Auditory Comprehension in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss

Predictors of Listening-Related Fatigue in Adolescents With Hearing Loss

PURPOSE

Self-reported listening-related fatigue in adolescents with hearing loss (HL) was investigated. Specifically, the extent to which listening-related fatigue is associated with school accommodations, audiologic characteristics, and listening breaks was examined.

METHOD

Participants were 144 adolescents with HL ages 12-19 years. Data were collected online via Qualtrics. The Vanderbilt Fatigue Scale-Child was used to measure listening-related fatigue. Participants also reported on their use of listening breaks and school accommodations, including an Individualized Education Program (IEP) or 504 plan, remote microphone systems, closed captioning, preferential seating, sign language interpreters, live transcriptions, and notetakers.

RESULTS

After controlling for age, HL laterality, and self-perceived listening difficulty, adolescents with an IEP or a 504 plan reported lower listening-related fatigue compared to adolescents without an IEP or a 504 plan. Adolescents who more frequently used remote microphone systems or notetakers reported higher listening-related fatigue compared to adolescents who used these accommodations less frequently, whereas increased use of a sign language interpreter was associated with decreased listening-related fatigue. Among adolescents with unilateral HL, higher age was associated with lower listening-related fatigue; no effect of age was found among adolescents with bilateral HL. Listening-related fatigue did not differ based on hearing device configuration.

CONCLUSIONS

Adolescents with HL should be considered at risk for listening-related fatigue regardless of the type of hearing devices used or the degree of HL. The individualized support provided by an IEP or 504 plan may help alleviate listening-related fatigue, especially by empowering adolescents with HL to be self-advocates in terms of their listening needs and accommodations in school. Additional research is needed to better understand the role of specific school accommodations and listening breaks in addressing listening-related fatigue.

The Not-So-Slight Perceptual Consequences of Slight Hearing Loss in School-Age Children: A Scoping Review

PURPOSE

This study aimed to conduct a scoping review of research exploring the effects of slight hearing loss on auditory and speech perception in children.

METHOD

A comprehensive search conducted in August 2023 identified a total of 402 potential articles sourced from eight prominent bibliographic databases. These articles were subjected to rigorous evaluation for inclusion criteria, specifically focusing on their reporting of speech or auditory perception using psychoacoustic tasks. The selected studies exclusively examined school-age children, encompassing those between 5 and 18 years of age. Following rigorous evaluation, 10 articles meeting these criteria were selected for inclusion in the review.

RESULTS

The analysis of included articles consistently shows that even slight hearing loss in school-age children significantly affects their speech and auditory perception. Notably, most of the included articles highlighted a common trend, demonstrating that perceptual deficits originating due to slight hearing loss in children are particularly observable under challenging experimental conditions and/or in cognitively demanding listening tasks. Recent evidence further underscores that the negative impacts of slight hearing loss in school-age children cannot be solely predicted by their pure-tone thresholds alone. However, there is limited evidence concerning the effect of slight hearing loss on the segregation of competing speech, which may be a better representation of listening in the classroom.

CONCLUSION

This scoping review discusses the perceptual consequences of slight hearing loss in school-age children and provides insights into an array of methodological issues associated with studying perceptual skills in school-age children with slight hearing losses, offering guidance for future research endeavors.

Speech, language, functional communication, psychosocial outcomes and QOL in school-age children with congenital unilateral hearing loss

Introduction

Children with early-identified unilateral hearing loss (UHL) might be at risk for delays in early speech and language, functional communication, psychosocial skills, and quality of life (QOL). However, a paucity of relevant research prohibits strong conclusions. This study aimed to provide new evidence relevant to this issue.

Methods

Participants were 34 children, ages 9;0 to 12;7 (years;months), who were identified with UHL via newborn hearing screening. Nineteen children had been fitted with hearing devices, whereas 15 had not. Assessments included measures of speech perception and intelligibility; language and cognition; functional communication; psychosocial abilities; and QOL.

Results and discussion

As a group, the children scored significantly below the normative mean and more than one standard deviation below the typical range on speech perception in spatially separated noise, and significantly below the normative mean on written passage comprehension. Outcomes in other aspects appear typical. There was however considerable within participant variation in the children's degree of hearing loss over time, raising the possibility that this pattern of results might change as children get older. The current study also revealed that participants with higher levels of nonverbal ability demonstrated better general language skills and better ability to comprehend written passages. By contrast, neither perception of speech in collocated noise nor fitting with a hearing device accounted for unique variance in outcome measures. Future research should, however, evaluate the fitting of hearing devices using random assignment of participants to groups in order to avoid any confounding influence of degree of hearing loss or children's past/current level of progress.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review

OBJECTIVES

Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) ( Healthy People 2030 ) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends.

