www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
ORIGINAL
ARTICLE
Hearing
in
Noise
Test,
HINT-Brazil,
in
normal-hearing
children
夽
Carolina
Lino
Novelli
∗,
Nádia
Giulian
de
Carvalho,
Maria
Francisca
Colella-Santos
UniversidadeEstadualdeCampinas(UNICAMP),FaculdadedeCiênciasMédicas,CentrodeInvestigac¸ãoemPediatria,Campinas, SP,Brazil
Received21November2016;accepted11April2017 Availableonline9May2017
KEYWORDS Speech; Hearing; Noise; Child Abstract
Introduction:Theauditoryprocessingisrelatedtocertainskillssuchasspeechrecognitionin noise.TheHINT-BraziltestallowsthemeasurementoftheSpeech/Noiseratiohoweverthere arenostudiesinthenationalliteraturethatestablishparametersforthechildpopulation.
Objective:Toanalyzetheperformanceofnormal-hearingsubjectsaged8---10yearsoldintasks forspeechrecognitioninnoiseusingHINTtest.
Methods:Sixtyschoolchildrenwereevaluated.Theywerebetween8and10yearsofage,of bothgenders,andhadnoauditoryandschoolcomplaints,withresultsrankingwithinnormality fortheBasicAudiologicalAssessmentandtheDichoticDigitsTest.HINT-Braziltestwasapplied withheadphones,withtheSpeech/Noiseratioinconditionsoffrontalnoise,noisetotheright, andnoisetotheleftbeinginvestigated.ThesoftwarecalculatedtheCompositeNoise,which correspondstotheweightedmeanofthetestedconditions.
Results:Therewasnostatisticallysignificantdifferencebetweentheears, norbetweenthe genders.Therewasastatisticallysignificantdifferenceforagerangesof8and10years,in situa-tionswithnoise,andforCompositeNoise.Theagegroupof10yearsshowedbetterperformance thantheagegroupof8;theagegroupof9yearsdidnotshowstatisticallysignificant differ-enceregardingtheotherageranges.Wesuggestthevaluesofmeanandstandarddeviationof theSpeech/Noiseratio,consideringtheagerangesof:8years---FrontalNoise:−2.09(±1.09); Right Noise:−7.64(±1.72);Left Noise:−7.53(±2.80);CompositeNoise: −4.86(±1.31);9 years---FrontalNoise:−2.82(±0.74);RightNoise:−8.49(±2.24);LeftNoise:−8.41(±1.75); CompositeNoise:−5.63(±1.02);10years---FrontalNoise:−3.01(±0.95);RightNoise:−9.47 (±1.43);LeftNoise:−9.16(±1.65);CompositeNoise:−6.16(±0.91).
夽 Pleasecitethisarticleas:NovelliCL,CarvalhoNG,Colella-SantosMF.HearinginNoiseTest,HINT-Brazil,innormal-hearingchildren.
BrazJOtorhinolaryngol.2018;84:360---7.
∗Correspondingauthor.
E-mail:carolvlino@gmail.com(C.L.Novelli).
PeerReviewundertheresponsibilityofAssociac¸ãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial.
https://doi.org/10.1016/j.bjorl.2017.04.006
1808-8694/©2017Associac¸˜aoBrasileiradeOtorrinolaringologiaeCirurgiaC´ervico-Facial.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).
Conclusion: HINT-Braziltestisasimpleandfasttest,andisnotdifficulttoperformedwith normal-hearingchildren.Theresultsconfirmthatitisanefficienttesttobeusedwiththeage rangeevaluated.
© 2017 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). PALAVRAS-CHAVE Fala; Audic¸ão; Ruído; Crianc¸a
TestedeReconhecimentodeFalanoRuído,HINT-Brasil,emcrianc¸asnormo-ouvintes Resumo
Introduc¸ão: O processamento auditivo está relacionado a determinadas habilidades, como o reconhecimento de fala no ruído. O teste HINT-Brasil permite a mensurac¸ão da relac¸ão Fala/Ruído,porém,nãohánaliteraturanacionalestudosqueestabelec¸amparâmetrospara apopulac¸ãoinfantil.
Objetivo: Analisarodesempenhodenormo-ouvintes,de8a10anos,nastarefasde reconhec-imentodefalanoruído,pormeiodotesteHINT.
