While adults and children with listening difficulties frequently have hearing loss, a substantial proportion of those attending audiology clinics have normal audiometric sensitivity, explains David R. Moore, PhD. “A recent study estimated that 40 million adults with clinically normal hearing in the United States report having listening difficulties, which is equal to the number of people with a clinical hearing loss,” Dr. Moore says. “These proportions in children are unknown, but they likely exceed the ratio seen in adults.”

For some children, listening difficulties are especially challenging because they can contribute to delays in social, academic, and personal development. “Parents of children with listening difficulties often report that their kids are falling behind at school, have challenges keeping their attention, and exhibit speech or language difficulties,” Dr. Moore says. “Unfortunately, little is known about the causes of listening difficulties in children and the optimal approach to managing these patients.”

For a study published in Ear and Hearing, Dr. Moore and colleagues assessed listening ability in children using the Evaluation of Children’s Listening and Processing Skills (ECLiPS) tool, a reliable and validated caregiver questionnaire. The study included 146 children aged 6-13 with normal audiograms. Using quantitative metrics from a battery of auditory and cognitive tests, investigators compared behavioral assessments of children with “listening difficulties” to an age-matched control group that was “typically developing.”

 Listening Difficulties Linked to Impaired Cognitive Function

“Using the most sensitive measures of hearing, our study found some evidence of subclinical hearing loss in both the ear and the brainstem,” Dr. Moore says. “However, these subtle effects were dwarfed by problems with speech perception, inattention, impaired working and longer-term memory, and verbal and non-verbal intelligence. Regarding speech-in-noise (SiN) hearing, children were able to sense but not process speech.”

According to the study results, all scores from the ECLiPS, the SCAN-3:C, and the NIH Cognition Toolbox were significantly lower for children with listening difficulties than for their typically developing peers. A similar effect was seen on the Listening in Spatialized Noise—Sentences (LiSN-S) test for speech sentence-in-noise intelligibility, but this only reached significance for the Low Cue and High Cue conditions and the Talker Advantage derived score.

In a stepwise regression analysis examining factors that contributed to the ECLiPS total scaled score, the researchers found a model that explained 42% of its variance based on the SCAN-3:C composite, LiSN-S Talker Advantage, the NIH Toolbox Picture Vocabulary, and Dimensional Change Card Sorting scores. High correlations were seen between many test scores, including the ECLiPS, SCAN-3:C, and NIH Toolbox composite measures. In univariate statistical comparisons, most measures showed significantly poorer performance for the listening difficulties group than for the typically developing group.

Call to Action: Go Beyond Auditory Testing

Considering the study findings, Dr. Moore recommends children and adults with otherwise unexplained and persistent listening difficulties be referred for a full audiometric workup. “This should include SiN testing and extended high frequency (EHF) audiometry,” he says. “SiN and EHF tests are well-known to audiologists, but rarely used despite decades of researchers urging the adoption of these tests.”

Although there is no clear evidence-based treatment approach for children, Dr. Moore says the new evidence from his study team demonstrates why it is important to use these tests when diagnosing children. He also recommends that parents talk to audiologists about potential ways to draw the attention of children to important sounds to monitor progress with listening difficulties.

Dr. Moore notes that his study group, which includes speech therapists and neonatologists, is currently investigating if signs of listening difficulties and subclinical hearing loss are present in premature infants shortly after birth. “Most of these infants would pass current neonatal hearing screening,” he says. “However, if signs of listening difficulties and subclinical hearing loss can be detected, we may be able to coach their caregivers to use intensive communication techniques during the first year of life. This may be a unique opportunity to successfully intervene with long-term benefits.”