Prevalence and characteristics of children with serious hearing impairment in metropolitan Atlanta, 1991-1993

Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing

OBJECTIVE

 Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1 vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas.

STUDY DESIGN

 Data were collected through semistructured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach.

RESULTS

 Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas.

CONCLUSION

 These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services.

KEY POINTS

· Infants with suspected hearing loss may not receive timely diagnosis or early intervention.. · We interviewed healthcare providers in Texas along the hearing care continuum.. · Findings suggest strategies to increase the number of children with hearing loss identified early..

SLPs' perceptions of language learning myths about children who are DHH

This article reports on speech-language pathologists' (SLPs') knowledge related to myths about spoken language learning of children who are deaf and hard of hearing (DHH). The broader study was designed as a step toward narrowing the research-practice gap and providing effective, evidence-based language services to children. In the broader study, SLPs (n = 106) reported their agreement/disagreement with myth statements and true statements (n = 52) about 7 clinical topics related to speech and language development. For the current report, participant responses to 7 statements within the DHH topic were analyzed. Participants exhibited a relative strength in bilingualism knowledge for spoken languages and a relative weakness in audiovisual integration knowledge. Much individual variation was observed. Participants' responses were more likely to align with current evidence about bilingualism if the participants had less experience as an SLP. The findings provide guidance on prioritizing topics for speech-language pathology preservice and professional development.

Evaluation of Parental Perspectives and Concerns about Pediatric Cochlear Implantation: A Social Media Analysis

OBJECTIVE

Parents often experience uncertainty during decision-making for their child's cochlear implantation (CI) surgery, and online forums provide insight on parental opinions that might not be expressed in clinic. This study aims to evaluate parental perspectives and concerns about pediatric CI using social media analysis.

STUDY DESIGN

Qualitative study.

SETTING

Three online forums involving parental posts about pediatric CI.

INTERVENTION/METHODS

Forums were queried using keywords (e.g., "cochlear implant") to gather all U.S. parent-initiated posts about pediatric CI from 2006 to 2021. Thematic content analysis was performed to classify posts by overarching domain, themes, and subthemes. Posts were reviewed for thematic synthesis and double coded. Descriptive statistics were calculated for each theme by unique users.

RESULTS

A total of 79 posts by 41 unique users were analyzed. Themes relating to decision for CI included facilitators, inhibitors, resources, and feelings. Parents posted about lack of benefit from hearing aids promoting decision for CI and high cost as an inhibitor. Some expressed concern about making a major decision for a minor. Parents often mentioned their child's healthcare providers and social media as resources.

CONCLUSION

Through social media posts, parental priorities and concerns for decision-making of CI surgery were identified. Findings may guide discussions between physicians and parents and facilitate shared decision-making about CI.

Universal neonatal hearing screening and delayed hearing loss or late-developmental hearing loss

OBJECTIVE

To determine the percentage of children with permanent bilateral postnatal hearing loss in order to study its incidence, related risk factors, diagnosis and treatment.

METHODS

Retrospective study to collect data on children diagnosed with hearing loss outside the neonatal period in the Hearing Loss Unit of the Hospital Universitario Central de Asturias, from April 2014 to April 2021.

RESULTS

52 cases met the inclusion criteria. The detection rate of congenital hearing loss in the neonatal screening programme in the same study period was 1.5 children per thousand newborns per year, adding postnatal hearing loss results in a rate of infant bilateral hearing loss of 2.7 children per thousand (55.5% and 44.4% respectively). Thirty-five children presented risk factors for hearing loss, of which 23 were at retrocochlear risk. The mean age at referral was 91.9 (18-185) months. Hearing aid fitting was indicated in 44 cases (84.6%). Cochlear implantation was indicated in eight cases (15.4%).

DISCUSSION

Although congenital hearing loss accounts for the majority of childhood deafness, postnatal hearing loss has a significant incidence. This may be mainly due to: (1) that hearing impairment may arise in the first years of life, (2) that mild hearing loss as well as hearing loss in severe frequencies are undetectable by neonatal screening in some cases, (3) that some children may have false negative results.

CONCLUSION

postnatal hearing loss requires identification of risk factors and long-term follow-up of children with hearing loss, as it needs to be detected and treated early.

Potential Clinical and Economic Outcomes of Over-the-Counter Hearing Aids in the US

Importance

Over-the-counter (OTC) hearing aids are now available in the US; however, their clinical and economic outcomes are unknown.

Objective

To project the clinical and economic outcomes of traditional hearing aid provision compared with OTC hearing aid provision.

Design, Setting, and Participants

This cost-effectiveness analysis used a previously validated decision model of hearing loss (HL) to simulate US adults aged 40 years and older across their lifetime in US primary care offices who experienced yearly probabilities of acquiring HL (0.1%-10.4%), worsening of their HL, and traditional hearing aid uptake (0.5%-8.1%/y at a fixed uptake cost of $3690) and utility benefits (0.11 additional utils/y). For OTC hearing aid provision, persons with perceived mild to moderate HL experienced increased OTC hearing aid uptake (1%-16%/y) based on estimates of time to first HL diagnosis. In the base case, OTC hearing aid utility benefits ranged from 0.05 to 0.11 additional utils/y (45%-100% of traditional hearing aids), and costs were $200 to $1400 (5%-38% of traditional hearing aids). Distributions were assigned to parameters to conduct probabilistic uncertainty analysis.

Intervention

Provision of OTC hearing aids, at increased uptake rates, across a range of effectiveness and costs.

Main Outcomes and Measures

Lifetime undiscounted and discounted (3%/y) costs and quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).

Results

Traditional hearing aid provision resulted in 18.162 QALYs, compared with 18.162 to 18.186 for OTC hearing aids varying with OTC hearing aid utility benefit (45%-100% that of traditional hearing aids). Provision of OTC hearing aids was associated with greater lifetime discounted costs by $70 to $200 along with OTC device cost ($200-$1000/pair; 5%-38% traditional hearing aid cost) due to increased hearing aid uptake. Provision of OTC hearing aids was considered cost-effective (ICER<$100 000/QALY) if the OTC utility benefit was 0.06 or greater (55% of the traditional hearing aid effectiveness). In probabilistic uncertainty analysis, OTC hearing aid provision was cost-effective in 53% of simulations.

Conclusions and Relevance

In this cost-effectiveness analysis, provision of OTC hearing aids was associated with greater uptake of hearing intervention and was cost-effective over a range of prices so long as OTC hearing aids were greater than 55% as beneficial to patient quality of life as traditional hearing aids.

Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA

BACKGROUND

While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested.

OBJECTIVE

We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA.

DESIGN

Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5-8%/year) and discontinuation (13-4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30-120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening.

PARTICIPANTS

Forty-year-old persons in US primary care across their lifetime.

INTERVENTION

Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05-2.25-fold).

MAIN MEASURES

Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs).

KEY RESULTS

CD resulted in 1.20 average person-years of hearing aid use compared to 1.27-1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness.

LIMITATION

Input uncertainty around screening effectiveness.

CONCLUSIONS

We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.

Descriptions of Hearing Loss Severity Differentially Influence Parental Concern about the Impact of Childhood Hearing Loss

PURPOSE

The purpose of this study was to measure how parent concern about childhood hearing loss varies under different description conditions: classification-based, audibility-based, and simulation-based descriptions.

