Using Hearing Assistance Technology to Improve School Success for All Children

ABSTRACT

The acoustical conditions in the classroom play an important role in the learning process of children. Most daily instruction is verbal; therefore, all children in the classroom and other educational settings need access to auditory information. This chapter will provide information to teachers and administrators about hearing assistance technology that can facilitate classroom learning for typically developing children, second language learners, children who are hearing impaired, and children with normal hearing thresholds but significantly poorer auditory performance, such as children who are diagnosed with auditory processing disorder, autism spectrum disorder, attention-deficit hyperactivity disorder, and language disorder. Teachers and educational audiologists can collaborate on the use of technology to ensure children have access to auditory information in the classroom.

The acoustical conditions in the classroom play an important role in the learning process of children. Most daily instruction is verbal, and it is vital that students be able to hear their teachers as well as their classmates. In addition, teachers may abuse their voices if they have to speak loudly in order to be heard by the children in a noisy classroom.

In reality, classrooms can be noisy places. Noise in classrooms is unwanted sound that is usually created by heating, ventilating, and air-conditioning equipment (HVAC), noise from outside the building leaking through windows and doors, noise from adjacent rooms and hallways leaking through walls and doors, and noise produced by the children themselves in the classroom. Classrooms are also reverberant places. Reverberation is the persistence of sound after its source quiets and arises from sound reflecting from hard walls, floors, and ceilings.

The American National Standards Institute (2010) guidelines pertaining to classroom acoustics suggest that the ambient noise level of an unoccupied classroom should not exceed 35 dBA and reverberation times should not exceed 0.6 seconds. Furthermore, the signal-to-noise ratio (e.g., how loud a person’s voice is above background noise) ideally should be 15-20 dB _SPL for typically developing children. Research has shown that children require higher levels of a signal, such as speech, in the presence of noise in order to recognize words as accurately as adults (Talarico et al., 2007). Additionally, children demonstrate more difficulty than adults in recognizing speech in reverberant conditions (Finitzo-Hieber & Tillman, 1978).

Consequently, if an acoustic environment allows for a +15 dB SNR (signal-to-noise ratio) throughout the entire classroom, students with normal hearing can hear well enough to receive the spoken message fully. Yet, by the time children are 5 years old, many of them have spent most of their day in classroom environments that exceed recommended noise levels (Acoustical Society of America [ASA], 2002a, 2002b). Typical classrooms do not allow for teachers’ voices to be at least 15 dB _SPL above classroom noise (Picard & Bradley, 2001) and speech intelligibility ratings are 75% or less, meaning that listeners with normal hearing can understand at best 75% of the words read from a list (Acoustical Society of America [ASA], 2000, as cited in American Speech-Language-Hearing Association [ASHA], n.d.). Excessive noise has detrimental effects on typically developing children’s speech perception, attention, reading, spelling, behavior, and overall academic achievement (Jamieson, Kranjc, Yu, & Hodgetts, 2004).

Children also wrestle with significant difficulty with understanding speech that originates from a distance. This is because loudness decreases over distance. Specifically it drops 6 decibels (dBs) for every doubling of distance. For example, a teacher speaking at 60 dBs 3 feet out into the front of the classroom will be heard at 54 dBs 6 feet into the room and at 48 dBs 12 feet into the room and so on. Since the background noise levels often remain essentially the same, this decrease in the loudness of the teacher’s voice, means that the signal-to-noise ratio will be declining over the distance of the room. Crandell and Bess (1986) measured the speech recognition abilities of 5 to 7 year-old children in a typical classroom environment. The children scored 89% correct on a word recognition test when the words were presented from six feet away. However, their scores decreased to 36% correct when the words were presented 24 feet away.

Given the effects of noise, reverberation, and distance on the speech perception and academic performance of typically developing children, what kind of effects might noisy classrooms have on the auditory and academic performance of non-typically developing children? For example, children learning English as a second language have significantly poorer scores when listening to speech in noise. The differences between them and monolingual English-speaking children increase as signal-to-noise ratios become poorer (Crandell & Smaldino, 1996a). Students with hearing disorders will have added limitations that will not allow them to understand speech as well as their normal hearing classmates, irrespective of the signal-to-noise ratio (Iglehart, 2009).