Método: Avaliados60escolares,entre8e10anos,deambososgêneros,semqueixasauditivase escolares,ecomresultadosdentrodanormalidadeparaaAvaliac¸ãoAudiológicaBásicaeoTeste DicóticodeDígitos.OtesteHINT-Brasilfoiaplicadocomfonesdeouvido,sendopesquisadaa relac¸ãoFala/Ruídonascondic¸õesRuídoFrontal,RuídoàDireitaeRuídoàEsquerda.Osoftware calculouoRuídoComposto,quecorrespondeàmédiaponderadadascondic¸õestestadas.
Resultados: Nãohouvediferenc¸aestatisticamentesignificanteentreasorelhas,nementreos gêneros.Houvediferenc¸aestatisticamentesignificanteparaasfaixasetáriasde8e10anos,nas situac¸õescomruídoeparaoRuídoComposto.Afaixaetáriade10anosapresentoudesempenho melhordoqueafaixaetáriade8;afaixaetáriade9anosnãoapresentoudiferenc¸a estatistica-mentesignificantecomrelac¸ãoasoutrasfaixasetárias.SugerimososvaloresdeMédiaeDesvio Padrãodarelac¸ãoF/R,considerandoasfaixasetárias:8anos-RF:-2,09(±1,09);RD:-7,64 (±1,72);RE:-7,53(±2,80);RC:-4,86(±1,31);9anos-RF:-2,82(±0,74);RD:-8,49(±2,24); RE:-8,41(±1,75);RC:-5,63(±1,02);10anos-RF:-3,01(±0,95);RD:-9,47(±1,43);RE:-9,16 (±1,65);RC:-6,16(±0,91).
Conclusão:OtesteHINT-Brasiléumtestesimpleserápido,enãooferecedificuldadesemseu usocomcrianc¸asnormo-ouvintes;osresultadosmostramsetratardeumtesteeficazparaser utilizadocomafaixaetáriaavaliada.
© 2017 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Publicado por Elsevier Editora Ltda. Este ´e um artigo Open Access sob uma licenc¸a CC BY (http:// creativecommons.org/licenses/by/4.0/).
Introduction
Communicationenableshumanstocreateandtransformthe environmentwheretheylive,beingdecisiveintheirquality oflife.Communicationismainlyexpressedthroughoral lan-guage,whichrequiresanintactauditorysystem,sothatthe individual can listen, understand and process knowledge, resultinginlearning.
Theauditorysystemconsistsoftheperipheraland cen-tralparts.Theperipheralpartisthatwhosemainfunction istocapture andtransmitthesoundwavetothecochlea, where it will be processed and sent to the central part throughthevestibulocochlearnerve.The centralauditory system is responsible for the functions of sound discrim-ination, location, recognition, comprehension, selective attentionandauditorymemory.Thus,thecomplexityofthe centralauditorynervoussystemallowstheanalysisofsound events, fromthe simplesttothemost complexmessages, suchasspeech.1
Hearinglossisdefinedasadeviationorachangeforthe worse in the auditory structure or function.2 The central
auditoryprocessingreferstotheseriesofprocessesinvolved intheauditoryfunctionsthatwerealreadydescribed, refer-ringtothemechanismsthatarebasicallyperformedbythe structuresofthecentralauditorynervoussystem.3Wecan
thereforesaythattheauditoryprocessingdisordercanbe definedasadeficitinatleastoneofthesemechanisms.
Sincethe1950s,researchershavestudied childrenwho presentedaudiogramswithinnormalrange,butwith audi-tory complaints. The symptoms described indicated good auditoryacuityinacousticallycontrolledplaces,buthearing difficultiesinreallisteningenvironments.Thus,the exist-ence of a deficit in the auditory perception was found, mainlyregardingthesuppressionofacompetitivenoiseto payattentiontoanother.4
The perception of speech has always been of great interest to those who work with human communication. Toevaluateanddiagnosehowimpairedthisperceptionis,
severaltestsareusedinclinicalpractice,butmostofthem useisolatedstimuliwithmonoanddissyllablewords.5,6
Jacobetal.7 highlightedthe importanceofconducting
testsinthepresenceofnoise,becausetheresultsof evalu-ationsofpatientswiththesamespeechrecognitionabilities insilencemaybecompletelydifferentincompetitive situa-tionsofspeech.Thus,thetestsusedintheLogoaudiometry, whichispartoftheBasicAudiologicalAssessment,arenot as effective in detecting how the functional capacity of the individual perceives and understands speech in noisy environments,becausetheyareappliedinsilence.The eval-uationoftheauditoryabilityofchildrenintheseconditions isevenmorecomplex.