METHOD

We randomly allocated study participants (n = 143) to complete an online survey about expected child difficulties with listening situations with hearing loss. Our participants were parents of children with typical hearing in the 0- to 12-month age range. Participants were exposed to one type of description (classification-based, audibility-based, or simulation-based) and one level of hearing loss (slight, mild, and moderate or their audibility and simulation equivalents), producing nine total groups. Participants rated the level of expected difficulty their child would experience performing age-appropriate listening tasks with the given hearing loss. They also selected what they perceived as the most appropriate intervention from a list of increasingly intense options.

RESULTS

Our findings revealed that audibility-based descriptions elicited significantly higher levels of parent concerns about hearing loss than classification-based strategies, but that simulation-based descriptions elicited the highest levels of concern. Those assigned to simulation-based and audibility-based groups also judged relatively more intense intervention options as appropriate compared to those assigned to classification-based groups.

CONCLUSIONS

This study expands our knowledge base about descriptive factors that impact levels of parent concern about hearing loss after diagnosis. This has potentially cascading effects on later intervention actions such as fitting hearing technology. It also provides a foundation for developing and testing clinical applications of audibility-based counseling strategies.

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule

Importance

Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults.

Objective

To project the monetary value of future research clarifying uncertainties around the optimal adult hearing screening schedule.

Design, Setting, and Participants

In this economic evaluation, a validated decision model of HL (DeciBHAL-US: Decision model of the Burden of Hearing loss Across the Lifespan) was used to simulate current detection and treatment of HL vs hearing screening schedules. Key model inputs included HL incidence (0.06%-10.42%/y), hearing aid uptake (0.54%-8.14%/y), screening effectiveness (1.62 × hearing aid uptake), utility benefits of hearing aids (+0.11), and hearing aid device costs ($3690). Distributions to model parameters for probabilistic uncertainty analysis were assigned. The expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) using a willingness to pay of $100 000 per quality-adjusted life-year (QALY) was estimated. The EVPI and EVPPI estimate the upper bound of the dollar value of future research. This study was based on 40-year-old persons over their remaining lifetimes in a US primary care setting.

Exposures

Screening schedules beginning at ages 45, 55, 65, and 75 years, and frequencies of every 1 or 5 years.

Main Outcomes and Measures

The main outcomes were QALYs and costs (2020 US dollars) from a health system perspective.

Results

The average incremental cost-effectiveness ratio for yearly screening beginning at ages 55 to 75 years ranged from $39 200 to $80 200/QALY. Yearly screening beginning at age 55 years was the optimal screening schedule in 38% of probabilistic uncertainty analysis simulations. The population EVPI, or value of reducing all uncertainty, was $8.2 to $12.6 billion varying with willingness to pay and the EVPPI, or value of reducing all screening effectiveness uncertainty, was $2.4 billion.

Conclusions and Relevance

In this economic evaluation of US adult hearing screening, large uncertainty around the optimal adult hearing screening schedule was identified. Future research on hearing screening has a high potential value so is likely justified.

Early Identification of Hearing Loss and Language Development at 32 Months of Age

This study examines the relationship between the early identification of hearing loss and language outcomes for deaf/hard of hearing (D/HH) children, with bilateral or unilateral hearing loss and with or without additional disabilities. It was hypothesized that hearing loss identified by 3 months of age would be associated with better language outcomes. Using a prospective, longitudinal design, 86 families completed developmental instruments at two time points: at an average age of 14.8 months and an average age of 32.1 months. Multiple regression examined how hearing loss identified by 3 months of age contributed to later language outcomes while controlling for developmental level at the first time point. Hearing loss identified by 3 months of age was positively associated with better language outcomes for D/HH children at 32 months of age; however, D/HH children still exhibited language delays, compared to normative scores for same-aged hearing peers for reported measures. Language outcomes of children with unilateral hearing loss were not better than those of children with mild-to-moderate bilateral hearing loss. Children with additional disabilities and more severe bilateral hearing loss had lower language scores than those without.

Considerations for the identification of autism spectrum disorder in children with vision or hearing impairment: A critical review of the literature and recommendations for practice

OBJECTIVE

There is higher risk for autism spectrum disorder (ASD) across many pediatric neurological conditions characterized by vision impairment or hearing loss. Early and accurate identification of ASD is imperative in promoting access to appropriate and early evidenced-based intervention; however, differential diagnosis can be particularly challenging in children with sensory impairment given the heterogeneity of ASD combined with the impact of vision impairment or hearing loss/deafness on development and behavior. A neuropsychologist's unique expertise and appreciation of the interplay between sensory and behavioral manifestations can be valuable for making an early and accurate ASD diagnosis in children who are blind/visually impaired or deaf/hard-of-hearing. This article highlights clinical considerations when identifying ASD within the context of vision impairment or hearing loss/deafness.

METHOD

We discuss clinical considerations for the early identification of ASD in children who are blind/visually impaired and deaf/hard-of-hearing. Information presented in the article is based on a critical review of the literature and the expertise of the author group.

CONCLUSION

Ongoing development of clinical expertise and evidence-based assessment methods are important when informing the early differential diagnosis of ASD in individuals with sensory impairment. Accurate identification is also vital for the development of targeted interventions across the lifespan.

Main outcomes from the first two years of France's screening programme for neonatal permanent hearing loss through a descriptive study

AIM

This study aimed to evaluate the implementation of France's neonatal hearing loss screening programme two years after its launch, and to estimate permanent bilateral neonatal hearing loss (PBNHL) prevalence and distribution by severity.

METHODS

This descriptive study used aggregated regional data on all births in France in 2015-2016. Screening coverage, refusal rate, positive predictive value (PPV), proportion of children with suspected PBNHL, PBNHL prevalence and distribution by severity were calculated.

RESULTS

800,000 neonates were eligible for the screening programme per year. Between 2015 and 2016, screening coverage increased (83.3 vs 93.8%; p<0.001), and the refusal rate remained stable (0.1%). In 2016, when considering the additional tests performed several weeks after birth, the proportion of suspected PBNHL neonates decreased (1.4 vs 0.9%) while the PPV increased (4.7 vs 7.6%). In 2015, the estimated prevalence of PBNHL (moderate to profound) was 0.09% (95% CI 0.08-0.10). Among neonates with >=41 decibels deficit, 56.8%, 16.6%, and 26.6% had moderate, severe and profound hearing loss, respectively.

CONCLUSION

The national target of 90% screening coverage was exceeded. The additional test could be useful to avoid overcrowding in diagnostic structures. Diagnostic data quality must be improved to confirm PBNHL prevalence and distribution by severity.

Development and validation of DeciBHAL-US: A novel microsimulation model of hearing loss across the lifespan in the United States

BACKGROUND

Hearing loss affects over 50% of people in the US across their lifespan and there is a lack of decision modeling frameworks to inform optimal hearing healthcare delivery. Our objective was to develop and validate a microsimulation model of hearing loss across the lifespan in the US.

METHODS

We collaborated with the Lancet Commission on Hearing Loss to outline model structure, identify input data sources, and calibrate/validate DeciBHAL-US (Decision model of the Burden of Hearing loss Across the Lifespan). We populated the model with literature-based estimates and validated the conceptual model with key informants. We validated key model endpoints to the published literature, including: 1) natural history of sensorineural hearing loss (SNHL), 2) natural history of conductive hearing loss (CHL), and 3) the hearing loss cascade of care. We reported the coefficient of variance root mean square error (CV-RMSE), considering values ≤15% to indicate adequate fit.

