The use of hearing devices can be critical to support the language and cognitive development of children with hearing loss. But what happens to these children when a lockdown is implemented, such as those in response to the COVID-19 pandemic?
A study recently published in the JAMA Otolaryngology–Head & Neck Surgery found that children with hearing loss who used cochlear implants (CIs) experienced “a significant quieting of their worlds” during the pandemic-related lockdowns (JAMA Otolaryngol Head Neck Surg. 2021;147:368-376. doi:10.1001/jamaoto.2020.5496.) Specifically, school-age kids with CIs had 10 percent less access to speech, “which translates to extensive loss of spoken communication that is essential for psychosocial, academic, and language development.”
The study focused on a sample of 45 children with CIs in Ontario, Canada. The researchers used the datalogs from those devices to quantitatively compare captured sounds before and during lockdown.
Corresponding author Karen A. Gordon, PhD, CCC-A, explained to The Hearing Journal how they collected the data amid safety restrictions enforced at the height of the pandemic.
“We had a unique opportunity to quantify changes in sound exposure in children using the datalogging system in their CIs. The main challenge was that there was no way to collect these data remotely at that time. To address this, we created a mobile data collection unit. Using approved safety guidelines, we were able to visit the families at their homes to collect the datalogs from children's cochlear implants safely.”
The researchers compared datalogs captured pre-COVID-19 lockdown—February 1 to March 15, 2020—against those during the lockdown period. These datalogs were categorized into sound types, namely: quiet sounds (those at lower than 50 dBA sound pressure level), speech (the sound of a single human voice without competing sounds), speech-in-noise, music, noise, and other sounds.
“We found that children continued to use their CIs as consistently during COVID-19 related lockdowns with school closures as they had done prior. Within these hours, however, their exposure to quiet sounds increased and their exposure to speech decreased,” said Gordon, who is a clinical audiologist at The Hospital for Sick Children in Ontario, Canada, and a professor at the University of Toronto.
Pre-lockdown, the children had 4.27 hours of daily exposure to speech and speech-in-noise combined. This fell to just 3.34 hours during the lockdown. Meanwhile, their daily time spent in quiet increased from 2.73 hours to 3.50 hours.
The study also noted that the greatest reduction in speech exposure was among school-age children, “reflecting the impact of the school closures,” Gordon said.
She added that these findings may apply even to kids not wearing CIs.
“Although these data were collected in children using CIs, these participants were subject to the same COVID-19-related restrictions as all other children in our province. The findings thus have implications for all children.”
A notable factor examined in the study was the in-person bubble, defined as the number of people with whom the child could interact in-person during the COVID-19 lockdown. “The increase in quiet was less pronounced for children whose in-person bubbles were medium or large in size, but this did not translate into increased exposure to speech,” highlighted Gordon. Medium bubbles consisted of four to seven people; large ones had eight or more.
Results showed that children with a greater bubble size spent less time in quiet than those with smaller bubbles. However, the study did not find an association between bubble size and speech exposure.
While there was an “overall quieting of life” during COVID-19 lockdowns, the researchers noted that this quieting affected speech sounds more than environmental noise.
“Reduced exposure to loud sounds might have been beneficial for listening if it was specific to non-speech sounds. [However,] decreased exposure was found for sounds containing speech-in-noise but not sound in the noise-only category, suggesting that lost sounds during lockdowns were particular to spoken language.”
For Gordon, this means that children need richer communication within their social bubbles.
“The number of words that children are exposed to is important for spoken language development and the datalogging system is useful to quantify when speech is in the soundscape. It is also becoming clear that children also need to be engaged in communication using conversational turn-taking; however, those interactions are not tracked by the present data logging system,” she said.
“COVID-19 lockdowns restrict the number of people that school-age children typically converse with, which not only reduces their exposure to speech sounds, as quantified in this study but also the opportunity to engage in communication. The remaining question is, to what extent can this gap be closed by the individuals in the child's ‘bubble’ and other online interactions? In the meantime, while COVID-19-related safety measures are needed, it is important to spend time to engage and communicate with the children in our ‘bubbles’.”