abstract

OBJECTIVES Listening difficulty refers to difficulty hearing speech despite normal pure-tone audiometry. It is as prevalent as clinical hearing loss among adults, but incidence, causes and treatment remain poorly understood in children. We hypothesized that four medical risk factors would be associated with listening difficulty in children.

METHODS A prospective, case-control study was conducted in a tertiary care children’s hospital. Children (6-13 years old) with clinically normal hearing divided into listening difficulty (n=68) and typically developing (n=84) groups based on a validated caregiver report. All children were native English users without reported conditions restricting participation. Testing included extended high frequency (EHF) audiometry, speech and spatial perception, and cognitive function. Caregiver reports, electronic medical records, and testing ascertained risk of prematurity, head injury, otitis media and EHF hearing loss. Logistic regression, chi-square, correlation, and odds ratios determined associations of listening difficulty with risk factors.

RESULTS Prevalence and risk of prematurity (18%, OR 3.39 [95% CI, 1.1-10.2]), head injury (21%, 3.37 [1.2-9.3]), and high frequency hearing loss (32%, 2.42 [1.1-5.5]) were significantly greater for children with listening difficulty than typically developing children. Ventilation tubes were no more common in the listening difficulty group (25%, 1.14 [0.5-2.4]). EHF hearing loss was associated with prematurity and tubes. Prematurity, tubes, and EHF loss were significantly related to poorer competing speech perception and dichotic listening.

CONCLUSIONS Children with a history of prematurity, head injury or EHF loss were at increased risk of listening difficulties. Early intervention to boost communication skills could potentially improve poorer long-term outcomes.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

All phases of this study were supported by NIH grant DC014078 and by the Cincinnati Childrens Research Foundation. Analysis, interpretation and writing were supported by NIH grant DC018734, and by the NIHR Manchester Biomedical Research Centre

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Cincinnati Childrens Hospital Medical Center Institutional Review Board

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Data Availability

All data produced in the present study are available upon reasonable request to the authors

AbbreviationsADHDattention deficit-hyperactivity disorderCCC-2Children’s Communication ChecklistEHFextended high frequencyEMRelectronic medical recordsGCCGeneral Communication CompositeLiDlistening difficultiesLiSN-SListening in Spatialized Noise - Sentences testNICUneonatal intensive care unitOMotitis mediaPEpressure equalizationSIDISocial Interaction Difference IndexSPDspatial processing disorderSRTspeech reception thresholdTDtypically developingTBItraumatic brain injury