Abstract
Very early bilateral implantation is thought to significantly reduce the attentional effort required to acquire spoken language, and consequently offer a profound improvement in quality of life. Despite the early intervention, however, auditory and communicative outcomes in children with cochlear implants remain poorer than in hearing children. The distorted auditory input via the cochlear implants requires more auditory attention resulting in increased listening effort and fatigue. Listening effort and fatigue may critically affect attention to speech, and in turn language processing, which may help to explain the variation in language and communication abilities. However, measuring attention to speech and listening effort is demanding in infants and very young children. Three objective techniques for measuring listening effort are presented in this paper that may address the challenges of testing very young and/or uncooperative children with cochlear implants: pupillometry, electroencephalography, and functional near-infrared spectroscopy. We review the studies of listening effort that used these techniques in paediatric populations with hearing loss, and discuss potential benefits of the systematic evaluation of listening effort in these populations.
Highlights
Early-life sensory inputs serve as fundamental building blocks for the functional organization of the developing brain
Despite the steep increase in the number of studies on listening effort in the last decade, very little is known about how young children with cochlear implant (CI) cope with noisy listening environments, compared to normally-hearing peers
EEG can allow objective measurement of auditory strain in paediatric age by: (1) recording of task-related phasic oscillations of specific activities known to be associated with cognitive engagement and localized in specific cortical regions; (2) examining the extent of lateralisation of cortical activity based on the theory that poor lateralisation corresponds to the recruitment of a larger cortical area and a greater investment of cognitive resource; and (3) investigating the manner of lateralisation of cortical activity: the more this deviates from the norm, the less hemispheric specialization and, as a consequence, the more cognitive energy expended by the cortex during a listening task
Summary
Early-life sensory inputs serve as fundamental building blocks for the functional organization of the developing brain. Despite the steep increase in the number of studies on listening effort in the last decade, very little is known about how young (preschool) children with (bilateral) CIs cope with noisy listening environments, compared to normally-hearing peers. Several objective psychoacoustic measures have been developed in parallel to assess listening effort, such as the use of dual-task paradigms, in which an auditory task (e.g., word/phrase repetition in noise) is administered together with a visual task (e.g., detection of visual targets) [19,25] Administering these tests on young preschool children is frequently challenging, and their responses tend to be unreliable [10]. We discuss the advantages and drawbacks of each method, as well as the possibilities for their application in clinical practice
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