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

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 children9s audiological, psychoacoustic, physiological and cognitive abilities. This report is an overview of the study and focuses on the children9s 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 Children9s Hospital, and advertisements placed in the hospital online information service. We aimed recruitment into two demographically-matched groups, a 9listening difficulties9 group and a 9typically developing9 control group. Caregivers completed the 9ECLiPS9 questionnaire and the resulting 9total9 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.