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Development and Validation of the Pediatric AzBio Sentence Lists

Spahr, Anthony J.1,2,3; Dorman, Michael F.2; Litvak, Leonid M.1; Cook, Sarah J.2; Loiselle, Louise M.2; DeJong, Melissa D.4; Hedley-Williams, Andrea3; Sunderhaus, Linsey S.3; Hayes, Catherine A.3; Gifford, René H.3

doi: 10.1097/AUD.0000000000000031
Research Articles

Objectives: The goal of this study was to create and validate a new set of sentence lists that could be used to evaluate the speech-perception abilities of listeners with hearing loss in cases where adult materials are inappropriate due to difficulty level or content. The authors aimed to generate a large number of sentence lists with an equivalent level of difficulty for the evaluation of performance over time and across conditions.

Design: The original Pediatric AzBio sentence corpus included 450 sentences recorded from one female talker. All sentences included in the corpus were successfully repeated by kindergarten and first-grade students with normal hearing. The mean intelligibility of each sentence was estimated by processing each sentence through a cochlear implant simulation and calculating the mean percent correct score achieved by 15 normal-hearing listeners. After sorting sentences by mean percent correct scores, 320 sentences were assigned to 16 lists of equivalent difficulty. List equivalency was then validated by presenting all sentence lists, in a novel random order, to adults and children with hearing loss. A final-validation stage examined single-list comparisons from adult and pediatric listeners tested in research or clinical settings.

Results: The results of the simulation study allowed for the creation of 16 lists of 20 sentences. The average intelligibility of each list ranged from 78.4 to 78.7%. List equivalency was then validated, when the results of 16 adult cochlear implant users and 9 pediatric hearing aid and cochlear implant users revealed no significant differences across lists. The binomial distribution model was used to account for the inherent variability observed in the lists. This model was also used to generate 95% confidence intervals for one and two list comparisons. A retrospective analysis of 361 instances from 78 adult cochlear implant users and 48 instances from 36 pediatric cochlear implant users revealed that the 95% confidence intervals derived from the model captured 94% of all responses (385 of 409).

Conclusions: The cochlear implant simulation was shown to be an effective method for estimating the intelligibility of individual sentences for use in the evaluation of cochlear implant users. Furthermore, the method used for constructing equivalent sentence lists and estimating the inherent variability of the materials has also been validated. Thus, the AzBio Pediatric Sentence Lists are equivalent and appropriate for the assessment of speech-understanding abilities of children with hearing loss as well as adults for whom performance on AzBio sentences is near the floor.

The Pediatric AzBio sentence lists were developed specifically for the evaluation of children with hearing loss or in cases where adult materials are inappropriate due to difficulty level or content. This article describes the process used to create and validate age-appropriateness and equivalency of these sentence lists. After validation, the process yielded 16 equivalent lists of 20 sentences. The binomial distribution model was used to estimate the inherent variability of the lists and to construct 95% confidence intervals to identify significant differences in performance based on one and two list comparisons. A retrospective analysis of research data confirmed the accuracy of the model and inherent variability of the materials.

1Department of Research and Technology, Advanced Bionics Corporation, Valencia, California, USA; 2Department of Speech and Hearing Sciences, Arizona State University, Tempe, Arizona, USA; 3Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee, USA; and 4Mayo Clinic, Rochester, Minnesota, USA.

The authors declare no other conflict of interest.

Address for correspondence: Anthony J. Spahr, Advanced Bionics Corporation, 28515 Westinghouse Place, Valencia, CA 91355, USA. E-mail:

Received March 19, 2013; accepted December 2, 2013.

© 2014 by Lippincott Williams & Wilkins