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Bonino AY, Mood D. Identifying reduced hearing in children who have developmental disabilities: Insights for inclusive research practices with electronic health records. Front Psychol 2023; 14:1134034. [PMID: 37008840 PMCID: PMC10050381 DOI: 10.3389/fpsyg.2023.1134034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionRecent advancements in big data analytics and the formation of large-scale clinical data repositories provide a unique opportunity to determine the current state of pediatric hearing health care for children who have developmental disabilities. Before answering unresolved questions about diagnostic practice, it is paramount to determine a standard and reliable method for identifying children who have reduced hearing because clinical management is affected by hearing status. The purpose of this study was to compare 5 different methods for identifying cases of reduced hearing from pure-tone thresholds based on developmental disability status.MethodsUsing retrospective clinical data from 100,960 children (0–18 years), hearing status was determined for a total of 226,580 encounters from three clinical sites. 9% of the children had a diagnosis of intellectual disability, autism spectrum disorder, Down syndrome, or cerebral palsy.ResultsResults revealed that encounters from children who have developmental disabilities were more likely to have insufficient data to allow hearing status to be determined. Moreover, methods with higher data demands (i.e., number of thresholds and ear-specific thresholds) resulted in fewer classifiable encounters. The average child age when hearing status was classified for the first time was older for children who have developmental disabilities than for children in the comparison group. Allowing thresholds to build up over multiple test sessions did result in more children who have developmental disabilities being classified than for single-encounter methods, but a meaningful decrease in child age at the time of classification was not seen for this strategy. Compared to the comparison group, children who have developmental disabilities were more likely to have reduced hearing that was stable over time, yet their hearing status was determined at older ages.DiscussionResults provide key guidance to researchers for how to determine hearing status in children for big data applications using electronic health records. Furthermore, several assessment disparities are spotlighted for children who have developmental disabilities that warrant further investigation.
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Affiliation(s)
- Angela Yarnell Bonino
- Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder, Boulder, CO, United States
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Angela Yarnell Bonino,
| | - Deborah Mood
- Department of Pediatrics, University of Colorado Denver | Anschutz Medical Campus, Aurora, CO, United States
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Dettman S, Choo D, Au A, Luu A, Dowell R. Speech Perception and Language Outcomes for Infants Receiving Cochlear Implants Before or After 9 Months of Age: Use of Category-Based Aggregation of Data in an Unselected Pediatric Cohort. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1023-1039. [PMID: 33630667 DOI: 10.1044/2020_jslhr-20-00228] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This retrospective study aimed to amass large data sets to enable statistical comparisons of communication outcomes for infants receiving cochlear implants (CIs) before 9 months of age compared to groups who received their first CI between 9 months and 3.5 years of age. Method Speech perception scores and experienced clinicians' observations were used to refine the Categories of Auditory Performance Index (CAPI), thus creating its revised version, namely, the CAPI-Revised (CAPI-R). Standardized and criterion-referenced language data were used to create the novel Categories of Linguistic Performance (CLIP). The association between CAPI-R and CLIP data at two time points post implant (at 2 years of device experience and at 5 years of age) was examined in a large unselected cohort stratified for age at first implant: before 9 months (Group 1), between 9 and 12 months (Group 2), between 13 and 18 months (Group 3), between 19 and 24 months (Group 4), between 25 and 30 months (Group 5), between 31 and 36 months (Group 6), and between 37 and 42 months (Group 7). Results CAPI-R medians were 5 at 2 years of device experience, and 6 at 5 years of age. At 2 years of device experience, there was no significant difference in CAPI-R medians for children who received their first CI before 9 months compared to all other age-at-implant groups. At 5 years of age, a significantly better CAPI-R median was demonstrated by Group 1 (CI before 9 months) compared to Groups 4, 5, 6, and 7. CLIP medians were 3 at 2 years of device experience, and at 5 years of age. At 2 years device experience, and at 5 years of age, the Group 1 CLIP medians were significantly better than later age-at-implant groups. Conclusion Median CAPI-R outcomes supported access to CIs before 18 months of age for speech perception, and median CLIP outcomes supported access to CIs before 9 months of age for optimum language development.