While it is evident that improving acoustics in classrooms used by children with hearing impairment is critical, there are benefits for children with normal hearing thresholds as well, including

Moreover, if classroom acoustics meet national standards, teachers should be able to use a natural teaching voice free from vocal strain (ASHA, n.d.).

If the acoustics of the classroom are not within standards, hearing assistance technology (HAT) can be used to improve students’ access to the teacher and other speakers by diminishing the effects of distance, noise and reverberation in the classroom. HAT can benefit typically developing children, second language learners, children who are hearing impaired, and children with normal hearing thresholds but significantly poorer auditory performance, such as children who are diagnosed with auditory processing disorder, autism spectrum disorder, attention-deficit hyperactivity disorder, and language disorder.

Research on three HAT wireless delivery options will be discussed in relationship to the different student populations.

The use of other technology including closed captioning, apps, and SMART boards also will be briefly reviewed.

Years of research on the subject of room acoustics and the effects of poor acoustics on listening and learning in the public school classroom have led to certain principles concerning classroom acoustics (Crandell & Smaldino, 1999; Nelson, 2000).

These principles formed the basis for guidelines and standards created to ensure adequate classroom acoustics for listening and learning. In 1995 the American Speech-Language-Hearing Association (ASHA) published a “Position Statement and Guidelines for Acoustics in Educational Settings.” These guidelines called for background noise levels not to exceed 30 dBA, reverberation times not to exceed 0.4 seconds, and an overall teacher signal-to-noise ratio (SNR) of +15 dB (ASHA, 1995). In 2002 the American National Standards Institute (ANSI) published the “ANSI S12.60-2002 Acoustical Performance Criteria, Design Requirements and Guidelines for Schools” (ANSI, 2002), that had similar specifications. These specifications recommended that based on room size, background noise levels not exceed 35 dBA, reverberation times not exceed 0.6-0.7 seconds, and a SNR of +15 dB exist.

Recently researchers documented the types of listening situations students routinely experience in school environments in different locations, with different speakers, and with different competing noise sources (Picou & Ricketts, 2014). They followed children with and without hearing loss for an average of 5.8 hours during typical school days.

Results revealed that students spent 70% of their day involved in active listening and just 30% of their day quietly working or playing alone, not listening to any talker. The researchers also found that students spent 80% of their active listening time in background noise. Across all listening environments, the speaker of interest (e.g., teacher or classmate) was in front of the student 42% of the time. For the remaining 58% of the time, the main speaker was behind or off to the side of the student (35%) or there were multiple speakers (23%) (Picou & Ricketts, 2014).

Use of remote microphone hearing assistance technology (HAT) is the most effective method to improve speech recognition in classrooms that do not meet ANSI acoustic standards. Remote microphone wireless systems are available in an array of configurations and include classroom audio distribution (CAD) systems (AKA sound field amplification systems), personal sound field systems, or personal radio frequency (RF) systems. Remote microphone wireless assistance technology refers to a system that contains a transmitter that captures a signal (typically from a microphone) and wirelessly transmits that signal to either a personal receiver coupled to a child’s hearing aid or cochlear implant, or to a loudspeaker or multiple loudspeakers.

Classroom audio distribution (CAD) systems consist of a microphone coupled to a transmitter, which wirelessly delivers the signal captured by the microphone to one or more loudspeakers that are strategically placed in the classroom. Some CAD systems use one loudspeaker to distribute the sound, while others use multiple loudspeakers (generally two to four) to provide a more uniform distribution of the signal around the classroom.

CAD or sound field amplification systems improve the signal-to-noise ratio in a classroom by using a microphone transmitter to amplify the teacher’s voice over background noise levels and deliver the signal to one or more speakers in the ceiling or along the walls of a classroom. They improve the listener’s auditory access to the teacher by diminishing the effects of noise, reverberation, and distance from the teacher. A CAD system is not a substitute for hearing aids or cochlear implants or inadequate acoustical treatment of the classroom (learning) environment.

