Dan Med J 67/1 / January 2020 1 DANISH MEDICAL JOURNAL Evaluation of a sentence test in noise in children with hearing impairment Lone Percy-Smith 1 , Signe Wischmann 1 , Jane Lignel Josvassen 1 , Maria Hallstrøm 1 , Ariane Laplante-Lévesque 3, 4 , Maria Grube Sorgenfrei 3 & Per Caye-Thomasen 2 perience has shown that sensory deprivation in the pre- natal period can have a profound and permanent effect on the development on the entire central auditory sys- tem [2]. Therefore, it is important to keep monitoring paediatric populations with HI in terms of all aspects of audition and language development [3]. Listening and holding conversations in noisy environments repre- sents a major problem for many people with HI [4]. Noisy environments are, nevertheless, part of children’s everyday school life and, therefore, it is of great inter- est to study how school-aged children with HI perform in noisy environments. Recent research has focused on cognitive hearing science and the cognitive energy in- volved in the listening process for populations with HI [5-7]. However, little is known about the “new” gener- ation of children with HI with early identification of HI, early treatment with HA/CI and with intensive audi- tory verbal (re)habilitation. Will they encounter the same listening effort and fatigue as reported by adult populations with HI [6]? Most children with HI attend regular schools, where noise and distance to speakers are an inevitable part of a regular school day [8, 9]. The present study is part of a larger project “IHEAR – in school with hearing impairment” with the overall vision: No child with HI left behind. This vision is understood in broad terms and incorporates areas of audition/listening, speech, language, cognition and so- cial well-being. The research unit of Decibel [10] is the principal investigator of the project and works in part- nerships with Oticon/Oticon Medical, Rigshospitalet, Aarhus University Hospital and the Capital Region of Denmark. The primary aim of the present study was to investigate whether children with normal hearing (NH) and HI can perform the speech recognition test Dantale II – a Danish sentence-based test of speech perception – in noise. Dantale II is a well-known clinical tool in Denmark but is seldomly used for paediatric popula- tions, even though the original study stressed that Dantale II can be used with children who are able to memorize five-word sentences [4]. A secondary aim was to identify differences and similarities between children with NH/HI and between children with HA/CI and track developments over a two-year period. Fur- thermore, the study investigated possible associations between Dantale II and verbal working memory, as ORIGINAL ARTICLE 1) Decibel, Hellerup, Denmark 2) Department of Oto-rhino-laryngology, Head and Neck Surgery, Rigshospitalet, Denmark 3) Oticon Medical, Denmark 4) Behavioral Sciences and Learning, Linköping University, Sweden Dan Med J 2020;67(1):A06190358 ABSTRACT INTRODUCTION: School-aged children with hearing impair- ment (HI) listen and learn in noisy environments. On-going monitoring of speech understanding in noise is essential to adjust clinical interventions accordingly. METHODS: The aim of this study was to assess Dantale II in a paediatric population. The secondary aims were identifi- cation of differences and similarities between groups of children with HI and normal hearing and between different hearing technologies; investigation of possible associations between Dantale II and verbal working memory. This was a longitudinal, prospective study comparing groups of children (n = 70) using the Dantale II with five-word sentences and verbal working memory with the Clinical Evaluation of Language Functioning-4. RESULTS: Dantale II seems clinically feasible from the age of six years. Children with NH outperformed children with HI both on completion of the tests and dB signal-to-noise ratio (SNR) scores. Children with hearing aids outperformed children with CI on dB SNR scores. A significant and moderately strong association between speech understanding in noise and verbal working memory was identified. CONCLUSIONS: Our study produced knowledge about a new generation of children with HI, who showed potentials not previously described. Future research on cognitive development of paediatric populations with HI is essential, as knowledge from adult populations cannot be transferred directly to paediatric populations. FUNDING: The project received funding from the Innovation Foundation, the Oticon Foundation, Decibel and The Capital Region of Denmark. TRIAL REGISTRATION: not relevant. The introduction of universal neonatal hearing screen- ing, digital hearing aids (HA) and cochlear implants (CI) for paediatric populations with hearing impair- ment (HI) has improved the life conditions for children with congenital HI. It has been documented that early intervention with fitting of HA by three months of age and enrolment in family-centred auditory verbal inter- vention by six months of age allow children to close the language gap and develop age equivalent language al- ready at three years of age [1]. However, clinical ex-