FINDINGS

For SNHL prevalence, the CV-RMSE for model projected male and female age-specific prevalence compared to sex-adjusted National Health and Nutrition Examination Survey (NHANES) data was 4.9 and 5.7%, respectively. Incorporating literature-based age-related decline in SNHL, we validated mean four-frequency average hearing loss in the better ear (dB) among all persons to longitudinal data (CV-RMSE=11.3%). We validated the age-stratified prevalence of CHL to adjusted NHANES data (CV-RMSE=10.9%). We incorporated age- and severity-stratified time to first hearing aid (HA) use data and HA discontinuation data (adjusted for time-period of use) and validated to NHANES estimates on the prevalence of adult HA use (CV-RMSE=10.3%).

INTERPRETATION

Our results indicate adequate model fit to internal and external validation data. Future incorporation of cost and severity-stratified utility data will allow for cost-effectiveness analysis of US hearing healthcare interventions across the lifespan. Further research might expand the modeling framework to international settings.

FUNDING

This study was funded by the National Institute on Deafness and Other Communication Disorders and the National Institute on Aging (3UL1-TR002553-03S3 and F30 DC019846).

Prelinguistic Vocal Development in Children With Cochlear Implants: A Systematic Review

OBJECTIVES

This systematic review is designed to (a) describe measures used to quantify vocal development in pediatric cochlear implant (CI) users, (b) synthesize the evidence on prelinguistic vocal development in young children before and after cochlear implantation, and (c) analyze the application of the current evidence for evaluating change in vocal development before and after cochlear implantation for young children. Investigations of prelinguistic vocal development after cochlear implantation are only beginning to uncover the expected course of prelinguistic vocal development in children with CIs and what factors influence that course, which varies substantially across pediatric CI users. A deeper understanding of prelinguistic vocal development will improve professionals' abilities to determine whether a child with a CI is exhibiting sufficient progress soon after implantation and to adjust intervention as needed.

DESIGN

We systematically searched PubMed, ProQuest, and CINAHL databases for primary reports of children who received a CI before 5 years 0 months of age that included at least one measure of nonword, nonvegetative vocalizations. We also completed supplementary searches.

RESULTS

Of the 1916 identified records, 59 met inclusion criteria. The included records included 1125 total participants, which came from 36 unique samples. Records included a median of 8 participants and rarely included children with disabilities other than hearing loss. Nearly all of the records met criteria for level 3 for quality of evidence on a scale of 1 (highest) to 4 (lowest). Records utilized a wide variety of vocalization measures but often incorporated features related to canonical babbling. The limited evidence from pediatric CI candidates before implantation suggests that they are likely to exhibit deficits in canonical syllables, a critical vocal development skill, and phonetic inventory size. Following cochlear implantation, multiple studies report similar patterns of growth, but faster rates producing canonical syllables in children with CIs than peers with comparable durations of robust hearing. However, caution is warranted because these demonstrated vocal development skills still occur at older chronological ages for children with CIs than chronological age peers with typical hearing.

CONCLUSIONS

Despite including a relatively large number of records, the evidence in this review regarding changes in vocal development before and after cochlear implantation in young children remains limited. A deeper understanding of when prelinguistic skills are expected to develop, factors that explain deviation from that course, and the long-term impacts of variations in vocal prelinguistic development is needed. The diverse and dynamic nature of the relatively small population of pediatric CI users as well as relatively new vocal development measures present challenges for documenting and predicting vocal development in pediatric CI users before and after cochlear implantation. Synthesizing results across multiple institutions and completing rigorous studies with theoretically motivated, falsifiable research questions will address a number of challenges for understanding prelinguistic vocal development in children with CIs and its relations with other current and future skills. Clinical implications include the need to measure prelinguistic vocalizations regularly and systematically to inform intervention planning.

Youth with hearing loss: Emotional and behavioral problems and quality of life

OBJECTIVES

To compare parent- and self-reported emotional and behavioral problems and quality of life (QoL) among youth with hearing loss (HL) to norms, and to investigate possible associations between emotional and behavioral problems and QoL among youth with HL.

METHODS

We used the Strengths and Difficulties questionnaire (SDQ) and the Inventory of Life Quality in Children and Adolescents (ILC) to measure emotional and behavioral problems and QoL in youth with HL (n = 317, ages 6-18), where 78% had bilateral HL, 22% unilateral HL, 16% had cochlear implants, and 59% conventional hearing aids.

RESULTS

The youth with HL had significantly more parent-reported (but not self-reported) emotional and behavioral problems and poorer parent- and self-reported QoL than hearing youth. SDQ and ILC total scores were significantly correlated (-0.47 to -0.63). Conclusion Emotional and behavioral problems and poor QoL appear closely related in youth with HL, suggesting that attending to these problems may improve QoL.

Aetiologies of profound bilateral sensorineural hearing loss among children in Ekiti State, South Western Nigeria

Introduction

a strong need exists for the knowledge of aetiologies of diseases as this will guide the clinicians on the strategies for their treatment and prevention. In this study, we determined the aetiologies of profound bilateral sensorineural hearing loss (pbSNHL) with a view to provide the relevant data needed for preventive and therapeutic intervention among children in Ekiti State, South Western Nigeria.

Methods

medical records of children with pbSNHL seen over a ten-year period were analysed.

Results

in all, records of 142 children with pbSNHL were analysed. The results showed spectrum of aetiologies that were similar to those reported decades ago with the 'unknown' assuming a recurring decimal. Of the known (acquired) cases, measles takes up the largest 'chunk' with a prevalence of 45.8%. Twenty-eight (32.2%) of those with febrile illnesses had treated their fever with ototoxic antibiotics. Late diagnosis was characteristic of the pbSNHL.

Conclusion

this study shows that there hasn't been any significant shift in the common causes of pbSNHL. Of great concern is the persistence of the 'unknown' causes which assumes a recurring decimal in this and previous studies. Also worrisome is the high prevalence of measles-induced pbSNHL despite the availability of anti-measles vaccine. We therefore suggest effective immunization against measles and other vaccine-preventable causes of pbSNHL. The need for intensive research on the unknown causes of pbSNHL is hereby stressed. Also recommended is routine hearing assessment for survivors of febrile conditions so as to detect, if any, hearing loss promptly.

A National Survey of Hearing Loss in the Philippines

This study aimed to estimate the prevalence of hearing loss in the Philippines using a nationally representative sample. A cross-sectional national survey was undertaken utilizing a 3-stage stratified cluster design. Participants in the present study comprised 2275 adults and children with pure tone hearing assessment results. Prevalence of moderate or worse hearing loss, defined as 4FA ≥41 dBHL, was 7.5% in children <18 years, 14.7% in adults between 18 and 65 years, and 49.1% in adults >65 years. Factors associated with greater risk of moderate hearing loss in the better ear were presence of a middle ear condition (adjusted odds ratio = 2.39, 95% confidence interval = 1.49-3.85) and socioeconomic status (household income; adjusted odds ratio = 1.64, 95% confidence interval = 1.23-2.19). Age was also associated with increased risk, with adjusted odds ratios varying with age category. Prevalence of wax occlusion and outer and middle ear disease was 12.2% and 14.2%, respectively. Prevalence of hearing loss, outer, and middle ear disease appear comparatively high in the Philippines when compared with rates reported in high-income countries. Higher proportions of severe to profound hearing loss were also identified, indicating that there is both an increased prevalence and severity of hearing loss in this population.

