Boosting Speech Perception for Kids With Hearing Loss Andrea Dunn is researching the functional impact of hearing loss in children and ways to improve speech perception ability. Foundational Questions
Foundational Questions  |   August 01, 2017
Boosting Speech Perception for Kids With Hearing Loss
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Article Information
Hearing & Speech Perception / Hearing Disorders / Foundational Questions
Foundational Questions   |   August 01, 2017
Boosting Speech Perception for Kids With Hearing Loss
The ASHA Leader, August 2017, Vol. 22, online only. doi:10.1044/
The ASHA Leader, August 2017, Vol. 22, online only. doi:10.1044/
Name: Andrea Dunn, AuD, PhD, CCC-A
Position: Assistant Professor, University of North Carolina at Chapel Hill
ASHFoundation Awards:
  • Clinical Research Grant, 2013–2016, “Binaural Hearing in Children With Asymmetric Hearing Loss Using Frequency-Compression Hearing Aids”

  • New Century Scholars Doctoral Scholarship, 2009, “Behavioral and Electrophysiological Measurement of Audiovisual Processing Development”

What is the focus of your research?
Broadly, my clinical and research interests pertain to pediatric audiology and speech perception. The latter of these was the focus of my ASHFoundation-funded research, which evaluated the role of a type of hearing aid technology—called nonlinear frequency compression (NLFC)—on binaural speech perception in children with asymmetric hearing loss. This technology compresses spectral information above a specified start-frequency into a lower frequency region. The goal is to increase high-frequency access, thereby widening the audible bandwidth, which has been shown to improve speech perception in children.
In the study, we measured word recognition in a competing background of two-talker speech in a variety of aided conditions, including hearing aids set with symmetric (matched) and asymmetric (ear-specific) NLFC processing. Binaural effects (head shadow and squelch) were computed, and the magnitude of the effects were compared for symmetric versus asymmetric processing. Study results showed no significant differences in group-average data across conditions for either source of binaural benefit, suggesting that the cross-ear frequency mismatch may not pose a problem for aided binaural hearing.
Although non-significant, an important and novel finding of the work was that prioritizing individual-ear high-frequency audibility with asymmetric NLFC settings did not come at a cost to aided binaural speech perception in children with asymmetric hearing loss. Results showing a lack of interference from cross-ear frequency mismatch are highly relevant to audiologists fitting such technology in children.
How did your award from the ASHFoundation lead to your current work?
The goal of the ASHFoundation project was to evaluate how matched versus asymmetric NLFC programming affected children’s ability to understand speech in a competing background, and ultimately to inform NLFC programming recommendations for maximizing understanding in “noise.” Although results showed no significant group difference, a compelling need remains for further research on factors influencing children’s speech perception in complex environments. This work—along with earlier research with mentors Lori Leibold, PhD, and Emily Buss, PhD, that showed a lack of congruence between parent-rated functional communication skills of children with hearing loss and clinical measures of speech perception—inspired my current work.
Colleagues and I are now developing a pediatric hearing-handicap questionnaire. This short, simple tool will be administered to school-age children with varying degrees of hearing loss to quantify self-perceived functional ability. Another area of my research relates to assistive technology. A LEND (Leadership Education in Neurodevelopmental and Related Disabilities) student and I are developing a survey to assess educational audiologists’ beliefs and observations about students’ use of wireless sound-enhancing assistive technology in North Carolina schools.
What do you hope to demonstrate through your research?
We hope the pediatric hearing-handicap questionnaire can serve as a powerful counseling and validation tool for clinicians. It can offer insight into patient-perceived functional ability and track the impact of an intervention. From a patient-monitoring standpoint, it can be used to signal the need to reconsider or revise technologies, strategies or supports at home or school, initiate cross-provider communication or referral(s), and track changes in perceived handicap over time or following strategic action(s).
The goal of the assistive technology survey is to identify factors underlying recommendations for wireless signal-enhancing devices, barriers to assistive technology use in North Carolina schools, and the relationship between audiologists’ beliefs and practices with regard to use.
The unifying goal across these projects is to improve communication ability for children with hearing loss through ongoing research aimed at quantifying real-world functional ability and understanding the role of factors such as technology, environment and support services that influence communicative success.
Why did you choose this research focus?
Despite my ongoing commitment to research I also identify strongly as a clinician. My research is greatly influenced by practical questions encountered working clinically and the challenges or concerns expressed by patients and families. The overarching goal of my research is to accurately identify the functional impact of hearing loss in children and ways to improve communication ability. Improved speech perception can have a potentially dramatic and widespread impact on other global aspects of functioning and well-being. Improved understanding can lead to enhanced social interactions, self-esteem, quality of life, academic achievement, future job attainment, and even physiological changes (reduced fatigue and stress, for example).
I hope that clinicians and families will benefit from our work and that of other researchers in hearing and speech sciences and related fields. I hope we can arm patients, families and providers with information and tools to better identify patient needs and to promote evidence-based decision-making in clinics, schools, and the home to ultimately advance outcomes for children with hearing loss.
How has ASHFoundation funding affected your professional life?
During the process of completing the ASHFoundation grant, I honed my skills at writing, planning and executing a competitive proposal and research project. It was a tremendous skill-builder and a springboard for competing for future grants and sharing the knowledge gained from the work with others in the field.
While completing the project, I was privileged to draw on the knowledge and expertise of several phenomenal scientists and collaborators—Lori Leibold, Emily Buss and Wesley Grantham. I forged an invaluable network of support which instilled in me a commitment to the ongoing mentorship of students through supervision, committee participation and teaching.
I’m very proud to have been awarded this grant from the ASHFoundation because its represents the continued commitment from within our community of audiologists and speech-language pathologists to improving patient outcomes through research. I look forward to continuing to support ASHFoundation research and to contributing to the field through my clinical and research efforts.
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August 2017
Volume 22, Issue 8