateral hearing loss.7 But we can get some inspiration from fitting experiences with asymmetrical hearing loss.
While a program button to access multiple listening programs may be of little relevance for patients with UHL, a volume control is a must.
WDRC will automatically adjust the gain of the hearing aid based on the input sound level to ensure natural perception of loudness. For children, the use of directional microphone may be beneficial in some listening situations, such as when the target signal is located in front of the listener; however, decreased performance with directional response has been noted when the target signal was located to the side or behind the listener. Such hearing aids can receive an audio signal from a remote location to improve signal-to-noise ratio (SNR) and can be of particular benefit when listening in noisy environments.
The time of arrival of the streamed wireless signal to the impaired ear should not be delayed too much relative to the good ear receiving the signal acoustically to avoid disturbing perceptual effects.
Noise reduction has not been found to improve or degrade speech understanding in adults or school-aged children, but it can improve comfort and ease-of-listening in realistic listening situations. Since the good ear will receive undistorted normal sound, the frequency lowered sound may interfere with binaural processing.
The role of aided ear is to provide more useful information to help understand speech and for binaural processing.
The relevance of other treatment options than conventional hearing aids, such as FM, CROS, BAHA, and a cochlear implant, also should be considered and communicated to the patient.
Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. An evidence-based systematic review of amplitude compression in hearing aids for school-age children with hearing loss. Fewer wires, less complexity, and more connections: The new challenge for wireless hearing instruments.
The objective of this review is to illustrate, to the non-otolaryngologist, the consequences of asymmetric and unilateral hearing loss in children on developmental and educational outcomes.
AVEd).The LSLS certification is awarded to qualified professionals who have met rigorous academic, professional, post-graduate education and mentoring requirements, and have passed a certification exam. In the reference section, there are links to simulations of hearing loss and listening with technology that is insightful.
This visual simulation is similar to the listening ability of a child with well-fit hearing aids. A hearing loss is invisible and therefore it is easy to forget the effort required to attend, learn and participate. The book takes the reader on a journey through current theory, practice, and evidence-based outcomes. I learned ASL (American Sign Language)at 25 years old and felt connected with people for the first time in my life. It is especially difficult to find resources for children who are implanted late who need to start from the very beginning to learn speech and listening. The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. In animals, unilateral conductive hearing loss (UCHL) results in structural and functional changes within the auditory system.
Self-assessment questionnaires that probe hearing in different listening environments indicated numerous hearing difficulties in those with congenital UCHL (Priwin et al., 2007).
After the earplug was removed, these owls again made localization errors but after some weeks they regained accuracy. However, in a later longitudinal study of adults with otosclerosis, MLDs returned to normal in many participants when tested a year after hearing restoration (Hall and Grose, 1993).
Post-surgery binaural improvements were significant for some individuals and some tasks but not all; sound localization and speech recognition continued to be difficult especially when noise was towards the NH ear and the restored ear was relied upon for speech understanding.
P1’s father had successful stapes surgery in adulthood as a treatment for otosclerosis induced hearing loss.
This procedure is designed to restore mobility to the middle ear bones for improved sound conduction. All loudspeakers presented a recording of diffuse restaurant noise (60 dB SPL), replicating a challenging real-life listening situation.
Spectral RSS differed by dividing the bandwidth into 3–16 spectral bands and changing between bands at a fixed temporal rate of 3 Hz. The Speech domain probes speech recognition in a variety of listening environments and a range of talker visibility.
Presentation times for RSS stimuli varied during 9-s silent intervals in 11-s volume acquisitions, which enabled capture of BOLD at different stimulus delays with respect to the echo-planar images (EPI) in this interrupted single event design (Belin et al., 1999). Note that the 9-month results were equivalent.) As expected, thresholds for the NH or left ear (blue symbols) were unchanged compared to pre-surgical results. Means and standard deviations of reported loudspeakers are plotted for each source loudspeaker location for pre-surgery and post-surgery test intervals of 3 and 9 months, respectively in Panels A to C. Her research interest and experience encompass many aspects of hearing rehabilitation for children and adults with hearing loss: amplification requirements, speech intelligibility, psychoacoustic abilities, evaluation methods for children, bimodal hearing and bilateral cochlear implantation. Vivienne has now moved into a dual role as a project coordinator and research speech pathologist for the project. She has co-authored more than 15 articles published in academic journals, and was awarded several prizes from a variety of international conferences and academic institutes. Since joining the LOCHI team in 2008, Sanna has become an invaluable source of experience, insight and smiles.
She is a current member of Speech Pathology Australia and participates in the continuing professional development program. The children with UHL also had significantly poorer speech-recognition scores than their normal-hearing peers. Children who were fit earlier showed bilateral benefit, whereas children who were fit later showed bilateral interference.
Thus, any binaural correction should be used even though only one hearing aid is being fit to compensate for binaural summation effects. Then, ask the patient about where they perceive your voice to be coming from when you are sitting in front of him or her. This is because it won’t be known how the poor ear with amplification will interact with the good ear in real-world situations.
