Performance of Children With Hearing Loss on an Audiovisual Version of a Nonword Repetition Task

Access to Cochlear Implantation: Trends in Surgeon Volume and Training

OBJECTIVES

Evaluate the training background of surgeons performing high volumes of cochlear implants (CIs) and estimate the ratio of providers trained in otology/neurotology (O&N) to the number of traditional CI candidates and audiologists.

METHODS

A retrospective review of US surgeon registration data from a single CI manufacturer was performed to determine CI volume based on surgeon training. The prevalence of traditional candidates for CIs was estimated from US census population data and compared with the number of O&N providers. The ratio of audiologists to O&N providers was estimated from the Bureau of Labor and Statistics and American Speech-Language-Hearing Association databases.

RESULTS

From 2021 to 2023, a mean of 88% of providers performing ≥25 CIs per year and 90% performing ≥40 per year had training in O&N. All surgeons registering ≥100 implants per year were O&N providers. The mean percentage of O&N providers performing ≥25 CIs per year and ≥ 40 per year was higher than the percentage of General and Pediatric Otolaryngology providers performing the same volume: mean difference = 76%, p < 0.001 and mean difference = 79%, p < 0.001, respectively. The mean estimated prevalence of traditional CI candidates per O&N provider is 3,354 with an estimated mean of 32 audiologists (3.5 trained in CIs) per O&N provider.

CONCLUSION

88% of high-volume CI surgeons have fellowship training in O&N. To meet the current state of CI underutilization and anticipated growing population of CI candidates, we propose increasing the surgical capacity of O&N providers and the number of surgeons proficient in CIs.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:2146-2153, 2025.

Synchrony perception of audiovisual speech is a reliable, yet individual construct

Audiovisual (AV) (a)synchrony perception, measured by a simultaneity judgment task, provides a proxy measure for the temporal binding window (TBW), the interval of time within which participants perceive individual auditory and visual events as synchronous. The TBW is a sensitive measure showing group level differences across the lifespan. However, the significance of these findings hinges on whether AV synchrony perception is characteristic to an individual and whether it is reliable across sessions. As there is little evidence to this latter assumption, this work aimed to establish test-retest reliability of the TBW. Eighteen participants completed a simultaneity judgment task, twice, on different days, where they judged whether or not the audio and video of word-length speech stimuli were presented at the same or different times. Results showed effects of task familiarity indicated by significantly faster response times observed at the second timepoint. The slope and amplitude asymptote of the TBW also increased, however no change in TBW suggests no change in sensitivity to AV (a)synchrony. The combination of high within-subject correlations (R = 0.71) and substantial intersubject variability provide strong support for the TBW as a robust measure of AV temporal perception, and suggest a conserved mechanistic underpinning within individuals.

"Cool" and "Hot" executive functions in deaf children: the executive brain battery (EBB)

Although previous studies have suggested that language deprivation may affect the development of executive functions (EFs), there are no assessment tools adapted to the language needs of deaf-and-hard-of-hearing (DHH) children. The present study had two objectives: (1) to examine the feasibility of the Executive Brain Battery in assessing 40 prelingually deaf-and-hard-of-hearing children between 6 and 12 years, and (2) to explore whether some sociodemographic and clinical variables could be associated with the performance of deaf children. The results showed that all tasks included in the Executive Brain Battery were practicable for more than 75% of participants, with the decision-making task being the only one that demonstrated an improvement in the performance of children between 6-8 and 9-12 years of age. Moreover, the 6-8 years group displayed a sex effect in inhibition and decision-making tasks. However, this effect disappears in the 9-12 years group, which showed only a negative effect of cochlear implants on the theory of mind task.

Does Mild and Moderate Hearing Loss Affect Verbal Working Memory and Language Skills in Children?

INTRODUCTION

For a comprehensive approach in children with hearing loss (HL), some cognitive and language skills should also be considered, along with auditory skills. The main aim of this study was to evaluate the working memory and language skills in children with mild to moderate HL.

METHODS

Forty children with mild to moderate HL between the ages of 4 and 9 years were included in this study. The children with mild and moderate HL were evaluated in two groups. The Meaningless Word Repetition test, Test of Language Development-Primary test, and Meaningful Auditory Integration Scale were administered to assess working memory, language skills, and auditory perception, respectively. Also, the relationship between language and memory skills was evaluated.

