10.14639/0392-100X-N1746
Objective. To analyse hearing attention and quality of listening in a cohort of children affected by moderate to severe unilateral hearing loss, comparing a group of hearing aid users to children with no hearing aid. Methods. Twenty-four children (12 hearing aid users, and 12 without hearing rehabilitation) underwent audiological evaluation with speech audiometry in quiet and noise, hearing attention tests, and the speech, spatial and quality of hearing questionnaire in the version for parents. Results. Concerning speech audiometry in noise, in the most difficult condition no one in the unaided group achieved a normal speech recognition threshold score (0% vs 11.6 ± 2.7% in the aided group). The selective hearing attention and shifting tests showed fewer errors in the aided group vs. the non-aided group. The questionnaire showed a significant difference between the quality of listening perceived by the parents of the two groups. The mean total scores were 152.8 ± 2.7 in the aided group and 116.1 ± 2.6 in the non-aided group (p &gt; 0.001). Conclusions. Children with unilateral hearing loss without hearing rehabilitation show a lower quality of hearing, especially with regards to divided auditory attention. Hearing rehabilitation should be proposed as soon as possible in children with moderate to severe unilateral hearing loss.
text/xml
1827-675X
1746
en
Rosaria Turchetta
http://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
hearing loss
Hearing attention and quality of listening in children with unilateral hearing loss with and without hearing aid
Text.Serial.Journal
https://www.actaitalica.it/
42
Audiology
2022-05-16
2021-06-24
2022-05-23
2022-05-23
169-175
1
Rosaria Turchetta
2022/05/16
10.14639/0392-100X-N1746
169
Department of Sense Organs, ENT Department, Sapienza University of Rome, Rome, Italy
1827-675X
hearing loss
en
175
Hearing attention and quality of listening in children with unilateral hearing loss with and without hearing aid
https://www.actaitalica.it/article/download/1746/798
42
ACTA OTORHINOLARYNGOLOGICA ITALICA 2022;42:169-175; doi: 10.14639/0392-100X-N1746




Audiology


Hearing attention and quality of listening in children
with unilateral hearing loss with and without hearing aid
Attenzione uditiva e qualità dell’udito in bambini affetti da ipoacusia monolaterale
con o senza protesi
Francesca Yoshie Russo1, Daniele De Seta2, Maria Patrizia Orlando1, Massimo Ralli1, Maria Gloria Cammeresi1,
Antonio Greco1, Marco de Vincentiis1, Giovanni Ruoppolo1, Patrizia Mancini1, Rosaria Turchetta1
1
 Department of Sense Organs, ENT Department, Sapienza University of Rome, Rome, Italy; 2 Department of Surgery, ENT Unit,
University of Cagliari, Cagliari, Italy


