Pilot study of cognition in children with unilateral hearing loss

doi:10.1016/j.ijporl.2013.08.028

International Journal of Pediatric Otorhinolaryngology

Volume 77, Issue 11, November 2013, Pages 1856-1860

https://doi.org/10.1016/j.ijporl.2013.08.028 Get rights and content

Abstract

Objective

The objective of this study was to obtain preliminary data on the cognitive function of children with unilateral hearing loss in order to identify, quantify, and interpret differences in cognitive and language functions between children with unilateral hearing loss and with normal hearing.

Methods

Fourteen children ages 9–14 years old (7 with severe-to-profound sensorineural unilateral hearing loss and 7 sibling controls with normal hearing) were administered five tests that assessed cognitive functions of working memory, processing speed, attention, and phonological processing.

Results

Mean composite scores for phonological processing were significantly lower for the group with unilateral hearing loss than for controls on one composite and four subtests. The unilateral hearing loss group trended toward worse performance on one additional composite and on two additional phonological processing subtests. The unilateral hearing loss group also performed worse than the control group on the complex letter span task. Analysis examining performance on the two levels of task difficulty revealed a significant main effect of task difficulty and an interaction between task difficulty and group.

Conclusions

Cognitive function and phonological processing test results suggest two related deficits associated with unilateral hearing loss: (1) reduced accuracy and efficiency associated with phonological processing, and (2) impaired executive control function when engaged in maintaining verbal information in the face of processing incoming, irrelevant verbal information. These results provide a possible explanation for the educational difficulties experienced by children with unilateral hearing loss.

Introduction

Unilateral hearing loss (UHL) has become increasingly common, such that one of 40 adolescents in the United State has UHL [1]. Children with UHL have been noted to have significantly lower scores on oral language tests, a four-fold greater odds of Individualized Education Plans (a measure of educational difficulty or failure), and greater than two-fold increased odds of speech therapy compared to siblings with normal hearing [2]. A longitudinal study of children with UHL demonstrated that although language and verbal cognitive scores increased over time, problems with behavior, school performance, and academic weaknesses persisted according to parental and teacher reports [3]. Pilot studies of brain networks using resting state functional connectivity MRI (rs-fcMRI) have shown significant differences between children with UHL and their normal hearing siblings. These differences include areas that are thought to be related to executive functions (task control), auditory processing, and memory formation [4].

Possible explanations for the observations from the behavioral and rs-fcMRI studies summarized above are that they result from asymmetric auditory deficit only, or that asymmetric auditory deficit affects language development, or that asymmetric auditory deficit affects cognitive function. Studies in children with bilateral hearing loss who have undergone habilitation with hearing aids or cochlear implants suggest that they continue to demonstrate cognitive deficits even after hearing habilitation has been optimized [5], [6], [7], [8], [9], [10], [11]. These deficits included poorer working memory, longer processing speeds, poorer phonological memory, and poorer attention. In particular, Pisoni and Geers concluded that working memory plays an important role in mediating performance of different tasks that include phonologic coding and rehearsal processes used to retrieve and manipulate the phonological representations of spoken words [12]. In children with bilateral hearing loss, significant amounts of the currently unexplained variance in word recognition scores (up to 20%) may be due to individual cognitive differences in working memory and speed of verbal processing [13]. Furthermore, Burkholder and Pisoni concluded that the lack of early auditory experience and phonological processing activities before implantation produced measurable effects on working memory function that relies on verbal rehearsal and serial scanning of phonologic information [5].

The objective of this study was to obtain preliminary data on the cognitive function of children with UHL in order to identify, quantify, and interpret differences in cognitive and language functions between children with UHL and with normal hearing (NH). We hypothesized that children with UHL would not perform as well as their NH siblings on measures of cognition and phonological processing.

Section snippets

Methods

The Washington University Medical Center Human Research Protection Office gave institutional review board approval prior to the initiation of this study. All parents gave written informed consent and all participants gave pediatric assent for this study.

Demographic and clinical background

Fourteen participants were recruited for the study, 7 with UHL and 7 sibling controls with NH. All of the children with UHL were identified through ICD-9 diagnosis codes from Otolaryngology clinics and not due to concerns from schools. Individual participant demographic characteristics, IQ, and hearing characteristics are summarized in Table 1 while the participants with UHL versus NH control groups’ demographic characteristics are summarized in Table 2. There were no demographic differences

Discussion

In this pilot study, we found significant deficits in complex verbal working memory and several aspects of phonological processing in children with UHL compared to their siblings with NH. The results of the tests of cognitive function and phonological processing suggest that there may be two related verbal deficits associated with UHL. The first is reduced accuracy and efficiency associated with phonological processing that is especially pronounced when listening to unfamiliar verbal

