{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:08:25Z","timestamp":1791871705685,"version":"4.3.4"},"reference-count":45,"publisher":"American Speech Language Hearing Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Audiol"],"published-print":{"date-parts":[[2026,3,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study examined how cognitive skills (nonverbal intelligence, verbal working memory, and attention) influence academic performance in children with minimal to mild conductive hearing loss (mCHL) and whether this relationship is moderated by subjective fatigue and listening effort. We also compared these effects with age- and sex-matched children with normal hearing sensitivity (NHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>A cross-sectional correlational study was conducted on 130 children with mCHL and 130 children with NHS (aged 10\u201312 years). Audiological testing, cognitive assessments (Seguin form board test, digit span, operation span, and dichotic digit tests), and subjective fatigue ratings (visual analog scale) were collected. Listening effort was measured using a dual-task paradigm that involved speech-in-noise and digit-reversal tasks. Teachers rated academic performance using the Academic Performance Rating Scale and supported by recent academic marks. Multiple linear regression and moderation analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Children with mCHL exhibited significantly higher listening effort, greater subjective fatigue, lower cognitive scores, and poorer academic performance than their peers with NHS did. Moderation analysis revealed that subjective fatigue significantly weakened the positive relationship between cognition and academic performance in children with mCHL but not in children with NHS. A\n                      <jats:italic toggle=\"yes\">z<\/jats:italic>\n                      test confirmed that the moderating effect was significantly stronger in the mCHL group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings suggest that subjective fatigue plays a critical role in modulating the effects of cognition on academic success in children with mCHL. Interventions addressing listening efforts and fatigue management are suggested for improving educational outcomes in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Supplemental Material:<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.23641\/asha.31057807\">https:\/\/doi.org\/10.23641\/asha.31057807<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1044\/2025_aja-25-00196","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T15:37:17Z","timestamp":1769441837000},"page":"104-117","source":"Crossref","is-referenced-by-count":3,"title":["Cognitive Skills and Academic Performance in Children With Minimal to Mild Conductive Hearing Loss: The Roles of Listening Effort and Subjective Fatigue"],"prefix":"10.1044","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0434-0785","authenticated-orcid":false,"given":"Saransh","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Prevention of Communication Disorders, All India Institute of Speech and Hearing, University of Mysore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasantha","family":"Lakshmi M. S.","sequence":"additional","affiliation":[{"name":"Center for Prevention of Communication Disorders &amp; Epidemiological Research &amp; Cognitive Behavioural Science in Communication Disorders, All India Institute of Speech and Hearing, University of Mysore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8686-1391","authenticated-orcid":false,"given":"Sanjana","family":"Singh S.","sequence":"additional","affiliation":[{"name":"Department of Audiology, JSS Institute of Speech and Hearing, University of Mysore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshan","family":"Kumar H. S.","sequence":"additional","affiliation":[{"name":"Department of Speech Pathology, JSS Institute of Speech and Hearing, University of Mysore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6704-7319","authenticated-orcid":false,"given":"Chandni","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Audiology, All India Institute of Speech and Hearing, University of Mysore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1310","reference":[{"issue":"1","key":"e_1_3_2_2_1","article-title":"A prevalence study of hearing loss among primary school children in the South East of Iran","volume":"2013","author":"Absalan A.","year":"2013","unstructured":"Absalan, A., Pirasteh, I., Dashti Khavidaki, G. A., Asemi rad, A., Nasr Esfahani, A. A., & Nilforoush, M. H. (2013). A prevalence study of hearing loss among primary school children in the South East of Iran. International Journal of Otolaryngology, 2013(1), Article 138935. https:\/\/doi.org\/10.1155\/2013\/138935","journal-title":"International Journal of Otolaryngology"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1127578"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"American Speech-Language-Hearing Association. (1988). Determining threshold level for speech. https:\/\/doi.org\/10.1044\/policy.GL1988-00008","DOI":"10.1044\/policy.GL1988-00008"},{"key":"e_1_3_2_5_1","unstructured":"American Speech-Language-Hearing Association. (2008). Hearing loss in children. https:\/\/www.asha.org\/practice-portal\/clinical-topics\/hearing-loss-in-children"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1044\/2019_LSHSS-OCHL-19-0017"},{"key":"e_1_3_2_7_1","first-page":"1","article-title":"How hard can it be to listen? Fatigue in school-age children with hearing loss","volume":"20","author":"Bess F. H.","year":"2014","unstructured":"Bess, F. H., Gustafson, S. J., & Hornsby, B. W. Y. (2014). How hard can it be to listen? Fatigue in school-age children with hearing loss. Journal of Educational Audiology, 20, 1\u201310. https:\/\/www.edaud.org\/assets\/docs\/2-article-14.pdf [PDF]","journal-title":"Journal of Educational Audiology"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.learninstruc.2015.09.004"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-0663.96.1.31"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0014402918773316"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.3766\/jaaa.15084"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1044\/jshd.2404.330"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/02796015.1991.12085552"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2017.01.016"},{"key":"e_1_3_2_15_1","volume-title":"Handbook of Seguin Form Board","author":"Goel K.","year":"1990","unstructured":"Goel, K., & Bhargave, M. (1990). Handbook of Seguin Form Board. National Psychological Corporation."