In cases of moderate noise in the classroom, the CAD (sound field amplification) system can be employed to augment the teacher's voice, especially when she or he is a quiet talker, and as a multimedia sound distribution system. A sound field amplification system should not be used as a substitute for good acoustics. Classroom noise levels and reverberation times must be documented prior to installation. Acoustical consultants or credentialed educational audiologists can assess classrooms for CAD system installation.

The purpose of a CAD system is to provide an even distribution of the signal throughout the classroom so that each child has consistent access to the primary signal regardless of the position of the teacher or the students. The improvement in SNR provided by CAD systems depends on a number of factors, including the quality and position of the loudspeakers, the position of the students relative to the loudspeakers, and the acoustics of the classroom. Research in classrooms with children with normal hearing has reported that CAD systems improve SNR by as little as 2 dB and as much as 11 dB (Larsen & Blair, 2008; Massie & Dillon, 2006). Additional research has shown that use of CAD systems results in improvements in literacy development, standardized test scores, and classroom behavior as well as a reduction in teacher absences (Massie & Dillon, 2006; Massie, Theodoros, McPherson, & Smaldino, 2004).

A personal sound field system is basically comprised of the same components as a CAD system, but the loudspeaker is smaller and intended to be placed on the desk of a child with hearing impairment. The close proximity of the loudspeaker to the child allows for a more favorable SNR than a CAD system. Very little research exists examining the SNR improvement provided by personal sound field systems. Crandell, Charlton, Kinder, and Kreisman (2001) found significant improvement in speech recognition for a desktop portable sound field system over unaided listening, but the desktop system was not as effective as a body-worn personal FM receiver. Iglehart (2004) reported improved speech perception by children wearing cochlear implants with desktop and sound field FM systems, but no difference between the two types of FM systems in a quiet classroom and an advantage for the desktop in noisy classrooms.

Remote microphone personal radio frequency (RF) systems are usually referred to as personal FM systems. They are composed of a microphone, which is coupled to a transmitter that wirelessly delivers the signal captured by the microphone to RF receivers that are directly coupled to a child’s hearing aids or cochlear implants. Personal FM systems provide the most improvement in SNR, ranging from as little as 5-15 dB (when the microphone of the RF system and hearing aid are both active) to as large as 15-25 dB when the RF microphone is active and the hearing aid microphone is disabled (Boothroyd & Iglehart, 1998). As a rule, the microphones of the FM (RF) system and the hearing aid are both activated so the child has access to the signal from the FM (RF) systems, his/her own voice, and other speech and environmental sounds throughout the classroom. Personal FM systems can improve speech recognition in noise by as much as 50-60% when compared to speech recognition without a personal RF system (Schafer & Thibodeau, 2004).

Roger is a variation on a FM system. It is an adaptive digital wireless transmission technology running on the 2.4 GHz band. Audio signals are digitized and packaged in very short (160 μs) digital bursts of codes (packets) and broadcast several times, each at different channels between 2.4000 and 2.4835 GHz. Frequency hopping between channels, in combination with repeated broadcast, avoids interference issues (e.g., from other classrooms). The frequency hopping Roger employs is adaptive, which means only free channels are used. Roger receivers regularly provide feedback to the transmitting wireless microphones, informing the microphones about which channels are steadily occupied (by any other nearby system operating at 2.4 GHz, like a WiFi network) and which channels are free. The Roger wireless microphone then automatically ‘hops’ around these occupied channels searching for unoccupied channels. The Roger wireless microphones can also sense the presence of a WiFi network, and respond to this accordingly.

Roger wireless microphones continually estimate the ambient noise level with high accuracy. These measurements in turn control the gain of Roger receivers. This advanced dynamic behavior has led to significant improvements in speech recognition in noise, especially at higher noise levels of up to 80 dBA. These high noise levels are found in public places and in the workplace. Roger is not commonly used in classrooms. According to a study of the performance of adults with hearing loss using adaptive digital technology like Roger, the adults had significantly better speech scores using the adaptive digital technology than when using FM technology, with the greatest benefits at the highest noise levels. The different wireless technologies allowed the adults with hearing loss to perform better than persons with normal hearing while listening to speech in noise, with the greatest benefit occurring with adaptive digital technology (Thibodeau, 2014).

