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One of the perceived downfalls of living in a largely rural state is the lack of access to needed health and wellness services. There are a variety of resources at your disposal in South Dakota for dealing with the effects of hearing loss in both children and adults. If there is a young person in your family who is experiencing hearing loss, there are educational resources available to you in-state in the form of the South Dakota School for the Deaf. If you’re in the process of determining your needs when it comes to listening, one big step is to see an audiologist and get your hearing tested at a hearing clinic. Remember that you have the opportunity to improve your everyday life through services right here in South Dakota. It is well recognized that hearing is critical to speech and language development, communication, and learning. The earlier hearing loss occurs in a child's life, the more serious the effects on the child's development. It causes delay in the development of receptive and expressive communication skills (speech and language). Children with hearing loss learn concrete words like cat, jump, five, and red more easily than abstract words like before, after, equal to, and jealous. The gap between the vocabulary of children with normal hearing and those with hearing loss widens with age. Children with hearing loss comprehend and produce shorter and simpler sentences than children with normal hearing. Children with hearing loss often cannot hear quiet speech sounds such as "s," "sh," "f," "t," and "k" and therefore do not include them in their speech. Children with hearing loss have difficulty with all areas of academic achievement, especially reading and mathematical concepts. Children with mild to moderate hearing losses, on average, achieve one to four grade levels lower than their peers with normal hearing, unless appropriate management occurs.
Children with severe to profound hearing loss usually achieve skills no higher than the third- or fourth-grade level, unless appropriate educational intervention occurs early. The gap in academic achievement between children with normal hearing and those with hearing loss usually widens as they progress through school. The level of achievement is related to parental involvement and the quantity, quality, and timing of the support services children receive. Children with severe to profound hearing losses often report feeling isolated, without friends, and unhappy in school, particularly when their socialization with other children with hearing loss is limited.
These social problems appear to be more frequent in children with a mild or moderate hearing losses than in those with a severe to profound loss.
To find an audiologist in your area, contact the American Speech-Language-Hearing Association (ASHA) by calling 800-638-8255 or use the Find a Professional service on ASHA's website.
You must have JavaScript enabled in your browser to utilize the functionality of this website. Our product comparison charts can help you determine the features you want and need for alarm clocks, telephones, TV amplifiers and more! This book was written for parents, siblings and extended family members who want a better understanding of the impact hearing loss can have in their young loved one. Hearing loss in children can have more devastating effects than in adults because it can impair the ability to learn vocabulary, grammar, word order, idiomatic expressions and other aspects of verbal communication.
Readers can even prevent some of the pitfalls common among families new to a child with hearing loss. Come out and join us Saturday, September 27 at Lake Calhoun in Minneapolis, MN for some fun exercise at HLAA's Walk4Hearing! Key words: age-related hearing loss, aging, auditory temporal processing, aural rehabilitation, hearing aids, hearing disability, presbycusis, reverberant speech, signal processing, speech perception, time-compressed speech.
Abbreviations: DL = difference limen, FCC = Federal Communications Commission, FM = frequency modulation, IOI = interonset interval, SNR = signal-to-noise ratio, SPL = sound pressure level, WPM = words per minute.
This material was based on work supported by the National Institute on Aging, grant R37AG09191. Perhaps the most important consequence of the decline in hearing sensitivity with aging is difficulty understanding speech.
Difficulties arise when elderly listeners must follow conversational speech in adverse listening conditions, including noise and reverberation. SNR = signal-to-noise ratio, R-SPIN = Revised Speech Perception in Noise test, SPL = sound pressure level, SRT = speech-recognition threshold, NU-6 = Northwestern University Test No.
Another variable that has received considerable attention in recent literature is age-related differences in the masking release afforded by a modulated noise masker compared with a steady-state noise masker.
