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Is One Ear Good Enough? Unilateral Hearing Loss and Preschoolers’ Comprehension of the English Plural

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Is One Ear Good Enough? Unilateral Hearing Loss and Preschoolers’ Comprehension of the English Plural JSLHR Research Note Is One Ear Good Enough? Unilateral Hearing Loss and Preschoolers’ Comprehension of the English Plural Benjamin Davies,a,b,c Nan Xu Rattanasone,a,b,c Aleisha Davis,b,d and Katherine Demutha,b,c Purpose: The plural is one of the first grammatical morphemes whether an auditorily presented novel word was singular acquired by English-speaking children with normal hearing (e.g., tep, koss)orplural(e.g.,teps, kosses)bytouchingthe (NH). Yet, those with hearing loss show delays in both plural appropriate novel picture. comprehension and production. However, little is known Results: Like their NH peers, children with UHL demonstrated about the effects of unilateral hearing loss (UHL) on children’s comprehension of novel singulars. However, they were acquisition of the plural, where children’s ability to perceive significantly less accurate at identifying novel plurals, fricatives (e.g., the /s/ in cats) can be compromised. This withperformanceatchance.However,thereweresigns study therefore tested whether children with UHL were able that their ability to identify novel plurals may improve with to identify the grammatical number of newly heard words, age. both singular and plural. Conclusion: While comparable to their NH peers at identifying Method: Eleven 3- to 5-year-olds with UHL participated in novel singulars, these results suggest that young children a novel word two-alternative forced choice task presented with UHL do not yet have a robust representation of plural on an iPad. Their results were compared to those of 129 NH morphology, particularly on words they have not encountered 3- to 5-year-olds. During the task, children had to choose before. hildren’s ability to perceive subtle cues from the 1 kHz, and 2 kHz; Bess et al., 1998, 1986). Despite affecting language spoken to and around them is crucial for roughly 3%–5% of school-aged children (Bess et al., 1998; C their linguistic development. For this reason, chil- Niskar et al., 1998), UHL has historically received limited dren with hearing loss are at a greater risk of language delay clinical attention, perhaps due to the commonly held mis- than their normal-hearing (NH) peers (e.g., Vohr et al., 2008; conception that one ear is good enough (Tharpe, 2008). Wake et al., 2004). While there has been much focus on chil- However, UHL can have wide-ranging effects on children’s dren with bilateral hearing loss (BHL), there is growing evi- developing social skills (Laugen et al., 2017), academic dence that children with unilateral hearing loss (UHL) are also achievement (Kuppler et al., 2013; Most, 2004), and overall at risk of language delay (José et al., 2014; Lieu et al., 2010). quality of life (Borton et al., 2010). UHL is defined as NH in one ear accompanied by a There is also increasing evidence that children with hearing loss in the other (e.g., > 15 dB HL PTA at 500 Hz, UHL are at a particular risk of falling behind in language development. Even before their first birthday, many chil- dren with UHL are already behind their NH peers in their a Department of Linguistics, Macquarie University, Sydney, New listening and oral communication skills (Kishon-Rabin South Wales, Australia b et al., 2015). There is also growing evidence that both pri- The HEARing Cooperative Research Centre (CRC), Melbourne, mary school–aged children (Lieu et al., 2010) and adolescents Victoria, Australia cARC Centre of Excellence in Cognition and Its Disorders, (Fischer & Lieu, 2014) with UHL perform below their NH Macquarie University, Sydney, New South Wales, Australia peers on measures of language comprehension and expres- dThe Shepherd Centre, Sydney, New South Wales, Australia sion, although the language scores for some appear to im- Correspondence to Benjamin Davies: [email protected] prove over time (Lieu et al., 2012). What is less clear is ’ Editor-in-Chief: Frederick (Erick) Gallun how UHL affects children s early linguistic representations, Editor: Rachael Frush Holt essential for building a robust grammatical system. This ’ Received February 25, 2020 study therefore explored the effect of UHL on preschoolers Revision received June 2, 2020 Accepted September 25, 2020 Disclosure: The authors have declared that no competing interests existed at the time https://doi.org/10.1044/2020_JSLHR-20-00089 of publication. 