Induction loop systems can be used in large group areas or can be purchased for individual use. They work with hearing aids. An induction loop wire is permanently installed (typically under a carpet or in the ceiling) and connects to a microphone used by a speaker. The person talking into the microphone generates a current in the wire, which creates an electromagnetic field in the room. When the hearing aid is switched to the “T” (telecoil/telephone) setting, the hearing aid telecoil picks up the electromagnetic signal. The volume of the signal can be adjusted through the hearing aid. Induction loop systems are no longer commonly used in classrooms because more advanced technology exists.

According to the 2000 US Census Bureau, 20% of all school-aged children who speak languages other then English at home have limited proficiency in English. Across the United States, major metropolitan areas are reporting that 40% or more of their students speak languages other than English at home (US Census, 2000).

All individuals listening in a non-native language are more susceptible to background noise (Mayo, Florentine, & Buus, 1997). Children who are learning English as a second language are affected by classroom noise and need quiet classrooms to better understand their teachers and classmates. Nelson, Kohnert, Sabur, and Shaw (2005) demonstrated that two groups of second-grade children (those whose first language was Spanish and those who spoke only English) performed equally on English word understanding tests in quiet. In contrast, the Spanish-speaking children performed significantly more poorly than the English-speaking children when listening to words in noise at +10 dB SNR.

Crandell and Smaldino (1996b) reported data on the effects of sound field amplification on the speech perception of children learning English as a second language (ESL) (Spanish speakers). Speech perception was assessed in a “typical” classroom environment with a SNR of +6 dB and a reverberation time of 0.6 second. The ESL children exhibited significant speech perception difficulties in the classroom, particularly when seated in the middle (12 feet) or rear (24 feet) of the room. A sound field amplification system significantly improved speech perception scores for the ESL children, especially those seated in the middle or rear of the room.

Approximately twenty years ago researchers began finding evidence that the use of sound field amplification in the classroom provides significant improvement in word and sentence recognition for typically developing students with normal hearing (Crandell, 1993; Jones, Berg, & Viehweg, 1989), students with developmental disabilities (Flexer, Millin, & Brown, 1990), English as a second language learners (Crandell, 1996; Crandell & Smaldino, 1996b; Eriks-Brophy & Ayukawa, 2000; Nelson & Soli, 2000), and for students with minimal degrees of hearing impairment (Jones, Berg, & Viehweg, 1989). Furthermore, consistent use of sound field amplification has been found to improve the academic performance of typical learners (Flexer, 1992; Osbourn, VonderEmbse, & Graves, 1989; Rosenberg et al., 1999) and improve on-task or listening behaviors for preschool, elementary, and secondary school children (Allen & Patton, 1990; Gilman & Danzer, 1989).

In a recent study, speech recognition in quiet and in noise was assessed for adults with normal hearing, children with normal hearing, and children with hearing loss. Speech recognition was evaluated in a classroom environment without the use of HAT and with two different CAD systems. Children’s speech recognition was also assessed with an adaptive personal frequency modulation (FM) system coupled to their personal hearing aids as well as while using both the personal FM system and the CAD systems (Wolfe et al., 2013). The following are among the researchers’ conclusions regarding the children’s performance:

Children with hearing loss require classroom modifications in order to access verbal instruction as fully as possible within the limitations of their hearing loss. The use of hearing assistance technology such as an FM system by the child with hearing impairment is necessary. However, classrooms are obviously noisy and reverberant learning environments with typical noise levels ranging from 53-74 dB (Finitzo-Hieber, 1988). The use of an FM system alone will not effectively address the listening needs of children with hearing impairment when a classroom is noisy or reverberant. For children with hearing impairment the combination of adequate classroom acoustics and FM technology is required to ensure that noise will not be an obstacle to learning within the classroom. The use of another type of hearing assistance technology, such as a sound field classroom amplification system, may benefit children with normal hearing and the teacher, but it alone will not be appropriate for children with hearing impairment.