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Affiliation(s)
- Shani Dettman
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- The HEARing CRC, Carlton, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Dawn Choo
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- The HEARing CRC, Carlton, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Agnes Au
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Amy Luu
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Dowell
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, Victoria, Australia
- The HEARing CRC, Carlton, Victoria, Australia
- Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Nightengale EE, Wolter-Warmerdam K, Yoon PJ, Daniels D, Hickey F. Behavioral Audiology Procedures in Children With Down Syndrome. Am J Audiol 2020; 29:356-364. [PMID: 32539476 DOI: 10.1044/2020_aja-19-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Normative data regarding behavioral audiologic testing procedures are based upon the general population and often do not apply to children with Down syndrome (DS). Testing children with DS can be challenging, and outcomes may be unreliable due to their different cognitive demands and delays. The aim of this study was to assess optimal audiologic testing procedures for specific age groups of children with DS. Method This study used a retrospective investigation of 273 children with DS (145 boys, 128 girls; average age at evaluation = 5.92 ± 4.74 years) who received an audiologic evaluation during 2013 as part of their medical care at a large pediatric hospital (satellite facilities included). Results Age ranges for the completion of audiometry procedures in children with DS are provided. Average age to reliably complete behavioral testing in children with DS was delayed by up to 30 months compared to typically developing children. The majority of children with DS achieved at least good-to-fair reliability for audiologic results starting at 16 months (85.7%) and two ear results at 6-10 years (76.1%). Though not statistically significant, the use of a two-tester assistant compared to a single tester appeared to be helpful in obtaining reliable results. Conclusion The results provide a guide to optimal audiologic test procedures for children with DS, as the standard audiologic guidelines for typically developing infants and children do not apply.
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Affiliation(s)
| | | | - Patricia J. Yoon
- Children's Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Dee Daniels
- Children's Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Fran Hickey
- Children's Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
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Karzon RK, Banerjee P. Animated Toys Versus Video Reinforcement in 16–24-Month-Old Children in a Clinical Setting. Am J Audiol 2010; 19:91-9. [DOI: 10.1044/1059-0889(2010/10-0009)] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
To compare the clinical efficacy of visual reinforcement audiometry (VRA) with animated toy animal reinforcement (AVRA) to the efficacy of VRA with video reinforcement (VVRA) in children age 16 to 24 months in a fast-paced medical practice.
Method
The 145 participants (age 16 to 24 months) were referred by either their primary care physician or an otolaryngology practitioner (physician or nurse practitioner) for audiologic assessment. Children were assigned in a counterbalanced manner to either the AVRA or VVRA group.
Results
Significantly more threshold estimates were obtained with AVRA (
M
= 5.52) than with VVRA (
M
= 3.47). There were no significant differences in performance based on age, hearing status, or gender.
Conclusions
Number and relative strength of the visual reinforcers used are posited as the main reasons for the disparate outcomes. Clinical practices that test large numbers of children with VRA would be well-served to have both AVRA and VVRA available to meet the needs of individual patients.
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Affiliation(s)
- Roanne K. Karzon
- St. Louis Children’s Hospital, St. Louis, MO, and Washington University School of Medicine, St. Louis
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Porter H, Tharpe AM. Hearing Loss among Persons with Down Syndrome. INTERNATIONAL REVIEW OF RESEARCH IN MENTAL RETARDATION 2010. [DOI: 10.1016/s0074-7750(10)39007-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
In assessing children with suspected hearing loss, audiologists are faced with the challenge of attempting to describe auditory function in a population that presents with a wide range developmental levels and abilities. Fortunately, there are a number of behavioral and physiologic tools available for the evaluation of auditory sensitivity and system integrity in children of all ages and developmental abilities. As powerful as many of these tools may be, however, it is important that the diagnosis of hearing loss be based on the outcome of independent measures of auditory function, which serve to cross-check and complement one another. Failure to do so is likely to result in inaccurate or incomplete delineation of auditory function.
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Affiliation(s)
- Karen C Johnson
- Children's Auditory Research and Evaluation Center, House Ear Institute, 2100 West Third Street, Fifth Floor, Los Angeles, CA 90057, USA.
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Abstract
A behavioral approach is the first choice for hearing assessment in infants and children. It is the only true test of hearing. Physiologic measures are not tests of hearing, only indicators of auditory function. The use of physiologic measures in estimating hearing levels makes some presumptions regarding the concept of hearing. As such, these measures are used when a definitive statement about hearing cannot be made on the basis of behavioral audiometric results, or when other factors (e.g., age or developmental delay) preclude obtaining reliable behavioral information.
