Language ability in children with permanent hearing impairment: the influence of early management and family participation

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.

Quality Standard for Rehabilitation of Young Deaf Children Receiving Cochlear Implants

Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project "VOICE"-vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent.

Perinatal Cytomegalovirus Infection

PURPOSE OF REVIEW

There have been recent advances in the field of congenital CMV infection (cCMV) related to antiviral treatment of pregnant women and infants, the implementation of newborn CMV screening programs, and the frequency and diagnosis of complications among infected children. In addition, postnatal CMV infection (pCMV) is increasingly recognized as a potential cause of long-term sequelae in addition to acute complications among preterm infants, raising important questions related to treatment, and prevention.

RECENT FINDINGS

High-dose valacyclovir appears to be safe and effective for the prevention of cCMV among women with first-trimester primary CMV infection. New studies reveal high rates of vestibular dysfunction and neuropsychiatric manifestations among children with cCMV. Some studies report associations between pCMV and long-term consequences, including neurodevelopmental delay and bronchopulmonary dysplasia, among very low birth weight infants, in addition to high risk of sepsis and death acutely, which has motivated efforts to eliminate the virus from breast milk by different methods.

SUMMARY

More long-term complications of cCMV are increasingly recognized among children previously thought to be asymptomatic. Although a preventive CMV vaccine may be achievable, strategies to reduce the burden of cCMV disease include maternal education about risk-reduction behaviors, antiviral treatment of pregnant women with primary infection, and newborn screening to allow timely, appropriate care. Similarly, although it remains unclear if pCMV causes long-term problems, there is growing interest in identifying and preventing disease from CMV infections among preterm infants.

Pre-linguistic social communication skills and post implant language outcomes in deaf children with cochlear implants

PURPOSE

This study investigates the relationship between pre-linguistic social communication skills and age of cochlear implant for future language outcomes in a large sample of deaf children.

METHOD

A retrospective cohort study of records from 75 children. Pre-implant data included Age at Implant, pre-linguistic communication (social, symbolic and speech) skills, and non-verbal ability. Receptive and expressive language development data at 1 year, 2 years and 4 years post implant were analysed to investigate the relationships between pre-implant factors and language outcomes, in particular pre-linguistic social communication skills in early and late implanted children.

RESULTS

Age at Implant was the strongest correlate of post implant expressive and receptive language outcomes. The sample was divided into early implanted (<18 month) and late implanted (>18 months) children. In the early implanted group, pre-linguistic social communication skills were the strongest pre-implant correlate of language outcomes four years post-implant. In the late implanted group, there were no significant pre-implant correlates of language outcomes.

CONCLUSIONS

Long term language outcomes after cochlear implantation are the product of a set of communicative, cognitive and environmental factors. Early pre-implant social communication skills are an important consideration for clinicians who guide parents as to likely long-term outcomes post cochlear implantation. Social communication skills are particularly important for children who receive implants before the age of 18 months.

Characterizing North Carolina's Deaf and Hard of Hearing Infants and Toddlers: Predictors of Vocabulary, Diagnosis, and Intervention

PURPOSE

This study sought to (a) characterize the demographic, audiological, and intervention variability in a population of Deaf and Hard of Hearing (DHH) children receiving state services for hearing loss; (b) identify predictors of vocabulary delays; and (c) evaluate factors influencing the success and timing of early identification and intervention efforts at a state level.

METHOD

One hundred DHH infants and toddlers (aged 4-36 months) enrolled in early intervention completed the MacArthur-Bates Communicative Development Inventories, and detailed information about their audiological and clinical history was collected. We examined the influence of demographic, clinical, and audiological factors on vocabulary outcomes and early intervention efforts.

RESULTS

We found that this sample showed spoken language vocabulary delays (production) relative to hearing peers and showed room for improvement in rates of early diagnosis and intervention. These delays in vocabulary and early support services were predicted by an overlapping subset of hearing-, health-, and home-related variables.

CONCLUSIONS

In a diverse sample of DHH children receiving early intervention, we identify variables that predict delays in vocabulary and early support services, which reflected both dimensions that are immutable, and those that clinicians and caretakers can potentially alter. We provide a discussion on the implications for clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19449839.

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model

At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.

