Speech-in-Noise and Quality-of-Life Measures in School-Aged Children With Normal Hearing and With Unilateral Hearing Loss

Objectives: (1) Measure sentence recognition in co-located and spatially separated target and masker configurations in school-aged children with unilateral hearing loss (UHL) and with normal hearing (NH). (2) Compare self-reported hearing-related quality-of-life (QoL) scores in school-aged children with UHL and NH. Design: Listeners were school-aged children (6 to 12 yrs) with permanent UHL (n = 41) or NH (n = 35) and adults with NH (n = 23). Sentence reception thresholds (SRTs) were measured using Hearing In Noise Test–Children sentences in quiet and in the presence of 2-talker child babble or a speech-shaped noise masker in target/masker spatial configurations: 0/0, 0/−60, 0/+60, or 0/±60 degrees azimuth. Maskers were presented at a fixed level of 55 dBA, while the level of the target sentences varied adaptively to estimate the SRT. Hearing-related QoL was measured using the Hearing Environments and Reflection on Quality of Life (HEAR-QL-26) questionnaire for child subjects. Results: As a group, subjects with unaided UHL had higher (poorer) SRTs than age-matched peers with NH in all listening conditions. Effects of age, masker type, and spatial configuration of target and masker signals were found. Spatial release from masking was significantly reduced in conditions where the masker was directed toward UHL subjects' normal-hearing ear. Hearing-related QoL scores were significantly poorer in subjects with UHL compared to those with NH. Degree of UHL, as measured by four-frequency pure-tone average, was significantly correlated with SRTs only in the two conditions where the masker was directed towards subjects' normal-hearing ear, although the unaided Speech Intelligibility Index at 65 dB SPL was significantly correlated with SRTs in four conditions, some of which directed the masker to the impaired ear or both ears. Neither pure-tone average nor unaided Speech Intelligibility Index was correlated with QoL scores. Conclusions: As a group, school-aged children with UHL showed substantial reductions in masked speech perception and hearing-related QoL, irrespective of sex, laterality of hearing loss, and degree of hearing loss. While some children demonstrated normal or near-normal performance in certain listening conditions, a disproportionate number of thresholds fell in the poorest decile of the NH data. These findings add to the growing literature challenging the past assumption that one ear is "good enough." ACKNOWLEDGMENTS: The authors are grateful to Kelsey Cappetta for her assistance with subject recruitment and data collection, Kevin Randall and Michael Rogers for their support with software development, Kosuke Kawai for his assistance with statistical support, Patrick Zurek for his helpful comments on an earlier version of this article, and most especially to all the children and families who graciously participated in this research project. The authors also acknowledge the generosity of the following funding sources, which contributed to the execution of the research project: National Institute on Deafness and Other Communication Disorders DC-01625, University of Massachusetts Amherst Graduate School, Boston Children's Hospital Otolaryngology Foundation. Portions of this research were completed at the University of Massachusetts Amherst in partial fulfillment of the first author's doctoral dissertation requirements. Preliminary results of this study were presented at the Annual Scientific and Technology Conference of the American Auditory Society, Scottsdale, AZ, March 2017. The authors declare no conflict of interest. Address for correspondence Amanda Griffin, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 9 Hope Avenue, Waltham, MA 02453, USA. E-mail: Amanda.Griffin@childrens.harvard.edu Received April 23, 2018; accepted August 20, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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