Time compression is a method to simulate rapid speech rates and is currently accomplished with computer algorithms that sample the spoken message, remove a proportion of quasiperiodic pitch periods in the speech sample, and concatenate the remainder of the acoustic signal. Some research has been directed at techniques that might improve elderly listeners' performance. The observed deficit that elderly people exhibit in understanding fast speech has led to the hypothesis that the ability to process rapid acoustic information may deteriorate with aging [47-48]. One basic question is, Do elderly people have difficulty processing changes in stimulus duration for stimuli presented in isolation and for stimuli embedded in a sequence? The principal treatment for age-related hearing loss at present is with suitable amplification that provides appropriate gain at selective frequencies, compression of high-level signals, and attenuation of background noise through adaptive filtering and directional microphones. Despite the documented benefit of amplification for elderly, hearing-impaired individuals, market trends show that only about 20 percent of this population purchase hearing aids [3]. Recent technological developments provide solutions to many of these seemingly intractable problems. Closed captioning is an assistive technology designed to provide access to television and other video broadcasts for persons with hearing disabilities.
Cochlear implants are another treatment option and have been shown to be quite beneficial for elderly people (>60 years) with severe and profound acquired hearing losses. Future technological developments in digital hearing aids are likely to employ signal processing strategies that alter the speech signal in some manner to make it more intelligible for elderly people. Hearing loss among elderly citizens is a prevalent problem that affects their ability to understand speech in quiet, noise, and reverberation. Peter Fitzgibbons' reviewing of an earlier draft of this manuscript is gratefully appreciated. Job-induced hearing loss is a big problem in todaya€™s work settings, affecting workers in industry sectors such as manufacturing, construction, mining, transportation, agriculture, and the military. The National Institute for Occupational Safety and Health (NIOSH) has developed the NIOSH Hearing Loss Simulator, a software training and communication tool that demonstrates the effects of noise exposure on a workera€™s hearing without exposing the person to harmful noise levels or toxic materials. At present exposure limits, 1 in 4 people exposed to excessive noise or other toxicants while on the job will develop permanent hearing loss.
Human speech is considered the most complex and important sound most workers need to perceive so this software training and communication tool allows the user to combine speech with common background noises to demonstrate hearing loss. Headquartered in Sioux Falls, the school offers programs in nearby Brandon and Harrisburg as well and provides outreach across the state in cities such as Pierre and Rapid City.
There are a variety of hearing clinics available in South Dakota, including Audiology Specialty Clinic and Stanford Hearing Aids in Sioux Falls and Aberdeen Hearing Clinic in Aberdeen.
One such provider is Beltone, which has locations in Sioux Falls, Rapid City and Spearfish.
In fact, there are resources that provide the delivery of the equipment and sometimes the equipment itself for no charge.
Take advantage of the quality resources at your fingertips, and utilize the talents and time of South Dakota’s able residents. Children with listening difficulties due to hearing loss or auditory processing problems continue to be an underidentified and underserved population. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact.
This leads to misunderstandings and misuse of verb tense, pluralization, nonagreement of subject and verb, and possessives.
This book is a guide on how to address the most important educational issues and processes through the school years, including legal rights and legislation. This book also covers the latest technology available to these children, especially in the classroom, including assistive listening devices, hearing aids and cochlear implants. It focuses on research from the University of Maryland on problems in auditory temporal processing by elderly listeners as assessed in speech perception experiments using temporally altered signals and in psycho-acoustic experiments of duration and rhythm discrimination for simple and complex signals. The estimated prevalence of significant hearing impairment among people over the age of 65 is approximately 40 to 45 percent and among people over the age of 70 exceeds 83 percent [2].
Articulation Index theory predicts that recognition of average conversational speech (60 dB sound pressure level [SPL]) will be reduced among people with age-related hearing loss (presbycusis) as a result of the limited audibility of high-frequency acoustic cues [8]. The research evidence supporting age-related deficits for speech recognition in noise is mixed, however, and appears to depend on a number of stimulus variables, including the audibility of the speech signal, the type of speech signal (words vs.
Reverberation is the prolongation of sound in an enclosed room and is quantified as the time, in seconds, for a signal to decay 60 dB below its steady-state value after termination. The time-compression ratio describes the percentage of reduction in the overall duration of the compressed speech signal relative to the original signal. For example, one aspect of language processing that appears to be preserved with aging is the lexical system and its semantic associations [45].
This method of slowing was detrimental for most listeners when understanding low-context sentences (Figure 7(a)), perhaps because of the added memory load or disruption of natural prosody with this technique.


A comprehensive examination of temporal processing deficits using speech signals is limited because the listener's knowledge of the language has a substantial influence on performance, as noted earlier. A related issue is the extent to which possible age effects interact with loss of hearing sensitivity on these measures.