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Affiliation(s)
- R C Folsom
- Department of Speech and Hearing Sciences, University of Washington, Seattle, USA
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Werner LA, Mancl LR, Folsom RC. Preliminary observations on the development of auditory sensitivity in infants with Down syndrome. Ear Hear 1996; 17:455-68. [PMID: 8979034 DOI: 10.1097/00003446-199612000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hearing loss commonly is associated with Down syndrome, but little is known about the development of auditory sensitivity in individuals with Down syndrome. This study had two objectives: 1) to determine whether an observer-based procedure can be used to assess the behavioral sensitivity of infants with Down syndrome, and 2) to provide preliminary information about the early course of hearing development among infants with Down syndrome. DESIGN Behavioral measures of sensitivity were made in 16 infants with Down syndrome using an observer-based procedure. Ten of the infants were followed longitudinally between 2 and 12 mo of age. All infants passed a screening auditory brain stem response at 20 dB nHL during the study and completed screening tympanometry at each test session. The infants detected a 4000 Hz tone at levels ranging from 25 to 50 dB SPL; psychometric functions and thresholds for the tone were obtained. RESULTS Infants with Down syndrome completed 80% of the test sessions they began, a rate similar to that seen in normally developing infants in the same type of study. Performance improved with increasing stimulus level, as one would expect, and thresholds were obtained from 15 of 16 infants for at least one age. The performance of infants with Down syndrome generally improved with age. The sensitivity of 2- to 3-mo-olds was poorer than that of older infants, but little if any improvement in sensitivity occurred between 4 and 12 mo. This pattern is similar to that seen in normally developing infants. Thresholds of infants with Down syndrome were 10 to 25 dB higher than those reported for normally developing infants. The psychometric functions of infants with Down syndrome were shallower than the psychometric functions of normally developing infants, and the slope of the psychometric functions did not change with age. Infants with Down syndrome achieved only 75 to 80% correct at any of the levels tested, 5 to 10% poorer than reported for other infants. These characteristics of the psychometric functions of the infants with Down syndrome suggest that they are inattentive during testing more often than are normally developing infants. CONCLUSIONS An observer-based procedure can be used to obtain reasonable thresholds from infants with Down syndrome who are as young as 2 mo of age. Both sensory and nonsensory factors could contribute to the threshold elevation seen in infants with Down syndrome. At least on preliminary examination, the course of auditory sensitivity development of infants with Down syndrome is qualitatively similar to that seen in normally developing infants.
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Affiliation(s)
- L A Werner
- University of Washington, Department of Speech and Hearing Sciences, Seattle, USA
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Abstract
It has been suggested that many children with Down syndrome possess unique physical and behavioral characteristics that should be considered when doing audiologic assessments. Possible test modifications have been suggested to maximize attending behavior and to improve test reliability and validity. It has been reported that children with Down syndrome may not hear as well as other children, and determining the presence of hearing impairment can be problematic. Research needs have been highlighted. Because these children are at risk for middle ear disease and hearing impairment, audiologic assessment should occur early (infancy) and frequently (4–6 month intervals), with use of amplification when appropriate.
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Affiliation(s)
- Jack E. Kile
- Center for Communicative Disorders, University of Wisconsin-Oshkosh, Oshkosh, WI 54901
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Lancioni GE, Hoogland GA, Smeets PM, Brozzi G, Scoponi MV, Piattella L, Zamponi N. Hearing assessment in developmentally impaired infants: classical conditioning as a supplement to brainstem-evoked response audiometry (BERA). Int J Pediatr Otorhinolaryngol 1985; 10:221-8. [PMID: 2420739 DOI: 10.1016/s0165-5876(85)80068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The brainstem-evoked response audiometry (BERA) is probably the most common approach to hearing assessment in high-risk and developmentally handicapped infants. It is usually suggested, however, that BERA should not be the sole assessment method. In an attempt to determine an effective supplement to BERA, the present study evaluated a classical conditioning procedure with developmentally impaired babies. Within this procedure, different tones served as conditioned stimuli while an air-puff was used as the unconditioned stimulus. Results indicate that this procedure could be successfully applied with almost all of the babies.
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Squires N, Aine C, Buchwald J, Norman R, Galbraith G. Auditory brain stem response abnormalities in severely and profoundly retarded adults. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1980; 50:172-85. [PMID: 6159185 DOI: 10.1016/0013-4694(80)90334-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The auditory brain stem evoked responses (ABRs) of two groups of retarded adults (Down's syndrome and retarded of unknown etiology) were compared with those of a group of non-retarded control subjects as a function of changes in stimulus repetition rate and stimulus intensity. The absence of ABRs at the highest stimulus intensity suggested profound hearing deficits in one or both ears of 4 Down's syndrome and 2 unknown-etiology subjects. Other abnormalities were noted in particular individuals of each group of retarded. In addition, the ABRs of the Down's group as a whole showed a significant pattern of abnormalities. The intervals between peaks I and II and III and IV were shorter than normal white the IV--V interval was prolonged. Wave V also showed abnormally small latency increases at fast click rates. The ABRs of the unknown-etiology group showed a shortened III--IV interval and a prolongation of the IV--V interval, but were otherwise not significantly different from the normal controls. These data suggest a high incidence of hearing loss in both diagnostic categories studies, and abnormal functioning of the auditory brain stem pathway in the Down's syndrome group as a whole.
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