title: Language Outcomes in Young Children with Mild to Severe Hearing Loss.
abstract: OBJECTIVE
  This study examined the language outcomes of children with mild to severe hearing loss during the preschool years. The longitudinal design was leveraged to test whether language growth trajectories were associated with degree of hearing loss and whether aided hearing influenced language growth in a systematic manner. The study also explored the influence of the timing of hearing aid fitting and extent of use on children's language growth. Finally, the study tested the hypothesis that morphosyntax may be at particular risk due to the demands it places on the processing of fine details in the linguistic input.
  
  
  METHODS
  The full cohort of children in this study comprised 290 children who were hard of hearing (CHH) and 112 children with normal hearing who participated in the Outcomes of Children with Hearing Loss (OCHL) study between the ages of 2 and 6 years. CHH had a mean better-ear pure-tone average of 47.66 dB HL (SD = 13.35). All children received a comprehensive battery of language measures at annual intervals, including standardized tests, parent-report measures, and spontaneous and elicited language samples. Principal components analysis supported the use of a single composite language score for each of the age levels (2, 3, 4, 5, and 6 years). Measures of unaided (better-ear pure-tone average, speech intelligibility index) and aided (residualized speech intelligibility index) hearing were collected, along with parent-report measures of daily hearing aid use time. Mixed modeling procedures were applied to examine the rate of change (227 CHH; 94 children with normal hearing) in language ability over time in relation to (1) degree of hearing loss, (2) aided hearing, (3) age of hearing aid fit and duration of use, and (4) daily hearing aid use. Principal components analysis was also employed to examine factor loadings from spontaneous language samples and to test their correspondence with standardized measures. Multiple regression analysis was used to test for differential effects of hearing loss on morphosyntax and lexical development.
  
  
  RESULTS
  Children with mild to severe hearing loss, on average, showed depressed language levels compared with peers with normal hearing who were matched on age and socioeconomic status. The degree to which CHH fell behind increased with greater severity of hearing loss. The amount of improved audibility with hearing aids was associated with differential rates of language growth; better audibility was associated with faster rates of language growth in the preschool years. Children fit early with hearing aids had better early language achievement than children fit later. However, children who were fit after 18 months of age improved in their language abilities as a function of the duration of hearing aid use. These results suggest that the language learning system remains open to experience provided by improved access to linguistic input. Performance in the domain of morphosyntax was found to be more delayed in CHH than their semantic abilities.
  
  
  CONCLUSIONS
  The data obtained in this study largely support the predictions, suggesting that mild to severe hearing loss places children at risk for delays in language development. Risks are moderated by the provision of early and consistent access to well-fit hearing aids that provide optimized audibility.
authors.affiliation: 1Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA; 2Department of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; 3Center for Childhood Deafness, Boys Town National Research Hospital, Omaha, Nebraska, USA; and 4Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA.
authors.forename: J Bruce
authors.initials: JB
authors.lastname: Tomblin
authors.forename: Melody
authors.initials: M
authors.lastname: Harrison
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Ambrose
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walker
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Oleson
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Moeller
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006310:Hearing Aids; D006312:Hearing Loss, Bilateral / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D007804:Language Development; D007805:Language Development Disorders / Q000503:physiopathology*; D008297:Male; D012044:Regression Analysis; D012720:Severity of Illness Index