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For Children with Hearing Loss, Listening Can Be Exhausting Work

McCreery, Ryan PhD

doi: 10.1097/01.HJ.0000465741.63770.2a
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Dr. McCreery is associate director of audiology and staff scientist at Boys Town National Research Hospital in Omaha, NE.



Clinicians frequently hear about fatigue experienced by their school-age pediatric patients with hearing loss. Parents often report that their children with hearing loss seem to become exhausted by activities that involve intensive listening, particularly during school. Children with hearing loss may say they feel overly tired at the end of a busy day compared with their peers who have normal hearing. These challenges can place children with hearing loss at a greater risk of academic difficulties and even long-term health problems.



In contrast to the ubiquity of these experiences among children seen in the clinic, the scientific evidence about the mechanisms behind listening fatigue and potential solutions for this problem have been limited, until recently. Researchers at Vanderbilt University have undertaken a large study to help shed light on fatigue in children with hearing loss.

How Hard Can It Be To Listen? Fatigue in School-Age Children with Hearing Loss

Bess FH, Gustafson SJ, Hornsby BW

J Educ Audiol


Even though nearly everyone has experienced feelings of tiredness, exhaustion, or limited energy, there still is limited agreement among scientists on how to define fatigue. Fatigue can occur from physical exercise or from intensive cognitive processing.

Fred H. Bess, PhD, and colleagues suggest that cognitive fatigue from mental exertion during listening tasks is the most concerning type for school-age children with hearing loss. In their paper, the authors present a theoretical model of how children with hearing loss experience fatigue.

Specifically, the task of understanding and processing speech degraded by the child's hearing loss or the presence of background noise requires the allocation of cognitive resources to support understanding and learning. This increased demand on mental effort has a cumulative effect on the child over an entire day of listening to parents, teachers, and friends in noisy environments.

Because children with hearing loss may have to allocate more of their limited pool of cognitive resources to listening tasks, fewer of these resources are left available for other processes, such as taking notes and integrating new information. This means that children with hearing loss may fall behind in classroom discussions or miss important information while they are trying to understand what they are hearing.

Consistent listening fatigue can result in frustration or a lack of confidence. Over a longer period of time, fatigue can increase feelings of stress, which can have enduring implications for health and psychological well-being. Both the immediate and long-term consequences of listening fatigue can have significant negative effects on children with hearing loss.

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The topic of fatigue has been explored in children with a wide range of chronic health conditions, including cancer, obesity, and diabetes. Research on fatigue in children with hearing loss is sparser but has started to support the predictions of Dr. Bess and colleagues’ theoretical model.

Much of the early research on fatigue in children with hearing loss was designed to establish ways to quantify fatigue and its various consequences for this population. Subjective measures of fatigue have been assessed in groups of children with other health conditions using self-report questionnaires.

A recent paper by Benjamin W.Y. Hornsby, PhD, and colleagues describes the use of the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS) with children who have hearing loss ( Am J Audiol 2014;23[1]:129-134 The PedsQL MFS includes questions about different aspects of fatigue that children can answer.

As expected, children with hearing loss reported greater fatigue of all types than age-matched children with normal hearing. Children with hearing loss also reported greater fatigue than other groups of children with chronic health conditions who were evaluated in previous studies using the PedsQL MFS. These results demonstrate that fatigue is a prevalent concern for children who have hearing loss.

In terms of objective measures of fatigue, such indicators as the level of the hormone cortisol in the child's saliva can be used to understand better the underlying physiological mechanisms, the article by Dr. Bess and colleagues notes.

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The authors conclude by discussing the clinical implications of research findings on listening effort and fatigue in children with hearing loss. While specific interventions that would minimize fatigue in these patients have yet to be developed or validated, preliminary evidence suggests several factors that may help.

For example, amplification or hearing assistive technology may reduce the amount of listening effort required in difficult listening situations, thereby decreasing the likelihood of stress and fatigue.

Specific signal processing strategies in hearing aids, such as directional microphones and digital noise reduction, are designed to lessen the perceptual consequences of noise. Data on the benefits of these strategies for reducing fatigue in children with hearing loss is limited; however, research in adults has suggested greater ease of listening in background noise with these features.

The use of frequency modulation or remote microphone hearing assistance technology can also help minimize the effects of noise and decrease the level of effort required to listen in specific situations, such as classrooms.

By ensuring access to appropriate amplification and hearing assistance technology, clinicians can give children the best opportunity to access the auditory signal with the least amount of effort.

The review of listening effort and fatigue by Dr. Bess and colleagues does an excellent job translating scientific findings into information clinicians can use. Because the study is ongoing, clinicians should keep an eye on the peer-reviewed literature for the publication of additional findings.

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