Effects of Three Amplification Strategies on Speech Perception by Children With Severe and Profound Hearing Loss

In Brief Objective: Traditionally in the United Kingdom, children with severe and profound hearing loss have been fitted with linear, analog hearing aids. Fast-acting, wide-dynamic-range compression (WDRC) has been shown to give better discrimination of speech than linear amplification for moderately hearing-impaired young adults. For severe and profound hearing losses, higher compression ratios are needed. The resultant distortion of the temporal envelope and reduced modulation depth may offset improvements in audibility offered by WDRC. In this study, speech recognition and discrimination were assessed for severely and profoundly hearing-impaired children, using three different amplification strategies, including WDRC. Design: Fifteen children (ages 7 to 15 yr) with severe and profound hearing loss were fitted bilaterally with high-power, multichannel compression hearing aids, incorporating one of three different amplification strategies: linear with peak clipping, linear with compression limiting, or WDRC. Output responses were matched to Desired Sensation Level (DSL i/o) targets. The children wore hearing aids programmed with each of the amplification strategies in turn, for at least 1 wk, in a counterbalanced order across children. After using a particular amplification strategy for at least 1 wk, speech perception tests were carried out. Results: Speech scores on closed-set testing for the profound group showed significant benefit for WDRC over the other two algorithms. None of the other results showed a statistically significant effect of algorithm on speech performance. Conclusions: WDRC amplification sometimes led to better performance than linear amplification with peak clipping or output limiting, and it never led to poorer performance. Therefore, it appears to be safe to use well-designed WDRC for hearing-impaired children with severe or profound hearing loss. Children with severe and profound sensorineural hearing losses have typically been fitted with linear amplification. The use of compression amplification can increase audibility of the speech spectrum but increased distortion in the temporal envelope may offset any benefits in performance. In this study, 15 children were fitted with three different amplification strategies using linear, output compression, and wide-dynamic range compression (WDRC) conditions in counterbalanced order. Results from closed-set speech discrimination testing show significant benefit for WDRC over the other two algorithms for the profoundly impaired children. These and other test results indicate that WDRC may lead to better performance, and never led to poorer performance. It appears that it is safe to use well-designed WDRC for children with severe and profound hearing loss.