SUMMARY
Objective. To analyse hearing attention and quality of listening in a cohort of children af-
fected by moderate to severe unilateral hearing loss, comparing a group of hearing aid users
to children with no hearing aid.
Methods. Twenty-four children (12 hearing aid users, and 12 without hearing rehabilita-
tion) underwent audiological evaluation with speech audiometry in quiet and noise, hearing
attention tests, and the speech, spatial and quality of hearing questionnaire in the version
for parents.
Results. Concerning speech audiometry in noise, in the most difficult condition no one in
the unaided group achieved a normal speech recognition threshold score (0% vs 11.6 ± 2.7%
in the aided group). The selective hearing attention and shifting tests showed fewer errors
in the aided group vs. the non-aided group. The questionnaire showed a significant differ-
ence between the quality of listening perceived by the parents of the two groups. The mean
total scores were 152.8 ± 2.7 in the aided group and 116.1 ± 2.6 in the non-aided group
(p > 0.001).
Conclusions. Children with unilateral hearing loss without hearing rehabilitation show a
lower quality of hearing, especially with regards to divided auditory attention. Hearing        Received: June 24, 2021
                                                                                                Accepted: October 18, 2021
rehabilitation should be proposed as soon as possible in children with moderate to severe
unilateral hearing loss.
                                                                                                Correspondence
KEY WORDS: hearing aid, unilateral hearing loss, hearing attention, cognition, hearing          Francesca Yoshie Russo
loss                                                                                            Department of Sense Organs, Sapienza University
                                                                                                of Rome, viale del Policlinico 155, 0161 Rome,
                                                                                                Italy
RIASSUNTO                                                                                       Tel. +39 06 49976854
Obiettivo. analizzare l’attenzione uditiva e la qualità di ascolto in bambini affetti da ipo-   E-mail: Francescayoshie.russo@uniroma1.it
acusia unilaterale da moderata a grave, confrontando un gruppo di pazienti portatori di
protesi acustica con bambini non riabilitati.                                                     How to cite this article: Russo FY, De Seta D,
Metodi. Ventiquattro bambini (12 portatori di protesi acustiche e 12 non protesizzati) sono       Orlando MP, et al. Hearing attention and quality
stati sottoposti a valutazione audiologica con audiometria vocale, test di attenzione uditiva     of listening in children with unilateral hearing
e questionario sulla qualità dell’udito nella versione per genitori.                              loss with and without hearing aid. Acta Otorhi-
Risultati. Nella condizione più difficile, in audiometria vocale nel rumore i bambini non         nolaryngol Ital 2022;42:169-175. https://doi.
riabilitati avevano delle performance scarse (0% vs 11,6 ± 2,7%). L’attenzione selettiva e        org/10.14639/0392-100X-N1746
i test di shifting hanno mostrato un numero significativamente inferiore di errori nel grup-
po dei protesizzati rispetto ai non protesizzati. Il questionario ha mostrato una differenza    © Società Italiana di Otorinolaringoiatria
                                                                                                e Chirurgia Cervico-Facciale
significativa tra la qualità dell’ascolto percepita dai genitori dei due gruppi (152,8 ± 2,7
protesizzati e 116,1 ± 2,6 non protesizzati p > 0,001).
                                                                                                               OPEN ACCESS
Conclusioni. I bambini con ipoacusia unilaterale senza riabilitazione uditiva mostrano
una peggiore attenzione uditiva, soprattutto per quanto riguarda l’attenzione uditiva se-       This is an open access article distributed in accordance with
                                                                                                the CC-BY-NC-ND (Creative Commons Attribution-Non-
lettiva. La riabilitazione protesica dovrebbe essere proposta il prima possibile nei bambini    Commercial-NoDerivatives 4.0 International) license. The
con ipoacusia unilaterale da moderata a grave.                                                  article can be used by giving appropriate credit and mentio-
                                                                                                ning the license, but only for non-commercial purposes and
PAROLE CHIAVE: ipoacusia unilaterale, protesizzazione acustica, attenzione uditiva,             only in the original version. For further information: https://
qualità dell’ascolto, sforzo cognitivo                                                          creativecommons.org/licenses/by-nc-nd/4.0/deed.en