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Brain plasticity and hearing disorders
2021, Revue Neurologique
Citation Excerpt :
Therefore, subjects, either children or adults, experiencing asymmetrical hearing loss present deleterious behavioral consequences [57–59]. For example, in children, profound unilateral hearing loss stirs developmental [60] and language [58] delays inducing lower school performances (higher grade failure up to 33% [58,61], thus requiring intervention as early as possible to avoid future handicaps in their daily life [62,63]. In UHL adults compared to NH peers, consequences are presented as degraded localization and speech recognition-in-noise performances [64,65] and a lower global quality of life [66].
Permanently changed sensory stimulation can modify functional connectivity patterns in the healthy brain and in pathology. In the pathology case, these adaptive modifications of the brain are referred to as compensation, and the subsequent configurations of functional connectivity are called compensatory plasticity. The variability and extent of auditory deficits due to the impairments in the hearing system determine the related brain reorganization and rehabilitation. In this review, we consider cross-modal and intra-modal brain plasticity related to bilateral and unilateral hearing loss and their restoration using cochlear implantation. Cross-modal brain plasticity may have both beneficial and detrimental effects on hearing disorders. It has a beneficial effect when it serves to improve a patient's adaptation to the visuo-auditory environment. However, the occupation of the auditory cortex by visual functions may be a negative factor for the restoration of hearing with cochlear implants. In what concerns intra-modal plasticity, the loss of interhemispheric asymmetry in asymmetric hearing loss is deleterious for the auditory spatial localization. Research on brain plasticity in hearing disorders can advance our understanding of brain plasticity and improve the rehabilitation of the patients using prognostic, evidence-based approaches from cognitive neuroscience combined with post-rehabilitation objective biomarkers of this plasticity utilizing neuroimaging.
Unilateral congenital hearing loss in children: Challenges and potentials
2019, Hearing Research
Citation Excerpt :
Children with UHL were found to present lower (verbal) IQ scores than their NH peers (Niedzielski et al., 2006; Martínez-Cruz et al., 2009; Lieu et al., 2013; Purcell et al., 2016), although verbal IQ also improved in some children in the course of time (Lieu et al., 2012). Ead et al. (2013) reported significant deficits in a complex verbal working memory task in children with UHL. They had difficulty maintaining verbal information while processing irrelevant verbal information (impaired executive control function).
The estimated incidence of sensorineural hearing impairment (>40 dB HL) at birth is 1.86 per 1000 newborns in developed countries and 30–40% of these are unilateral. Profound sensorineural unilateral hearing impairment or single sided deafness (SSD) can be treated with a cochlear implant. However, this treatment is costly and invasive and unnecessary in the eyes of many. Very young children with SSD often do not exhibit language and cognitive delays and it is hard to imagine that neurocognitive skills will present difficulties with one good ear. In the current paper we review the most recent evidence on the consequences of unilateral hearing impairment for auditory and neurocognitive factors. While data of both adults and children are discussed, we focus on developmental factors, congenital deafness and a window of opportunity for intervention. We discuss which etiologies qualify for a cochlear implant and present our multi-center prospective study on cochlear implants in infants with one deaf ear. The large, state-of-the art body of research allows for evidence-based decisions regarding management of unilateral hearing loss in children.
Analysis of the relationship between cognitive skills and unilateral sensory hearing loss
2018, Neurologia
Analizar la asociación de competencias cognitivas en sujetos con hipoacusia unilateral severa versus sujetos con audición normal.
Participaron 40 adultos; 20 pacientes, 10 de cada género, con hipoacusia unilateral sensorial severa y 20 sujetos sanos pareados al grupo de estudio. Las habilidades cognitivas se midieron con la batería Woodcock Muñoz-revisada y los procesos centrales auditivos con pruebas psicoacústicas monoaurales. Se realizaron gráficas de caja y prueba t de Student para muestras relacionadas con significación p ≤ 0,05.
Al comparar el desempeño en las pruebas palabra filtrada y bisílabos comprimidos, se encontró diferencia estadísticamente significativa p ≤ 0,05, con mayor variabilidad de respuesta en los hipoacúsicos, los cuales también tuvieron mejor desempeño cognitivo en las subpruebas inversión de números, aprendizaje visual auditivo, análisis y síntesis, formación de conceptos y palabras incompletas.
Los hipoacúsicos presentaron bajo desempeño en palabra filtrada y bisílabos comprimidos, y mayor habilidad para memoria, razonamiento y procesamiento auditivo. Es importante realizar pruebas complementarias, tales como procesos centrales auditivos y habilidades cognitivas que permitan establecer estrategias de habilitación, rehabilitación y terapéuticas con la finalidad de optimizar y estimular las habilidades de los sujetos con hipoacusia unilateral.
To analyse cognitive skills in patients with severe unilateral hearing loss versus those in subjects with normal hearing.
40 adults participated: 20 patients (10 women and 10 men) with severe unilateral hearing loss and 20 healthy subjects matched to the study group. Cognitive abilities were measured with the Spanish version of the Woodcock Johnson Battery-Revised; central auditory processing was assessed with monaural psychoacoustic tests. Box plots were drawn and t tests were performed for samples with a significance of P≤.05.