The results of hearing screening in refugee school children living in Şanliurfa /Turkey and the related risk factors

OBJECTIVES

Determining the frequency of and the risk factors for hearing loss among school-age children by comparing the results of hearing screening in children from Syrian refugee and native Turkish population.

METHODS

The results of the official hearing test, which was conducted by the Ministry of Health of the Republic of Turkey for schoolchildren in the first grade in the 2017-2018 academic year in the Province of Şanlıurfa, were analyzed.

RESULTS

A total of 23,664 children were screened; 20,603 (87.1%) were Turkish native, and 3,061 (12.9%) were Syrian refugees. The age range was between 69 and 84 months. The screening results indicated in Turkish children, sensorineural hearing loss (SNHL) in 0.26%, otitis media with effusion (OME) in 0.41%, and chronic otitis media (COM) in 0.08%. In the refugee children, the frequency of SNHL was 1.11%, OME was 0.94%, and COM was 0.62%. The rate of COM and SNHL was significantly higher in the refugee children (p < 0.001). Moreover, among those with hearing loss, the frequency of low birth weight, inflammatory diseases, and the family history of consanguineous marriage was significantly higher in refugee children compared to those in Turkish native population (p = 0.018, p = 0.003, and p = 0.022, respectively).

CONCLUSION

Hearing loss is a major preventable and treatable cause of developmental disorder in childhood. When untreated, hearing loss may delay speaking and prevent socio-emotional development, leading to longterm negative consequences. We believe that programs for hearing screening in schoolchildren should be expanded and that immigrants who carry several risk factors for developmental hearing loss should be included in these programs.

Prevalence of Mild Hearing Loss in Schoolchildren and its Association with their School Performance

Introduction  Hearing is important for the proper development of every child, especially for those younger than 5 years of age, because it helps in the development of language and speech. Emotional and social problems, as well as issues with academic performance, can result from hearing loss even of mild degree. Early diagnosis and management can overcome those negative impacts.

Objective  To determine the prevalence of mild hearing loss in primary-school children and its association with their school performance.

Methods  A comparative cross-sectional study was conducted at a regular school. The study included the random selection of 120 apparently normal students (aged 6-9 years) who were considered as having normal hearing by their parents. A total of 20 students were excluded from the study due to the presence of wax in their ears. Finally, the study was conducted with 100 students. All participants were subjected to a basic audiological evaluation, and the Screening Instrument for Targeting Educational Risk (SIFTER) questionnaire was given to their teachers to evaluate their school performance.

Results  From a total of 100 students, we confirmed that 23 (23%) had mild hearing loss, 17 (17%) had bilateral conductive hearing loss, and 6 (6%) had bilateral sensorineural hearing loss. The students who had low attention and communication performance were significantly associated with mild hearing loss.

Conclusion  The prevalence of mild hearing loss was of 23% (23 cases). This problem had an effect on the communication and attention in school; and it might affect academic performance later in life. A hearing assessment is highly recommended for every child, especially those who have a low rate of academic performance.

A Two-Interval, Forced-Choice, Observer-Based Procedure for Evaluating Hearing Sensitivity in Children With Motor and Developmental Impairments

Purpose It can be challenging to collect reliable behavioral responses to sound from individuals with significant motor or developmental impairments, the most common types of comorbid disability found in children with hearing loss (e.g., Gallaudet Research Institute, 2011). The purpose of this study was to test the feasibility of using a 2-interval, forced-choice, observer-based method for individuals considered to be difficult-to-test using behavioral audiometric assessments. Method Participants were 5 children with motor and developmental impairments, ages 5-15 years (M = 11.6, SD = 4.6). The functional abilities of all participants were greater than 2 SDs below the mean, as measured by the Vineland-II Parent Caregiver Rating Form. Participants listened to either a male talker saying the word "playground" or a 1000-Hz warble tone, presented via an insert earphone or a sound field speaker. An observer, blind to signal presentation, selected 1 of 2 temporal intervals, determining which contained the signal based only on participant behavior. Criterion was reached when the observer correctly identified the interval containing the signal for 8 of the last 10 trials. Results An 80%-correct criterion was met for all participants, suggesting feasibility for use in children with motor or developmental impairment. Two participants were tested using an adaptive tracking procedure; a reliable threshold estimate was obtained for both children. This method offers promise for children who have difficulty performing behavioral audiometric assessments currently in use clinically.

Trends in sociodemographic disparities of pediatric cochlear implantation over a 15-year period

OBJECTIVE

Sociodemographic disparities of cochlear implantation in children have been reported. This study sought to determine if disparities in children receiving cochlear implants have narrowed, widened or remained constant.

METHODS

Children 18 years or younger who underwent cochlear implantation from 1997 to 2012 were selected using the Kids' Inpatient Database. Demographic data included primary insurance payer, income quartile and race. The Cochran-Armitage test was used to determine if trends were significant. Prevalence rates of cochlear implantation by race were generated. A Poisson regression model was used to evaluate the rates of cochlear implantation within each racial group.

RESULTS

The proportion of children receiving cochlear implants with private insurance decreased from 79.3% to 42.6% (p < .0001), whereas children with Medicaid increased from 17.4% to 35.2% (p < .0001). Proportion of implanted children from the lowest two income quartiles increased from 15.5% to 24.4% (p < .0001) and 10.3%-21.8% (p < .0035), respectively. Rates of implantation among children from income quartile four decreased from 50.9% to 35.3% (p < .0001). White children were implanted twice as often as Black or Hispanic children (p = .007 and p = .0012 respectively). Asian children were implanted more than twice as often as Black or Hispanic Children (p = .0154 and p = .0098 respectively).

CONCLUSIONS

Income and insurance disparities have narrowed within the inpatient pediatric cochlear implantation cohort. Racial disparities still exist. White and Asian children are implanted at higher rates than Black or Hispanic children.

Benefit of Cochlear Implantation in Children with Multiple-handicaps: Parent's Perspective

Introduction  The cochlear implants centers in the world are studying the cochlear implantation in children with multiple handicaps.

Objective  To develop a questionnaire to analyze the subjective benefits of the cochlear implantation in multiple handicapped children according to their parent's perspective.

Methods  A questionnaire was applied to 14 families of multiple handicapped children, aging from 2–12 years old and having from 11 months to 11 years of implant use.

Results  The social-emotional abilities were improved because of many factors, such as: auditory exposure, which happened in 84% of the children; recognition of their own names, which increased in 56%; and development of eye contact, in 28% of the subjects. Other benefits appeared to be: music appreciation and more attention and adherence to other therapies and school activities. Besides, some children became interested in objects, playing with other children, and more adapted to daily routines. Thirty-five percent of the children acquired oral language, mainly the bilaterally implanted, while 14% of them were engaged in sign language. Although all of the children showed a significant improvement in communication, the emotional issues of some families and the severity of the handicaps negatively impacted the outcomes. In spite of the families' acknowledgement of some benefits, the diagnosis of autism spectrum disorder caused frustration, requiring a readjustment of the expectations.