                                                                                                                                                        169
F.Y. Russo et al.




Introduction                                                       The main goal of the present prospective study is to analyse
                                                                   the hearing attention and quality of hearing in a cohort of
The incidence of unilateral hearing loss (UHL) is estimated
                                                                   children affected by UHL, comparing a group of HA users
to be between 1 and 6% in school aged children with a              to children with no HA.
high variability based on the assessment method of hearing
loss 1,2. This condition has been widely underestimated in
the past, but is currently matter of attention as its diagnosis    Materials and methods
is made earlier due to universal newborn hearing screen-           A prospective, clinical study was conducted at a University
ing and to stricter follow-up of children at risk 3,4. It is now   hospital. Children and their families were enrolled in the
recognised that sensory deprivation of an auditory pathway         study between April 2017 and September 2019. The study
leads to the loss of binaurality, and patients affected by this    group included 24 patients affected by moderate to severe
condition clearly manifest a lesser ability to localise sounds     UHL selected in the records among all patients followed
and discriminate the signal in noise 5. In addition, we are        at the Otolaryngology Department, Paediatric Audiology
beginning to understand the complex effects of these dis-          Unit. Among more than 80 patients followed in the center
advantages on psycho-cognitive development in children             since 2014, subjects corresponding to the inclusion criteria
and young adults, although there are currently no univer-          and whose parents agreed to enter the protocol were se-
sally accepted guidelines concerning hearing rehabilita-           lected. Twelve patients were HA users for at least 1 year
tion for UHL. In past decades, the common knowledge                (HA group), and 12 patients did not benefit from hearing
among medical and educational professionals was that the           rehabilitation because the family previously chose to not
presence of one normal hearing ear was sufficient for the          use hearing aids (non-HA group). All patients in the study
correct development of language 6. Nevertheless, we now            had an air conduction HA, and had to use the device for at
know that these children are at risk of psychoeducational          least 8 hours a day.
difficulties, with an augmented rate of failing a grade, and       Inclusion criteria were: permanent unilateral moderate to
with increased perceived behavioural issues 7. This may be         severe conductive, sensorineural or mixed hearing loss, age
mostly due to the considerable amount of time that children        comprised between 6 and 11 years old, native Italian speak-
spend in adverse acoustic environments, with high levels of        er. Patients with concomitant otitis media with effusion,
background noise and reverberation 8,9. Indeed, the capac-         diagnosis of developmental delay, or concomitant severe
ity to understand degraded speech is crucial in the devel-         pathologies were excluded. For UHL, we considered the
opmental processes that lasts until adolescence 10. Several        definition of the National Workshop on mild bilateral and
studies have shown that the need to spend energy to focus          unilateral hearing loss 16: average pure tone air conduction
attention on the signal leads to a lower availability of cog-      threshold at 0.5, 1, 2 kHz of any level greater than or equal
nitive resources and therefore to a decrease in performance        to 20 dB HL or pure tone air conduction thresholds greater
in contexts of multi-activity and learning 11. In developing       than 25 dB HL at two or more frequencies above 2 kHz in
children, the loss of audibility is a great challenge in every-    the affected ear with an average pure tone air conduction
day life, and the primary contributor to a delay in matura-        threshold in the good ear less than or equal to 15 dB.
tion of cognitive and linguistic skills 12.                        All patients underwent audiological evaluation and audito-
Another issue arising in this context is the diminished audi-      ry attention test, and parents underwent the SSQ question-
tory attention as a contributing factor to problems of cogni-      naire (speech, spatial and quality of hearing) in the adapted
tive and linguistic development, but also of quality of life.      version for parents 17.
Certainly, compared to their normal hearing peers many of
these children have difficulty in direct selective attention       Audiological examination
during multi-talker listening 11.                                  Patients underwent anamnestic interview and a full ear, nose
Options for management of UHL in children include con-             and throat examination. Hearing ability was evaluated using
ventional hearing aids (HA), bone-conduction hearing               age-appropriate behavioural audiometric assessment tech-
devices, contralateral routing of signal (CROS) aids, and          niques. Audiological evaluation included: pure tone audiom-
Remote Microphone Hearing Assistance Technology sys-               etry with headphones or play audiometry with headphones
tems 13.                                                           at the frequency range 500-4000 Hz; tympanometry; speech
To date, there is no agreement on which degrees of UHL             audiometry in sound field, in a sound-proof cabin, with lists
require amplification, and there are conflicting studies on        of 10 disyllabic words, in quiet and in noise. For the test in
the hearing benefit in children in whom normal perception          noise, we used a broad band noise at SNR+10, with speech
of the signal has been restored through hearing aid 14,15.         and noise coming from the frontal speaker (0°) positioned