A child with speech comprehension difficulties in the presenceof noise may beunableto usehis/her language knowledge to improvethe degraded signal. On the other hand,his/herdifficulty in recordingthe propertiesof the acousticsignal maybeso deficientthat eventhefull use oflanguageknowledgecouldnotleadtosatisfactory under-standing;thus,theproblemresultsinaninabilitytoprocess auditorysignals.8
Therefore,theinclusionofHearinginNoiseTests(HINT) intheauditoryevaluationofschoolchildrenbecomes essen-tialbecausethesetestsmoreclosely resemblethespeech situationsoftheindividuals,andensurethattheevaluation isperformedinarealenvironmentofdailylistening.
Forbetterevaluationofspeechrecognitioninthe pres-ence of competitive stimulus, the use of sentences is superiorthantheuseofwords,becausethesentences sim-ulatethesituationsofdailycommunicationbetter.9
It is therefore important that research is carried out in the area of speech perception and central auditory processing,withtypesof noise thatarerepresentative of thedailylisteningsituation,inordertoevaluateits effec-tivenessinclinicalpractice.10
TheHINTisanadaptivetestforthemeasurementofthe Sentence Recognition Threshold (SeRT), which proves the statistical andpractical efficiency of hearingin the noise throughsentencesofeverydaylife.Itcanbeusedtoassess auditory functional capacity, i.e., to determine how well the person is able to hear and understand in noisy envi-ronments.Itconsistsofdigitallyrecordedsentences,which canbe presented in silence andnoise; the masking noise usedinthe HINTtest isa whitenoise,which was synthe-sized at the original sample rate and scaled tothe same amplitude of the sentences.11 The sentences were
stan-dardizedforlanguage,difficulty,intelligibilityandphonetic distribution.
TheHINTmethodwasdevelopedbytheHouseEar Insti-tute(HEI)in 1994,beinginitiallytestedinnormal-hearing adults, so that parameters could be obtained for other groups.11
ForthedevelopmentandapplicationofHINTinBrazil,a materialof controlledsentences wasinitially elaborated. The material was elaborated in a work of partnership betweenresearchersoftheUniversidadeEstadualde Cam-pinas and Universidade de São Paulo, in Bauru, which standardizedthetestwithanativeBrazilianspeaker.12
ABrazilianstudywithadults,whencomparingHINTwith the speechperception tests applied in clinical audiology, observedthatHINTallowedmeasuringdifficultiesin normal-hearingsubjects.13
Wefoundinthenationalliterature11studiesthatused HINTasamethodtoevaluatespeechrecognitioninnoise.Of these,fourwereperformedwiththechildpopulation,but onlyoneincludedchildrenwithhearingwithinnormallimits inthesample,with21childrenbetween7and14yearsold.7
Inaddition,SeRTresearchwasconductedinfreefield,with nouseofheadphones.
HINT test has, in the international literature, some adapted versions for children, which consist of a subset ofthelistsof sentencesoftheoriginal HINT,but theyare recordedinthesilence,bychildren.Thesestudiesindicated thattheHINTversionforthisagegroupcanbeusedclinically intheassessmentofspeechrecognitioninnoisein individ-uals withdifferenthearing disorders,and alsowiththose withnormalhearing.14---17
Although some studies have applied HINT-Brazil in the childpopulation,5,7,18---20becausethespeechmaterial
devel-opedseekstocontrolthevariablesthatcaninfluencespeech intelligibilityforadultsandchildren,7thesoftwaredoesnot
provide atestversion forthispopulation, asin other lan-guages.Thus,itisfundamentalthatthereareinstruments containingmorecomplextaskstodetectthedifficultiesof speechperceptioninnoiseofschoolagechildren,sincethe learningdisorderscanbeassociatedwithdifficultiesof audi-toryprocessingintheclassroom.
