Children with mild to moderate sensorineural hearing loss (MMHL) have poorer auditory processing (AP) than children with normal hearing, particularly in temporal fine structure (TFS) processing. This poorer AP is not fully explained by reduced audibility alone and is not related to nonverbal IQ or attention. Deficits in AP, especially TFS processing, are associated with poorer language outcomes in children with MMHL. While envelope processing deficits are generally not linked to language difficulties, children who have them are likely to also experience language problems. Overall, AP abilities appear to be important for language development in children with MMHL.
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3. Taxi driver test…
A bit
deaf…
They wear those
things… Like
glasses for ears
You have
to shout
They can’t
hear things as
well, right?
4. …Those aspects of hearing that are
affected by factors other than, or in
addition to, how audible something is...
Auditory processing (AP)
5. …Those aspects of hearing that are
affected by factors other than, or in
addition to, how audible something is...
Auditory processing (AP)
temporal
fine
structure
temporal
processing
frequency
selectivityabsolute
threshold
broader
auditory
filters
envelope
pitch
perception
phase
locking
speech
perception
speech in
noise
binaural
hearing
Loudness
recruitment
7. Sensorineural hearing loss (SNHL)
mild
21-40 dB HL
moderate
41-70 dB HL
severe
71-90 dB HL
profound
91+ dB HL
difficulty
following
speech in noise
difficulty
following
speech without
hearing aid(s)
unable to follow
speech without
amplification
mainstream schools
hearing aids, FM systems
Powerful hearing aids +/or cochlear
implants
(speech reading;
sign language;
specialist schools)
severity
little/no access
to speech
without cochlear
implants
8. Mild to moderate SNHL (MMHL)
mild
21-40 dB HL
moderate
41-70 dB HL
difficulty
following
speech in noise
difficulty
following
speech without
hearing aid(s)
mainstream schools
hearing aids, FM systems
severity
10. Participants
Information sent to 900
children with MMHL across
London and SE England
Inclusion criteria:
Aged 8 – 16 years
Native English-only
speakers
No additional diagnoses
Information sent to 2000
normally hearing (NH)
children across London
and SE England
Consent
n = 59
Consent
n > 70
Age-match to MMHL
Did not consent/
no reply
Exclusions:
High-frequency HL
Auditory Neuropathy
Spectrum Disorder
(ANSD)
Additional diagnoses
n = 2
Screen:
Pure tone audiometry
NVIQ
n = 57
Screen:
Pure tone audiometry
NVIQ
n = 44
n = 46 n = 44
Exclusions:
PTA < 20 >70 dB HL
NVIQ < 85
n = 5
Exclusions:
PTA > 20 dB HL
NVIQ < 85
n = 0
Test sessions 1 and 2
n = 52
Test sessions 1 and 2
n = 44
Drop out
n = 6
11. Variable
MM group
n = 46
Control (NH) group
n = 44
Age (years) 11.4 (8.5 - 16.4) 11.5 (8.0 - 15.9)
Gender (girls: boys) 19:27 25:19
PTA threshold (dB HL) 46.0 (27.5 - 69.2) 8.9 (0 - 15.8)
HL confirmed (months) 53 (2 - 179)
Hearing aids (n) 43 0
Nonverbal IQ (T score) 55.6 (40 - 78) 60.6 (40 - 78)
Participants
27. Relationship between AP and language
NH
MMHL
Good AP
Good language
Halliday, Tuomainen, & Rosen (2017). Cognition, 166, 139-151
Poor AP
Poor language
Good AP
Poor language
Poor AP
Good language
28. Relationship between AP and language
NH
MMHL
Good AP
Good language
Halliday, Tuomainen, & Rosen (2017). Cognition, 166, 139-151
Poor AP
Poor language
Good AP
Poor language
Poor AP
Good language
General AP deficits
are often linked to
language
difficulties, but not
always
29. Relationship between E and language
Halliday, Tuomainen, & Rosen (2017). Cognition, 166, 139-151
Good E
Poor language
E processing
deficits not usually
linked to language
difficulties, but if a
child has them, they
are likely to also
have language
difficulties
Good E
Good language
Poor E
Good
language
Poor E
Poor
language
NH
MMHL
31. Predictors of vocabulary
Estimate SE t P -2 LL p
Intercept 32.2 22.0 1.5 .150 ----
Age 0.5 0.9 0.6 .578 ----
Hearing loss 0.4 0.2 2.0 .056 ----
Maternal education 0.3 0.7 0.4 .684 ----
Nonverbal IQ 0.7 0.2 3.4 .002 <.05
Family history 9.5 4.1 2.3 .024 <.05
TFS -4.0 1.5 -2.6 .012 <.05
Cabrera, Rosen, & Halliday (in prep).
• Mixed models analysis predicting BPVS scores MM group only
Do
deficits
in AP
matter?
32. Is poor AP
linked to
difficulties with
language in
children with
MMHL?
Yes…
Summary
In particular,
TFS seems
to be
especially
important for
language
33. Take home messages
Children with
MMHL have
poorer AP
than those
with NH
Particular
difficulties
with TFS (but
not E)
processing
Not only due
to difficulty
hearing
(audibility)
Not due to
poorer
nonverbal IQ
or attention
Associated
with poorer
language
outcomes
34. The future…
Language Development and Disorder in Children with SNHL: A UK Cohort Study
Year 1
Background Auditory Cognitive Language Academic
SES Audiometry Nonverbal IQ Phonology EYFSP
Questionnaires Auditory processing Working memory Vocabulary KS1
Communication Grammar KS2
Social, emotional, Reading
behavioural
longitudinal
Early-confirmed
mild-profound
SNHL
(N = 126)
Late-confirmed
mild SNHL
(N ≥ 43)
DLD and DRD
(N ~ 50)
Unilateral SNHL
(N = 86)
ANSD
(N = 17)
Year 2
Year 3 Years 6-7 Years 6-7
participantsdesign
Year 4
prospective
Year 5
Year 6
battery
retrospective
Years 6-7