Phonak

Field Study News .

Roger Focus II; A solution for
Auditory Processing Deficits

Despite having normal pure tone thresholds, students with Auditory

Processing Deficits (AP deficits) are particularly disadvantaged by the
rarely ideal listening conditions in many classrooms.1,2 The most
common manifestation of AP deficits is difficulty understanding
speech in noise or reverberation, but many also report distractibility
as a primary concern.3 For children with AP deficits, Roger Focus II
can significantly improve speech intelligibility and auditory attention
skills.
November 2022: Jodie Nelson and Lucy Shiels

Key highlights Considerations for practice

• Roger Focus II can help children with AP deficits even
in quiet classrooms. They can be seated 5m away and
still hear the teacher thanks to Roger Focus II.
• When using Roger Focus II, children with AP deficits
have significantly greater access to the teacher's
speech than their peers do when seated at a distance
in a noisy classroom.
(5m, -10 dB SNR; peers not using Roger Focus II).
• Roger Focus II significantly improves auditory
attention and sustained auditory attention skills for
children with AP deficits.
• Consider a Roger solution incorporating Roger Focus
II and a Roger microphone as an intervention for
children with AP deficits and listening difficulties.
• Many children with AP deficits present to audiologists
with attention challenges. Roger Focus II should be
considered an appropriate intervention for addressing
these common concerns.
• Promote full access to peer speech and environmental
sounds by fitting the smallest dome that the child
considers to be comfortable and non-occluding.
Introduction
Too often, noise and reverberation levels fail to meet
acoustic recommendations in school classrooms.1,2 While
poor listening conditions can negatively impact learning
outcomes for all students, children with AP deficits are
particularly vulnerable to missing important teacher
instructions. These children most frequently present to
audiologists with difficulties understanding speech in noisy
environments. Other common concerns include difficulty
following rapid speech, requiring excessive repetition of
instructions, inattentiveness, and diminished academic
performance.2
The use of Remote Microphone Technology (RMT) is one way
to enhance the listening environment for children with AP
deficits. Multiple assistive benefits from RMT have been
previously documented in the literature. Studies have
measured speech perception gains in quiet and spatially
separated noise,5,6 and questionnaires have indicated
improvements in classroom listening, on-task behaviors,
following instructions, academic outcomes, and
attentiveness.3,7,8 While changes in attention are often
reported clinically, the effect of RMT during use (i.e., when
wearing the devices) on attention skills has not previously
been investigated. A study undertaken at the University of
Melbourne, Australia, in 2020-2022 investigated the effect
of RMT use on speech intelligibility, auditory attention and
visual attention skills in children with AP deficits and
compared performance to that of children with no reported
listening concerns.
The RMT used included Phonak Roger Focus II paired with
the Phonak Roger Touchscreen Mic (TSM). Roger Focus II is
the latest ear-level receiver which, when paired with a
Roger microphone, can dramatically improve signal-to-noise
ratio (SNR) and enhance speech intelligibility in many
environments for people with normal hearing.
Methodology
Participant selection
Two groups of children were included in this study: an AP
deficit group and a control group. When considering the AP
deficit group, children falling two or more standard
deviations below the mean on a measure of an AP skill is
considered as having an AP deficit and therefore eligible to
participate in this study. Other inclusion criteria for both
groups were: normal pure-tone hearing thresholds, normal
middle ear function bilaterally, no neurodevelopmental
diagnoses or learning disabilities, and English as their
primary language.
Phonak Field Study News. Roger Focus II; A solution for Auditory Processing Deficits
Twenty-eight of the children (17 males) with AP deficits
were recruited through the University of Melbourne
Audiology Clinic following a participation in an AP
assessment using the selection criteria mentioned. The other
ten children (5 males) were recruited as controls and had no
parent-reported listening concerns.
Device fitting
Roger Focus II-312 devices were fit to both ears coupled to
an appropriately sized SDS 4.0 SlimTube and either a small
open or cap dome, based on feedback and observation of
comfort and retention. All children wore the devices during
behavioral testing sessions. The AP deficit group took the
devices home for a 2-week school-based trial between the
two sessions.
Loudness comfort
Prior to testing, a 5-point Likert scale, Figure 1, was used to
ensure that each participant was comfortable with the
loudness of their Roger solution. EasyGain was adjusted on
each RFII until the participant stated that the loudness of
live voice speech in quiet was “Just right”.
Figure 1. Likert scale for loudness comfort
Child questionnaire - classroom listening challenge
The Life-R was used to measure perceived classroom
listening challenges as measured by the student.
This questionnaire quantifies the child’s degree of listening
difficulty in 15 school-based listening scenarios on a 5-point
Likert scale (from always easy – 10 points – to always
difficult – 0 points). The lower the score, the more difficulty
the child reports.
In this study, the Life-R was completed during the first visit
and at the end of a two-week trial using Roger Focus II.
Children were asked to consider listening with Roger Focus II
when completing the Life-R at post-trial.
Speech intelligibility
Testing was completed in a realistic, simulated classroom
environment. All children completed testing with and
without Roger Focus II.
AZ Bio sentences were used as the test material and were
calibrated at 1m (3ft) from the speaker. A Phonak Roger
TSM was suspended 20cm (7.9 inches) below a speaker
located in front of the participant (0° azimuth). Speech
intelligibility for each participant was measured at a
distance of 1.5 and 5m (5 and 16 ft) from the front speaker
2
to represent different seating locations in a typical
classroom (i.e., front, back) (Figure 2). Diffuse noise (four-
talker babble) was played from four speakers in the corners
of the room. The noise was calibrated so that it was the
same dBA level at the participant and at the TSM. At each
distance, an AZ-Bio list was completed in a quiet and a
noise condition. Table 1 shows the resulting SNR in each
condition.