RESULTS

The study found statistically significant correlations between language skills and working memory test scores. Additionally, statistically significant differences were found between children with mild and moderate HL in terms of language and memory skills (p < 0.001).

CONCLUSION

The children with moderate HL demonstrated poorer performance compared to those with mild HL. Even if it is mild, the degree of HL affects children's language and memory skills. It is emphasized that the relationship between language and working memory should be taken into consideration in auditory rehabilitation programs for these children.

Factors associated with nonword repetition skills in 4-to 6-year-old deaf and hard-of-hearing and typically hearing children

Children identified as deaf and hard of hearing (DHH) exhibit an increased risk of speech and language difficulties. Nonword repetition (NWR) is a potential tool for identifying language difficulties in children with limited experience with the target language. In this study, we explored associations between auditory, linguistic, demographic and cognitive factors and NWR performance in DHH children and their typically hearing (TH) peers. We also examined the effect of the group on NWR outcomes when different factors were statistically controlled for. Our study included 68 4- to 6-year-old children: 18 with bilateral hearing aids (BiHAs), 18 with bilateral cochlear implants (BiCIs) and 32 with TH. The participants completed the Finnish Nonword Repetition Test comprising 24 test items with varying syllable lengths. The assessment methods also included tests of phonological, lexical, language comprehension and sentence repetition skills, along with a measure of nonverbal intelligence. The results showed that none of the auditory, linguistic, demographic and cognitive factors examined in the present study were correlated with NWR performance in the BiHA group, while significant correlations between NWR skills and linguistic abilities were observed in the BiCI group. The DHH children showed extraordinary difficulties in NWR compared to their TH peers, and these group differences remained after controlling for linguistic and demographic variables. The NWR task may be a potential clinical tool for identifying DHH children at risk for poor language outcomes and in need of speech and language intervention.

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.

Assessment of Executive Functions in Children with Sensorineural Hearing Loss and in Children with Specific Language Impairment: Preliminary Reports

Executive functions (EFs) are related abilities, associated with the frontal lobes functions, that allow individuals to modify behavioral patterns when they become unsatisfactory. The aim of this study was to assess EFs in children with sensorineural hearing loss (SNHL) and in children with "specific language impairment" (SLI), compared with a control group of children with normal development, to identify specific skill deficits. Three groups of preschool children aged between 2 and 6 years were assessed: 19 children with normal hearing, cognitive, and language development, 10 children with SNHL, and 20 children with SLI. The FE-PS 2-6 Battery was used for the assessment of preschool EFs, supplemented with the Modified Bell Test for the analysis of selective attention. Statistically significant differences were found between the two experimental groups and the control one, regarding the investigated skills. Children with SNHL showed a clear deficit in flexibility, whereas children with SLI had greater problems in self-regulation and management of waiting for gratification. Selective attention was found to be deficient in all three groups, with no statistically significant differences. This study shows that the skills investigated were found to be deficient in both SNHL and SLI patients. It is essential to start targeted exercises based on specific deficient skills as part of the rehabilitation program. It is of great importance to understand the consequences of EF deficit in preschool children to achieve an accurate diagnosis and carry out customized rehabilitation programs.

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.

Downward trends in the global burden of congenital complete hearing loss in children younger than five years from 1990 to 2030

Background

The global epidemiological data on congenital hearing loss in children is sparse. We aimed to analyse the trends in the burden of complete hearing loss caused by congenital birth defects in children younger than five years from 1990 to 2030.

Methods

Using data from the Global Burden of Disease (GBD) Study 2019, we reported the counts and rates of prevalence and years lived with disability (YLD) by age, sex, and sociodemographic index (SDI). We also forecasted the prevalence rates until 2030 through the autoregressive integrated moving average (ARIMA) and Bayesian age-period-cohort (BAPC) models.

Results

We observed a global prevalence rate of 15.4 (95% uncertainty interval (UI) = 5.8 to 33.8) and a YLD rate of 3.3 (95% UI = 1.1 to 7.1) per 100 000 population in 2019, with both showing downward trends from 1990 to 2019. Regionally, Oceania had the highest prevalence (47.2; 95% UI = 18.8 to 96.6) and YLD (10; 95% UI = 3.2 to 22.8) rates, while Central Europe had the lowest rates. Nationally, the prevalence (85.0; 95% UI = 36.8 to 166.8) and YLD (17.9; 95% UI = 6.6 to 36.9) rates were highest in Myanmar and lowest in Peru. Only the United States of America (2.6%; 95% UI = -4.6 to 14.4) and Norway (0.6%; 95% UI = -6.7 to 16.2) showed upward trends. Compared to girls, the prevalence and YLD rates were higher for boys at global, regional, and five SDI quintile levels, except for Eastern Sub-Saharan Africa. At the global level, downward trends were predicted in prevalence rates from 2019 to 2030 between boys and girls.

