HearStart: Development of a Novel Tool for Evaluating Listening Outcomes in School-Entry Children with Unilateral and Mild Hearing Loss

Project goals and methodology

Many young children with mild bilateral or one-sided hearing loss may hear well in quiet but often struggle to follow speech in noisy environments such as classrooms, childcare centres, and playgrounds. These listening challenges can affect attention, learning, and participation in group activities. However, standard hearing and language tests, which are typically completed in quiet, do not always identify these real-world difficulties. As a result, some children may miss out on timely support during the crucial early school years, and clinicians may have limited tools to understand their functional listening needs.

The HearStart project set out to address this gap by developing a new tool to measure how school-entry children (aged 4–6 years) understand spoken language in realistic acoustic environments. Working with audiologists, speech pathologists, teachers, parents, and researchers, the team designed a web-based Listening Comprehension (LC) tool that presents short, age-appropriate stories with pictures and questions in both quiet and noisy conditions to reflect everyday listening situations. To create and refine the tool, the team undertook several rounds of development, including expert review, parents and teachers feedback, and pilot testing with children to ensure the materials were age-appropriate, clear, engaging, and suitable for young children. The evaluation involved 95 children with normal hearing as well as those with mild bilateral or unilateral hearing loss. Testing was carried out both in clinics and at home to assess the tool’s usability and flexibility in real-world settings.

Key findings

The new LC tool was found to be valid, effective, and suitable for school-entry children. It matched well with existing language and hearing tests, showing that it works as intended. Both parents and clinicians found the tool clear, engaging, and age-appropriate. The LC tool identified differences between children with normal hearing and those with hearing loss, even when standard tests failed to show a problem. This indicates the tool’s potential to highlight real-world listening challenges that may otherwise go unnoticed.

The tool worked equally well when administered by clinicians in a clinic or by parents at home. This flexibility provides families with alternative option when regular appointments are difficult to attend and allows clinicians to monitor children’s listening in a wider range of settings, including remote or regional areas. Early findings also suggest that the tool may be more sensitive than some existing assessments when clinicians or caregivers report concerns that are not explained by standard test results.

Next steps and potential applications

The HearStart project successfully developed and validated a new Listening Comprehension tool that provides meaningful insights into how young children understand speech in real-world environments. The tool is practical, engaging, and feasible for use in both clinics and at home. It fills a clinical gap in paediatric audiology by providing a more realistic measure of functional listening—particularly for children whose difficulties may not be captured by standard tests. The LC tool has strong potential to become an important addition to clinical practice, helping clinicians identify children who may struggle in noisy real-world settings and supporting better-informed decisions about intervention and classroom support.