An example of a wireless accessory that could be used for this purpose is a companion microphone that can be held or worn by a conversational partner or speaker-of-interest. When the poor ear has a severe hearing loss, the aided sound can reach the brain, but it may not be helpful. Unilateral hearing loss is associated with worse speech-language scores in children: a case-control study.


Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Typically, LSLS certified practitioners are licensed audiologists, speech-language pathologists, or educators of the deaf who have the required background, training and experience in listening and spoken language theory and practice with children with hearing loss and their families.
Become familiar with variables that effect hearing such as the impact of noise, distance, room acoustics and equipment malfunctions and ways to manage them. The small ?font size represents that sound is perceived more quietly than it is for typically hearing? children. Children with language delays or additional learning issues make this even more challenging.
White explains the differences in raising children with hearing loss today versus 35 years ago and the key factors for successful language development. It offers knowledge, guidance, encouragement and hope for future generations of children who are deaf or hard of hearing, their families and professionals.  Lynn is an Audiologist, is a LSLS Cert AVT who has worked with individuals with hearing loss and their families for over 30 years.
We investigated effects of long-term congenital unilateral hearing loss on localization, speech understanding, and cortical organization following hearing recovery. For example, on the UCHL side in rats, the size of neurons in the anteroventral cochlear nucleus was smaller (Coleman and O’Connor, 1979) and binaural interactions were absent in the inferior colliculus (Silverman and Clopton, 1977). However, localization performance did not recover when ear plugging occurred in older owls or even in younger owls when the plug remained in place beyond a few weeks. Otosclerosis is typically diagnosed in young to middle adulthood and the hearing loss is often progressive in nature (and primarily conductive), thus these individuals had several years of normal hearing (NH) prior to hearing loss onset. When left untreated into adulthood, individuals will have extended periods of auditory deprivation. Abnormal auditory experience in early life may affect later binaural abilities; however, the nature and impact of these interactions are not entirely clear. P1 and her family had believed P1’s hearing loss to be sensorineural and non-correctable. Air-conduction thresholds via TDH headphones (Panel A) or insert earphones (Panel B) are indicated with blue Xs for the left ear and red triangles or circles for the right ear. The participant sat approximately three feet in front of the center loudspeaker, was unaware that five loudspeakers were inactive (#2, 4, 8, 12, 14), and was instructed to face the center loudspeaker between each presentation but was allowed head turns during each carrier-word presentation.
Two 20 sentence lists were administered and an average signal-to-noise ratio (SNR) for 50% accuracy (SNR-50) obtained. There were three noise types: multi-talker babble (MTB) and two types of single-talker noise (a female talker and a male talker each presenting Harvard IEEE sentences). Temporal RSS differed by changing between three spectral bands at temporal rates between 8 and 30 Hz. Subsequent assembly of BOLD amplitudes relative to baseline (% change in response) at stimulus delays from 2 to 9 s prior to the EPI reconstructed an average BOLD response time course. Thus, the analyses evaluated activity in core primary auditory (Te1), planum temporale (Te2), and planum polare (Te3). The red line connects post-surgical air-conduction thresholds (obtained with insert earphones having approximately 75–90 dB interaural attenuation).
Correct identification of all presentations results in a straight diagonal line from the lower left- to the upper right corner. The y-axis shows the possible reported response loudspeaker locations in degrees azimuth that range from −70 degrees toward the NH ear side at the bottom of the axis to +70 degrees toward the hearing-impaired ear side at the top of the axis.
Pre-surgery, P1 had 50% accuracy for sentences presented 3.5 dB softer than the surrounding restaurant noise (60 dB SPL). Her current research interests include amplification for children, electrophysiology, effective screening techniques in neonatal hearing screening. And, without hearing aid amplification, localization performance in children with UHL rarely equals that of peers. Increase or decrease gain accordingly until the patient reports hearing your voice at the front and center of the head. The patient should have the opportunity to make volume adjustments to match the good ear.11 For young children, the volume control may need to be deactivated for safety concerns.
The speaker’s voice will be picked up by the microphone and transmitted wirelessly to the hearing aid. An evidence-based systematic review of directional microphones and digital noise reduction hearing aids in school-age children with hearing loss.
Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices.
Learn about the child’s listening and learning abilities, social needs, and the IEP accommodations.
She has a private practice specializing in AVT, post cochlear implant rehabilitation for children and adults and therapy for individuals with auditory processing disorder. Hearing in the congenitally affected ear of a 41 year old female improved significantly after stapedotomy and reconstruction. Likewise in cats, UCHL reduced the inhibition from the ipsilateral ear on neurons in the inferior colliculus when the contralateral ear was deprived of sound (Moore and Irvine, 1981). Thus, the ability to recover was affected by the age at which UCHL occurred as well as the age at which hearing was restored. A hearing aid was fitted around age 5 but discontinued after a brief trial due to lack of benefit. Circles indicate unmasked right ear thresholds and triangles indicate thresholds obtained with masking noise presented to the better hearing left ear.