170
                                                                                                                             Hearing attention in unilateral hearing loss




at 1 metre from the subject (S0N0 configuration). For both                              Questionnaire
quiet and noise tests, speech was presented at 60 dB, 50 dB,                            The parents’ subjective perception of the children’s qual-
40 dB, 30 dB and 20 dB HL, while in noise test the noise var-                           ity of hearing was evaluated using a questionnaire derived
ied accordingly. Patients in the HA group underwent speech                              from SSQ designed for adults 20. To date, there is no vali-
audiometry wearing their HA.                                                            dated paediatric questionnaire that explores the quality of
                                                                                        hearing and its relevant domains in sufficient detail. There-
Hearing attention test                                                                  fore, we administered the modified version by Galvin et al.
All patients underwent the auditory attention tests devel-                              and previously published 17.
oped by Bertelli and Bilancia in 2006 18. These tests are                               The three sections of the scale examined speech perception
methodologically based on the scheme of the attention tests                             (in quiet, on the telephone, in groups and/or in noisy or re-
developed in 1983 by Cherry and Kruger 19.                                              verberant environments), spatial hearing (the location and
The battery tests for evaluation of auditory attention (AA)                             direction of sounds), and other qualities of hearing (segre-
separately analyse the different procedural components of                               gating and identifying sounds and listening effort). In or-
AA. In this study, our interest focused on selective attention                          der to maximise the accuracy of the answers, parents were
(TS1 and TS2) and the shifting process or divided attention                             asked to observe the children for 5 days before answering
(SH1 and SH2).                                                                          the questionnaire. For each situation described, the parent
One training list was administered before starting the test.                            indicated a score of the child’s listening skill on a scale
TS1 and TS2 consisted of two tests for selective attention,                             from 1 to 10. The questionnaire was translated and admin-
in which the weight of the distraction factor and the cogni-                            istered in Italian.
tive load were differentiated. The two tests were adminis-
tered in a dichotic listening configuration with the signal on                          Statistical analysis
the hearing loss side and the noise on the normal hearing                               Results were reported as means ± Standard Error of Mean
side (ShlNnh configuration) with the speakers positioned at                             (SEM). Considering the small number of the sample non-
                                                                                        parametric tests were used. Mann-Whitney U test was
+90° and -90° 1 metre apart from the head of subject. TS1
                                                                                        used to analyse the results and differences between the two
consisted of a list of 46 disyllabic words in which the target
                                                                                        groups (aided vs unaided). Spearman’s test was used for
(the word dog, disyllabic word in Italian) was presented
                                                                                        correlation between SSQ questionnaire and auditory atten-
eight times, and 19 distractors presented twice in casual
                                                                                        tion tests. All statistical analyses were performed with IBM
order; TS2 consisted of a list composed of the same dis-
                                                                                        SPSS Statistics for Windows (v 22.0, IBM Corp., Armonk,
tractors and 8 animal names that constitute the target to be
                                                                                        NY, USA). The cut-off level for statistical significance was
identified as a category. In both tests the list of words was
                                                                                        set to 0.05.
opposed to 3 different background noises (melody, news,
tale) in three successive tests lasting 1’ and 15’’ each.
The two shifting tests (SH1 and SH2) were also admin-                                   Results
istered in dichotic listening, built with a double target: in                           All patients completed the protocol. The participants in the
SH1, the background noise was a musical theme, the dis-                                 two groups were matched for sex and age (Tab. I). Mean
tractors were the verses of 14 different animals, the targets                           pure tone averages (PTAs) for the worse ear were 69.9 ± 4.0
to be identified were the word flower and the verse of the                              dB vs 69.3 ± 4.2 dB for aided and non-aided group respec-
cat (each one repeated 8 times). In SH2, a musical theme                                tively (p = 0.8, Mann-Whitney U test). In the no HA group,
and a list of 27 words were presented, and the targets were                             7 patients had moderate hearing loss and 7 severe hearing
the verse of a sheep and the word moon (each one repeated                               loss, and in the HA group 6 patients had moderate and 8
8 times). The duration of each of the two tests was 3’22’’.                             patients severe hearing loss.
For each test, the examiner noted the correct and incorrect                             The mean speech perception scores of the two groups in
answers.                                                                                quiet and noise are reported in Table II. In noise, in the most


Table I. Patient characteristics.
                                                  Age (y)                          Sex (m:f)                  PTA worse ear (dB)                   HA use (y)
 HA group                                       9.3 ± 0.56                            8:4                         69.9 ± 4.06                      2.3 ± 0.3
 Non-HA group                                   9.4 ± 0.49                            8:4                         69.3 ± 4.29                          -
Patients were matched for sex, age and PTA use. Results are reported as means ± SEM. PTA: Pure Tone Average; SEM: Standard Error of Mean.




