Objectives: Unilateral hearing loss (UHL) in children may affect phonological awareness; however, it remains unclear whether different phonological subskills are affected similarly. This study aimed to compare nonword-based phonological manipulation skills in children with UHL and normal-hearing peers across quiet and noisy conditions.
Methods: Twenty-six Persian-speaking first- and second-grade children participated, including ۱۳ children with UHL and ۱۳ children with normal hearing.
Phonological awareness was assessed using five nonword-based subtests: blending, segmentation, and initial-, medial-, and final-phoneme deletion. Each subtest was administered under quiet and noisy conditions at a +۵ dB signal-to-noise ratio. Backward digit span was assessed as a working-memory and eligibility measure. Multiple comparisons were adjusted using the Holm procedure.
Results: In first-grade children, the normal-hearing group obtained higher mean scores across all subtests, but no subtest-level between-group difference remained statistically significant after Holm correction. In second-grade children, the normal-hearing group performed significantly better in blending in noise, segmentation in both quiet and noise, and initial- and medial-phoneme deletion in noise. Significant quiet–noise differences remained for three subtests in first-grade children with UHL and four subtests in second-grade children with UHL, compared with one subtest in first-grade children with normal hearing and none in second-grade children with normal hearing. No subtest-level grade differences remained significant after correction; however, total nonword scores were higher in second-grade children with normal hearing under both listening conditions. Backward Digit Span scores did not differ significantly between the groups.
Discussion: Phonological-awareness performance was task- and grade-specific rather than uniformly impaired in children with UHL. Subtest-level between-group differences were most evident among second-grade children, particularly for tasks presented in noise. Although quiet–noise differences occurred across more subtests within the UHL groups, these findings should be interpreted cautiously because the listening-condition order was fixed and a direct group-by-condition interaction was not tested. Assessment should include multiple phonological tasks under both quiet and noisy conditions.