Figure 3. IVA-QS room setup

Results

The full results of this study will be available in the peer

review paper; manuscript in preparation.

The results presented here are for one child from the AP
deficit group, who we will call Meg. Meg’s results reflect the
Figure 2. Room setup for speech intelligibility testing average of the AP deficit group, and these are compared to
the average results of the control group when they were not
using Roger Focus II.
Condition Distance Signal level Noise level SNR at Meg is an 8-year-old who presented to the clinic with
(m) (dBA)* (dBA)** listener’s primarily difficulties concentrating in her classroom. At her
head initial AP assessment, she was identified to have a binaural
Quiet at 1.5m 1.5 65 50 +12 integration deficit, but all other AP test results were within
Noise at 1.5m 1.5 72 65 +5 normal limits.
Quiet at 5m 5 65 50 0
Noise at 5m 5 72 65 -10
Loudness comfort
Table 1: Listening conditions and resulting SNR There was a wide variation in the EasyGain preferences for
* Speech signal calibrated at 1 m from the speaker the AP deficit group, however, the majority (23 out of 28)
** Diffuse 4-talker babble
needed slight or no change to the settings before the
loudness of live speech was rated as being comfortable. Meg
Auditory and visual attention
was one of the children who found the loudness of speech
Measures of auditory and visual attention were obtained
comfortable at the default setting (EasyGain 0).
using the IVA-QS. Test items were presented at 50 dB(A)
calibrated at 5m from the speech speaker and diffuse noise
Speech intelligibility
was provided from four speakers to create an SNR of 0dB. As can be seen in Figure 4, Meg was able to perform the
The participant was seated 5m from the speech speaker. See
speech intelligibility task at a level that was comparable to
Figure 3 for the IVA-QS room setup. her peers when sitting 1.5m from the speaker in a relatively
During the IVA-QS testing, participants were required to quiet environment. It would appear in this situation that her
click a computer mouse when a number “one” was seen or listening difficulties were not hindering her performance.
heard but ignore any number “two” stimuli for a period of 8 However, when she was moved further away (5m), her
minutes. This test provides information on 5 subscales: full performance dropped to 59%. When using Roger Focus II,
scale, auditory, visual, sustained auditory and sustained she was able to access the target speech and complete this
visual attention. task at her maximum performance level, demonstrating the
benefit of Roger even in relatively quiet classrooms. As her

