The Complexities of Fatigue in Children with Hearing Loss

: http://si p://pubs.as Fatigue is a common phenomenon in our society, and it can have a major impact on an individual’s performance and wellbeing. Parents and teachers have long believed that children with hearing loss (CHL) are at increased risk for fatigue. One could easily speculate that toward the end of a school day, CHL may be “physically and mentally spent” as a result of focusing so intently on a teacher’s speech, as well as conversations with other students. Moreover, the increased listening effort, stress, and subsequent fatigue experienced by CHL could jeopardize the ability to learn in a noisy classroom environment, thus increasing the risk for problems in school. Only recently, however, have we begun to see empirical studies supporting the notion that CHL experience more fatigue than children with normal hearing (CNH). This review was developed to enhance the awareness of fatigue among those audiologists interested in serving CHL. To this end, we have presented an overview on fatigue in CHL, including its importance, definitions, prevalence, consequences, and recent developments. The complexity and multifaceted nature of fatigue has been highlighted and the need for additional research on fatigue in CHL is emphasized. It has long been recognized that fatigue, resulting from sustained listening demands, is a significant concern for working adults with hearing loss. The additional attention, concentration, and effort needed to overcome the communicative problems associated with hearing loss results in increased reports of listening effort, stress, and fatigue compared to adults with normal hearing (Hétu, Riverin, Lalande, Getty, & St-Cyr, 1988; Hornsby, 2013). The fatigue associated with these sustained listening-demands has a significant negative impact on work performance and quality of life (Kramer, Kapteyn, & Houtgast, 2006; Nachtegaal et al., 2009). Children with hearing loss (CHL) may also be physically and mentally tired as a result of focusing so intently on a teacher’s speech, as well as the conversations of other children. Pilot studies and reports from teachers and parents of CHL support the belief that CHL seem to be at increased risk for stress and fatigue (Hicks & Tharpe, 2002; Noon, 2013; M. Ross, personal communication, August 13, 2012). Only recently, however, have experimental studies begun to offer support to this longstanding premise (Gagne, Alepins, & Dubois, 2010; Gustafson, Delong, Werfel, & Bess, 2013; Hicks & Tharpe, 2002; Hornsby, Werfel, Camarata, & Bess, 2014; McFadden & Pittman, 2008; Pittman, 2011a; Rentmeester, Shuster, Hornsby, & Bess, 2013). In addition to the inherent disadvantage of reduced access to auditory information resulting from hearing loss, the increased listening effort, stress, and subsequent fatigue could compromise their facility to learn in a noisy classroom environment, thus increasing the risk for learning problems in school. Is it really that difficult for CHL to listen, process speech, attend, and learn in the school environment? We believe that it is—at least for a portion of school-age CHL. A simplified conceptual model linking CHL to listening effort, stress,