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Minimal Hearing Loss in Students with Reading Impairments


University of South Carolina Office of the Provost Social Sciences Grant (PI: Werfel)


Only 68% of students with reading impairments in the US graduate high school with a regular high school diploma (Cortiella & Horowitz, 2014). Even when provided high-quality, evidence-based reading interventions that specifically target phonological awareness and phonemic decoding in kindergarten and first grade, only about 60% of students consistently have improved reading skills (Al Otaiba & Fuchs, 2006). Overwhelmingly, non-responders to reading instruction exhibit deficits in phonological awareness, which requires the analysis of the sounds of words (Al Otaiba & Fuchs, 2002). Phonological awareness is one skill that underlies decoding development (Adams, 1990).

The goal of this study is to explore one potential underlying factor that contributes to poor reading skills, especially in children who do not improve with intervention: minimal hearing loss. Minimal hearing loss often goes undetected. Children with minimal hearing loss may not have difficulty carrying on conversations and hearing environmental sounds. Learning to analyze individual sounds in words, however, may be affected by these relatively small degrees of hearing loss. 

The MINI study has two primary goals: 

Aim 1: Determine whether students with reading impairments fail hearing screenings at higher rates than students without reading impairments. The prevalence of minimal hearing loss in the general population is estimated to be between 5 and 20% (Bess et al., 1998; Teasdale & Sorensen, 2007). Preliminary work in our lab, however, suggests that up to 50% of students with poor reading skills may fail hearing screenings (Werfel & Hendricks, 2015; Werfel, Reynolds, & Bassard, 2018). Therefore, we predict that students with reading impairments will be up to ten times more likely to fail hearing screenings than students with typical reading skills.

Aim 2: Determine whether children who fail hearing screenings have difficulty with word decoding and/or reading comprehension skills. Children with hearing loss experience particular difficulty developing phonological awareness skills (Easterbrooks et al., 2008; Werfel, 2017), because phonological awareness requires one to analyze the sounds of words. Phonological awareness is an important predictor of word decoding but much less so for reading comprehension (Oakhill, Cain, & Bryant, 2003). Therefore, we predict that failed hearing screenings will be more strongly associated with poor word decoding than with poor reading comprehension.

Publications and Presentations from the MINI Study:


Werfel, K. L., Hendricks, A. E. (2016). Identifying minimal hearing loss and managing its effects on literacy learning. TEACHING Exceptional Children, 48, 213-17. doi: 10.1177/0040059915626135


Bassard, S., Reynolds, G.,Werfel, K. L. (2019, November). Spelling error analysis using multi-linguistic coding in children with reading impairments. Annual Conference of the American Speech-Language-Hearing Association, Orlando, FL.

Werfel, K. L., Reynolds, G., & Bassard, S. (2018, July). The rate of hearing screen failure in students with reading impairments. Annual Conference of the Society for the Scientific Study of Reading, Brighton, UK.

Straley, S., & Werfel, K. L. (2017, June). Minimal hearing loss in middle school: Prevalence and relationship to reading impairmentAnnual Symposium on Research in Child Language Disorders, Madison, WI.

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