Therefore,itisnecessarytoelaborateevaluation proto-colsthataim toanalyzetheperformanceofchildrenwith nohearingimpairmentinlinguistictasksinthepresenceof noise,sothatthenormalitythresholds canbeestablished andusedintheevaluationofchildrenwithbothperipheral andcentralhearingdisorders.
Thus,theobjectiveofthisstudyistoevaluatethe per-formanceofnormal-hearingchildrenbetweentheagesof8 and10inthetasksofspeechrecognition,insilentsettings andinnoise,usingHINTtest,consideringtheagegroupand thefemaleandmalegenders.
Methods
This work is a descriptive, observational, cross-sectional, prospective study developed at the Institution where the research was carried out. It was approved by the Ethics Committeeunderno.785723.
Atotalof60schoolchildrenwereevaluated,ofwhich32 werefemale and28were male,withagesranging from8 to10years,fromElementarySchooloftheMunicipalSchool Network.
Thesubjectsweredividedintothreegroups:22children aged8yearsinGroupI,18childrenaged9yearsinGroupII, and20childrenaged10yearsinGroupIII.Datacollection wascarriedoutfromAugust2014toJanuary2016.
Initiallythechildrenwereselectedthrougha question-naire answered by the pedagogical team of the selected schools.Thequestionnaireconsistedofquestionsregarding theschoolperformanceofeachstudent,theirattentionand behavior,andthepresenceofevidenceofhearing difficul-ties in the child. The questionnaires were analyzed, and onlythechildrenwithadequateschoolperformance,good behavior,whowereattentiveandhadnoevidenceof audi-toryalterationswereselected.
Next,atelephonecontactwasmadewiththeparentsor guardiansofeachchild,forexplainingtheproceduresthat wouldbeperformed,thevoluntarynatureoftheresearch, theobjectivesofthestudy,andtheabsenceofhealthrisk. Thosewhoagreedwereinvitedtogototheplaceof data collectionwiththechild.Onthescheduled date,the per-sonresponsiblefor thechildsignedtheFreeandInformed ConsentForm.
Inclusioncriteriawere:agerangeof8---10years,tobea studentinthepublicschoolsystem,nottohavedifficulties atschool,nottohavecomplaintsand/orhearingproblems, andtohavenormalresultsintheBasicAudiological Assess-mentandtheDichoticDigitTest.
As exclusioncriteria, thefollowing wasconsidered: to have difficulties at school, to have speech and hearing complaints, to have a history of otitis, to be on the use of psychoactive drugs, to present hearing loss or unilat-eral or bilateral alterations of the auditory structure or functionandtohavemental,neurological,and/orgenetic syndromes.
Thefollowingprocedureswereperformed:
Anamnesis:carriedoutwithparentssothatchildrenwith hearing loss and/or a history of recurrent otitis media, childrenwhohadalreadyundergonespeechtherapy,and possibleothercomplaintssuchasinattentionand difficul-tiesinorallanguageacquisition,readingandwritingwere excludedfromthestudy.
Meatoscopy:allowedtoobservethepresenceofobstacles totheperformanceofthetest;
BasicAudiologicalEvaluation:consistingofthetests:pure toneaudiometry,Logoaudiometry,Immittanciometry. Dichotic Digits Test: The Free Attention stage of this test wasusedas a procedure for screening theauditory processing, as it allows for evaluation of the figure-background ability for verbal sounds through binaural integration.21
HINT-Brazil test: Children who had results within the parameters of normality for the performed procedures werereferredfortheHINTtest,inthesituationwith head-phones.
TheHINTtestkitcontainstheHearingTestDevice(HTD) microprocessor,version7.2,manufacturedin2003,by Bio-Logic System Corp. and developed by HEI’s Laboratory of HearingDevicesResearchoftheScienceandHuman Commu-nicationDepartment. This equipmentcontains a software thatconductsthetestprocesswiththesentencesrecorded, andtheconcurrentnoise ofthewhitenoise type.TDH 39 headphoneswereused.
HINTconsistsofdigitallyrecordedsentences,whichcan bepresentedinsilenceornoise,withheadphonesor speak-ers,inafreefield.EachHINT-Braziltestlisthas20sentences andthetestadministrationtimevariesfrom8to10min.
