Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise

Objectives: The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise. Design: In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps. Results: Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise. Conclusions: Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. ACKNOWLEDGMENTS: We thank all subjects for their participation in this study. We thank the teachers and personnel of the Europaschool and Roelof Venema School for their cooperation. We thank Hans van Beek for preparing test software and technical support, Ilham Saadane for data collection in the initial part of the study, and Job Koopmans for useful comments on the manuscript. W.J.A.K. designed and performed the experiments, analyzed the data, and wrote the article. S.T.G. designed the experiments, discussed the results and implications, and commented on the manuscript at all stages. C.S. designed the experiments, analyzed the data, discussed the results and implications, and commented on the manuscript at all stages. This work was supported by the Ministry Onderwijs, Cultuur en Wetenschappen funding. The authors have no conflicts of interest to disclose. Address for correspondence: Cas Smits, Department of Otolaryngology-Head and Neck Surgery, Section Ear and Hearing, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: c.smits@vumc.nl Received March 4, 2017; accepted January 30, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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