272 Journal of Speech, Language, and Hearing Research • Vol. 64 • 272–278 • January 2021 • Copyright © 2020 American Speech-Language-Hearing Association Downloaded from: https://pubs.asha.org Linda True on 01/18/2021, Terms of Use: https://pubs.asha.org/pubs/rights_and_permissions comprehension of one of the earliest acquired grammatical preschool in Sydney, Australia. Parents/guardians reported morphemes in English, the plural. none had any suspected or diagnosed hearing loss. To help The plural is one of the first grammatical morphemes ensure that the controls were representative of normal lan- acquired by NH children (Brown, 1973; Davies et al., 2017). guage development, all NH children included in the study However, young children with BHL are often delayed in passed the Preschool Language Scale–Fifth Edition Lan- their use of the plural (Koehlinger et al., 2015; McGuckian guage Screener appropriate for their age (Zimmerman et al., & Henry, 2007). A recent study by Davies et al. (2020) sug- 2011). gests that this is partly due to difficulty in acquiring produc- The UHL group was composed of 11 English-speaking tive representations of plural morphology, possibly due to children (five girls, six boys) also aged 3–5years(36– limited input/experience with these hard to perceive word- 64 months, M = 48.7 months, SD = 10.4 months). All were final fricatives. Even if perceived, it is not enough to know reported to have been diagnosed with UHL prelingually, that a word such as cats means “more than one cat”; chil- detected as a result of Australian newborn hearing screen- dren must develop an understanding that the word is com- ing (King, 2010). All received listening and spoken language posed of two morphemes, a referent and the plural (e.g., cat + early intervention. The children with UHL had a four- s). Having a productive representation of plural morphol- frequency binaural average loss ranging from 3.8 to 27.5 dB1 ogy is knowing that other plural words also have this struc- (M =14.2dB,SD = 8.2 dB), with the average four-frequency ture (e.g., tops =top+s,wombats = wombat + s), including loss in their affected ear (left ear = 5, right ear = 6) ranging words never heard before (e.g., teps = tep + s). Davies et al. from 53.8 to 100 dB (M =78.9dB,SD = 17.9 dB). Individual- (2020) demonstrated that 3- to 5-year-olds with NH know ear four-frequency average loss information for children that novel words such as teps are plural, but that children with conductive losses (i.e., UHL-03, UHL-05, UHL-06) with BHL did not. was unable to be supplied by their language intervention Acoustically, /s/ (e.g., cats /kæts/) and /z/ (e.g., dogs providers. Two participants used no device. Four were fitted /dɔgz/) are high-frequency sounds with low intensity (Jongman with cochlear implants, two with hearing aids and three et al., 2000), making them less perceptually salient and diffi- with bone-anchored hearing aids. All device fittings were cult for those with HL to perceive (Pittman & Stelmachowicz, reported as being optimized as part of the child’s regular au- 2003). Indeed, this low perceptual salience is argued to con- diological services. There were no clinical concerns for any tribute to difficulties children with developmental language child regarding access to speech sounds at conversational delay experience in acquiring English morphosyntax (e.g., levels (55–65 dBA). All children with UHL came from the surface hypothesis; see Leonard et al., 1997). While chil- English-speaking homes (though UHL-03 and UHL-10 dren with UHL have normal access to sound in one ear, had some exposure to other languages). No participant andperformsimilarlytotheirNHpeersonspeechrecog- had any diagnosed additional needs. All clinical and de- nition tasks in optimal listening conditions (Sargent et al., mographic information was provided by their language 2001), the loss of binaural hearing puts them at a disad- intervention provider with written parental consent (see vantage in adverse listening conditions, such as in the pres- Table 1). ence of noise and reverberation (Sargent et al., 2001; Welsh et al., 2004). This unreliable access to these already hard-to- Equipment hear fricatives may result in inconsistent input, meaning the plural morpheme is only perceived some of the time. That TheexperimentwasperformedonanAppleiPad is, sometimes they hear “two dogs,” while other times they Air 2. Children in the NH group wore Sennheiser HD 280 might hear “two dog.” This inconsistent input could make Pro headphones. Children in the UHL group were presented acquiring representations of productive plural morphology auditory stimuli out of a GENELEC 8020A active moni- a challenge. toring loudspeaker. To explore this possibility, we analyzed data testing knowledge of plural morphology from 11 children with Auditory Stimuli and Preparation UHL, collected as part of a larger study on children with HL (cf. Davies et al., 2020). We then compared their data The auditory stimuli were produced by a female na- with the previously reported Davies et al. (2020) perfor- tive speaker of Australian English. Each stimulus item was mance by NH children. We predicted that children with UHL presented within the carrier phrase: touch the [target]. The would show lower comprehension abilities than that of their target word was either a real word (i.e., bat/s, pig/s, mop/s, NH peers, but that this would improve with age. crab/s, horse/s, bus/es,androse/s) or a novel word. The 24 novel words (see Table 2) all contained Australian English short vowels (Harrington et al., 1997) and early-acquired Method onset stops (Smit et al., 1990).
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