Phonak Field Study News. Roger Focus II; A solution for Auditory Processing Deficits 3
result reflects the average for the AP deficit group, this Perhaps less expected was the additional benefits for Meg’s
benefit can also be applied to other children with AP visual attention and sustained visual attention. Excitingly,
deficits. the changes in Meg’s auditory and visual attention were
large enough to drive scores into the normal range.
Now let’s move into a more typical classroom where
listening conditions are rarely ideal.1,2 As soon as more noise Typical teaching styles utilise both visual and auditory
was introduced, Meg’s speech intelligibility decreased to the strategies, and students often require multi-modal focus.
point where she was only able to identify 12% of the words The current results suggest that minimizing the level of
correctly at 5m. This isn’t surprising as we know that noise energy required to focus on teacher instructions may allow
degrades speech intelligibility and children with AP deficits for more cognitive resources to be allocated to visual
are impacted significantly in noisy settings.3 concentration.
When Meg was using the Roger Focus II, her access to the
teacher’s speech improved to the point where her speech
intelligibility was comparable to her peers (1.5m in quiet
and noise) or she out-performed her peers (5m in quiet and
noise). One could imagine that these more challenging SNRs
are quite realistic in places like school assemblies, sports
activities in a school hall or outside on a sporting field, or
even during noisy classroom activities and excursions.

Figure 5. Mean IVQ-AS Standard score; Meg with and without Roger vs. control
without Roger. The shaded area indicates the normal range for attention scores
(70 – 130).

Child questionnaires – Perceived listening challenges

Results from Meg’s initial LIFE-R (Figure 6) shows that she
believed she had significant difficulties in the classroom,
and other school listening scenarios. When using the Roger
Figure 4. Speech intelligibility at various SNRs
solution, her LIFE-R scores improved significantly, but she
still perceived greater difficulties than her normal-listening
Auditory and visual attention
peers. Interestingly, Meg rated her challenges as more severe
As is typical for many children with AP deficits, Meg
than the overall AP deficit group who had mean LIFE-R
presented to her initial assessment with main concerns of
scores of 60.05 at pre-trial, improving to 98.36 at post-trial.
distractibility and difficulties maintaining focus on her
This may have been due to the subjective nature of the
teacher in class. Despite these concerns, Meg scored within
questionnaire, or that two weeks was not long enough for
normal limits on an attention test in quiet and was recruited
Meg to adapt to device use. This emphasizes the importance
into the study instead with a binaural integration deficit.
of a school-based trial when considering Roger solutions for
However, as seen in figure 5, completion of the same
children with AP deficits.
attention task in a simulated classroom environment
(distance of 5m in 0dB SNR) significantly impacted Meg’s
ability to focus. Her auditory and visual scores were below
normal limits and much poorer than the average abilities of
her peers who completed the task in the same simulated
classroom condition.
The introduction of Roger Focus II positively impacted Meg’s
attention. By overcoming the negative effects of noise and
distance, the device led to an increase in her ability to
attend to and maintain focus on the auditory targets.

Phonak Field Study News. Roger Focus II; A solution for Auditory Processing Deficits 4