DESIGN

Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL.

RESULTS

Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level.

CONCLUSIONS

Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.

Impact of room acoustics and visual cues on speech perception and talker localization by children with mild bilateral or unilateral hearing loss

Introduction

This study evaluated the ability of children (8-12 years) with mild bilateral or unilateral hearing loss (MBHL/UHL) listening unaided, or normal hearing (NH) to locate and understand talkers in varying auditory/visual acoustic environments. Potential differences across hearing status were examined.

Methods

Participants heard sentences presented by female talkers from five surrounding locations in varying acoustic environments. A localization-only task included two conditions (auditory only, visually guided auditory) in three acoustic environments (favorable, typical, poor). Participants were asked to locate each talker. A speech perception task included four conditions [auditory-only, visually guided auditory, audiovisual, auditory-only from 0° azimuth (baseline)] in a single acoustic environment. Participants were asked to locate talkers, then repeat what was said.

Results

In the localization-only task, participants were better able to locate talkers and looking times were shorter with visual guidance to talker location. Correct looking was poorest and looking times longest in the poor acoustic environment. There were no significant effects of hearing status/age. In the speech perception task, performance was highest in the audiovisual condition and was better in the visually guided and auditory-only conditions than in the baseline condition. Although audiovisual performance was best overall, children with MBHL or UHL performed more poorly than peers with NH. Better-ear pure-tone averages for children with MBHL had a greater effect on keyword understanding than did poorer-ear pure-tone averages for children with UHL.

Conclusion

Although children could locate talkers more easily and quickly with visual information, finding locations alone did not improve speech perception. Best speech perception occurred in the audiovisual condition; however, poorer performance by children with MBHL or UHL suggested that being able to see talkers did not overcome reduced auditory access. Children with UHL exhibited better speech perception than children with MBHL, supporting benefits of NH in at least one ear.

Early cochlear implantation supports narrative skills of children with prelingual single-sided deafness

Prelingual single-sided deafness (SSD) not only affects children's hearing skills, but can also lead to speech-language delays and academic underachievement. Early cochlear implantation leads to improved spatial hearing, but the impact on language development is less studied. In our longitudinal study, we assessed the language skills of young children with SSD and a cochlear implant (CI). In particular, we investigated their narrative skills in comparison to two control groups: children with SSD without a CI, and children with bilateral normal hearing. We found that children with SSD and a CI performed in line with their normal-hearing peers with regard to narrative and verbal short-term memory skills. Children with SSD without a CI had worse narrative (group difference = - 0.67, p = 0.02) and verbal short-term memory (group difference = - 0.68, p = 0.03) scores than the implanted group. Verbal short-term memory scores and grammar scores each correlated positively with narrative scores across all groups. Early grammar scores (at 2-3 years of age) could partially predict later narrative scores (at 4-6 years of age). These results show that young children with prelingual SSD can benefit from early cochlear implantation to achieve age-appropriate language skills. They support the provision of a CI to children with prelingual SSD.

Delayed Lexical Access and Cascading Effects on Spreading Semantic Activation During Spoken Word Recognition in Children With Hearing Aids and Cochlear Implants: Evidence From Eye-Tracking

OBJECTIVE

The objective of this study was to characterize the dynamics of real-time lexical access, including lexical competition among phonologically similar words, and spreading semantic activation in school-age children with hearing aids (HAs) and children with cochlear implants (CIs). We hypothesized that developing spoken language via degraded auditory input would lead children with HAs or CIs to adapt their approach to spoken word recognition, especially by slowing down lexical access.

DESIGN

Participants were children ages 9- to 12-years old with normal hearing (NH), HAs, or CIs. Participants completed a Visual World Paradigm task in which they heard a spoken word and selected the matching picture from four options. Competitor items were either phonologically similar, semantically similar, or unrelated to the target word. As the target word unfolded, children's fixations to the target word, cohort competitor, rhyme competitor, semantically related item, and unrelated item were recorded as indices of ongoing lexical access and spreading semantic activation.

