Medical Risk Factors Associated with Listening Difficulties in Children

OBJECTIVESListening difficulty refers to difficulty hearing speech despite normal pure-tone audiometry. It is as prevalent as clinical hearing loss among adults, but incidence, causes and treatment remain poorly understood in children. We hypothesized that four medical risk factors would be associated with listening difficulty in children. METHODSA prospective, case-control study was conducted in a tertiary care childrens hospital. Children (6-13 years old) with clinically normal hearing divided into listening difficulty (n=68) and typically developing (n=84) groups based on a validated caregiver report. All children were native English users without reported conditions restricting participation. Testing included extended high frequency (EHF) audiometry, speech and spatial perception, and cognitive function. Caregiver reports, electronic medical records, and testing ascertained risk of prematurity, head injury, otitis media and EHF hearing loss. Logistic regression, chi-square, correlation, and odds ratios determined associations of listening difficulty with risk factors. RESULTSPrevalence and risk of prematurity (18%, OR 3.39 [95% CI, 1.1-10.2]), head injury (21%, 3.37 [1.2-9.3]), and high frequency hearing loss (32%, 2.42 [1.1-5.5]) were significantly greater for children with listening difficulty than typically developing children. Ventilation tubes were no more common in the listening difficulty group (25%, 1.14 [0.5-2.4]). EHF hearing loss was associated with prematurity and tubes. Prematurity, tubes, and EHF loss were significantly related to poorer competing speech perception and dichotic listening. CONCLUSIONSChildren with a history of prematurity, head injury or EHF loss were at increased risk of listening difficulties. Early intervention to boost communication skills could potentially improve poorer long-term outcomes.