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Ratchanok Sirichokswad, Pornchai Chanyagorn, Warakorn Charoensuk, Krisana Lertsukprasert, 4Kwanjeera Wanichthanarak, 5Panuthat Boonpramook

International Biomedical Engineering Programme, Mahidol University, Thailand


Department of Electrical Engineering, Faculty of Engineering, Mahidol University, Thailand


Audiology and Speech Clinic, Department of Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand 4 Bioinformatics, School of Bioresources and Technology and the School of Information Technology, KMUTT, Thailand 5 Department of Engineering, KMUTT, Thailand


To improve hearing system in hearing impaired children, the auditory training program has an advantage to improve the listening system. Due to various levels of hearing problem, this research designs an educated media that is appropriate with knowledge, experience and age of hearing impaired children. We select 50 sound effects from surrounding environment. These sounds are tested by eight normal subjects in order to check sound quality. The results of normal listening perception have the mean of correct percentage in corresponding to fifty sound effects up to 81.6%. Then, sound effects are analyzed by Power Spectral Density (PSD) to separate sounds into three groups. These sound groups are applied to design matched visualized images and produce the auditory training program. Moreover, we present word and sentence that are suitable in each sound. It helps hearing impaired children to discriminate sounds and clearly understand meaning of words and sentences.

1. INTRODUCTION The hearing loss can be classified in terms of hard of hearing, deaf and hearing impaired. It may be caused by four types of hearing loss: Conductive (Hearing problem from the outer or middle ear), Sensorineural (Hearing problem from the cochlea or the hearing nerve in the neural part), Mixed and Central hearing loss [1]. Hearing loss can be described by two characteristics of hearing sense: the intensity or loudness (measured in Decibels, dB) and quality or clarity (measured in Hertz). The expected value of pure tone can be classified into the three thresholds at 500, 1000, and 2000 Hz. Generally, Most of technicians use the intensity to classify levels of hearing impairment that can be categorized into six levels: Normal hearing (0-27 dB, nearly 27 dB defining

difficult listen), Slight hearing loss (27-40 dB, nearly 40 dB defining support with hearing aids equipment), Mild hearing loss (40-55 dB,), Moderate hearing loss (55-70 dB), Severe hearing loss and Profound hearing loss (7093 dB) [2]. To cure the hearing-loss problem, hearing aid fitting or cochlear implant is applied in order to restore the hearing capability of the subjects. After hearing aid fitting or cochlear implant, the intensive training in auditory skills must also apply in order to stimulate hearing practice of the impaired hearing especially in children. Hearing impaired children are mostly able to perceive and understand the meaning of sounds after auditory training. The multimedia-program including visual information and sounds of isolated animals, places, things and environment pictures, broad types of sound effects are help these children to improve their access to sounds [3]. Not only they practice to discriminate sounds of objects but they also learn sound-related skills through speech therapy, speech reading and cued speech in order to develop skill of their communication and reading. The advance multimedia software including visual information, natural pitch and rhythm of speeches and sound effects is generate to train auditory system so as to help hearing impaired children to discriminate sounds and understand language [4]. However, it is not easy to develop listening and language for hearing impaired children. It is because that listening and language development in children with hearing loss may be influenced by the severity of hearing loss, age of the hearing loss, the use of hearing aids and auditory training technique. For example, the lip read are mostly used to teach the hearing impaired children to learn language speaking. It does not mean this technique can be used in all hearing problem cases because it may make some children to miss some conversation that less visible phonemes, ambiguous in the lips (p, b, m) or non-face to face conversation. Thus, it is very important for technicians to concern about characteristics of hearing impaired children and common training approaches so that they can choose the appropriate approach to train


The 3rd International Symposium on Biomedical Engineering (ISBME 2008)

hearing impaired children. There are several procedures to teach hearing impaired children to have efficiency in listening, reading and speaking. Some of them include encoding text, decoding text, handwriting, phonetic concepts, speech reading and so on [5, 6, 7]. The objective of this research is to develop the program for the first step to practice and train hearing impaired children to understand the real sounds of the animals, music instrument, household things and environments. We do not generate the program to teach children to encode text or decode text, write sentence or read sentence. It is because that before children can encode text or read sentences, they have to understand natural sound effects and practice to discriminate sounds so as to know where the sound effects are from. Moreover, this program can support hearing impaired children to image picture of each sound. Children will have a chance to learn the suitable sentence that is matched with the verbal word of each sound. It is a good way for hearing impaired children to study the program that provides special sound and visual information in corresponding to their surrounding events. Thus, this program helps them to easily understand the meaning of word and sentence. This research is as a basic step for hearing impaired children to train their listening system. However, they need much practice their hearing system in the next stage in the further advance procedure. Additionally, this task has an emphasis on the beginning to learn the words and sentence by listening of sentence from each event as natural learning. The present work investigates technique for selection of suitable sound effects that is related with the perceptual pitch in hearing impaired children. Moreover, this project designs and creates auditory training program for auditory therapy for skills progression of hearing impaired children. 2. MATERIALS AND METHODS 2.1. Sound Effects Materials