Overall, middle-aged and elderly men report less hearing disability than women in the same age range [58], although as noted earlier, men generally have poorer hearing sensitivity than women of the same age. The current generation of hearing aids provides acoustic cues across the frequency range for most elderly people with age-related hearing loss and produces significant improvements in speech recognition in quiet, ideal listening environments [61-62]. The reasons for this low rate of hearing aid use are likely to be complex and may vary between those individuals who never inquire about a hearing aid, those who seek to obtain hearing healthcare but do not choose to follow a recommendation to purchase a hearing aid, and those who acquire a hearing aid but do not use it regularly.
Assistive listening devices, including frequency modulation (FM) systems and infrared systems, improve speech understanding in rooms characterized by long reverberation times and poor SNRs. A text display of the audio portion of the program is superimposed on the video at a rate of approximately 141 WPM [72]. Elderly people show better speech-recognition performance in quiet with their cochlear implants than their preimplant performance [74-75].
One promising strategy is to increase the duration of selected segments of the speech signal, as discussed in a previous section (page 15) of this article.
World Health Organization (WHO) The international classification of functioning, disability and health: ICF. Larson VD, Williams DW, Henderson WG, Luethke LE, Beck LB, Noffsinger D, Wilson RH, Dobie RA, Haskell GB, Bratt GW, Shanks JE, Stelmachowicz P, Studebaker GA, Boysen AE, Donahue A, Canalis R, Fausti SA, Rappaport BZ.
Mulrow CD, Aguilar C, Endicott JE, Tuley MR, Velez R, Charlip WS, Rhodes MC, Hill JA, DeNino LA. Approximately 22 million workers are exposed on the job to noise levels that could harm their hearing. The software considers several factors including age, gender, level of exposure, and years of exposure, and then simulates human speech that is degraded to reflect the estimated hearing loss. The guide details the simulatora€™s functions, lists the major objectives that can be addressed with the simulator, and provides training scenarios that can be applied to real-life real-worker situations. Demonstrating degrees of hearing loss under various circumstances helps users better understand how different exposure levels may affect hearing loss.
Scenarios that participants can directly relate to are more meaningful, relevant, and motivational.
The school provides audiology examinations and testing, as well as educational programs and transition assistance. Hearing clinics are meant to test your abilities at all ages and can assist you in finding the right devices to meet your needs. The Telecommunications Equipment Distribution (TED) program through Relay South Dakota does just that if you’re a state resident and have difficulty communicating on the phone because of a hearing or speech impairment. An audiologist, as part of an interdisciplinary team of professionals, will evaluate your child and suggest the most appropriate audiologic intervention program.
It also addresses the profound emotional impact hearing loss can have on a child and how it can affect the entire family dynamic, and what to do about it.
It dispels myths associated with wearing amplified devices and explains how families can give these children the proper tools that will empower them for life. Despite the widespread occurrence of significant hearing loss in the elderly population, only about 20 percent of elderly individuals with significant hearing impairment obtain hearing aids [3].
However, elderly people usually do not experience problems understanding speech in ideal listening conditions that include quiet environments and familiar talkers, as long as the speech level permits audibility of high-frequency information [9]. Age-related changes in monosyllabic word recognition performance when audibility is held constant. Word recognition in continuous and interrupted broadband noise by young normal-hearing, older normal-hearing, and presbyacusic listeners.
Several reports indicate that elderly listeners can benefit from temporal interruptions in noise to improve speech-recognition scores compared with steady-state noise conditions, but the magnitude of the temporal masking release is smaller than that observed in young listeners [13,17-18].
Large rooms with high ceilings and walls composed of glass (windows or mirrors) are characterized by long reverberation times. Thus, a signal that is 60 percent time-compressed has a duration that is 60 percent less than that of the original signal. Studies have shown that elderly listeners with and without hearing impairment are able to take advantage of a few contextual cues in a message to achieve nearly perfect speech-recognition scores, despite challenging listening conditions with noise, altered timing, and an added memory load [42-43].
