Hearing Loss Diagnosis and Early Hearing-Related Interventions in Infants With or at High Risk for Cerebral Palsy: A Systematic Review

Rethinking the Accessibility of Hearing Assessments for Children with Developmental Disabilities

We aim to determine the accessibility of gold-standard hearing assessments - audiogram or auditory brainstem response (ABR) - during the first 3 months of hearing health care for children with and without developmental disabilities. Electronic health records were examined from children (0-18 years) who received hearing health care at three hospitals. Children with developmental disabilities had a diagnosis of autism, cerebral palsy, Down syndrome, or intellectual disability. Assessments from the first 3 months were reviewed to determine if ≥ 1 audiogram or ABR threshold was recorded. To evaluate differences in assessment based on disability status, logistic regression models were built while accounting for age, race, ethnicity, sex, and site. Of the 131,783 children, 9.8% had developmental disabilities. Whereas 9.3% of children in the comparison group did not access a gold-standard assessment, this rate was 24.4% for children with developmental disabilities (relative risk (RR) = 3.79; p < 0.001). All subgroups were at higher risk relative to the comparison group (all p < 0.001): multiple diagnoses (RR = 13.24), intellectual disabilities (RR = 11.52), cerebral palsy (RR = 9.87), Down syndrome (RR = 6.14), and autism (RR = 2.88). Children with developmental disabilities are at high risk for suboptimal hearing evaluations that lack a gold-standard assessment. Failure to access a gold-standard assessment results in children being at risk for late or missed diagnosis for reduced hearing. Results highlight the need for (1) close monitoring of hearing by healthcare providers, and (2) advancements in testing methods and guidelines.

Hearing and speech interactions in children with cerebral palsy, in the first 2 years : Focus on cerebral palsy

Children with cerebral palsy (CP) face communication challenges stemming from neural lesions, hearing issues, and executive function impairments, which are further complicated by interactions between motor and hearing impairments. These challenges lead to limitations in daily activities and are compounded by delays in diagnosis and interventions, adversely affecting speech, language, and cognitive function. In infants with CP, impaired motor function disrupts both feedforward and feedback mechanisms crucial for speech sound production, exacerbating the overall impact on communication development. Understanding the interplay between hearing loss and speech production in children with CP, especially in the crucial early developmental stages, is essential for implementing timely interventions and guiding multidisciplinary care teams in both clinical and home settings. IMPACT QUESTIONS: Children with cerebral palsy (CP) face communication challenges due to neural, hearing, and motor issues, impacting speech and language development. Early and comprehensive testing, including auditory brainstem response, is crucial for timely diagnosis and intervention to mitigate adverse effects. The article emphasizes the need for advanced diagnostics and multidisciplinary interventions to improve communication skills and cognitive outcomes in children with CP.

Tele-audiology diagnostic testing services for children with disabilities in a school setting: A pilot study

OBJECTIVE

Children with disabilities (CWDs) having comorbidities face challenges in accessing and completing diagnostic hearing evaluations. This study was conducted to determine whether a tele-audiology diagnostic test battery can be administered to school-aged CWDs having comorbidities in a school-setting.

DESIGN

A proof-of-concept pilot study using a cross-sectional design.

STUDY SAMPLE

Ten typically developing children between 3 years 9 months and 10 years 9 months of age; mean age of 8 years 3 months (pilot-norm group) and seven CWDs having comorbidities between 3 years and 8 years and 1 month of age; mean age of 5 years and 2 months (CWD group) participated in the study. A diagnostic test protocol delivered via tele-audiology was first administered to the pilot-norm group to ensure its efficiency and suitability for use in the CWD group. Following modifications, the diagnostic test protocol was delivered for CWDs.

RESULTS

We identified key aspects, including the role of the facilitator in conducting a diagnostic test battery using tele-audiology on CWDs, the usefulness of having co-facilitators to support child-friendly testing, as well as technology-related requirements. With respect to tele-audiology diagnostic testing, it was possible to quickly assess peripheral hearing using synchronous tele video-otoscopy, tympanometry, and DPOAEs. We identified limitations in conducting behavioral audiometry and completing tone-burst ABRs in CWDs.

CONCLUSION

Evidence was obtained from this exploratory pilot study that a tele-audiology diagnostic test battery can be administered in a school setting to school-aged CWDs having comorbidities. Tele-audiology can be considered to provide hearing healthcare services to school-aged CWDs who may otherwise not receive these services.