RESULTS

Children with HAs and children with CIs showed slower fixations to the target, reduced fixations to the cohort competitor, and increased fixations to the rhyme competitor, relative to children with NH. This wait-and-see profile was more pronounced in the children with CIs than the children with HAs. Children with HAs and children with CIs also showed delayed fixations to the semantically related item, although this delay was attributable to their delay in activating words in general, not to a distinct semantic source.

CONCLUSIONS

Children with HAs and children with CIs showed qualitatively similar patterns of real-time spoken word recognition. Findings suggest that developing spoken language via degraded auditory input causes long-term cognitive adaptations to how listeners recognize spoken words, regardless of the type of hearing device used. Delayed lexical access directly led to delays in spreading semantic activation in children with HAs and CIs. This delay in semantic processing may impact these children's ability to understand connected speech in everyday life.

Speech Understanding in Complex Environments by School-Age Children with Mild Bilateral or Unilateral Hearing Loss

Numerous studies have shown that children with mild bilateral (MBHL) or unilateral hearing loss (UHL) experience speech perception difficulties in poor acoustics. Much of the research in this area has been conducted via laboratory studies using speech-recognition tasks with a single talker and presentation via earphones and/or from a loudspeaker located directly in front of the listener. Real-world speech understanding is more complex, however, and these children may need to exert greater effort than their peers with normal hearing to understand speech, potentially impacting progress in a number of developmental areas. This article discusses issues and research relative to speech understanding in complex environments for children with MBHL or UHL and implications for real-world listening and understanding.

Spatial Hearing and Functional Auditory Skills in Children With Unilateral Hearing Loss

Purpose The purpose of this study was to characterize spatial hearing abilities of children with longstanding unilateral hearing loss (UHL). UHL was expected to negatively impact children's sound source localization and masked speech recognition, particularly when the target and masker were separated in space. Spatial release from masking (SRM) in the presence of a two-talker speech masker was expected to predict functional auditory performance as assessed by parent report. Method Participants were 5- to 14-year-olds with sensorineural or mixed UHL, age-matched children with normal hearing (NH), and adults with NH. Sound source localization was assessed on the horizontal plane (-90° to 90°), with noise that was either all-pass, low-pass, high-pass, or an unpredictable mixture. Speech recognition thresholds were measured in the sound field for sentences presented in two-talker speech or speech-shaped noise. Target speech was always presented from 0°; the masker was either colocated with the target or spatially separated at ±90°. Parents of children with UHL rated their children's functional auditory performance in everyday environments via questionnaire. Results Sound source localization was poorer for children with UHL than those with NH. Children with UHL also derived less SRM than those with NH, with increased masking for some conditions. Effects of UHL were larger in the two-talker than the noise masker, and SRM in two-talker speech increased with age for both groups of children. Children with UHL whose parents reported greater functional difficulties achieved less SRM when either masker was on the side of the better-hearing ear. Conclusions Children with UHL are clearly at a disadvantage compared with children with NH for both sound source localization and masked speech recognition with spatial separation. Parents' report of their children's real-world communication abilities suggests that spatial hearing plays an important role in outcomes for children with UHL.

Auricular reconstruction using Medpor combined with different hearing rehabilitation approaches for microtia

BACKGROUND

Congenital microtia-atresia affects patients in two specific ways: severe conductive hearing loss and difficulty in integrating into social environments due to auricle malformation.

AIMS/OBJECTIVES

To investigate the safety and efficacy of single-stage auricular reconstruction and hearing rehabilitation in children with microtia and external auditory canal atresia.

MATERIAL AND METHODS

From January 2016 to December 2019, we included 32 patients with microtia and external canal atresia who received auricle reconstruction with high-density polyethylene (Medpor) framework and three different hearing rehabilitation approaches at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Twenty patients underwent the traditional external auditory canal and middle ear repair (EACR), eight patients were implanted with Bonebridge (BB) devices, and four patients were implanted with bone-anchored hearing aid (BAHA) in one stage. Postoperative changes in auricle morphology and hearing and speech recognition and occurrence of complications were evaluated.