Nevertheless, providing contextual cues dramatically improved performance for young and elderly listeners in this challenging speech task, as illustrated in Figure 7(b). Researchers have turned to psychoacoustic measures of auditory temporal processing with simple tonal signals that permit better control of the spectral content of the acoustic stimulus and precise manipulation of the duration parameters of interest. Some psychophysical evidence demonstrates that measured thresholds for detecting brief temporal gaps between successive tone or noise bursts are diminished with aging. Garstecki and Erler specifically examined gender differences in self-perceived hearing disability among 301 women and men aged 65 and older [59] to identify possible sensory, physical, and social differences between men and women that could influence the impact of the hearing impairment.
Benefits in speech understanding in noise are reported for elderly people with the use of linear hearing aid circuits featuring output compression [61] and wide dynamic-range-compression hearing aids [62].
Factors reported by elderly people who do not adhere to recommendations to purchase a hearing aid are cost and a relatively low value placed on effective communication [66].
Miniature FM receivers can now be built into a behind-the-ear hearing aid, and with the use of a hand-held transmitter, a personal FM system is available as an option on an individual's own hearing aid, making this technology more portable and easier to use than ever before. The Federal Communications Commission (FCC) has required that all analog television sets with screens 13 inches and larger sold in the United States after 1993 contain the circuitry that decodes and displays closed captioning. In particular, the technique of selective time expansion of consonants has proven to be quite beneficial to young and elderly listeners alike when the original speech stimulus is presented at a fast rate [46]. Multiple sources are thought to contribute to the communication deficits of elderly people, including hearing loss, cognitive decline, and slowed temporal processing. The effects of talker familiarity on spoken word identification in younger and older listeners. Modulation detection, modulation masking, and speech understanding in noise in the elderly. Benefit of modulated maskers for speech recognition by younger and older adults with normal hearing. Effect of reverberation and noise on the intelligibility of sentences in cases of presbycusis. Speed of processing in normal aging: effects of speech rate, linguistic structure, and processing time.
Effects of stimulus and noise rate variability on speech perception by younger and older adults. Imitation of a VOT continuum by native speakers of English and Spanish: evidence for phonetic cate-gory formation. Persistent errors in the perception and production of word-initial English stop consonants by native speakers of Italian.
The perception of English and Spanish vowels by native English and Spanish listeners: a multidimensional scaling analysis. In search of the acoustic correlates of stress: fundamental frequency, amplitude, and duration in the connected utterance of some native and non-native speakers of English. Selected cognitive factors and speech recognition performance among young and elderly listeners. Prevalence of self-perceived auditory problems and their relation to audiometric thresholds in a middle-aged to elderly population. Older adult performance on the communication profile for the hearing impaired: gender difference. Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. Hearing loss, control, and demographic factors influencing hearing aid use among older adults.
Speech recognition of hearing-impaired listeners: predictions from audibility and the limited role of high-frequency amplification. Those results can then be used to demonstrate the tested individual’s actual hearing loss to individuals without hearing loss. There is a variety of other providers throughout the state – just make sure the one you choose is a licensed hearing-aid dispenser or audiologist. They may sound like they are mumbling because of poor stress, poor inflection, or poor rate of speaking. The clinical implications of the research findings are discussed in relation to hearing aid performance and use by elderly people as well as potential signal processing strategies that may prove to be beneficial for this population.
Moreover, about 30 percent of hearing aid owners are dissatisfied with their instruments [4], and approximately 16 percent of hearing aid owners report never using their hearing aids [5].
The Table presents results of recent investigations that examined age-related differences in speech-recognition performance in noise [10-15]. Other reports suggest that the reduction in temporal masking release is due primarily to the presence of hearing loss and not to age [15]. Reverberation has a smoothing effect on the waveform of the signal, thus creating a distortion of the temporal waveform [19]. As shown in Figure 4, elderly listeners with normal hearing and with mild-to-moderate hearing impairment exhibit significantly poorer speech-recognition scores than young listeners with comparable hearing sensitivity across a range of time-compression ratios (30%-60%), at high signal presentation levels in quiet conditions [22,28-30].
All of these senescent changes potentially limit accurate reception of a spoken message in complex listening tasks.


Elderly listeners are generally expected to have difficulty on measures that mimic some temporal aspects of rapid speech. Elderly listeners show gap thresholds that are about twice the magnitude of those reported for young listeners [49-51].
Older people's use of amplification also has been shown to reduce the perceived impact of the hearing loss in daily communication, as measured with the Hearing Handicap Inventory for the Elderly [63-65]. Some of these individuals also have low self-esteem, depression, and a low locus of self-control.
