... impairs the discrimination of speech in both quiet and in noise (Cai & McPherson, 2017). Chronic fluctuating HL increases the risk of educational difficulties (phonics, reading, and spelling) (Bennett, Haggard, Silva, & Stewart, 2001;Catts, Fey, Tomblin, & Zhang, 2002;Scarborough & Dobrich, 1990;Silva, Chalmers, & Stewart, 1986;Silva, Williams, & McGee, 1987) and adversely affects speech (Silva et al., 1986) and language development (Holm & Kunze, 1969;Silva et al., 1986). In addition, OME is associated with auditory processing deficits (Jerger & Musiek, 2000;Polley, Thompson, & Guo, 2013), self-esteem and behavioral problems (Bennett & Haggard, 1999;Silva et al., 1986), hyperactivity (Hagerman & Falkenstein, 1987), attention-deficit hyperactivity disorder (Adesman, Altshuler, Lipkin, & Walco, 1990;Padolsky, 2008), learning disability (Padolsky, 2008), and sociocommunicative difficulties (Tajima-Pozo et al., 2010). ...