RESULTS

After 6-24 months of follow-up, the auricle shape recovered well in all three groups, and the average score of 14 fine structures in the auricle was 9.43 (EACR), 10.67 (BB), and 9.75 (BAHA) points. The average score of auricle symmetry was 6.83 (EACR), 6.00 (BB), and 6.44 (BAHA) points. No significant differences in auricle shape were observed among the three groups (p > .05). After surgery, the average hearing improvement in the BB group was 43.33 dB, and the average speech recognition threshold declined to 42.28 dB. In the BAHA group, the average hearing improvement was 35 dB, and the average speech recognition threshold declined to 33.5 dB, similar to that of the BB group. However, in the EACR group, the average hearing improvement was only 4.13 dB, and the average speech recognition threshold declined to 11.36 dB. No vertigo, tinnitus, cerebrospinal fluid leakage, facial nerve paralysis, osseointegration failure, and other complications occurred in all the patients. In the EACR group, auricle stent fracture, ear canal restenosis, and canal atresia occurred in one patient each. In the BAHA group, two patients developed local ear infections.

CONCLUSIONS AND SIGNIFICANCE

The procedure of single-stage auricular reconstruction and hearing rehabilitation for microtia is feasible and effective. The appropriate method of hearing reconstruction should be determined by evaluating the development of the inner and middle ear of the patients. For those patients with poor development of the mastoid and ossicular chain, hearing aid devices are recommended to achieve a stable and significant hearing effect.

Spoken narrative comprehension for young adult listeners: effects of competing voices and noise

OBJECTIVE

To examine the influence of competing voices or noise on the comprehension of spoken narratives for young adults.

DESIGN

First, an intelligibility assessment of the target narratives was conducted to establish a signal-to-noise ratio ensuring accurate initial speech recognition. Then, narrative comprehension for two target types (fixed and varied target talker) was measured in four listening conditions (quiet, one-talker speech, speech babble, speech-shaped noise). After hearing target narratives in each listening condition, participants completed a visual recognition memory task that assessed the comprehension of the narrative materials at three levels of representation (surface form, propositional, event model).

STUDY SAMPLE

Seventy adults (18-32 years of age).

RESULTS

Narrative comprehension results revealed a main effect of listening condition at the event model level, indicating poorer narrative memory of described situations for all noise conditions compared to quiet. Increased positive responses to thematically consistent but situationally "wrong" memory probes drove this effect. No other significant effects were observed.

CONCLUSION

Despite near-perfect speech recognition, background noise negatively influenced aspects of spoken narrative comprehension and memory. Specifically, noise did not disrupt memory for what was said (surface form and propositional memory), but only memory for what was talked about (event model memory).

Where Do We Go From Here? Some Messages to Take Forward Regarding Children With Mild Bilateral and Unilateral Hearing Loss

Purpose

This epilogue discusses messages that we can take forward from the articles in the forum. A common theme throughout the forum is the ongoing need for research. The forum begins with evidence of potential progressive hearing loss in infants with mild bilateral hearing loss, who may be missed by current newborn hearing screening protocols, and supports the need for consensus regarding early identification in this population. Consensus regarding management similarly is a continuing need. Three studies add to the growing body of evidence that children with mild bilateral or unilateral hearing loss are at risk for difficulties in speech understanding in adverse environments, as well as delays in language and cognition, and that difficulties may persist beyond early childhood. Ambivalence regarding if and when children with mild bilateral or unilateral hearing loss should be fitted with personal amplification also impacts management decisions. Two articles address current evidence and support the need for further research into factors influencing decisions regarding amplification in these populations. A third article examines new criteria to determine hearing aid candidacy in children with mild hearing loss. The final contribution in this forum discusses listening-related fatigue in children with unilateral hearing loss. The absence of research specific to this population is evidence for the need for further investigation. Ongoing research that addresses difficulties experienced by children with mild bilateral and unilateral hearing loss and potential management options can help guide us toward interventions that are specific for the needs of these children.

Evidence-Based Practices and Outcomes for Children with Mild and Unilateral Hearing Loss

Purpose This forum provides an overview of current research and clinical practice for children with mild bilateral or unilateral hearing loss. Historically, there has been ambiguity surrounding the need for intervention in this population. Our goal is to explore the literature on outcomes and treatment so that audiologists, speech-language pathologists, teachers, physicians, and families can be confident in the clinical decision-making process when working with these children. To that end, topics include (a) progression of mild hearing loss in children; (b) the impact of mild or unilateral hearing loss on language, listening, and cognitive abilities; (c) research and reviews on intervention approaches; and (d) listening effort and fatigue in unilateral hearing loss. Conclusion Uncertainty about outcomes and treatment approaches for children with mild or unilateral hearing loss leads to inconsistent intervention and increased developmental risk. We hope that this forum will generate productive discussion among researchers and clinicians to ensure that all children with hearing loss reach their full potential.