Children who are hard of hearing (CHH) who wear hearing aids have experienced improved early childhood developmental outcomes due to early identification and intervention compared to previous generations, but may still face delays in specific abilities related to inconsistent auditory experience. Early language and cognitive abilities form the foundation for listening and learning in classrooms during elementary schools. Therefore, CHH who have deficits in these skills may face significant academic and social challenges as they enter school. However, the effect of inconsistent auditory experience during early childhood on the ability to understand speech in noise and reverberation has not been widely studied in CHH who wear hearing aids. The long-term goal of this research program is to optimize amplification and speech understanding in CHH by identifying the underlying processes that support listening in academic and social situations. The objective of this proposal is to examine how inconsistent auditory experience during early childhood affects speech understanding in noise and reverberation and on complex tasks that require cognitive processing. The current proposal will also examine how linguistic and cognitive skills may help minimize the negative consequences of limited auditory experience by supporting listening under degraded acoustic conditions. The central hypothesis of the current proposal is that inconsistent early auditory experience at age 3 will negatively impact speech understanding in noise and reverberation in CHH at school age.
Three specific aims are proposed to test this theory:
Aim 1. To test the hypothesis that inconsistent auditory experience of CHH prior to entering school results in poorer speech recognition at school-age and that cognitive and linguistic skills at 1st grade will mediate this relationship at 3rd grade.
Aim 2. To test the hypothesis that acoustic factors and working memory skills affect listening in modulated noise and reverberation in children.
Aim 3. To determine the extent to which concurrent memory, EF, and linguistic skills are related to speech perception and discrimination in CHH, and to evaluate how variations in listening task demands moderate that relationship.
In Aim 1, aided speech audibility, amount of daily hearing aid use, and the quantity and quality of parental language input at age 3 will be used to predict sentence recognition in classroom levels of noise and reverberation at 1st grade. Aided audibility, hearing aid use and 1st grade language skills will then be used to predict speech recognition in degraded conditions at 3rd grade.
In Aim 2, audibility and working memory will be used to predict how well children can use speech information from brief gaps of modulated noise to reconstruct the speech signal in noise and reverberation.
In Aim 3, concurrent language and cognitive abilities will be used to predict listening on a multi-talker speech recognition and gated-sentence recognition tasks. The data generated from this proposal will allow optimization of amplification based on the listening environment and lead to interventions that target the skills the support listening and learning in realistic environments.

Public Health Relevance

The purpose of this research is to identify the factors that support speech recognition in realistic environments with a large group of children with mild to severe hearing loss in the school years. We will extend our comprehensive evaluation of preschoolers into the school age years, which will provide important insights into the effectiveness of interventions designed to minimize the consequences of hearing loss on listening and learning. Our findings regarding the relative contributions of auditory skills to outcomes will inform scientific theories about developmental consequences of inconsistent early auditory experience. These data will guide evidence-based practice and health policy for the clinical management of children who are hard of hearing.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-IFCN-B (02))
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Donahue, Amy
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Father Flanagan's Boys' Home
Boys Town
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Walker, Elizabeth; McCreery, Ryan; Spratford, Meredith et al. (2016) Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes. J Am Acad Audiol 27:204-18
Brennan, Marc; McCreery, Ryan; Kopun, Judy et al. (2016) Masking Release in Children and Adults With Hearing Loss When Using Amplification. J Speech Lang Hear Res 59:110-21
McCreery, Ryan; Walker, Elizabeth; Spratford, Meredith et al. (2016) Stability of Audiometric Thresholds for Children with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Implications for Safety. J Am Acad Audiol 27:252-63
Moeller, Mary Pat; Tomblin, J Bruce; OCHL Collaboration (2015) Afterword: Lessons Learned About Multicenter Research Collaboration. Ear Hear 36 Suppl 1:99S-101S
Moeller, Mary Pat; Tomblin, J Bruce; OCHL Collaboration (2015) Epilogue: Conclusions and Implications for Research and Practice. Ear Hear 36 Suppl 1:92S-8S
McCreery, Ryan W; Kaminski, Jan; Beauchaine, Kathryn et al. (2015) The impact of degree of hearing loss on auditory brainstem response predictions of behavioral thresholds. Ear Hear 36:309-19
Walker, Elizabeth A; Holte, Lenore; McCreery, Ryan W et al. (2015) The Influence of Hearing Aid Use on Outcomes of Children With Mild Hearing Loss. J Speech Lang Hear Res 58:1611-25
McCreery, Ryan W; Walker, Elizabeth A; Spratford, Meredith et al. (2015) Speech Recognition and Parent Ratings From Auditory Development Questionnaires in Children Who Are Hard of Hearing. Ear Hear 36 Suppl 1:60S-75S
Walker, Elizabeth A; McCreery, Ryan W; Spratford, Meredith et al. (2015) Trends and Predictors of Longitudinal Hearing Aid Use for Children Who Are Hard of Hearing. Ear Hear 36 Suppl 1:38S-47S
Ambrose, Sophie E; Walker, Elizabeth A; Unflat-Berry, Lauren M et al. (2015) Quantity and Quality of Caregivers' Linguistic Input to 18-Month and 3-Year-Old Children Who Are Hard of Hearing. Ear Hear 36 Suppl 1:48S-59S

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