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Original Article
May 2004

The Importance of High-Frequency Audibility in the Speech and Language Development of Children With Hearing Loss

Author Affiliations

From the Boys Town National Research Hospital, Omaha, Neb. The authors have no relevant financial interest in this article.

Arch Otolaryngol Head Neck Surg. 2004;130(5):556-562. doi:10.1001/archotol.130.5.556

Objectives  To review recent research studies concerning the importance of high-frequency amplification for speech perception in adults and children with hearing loss and to provide preliminary data on the phonological development of normal-hearing and hearing-impaired infants.

Design and Setting  With the exception of preliminary data from a longitudinal study of phonological development, all of the reviewed studies were taken from the archival literature. To determine the course of phonological development in the first 4 years of life, the following 3 groups of children were recruited: 20 normal-hearing children, 12 hearing-impaired children identified and aided up to 12 months of age (early-ID group), and 4 hearing-impaired children identified after 12 months of age (late-ID group). Children were videotaped in 30-minute sessions at 6- to 8-week intervals from 4 to 36 months of age (or shortly after identification of hearing loss) and at 2- and 6-month intervals thereafter. Broad transcription of child vocalizations, babble, and words was conducted using the International Phonetic Alphabet. A phoneme was judged acquired if it was produced 3 times in a 30-minute session.

Subjects  Preliminary data are presented from the 20 normal-hearing children, 3 children from the early-ID group, and 2 children from the late-ID group.

Results  Compared with the normal-hearing group, the 3 children from the early-ID group showed marked delays in the acquisition of all phonemes. The delay was shortest for vowels and longest for fricatives. Delays for the 2 children from the late-ID group were substantially longer.

Conclusions  The reviewed studies and preliminary results from our longitudinal study suggest that (1) hearing-aid studies with adult subjects should not be used to predict speech and language performance in infants and young children; (2) the bandwidth of current behind-the-ear hearing aids is inadequate to accurately represent the high-frequency sounds of speech, particularly for female speakers; and (3) preliminary data on phonological development in infants with hearing loss suggest that the greatest delays occur for fricatives, consistent with predictions based on hearing-aid bandwidth.