                                                                                                                                                                   171
F.Y. Russo et al.




Table II. Audiological results.
                                          WRS in quiet (% correct)                                                        WRS at SNR +10 dB (% correct)
                   60 dB       50 dB       40 dB       30 dB       20 dB       60 dB      50 dB       40 dB       30 dB    20 dB
 HA group           100     98.3 ± 1.66 84.2 ± 5.56 61.7 ± 7.57 35.8 ± 5.28 98.3 ± 1.12 87.5 ± 5.2 75 ± 5.18 32.5 ± 5.52 11.7 ± 2.7
 Non-HA         98.3 ± 1.12 95.8 ± 1.92 79.2 ± 5.96 49.2 ± 5.14 17.1 ± 5.56 97.5 ± 1.3 81.7 ± 3.65 56.7 ± 6.55 20.0 ± 6.51   0
 group
Results are reported as means ± SEM. Signal varied from 60 to 20 dB both in quiet and in noise. WRS: Word Recognition Score; SNR: Signal-to-Noise-Ratio; SEM: Standard Error of Mean.




difficult condition no one in the no HA group achieved a
normal Speech Recognition Threshold (SRT) score (0% vs
11.6 ± 2.7% in the aided group). Statistical analysis showed
significantly better performance in quiet at 20 dB (p = 0.02,
Mann-Whitney U test) and in noise at 20 dB speech level
(p = 0.005, Mann-Whitney test). For aided patients, no dif-
ference was found for the other conditions, while a non-
significant trend for better scores in the HA vs no HA group
was evident, even in the easier test conditions in both quiet
and in noise (Fig. 1).
The auditory attention tests showed a clear difference be-
tween the two groups (Fig. 2). The selective attention and
shifting tests showed in all trials fewer errors in the HA
group vs the no HA group of children (p < 0.01, Mann-
Whitney U test).
The SSQ questionnaire showed a significant difference
in the quality of listening perceived by the parents of the                                    Figure 2. Mean number of errors in selective and shifting attention tests in
two groups. The mean total score for the HA group was                                          HA and no Ha patients.
152.8 ± 2.7, while the mean total score for the no HA group
was 116.1 ± 2.6 (p > 0.001 Mann-Whitney U test). Figure 3
shows the total and subscales scores for the two groups of
children; a higher score designates a better hearing quality.
In detail, the speech component of the questionnaire was
relevantly different between the two groups.
The SSQ questionnaire was correlated with the auditory at-




                                                                                               Figure 3. Results of SSQ questionnaire for parents, total and subscales
Figure 1. Speech perception scores in quiet and in noise (SNR +10; S0N0)                       scores for the two groups of children. A higher score designates a better hear-
in HA and no HA patients. SNR: Signal-to-Noise-Ratio.                                          ing quality.



172
                                                                                                          Hearing attention in unilateral hearing loss