Conclusions

Although the global burden of childhood congenital complete hearing loss showed inequalities across locations, sexes, and age groups, we found decreases in the global prevalence rates between 1990 and 2019 and predicted decreases from 2019 to 2030. Better prevention of infectious aetiologies, improving genetic diagnoses, and hearing restoration could alleviate this burden.

A Longitudinal Investigation of Code-Related Emergent Literacy Skills in Children Who Are Deaf and Hard of Hearing Across the Preschool Years

PURPOSE

The purpose of this longitudinal investigation was to compare the developmental trajectories of code-related emergent literacy skills of children who are deaf and hard of hearing (DHH) who use amplification and spoken language across the preschool years.

METHOD

Thirty children who are DHH and 31 children with typical hearing completed a language and emergent literacy assessment at 6-month intervals from age 4 through 6 years. Growth curve analysis was used to compare developmental trajectories between groups of the code-related skills of phonological awareness, phonological memory, phonological recoding, alphabet knowledge, and conceptual print knowledge.

RESULTS

Growth across the preschool years was observed on all code-related emergent literacy skills across groups. Children who are DHH scored consistently lower than children with typical hearing on phonological awareness, phonological memory, and conceptual print knowledge; no group differences were observed for phonological recoding or alphabet knowledge. No interactions of time and group were significant.

CONCLUSIONS

Children who are DHH exhibit consistent deficits in phonological awareness, phonological memory, and conceptual print knowledge across the preschool years and begin formal literacy instruction with a weaker foundation in emergent literacy skills. Future work should focus on optimizing emergent literacy interventions for children who are DHH during the preschool years.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21998153.

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.

Impact of unilateral hearing loss in early development

PURPOSE OF REVIEW

The purpose of this review is to provide an update on current literature as it relates to the impact of unilateral hearing loss for the pediatric population.

RECENT FINDINGS

Current studies further corroborate past research findings which reveal the potential consequences of unilateral hearing loss on spatial hearing, language, and neurocognitive functioning. Deficits among children with unilateral hearing loss may parallel those seen in children with bilateral hearing loss, further challenging historic views that hearing in one ear in childhood is sufficient for normal development. The potential deficiencies seen in children with unilateral hearing loss can be subtler than those seen with bilateral hearing loss, but may nonetheless also impact school performance, patient fatigue, parental stress, and quality of life. Early interventions within a sensitive period of development of the central auditory system may circumvent potential barriers in cognitive, academic, and psychosocial development.

SUMMARY

This review synthesizes the latest research on the impact of unilateral hearing loss in childhood and the role for possible interventions. The summarized information may serve to support the development of new guidelines for the evaluation and treatment of children with unilateral hearing loss.

A longitudinal study of the phonological organisation of novel word forms in children with developmental language disorder

Purpose: Deficits in the production of novel words, such as in nonword repetition tasks, are one of the early hallmarks of developmental language disorder (DLD). In children with DLD, the production of novel nonwords is characterised by speech sound inaccuracy. The focus of the present study is on the stable organisation of phonological sequences. Specifically, we aimed to identify the persistence of deficits in accuracy and in variability in sound sequencing in novel word production from pre-school to the early school years.Method: Children with and without DLD produced a set of six nonwords 12 times each, initially collected when children were 4- to 5-years old. Children repeated this task over the course of two years. Analyses included phonetic accuracy as well as network science indices of sound sequence organisation.Result: Children with DLD were less accurate than their peers with typical language at each timepoint, and their productions were markedly variable, as revealed by network science metrics; these children never converged with their peers with typical language.Conclusion: The findings suggest a unique deficit in phonological sequence production that persists beyond the pre-school years. These results offer new theoretical and clinical insights into mechanisms that underlie deficits in novel word form learning.

Best ear hearing level, time factors and language outcome in Swedish children with mild and moderate hearing loss with hearing aids

AIM

The risk for language disorder is high in children with all levels of hearing loss (HL). Early identification and intervention should be as important for children with mild HL as for those with more severe HL. Despite new-born hearing screening, a recent survey of speech language therapist services in southern Sweden indicates that children with mild and moderate HL are severely neglected when it comes to language assessment and language intervention. In this study we explore associations between Best Ear Hearing Level (BEHL), time factors and language skills in Swedish children with HL with hearing aids (HA).

