title: Effects of stimulus level on the speech perception abilities of children using cochlear implants or digital hearing aids.
abstract: OBJECTIVE
  The present investigation was designed to provide information to facilitate the decision of whether a child should continue using digital signal processing (DSP) hearing aids with wide dynamic range compression (WDRC) or be recommended for a cochlear implant, based on the unaided pure-tone average (PTA at 500, 1000, and 2000 Hz).
  
  
  METHODS
  Fifty-two children (ages 5 to 15 yr) with unaided PTAs in the moderately severe to profound range, wearing (DSP) hearing aids with (WDRC) or a Nucleus 24, Clarion 1.2, or CII cochlear implant system, participated: 26 with unaided PTAs from 60 to 98 dB HL using DSP hearing aids and 26 with pre-implant unaided PTAs from 93 to 120 dB HL, using cochlear implants. An open-set speech perception test, the Lexical Neighborhood Test (LNT; ), was administered at intensity levels representative of raised (70 dB SPL) and soft (50 dB SPL) speech at two different times approximately 1 mo apart. Minimum audibility of soft sounds was determined for the children with implants and with DSP hearing aids using warble-tone thresholds at octave intervals between 250 and 4000 Hz.
  
  
  RESULTS
  Regression analyses and significance testing were used to determine the unaided PTA values at which the performance of the DSP Hearing Aid group (DSP HA group) and Cochlear Implant group on the LNT test were statistically different at the 0.05 significance level. For the 70 dB SPL presentation level, the statistically different PTAs were 113 and 97 dB HL at Time 1 and Time 2, respectively, and 96 and 88 dB HL at 50 dB SPL for Time 1 and Time 2, respectively.
  
  
  CONCLUSIONS
  The Unaided PTA at which children in the cochlear implant group would be expected to score significantly better than the children in the DSP HA group was lowest (96 and 88 dB HL) for the lower signal level (50 dB SPL). Assuming that LNT scores at 50 dB SPL are representative of long-term hearing of soft incidental speech that is essential for language learning and fluent communication, the children with PTA values greater than the range from 88 to 96 dB HL would be expected to have significantly better LNT scores with a cochlear implant. These results should be further examined with research efforts focusing on early intervention with optimally fitted DSP hearing aids and cochlear implants.
authors.affiliation: Central Institute for the Deaf, Washington University, St. Louis, Missouri 63110, USA. davidsonl@ent.wustl.edu
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Davidson
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods*; D000293:Adolescent; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D005260:Female; D006310:Hearing Aids; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008144:Loudness Perception / Q000502:physiology*; D008297:Male; D011474:Prosthesis Design; D012044:Regression Analysis; D013063:Speech Discrimination Tests; D013067:Speech Perception / Q000502:physiology*