Pediatric Speech Perception in Noise

An acceptable acoustical environment is necessary for effective communication and learning. Children who experience abnormally poor speech perception in noise, including those with normal hearing sensitivity, are at risk for speech and language delay, reading disorders, psychosocial problems, and academic failure. The biological bases of speech perception in noise are complex and include processes at cortical as well as sub-cortical levels of the auditory nervous system. In children, the ability to perceive speech in degraded listening conditions improves significantly with age in parallel with developmental changes in the auditory nervous system. Difficulty in listening to speech in noisy surroundings is a common symptom associated with auditory processing disorders (APD). Clinical assessment of speech perception in noise quantifies potential problems that a child might face in daily listening situations. Optimally, pediatric speech in noise tests are designed to meet minimal psychometric criteria. A speech in noise test should be appropriate for the child's age and native language so as to minimize the role of linguistic factors. A diagnosis of APD should not be made based solely on a speech in noise test but, rather, on a battery of tests, each exploring a different suprathreshold auditory process. Speech in noise tests should be used and interpreted with extreme caution when assessing auditory processing in children with co-existing peripheral hearing loss. Children with normal hearing sensitivity, whose performance on tests using competing acoustic signals is below normal, can benefit from specific intervention and the use of signal enhancing devices such as FM systems.