tention test. A negative correlation was found between all                   creation of auditory attention in the developmental age, we
the subdomains of the test and the three subdomains and the                  investigated selective attention (TS1, TS2), which is the
total score of the questionnaire (-0.47 < r < -0.73, p < 0.01,               process by which a subject focuses attention on a specific
Spearman test), thus indicating that the lower number of                     stimulus to process information by ignoring other poten-
errors in the test was correlated with higher scores in SSQ                  tially distracting stimuli; divided attention (SH1, SH2),
questionnaire. Figure 4 shows the scatterplot for the cor-                   which is the process that allows to simultaneously manage
relation between TS2 tale and SSQ Speech.                                    two or more streams of stimuli, requires the ability to make
                                                                             rapid shifts from one information channel to another 23.
Discussion                                                                   We demonstrate that in unaided children with UHL these
                                                                             two types of attention are significantly impaired compared
The results of the present study demonstrate that children                   to their peers using HAs for at least one year, further dem-
with unilateral hearing loss, with or without hearing reha-                  onstrating that binaurality has a paramount importance
bilitation have a low level of auditory attention. This out-                 in auditory attention processes especially in presence of
come is more significant in children without hearing aids,                   competitive sounds, a circumstance that reflects the more
in which difficulties are more evident with regards to selec-                frequent listening conditions of these subjects (school,
tive and divided auditory attention.                                         canteen, sport facilities). However, one limit of the present
In both groups, parents seem to have a correct perception of                 study is the absence of a healthy control group perform-
the hearing state of their children, perceiving a greater dif-               ing the auditory attention battery, which could have given
ficulty in no HA children, especially in noisy environments                  useful information on the auditory attention capacities in
and difficult situations (speech subscale).                                  normal hearing children compared to, for example, reha-
The creation of the auditory attention is crucial in a devel-                bilitated children with unilateral hearing loss.
opmental age, especially in the early stages of the acquisi-                 One of the objectives of the construction of the battery for
tion of lexical language skills 21. An alteration in auditory                auditory attention was the possibility of using the tests ear-
attention, as noted by several authors 21,22, also diminishes                ly enough (starting from 6 years), considering the cruciality
the expansion of the properties of the lexical repertoire, and               of this phase for the development of language and cogni-
the elaboration of the semantic component of the language,                   tive abilities of the child. In fact, normal hearing subjects
and therefore the acquisition of new knowledge.                              are able to analyse the acoustic scene and identify auditory
Among the different mechanisms that participate in the                       objects properly, even in the presence of competing sounds,
                                                                             while degraded central processing due to unilateral hearing
                                                                             loss is likely to increase the time required to form auditory
                                                                             objects and focus selective attention, leading to a loss of
                                                                             the capacity to switch attention rapidly, a skill that is es-
                                                                             sential in complex hearing situations (noisy environment,
                                                                             conversation).
                                                                             These difficulties also emerge from the results of question-
                                                                             naires administered to parents, showing a significant dif-
                                                                             ference between the two groups in the results of all three
                                                                             subscales. Parents’ ability to identify childrens’ difficulties
                                                                             denotes the impact of unilateral hearing deprivation in eve-
                                                                             ryday life situations. In particular, the subscale regarding
                                                                             speech understanding is strongly impaired and is also cor-
                                                                             related with lower performance in selective attention tests.
                                                                             This result is consistent with what also occurs in adult sub-
                                                                             jects with unilateral hearing loss; in fact, it is now widely rec-
                                                                             ognised that adults reliant on a single ear are disadvantaged
                                                                             in all aspects of everyday listening and communication 24.
                                                                             To date, unilateral hearing loss is a crucial issue in the man-
                                                                             agement of childhood hearing loss, as well as in the adult;
                                                                             the latest report of the American Academy of Audiology
Figure 4. Correlation between TS2 tale test and results of the speech sub-   states that children with aidable unilateral hearing loss
scale in HA and no Ha groups.                                                should be considered as candidates for amplification in the