METHOD

Participants were 19 children with mild HL (BEHL 23-39) and 22 children with moderate HL (BEHL 40-70) aged 5-15 years. Information on age at diagnosis and at HA fitting were collected. The children performed a nonword repetition and a sentence comprehension task.

RESULTS

The time elapsed between diagnosis and fitting with HA was longer for the children with mild HL.Participants with mild HL received their HA significantly later than children with moderate HL. No association between BEHL and the two language measures was found, and language skills were not better in children with mild than moderate HL. 17% of participants performed below cut-off for language disorder on both language measures.

CONCLUSION

Given the risk for long-term academic and social consequences of even mild HL delayed HA intervention for children with HLleads to serious concerns by families, clinicians, and pedagogues.

What Can a Child Do With One Normal-Hearing Ear? Speech Perception and Word Learning in Children With Unilateral and Bilateral Hearing Losses Relative to Peers With Normal Hearing

OBJECTIVES

To examine the effects of unilateral hearing loss on children's ability to perceive familiar words and to learn and retain new words. Because children with unilateral hearing loss receive full auditory input in one ear, their performance was expected to be consistent with that of children with normal hearing rather than that of children with moderate bilateral hearing loss.

DESIGN

Participants were 36 school-age children with normal hearing bilaterally, 11 children with moderate bilateral hearing loss, and 11 children with mild-to-profound unilateral hearing loss (six right and five left). Half of the normally hearing children and two-thirds of the children with unilateral hearing loss were from bilingual Spanish/English-speaking homes. One of the 11 children with bilateral hearing loss was from a bilingual Spanish/English-speaking home. All children completed a word recognition test in English and in Spanish, a word-learning task comprised of nonsense words constructed using the phonotactic rules of English, Spanish, and Arabic, and a next-day word-retention test.

RESULTS

Word recognition did not differ across groups in English or Spanish. Learning and retention of nonsense words was highest for the children with normal hearing in all three languages. The children with unilateral and bilateral losses learned and recalled the English nonsense words as well as their normally hearing peers, but performance for the Spanish and Arabic nonsense words was significantly and similarly reduced by hearing loss in either ear.

CONCLUSIONS

Failure to learn and retain new words given a full auditory representation in one ear suggests that children with unilateral and bilateral hearing losses may share a unifying feature of impairment at the level of the central auditory system.

The Devil in the Details Can Be Hard to Spot: Malapropisms and Children With Hearing Loss

Purpose Better auditory prostheses and earlier interventions have led to remarkable improvements in spoken language abilities for children with hearing loss (HL), but these children often still struggle academically. This study tested a hypothesis for why this may be, proposing that the language of school becomes increasingly disconnected from everyday discourse, requiring greater reliance on bottom-up phonological structure, and children with HL have difficulty recovering that structure from the speech signal. Participants One hundred nineteen fourth graders participated: 48 with normal hearing (NH), 19 with moderate losses who used hearing aids (HAs), and 52 with severe-to-profound losses who used cochlear implants (CIs). Method Three analyses were conducted. #1: Sentences with malapropisms were created, and children's abilities to recognize them were assessed. #2: Factors contributing to those abilities were evaluated, including phonological awareness, phonological processing, vocabulary, verbal working memory, and oral narratives. #3: Teachers' ratings of students' academic competence were obtained, and factors accounting for those ratings were evaluated, including the five listed above, along with word reading and reading comprehension. Results #1: Children with HAs and CIs performed more poorly on malapropism recognition than children with NH, but similarly to each other. #2: All children with HL demonstrated large phonological deficits, but they were especially large for children with CIs. Phonological awareness explained the most variance in malapropism recognition for children with CIs. Vocabulary knowledge explained malapropism recognition for children with NH or HAs, but other factors also contributed. #3: Teachers rated academic competence for children with CIs more poorly than for children with NH or HAs, and variance in those ratings for children with CIs were primarily explained by malapropism scores. Conclusion Children with HL have difficulty recognizing acoustic-phonetic detail in the speech signal, and that constrains their abilities to follow conversations in academic settings, especially if HL is severe enough to require CIs. Supplemental Material https://doi.org/10.23641/asha.13133018.

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.