Related Experiment Video
Updated: Aug 13, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Hearing assessment in pre-school children with speech delay
George Psillas1, Anestis Psifidis, Magda Antoniadou-Hitoglou
11st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital 1, Stilponos Kyriakidi St., GR 540 06 Thessaloniki, Greece. psillasgeo@the.forthnet.gr
Insights
Many healthy preschoolers with speech delays have normal hearing, but some have sensorineural hearing loss. Early detection of hearing issues and other conditions, like autism, is crucial for language development.
Area of Science:
- Pediatric Audiology
- Developmental Pediatrics
- Speech-Language Pathology
Background:
- Speech delay is a common concern in preschool children.
- Identifying the underlying causes of speech delay is essential for timely intervention.
- Hearing loss can significantly impact speech and language development.
Purpose of the Study:
- To investigate the prevalence of hearing loss in preschool children presenting with speech delay.
- To differentiate between hearing-related and non-hearing-related causes of speech delay.
Main Methods:
- A cohort of 76 preschool children (aged 1-5 years) with speech delay underwent comprehensive audiological assessments.
- Audiological evaluations included tympanometry, free field testing, otoacoustic emissions, and auditory brainstem responses (ABRs).
- Children with normal hearing were further evaluated by a child neurologist-psychiatrist.
Main Results:
- 68.4% of children had normal hearing; their speech delays were often linked to pervasive developmental disorder (PDD) or specific language impairment (SLI).
- 28.9% had sensorineural hearing loss (SNHL), with profound SNHL correlating with more severe speech impairment.
- 2.6% had conductive hearing loss, presenting with complete lack of speech.
Conclusions:
- A significant proportion of preschool children with speech delay exhibit normal hearing, necessitating consideration of non-audiological factors like PDD.
- Profound SNHL is associated with more severe speech delays compared to moderate-to-severe SNHL.
- Early identification and intervention for hearing loss and other developmental disorders are critical for optimal language outcomes in early childhood.
Objective:
The purpose of this study was to detect any underlying hearing loss among the healthy pre-school children with speech delay.
Methods:
76 children, aged from 1 to 5 years, underwent a thorough audiological examination consisting of tympanometry, free field testing, otoacoustic emission recordings and auditory brainstem responses (ABRs). If hearing was normal, then they were evaluated by a child neurologist-psychiatrist.
Results:
According to our findings, the children were classified into 3 groups; those with normal hearing levels (group I, 52 children, 68.4%), sensorineural hearing loss (group II, 22 children, 28.9%) and conductive hearing loss (group III, 2 children, 2.6%). In group I, speech delay was attributed to pervasive developmental disorder (PDD), which represents high-functioning autistic children (37 cases). Other causes were specific language impairment (SLI)-expressive (3 cases), bilingualism (2 cases), and unknown etiology (10 cases). More than half (59%) of the children diagnosed with PDD evidenced significant language impairment limited to more than two words. Children with SLI-expressive and bilingualism used a maximum of two words. In group II, 13 children suffered from profound hearing loss in both ears, 3 from severe, 3 had profound hearing loss in one ear and severe in the other, 2 from moderate, and 1 had moderate in one ear and severe in the other. No child had mild sensorineural hearing loss. The children with profound hearing loss in at least one ear had total language impairment using no word at all (10 cases), or a maximum of two words (6 cases). When hearing loss was moderate to severe, then the speech vocabulary was confined to several words (more than two words-6 cases). Only two children suffering from conductive hearing loss both presented with complete lack of speech.
Conclusion:
A great number of healthy pre-school children with speech delay were found to have normal hearing. In this case, the otolaryngologist should be aware of the possible underlying clinical entities, especially of psychiatric nature. The children with profound sensorineural hearing loss exhibited more severe speech delay than those with moderate to severe. Regardless of etiology, the early identification and intervention contribute to positive outcome in this critical period of childhood for language development.