Hearing instruments, i.e., hearing aids and cochlear implants, can be ineffective in providing benefit in a noisy classroom. Every single dB gain in SNR leads to an increase in speech perception for listeners with hearing loss (Duquesnoy & Plomp, 1983). Children consistently have a higher level of speech perception performance when FM devices are utilized by hearing aid users (Boothroyd & Iglehart, 1998; Toe, 1999) or by cochlear implant users (Crandell, Holmes, Flexer, & Payne, 1998; Foster, Brackett, & Maxon, 1997). For example, listeners with severe to profound hearing impairment who have word recognition scores in quiet above 20% demonstrate benefit from the use of personal FM systems with increased attention to verbal instruction and decrease in dependency on note taking or cued/signed supplemental information (Toe, 1999). For cochlear implant users a desktop FM system can improve word recognition scores by approximately 20% (Foster et al., 1997).

In a recent study with preschool teachers, researchers examined several issues including how often sound field amplification (i.e., speakers placed around the classroom) and personal FM systems are used in preschool classrooms, teacher perceptions of the advantages and disadvantages of using HATS, and teacher recommendations and feedback for hearing assistance technology use in the preschool classroom (Nelson, Poole, & Muñoz, 2013). Surveys were sent to professionals who provided services to preschool children who were deaf or hearing impaired in either a public or private school. A total of 99 out of 306 surveys were returned for an estimated return rate of 32%. Surveys were received from teachers working at listening and spoken language preschool programs (65%) and teachers at bilingual-bicultural (Bi-Bi) or total communication preschool programs (35%). Bi-Bi programs use ASL as their primary form of communication and instruction. Average number of children per classroom was 7 with a range of 3 to 22 (Nelson et al., 2013).

Fifty-seven respondents indicated that they currently use or previously used sound field systems in their classrooms. Forty-four of the 57 respondents taught in listening and spoken language classrooms. The preschool teachers indicated that the sound field systems provided a significant advantage in increasing student attention (84%), improving language development (79%), reducing strain on teacher’s voice (77%), improving academic performance (71%), and improving student behavior (67%). Few respondents perceived sound field technology as having no or few advantages (Nelson et al., 2013).

The survey also inquired about the use of personal FM systems by the preschool-age children. Respondents who reported having children in their classrooms who used personal FM systems were asked to rate the advantages and disadvantages of the FM systems. The majority of respondents rated personal FM systems as being advantageous in improving students’ attention (86%), speech and language development (78%), academic performance (73%), and behavior (63%). Once again few respondents reported disadvantages in using an FM system (Nelson et al., 2013).

The majority of preschool teachers would either definitely or probably recommend a sound field system (77%) or personal FM system (71%) to other educators. Some of the respondents warned that teachers should be purposeful in understanding when using the technology is beneficial versus counterproductive. For example, when there is a need to develop skills for distance listening, use of hearing assistance technology could be counterproductive. In classrooms that focus on ASL, hearing assistance technology can be used if speech training is incorporated into the curriculum (Nelson, Poole, & Muñoz, 2013).

Published research reveals that children with normal pure tone hearing thresholds can exhibit auditory deficits. These children include those diagnosed with auditory processing disorder (APD), autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), language disorder, and Friedreich’s ataxia (FRDA).

Children with APD have shown significantly poorer speech recognition in noise at 0 and +3 SNRs by an average of 10% when compared to a control group without APD (Lagecé, Jutras, Giguére, & Gagné, 2011). Muchnik, Ari-Even, Othman-Jebara, Putter-Katz, Shabtai, and Hildesheimer (2004) conducted a study in which 12 out of 15 children with APD had speech–in-noise thresholds in at least one ear that were, on average, at least 20% lower and two standard deviations below the age and gender-matched control group.

Children with ASD and ADHD have similar difficulties understanding speech in noise (Corbett & Constantine, 2006; Schafer et al., 2013; Schafer et al., 2014b). When comparing speech recognition thresholds at 50% correct levels in children who were high functioning with ASD and/or ADHD as compared to a control group, children with the disorders had significantly poorer thresholds on the order of 2 to 5 dB SNR relative to the control group (Schafer et al., 2013).

