Neural envelope tracking predicts speech intelligibility and hearing aid benefit in children with hearing loss

Early assessment of hearing aid benefit is crucial, as the extent to which hearing aids provide audible speech information predicts speech and language outcomes. A growing body of research has proposed neural envelope tracking as an objective measure of speech intelligibility, particularly for individuals unable to provide reliable behavioral feedback. However, its potential for evaluating speech intelligibility and hearing aid benefit in children with hearing loss remains unexplored. In this study, we investigated neural envelope tracking in children with permanent hearing loss through two separate experiments. EEG data were recorded while children listened to age-appropriate stories (Experiment 1) or an animated movie (Experiment 2) under aided and unaided conditions (using personal hearing aids) at multiple stimulus intensities. Neural envelope tracking was evaluated using a linear decoder reconstructing the speech envelope from the EEG in the delta band (0.5-4 Hz). Additionally, we calculated temporal response functions (TRFs) to investigate the spatio-temporal dynamics of the response. In both experiments, neural tracking increased with increasing stimulus intensity, but only in the unaided condition. In the aided condition, neural tracking remained stable across a wide range of intensities, as long as speech intelligibility was maintained. Similarly, TRF amplitudes increased with increasing stimulus intensity in the unaided condition, while in the aided condition significant differences were found in TRF latency rather than TRF amplitude. This suggests that decreasing stimulus intensity does not necessarily impact neural tracking. Furthermore, the use of personal hearing aids significantly enhanced neural envelope tracking, particularly in challenging speech conditions that would be inaudible when unaided. Finally, we found a strong correlation between neural envelope tracking and behaviorally measured speech intelligibility for both narrated stories (Experiment 1) and movie stimuli (Experiment 2). Altogether, these findings indicate that neural envelope tracking could be a valuable tool for predicting speech intelligibility benefits derived from personal hearing aids in hearing-impaired children. Incorporating narrated stories or engaging movies expands the accessibility of these methods even in clinical settings, offering new avenues for using objective speech measures to guide pediatric audiology decision-making.