Listening Effort in School-Age Children With Normal Hearing Compared to Children With Limited Useable Hearing Unilaterally

Objectives: Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design: Two groups of school-age children (aged 7-12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (-12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of "task difficulty" and "hard to think" were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results: Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions: Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.