Listening Difficulties in Children with Normal Audiograms: Relation to Hearing and Cognition

Abstract

Objectives: Children presenting at audiology services with listening difficulties often have normal audiograms, yet the appropriate approach for the further assessment and clinical management of these children is currently unclear. In this study we assessed listening ability in a large (n = 146) and heterogeneous sample of 6-13 year-old children with normal audiograms using a reliable and validated caregiver questionnaire. The results were related to a multifaceted laboratory assessment of the children's audiological, psychoacoustic, physiological and cognitive abilities. This report is an overview of the study and focuses on the children's behavioral performance. The overall goals of the study are to understand the auditory and other neural mechanisms underlying childhood listening difficulties and to translate that understanding into clinical assessment and, ultimately, intervention. Design: Cross-sectional behavioral assessment of children recruited through relevant clinics of Cincinnati Children's Hospital, and advertisements placed in the hospital online information service. We aimed recruitment into two demographically-matched groups, a 'listening difficulties' group and a 'typically developing' control group. Caregivers completed the 'ECLiPS' questionnaire and the resulting 'total' standardized composite score formed the basis of further descriptive statistics, univariate and multivariate modeling of experimental data. Results: All scores of the ECLiPS, the SCAN-3:C, a standardized clinical test suite for auditory processing, and the NIH Cognition Toolbox were significantly lower for children with listening difficulties than for their typically developing peers, using group comparisons via t-tests and Wilcoxon Rank Sum tests. A similar effect was observed on the LiSN-S test for speech sentence-in-noise intelligibility, but only reached significance for the Low Cue and High Cue conditions, and the Talker Advantage derived score. Stepwise regression to examine factors contributing to the ECLiPS Total scaled score (pooled across groups) yielded a model that explained 42% of its variance based on the SCAN composite, LiSN-S Talker Advantage, and the NIH Toolbox Picture Vocabulary and Dimensional Change Card Sorting scores (F4,95 = 17.35, p < 0.001). High correlations were observed between many test scores including the ECLiPS, SCAN and NIH Toolbox composite measures. LiSN-S Advantage measures generally correlated weakly and non-significantly with non-LiSN-S measures. However, a significant interaction was found between extended high frequency threshold and LiSN-S Talker Advantage. Conclusions: Children with listening difficulties but normal audiograms have problems with the cognitive processing of auditory and non-auditory stimuli that include both fluid and crystallized reasoning. Analysis of poor performance on the LiSN-S Talker Advantage measure identified subclinical hearing loss as a possible minor contributing factor to talker segregation. Beyond auditory tests, evaluation of children with complaints of listening difficulties should include standardized caregiver observations and consideration of broad cognitive abilities.

Speech cortical activation and connectivity in typically developing children and those with listening difficulties

“…Children identified with LiD have difficulty in speech listening compared to TD children (Petley et al, 2020). These groups were distinguished by connectivity differences between cortical areas associated with language production, memory and word recognition, rather than by the activity or connectivity of primary auditory cortical areas.…”

“…All participants had normal audiometric hearing with thresholds < 25 dB HL at all octave-interval frequencies from 0.25 - 16 kHz in both ears (Figure 1A). In this paper we focus on the cortical results and their relationship with behavioural responses from the baseline of our longitudinal ‘SICLID’ study examining correlates of LiD in children (Hunter et al, 2020; Petley et al, 2020; Blankenship et al, in prep. ).…”

“…In human communication, listening also involves memory, language and executive function (Rudner & Signoret, 2016; Schiller et al, 2022). Listening difficulties (LiD) are frequently reported by caregivers of children with clinically normal hearing (Petley et al, 2021; Roeser et al, 2007). However, the mechanisms underlying childhood LiD without hearing loss remain poorly understood.…”

“…At the center of this controversy is the question of whether the children have primarily auditory sensory problems (“bottom-up”), cognitive and language problems (“top-down”), or some combination of the two (Dillon & Cameron, 2021; Moore et al, 2010). In this and other recent studies (Hunter et al, 2021; Petley et al, 2021) we sidestep this controversy by using the umbrella term LiD (Dillon & Cameron, 2021), and the quantitative metrics of a well-validated, reliable and standardized caregiver questionnaire (ECLiPS; Barry & Moore, 2021) to operationalize LiD.…”

“…In this report we present data from the first wave of a longitudinal study investigating the audiological and cognitive abilities of children (6-13 years old; Table 1) with LiD and their typically developing peers (6-13 years old; Table 1; Petley et al, 2021). All participants had clinically normal audiometry (≤ 20 dB HL, bilaterally; 0.25 – 8 kHz, Figure 1B), tympanometry (Hunter et al, 2021) and afferent auditory brainstem function (Hunter et al, 2022).…”