Sentences arepresented by a malespeaker, in silence andnoise;assuggestedby Bevilacqua,12 inthestudy that
performed the standardization of the Brazilian version of HINT,thenoiseisfixedat 65dB(A),andthespeechsignal intensityvariesaccordingtotherepetitions,thatis,ateach correctanswertheintensity ofthespeechdecreases, and ateacherrortheintensityincreases.
The initial speechintensity is 65dB(A), i.e., Signal to Noise Ratio (S/N=0); during the presentation of the first foursentences,variationsof4in4dB(A)occur,whichallows theestimationofthesubject’sthreshold.Fromthefifth sen-tence,thevariationbecomes2by2dB(A),andthethreshold ofeachtestconditionisdetermined,afterthepresentation ofthe20sentencesoftheselectedlist.22
Fourlistswereselected,outof12containedinthe HINT-Brazilmaterial.Theorderof presentationofthelists was fixedforallchildren.
ThesoftwareallowedthedeterminationoftheSeRT,in dB,inthecondition:SpeechinSilence(SS):Italsoallowed thedeterminationofthelowestSpeech/Noise(S/N)ratioin whichthesubjectcorrectlyrepeated50%ofthesentences presented,in thefollowing conditions:frontalnoise (FN); noisetotheright(RN);noisetotheleft(LN).
Eachofthesetestconditionscorrespondstoaparticular situationofsilenceornoiseasindicatedinFig.1.
Thetestsperformedwithheadphonesarepresentedwith adigitalfiltering,whichsimulatestheconditionsand char-acteristicsrelated tothepositionof the head thatwould occurinthetestscarriedoutinfreefield.23
At the beginning of the test, the students were asked torepeatthesentencestheyheard,evenifincompleteor incorrect.The sentence should be precisely repeated, to beconsideredcorrect;however,smallsubstitutionsinverbs and articles, for example, were allowed, as directed by Nilsson.11
ThestrategyusedallowedthedeterminationoftheS/N ratioineachtestcondition.Attheend,thesoftware com-putedtheCompositeNoise(CN),whichistheweightedmean of the S/N ratio in the three noise conditions, from the formulaCN=(2×FN+RN+LN)/4.
Dataweretabulated,and thefollowingstatistical ana-lyzes were carried out: comparison between genders; comparisonbetween ages;comparison between the right andleftears.
Statisticalanalysisofthecollecteddatawasperformed usingthesoftware‘‘TheSASSystemforWindows’’,version 9.4.Asignificancelevelof0.05(5%)wasadoptedand indi-catedbyanasterisk (*)inthe results.Mann---Whitneytest wasusedtocomparetheresultsbetweengenders,andthe Kruskal---Wallistestwasusedtocomparetheresultsbetween ages;thecomparisonoftheresultsbetweenright/leftears wasthroughVarianceAnalysis(ANOVA)forrepeated meas-ures.
Results
We present the results obtained in the HINT-Brazil test, regardingSeRT,undertheconditionstested,comparingthe valuesobtainedinrelationtothevariablesgenderandage andears.Table1showsthecharacterizationofthesample, accordingtothethreeagegroupsandmaleandfemale gen-ders.Therewasnostatisticallysignificantdifferenceforthe samplenumberconsideringthemaleandfemalegenders.
Table2showsthevaluesofmeanandSDoftheS/Nratio, ofthemaleandfemalegenders,regardless ofage,inthe testconditionsofSN,FN,RNandLN,andCN.Theresultsdo notindicateastatisticallysignificantdifferenceinrelation tothisvariable.
Test Condition Silence
Frontal Noise
Speech + Noise with Head Shadow Effect
Speech + Noise with no Head Shadow Effect Speech
Speech + Noise Speech + Noise Speech
Test Signal sent to the LE Test Signal sent to the RE
Noise to the Right
Noise to the Left Speech + Noise with no Head Shadow Effect
Speech + Noise with Head Shadow Effect
Figure1 Testconditionswiththeuseofheadphones.
Table1 Samplecharacterization,accordingtotheagegroupandgender.
8years 9years 10years Total p-Value
Male 9 9 10 28 0.5552a
Female 13 9 10 32
Total 22 18 20 60
aKruskal---Wallistest.
Table2 Maleandfemalechildren,accordingtotheperformanceonSS,FN,RNandLNtestconditionsandinCN.