                                                                                                                                                173
F.Y. Russo et al.




impaired ear due to evidence for potential developmental          be published. All authors discussed the results and contrib-
and academic delays 25. However, there is no universally          uted to the final manuscript.
accepted consensus for the rehabilitation of this condition,
and further clinical studies are needed to allow audiologists     Ethical consideration
and health care professionals to direct parents and the pa-       This study was approved by the Institutional Ethics Com-
tient towards the best choice.                                    mittee (Department of Sense Organs) (approval number/
                                                                  protocol number 7.10-2019 /23.07.2019).
Conclusions                                                       All parents gave their informed written consent and the
                                                                  study was performed according to the principles of the
We assessed that unilateral hearing-impaired children ex-         Declaration of Helsinki.
perience a consistent impairment in hearing attention, pos-
sibly leading to marked disabilities in realistic communica-
tion situations, particularly in speech understanding. These      References
difficulties are clearly overcome by their peers wearing          1
                                                                       Ross DS, Visser SN, Holstrum WJ, et al. Highly variable population-
HAs for at least one year, in which the restored binaurality           based prevalence rates of unilateral hearing loss after the application
                                                                       of common case definitions. Ear Hear 2010;31:126-133. https://doi.
allows better results in auditory attention tests and the SSQ          org/10.1097/AUD.0b013e3181bb69db
questionnaire administered to parents.                            2
                                                                       Niskar AS, Kieszak. Holmes A, et al. Prevalence of hearing loss
These results lead us to conclude that unilateral hearing              among children 6 to 19 years of age: The third national health and
loss, once considered not worthy of attention and for which            nutrition examination survey JAMA 1998; 279:1071-10758. https://
                                                                       doi.org/10.1001/jama.279.14.1071
there are still no rehabilitation guidelines, deserves greater
                                                                  3
                                                                       Ghogomu NA, Umansky A, Lieu JE. Epidemiology of unilateral
consideration in the field of paediatric hearing rehabilita-           sensorineural hearing loss with universal newborn hearing screen-
tion, which should be performed as early as possible as in             ing. Laryngoscope 2014;124:295-300. https://doi.org/10.1002/
all other forms of bilateral hearing impairment.                       lary.24059
                                                                  4
                                                                       Turchetta R, Conti G, Marsella P, et al. Universal newborn hearing
Conflict of interest statement                                         screening in the Lazio region, Italy. Ital J Pediatr 2018;44:104. https://
                                                                       doi.org/10.1186/s13052-018-0534-5
The authors declare no conflict of interest.                      5
                                                                       Kumpik DP, King AJ. A review of the effects of unilateral hear-
                                                                       ing loss on spatial hearing. Hear Res 2019;372:17-28. https://doi.
Funding                                                                org/10.1016/j.heares.2018.08.003
This research did not receive any specific grant from fund-       6
                                                                       Golub JS, Lin FR, Lustig LR, et al. Prevalence of adult unilateral
ing agencies in the public, commercial, or not-for-profit              hearing loss and hearing aid use in the United States. Laryngoscope
sectors.                                                               2018;128:1681-1686. https://doi.org/10.1002/lary.27017
                                                                  7
                                                                       Huttunen K, Erixon E, Lofkvist U, et al. The impact of permanent
                                                                       early-onset unilateral hearing impairment in children – a systematic
Authors’ contributions                                                 review Int J Pediatr Otorhinolaryngol 2019;120:173-183. https://doi.
FYR: study conception and design, carried out the exami-               org/10.1016/j.ijporl.2019.02.029
nations, writing of the manuscript, developping of the the-       8
                                                                       Goldsworthy RL, Markle KL. Pediatric hearing loss and speech
ory and performing of the computations. DDS: have made                 recognition in quiet and in different types of background
                                                                       noise. J Speech Lang Hear Res 2019;62:758-767. https://doi.
a substantial contribution to the concept of the article; writ-        org/10.1044/2018_JSLHR-H-17-0389
ing of the manuscript, analysis of the data. MPO: acquisi-        9
                                                                       Johnson CE. Childrens’ phoneme identification in reverberation
tion of data, interpretation of data. MR: revised the article          and noise. J Speech Lang Hear Res 2000;43:144-157. https://doi.
critically for important intellectual content. MGC: carried            org/10.1044/jslhr.4301.144
out the experiment and the examinations of the patients.          10
                                                                       Fischer C, Lieu J. Unilateral hearing loss is associated with a negative
AG: analysis of data, approved the version to be published.            effect on language scores in adolescents. Int J Pediatr Otorhinolaryn-
                                                                       gol 2014;78:1611-1617. https://doi.org/10.1016/j.ijporl.2014.07.005
MdV: analysis and interpretation of data for the article.         11
                                                                       Holmes E, Kitterick PT, Summerfield AQ. Peripheral hearing loss
GR: have made a substantial contribution to the concept of             reduces the ability of children to direct selective attention dur-
the article; performed analysis of the data. PM: agreed to             ing multi-talker listening. Hear Res 2017;350:160-172. https://doi.
be accountable for all aspects of the work in ensuring that            org/10.1016/j.heares.2017.05.005.
questions related to the accuracy or integrity of any part        12
                                                                       Anne S, Lieu JEC, Cohen MS. Speech and language consequences of
                                                                       unilateral hearing loss: a systematic review. Otolaryngol Head Neck
of the work are appropriately investigated and resolved,
                                                                       Surg 2017;157:572-579. https://doi.org/10.1177/0194599817726326
contributed to the analysis of the data. RT: conceived the        13
                                                                       van Wieringen A, Boudewyns A, Sangen A, et al. Unilateral con-
original idea, supervised the project, performed writing and           genital hearing loss in children: challenges and potentials. Hear Res
correction of the manuscript, approved the final version to            2019;372:29-41. https://doi.org/10.1016/j.heares.2018.01.010