The malleus and incus were mobile and the stapes firmly fixed in the oval window consistent with a congenitally fixed stapes. Head turns were allowed since it more accurately simulates talker localization in conversational settings. Sentences were presented from the front loudspeaker beginning at a +6 dB SNR and adapted to be easier or more difficult based on the participant’s responses. Spectral RSS had greater complexity with more spectral bands and temporal RSS were more complex with higher temporal rates. In the Qualities domain, respondents indicate sound naturalness, listening effort and the ability to segregate multiple sounds.
Open circles indicate unmasked thresholds and open triangles indicate thresholds obtained with the unaffected ear masked.
Symbols indicate mean responses for each active sound-source location and error bars represent ±1 standard deviation. By 9 months post-surgery, P1 was able to understand sentences at even softer levels (4.9 dB softer than the restaurant noise). She frequently presents invited addresses on aspects of aural rehabilitation, paediatic amplification and cochlear implantation at international conferences.
Auditory-Verbal Therapy must be conducted in adherence to the Principles LSLS of Auditory-Verbal Therapy” (AG Bell Academy, 2012).
Lynn is actively mentoring and consulting with programs that are transitioning from visual to auditory based and is a site for graduate student observations.
Pre-operative hearing threshold levels showed unilateral, mixed, moderately-severe to profound hearing loss. Additionally, UCHL leads to decreased 2-deoxyglucose uptake bilaterally in the higher auditory medial and lateral superior olive nuclei even in silence, indicating decreased neuronal activity (Tucci et al., 2001).
While it is well known that unilateral deprivation of the visual system early in life results in permanent impairment of binocular vision (Hubel and Wiesel, 1970), less is known about the developing auditory system’s ability to recover binaural abilities.
In adulthood, the participant had a comprehensive audiological evaluation that diagnosed the loss as mixed.
Masked bone-conduction thresholds for the right ear are indicated with red left-facing brackets.
A CO2 laser was used to make a stapedotomy in the center of the stapes footplate and a Teflon piston was placed and connected to the incus.
After each presentation, the participant repeated the word and indicated the source speaker number.
A four-alternative forced-choice task, without feedback, determined subsequent presentation levels that continued through four reversals using an adaptive paradigm based on participant responses. Separately for each imaging session, F-tests per voxel evaluated whether the variance of evoked BOLD responses was greater than variance due to baseline noise. Her current research focuses on predicting outcomes of children, including those with unilateral and bilateral hearing loss. Interestingly, in a number of these studies, bilateral conductive hearing loss had little to no effect on neuronal size or binaural interactions, with normal maintenance of contralateral and ipsilateral projections. Undefined in humans is a sensitive period for binaural hearing, where behavior can adapt to abnormal experience and develop accurate abilities, and a critical period, after which the ability to adapt to altered (including restored) hearing is greatly diminished or nonexistent. For localization, a root mean square (RMS) error score was calculated as the mean target-response difference, irrespective of error direction.
Establishment of a reference material for a “Language test for hearing-impaired children”, LATHIC.
Together, these studies suggest that modifications in the balance of afferent activity alter binaural interactions and auditory system structures. The manipulated variable was minimum detectable changes (JND) in spectral or temporal complexity. Measurements were of sound localization with intensity-roved stimuli and speech recognition in various noise conditions. The difference between the air- and bone-conduction thresholds identifies the conductive component of the participant’s hearing loss, that is, the portion of the loss that could potentially be corrected through surgery. Activation magnitudes were determined in core, belt, and parabelt auditory cortex regions via an interrupted single event design.
Hearing levels were normal in the unaffected left ear (blue symbols) resulting in a large hearing asymmetry between ears. Feedback was provided for correct responses and each of four test runs concluded with eight reversals. Hearing improvement following 40 years of congenital unilateral hearing loss resulted in substantially improved sound localization and speech recognition in noise.
With this level of asymmetry and the mixed nature of the hearing loss in the affected ear, audiological masking approaches become more complicated due to potential cross masking effects. Each of the JNDs for spectral and temporal RSS complexity was an average of the last four reversals. One-third octave narrow bands of masking noise (centered at the test frequency) were presented to the unaffected ear to isolate the affected ear during testing.
Contralateral auditory cortex responses were increased after hearing recovery and the extent of activated cortex was bilateral, including a greater portion of the posterior superior temporal plane. Testing was completed with TDH-49 headphones with 40–60 dB of interaural attenuation. Thus, prolonged predominant monaural stimulation did not prevent auditory system changes consequent to restored binaural hearing. Although a 15 dB plateau was achieved at each frequency (increases in masking level at the unaffected ear did not increase the patient’s response level in the affected ear), high levels of masking noise to the unaffected ear could possibly have been detected by the cochlea of the affected ear via bone conduction while attempting to identify accurate air-conduction thresholds of the affected ear. Results support future research of unilateral auditory deprivation effects and plasticity, with consideration for length of deprivation, age at hearing correction and degree and type of hearing loss.




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