Many children diagnosed with APD, ASD, and ADHD exhibit coexisting disabilities, with language disorders being one of the most common. Normal language processing abilities are necessary for successfully completing speech comprehension tasks in the classroom.

Friedreich's ataxia (FRDA) is a rare inherited disease that causes nervous system damage and movement problems. It usually begins in childhood and leads to impaired muscle coordination (ataxia) that worsens over time. In Friedreich’s ataxia the spinal cord and peripheral nerves degenerate, becoming thinner. The cerebellum, part of the brain that coordinates balance and movement, also degenerates to a lesser extent. Friedreich’s ataxia results in auditory neuropathy spectrum disorder. Auditory neuropathy is a hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired. It can affect people of all ages, from infancy through adulthood.

People with auditory neuropathy may have normal hearing, or hearing loss ranging from mild to severe. They always have poor speech perception abilities. Often, speech perception is worse than would be predicted by the degree of hearing loss. Rance, Corben, Du Bourg, King, and Delatycky (2010) reported that children with FRDA had significantly poorer phoneme-recognition scores in noise (0 dB SNR) by 26% compared to the typically developing control group.

Published research supports the use of FM systems for improving speech recognition in noise and other auditory behaviors for children who are diagnosed with APD, ASD, ADHD, language disorder, and FRDA. Schafer, Florence, Anderson, Dyson, Wright, Sanders, and Bryant (2014a) conducted a critical review of studies examining the use of hearing assistance technology in populations of children with APD, ASD, ADHD, language disorder, and FRDA. In most of these studies, children used ear-level, open ear FM systems designed for children with normal hearing sensitivity. Across the studies reviewed, there was a marked improvement in speech recognition performance in noise with an FM system versus without an FM system. FM system gains ranged from 17 to 86% for fixed-intensity stimuli and 6 to 10 dB for adaptive-test stimuli. For ten children with ASD, Rance et al. (2014) measured word recognition in babble at 0 dB SNR. The average improvement using an FM system versus no system was 17% for children with ASD as well as 10% for the control group. In addition, teachers rated the FM as “highly beneficial” for each child. The FM system improved listening, classroom behavior, and general attentiveness. In another study, Rance et al. (2010) measured word recognition in babble at 0 dB SNR for 10 children with FRDA. The average improvement using an FM system over no system was 34%.

Classrooms are primarily auditory-verbal environments where listening is the predominant modality for learning. As this discussion of acoustics and learning in the typical classroom has indicated, classrooms also can be noisy places where the presence of noise can have detrimental effects on children with normal hearing, children with hearing impairment, and children with other disabilities. These detrimental effects include effects on speech recognition, listening, attention, and academic performance. Numerous research studies have shown that hearing assistance technology can provide benefits for all children in classrooms that do and do not meet ANSI standards.

Closed captions are a text version of the spoken part of a television program, movie, or computer presentation. Closed captioning was developed to aid individuals who are deaf or hard-of-hearing, but it has proven useful for a variety of situations. For example, captions can be read when audio cannot be heard, either because of a noisy environment or because of an environment that must be kept quiet, such as a hospital. Captions can also benefit adults and children learning to read, as well as people learning English as a second language. Media used in the classroom should be closed-captioned if possible to provide an additional form of access to the information for children. Options for close captioning media with minimal costs are provided below.

Closed captioning is available on movies found on iTunes. Search in iTunes by using “closed caption” but with no quotes.

Captionfish identifies the times and locations of captioned movies. It also identifies captioned movie trailers. The results are identified by type of accessibility, such as open caption (OC), closed caption (CV, RWC, Sony-DV), and described audio (DA).

Media players with captioning include ABC Player (iTunes), Netflix (iTunes and Google Play), Hulu Plus (iTunes and Google Play), and TEDiSUB (iTunes); viewers can watch TED talks with subtitles embedded.