- Sounds caused by many Activities: Children Play, Claps, and Laugh. - Sounds caused by Mechanical devices: Airplane Start, Ambulance Siren, Boat, Fire-Engine Siren, Gunshot, Start Motorbike, Train Station, Firecracker and Rocket. - Sounds occurred in Public Places: Church Bell, Market and Restaurant. 2.2. Listening Process for Investigation of Excellent Sounds

These sound effects are tested for their quality by eight Thai subjects who have normal hearing. These subjects consist of four males and four females, who have age range between 22-27 year olds. All subjects do not have history of ear diseases and hearing impairments. They must answer a screening questionnaire to investigate the factors that lead to select the excellent hearing subjects. Each subject is obtained a brief practice period to investigate sounds. In listening session, the subject listens to each sound from headphone connecting to PC computer. Once the subject hears the sound, she/he must answer the name of the sound in momentally. The testing results are used to calculate the percentage of subject perception. The correct percentage of subject perception can be performed up to 100% in 21 sounds, 87.5% in 12 sounds, 75% in 5 sounds, 62.5% in 6 sounds, 50% in 7 sounds and 37.5% in 2 sounds, so the average value of correctness in percentage of subjects perception corresponding to fifty testing sounds is equal to 81.6%. 2.3. Spectral Analysis

The appropriate sounds are carefully selected in corresponding to each perceptual pitch of hearing in hearing-impaired children. The recorded environmental sounds are considered in the theoretical construction and methodological requirements (detection, identification, recognition, discrimination and similarity rating) [8]. This research uses 50 sound effects which are in digital format [9-14] to test and to design the training program. The sound effects are composed of - Animal Sounds: Bee, Cow, Dog, Frog, Lion, Pig, Bantam, Bird, Cat, Duck, Elephant, Goose and Horse - Environment Sounds: Ocean, Rain, Thunder, Wind and Rock splash. - Sounds of Musical Instruments: Flute, Sax, Drum (Tom), Krub and Ring. - Sounds of Household things and Environment: Close Door, Dingdong, Grand Clock, Vacuum, Open Wine, Scissor, Typing, Cuckoo clock, Glass Break, Phone, Pour Soda, Small Bell, and Open Newspaper.

After inspection of the testing sounds, we classified them into three groups by using the power spectral density [16]: the low, middle and high frequency group. Each sound effect group is constructed the auditory training program. The software program has the menu screen, which consists of the language selection icon, introduction icon, program instruction icon, sound group selection icon and exit program icon and they are shown in Figure 1.

Figure1. The menu screen of program

The 3rd International Symposium on Biomedical Engineering (ISBME 2008)


When user clicks on the program instruction icon in the main screen, the program will present details of how to use the auditory training program. The user can change the language by clicking on the Thai national flag for the Thai language or English national flag for the English language. When clicking on the sound group selection icon, it will show two icons of a beginning-level auditory training icon and an advanced level auditory training icon. The beginning and advanced auditory training have different number of sounds for auditory training. Each image situation in beginning-level auditory training has three sound effects, which are obtained from three frequency groups: low, middle and high frequency groups. Each image situation in advanced-level auditory training however have five or six sound effects, which are selected from the set of sounds classified in three frequency groups of low, middle and high frequency groups. For each image situation, if user clicks on a picture (e.g. Pig picture), the picture will have some movement as well as produce a corresponding sound effect. The developed program also visualizes verbal text of the corresponding object in the picture. The sound can be repeatedly generated by keep clicking on the picture. Then, user clicks on the visualized verbal text. The program will show the sentence of that visual verbal text as well as generate sound of reading of this sentence. This is also the same with the other images showing on the program screen. The sentence and reading sound are designed and made by the Thai and English language specialists as language editorial consultant. The auditory training program developed from this work can be used for training as well as monitoring the progress of improvement in listening skill of hearing impaired children. 3. RESULTS AND DISCUSSION For the sound effect classification task, the fifty sound effects are divided into the low, middle and high frequency group by using the power spectrum density (PSD). PSD of bee sound that is represented in the low frequency group is shown in Figure 2. PSD of elephant sound that is classified as the middle frequency group is shown in Figure 3. PSD of the sound normally occurred in a restaurant, which is in the high frequency group is shown in Figure 4.