Boothroyd reported that eight elderly listeners with hearing impairment achieved similar phoneme recognition scores in noise with an FM system compared with scores in quiet with amplification provided by a hearing aid [70].
While some reports indicate that elderly people achieve the same speech-recognition scores as younger people with cochlear implants [77], these same reports also indicate that elderly cochlear implant users have a slower learning curve. Processing brief changes in stimulus duration and presentation rate for signals embedded in sequences are notably difficult for elderly people, which suggests that auditory temporal processing deficits may relate to the observed problems in understanding rapid speech and accented English. The real-life scenarios of this software has the potential to raise awareness, increase motivation for hearing loss prevention, and reduce the number of people who suffer from hearing loss. This article will review recent research findings on auditory performance among elderly listeners (those over 65 years) that might help explain the limited use of hearing aids by this population. Nevertheless, the overall findings across studies suggest that elderly listeners with hearing loss are less able to use temporal fluctuations in noise than young listeners with normal hearing-a result that may partially explain the inordinate difficulty elderly listeners experience in daily situations with a background of multiple talkers. Elderly listeners with normal hearing, minimal hearing loss, or significant hearing loss perform poorer than young listeners with comparable hearing sensitivity in reverberation across a range of reverberation times [20-22]. Additionally, age-related deficits for time-compressed speech are larger in noise conditions than in quiet conditions [11,31].
Elderly listeners demonstrate poorer recall of target words at unfavorable SNRs than young listeners and remember fewer words to recall on a memory task in these adverse listening conditions compared with more favorable conditions [42]. Thus, the stimuli of interest are isolated or sequential stimuli that vary primarily in duration or presentation rate. Additional evidence is derived from duration discrimination experiments in which tonal reference stimuli are comparable in duration with monosyllabic words (250 ms). Participants responded to items on the Communication Profile for the Hearing Impaired [60], which samples opinions about the importance of effective communication, the respondent's typical communication environment, communication strategies employed, and personal adjustment to hearing loss.
A recent meta-analysis of 36 consumer surveys of hearing aid satisfaction and benefit showed that 31 percent of hearing aid consumers (average age of 69) report benefit from their hearing aids in noise and 76 percent report overall benefit with their hearing aids [4]. In addition to these factors, denial of the hearing loss, stigma, and low perceived benefit of amplification by some people may contribute to their reticence to seek assistance with a hearing loss. However, these elderly subjects tended to report less subjective benefit from the FM system than young subjects in the investigation.
Closed captioning eliminates the problems in hearing and understanding speech that may be produced by variable talkers, fast talkers, and heavily accented speakers. Other studies indicate that people over the age of 70 with cochlear implants, on average, obtain lower speech-recognition scores than younger people [78].
The device, which features user-selected speech rates, was developed for elderly people who have difficulty processing the rapid speech rates inherent in radio broadcasting. Hearing aids provide benefit for elderly people in hearing and understanding conversational speech in quiet and some noise conditions, and they reduce the communication disability imposed by hearing impairment.
NIOSH recommends that employers and individuals interested in hearing loss education and prevention take the following steps to learn more about the effects of noise exposure. Emerging trends in hearing aid technology and rehabilitative techniques will also be presented that may alleviate some of the auditory difficulties experienced by senior citizens.
Additionally, the specific age, gender, and hearing loss characteristics of the study samples influence observed results.
Figure 3 shows recognition performance of young adult and elderly listeners with normal hearing and mild-to-moderate hearing loss in four reverberation time conditions. The length of the recall task also affects elderly listeners detrimentally when the speech stimuli have few semantic contextual cues, but not when multiple contextual cues exist to aid recognition [43].
Young listeners generally require increments in stimulus duration that are about 15 percent of the reference duration of a single isolated tone for accurate discrimination, whereas elderly listeners require about a 25 percent duration increment [47]. In general, women were more concerned than men with communicating effectively in social situations, perhaps because most women were widowed and relied more on social interactions outside of the family.
Moreover, the results indicate that satisfaction is considerably higher for more technologically advanced instruments. However, a substantial group of elderly people remains who purchase hearing aids but rarely use them.
In another study, 18 elderly veterans with severe hearing loss reported improvement with the use of an FM system for hearing at a distance and for hearing conversations with groups in noise [71].