Subtitles and closed captions can be added to YouTube videos. Basic directions are as follow (https://support.google.com/youtube/answer/2734796#captioning_services).

Subtitles and closed captions open up your content to a larger audience, including deaf or hard of hearing viewers or those who speak languages besides the one spoken in your video. If you already have captions or subtitles, get help editing or removing existing captions.

The word “app” is an abbreviation for application. An app is a piece of software. It can run on the Internet, on computers, or on mobile electronic devices. Apps are available to assist children with disabilities to function more effectively in the classroom as well as to measure noise in the classroom. There are several places to purchase apps including the Apple Store, Google Play (Android), Blackberry App World (http://us.blackberry.com/apps/?lid=us:bb:Apps&lpos=us:bb:Apps), and Windows Phone Marketplace (http:/windosphone.com/en-US/marketplace).

When purchasing apps for children who are deaf or hard-of-hearing be sure to look for the following attributes:

Amplifier apps are available for children with hearing loss. These apps are easy to use with little to no acoustic delays (echoes) and good overall sound quality (Childress, 2013).

Apps are available to identify music with lyrics. Pandora is Internet radio. It is a desktop app that displays lyrics and is available on iTunes, Google Play, and BlackBerry App World. SoundHound will listen to a song and tell the listener the name of the song, artist, album, and lyrics that are synched (if available). It is available on iTunes, Google Play and Windows Phone.

There are noise level meter apps built for the classroom. These apps are built to help control noise levels of groups of children. For example, there is an app called “Too Loud Kids Noise Meter & Timer.” The timer duration can be set, as well as meter sensitivity. The timer is then started. While time passes, the meter measures and graphically shows the noise level. Behind the voice meter there is an animal, which reacts to the voice levels. When the background noise levels are quiet, the animal looks happy; however, when the noise levels get louder the animal and background landscapes react and show graphically that noise levels are too high. “Too Noisy” graphically displays the background noise level in a room. Star Awards can be given at predetermined time periods (from 1 to 13 minutes) for each of ten available awards for being quiet. This app is available on the App Store and Google Play. These two apps can be used to manage the noise levels in the classroom while making it a game for the children in the classroom.

A SMART board is an interactive whiteboard developed by SMART Technologies. It is a large touch-sensitive whiteboard that uses a sensor for detecting user input that is equivalent to normal PC input devices, such as a mouse or keyboard. A projector is used to display a computer's video output onto the whiteboard, which then acts as a huge touchscreen. A SMART board usually comes with digital writing utensils that use digital ink that replaces the traditional whiteboard markers.

These interactive whiteboards allow various media, including photos, games, and video, to be displayed. They also allow for integration of various technologies. Microscopes, document cameras, and video cameras can be attached to the SMART board. It is possible to integrate the interactive learning tools with a wide range of software applications.

SMART boards support a variety of learning styles. For example, teachers can project visual elements onto the whiteboard for visual learners, while the whiteboards come with touchscreen capabilities that allow tactile learners to touch and interact with the board. Furthermore, all the students in a classroom can hear the audio from the SMART board or the audio from the SMART board can be delivered directly to the personal FM receivers of children with hearing loss.

For students with identified hearing loss, listening difficulties, and/or auditory processing problems, accommodations and improvement strategies need to be implemented within the school environment. Classroom teachers are instrumental in identifying students who may be experiencing hearing loss or other types of listening problems and in referring students to the appropriate professionals for further assessment. Administrators can be instrumental in providing resources for collaboration among professionals to improve classroom acoustics and students' listening skills (ASHA, n.d.).

In classrooms where the acoustics are less than optimal, classroom teachers can accommodate students by using strategies that typically have been used for students with hearing loss, including

Teacher questionnaires can be utilized that document listening, communication, and academic difficulties for children in the classroom. Three questionnaires may be especially effective in assessing children in schools, the Screening Instrument for Targeting Educational Risk (S.I.F.T.E.R.; Anderson, 1989), the Children’s Auditory Performance Scale (CHAPS; Smoski, Brunt, & Tannahill, 1998), and the Listening Inventory for Education –Revised (LIFE-R) for the teacher (Anderson, Smaldino, & Spangler, 2012). Educational audiologists can provide teachers with these questionnaires. Each of the questionnaires provides normative data to assist in identifying when children present with educational risk, listening problems, or auditory processing differences when compared to their classmates.