S/Nratio Female Male p-Value
n Mean SD n Mean SD SS 32 22.07 3.18 28 23.00 2.86 0.2859a FN 32 −2.74 0.83 28 −2.47 1.20 0.3425a RN 32 −8.80 1.64 28 −8.17 2.21 0.1519b LN 32 −8.73 1.93 28 −7.89 2.51 CN 32 −5.75 1.00 28 −5.27 1.40 0.1380b
n,samplenumber;SD,standarddeviation;SS,SpeechinSilence;FN,frontalnoise;RN,noisetotheright;LN,noisetotheleft;CN, compositenoise.
aMann---Whitneytest.
b ANOVAcomparisonforrepeatedmeasures.
Table3 Childreninthe8-,9-and10-yearagegroup,accordingtotheirperformanceintheSS,FN,RNandLNtestconditions, andCN.
S/Nratio 8years 9years 10years p-Value
n Mean SD n Mean SD n Mean SD
SS 22 22.97 2.82 18 23.09 3.32 20 21.46 2.90 0.2332a FN 22 −2.09 1.09 18 −2.82 0.74 20 −3.01 0.95 0.0078(8>10)a RN 22 −7.64 1.72 18 −8.49 2.24 20 −9.47 1.43 0.0048 (8>10)b LN 22 −7.53 2.80 18 −8.41 1.75 20 −9.16 1.65 CN 22 −4.86 1.31 18 −5.63 1.02 20 −6.16 0.91 0.0035(8>10)a
n,samplenumber;SD,standarddeviation;SS,SpeechinSilence;FN,frontalnoise;RN,noisetotheright;LN,noisetotheleft;CN, compositenoise.
aKruskal---Wallistest.
b ANOVAcomparisonforrepeatedmeasures.
Table3showsthemeanandSDvaluesoftheS/Nratio, ages8, 9 and 10 years, regardless of gender, in the test conditionsSN,FN,RN,andLN,andCN.Theresultspointto astatisticallysignificantdifferenceforthenoiseconditions,
andforCNcalculation, regardingthecomparisonbetween theagesof8and10years.
Fig.2shows themean andSDvalues ofthe S/Nratio, ages8,9 and10years,regardless ofgender, innoise and
-2.82 -8.49 -8.41 -5.63 9 years FN RN LN CN -2.09 -7.64 -7.53 -4.86 -12 -10 -8 -6 -4 -2 0 Mean 8 years -3.01 -9.47 -9.16 -6.16 10 years
Figure2 Childrenof8-,9-and10-yearsagegroups,accordingtotheirperformanceintheSS,FN,RNandLNtestconditions,and CN.
CNconditions.LowervaluesoftheS/Nratioindicatebetter performance.
Table4presentsthegeneraldescriptiveanalysisof the study, withthe values of mean, median, standard devia-tion(SD),S/Nratiominimumandmaximum, foreachtest condition andfor thecalculated CN,regardlessof gender and age. There was no statistically significant difference between theears in the comparisonbetween the RN and LNtestconditions.
Discussion
HINT is a test that aims to analyze the auditory closure ability, by means of sentences, andtherefore it was cho-sen to be the instrument of evaluation of this study. It wasperformedinanacousticallytreatedenvironmentwith headphones.Theuseofheadphonesallowsavirtualsound fieldtobecreated,wherethehearingofbothearscanbe evaluatedsimultaneouslyandseparately;inaddition,it pre-ventserrorsintheresultsduetotheevaluatedperson’shead involuntarymovements.11
Thesampleconsistedof60individuals,32femalesand28 males,thusbeinghomogeneousintermsofgender(Table1). When analyzing the results withrespecttothe female andmalegender,therewasnostatisticallysignificant dif-ferenceinanyofthetestsituationsorintheCN(Table2).
The Brazilianstudythatcontainednormal-hearing chil-dren in the sample didnot present information regarding gender,7 therefore itcouldnotanalyzeiftherewasa
dif-ferenceforthisvariable.Sbompatoetal.,inastudywith apopulationofadults,andthataimedatthe standardiza-tionofHINT-Brazilforthispopulation,aswellasthepresent research,didnotfindsignificantdifferencesastogender.24
The studiesbyJerger,25 Garcia26 andcollaborators
ana-lyzedthespeechrecognitionin thenoisethroughthetest of sentence recognition with competitive message called PSI;again,bothstudies didnotfindsignificant differences betweengenders.
