Question
To what extent have the coronavirus disease 2019 (COVID-19) lockdowns changed children’s access to speech?
Findings
In this cohort study of 45 children, sound environments, cataloged using machine learning in hearing prostheses (cochlear implants), were measured both before and during COVID-19 lockdowns in Ontario, Canada. The pre–COVID-19 ratio of speech:quiet (1.6:1.0) significantly reduced to 0.9:1.0 during lockdowns, particularly in school-aged children.
Meaning
School closures due to COVID-19 lockdowns may be associated with reduced exposure to spoken communication during important stages of social, language, and cognitive development.
Importance
The coronavirus disease 2019 (COVID-19) lockdowns in Ontario, Canada in the spring of 2020 created unprecedented changes in the lives of all children, including children with hearing loss.
Objective
To quantify how these lockdowns changed the spoken communication environments of children with cochlear implants by comparing the sounds they were exposed to before the Ontario provincial state of emergency in March 2020 and during the resulting closures of schools and nonessential businesses.
Design, Setting, and Participants
This experimental cohort study comprised children with hearing loss who used cochlear implants to hear. These children were chosen because (1) their devices monitor and catalog levels and types of sounds during hourly use per day (datalogs), and (2) this group is particularly vulnerable to reduced sound exposure. Children were recruited from the Cochlear Implant Program at a tertiary pediatric hospital in Ontario, Canada. Children whose cochlear implant datalogs were captured between February 1 and March 16, 2020, shortly before lockdown (pre–COVID-19), were identified. Repeated measures were collected in 45 children during initial easing of lockdown restrictions (stages 1-2 of the provincial recovery plan); resulting datalogs encompassed the lockdown period (peri–COVID-19).
Main Outcomes and Measures
Hours of sound captured by the Cochlear Nucleus datalogging system (Cochlear Corporation) in 6 categories of input levels (<40, 40-49, 50-59, 60-69, 70-79, ≥80 A-weighted dB sound pressure levels [dBA]) and 6 auditory scene categories (quiet, speech, speech-in-noise, music, noise, and other). Mixed-model regression analyses revealed main effects with post hoc adjustment of confidence intervals using the Satterthwaite method.
Results
A total of 45 children (mean [SD] age, 7.7 [5.0] years; 23 girls [51.1%]) participated in this cohort study. Results showed similar daily use of cochlear implants during the pre– and peri–COVID-19 periods (9.80 mean hours pre–COVID-19 and 9.34 mean hours peri–COVID-19). Despite consistent device use, these children experienced significant quieting of input sound levels peri–COVID-19 by 0.49 hour (95% CI, 0.21-0.80 hour) at 60 to 69 dBA and 1.70 hours (95% CI, 1.42-1.99 hours) at 70 to 79 dBA with clear reductions in speech exposure by 0.98 hour (95% CI, 0.49-1.47 hours). This outcome translated into a reduction of speech:quiet from 1.6:1.0 pre–COVID-19 to 0.9:1.0 during lockdowns. The greatest reductions in percentage of daily speech occurred in school-aged children (elementary, 12.32% [95% CI, 7.15%-17.49%]; middle school, 11.76% [95% CI, 5.00%-18.52%]; and high school, 9.60% [95% CI, 3.27%-15.93%]). Increased daily percentage of quiet (7.00% [95% CI, 4.27%-9.74%]) was most prevalent for children who had fewer numbers of people in their household (estimate [SE] = −1.12% [0.50%] per person; Cohen f = 0.31).
Conclusions and Relevance
The findings of this cohort study indicate a clear association of COVID-19 lockdowns with a reduction in children’s access to spoken communication.