Schafer et al. (2014a) provide recommendations for conducting an evidence-based assessment for HAT that is designed for audiologists to obtain the financial support necessary to purchase hearing assistive technology (HAT) for children with APD, ASD, ADHD, language disorder, and FRDA. Among the recommended components of the assessment are: measuring classroom acoustics; observing the child in the classroom and interviewing the child and parents; conducting speech recognition tests in noise in a soundbooth or in the classroom; having the teacher complete a questionnaire; examining other evaluations and IEP goals to determine if HAT can assist in meeting intervention goals, and conducting a trial with HAT and examining pre- and post-trial observations, interviews, questionnaires, and speech recognition tests.

Very few studies have examined the impact of hearing assistive technology on student outcomes for preschool children. Controlled studies are needed to evaluate the impact of using sound field and personal FM systems on auditory perception, language growth, and academic performance for preschoolers. More research is needed on the use of hearing assistance technology in classrooms with input from teachers and administrators as to its usefulness and cost effectiveness. Input from parents should also be assessed.

Recent studies have shown that children with normal hearing have significantly poorer auditory comprehension (defined as answering questions about story content) in comparison to speech recognition (defined as repeating sentences) in conditions with the same signal-to-noise ratio (SNR) and level of reverberation (Schafer et al., 2013). Comprehension is a higher level auditory skill compared to speech recognition. It requires a combination of recognition, cognition, attention, and working memory. Recorded comprehension-based measures that are available for use in the classroom need to be developed. Subsequently, auditory comprehension skills in comparison to speech recognition skills of children with normal hearing, children with hearing impairment, and children with other disabilities need to be evaluated.

The acoustical conditions in the classroom play an important role in the learning process of children. Classrooms are auditory-verbal environments where learning takes place. Improving acoustics in classrooms is crucial because typically developing students under the age of 15 are still developing mature language and are less effective listeners for speech in noise than adults (Nelson, Sacks, & Hinckley, 2009). Students with disabilities, such as hearing impairment, central auditory processing disorders, autism spectrum disorders and other speech and language disorders as well as students whose native language is not English have additional difficulties understanding speech in noise. This chapter reviewed research about hearing assistance technology that can facilitate classroom learning for typically developing children, second language learners, children who are hearing impaired, and children with normal hearing thresholds but significantly poorer auditory performance in the classroom.

This research was previously published in the Handbook of Research on Transformative Digital Content and Learning Technologies edited by Jared Keengwe and Prince Hycy Bull; pages 311-328, copyright year 2017 by Information Science Reference (an imprint of IGI Global).

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Classroom Audio Distribution Systems (CADS): Sound field amplification systems that deliver the signal through loudspeakers.

Frequency Modulation (FM) System: Like miniature radio stations operating on special frequencies. The personal FM system consists of a transmitter microphone used by the speaker (such as a teacher in the classroom) and a receiver used by the listener. The receiver transmits the sound to either a person’s ears or directly to a hearing aid or cochlear implant.

Hearing Assistance Technology Systems (HATS): Devices that can help people function better in day-to-day communication situations. HATS can be used with or without hearing aids or cochlear implants to make hearing easier.

Poor Classroom Acoustics: Occur when the background noise and/or the amount of reverberation in the classroom are so high that they interfere with learning and teaching. Poor classroom acoustics can affect speech understanding, reading and spelling ability, behavior in the classroom, attention, and academic achievement.

Reverberation: The persistence of sound after its source quiets and arises from sound reflecting from walls, floors, and ceilings.

Signal-to-Noise Ratio (SNR): A measure of signal strength relative to background noise. The ratio is usually measured in decibels (dB).

Speech Perception/Recognition: Measurement of the understanding for different types of speech, such as words and sentences.

Chapter 38

Using Hearing Assistance Technology to Improve School Success for All Children