Narrative skills following early confirmation of permanent childhood hearing impairment

Aim The aim of this study was to compare spoken language production in children with permanent childhood hearing impairment (PCHI) whose PCHI was confirmed either early or late. Method Audio-taped spoken narrative was assessed for syntax, phonology, morphology, and narrative in transcripts from a population-based sample of 89 children (49 males, 40 females; age mean age 7y 7mo, SD1y 1mo, range 6y 6mo-10y 9mo) with bilateral PCHI (>= 40dB hearing loss) and a comparison group of 63 children (37 males, 26 females; mean age 8y 1mo; SD 1y) with normal hearing. Of the 89 children with PCHI, 41 (21 males, 20 females) had their hearing impairment confirmed by the age of 9 months. All children with PCHI were tested with hearing aids in place, including 16 with cochlear implants. The group of children whose PCHI had been confirmed by age 9 months was compared with the group with later confirmation of PCHI using regression models on the outcome measures. Results Compared with those with late-confirmed PCHI, children with early-confirmed PCHI used significantly more sentences (mean difference 2.7; 95% confidence interval [CI] 0.49-5.24; p=0.019) and categories of high-pitched morphological markers (mean difference 6.64; 95% CI 1.96-11.31; p=0.006). The number of categories of low-pitched morphological markers, phonological simplifications, and sentences with multiple clauses did not differ between groups. The odds ratios (95% CI) of superior narrative structure and narrative content in children whose PCHI was confirmed early were 3.03 (1.09-8.46; p=0.034) and 4.43 (1.52-12.89; p=0.006) respectively. Interpretation Early confirmation compared with late confirmation of PCHI was associated with benefit to narrative skills and to certain expressive aspects of syntax and morphology, but not expressive phonology.