Remote Microphone Hearing Aid Use Improves Classroom Listening, Without Adverse Effects on Spatial Listening and Attention Skills, in Children With Auditory Processing Disorder: A Randomised Controlled Trial

Georgios Stavrinos, Vasiliki Vivian Iliadou, Menelaos Pavlou, Doris-Eva Bamiou, Georgios Stavrinos, Vasiliki Vivian Iliadou, Menelaos Pavlou, Doris-Eva Bamiou

Abstract

Background: Children with Auditory Processing Disorder (APD) often have poor auditory processing skills in the presence of normal peripheral hearing. These children have worse listening-in-noise skills compared to typically developing peers, while other commonly reported symptoms include poor attention and distractibility. One of the management strategies for children with APD is the use of Remote Microphone Hearing Aids (RMHAs), which can help improve the signal-to-noise ratio in the child's ears. The aim of this randomised controlled trial was to examine whether RMHAs improved classroom listening in children with APD, and to further test their effects on children's listening-in-noise and attention skills following a 6-month intervention.

Methods: Twenty-six children diagnosed with APD, aged 7-12, in primary mainstream education, were randomised into the intervention (N = 13) and control group (N = 13). The primary outcome measure was the Listening Inventory for Education - Revised questionnaire, completed by children to assess their listening using RMHAs under several acoustically challenging situations in the classroom. Secondary outcome measures included the Listening in Spatialised Noise - Sentences test, assessing speech-in-noise perception and spatial listening, and the Test of Everyday Attention for Children, assessing different types of attention skills. Tests were conducted in unaided conditions. Mixed analysis of variance was used to analyse the data. The clinical trial was registered at clinicaltrials.gov (unique identifier: NCT02353091).

Results: The questionnaire scores of self-reported listening skills in the classroom significantly improved in the intervention group after 3, MD = 7.31, SE = 2.113, p = 0.014, and after 6 months, M = 5.00, SE = 1.468, p = 0.016. The behavioural measures of listening-in-noise and attention did not significantly change.

Conclusion: Use of RMHAs improves classroom listening, evidenced by the results of the questionnaire analysis, while a 6-month use did not have adverse effects on unaided spatial listening or attention skills.

Keywords: attention; audiology; auditory processing disorder; randomised controlled trial; remote microphone hearing aids; spatial listening.

Copyright © 2020 Stavrinos, Iliadou, Pavlou and Bamiou.

Figures

FIGURE 1
FIGURE 1
Flow diagram showing the attrition through the different stages of the clinical trial. Three children were excluded after enrolment as they did not meet the inclusion criteria (see relevant section), while there was no loss of participants due to follow-up. APD, Auditory Processing Disorder; RMHA, Remote Microphone Hearing Aid.
FIGURE 2
FIGURE 2
Plots of mean scores in the LIFE-R Total Score, for 12 controls and 13 RMHA children, at baseline, 3 and at 6 months. Error bars represent a 95% CI of the mean. The scores of the intervention group significantly improved from baseline to 3 months, as well as from baseline to 6 months. This was a non-standardised questionnaire, therefore there was no indication of a cut-off for abnormal performance. CI, Confidence Interval; LIFE-R, Listening Inventory for Education – Revised; RMHA, Remote Microphone Hearing Aid. ∗p < 0.05.
FIGURE 3
FIGURE 3
Plots of mean z scores in (A) the Low-cue SRT score, and (B) the Talker Advantage score, for 13 controls and 13 RMHA children, at baseline, 3 and 6 months. Error bars represent a 95% CI of the mean. The horizontal dotted line indicates the cut-off for what is considered abnormal performance (i.e., −2 z scores and below). CI, Confidence Interval; LiSN-S, Listening in Spatialised Noise – Sentences; RMHA, Remote Microphone Hearing Aid; SiN, Speech-in-Noise; SRT, Speech Reception Threshold.
FIGURE 4
FIGURE 4
Plots of mean z scores in (A) the High-cue SRT score, (B) the Spatial Advantage score, and (C) the Total Advantage score, for 13 controls and 12 RMHA children (and 13 controls and 13 RMHA children in the Spatial Advantage score only), at baseline, 3 months and at 6 months. Error bars represent a 95% CI of the mean. The horizontal dotted line indicates the cut-off for what is considered abnormal performance (i.e., −2 z scores and below). One participant had two outlying cases in post-intervention testing at 6 months in the High-cue SRT and Total Advantage scores. Outliers were removed, as the participant had decreased focus and interest and had difficulty remaining seated during the fourth and final test condition. This condition is used to calculate both the High-cue SRT and Total Advantage scores, and because it is the last condition it can indicate auditory fatigue or declining attention in the subject (National Acoustic Laboratories, 2010). Removal of this case resulted in a comparison of 13 controls against 12 RMHA children in the analyses of these two conditions. CI, Confidence Interval; LiSN-S, Listening in Spatialised Noise – Sentences; RMHA, Remote Microphone Hearing Aid; SRT, Speech Reception Threshold.
FIGURE 5
FIGURE 5
Plots of mean scaled scores in (A) the TEACh Sus-AA subtest, and (B) the TEACh Div-AVA subtest, for 13 controls and 13 RMHA children, at baseline, 3 and 6 months. Error bars represent a 95% CI of the mean. There was a significant difference between the two groups in the Div-AVA baseline scores, and significant difference in the Div-AVA scores of the intervention group from baseline to 6 months. The horizontal dotted line indicates the cut-off for what is considered abnormal performance (i.e., 4 scaled scores and below). CI, Confidence Interval; Div-AVA, Divided Auditory-Visual Attention; RMHA, Remote Microphone Hearing Aid; Sus-AA, Sustained Auditory Attention; TEACh, Test of Everyday Attention for Children. ∗∗p < 0.01.
FIGURE 6
FIGURE 6
Plots of mean scaled scores in (A) the TEACh Sel-VA subtest, and (B) the TEACh Div-AA subtest, for 13 controls and 13 RMHA children, at baseline, 3 and 6 months. Error bars represent a 95% CI of the mean. The horizontal dotted line indicates the cut-off for what is considered abnormal performance (i.e., 4 scaled scores and below). CI, Confidence Interval; Div-AA, Divided Auditory Attention; RMHA, Remote Microphone Hearing Aid; Sel-VA, Selective Visual Attention; TEACh, Test of Everyday Attention for Children.

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