It also eliminates problems associated with a poor SNR in the broadcast or because of poor acoustics in the viewing room. These observations are not surprising, because cochlear implants convey speech information using high pulse rates of stimulation, and aging appears to be accompanied by limits in processing information presented at a rapid rate. Preliminary reports indicate that elderly listeners show improvement for sentence recognition, but not word recognition, using this device [79].
Nevertheless, most elderly people with hearing loss do not choose to use amplification, because of an array of complex psychological and social factors. The age-related deficit is exacerbated in conditions that combine reverberation and noise [11,20,23]. Compared with young listeners, elderly listeners are also at a disadvantage, on tasks featuring talker variability, including the use of multiple target speakers and multiple speaking rates [44]. The age-related deficit increases substantially when the identical target stimuli are embedded in a sequence of contiguous tones, although young listeners exhibit comparable discrimination of stimuli in sequences and in isolation [52], as shown in Figure 9.
The men were more likely to deny experiencing negative reactions to their hearing loss when compared with women who reported feelings of stress associated with their hearing loss. Specifically, hearing aid users report greater satisfaction with directional and omnidirectional, programmable hearing aids (81% and 72% satisfaction, respectively) than for nonprogrammable hearing aids (58% satisfaction). Consumers report the top reason for not wearing hearing aids is poor benefit, particularly in noise, restaurants, and large groups [5]. Careful counseling and instruction appear to be crucial factors in maximizing the benefit of FM technology for this population. Moreover, a substantial number of elderly people who obtain hearing aids do not use them consistently, undoubtedly because hearing aids do not alleviate the communication difficulties that elderly people experience in many degraded listening situations.
These findings indicate that poor room acoustics that include both noise and reverberation are particularly adverse for communication by elderly people [24].
Thus, increasing the complexity of the target stimulus increases the difficulty of the duration discrimination task for elderly listeners but not for young listeners. Men and women also tended to rely on different communication strategies to accommodate their hearing loss. The rejection of hearing aid use by this group appears to be associated, at least in part, with the inordinate difficulties that elderly listeners experience in the realistic, degraded listening situations described earlier in this article (pages 11-14).
Rear window technology, developed by the National Center for Accessible Media at WGBH in Boston, provides closed captioning through a small Plexiglas screen that can be mounted at any seat in the theater [73].
The research findings suggest that the older person's problems in processing rapid acoustic information and information with disruption in prosody may be important to address in the next generation of signal processing hearing aids. In contrast, data from a large cohort of adults (48-92 years) in the Beaver Dam Epidemiology of Hearing Loss Study show significant age effects in word recognition scores in competing messages for both men and women, but performance is consistently poorer in men than in women at all age groups and hearing loss categories [14]. Effects of hearing loss are not observed consistently on these duration discrimination tasks for clearly audible signals. In particular, the women relied on nonverbal communication strategies, such as preferential seating and paying attention to the speaker's face, to a greater extent than the men.
The current generation of hearing aids, by themselves, will not reduce the deleterious effects of reverberation, rapid speech, or a background of multiple talkers. Although closed captioning was developed initially for use by deaf people, it undoubtedly improves reception of television programs and theater movies for elderly people with hearing loss. Assistive listening devices and new advances in digital signal processing hold great promise to improve speech reception for elderly listeners in some of these difficult communication situations. This preference for nonverbal strategies is less likely to call attention to the individual's hearing loss. Moreover, hearing aids will not reduce the impact of excessive cognitive demands of a particular listening task, which may include a considerable memory load, alternating talkers, and minimal contextual cues.
To date, however, virtually no research has been conducted to verify the benefit and use of closed captioning among elderly hearing-impaired adults. However, extensive counseling is necessary for elderly people to set realistic expectations of the value and use of new technology and ultimately to reap the benefits that new devices may provide. Thus, many of the differences in hearing disability reported by elderly men and women are probably related to differing sociodemographic variables and personality attributes. Hearing aids may also provide limited benefit for individuals with extensive damage to high-frequency regions of the cochlea [67-68] or throughout the cochlea as evidenced by severe-to-profound sensorineural hearing loss [69]. All the reports on hearing disability among elderly people suggest that some aspects of denial of the hearing loss, especially in men, could contribute to the relatively low rate of seeking and acquiring amplification.



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