The importance of high-frequency audibility in the speech and language development of children with hearing loss.

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.