Figure 2. The low frequency range of power spectrum density of the bee sound

Figure 3. The middle frequency range of power spectrum density of the elephant sound

Figure 4. The high frequency range of power spectrum density of the sound in the restaurant. The low frequency group consists of Airplane start, Ambulance siren, Bee, Boat, Children play, church bell, Close door, Cow, Dingdong, Dog, Fire-engine siren, Flute, Frog, Grand clock, Gunshot, Lion, Vacuum, Ocean, Open wine, Pig, Rain, Rock splash, Sax, Scissor, Start motorbike, Thunder, Tom, Train station, Typing, Wind sounds. The middle frequency group composes of Bantum, Bird, Cat, Claps, Cuckoo clock, Duck, Elephant, Firecracker, Glass break, Goose, Horse, Krub, Laugh, Market, Phone, Pour soda, Small bell, Strike bowling, Whistle sounds. The high frequency group includes Open newspaper, Restaurant, Ring, Rocket sounds. These sounds are tested by the normal subjects for the inspection of the suitable natural sound effects for using with hearing impaired children. The results of normal listening perception have the average of correctness in percentage equal to 81.6%. This perceptual percentage is not in a range of 90-100% because the normal subjects identified the different sounds with lacking of visualized information. The controlled subjects are also lacking of knowledge and experience in some type of testing sound such as sound generated from some musical instrument. Moreover, some testing sounds are nearly identical, such as the sounds of bee and fly, the sounds of ambulance siren and fire-engine siren. This auditory training program developed by this work is capable of adding more sound effects into its data storage which can help to extend the training of hearing impairment children. The program may also be use in combine with other CAI or computer games in order to have different training


The 3rd International Symposium on Biomedical Engineering (ISBME 2008)

paradigm. The combined program will help the technician to follow up progress of auditory training in hearing impaired children. In additionally, it will be more interesting if there is the real time process for the inspection of immediate hearing response of hearing impaired children. As a result, this auditory training program is as an educated media to help hearing impaired children to discriminate different kinds of sounds in surrounding environment and understand thoroughly the meaning of each sound. This program is as the first step of auditory training program. It supports children to improve their reading of specific word for each sound. Moreover, they also naturally learn to image picture of each sound and make sentence that is suitable for each word. This auditory training software may also be useful for the speech and language improvement in case of delayed speech and language development children Furthermore, to improve hearing impaired children, it is necessary to develop their skills in reading, speaking and writing in the next step of auditory training system. We make a plan to develop this auditory training system that links to practice decoding, encoding and writing of words and sentences. It also includes develop skill of hearing impaired children to speak. 4. CONCLUSION The auditory training program is an educated media that is comprised of the visual information, sound effects of surrounding environment, words and sentence. Testing of the program shows that it is an appropriate CAI for hearing perception adjustment of specific listener. The sound samples are checked by the normal hearing subjects for the increase of excellent pitch and rhythmic in natural sound effects, which lead to be the suitable sound for the hearing impaired children. The sentence of each word is made by the special language consultant. Thus, this program helps technician to train auditory system in hearing impaired children. It can help children to discriminate different kinds of sounds and keen on seeing the meaning of words. Hearing impaired children also learn the making sentence that is appropriate in each sound. 5. ACKNOWLEDGEMENT The authors express the cordial thanks to International Biomedical Engineering Programme, Department of Electrical Engineering, Department of Otolaryngology at Ramathibodi Hospital, Mahidol University and KMUTT for all supports during the development of this work. I also would like to thank Smart Medical Science and Technology Company Limited in all supports. Moreover, I am pleased to thank Ms. Vanida Phetpanya, Mr. William Joseph Klinkenberg and Mr. Kriangkrai Phrueksawan who are special language consultant for this project.

REFERENCES [1] S. Freeman, Hearing impairment, The early childhood special education and the educational services departments of western hills area education, Vol.17, No. 2, 2003. [2] Ear Nose & Throat Associates. Available from: http:/// [3] Ottos World of Sounds. Otikids, Auditory training program, Hong Kong [4] R. Van Hedel, F. Coninx, Curriculum Hoortraining, Institute for the Deaf, St. Michielsgestel, Nederland, 1995. [5] M. Harrism and J. Beech, Implicit phonogical awareness and early reading development in prelingually deaf children, Journal of deaf studied and deaf Education, Vol.1(2), No. 96-107, 1999 [6] X. Hu, A. Fourcin, A. Faulkner, J. Wei, Speechreading of words and sentences by normally hearing and hearing impaired Chinese subjects: the enhance effects of compound speech patterns, Speech, hearing and language, Vol. 9, No. 119-131, 1996 [7] J. D. Audrey, More appropriate; additional stories for students who are hearing impaired using the specialized program individualizing reading excellence (S.P.I.R.E.) curriculum, Program in Audiology and Communication Scienes, Washington University School of Medicine, 2007 [8] V. Shafiro, B. Gygi, How to select stimuli for environmental sound research and where to find them, Vol. 36, No. 4, pp. 590-598, 2004. [9] Sound Effects. Available from: [10] Sound Effects. Available from: [11] Sound Effects. Available from: [12] Sound Effects. Available from: [13] Sound Effects. Available from: [14] Sound Effects. Available from: [15] R. Shiavi, Introduction to applied statistical signal analysis, Irwin, 1991.

The 3rd International Symposium on Biomedical Engineering (ISBME 2008)