Minimal and mild hearing loss in children: Association with auditory perception, cognition, and communication problems

Abstract

Objectives: 'Minimal' and 'mild' hearing loss are the most common but least understood forms of hearing loss in children. Children with better ear hearing level as low as 30 dB HL have a global language impairment and, according to the World Health Organization, a "disabling level of hearing loss". We examined in a population of 6 -11 year olds how hearing level ≤ 40.0 dB HL (1 and 4 kHz pure tone average, PTA, threshold) related to auditory perception, cognition and communication. Design: School children (n=1638) were recruited in four centres across the UK. They completed a battery of hearing (audiometry, filter width, temporal envelope, speech-in-noise) and cognitive (IQ, attention, verbal memory, receptive language, reading) tests. Caregivers assessed their children's communication and listening skills. Children included in this study (702 male; 752 female) had four reliable tone thresholds (1, 4 kHz each ear), and no caregiver reported medical or intellectual disorder. Normal hearing children (n=1124, 77.1%) had all four thresholds and PTA < 15 dB HL. Children with ≥ 15 dB HL for at least one threshold, and PTA < 20 dB (n=245, 16.8%) had Minimal hearing loss. Children with 20 ≤ PTA < 40 dB HL (n=88, 6.0%) had Mild hearing loss. Interaural Asymmetric hearing loss (|Left PTA -Right PTA| ≥ 10 dB) was found in 28.9% of those with Minimal and 39.8% of those with Mild hearing loss. Results: Speech perception in noise, indexed by VCV pseudoword repetition in speech modulated noise, was impaired in children with Minimal and Mild hearing loss, relative to Normal hearing children. Effect size was largest (d=0.63) in Asymmetric Mild hearing loss and smallest (d=0.21) in Symmetric Minimal hearing loss.Spectral (filter width) and temporal (backward masking) perception were impaired in children with both forms of hearing loss, but supra-threshold perception generally related only weakly to PTA. Speech-in-noise (nonsense syllables) and language (pseudoword repetition) were also impaired in both forms of hearing loss and correlated more strongly with PTA. Children with Mild hearing loss were additionally impaired in working memory (digit span) and reading, and generally performed more poorly than those with Minimal loss. Asymmetric hearing loss produced as much impairment overall on both auditory and cognitive tasks as Symmetric hearing loss. Nonverbal IQ, attention and caregiver-rated listening and communication were not significantly impaired in children with hearing loss. Modelling suggested that 15 dB HL is objectively an appropriate lower audibility limit for diagnosis of hearing loss. Conclusions:Hearing loss between 15 -30 dB PTA is, at ~20%, much more prevalent in 6-11 y.o. children than most current estimates. Key aspects of auditory and cognitive skills are impaired in both symmetric and asymmetric minimal and mild hearing loss. Hearing loss < 30 dB HL is most closely related to speech perception in noise, and to cognitive abilities underpinning language and reading. The results suggest wider use of speech-innoise...

Adaptive Hearing Aid Benefit in Children With Mild/Moderate Hearing Loss: A Registered, Double-Blind, Randomized Clinical Trial

“…Cognition • The NIH Toolbox Cognition Battery assesses the brain's higher-level functions language, perception, planning and execution of behavior, and memory (Weintraub et al 2013). This battery was administered because of the previously demonstrated close relationship between hearing loss, listening difficulty and cognitive ability (Moore et al 2020;Petley et al 2021). Four subtests from this battery, each lasting 5 to 15 min, were administered to participants on an iPad with the tester seated next to them.…”

Audiometric profiles in children with speech sound disorder: Subclinical hearing loss as a potential factor

“…Early untreated hearing loss has negative impact on the development of the auditory cortex, essential for speech language learning (Cardon et al, 2012;Kral & Lenarz, 2015;Sharma et al, 2002). Even minimal hearing loss (MHL ≥15 dB HL and PTA <20 dB) may cause impaired speech-in-noise hearing and reduced phonological working memory (Moore et al, 2019). Considering the large impact of hearing on speech and language acquisition, it is surprising, that there is still limited knowledge in how hearing contributes to speech sound disorders (SSD), a condition in which speech perception, phonological processing and speech production, is compromised.…”

“…Thus, the auditory insensitivity, as proposed by Tamm (1912), was confirmed in the present study. Moore et al (2019) investigated auditory perception, cognition and communication in children with MHL (≥ 15 dB HL and < PTA 20 dB HL)) relative to children with normal hearing. Speech-in-noise hearing and phonological working memory were impaired in children with MHL, the latter comparably more in children with minimal symmetric hearing loss.…”

Impact of Mild to Moderate U-shape Hearing Loss on Listening Effort in School-aged Children with Alport Syndrome

“…Children develop key cognitive, linguistic, and academic skills in the classroom, however, the increased mental demands of effortful listening may exert deleterious effects on the educational outcomes [8,9]. Furthermore, it was shown in previous literatures that key aspects of auditory cognitive functions are impaired in school-aged children even though with mild hearing loss [10].Therefore, how and when to intervene is a signi cant concern for hearing-impaired children with AS. A better understanding of auditory cognitive ability in these population would be valuable to reduce listening effort and optimize learning performance.…”