The Relationship Between Linguistic Input and Communication Outcomes in Children With Unilateral Hearing Loss: The Impact of Device Fitting.

Abstract

Objectives: Although the benefits of hearing devices in children with bilateral hearing loss are well established, evidence in unilateral hearing loss (UHL) remains limited. This study aimed to (i) examine whether device fitting influences the relationship between linguistic input and communication outcomes (language and functional listening) in young children with UHL, and (ii) assess whether consistency of device use affects this relationship.

Design: A longitudinal study included 43 device-fitted and 61 non-fitted children with UHL at 12 mo (mean worse-ear hearing level: 80.9 versus 86.7 dB HL), and a subset of 26 and 15, respectively, at 3 yrs. Linguistic input (adult word count [AWC], conversational turn count [CTC]), nonlinguistic input, and child vocalizations were measured using Language ENvironment Analysis. Language was assessed with the Australian English Developmental Vocabulary Inventory at 12 mo, Peabody Picture Vocabulary Test and Preschool Language Scales at 3 yrs, and child vocalization count at both ages. Functional listening was assessed using the Parent Evaluation on Aural/Oral Performance (PEACH) questionnaire. Linear regression examined whether device fitting influenced the associations between linguistic input and communication outcomes. Similar regression analyses were completed in fitted children to assess the influence of consistency of device use on the relationship between linguistic input and communication outcomes.

Results: Linguistic and nonlinguistic input did not differ by device status. In cross-sectional analyses, better language abilities were found in children with higher CTC at both 12 mo and 3 yrs. Better functional listening abilities were found in children with higher CTC at 12 mo. A similar but not significant trend existed at 3 yrs. Associations between outcomes (except child vocalization count) and AWC were all nonsignificant. The nature of the association between AWC or CTC and communication outcomes did not vary between the fitted and not-fitted children in any of these analyses. Likewise, consistency of device use did not influence the association between linguistic input and communication outcomes. In longitudinal analyses, CTC increased with age similarly in both groups, however, no associations were evident between early linguistic input and later communication outcomes.

Conclusion: Similar to children with bilateral hearing loss, better communication outcomes in children with UHL are associated with increased two-way conversations with caregivers. There was no evidence that device fitting or consistency in device use affected this association. Outcomes underscore the importance of interactive communication between caregivers and children, regardless of fitting status.