Conclusion  The questionnaire turned out to be an adequate tool to reveal the social-emotional benefits of cochlear implantation. Although oral language was not the major outcome in these cases, the cochlear implant benefits involved the whole family. All of the families recommended the implant to other children in a similar situation.

Prevalence of childhood hearing impairment of different severities in urban and rural areas: a nationwide population-based study in Taiwan

OBJECTIVE

Childhood hearing impairment (CHI) is a major developmental disability, but data at the national level are limited, especially those on different severities. We conducted a study to fill this data gap.

DESIGN

A nationwide study on the basis of a reporting system.

SETTING

To provide services to disabled citizens, the Taiwanese government maintains a registry of certified cases. Using data from this registry, we estimated prevalence rates of CHI of different severities from 2004 to 2010 and made comparisons between urban and rural areas.

PARTICIPANTS

Taiwanese citizens ≤17 years old.

PRIMARY OUTCOME MEASURES

To qualify for CHI disability benefits, a child must have an unaided pure-tone better ear hearing level at 0.5, 1 and 2 kHz with an average ≥55 decibels (dB), confirmed by an otolaryngologist. The severity was classified by pure-tone better ear hearing level as mild (55-69 dB), moderate (70-89 dB) and severe (≥90 dB).

RESULTS

The registered cases under 17 years old decreased annually from 4075 in 2004 to 3533 in 2010, but changes in the prevalence rate were small, ranging from 7.62/10 000 in 2004 to 7.91/10 000 in 2006. The prevalence rates of mild CHI increased in all areas over time, but not those of moderate or severe CHI. Rural areas had higher overall prevalence rates than urban areas in all years, with rate ratios (RRs) between 1.01 and 1.09. By severity, rural areas had higher prevalence rates of mild (RRs between 1.08 and 1.25) and moderate (RRs between 1.06 and 1.21) CHI but had lower prevalence rates of severe CHI (RRs between 0.92 and 0.99).

CONCLUSION

While rural areas had higher overall prevalence rates of CHI than urban areas, the RRs decreased with CHI severity. Further studies that identify factors affecting the rural-urban difference might help the prevention of CHI.

Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes

BACKGROUND

Up to 15% of children with permanent hearing loss (HL) have auditory neuropathy spectrum disorder (ANSD), which involves normal outer hair cell function and disordered afferent neural activity in the auditory nerve or brainstem. Given the varying presentations of ANSD in children, there is a need for more evidence-based research on appropriate clinical interventions for this population.

PURPOSE

This study compared the speech production, speech perception, and language outcomes of children with ANSD, who are hard of hearing, to children with similar degrees of mild-to-moderately severe sensorineural hearing loss (SNHL), all of whom were fitted with bilateral hearing aids (HAs) based on the American Academy of Audiology pediatric amplification guidelines.

RESEARCH DESIGN

Speech perception and communication outcomes data were gathered in a prospective accelerated longitudinal design, with entry into the study between six mo and seven yr of age. Three sites were involved in participant recruitment: Boys Town National Research Hospital, the University of North Carolina at Chapel Hill, and the University of Iowa.

STUDY SAMPLE

The sample consisted of 12 children with ANSD and 22 children with SNHL. The groups were matched based on better-ear pure-tone average, better-ear aided speech intelligibility index, gender, maternal education level, and newborn hearing screening result (i.e., pass or refer).

DATA COLLECTION AND ANALYSIS

Children and their families participated in an initial baseline visit, followed by visits twice a year for children <2 yr of age and once a yr for children >2 yr of age. Paired-sample t-tests were used to compare children with ANSD to children with SNHL.

RESULTS

Paired t-tests indicated no significant differences between the ANSD and SNHL groups on language and articulation measures. Children with ANSD displayed functional speech perception skills in quiet. Although the number of participants was too small to conduct statistical analyses for speech perception testing, there appeared to be a trend in which the ANSD group performed more poorly in background noise with HAs, compared to the SNHL group.

CONCLUSIONS

The American Academy of Audiology Pediatric Amplification Guidelines recommend that children with ANSD receive an HA trial if their behavioral thresholds are sufficiently high enough to impede speech perception at conversational levels. For children with ANSD in the mild-to-severe HL range, the current results support this recommendation, as children with ANSD can achieve functional outcomes similar to peers with SNHL.

[Epidemiology of hearing loss in children of the first year of life]

The aim of this study was the investigation of the epidemiology of permanent hearing impairment in the children of first year of life in the Russian Federation after the implementation of the newborn universal hearing screening program. The prevalence of hearing loss in children in the first year of life was estimated at 2.5 per 1,000 based on the official statistical data and reports of hearing rehabilitation centres in 2016. A cohort of 405 children born in 2012 was examined at the age from 0 to 4 years of life. Among them 276 children were diagnosed with permanent congenital and prelingual hearing loss. 88% of the cases were bilateral, sensorineural hearing loss confirmed in 84% of the cases. The genetic cause of hearing loss was revealed in 58% of the patients assessed for the presence of GJB2 gene mutations. In preterm infants, the permanent hearing loss was detected in 70% of the cases. The comprehensive audiological assessment before 3 months of life was conducted only in 32% of the children; this finding is not consistent with the international newborn hearing screening recommendations. Only 70% of the cases of congenital and preverbal hearing loss were diagnosed during the first year of life.

What Contribution Did Economic Evidence Make to the Adoption of Universal Newborn Hearing Screening Policies in the United States?

Universal newborn hearing screening (UNHS), when accompanied by timely access to intervention services, can improve language outcomes for children born deaf or hard of hearing (D/HH) and result in economic benefits to society. Early Hearing Detection and Intervention (EHDI) programs promote UNHS and using information systems support access to follow-up diagnostic and early intervention services so that infants can be screened no later than 1 month of age, with those who do not pass their screen receiving diagnostic evaluation no later than 3 months of age, and those with diagnosed hearing loss receiving intervention services no later than 6 months of age. In this paper, we first document the rapid roll-out of UNHS/EHDI policies and programs at the national and state/territorial levels in the United States between 1997 and 2005. We then review cost analyses and economic arguments that were made in advancing those policies in the United States. Finally, we examine evidence on language and educational outcomes that pertain to the economic benefits of UNHS/EHDI. In conclusion, although formal cost-effectiveness analyses do not appear to have played a decisive role, informal economic assessments of costs and benefits appear to have contributed to the adoption of UNHS policies in the United States.

The risk ratio for development of hereditary sensorineural hearing loss in consanguineous marriage offspring

OBJECTIVES

This study aims to define the relative risk of development of hearing loss in offspring of consanguineous marriages.

MATERIALS AND METHODS

This is a retrospective case-control study conducted in a tertiary referral center in Jeddah, KSA. The study group included 1600 probands (848 males, 752 females), with age range 0.5-12 years (6.6 ± 3.6). The study group comprised of two equal, age and sex matched subgroups; Hearing Loss (HL) group and Normal Hearing (NH) group. The children included in the HL group should have idiopathic or non syndromic genetic sensorineural hearing loss.

RESULTS

The HL Group comprised 800 children with variable degrees of sensorineural hearing loss. Profound and severe degrees of hearing loss were the most prevalent degrees (P <0.05%). The prevalence of consanguineous marriage offspring in the NH group was 42.5%, while in the HL group it was 68.9% (P < 0.05). The differences between both study subgroups regarding the distribution of different degrees of parental consanguinity (first, second, double first, and first once removed cousins) were insignificant (P > 0.05). The relative risk and 95% confidence interval (RR, 95% CI) for development of hearing loss in offspring of consanguineous marriage was 1.76 (95% CI 1.57-1.97, P < 0.001).