Thus,despitethescarcityofstudiesinthenational lit-eraturewiththesamecharacteristicsofthisresearch,the studies that were found confirm the absence of interfer-enceofthegendervariableintheresponsesofindividuals inspeechrecognitiontasksinnoise.
Regarding the age group, the sample wasdivided into threegroups,of8,9and10yearsold,with22individuals inthe 8-year age group, 18 in the 9-year age group,and 20inthe10-yearagegroup.Themeanagewas8.97years (±0.84).
Weconsideritimportanttoanalyzethisagegroupsince itis thecrucial age for the developmentof school skills, andbecausetheirhearingabilitiesarealreadyassessable. According to American Speech-Language-Hearing Associa-tion(ASHA),due tothe greatvariability in theresults, it isrecommendedthatthetestsusedforauditoryprocessing arenotadministeredinchildrenunder7yearsofage.27
When comparing the results regarding age group, in the SS test condition (Table 3) the differences presented betweenthegroupswerenotstatisticallysignificant. How-ever,consideringthecomparisonoftheresultsregardingthe agegroupinthetestconditionsofFN,RN andLN, aswell asinCN,thedifferencepresentedwasstatistically signifi-cantwhencomparingtheagegroupsof8and10years,with the8-year-oldgrouphavinganaverageofS/Nratiohigher thanthe10-yeargroupindividuals, i.e.,theyhadaworse performance(Table3).
ACanadian studyofthe applicationof HINTinFrench, withasampleof70children,found avariationintheS/N ratiointheconditionwithnoiseamongtheagegroups,with thedecreaseofSeRTbeingstatisticallysignificantaccording toageincrease.14
Thesefindingsareinagreementwiththoseobtainedina studythatevaluated,inchildrenaged8---10years,withand withoutschooldifficulties, theprocessingofcertain audi-toryabilities,amongthemspeechrecognitioninnoise.The study obtained theimprovement of the answers withthe increaseof age, withthisimprovement beingstatistically significantfortheagegroupof10years,incomparisonwith theage group of8 years;the authorsconsidered the age groupof9asatransitionage,resemblingeitherthe8-year agegrouporthe10-yearagegroup.25
Myhrum et al. stated that the children population has morelimited vocabulary, and less knowledge of language rules compared to adults; thus, children tend to present greaterdifficultyinunderstandinglanguagesigns,especially whenthesearesentences.15
Boyd and Bee28 stated that the reticular formation,
pro-Table4 Mean,median,standarddeviation,minimumandmaximumfortheSS,FN,RNandLNtestconditions,andCN.
S/Nratio n Mean Median SD Minimum Maximum
SS 60 22.5 22.4 3.05 15.10 30.50
FN 60 −2.61 −2.75 1.02 −4.8 0.80
RN 60 −8.51 −8.80 1.94 −11.90 −2.10
LN 60 −8.34 −8.40 2.24 −12.80 1.20
CN 60 −5.53 −5.70 1.22 −7.60 −1.40
p-ValueRN×LN=0.2670(ANOVAcomparisonforrepeatedmeasures).
SeRT,SentenceRecognitionThreshold;n,samplenumber;SD,standarddeviation;SS,SpeechinSilence;FN,frontalnoise;RN,noiseto theright;LN,noisetotheleft;CN,compositenoise.
cesses,hasitsmyelinationstarted duringthefirst2 years oflife,butthisprocesscontinuesthroughoutchildhoodand adolescence,andiscompletedonlyaround20years.Since theprocessesofchoosingtheimportantsoundmessageto thedetrimentofanotherareregulatedbyattention,itcan bestatedthattheperformanceintheClosuretaskis gradu-allyimprovedwiththeincreaseofage,andthattheability ofspeechrecognitioninthenoiseisbasedinthe function-ingofauditorypathwaysthatdependonmaturationofthe pathways.1
According to studies performed at the HEI, for HINT speechmaterialsinAmericanEnglish,every1dBincreasein SeRTcorrespondstoabout10%poorerintelligibilityinnoisy listeningconditions.23
Thus,wethensuggestthevaluesofmeanandSDofthe S/Nratio,forthenoisetestconditionsandtheCN, consid-eringtheagesof8,9and10years(Table3).