A comparison of performances on the filtered word testing and time-compressed disyllabic word tests between patients and controls revealed a statistically significant difference (P≤.05) with greater variability among responses by hearing impaired subjects. This same group also showed a better cognitive performance on the numbers reversed, visual auditory learning, analysis synthesis, concept formation, and incomplete words tests.
Patients with hearing loss performed more poorly than controls on the filtered word and time-compressed disyllabic word tests, but more competently on memory, reasoning, and auditory processing tasks. Complementary tests, such as those assessing central auditory processes and cognitive ability tests, are important and helpful for designing habilitation/rehabilitation and therapeutic strategies intended to optimise and stimulate cognitive skills in subjects with unilateral hearing impairment.
Hearing Loss after Cardiac Surgery in Infancy: An Unintended Consequence of Life-Saving Care
2018, Journal of Pediatrics
Citation Excerpt :
Children with CHD are known to have decreased scores in cognitive examinations, the nature of which is multifactorial.2,31,32 Similarly, children with hearing loss are also known to perform less well on such tests.33-36 Cognitive tests are language based and most often administered verbally, relying on a child's ability to use language to answer examination questions.
To investigate the prevalence of hearing loss after cardiac surgery in infancy, patient and operative factors associated with hearing loss, and the relationship of hearing loss to neurodevelopmental outcomes.
Audiologic and neurodevelopmental evaluations were conducted on 348 children who underwent repair of congenital heart disease at the Children's Hospital of Philadelphia as part of a prospective study evaluating neurodevelopmental outcomes at 4 years of age. A prevalence estimate was calculated based on presence and type of hearing loss. Potential risk factors and the impact of hearing loss on neurodevelopmental outcomes were evaluated.
The prevalence of hearing loss was 21.6% (95% CI, 17.2-25.9). The prevalence of conductive hearing loss, sensorineural hearing loss, and indeterminate hearing loss were 12.4% (95% CI, 8.8-16.0), 6.9% (95% CI, 4.1-9.7), and 2.3% (95% CI, 0.6-4.0), respectively. Only 18 of 348 subjects (5.2%) had screened positive for hearing loss before this study and 10 used a hearing aid. After adjusting for patient and operative covariates, younger gestational age, longer postoperative duration of stay, and a confirmed genetic anomaly were associated with hearing loss (all P < .01). The presence of hearing loss was associated with worse language, cognition and attention (P <.01).
These findings suggest that the prevalence of hearing loss in preschool children after heart surgery in infancy may be 20-fold higher than in the 1% prevalence seen in the general population. Younger gestational age, presence of a genetic anomaly, and longer postoperative duration of stay were associated with hearing loss. Hearing loss was associated with worse neurodevelopmental outcomes.
Management of unilateral hearing loss
2016, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Full scale, verbal and performance IQ scores were lower for adolescents with UHL compared to sibling controls [73,75]. Additionally, children with UHL have shown deficits in complex verbal working memory [80]. Overall, although more research is needed, the evidence tends to indicate that children with UHL may have lower performance on complex verbal IQ tasks compared to their NH peers.
A representative sample of literature regarding unilateral hearing loss (UHL) was reviewed to provide evidence of the effects of UHL and the intervention options available for children with UHL. Considerations during the assessment and management of children with UHL are illustrated using case illustrations.
Research articles published from 2013 to 2015 were searched in the PubMed database using the keywords “unilateral hearing loss”. Articles from 1950 to 2013 were included from a previous literature review on minimal hearing loss [1]. A retrospective review of charts of 14 children with UHL was also conducted.
The evidence indicates that children with UHL are more likely to have structural anomalies of the inner ear; may face challenges in six different domains, and have six intervention options available. Evidence also indicates that although some children appear to exhibit no delays or difficulties, others have significant challenges, some of which continue into adulthood.
Children with UHL have to be treated on a case-by-case basis. Parent education regarding UHL, its effects, and all available management options is critical so they can make informed decisions. Close monitoring and good communication between professionals in different domains is crucial in order to minimize the potential negative effects of UHL.
Inner-ear malformations as a cause of single-sided deafness
2020, Journal of Laryngology and Otology

View all citing articles on Scopus

^☆: This study was partially supported by the St. Louis Children's Hospital Foundation/Children's Surgical Sciences Institute.

View full text

Pilot study of cognition in children with unilateral hearing loss☆

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Demographic and clinical background

Discussion

J. Exp. Child Psychol.

J. Exp. Child Psychol.

Trends Cogn. Sci.

NeuroImage

J. Mem. Lang.

Change in prevalence of hearing loss in US adolescents

JAMA

Unilateral hearing loss is associated with worse speech-language scores in children

Pediatrics

Longitudinal study of children with unilateral hearing loss

Laryngoscope

Interregional brain interactions in children with unilateral hearing loss

Otolaryngol. Head Neck Surg.

Some measures of verbal and spatial working memory in eight- and nine-year-old hearing-impaired children with cochlear implants

Ear Hear.

Neuropsychological correlates of vocabulary, reading, and working memory in deaf children with cochlear implants

J. Deaf Stud. Deaf Educ.

Development of visual attention skills in prelingually deaf children who use cochlear implants

Ear Hear.

The impact of audition on the development of visual attention

Psychol. Sci.

Audition and visual attention: the developmental trajectory in deaf and hearing populations

Dev. Psychol.