Adams, Bethany
(2025)
Understanding the basis of fatigue in children with unilateral hearing loss.
PhD thesis, University of Nottingham.
Abstract
Children with hearing loss (CHL) appear to experience greater fatigue than children with normal hearing (CNH). Listening-related fatigue is a type of fatigue often associated with an increase in effortful listening or difficult listening situations. This has been observed in children with bilateral hearing loss (CBHL) and, more recently, in children with unilateral hearing loss (CUHL). Available tools for measuring fatigue in children include general fatigue questionnaires such as the child self-report and parent-proxy versions of the PedsQLTM Multidimensional Fatigue Scale (MFS) and the PROMIS Fatigue Scale. Recently, the Vanderbilt Fatigue Scale (VFS-C: child self-report; VFS-P: parent-proxy report) was introduced with a specific focus on listening-related fatigue. Though CHL experience listening-related fatigue, it is unclear which tools are the best for measuring fatigue in this population, its mechanisms in CUHL and CBHL and how/if they differ, or the nature of the fatigue these children experience.
This PhD aimed to answer the above questions via four approaches. Firstly, semi-structured interviews with CHL and their parents were performed, to help characterise the fatigue experienced by CHL. Data were analysed using the constructivist grounded theory methodology, resulting in four themes: behavioural attributes of fatigue, causes of listening related fatigue, implications of hearing loss and fatigue, and strategies used to cope with fatigue. This study has improved understanding of the lived experience of CHL and provided unique perspectives from both children and parents.
Secondly, fatigue was measured in CHL using the current available questionnaires, comparing responses from the child’s self-report measures and the parent-proxy measures. It was found that all child self-report fatigue measures indicated that CBHL experience greater fatigue than CNH. Only the listening-specific tool (VFS-C) was sufficiently able to show greater fatigue experienced by CUHL compared with CNH. Similarly, all parent-proxy measures of fatigue indicated that CBHL experience significantly greater fatigue than CNH. Data from VFS-P and the PROMIS Fatigue Parent-Proxy also showed that CUHL experienced greater fatigue than CNH. Agreement between the parent-proxy and child self-report measures were found for the PedsQL-MFS and the PROMIS Fatigue Scale. These results suggest that CBHL experience greater daily-life fatigue compared to CNH. CUHL also appear to experience more fatigue than CNH, and listening-specific measures of fatigue may be better able to detect this effect.
Next, exploratory factor analysis (EFA) was performed to examine the validity of these self-report and parent-proxy measures of fatigue in CHL. It was found that all three questionnaires showed acceptable validity, confirming their effectiveness in measuring fatigue. EFA found the VFS-C, VFS-P, PROMIS self-report, and PROMIS parent-proxy report to be predominately unidimensional, whilst the PedsQL MFS was found to be multifactorial.
Finally, to understand more about the mechanisms of fatigue in CHL, and the potential differences in mechanisms between CUHL and CBHL, a collection of listening tasks were performed. This allowed the potential associations between speech in noise and spatial hearing deficits with listening-related fatigue to be tested. This study confirmed that CHL experienced more fatigue after performing listening tasks than before. CHL performed significantly poor than CHL in both localisation tasks. In speech in noise tasks, CNH performed better than those with HL, though no statistical differences were found. A higher degree of asymmetry was associated with poorer performance in localisation tasks. There was also a significant correlation between momentary fatigue (after performing listening tasks) and the VFS and PedsQL-MFS (Cognitive and Total domains) with both localisation tasks, suggesting a relationship between poor localisation ability and listening-related fatigue exists.
This body of research brings together a new understanding of children’s experiences of listening-related fatigue and improves our understanding of why CHL experience greater levels of fatigue compared to their NH peers. Through a combination of qualitative and quantitative methods, the research highlights the significant impact of hearing loss and fatigue on children's daily lives. The findings reveal that CHL experience higher levels of fatigue compared to their peers with normal hearing (CNH), with CUHL experiencing similar levels of fatigue as CBHL. The study underscores the importance of addressing listening-related fatigue in clinical and educational settings to improve the quality of life for these children. It also calls for further research to understand the definitive causes of listening-related fatigue and to develop effective interventions to alleviate this fatigue. By advancing our understanding of the mechanisms behind listening-related fatigue, this research aims to contribute to better support and management strategies for CHL, ultimately enhancing their overall well-being and academic performance.
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