Hearing Experience and Working Memory Develop Together, Study Finds

A study of 47 preschool children with bilateral cochlear implants found that longer hearing device experience went hand in hand with stronger working memory and better everyday listening behavior.

How much of thinking is built on hearing? For young children, the answer appears to be: quite a lot. Sound is the raw material of spoken language, and spoken language is one of the main tools children use to hold information in mind, follow instructions, and manage their own behavior.

A new study from Turkey adds detail to that picture. Working with preschool children who use cochlear implants, two audiology researchers found that hearing experience and executive function skills are not separate tracks. They appear to develop in synergy, each feeding the other.

Background: Why the Researchers Looked at This

A cochlear implant is a surgically placed device that bypasses damaged sensory cells in the inner ear and stimulates the hearing nerve directly. For children with severe-to-profound hearing loss, implants can restore access to sound during the years when the brain is most ready to learn spoken language.

Executive functions are the brain's self-management toolkit: skills like working memory, which holds information in mind while using it, and inhibition, which keeps impulses in check. Earlier research has suggested that children with hearing loss can lag behind hearing peers on some of these skills, presumably because a period of limited auditory input affects more than hearing alone. What has been less clear is how everyday listening behavior, device experience, and executive function relate to one another in young implant users. That is the question this study set out to answer.

How the Study Was Done

The researchers recruited 47 children, 23 girls and 24 boys, aged 4 to 6 years, all using cochlear implants in both ears. As a group the children had successful auditory access: aided hearing thresholds averaged 24.8 dB HL, and word recognition averaged 82.5 percent.

Two standardized questionnaires were used, each completed by a different adult in the child's life. Parents rated everyday listening skills on the Auditory Behavior in Everyday Life scale, known as ABEL, while teachers rated executive functions on the Childhood Executive Functioning Inventory, known as CHEXI. The team then analyzed the data using correlation, hierarchical regression, and mediation analyses, statistical approaches that test not just whether two things are related but how the relationship might flow.

What the Researchers Found

Time with the device mattered. Duration of cochlear implant use showed a significant correlation of .50 with everyday auditory behaviors and .48 with working memory. In other words, children who had used their implants longer tended to listen better in daily life and to score higher on teacher-rated memory skills.

Working memory was not a bystander. In the regression analysis, it explained an additional 22 percent of the variance in auditory performance beyond what other factors accounted for. Listening in the real world, it seems, leans heavily on the ability to hold and manipulate information.

The mediation analysis tied the pieces together: everyday auditory behaviors partially mediated the relationship between device experience and working memory development, with an indirect effect of .22. Put plainly, device time appears to improve real-world listening, and that daily listening practice in turn appears to support the growth of memory skills. The study also found that girls scored significantly higher than boys on working memory.

The authors conclude that working memory is a vital cognitive resource that operates in synergy with auditory experience, and they recommend that clinical rehabilitation protocols include strategies to support memory capacity alongside listening skills.

What It Means for People with Hearing Loss

For families of children with cochlear implants, the finding reinforces something clinicians often emphasize: consistent, all-day device use is not only about hearing in the moment. Accumulated listening experience appears to be tied to the cognitive skills a child brings to school, and rehabilitation that trains memory alongside listening may pay double dividends.

The broader principle reaches beyond childhood. The idea that the brain builds cognitive skill on top of reliable auditory input echoes a growing body of adult research linking untreated hearing loss with cognitive strain and decline. This study cannot speak to adults directly, but it adds one more data point to a consistent theme: hearing and thinking are deeply intertwined.

Consistent Listening Practice Needs Consistent Sound

This study concerns children with cochlear implants, who need surgical teams and pediatric specialists. The underlying principle, though, travels well: the benefits observed here tracked with accumulated hearing experience, meaning hours and years of steady auditory input. For adults with mild-to-moderate hearing loss, getting to that kind of consistency is far simpler than it once was, because FDA-OTC hearing aids can be purchased directly and worn every day without a clinic visit.

Panda Quantum is one such device, a 16-channel receiver-in-canal hearing aid with adaptive noise reduction built for clear speech in noisy environments, where listening effort runs highest. An optional app-based in-ear hearing test can tailor gain and frequency response to the wearer's hearing profile, a form of app-based hearing personalization that takes only a few quiet minutes, and Quantum works fully without the app as well.

A single charge runs 20 hours, and the case carries three additional full charges for 80 hours of total use, which makes all-day wear practical. Bluetooth handles calls, TV, and music, and the device comes with a 5-year warranty and a 45-day trial that begins on delivery. One honest caveat: OTC hearing aids are approved for adults with mild-to-moderate loss, while severe or profound hearing loss, like that of the children in this study, still benefits most from clinical fittings.

Limitations of This Research

With 47 children, the sample was modest, and the cross-sectional design cannot prove causation; children who hear well may simply be easier to keep in their devices, reversing the arrow. Both key measures were adult-report questionnaires rather than direct laboratory testing of the children, and the sample came from a single country. The published abstract does not detail funding sources or conflicts of interest.

Where This Leaves Us

Hearing devices do their real work in the accumulated hours of ordinary days: conversations at the dinner table, instructions in a classroom, stories before bed. This study suggests those hours feed not just listening skill but the memory systems that support learning itself, which is one more reason, at any age, to make consistent hearing care a daily habit rather than a someday plan.

Akbaş RN, Özer A. The relationship between executive functions and daily auditory behaviors in preschool cochlear implant users. Applied Neuropsychology: Child. 2026. Retrieved from PubMed. https://doi.org/10.1080/21622965.2026.2720752