Figure 6. LIFE-R pre-study, after study and control.
Discussion and implications for practice
These conclusions have been made based on the results of
all children in the study which will be provided in the peer
reviewed paper, manuscript in preparation. The results for
Meg reflect those for the average of the AP deficit group.
This study shows that using Roger Focus II combined with a
Roger microphone such as the Touchscreen Mic is an
effective way to modify the environment for children with
AP deficits and therefore should be considered as an option
for these children.
Not only does Roger Focus II improve access to the teacher’s
voice and speech intelligibility, the results also clearly
highlight additional benefits for auditory attention. Children
with AP deficits in this study were able to perform the
auditory and visual attention tasks within normal limits
when they were using Roger Focus II paired with a TSM.
The case study described highlights the importance of
conducting a trial of Roger Focus II in the child’s usual
classroom setting. Although objective benefits are likely to
be obtained by all children with AP deficits, real-world
outcomes may differ amongst individuals and should be
documented using questionnaires.
Findings of the study have important implications on
management of AP deficits. Roger Focus II should be
considered as a viable option for children with AP Deficits
who present with difficulties in the area of speech
discrimination in noise, attention challenges, or a
combination of these.
References
1. Lagacé, J., Jutras, B., & Gagné, J. P. (2010). Auditory
Processing Disorder and Speech Perception Problems in
Noise: Finding the Underlying Origin. American Journal
of Audiology, 19(1), 17-25.
https://doi.org/10.1044/1059-0889(2010/09-0022)
Phonak Field Study News. Roger Focus II; A solution for Auditory Processing Deficits
2. Howard, C. S., Munro, K. J., & Plack, C. J. (2010).
Listening effort at signal-to-noise ratios that are typical
of the school classroom. International Journal of
Audiology, 49(12), 928-932.
https://doi.org/10.3109/14992027.2010.520036 (AAA,
2010).
3. American Academy of Audiology. (2010). American
Academy of Audiology clinical practice guidelines.
Diagnosis, treatment and management of children and
adults with central auditory processing disorder. Reston,
VA. American Academy of Audiology. https://audiology-
web.s3.amazonaws.com/migrated/CAP
DEFICITS%20Guidelines%208-
2010.pdf_539952af956c79.73897613.pdf
4. American Speech-Language-Hearing Association (2005).
(Central) auditory processing disorders. Technical report.
Rockville, MD. American Speech-Language-Hearing
Association. https://www.asha.org/practice-
portal/clinical-topics/central-auditory-processing-
disorder/
5. Johnston, K. N., John, A. B., Kreisman, N. V., Hall, J. W.,
III, & Crandell, C. C. (2009). Multiple benefits of personal
FM system use by children with auditory processing
disorder (AP DEFICITS). International Journal of
Audiology, 48(6), 371-383.
https://doi.org/10.1080/14992020802687516
6. Smart, J. L., Purdy, S. C., & Kelly, A. S. (2018). Impact of
Personal Frequency Modulation Systems on Behavioral
and Cortical Auditory Evoked Potential Measures of
Auditory Processing and Classroom Listening in School-
Aged Children with Auditory Processing Disorder.
Journal of the American Academy of Audiology, 29(7),
568-586. https://doi.org/10.3766/jaaa.16074
7. Friederichs, E., & Friederichs, P. (2005).
Electrophysiologic and PsychoAcoustic Findings
Following One-Year Application of a Personal Ear-Level
FM Device in Children with Attention Deficit and
Suspected Central Auditory Processing Disorder. Journal
of Educational Audiology, 12, 31-36.
8. Stavrinos, G., Iliadou, V., Pavlou, M., & Bamiou, D.
(2020). Remote Microphone Hearing Aid Use Improves
Classroom Listening, Without Adverse Effects on Spatial
Listening and Attention Skills, in Children With Auditory
Processing Disorder: A Randomised Controlled Trial.
Frontiers in neuroscience,
https://doi.org/10.3389/fnins.2020.00904
Authors and Investigators
Researcher and Co-author
Lucy Shiels, PhD
Pediatric Audiologist, University of Melbourne, Australia
5
 Lucy Shiels is a paediatric audiologist
and PhD candidate at the University of
Melbourne in Australia. Her current
role in the Autism Listening Clinic
involves the assessment and
management of listening difficulties
in children with autism spectrum disorder. Lucy’s PhD is
focused on investigating the benefits of remote microphone
technology use in children with attention and listening
difficulties.

Principal investigator
Gary Rance, PhD
Audiologist, University of Melbourne, Australia

Gary Rance is an audiologist, clinical

researcher and Professor at the
University of Melbourne where he
holds the Graeme Clark Chair in
Audiology and Speech Science.
His research areas include auditory
evoked potentials, auditory
neuroscience and the perceptual effects of permanent and
transient hearing loss. He is a leader in the field of auditory
neuropathy (AN) and was responsible for the first
publications to describe this form
of hearing abnormality in newborn babies.

Author
Jodie Nelson,
Global Pediatric Audiology Manager, Phonak HQ,
Switzerland

Jodie Nelson is the Global Phonak

Pediatric Audiology Manager based at
Phonak headquarters in Switzerland. In
her role she ensures that Phonak offers
the highest quality pediatric hearing
solutions for children with all degrees
and types of hearing loss. She works by
the motto ‘every child matters’. Her knowledge is based on
years of clinical experiences while working as a Pediatric
Audiologist and Clinical leader in Australia.

Phonak Field Study News. Roger Focus II; A solution for Auditory Processing Deficits 6