174
                                                                                                                   Hearing attention in unilateral hearing loss




14
     Appachi S, Specht JL, Raol N, et al. Auditory outcomes with hear-           20
                                                                                      Cherry RS, Kruger B. Selective auditory attention abilities of learning
     ing rehabilitation in children with unilateral hearing loss: a systematic        disabled and normal achieving children. J Learn Disabil 1983;16:202-
     review. Otolaryngol Head Neck Surg 2017;157:565-571. https://doi.                205. https://doi.org/10.1177/002221948301600405
     org/10.1177/0194599817726757                                                21
                                                                                      Jusczyk PW, Hohne EA. Infants’ memory for spoken words. Science
15
     Priwin C, Jönsson R, Hultcrantz M, et al. BAHA in children and ado-              1997;277:1984-1986. https://doi.org/10.1126/science.277.5334.1984
     lescents with unilateral or bilateral conductive hearing loss: a study of   22
                                                                                      Frezza S, Catenazzi P, Gallus R, et al. Hearing loss in very pre-
     outcome. Int J Pediatr Otorhinolaryngol 2007;71:135-145. https://doi.            term infants: should we wait or treat? Acta Otorhinolaryngol Ital
     org/10.1016/j.ijporl.2006.09.014                                                 2019;39:257-262. https://doi.org/10.14639/0392-100X-2116
16
     2005 Annual Data Early Hearing Detection and Intervention (EHDI)
                                                                                 23
                                                                                      Alliger Ruff H, Klevjord Rothbart M. Attention in early development:
     Program. www.cdc.gov. Accessed January 2020.                                     themes and variations. Oxford Scholarship Online, 2010. https://doi.
                                                                                      org/10.1093/acprof:oso/9780195136326.001.0001
17
     Gatehouse S, Noble W. The Speech, Spatial and Qualities of                  24
                                                                                      Gomes H, Molholm S, Christodoulou C, et al. The development of
     Hearing Scale (SSQ). Int J Audiol 2004;43:85-99. https://doi.
                                                                                      auditory attention in children. Front Biosci 2000;5:108-120. https://
     org/10.1080/14992020400050014
                                                                                      doi.org/10.2741/gomes
18
     Galvin KL, Noble W. Adaptation of the speech, spatial, and qualities        25
                                                                                      Dwyer NY, Firszt JB, Reeder RM. Effects of unilateral input and
     of hearing scale for use with children, parents, and teachers. Coch-             mode of hearing in the better ear: self-reported performance using the
     lear Implants Int 2013;14:135-141. https://doi.org/10.1179/1754762               speech, spatial and qualities of hearing scale. Ear Hear 2014;35:126-
     812Y.0000000014                                                                  136. https://doi.org/10.1097/AUD.0b013e3182a3648b
19
     Bertelli B, Bilancia G. VAUMELF, Batteries for the evaluation of au-        26
                                                                                      American Academy of Audiology. American Academy of Audiology
     ditory attention and phonological working memory in the develop-                 Clinical Practice Guidelines: pediatric amplification. Reston (VA):
     mental age. Firenze: OS Giunti; 2006.                                            American Academy of Audiology; 2013.




                                                                                                                                                         175