},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0136446"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1044\/2018_JSLHR-H-17-0314"},{"key":"e_1_3_2_18_1","volume-title":"Introduction to mediation, moderation, and conditional process analysis: A regression-based approach","author":"Hayes A. F.","year":"2013","unstructured":"Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press."},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2002\/046)"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139015394"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/AUD.0b013e31828003d8"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1044\/2017_AJA-17-0007"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1044\/1059-0889(2013\/13-0017)"},{"key":"e_1_3_2_24_1","unstructured":"Jain C. & Kumar A. U. (2016). Relationship between psychophysical abilities speech perception in noise and working memory in individuals with normal hearing sensitivity across age groups [Doctoral thesis University of Mysore]."},{"issue":"2","key":"e_1_3_2_25_1","first-page":"23","article-title":"Maturation of temporal processing in children: Measurements using speech and non-speech stimuli","volume":"5","author":"Jain S.","year":"2015","unstructured":"Jain, S., Vasudevemurthy, B., & Raghavendra, A. (2015). Maturation of temporal processing in children: Measurements using speech and non-speech stimuli. Journal of Health Science, 5(2), 23\u201335. https:\/\/doi.org\/10.17430\/893284","journal-title":"Journal of Health Science"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1037\/0096-3445.133.2.189"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1044\/1059-0889(2002\/009)"},{"key":"e_1_3_2_28_1","first-page":"438","volume-title":"Handbook of clinical audiology","author":"Margolis R.","year":"1985","unstructured":"Margolis, R., & Shanks, J. (1985). Tympanometry. In J. Katz (Ed.), Handbook of clinical audiology (3rd ed., pp. 438\u2013475). Wolters Kluwer Health.","edition":"3"},{"key":"e_1_3_2_29_1","unstructured":"Mayadevi. (1974). The development and standardization of a comon speech discrimination test for Indians [Unpublished master's dissertation]. University of Mysore."},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jecp.2017.04.006"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.95.1.48-52"},{"key":"e_1_3_2_32_1","unstructured":"National Council of Educational Research and Training. (2022). PRASHAST: A disability screening checklist for schools (Parts 1 & 2). Central Institute of Educational Technology (CIET) Department of School Education and Literacy Ministry of Education Government of India. https:\/\/ciet.ncert.gov.in\/prashast"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1044\/2024_LSHSS-23-00165"},{"key":"e_1_3_2_34_1","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-018-01193-y"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/AUD.0000000000000312"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2012.08.003"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.70077"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000003225"},{"issue":"2","key":"e_1_3_2_39_1","first-page":"185","article-title":"The reliability and validity of short-term and working memory pointing tasks developed for clinical populations with speech and language disorders","volume":"16","author":"Sung J. E.","year":"2011","unstructured":"Sung, J. E. (2011). The reliability and validity of short-term and working memory pointing tasks developed for clinical populations with speech and language disorders. Communication Sciences & Disorders, 16(2), 185\u2013201. https:\/\/www.e-csd.org\/journal\/view.php?number=459","journal-title":"Communication Sciences & Disorders"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-3955(05)70081-X"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03192720"},{"key":"e_1_3_2_42_1","unstructured":"Varni J. W. (1998). PedsQL (Pediatric Quality of Life Inventory). http:\/\/www.pedsql.org\/about_pedsql.html"},{"issue":"1","key":"e_1_3_2_43_1","first-page":"38","article-title":"Revalidation of Seguin form board test for Indian children","volume":"35","author":"Venkateshan S.","year":"1998","unstructured":"Venkateshan, S. (1998). Revalidation of Seguin form board test for Indian children. Indian Journal of Applied Psychology, 35(1 & 2), 38\u201342.","journal-title":"Indian Journal of Applied Psychology"},{"key":"e_1_3_2_44_1","doi-asserted-by":"publisher","DOI":"10.25259\/NMJI_66_21"},{"key":"e_1_3_2_45_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03195534"},{"key":"e_1_3_2_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/AUD.0000000000000242"}],"container-title":["American Journal of Audiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.asha.org\/doi\/pdf\/10.1044\/2025_AJA-25-00196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T18:16:36Z","timestamp":1772734596000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.asha.org\/doi\/10.1044\/2025_AJA-25-00196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3,5]]}},"alternative-id":["10.1044\/2025_AJA-25-00196"],"URL":"https:\/\/doi.org\/10.1044\/2025_aja-25-00196","relation":{},"ISSN":["1059-0889","1558-9137"],"issn-type":[{"value":"1059-0889","type":"print"},{"value":"1558-9137","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]}}}