Hearing sensitivity and speech perception in Mandarin-speaking children with otitis media with effusion

Abstract

The potential effects of otitis media with effusion (OME) on children’s speech and language development have been well studied for decades. However, most previous studies have focused on the long term influences of OME on later language performance. Hearing sensitivity and speech perception in children who currently suffer from OME have not been comprehensively investigated. Lexical tone perception, which is important for tonal language speakers, receives even less attention in this population. In addition, simulated models of OME related hearing loss are useful in determining degree of speech perception disadvantage and possible rehabilitation benefits. There have been few simulation studies to date and the validity of the simulation paradigms used was not established. The present research evaluated the impact of OME on hearing sensitivity and speech perception in Mandarin-speaking children, investigated the interaction among hearing sensitivity, speech perception, and listening environment, and determined the validity of a simulated model of OME related hearing loss. Firstly, a systematic review on pure tone thresholds and speech perception related with OME was initiated to clarify our present knowledge and identify research needs. Secondly, Mandarin-speaking school age children with and without OME were invited to participate in the ensuing research program. Two behavioral tests of audition were administered, to evaluate sentence perception in quiet and noisy environments and lexical tone recognition in noise. A hierarchical cluster algorithm was employed to stratify hearing loss associated with OME, and its stability and validity was assessed. Thirdly, a frequency-specific attenuation-based simulation of OME related hearing loss was administered in an additional group of otologically normal children. Speech perception abilities in children with normal hearing, actual OME related hearing loss, and simulated OME related hearing loss were compared. Results of the research program indicated that the hearing thresholds associated with OME ranged from 8.3 to 53.3 dB HL, with an average of 26.8 dB HL. The hierarchical cluster algorithm was stable and valid in stratifying OME related hearing loss into different categories of risk for speech perception disadvantage. Children who were assigned to the low risk group did not have significantly impaired speech perception in noise compared to their peers with normal hearing. Children who were allocated to the high risk group demonstrated significant poorer speech perception abilities in adverse listening conditions compared to their counterparts with normal hearing and those children in the low risk group. Adverse listening conditions which are typical in real world classrooms imposed considerable disabilities on speech perception for children with or without hearing loss. The simulation based on frequency-specific attenuation could be used to reflect speech perception disabilities in quiet and to roughly estimate speech perception impairment in typical classroom environments. As the first research program to investigate hearing sensitivity and speech perception in Mandarin-speaking children with OME, this series of studies has shown the hierarchical cluster analysis approach may effectively gauge the effects of OME related hearing loss on general speech perception and lexical tone recognition in noise. The stratification of OME related hearing loss provides a rationale for evidence-based intervention and rehabilitation of OME related hearing loss.