Listening Difficulties in Children with Normal Audiograms: Relation to Hearing and Cognition
Authors: Petley Lauren , Hunter Lisa L. , Zadeh Lina Motlagh , Stewart Hannah J. , Sloat Nicholette T. , Perdew Audrey , Lin Li , Moore David R. 
Published: October 2020

Objectives

Children presenting at audiology services with caregiver-reported listening difficulties often have normal audiograms. The appropriate approach for the further assessment and clinical management of these children is currently unclear. In this Sensitive Indicators of Childhood Listening Difficulties (SICLiD) study we assessed listening ability using a reliable and validated caregiver questionnaire (the ECLiPS) in a large (n = 146) and heterogeneous sample of 6-13 year-old children with normal audiograms. Scores on the ECLiPS were related to a multifaceted laboratory assessment of the children’s audiological, psycho- and physiological-acoustic and cognitive abilities. This report is an overview of the SICLiD study and focuses on the children’s behavioral performance. The overall goals of SICLiD were 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 with ‘listening difficulties’ and an age-matched ‘typically developing’ control group. Caregivers completed the ECLiPS 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 viat-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 the factors contributing to the ECLiPS Total scaled score (pooled across groups) yielded a model that explained 42% of its variance based on the SCAN-3:C 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-3:C 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 minor contributing factor to talker segregation. Beyond auditory tests, evaluations of children with complaints of listening difficulties should include standardized caregiver observations and consideration of broad cognitive abilities.