CONCLUSIONS

There was 76% increased risk for consanguineous marriage progeny to develop SNHL when compared to non consanguineous progeny.

Exploring reasons for late identification of children with early-onset hearing loss

INTRODUCTION

Several studies have shown that early identification of childhood hearing loss leads to better language outcomes. However, delays in the confirmation of hearing loss persist even in the presence of well-established universal newborn hearing screening programs (UNHS). The objective of this population-based study was to document the proportion of children who experienced delayed confirmation of congenital and early onset hearing loss in a UNHS program in one region of Canada. The study also sought to determine the reasons for delayed confirmation of hearing loss in children.

METHODS

Population level data related to age of first assessment, age of identification and clinical characteristics were collected prospectively for all children identified through the UNHS program. We documented the number of children who experienced delay (defined as more than 3 months) from initial audiologic assessment to confirmation of hearing loss. A detailed chart review was subsequently performed to examine the reasons for delay to confirmation.

RESULTS

Of 418 children identified from 2003 to 2013, 182 (43.5%) presented with congenital or early onset hearing loss, of whom 30 (16.5%) experienced more than 3 months delay from initial audiologic assessment to confirmation of their hearing disorder. The median age of first assessment and confirmation of hearing loss for these 30 children was 3.7 months (IQR: 2.0, 7.6) and 13.8 months (IQR: 9.7, 26.1) respectively. Close examination of the factors related to delay to confirmation revealed that for the overwhelming majority of children, a constellation of factors contributed to late diagnosis. Several children (n = 22; 73.3%) presented with developmental/medical issues, 15 of whom also had middle ear dysfunction at assessment, and 9 of whom had documented family follow-up concerns. For the remaining eight children, additional reasons included ongoing middle ear dysfunction for five children, complicated by family follow-up concerns (n = 3) and mild hearing loss (n = 1) and the remaining three children had isolated reasons related to family follow-up (n = 1) or mild hearing loss (n = 2).

CONCLUSION

Despite the progress made in the early detection of pediatric hearing loss since UNHS, a substantial number of children referred for early assessment can experience late confirmation and intervention. In particular, infants with developmental and/or medical issues including middle ear disorders are at particular risk for longer time to confirmation of hearing loss.

Prevalence and characteristics of self-reported physical and mental disorders among adults with hearing loss in Denmark: a national survey

PURPOSE

Existing research shows that people with hearing loss have a high risk of additional physical and mental disorders. However, only a few population-based studies have been conducted. This study assesses the prevalence and characteristics of additional disorders among adults with hearing loss in Denmark and thereby contributes a population-based study to this area of research.

METHOD

Data on self-reported physical and mental disorders from a national survey of 772 adults with hearing loss were compared to corresponding data from a national survey of 18,017 adults from the general population.

RESULTS

People with hearing loss reported more physical and mental disorders than the general population. Specifically, they reported higher incidences of visual impairment, cerebral palsy, intellectual impairment, and "other mental disorders".

CONCLUSION

Adults with hearing loss have a greater risk of additional physical and mental disorders. It is important for clinicians to have some understanding of the communication needs and characteristics of deaf and hard-of-hearing patients, so that they can recognize and treat symptoms and provide appropriate support.

[The analysis of acoustic activity unsynchronized with the stimulus with the use of TEOAE]

The presence of ambient noise or the troubled child's behavior during the registration of transiently induced optoacoustic emission (TEOAE) can lead to false positive results at the first stage of hearing screening. The aim of this study is to evaluate the effectiveness of the noise reduction method based on weighted averaging of the data in the frequency and time slot, to check TEOAE, and to improve the effectiveness of universal hearing screening. Particular attention is paid to the analysis of the origin of noise recorded during the UAE.

PATIENTS AND METHODS

We have developed a method of noise reduction, based on weighted averaging of the data in the frequency and time cells. In this study, 20 people were examined (9 adults and 11 children). TEOAE was performed using the probe of the ILO 288 instrument manufactured by Otodinamics Ltd. that was connected to the E-MU 0204 sound card. The probe microphone was connected through the preamplifier to one input channel of the sound card, and the second channel was used to receive a signal from the ECG and the respiration recorder. Thereafter, the data thus obtained were processed by several methods, including the method of averaging in the frequency and time slot designed to average a set of implementations that contain a noisy signal. The comparison of the results of the use of noise suppression method based on weighted averaging of the data in the frequency and time cells showed that it increases the accuracy of TEOAE.

MAIN RESULTS

Our work suggests that the use of the noise suppression method based on weighted averaging of the data in the frequency and time cells, increases the accuracy of TEOAE. Similar results were obtained by the weighted averaging method.

Associations between childhood hearing loss and behavioural and academic difficulties: A Danish cohort study

OBJECTIVE

Negative associations between hearing loss (HL) and behavioural and academic difficulties have been reported. However, most studies are based on small clinical samples. The aim of the present study was to investigate such associations using data from a large-scale non-clinical Danish birth cohort controlling for a large number of relevant confounding factors.

METHODS

The study applied data from the Aarhus Birth Cohort's 10-12-year-old follow-up (N = 7599). Associations between parent-reported HL on the one hand, and parent- and teacher-reported behavioural difficulties measured by the Strengths and Difficulties Questionnaire (SDQ) and parent-reported academic difficulties on the other hand, were investigated.

RESULTS

After controlling for relevant confounding factors, significant associations were observed between parent-reported HL and parent- and teacher-reported Externalising scores, and academic difficulties.

CONCLUSIONS

Childhood HL is associated with behavioural and academic difficulties. Parent reported HL in a non-clinical cohort is indicative for academic and behavioural difficulties.

Diagnosis and Management of Congenital Sensorineural Hearing Loss

Hearing loss is the most common sensory disorder in the USA. The diagnosis of congenital hearing loss starts with newborn hearing screening, which is best performed with auditory brainstem evoked responses in order to avoid the risk of missing auditory neuropathy spectrum disorder. A careful history and physical exam can occasionally help reveal the etiology for congenital hearing loss. Imaging studies, either CT temporal bones or MRI of the internal auditory canals without gadolinium, and genetic testing, in particular for connexin 26, connexin 30, and Pendred syndrome, are the most useful diagnostic tests. Management of congenital hearing loss involves early fitting of amplification. Early cochlear implantation, preferably before 2 years of age, should be strongly considered for children with bilateral severe hearing loss.

Project ASPIRE: Spoken Language Intervention Curriculum for Parents of Low-socioeconomic Status and Their Deaf and Hard-of-Hearing Children

OBJECTIVE

To investigate the impact of a spoken language intervention curriculum aiming to improve the language environments caregivers of low socioeconomic status (SES) provide for their D/HH children with CI & HA to support children's spoken language development.

STUDY DESIGN

Quasiexperimental.

SETTING

Tertiary.

PATIENTS

Thirty-two caregiver-child dyads of low-SES (as defined by caregiver education ≤ MA/MS and the income proxies = Medicaid or WIC/LINK) and children aged < 4.5 years, hearing loss of ≥ 30 dB, between 500 and 4000 Hz, using at least one amplification device with adequate amplification (hearing aid, cochlear implant, osseo-integrated device).