Finally,Table4showsthevaluesforthegeneralmean, regardlessofageorgender,inalltestsituations.
RegardingtheFNtestcondition,thetotalmeanS/Nratio was-2.61.Thisvalueishigherwhencomparedto−6.5found inanAmericanstudyaboutHINT-Brazilinyoungadults29and
alsotothevalueof−4.6foundintheBrazilianPortuguese HINT,12astandardizationstudyofHINTalsoinadults.These
studiesareinlinewiththefindingsbyVaillancourtetal.,14
whoseanalysisdemonstratedthatSeRTreachesadultvalues onlyinolderchildren.RegardingthefindingsofaNorwegian studywith children,however, mean valuesbetween −0.3 and−3.3were obtained inthe FNcondition,15 coinciding
withourfindings.
Regarding CN, this was obtained by calculating CN=(2×FN+RN+LN)/4. This calculation equalizes the contribution of the FN and the two lateral tests (RN and LN), thus providing a single general index of speech recognitioninnoisyenvironments.23
CN overall mean, obtained in the present study, was −5.53 (Table 4). Again, comparing with the findings of theNorwegian study,valuesbetween−5.7and−9.7were obtained, that is, Norwegian children had better perfor-manceunderthe conditionsevaluated.15 These variations
mayberelatedtothedifferencebetweentheagegroupsof thetwostudies,sincetheinternational researchwas car-ried out with children between 6 and 13 years old, thus integratingchildren upto3 yearsolder thanthose inthe currentresearch;inaddition,theaforementionedstudywas performedinafreefield,thatis,indifferentlistening con-ditions.
Considering the conditions in which auditory closure ability was evaluated as a dichotic task, in RN and LN test situations general mean values of −8.51 and −8.34 were obtained,respectively, in our study; however,there is no statistically significant difference between the ears (Table 4). Similarly, another study alsodid not observe a differencebetween theears whenapplyingHINT-Brazil in normal-hearingchildreninafreefield.7
Arecentstudythatsoughttoestablishstandardsof nor-mality for young adults in HINT-Brazil obtained values of −12.1and−12.2forRNandLN,respectively,valuesthatare lowerthanthoseobtainedinthisstudy,becausethesample hadsubjectsin theagerangebetween18 and50years.12
This fact is in agreement withthe statement by Myhrum et al. that the values obtained for speechrecognition in noiseinchildrenarefurtherawayfromvaluesobtainedin adults,especiallyintasksthatrequirelateralization.15
Finally,thisstudymayprovethatHINT-Braziltestisa sim-pleandrapidtest,anddoesnotposedifficultiesforitsuse withnormal-hearingchildrenwithnocomplaintsatschool; thechildrenwereattentive andwillingtoperformwell in thetest,whichmadeHINTanattractiveandeasytoapply instrument.Inaddition,theresultsthat donotindicatea statistically significant differencebetweenthe gendersor betweentheearsshowthatitisaneffectivetesttobeused withtheagegroupevaluated.
Therefore, it is important that new research evaluat-ing the closure ability, using theHINT test in children, is performed,sothattheresultscanbecompared.
Conclusion
Basedontheresultsofthisresearch,inwhichHINTtestwas appliedto60normal-hearingschoolchildrenaged8,9and 10years,thefollowingconclusionswereobtained:
- No statistically significant differences were observed regardingHINTresults andthe variablessideof theear andfemaleandmalegender;
- The8-yearagegrouppresentedastatisticallysignificant differencecomparedtothe10-yearagegroup,withthe latter showing better performance than the 8-year age group,for both noise andCN situations;the 9-year age group did not show a statistically significant difference comparedtothe8-and 10-yearage groups,in anytest condition,norforCN;
- Wesuggest the valuesof meanand SDof theS/N ratio obtained, considering the age groups: 8 years --- FN: −2.09(±1.09); RN: −7.64 (±1.72); LN: −7.53(±2.80); RN: −4.86 (±1.31); 9 years --- FN: −2.82 (±0.74); RN: −8.49(±2.24); LN: −8.41(±1.75); CN:−5.63(±1.02); 10 years--- FN:−3.01 (±0.95); RN: −9.47 (±1.43); LN: −9.16(±1.65);CN:−6.16(±0.91).
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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