INTERVENTION

Behavioral. Caregiver-directed educational intervention curriculum designed to improve D/HH children's early language environments.

MAIN OUTCOME MEASURES

Changes in caregiver knowledge of child language development (questionnaire scores) and language behavior (word types, word tokens, utterances, mean length of utterance [MLU], LENA Adult Word Count (AWC), Conversational Turn Count (CTC)).

RESULTS

Significant increases in caregiver questionnaire scores as well as utterances, word types, word tokens, and MLU in the treatment but not the control group. No significant changes in LENA outcomes.

CONCLUSION

Results partially support the notion that caregiver-directed language enrichment interventions can change home language environments of D/HH children from low-SES backgrounds. Further longitudinal studies are necessary.

[The Russian and international experience with the implementation of the programs of universal audiological screening of the newborn infants]

The problem of diagnostics of congenital hearing impairment has acquired special importance in the light of new possibilities for the early rehabilitation of the patients presenting with this condition. The implementation of the programs of universal audiological screening into the clinical practice of Russia and many other countries made it possible to significantly reducethe time necessary to confirm congenital impairment of hearing and begin the rehabilitative treatment. The present paper was designed to analyze the international experience with the implementation of the programs of universal audiological screening of the newborn infants as exemplified by such countries as Great Britain, USA, Germany, and Poland. The main indicators of the quality and the efficiency of such programs are considered taking into account the results of the epidemiological studies on the prevalence of congenital hearing impairment. A total of 1.8 mln newborn infants were examined in Russia during 2013. The first stage of screening involved 96.7% of the children, and only 2.9% of them remained uncovered by the examination. As many as 5,659 children were found to present with the congenital loss of hearing,with the prevalence of this condition being 3 per 1.000 newborn infants and the prevalence of deafness 0.6 per 1.000. The principal problem to be resolved for the organization of the management of these patients, both in Russia and other countries, remains the enhancement of the availability of comprehensive diagnostic examination and the timelyreferral of the patients to such examination (if appropriate based on the results of the screening). The successful solution of this problem requires personalized recording of the screening data with the use of the commonly accepted medical information systems.

Prevalence of 2.2 per mille of significant hearing loss at school age suggests rescreening after NHS

OBJECTIVES

The study aims to determine the prevalence of different degrees of significant hearing loss in a complete sample of Austrian school-age children born between 1997 and 2001 living in the federal state of Carinthia and to evaluate the role of Newborn Hearing Screening (NHS) in the identification of later hearing loss.

METHODS

In Carinthia, all school-age children with significant hearing loss (mean pure tone average in the better ear above 40 dB) are registered by the Department of Education. From five complete birth cohorts from 1997 to 2001 (n = 28.171) all the children with sensorineural hearing loss (n = 61, mean age 10.5, age range 7.5-13.6 years) were assessed for their hearing threshold and level of cognitive functioning. Socio-demographic data, including information about NHS and amplification with hearing devices, were collected from parents and teachers using structured interviews.

RESULTS

2.2 children per thousand (49.2% male) were found to be affected by significant bilateral hearing loss at school age, with 36.1% of them having a moderate hearing loss, 34.4% severe, and 29.5% profound. Fourteen children (23.0%) used cochlear implants. Their mean nonverbal IQ was 93.4 (SD 23.1), including 13.1% of children with intellectual disabilities (IQ < 70). Of those who had undergone NHS (85.2%), 50.0% had passed the screening according to parents' reports.

CONCLUSIONS

A rate of significant hearing loss in school-age children was observed which was twice the rate found in newborns. Ongoing awareness of late-onset hearing loss to improve identification and hearing screening at school entry are recommended.

Timeliness of service delivery for children with later-identified mild-to-severe hearing loss

PURPOSE

In this study, the authors examined diagnostic and intervention services for children identified with hearing loss (HL) after the newborn period.

METHOD

The authors compared ages at service delivery and length of delays between service delivery steps for 57 later-identified children with HL and 193 children who referred for assessment from the newborn hearing screen (NHS). For only later-identified children, regression models were used to investigate relationships among predictor variables and dependent variables related to service delivery.

RESULTS

Children who referred from the NHS received follow-up services at younger ages than later-identified children. Later-identified children had significantly longer delays from HL confirmation to entry into early intervention, compared to children who referred from the NHS. For later-identified children, degree of HL predicted ages at follow-up clinical services. Children with more severe HL received services at younger ages compared to children with milder HL. Gender predicted the length of the delay from confirmation to entry into early intervention, with girls demonstrating shorter delays.

CONCLUSIONS

The current results lend support to the need for ongoing hearing monitoring programs after the neonatal period, particularly when children enter early intervention programs because of language/developmental delays.

The effect of psychosocial factors on outcomes of cochlear implantation

CONCLUSION

Psychosocial factors should be considered during cochlear implantation (CI). There were differences in psychosocial characteristics according to the etiology of deafness. The outcomes may be affected by psychosocial variables such as the severity of mental distress and social problems as well as duration of deafness.

OBJECTIVE

To evaluate the psychosocial characteristics of deaf people undergoing CI and to determine which psychosocial factors affect performance after CI.

METHODS

A total of 289 subjects who underwent CI were enrolled. The participants were classified into prelingually deaf (pre-LD) and postlingually deaf groups (post-LD), including progressive and sudden deafness subgroups. The Minnesota Multiphasic Personality Inventory (MMPI) was administered before CI to measure psychosocial and emotional problems. To measure CI outcomes, speech perception ability was assessed by the open-set Korean version of the Central Institute of Deafness (K-CID) test and categories of auditory performance (CAP) scores before and after CI.

RESULTS

Approximately 45% of subjects experienced psychological problems before undergoing CI. Subjects in the Pre-LD group had more psychosocial distress and were more likely to be oversensitive in interpersonal situations, while those in the post-LD group were more depressed. Deafness duration and psychosocial factors significantly predicted hearing ability after CI. Deafness duration directly and indirectly affected the outcome of CI. That is, duration of deafness caused psychosocial problems, which may have resulted in negative effects on outcomes of CI.

Profound childhood hearing loss in a South Africa cohort: risk profile, diagnosis and age of intervention

OBJECTIVE

To describe profound childhood hearing loss in a South African population of pediatric cochlear implant recipients in terms of risk profile, and age of diagnosis and intervention.

METHODS

A retrospective review of patient files for 264 pediatric cochlear implant recipients from five cochlear implant programs was conducted. Data was captured from 264 eligible subjects, of which all were implanted between 1996 and 2013 and PCEHL was confirmed under the age of 5 years old. Data collected included demographical information, risk factors from case histories, diagnostic test procedures conducted, diagnosis (type, onset and degree of hearing loss) and documented ages of caregiver suspicion, initial diagnosis and intervention.

RESULTS

Risk factors for permanent childhood hearing loss were present in 51.1% of cases, with the most prevalent risks being NICU admittance (28.1%), family history of childhood hearing loss (19.6%) and prematurity (15.1%). An associated syndrome was diagnosed in 10% of children and 23.5% presented with at least one additional developmental condition. Hearing loss for most (77.6%) children was confirmed as congenital/early onset, while 20.3% presented with postnatal onset of hearing loss. ANSD was diagnosed in 5% of children, with admittance to NICU (80%) and hyperbilirubinemia (50%) being the most prevalent risk factors for these cases. Hearing loss was typically diagnosed late (15.3 months), resulting in delayed initial hearing aid fitting (18.8 months), enrollment in early intervention services (19.5 months) and eventual cochlear implantation (43.6 months).

CONCLUSION

Most prevalent risk factors in profound childhood hearing loss were admittance to NICU, family history and prematurity. Diagnosis and intervention was typically delayed predisposing this population to poorer outcomes.

Screening, rubella vaccination, and childhood hearing impairment in Taiwan

Childhood hearing impairment (CHI) is a major developmental disability, but data at the national level are limited, especially those on the changes in the prevalence over time. In Taiwan, the government began to certify disabled residents for providing various services in 1980 and maintains a registry of certified cases, which provides a rare opportunity for studying the trends of CHI prevalence. Using the registry data, we estimated the prevalence of CHI by age and severity and explored factors affecting its changes over time. From 2000 to 2011, the registered cases under 17 years old ranged from 3427 to 4075. The overall prevalence increased from 2000 to 2006, but then decreased till 2011. While the prevalence of mild CHI increased over the years, such a pattern was not observed in moderate or severe CHI. In general, the overall prevalence increased over the years in the age groups <3 years, 3-5 years, and 6-11 years (p<0.01), and the largest increase was observed in the age group <3 years, particularly after the promotion of screening by the government in 2003. The decrease after 2006 was mainly attributable to decreases in the age groups 12-14 (with a decreasing trend from 2001, p<0.01) and 15-17 years (with a decreasing trend from 2004, p<0.01). The timing was related to the implementation of a nationwide rubella vaccination program. Similar decreases had been observed in countries with rubella vaccination programs.

Childhood hearing impairment in northern Finland, etiology and additional disabilities

OBJECTIVES

The purpose of this study was to determine the prevalence and etiology of hearing impairment (HI) in Finnish children and to evaluate the frequency and type of additional disabilities among children with HI.

METHODS

Subjects consisted of 214 children with mild to profound HI ascertained until the age of 10 years. They belonged to the birth cohort spanning the years 1993-2002 in northern Finland. The clinical data were collected from the electronic patient records of the Oulu University Hospital. Age at ascertainment, degree and type of HI and audiogram configuration were determined. Risk factors and etiology of HI and co-existing disabilities were recorded.

RESULTS

The prevalence of childhood HI was 2.3/1000 live births (95% CI; 2.0, 2.7). The etiology of HI was genetic in 47.2%, acquired in 16.4% and unknown in 36.4% children. Among the 214 children with HI, 101 (47.2%) had other minor or major disabilities. The frequency of additional disabilities did not differ between children with mild HI and those with moderate or severe HI (p=0.78). Additional disabilities were more common (65.7%) in children with acquired HI than in children with genetic or unknown HI (43.6%) (p=0.035).

CONCLUSION

The prevalence of childhood HI has remained unchanged in northern Finland as compared to previous studies. Genetic causes were the most common (47%) etiology of childhood HI. Among acquired causes of HI, perinatal risk factors were more common than previously. The frequency of additional disabilities was similar among children with different degrees of HI. Because almost 40% of children had one or more additional disabilities affecting development or learning, it is important to take them into consideration in rehabilitation.

Psychiatric diagnoses and psychosocial needs of outpatient deaf children and adolescents

Deaf youth may be more vulnerable to psychiatric disorders but very little research data is available. The current study identified prevalence rates of psychiatric disorders and examined the psychosocial needs and strengths of deaf youth aged 4-17 receiving specialized outpatient mental health services for the deaf. Compared to hearing peers, deaf youth had greater rates of attention deficit hyperactivity disorder, conduct, autism-spectrum and bipolar disorders and spent three times longer in treatment than their hearing peers. In the deaf subsample, moderate-severe risk was found in social functioning (33.3 %) and suicidal behavior (14 %). Deaf youth had moderate to severe impairment in social relationships (54.8 %), school functioning (42.9 %). Over one-third of deaf youth had impaired family relationships, living situation, communication, judgment and physical health. Deaf youth present with higher rates of certain clinical disorders and have deficits in multiple life domains that may impact functioning and create a longer treatment course.

[Deaf patients in psychiatry]

Prelingual deafness has multiple and far reaching consequences for the development of language, cognition and the psychosocial dimension. Almost one of a thousand of the population is affected. Barriers in communication limit access to knowledge and participation in society. The use of sign language connects deaf people socio-culturally. This review shows discrepancies between high prevalence rates of mental health disorders with complex psychiatric challenges and barriers to mental health care. The UN convention on the rights of persons with disabilities obliges to counteract these discrepancies. Services with specialised signing professionals and the use of interpreters can improve access to mental health care.

Disability as a risk factor? Development of psychopathology in children with disabilities

Empirical research has established that children with disabilities are more likely to develop psychopathology than children without disabilities. But too little is known about the association between disability and psychopathology. The aim of this article is to discuss developmental psychopathological models that conceptualise the connection between childhood disability and psychopathology. Empirical studies of psychopathology among children with a congenital hearing impairment and children with cerebral palsy will be reviewed, representing in-depth examples of association between disability and psychopathology. Both a congenital hearing impairment and cerebral palsy were found to be dominating risk factors for all types of psychopathology, but no relationship was identified between degree of disability and risk of psychopathology. The higher risk cannot be explained by biological impairments alone. To explain the contradictory findings, developmental models of disability and psychopathology are applied. Within a multi-factorial developmental psychopathological perspective and a dialectical model of disability (Vygotsky, 1993), it is suggested that disability can be understood as an incongruence between the individual development of the child and demands and expectations in the specific relations and institutions in which the child participates. This incongruence creates and strengthens negative factors for the child with disability and results in a higher risk of psychopathology.

Hearing difficulties in children with special health care needs

OBJECTIVE

To determine characteristics of children with special health care needs (CSHCN) with hearing difficulties including patterns of hearing aid use, comorbidity, and social and communication function.

METHODS

Bivariate and multivariable analysis of cross-sectional data on 40,723 children aged from birth to 17 years from the 2005-2006 National Survey of Children with Special Health Care Needs, including 1,982 (5%) with parent-reported hearing difficulties.

RESULTS

Among CSHCN, 383 (1%) used hearing aids, representing 20% of those with reported hearing difficulties. Odds of hearing aid use increased with age, primary language other than English, and lower income. More than half (58%) of the aided children reported hearing difficulties even with their aid. Among CSHCN with cerebral palsy, 13% had reported hearing difficulties and 3% used hearing aids. Equivalent figures for children with Down syndrome were 24% and 4%, mental retardation/developmental delay 12% and 5%, and autism spectrum disorder 9% and 2%. Overall, two-thirds of CSHCN with hearing difficulties had one or more sensory/developmental comorbidities; CSHCN with both hearing difficulties and a sensory/developmental comorbidity had highest odds of learning difficulties, speaking/communication difficulties, feeling anxious/depressed, acting out/bullying, and difficulty making friends. CSHCN with hearing difficulties alone, or sensory/developmental conditions alone had intermediate odds, after socio-demographic adjustment.

CONCLUSIONS

Sensory/developmental comorbidities are common among CSHCN with hearing difficulties, and they are associated with higher odds of poorer social, communication, and educational function. Services for CSHCN must be equipped to address a range of hearing difficulties as well as sensory/developmental comorbidities and to improve social/emotional functioning as well as learning and communication.