Language-Independent Hearing Screening - Increasing the Feasibility of a Hearing Screening Self-Test at School-Entry

A tablet-based language-independent self-test involving the recognition of ecological sounds in background noise, the Sound Ear Check (SEC), was adapted to make it feasible for young children. Two experiments were conducted. The first experiment investigated the SEC's feasibility, as well as its sensitivity and specificity for detecting childhood hearing loss with a monaural adaptive test procedure. In the second experiment, the SEC sounds, noise, and test format were adapted based on the findings of the first experiment. The adaptations were combined with three test procedures, one similar to the one used in Experiment 1, one presenting the sounds dichotically in diotic noise, and one presenting all the sounds with a fixed signal-to-noise ratio and a stopping rule. Results in young children show high sensitivity and specificity to detect different grades of conductive and sensorineural hearing loss (70-90%). When using an adaptive, monaural procedure, the test duration was approximately 6 min, and 17% of the results obtained were unreliable. Adaptive staircase analyses showed that the unreliable results probably occur due to attention/motivation loss. The test duration could be reduced to 3-4 min with adapted test formats without decreasing the test-retest reliability. The unreliable test results could be reduced from 17% to as low as 5%. However, dichotic presentation requires longer training, reducing the dichotic test format's feasibility.

Cost-Effectiveness of Screening Preschool Children for Hearing Loss in Australia

OBJECTIVES

While all newborns in Australia are tested for congenital hearing loss through universal newborn hearing screening programs, some children will acquire hearing loss in their first five years of life. Delayed diagnosed or undiagnosed hearing loss in children can have substantial immediate- and long-term consequences. It can significantly reduce school readiness, language and communication development, social and emotional development, and mental health. It can also compromise lifetime educational achievements and employment opportunities and future economic contribution to society through lost productivity. The need for a universal hearing screening program for children entering their first year of primary school has been noted in two separate Australian Government hearing inquiries in the last decade. Sound Scouts is a hearing screening application (app) that tests for hearing loss in children using a tablet or mobile device, supervised by parents at home. It tests for sensorineural or permanent conductive hearing loss and central auditory processing disorder in children. In 2018 the Australian Government funded the roll-out of Sound Scouts to allow up to 600,000 children to test their hearing using Sound Scouts. This study estimated the cost-effectiveness of screening 5-year-old children for hearing loss using Sound Scouts at home, compared with no screening.

DESIGN

A decision-analytic model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of administering Sound Scouts over a 20-year time horizon. Testing accuracy was based on comparing Sound Scouts test results to clinical test results while other parameters were based on published data. Costs were estimated from the perspective of the Australian health care system. Univariate and probabilistic sensitivity analyses were undertaken.

RESULTS

Sound Scouts is estimated to result in an average incremental cost of A$61.02 and an average incremental increase in QALYs of 0.01. This resulted in an incremental cost-effectiveness ratio of A$5392 per QALY gained, which is likely to be considered cost-effective by Australian decision makers. Screening with Sound Scouts was found to have a 96.2 per cent probability of being cost-effective using a threshold of A$60,000 per QALY gained.

CONCLUSIONS

Using Sound Scouts to screen five-year-old children for hearing loss (at home) is likely to be cost-effective. Screening children using Sound Scouts will result in early identification and intervention in childhood hearing loss, thereby reducing early childhood disadvantage through cumulative gains in quality of life, education, and economic outcomes over their lifetime.

Tracking Home Language Production and Environment in Children Who Are Deaf or Hard of Hearing

OBJECTIVE

To use an automated speech-processing technology to identify patterns in sound environments and language output for deaf or hard-of-hearing infants and toddlers.

STUDY DESIGN

Observational study based on a convenience sample.

SETTING

Home observation conducted by tertiary children's hospital.

METHODS

The system analyzed 115 naturalistic recordings of 28 children <3.5 years old. Hearing ability was stratified into groups by access to sound. Outcomes were compared across hearing groups, and multivariable linear regression was used to test associations.

RESULTS

There was a significant difference in age-adjusted child vocalizations (P = .042), conversational turns (P = .022), and language development scores (P = .05) between hearing groups but no significant difference in adult words (P = .11). Conversational turns were positively associated with each language development measure, while adult words were not. For each hour of electronic media, there were significant reductions in child vocalizations (β = -0.47; 95% CI, -0.71 to -0.19), conversational turns (β = -0.45; 95% CI, -0.65 to -0.22), and language development (β = -0.37; 95% CI, -0.61 to -0.15).

CONCLUSIONS

Conversational turn scores differ among hearing groups and are positively associated with language development outcomes. Electronic media is associated with reduced discernible adult speech, child vocalizations, conversational turns, and language development scores. This effect was larger in children who are deaf or hard of hearing as compared with other reports in typically hearing populations. These findings underscore the need to optimize early language environments and limit electronic noise exposure in children who are deaf or hard of hearing.

Diagnosis and patterns of hearing loss in children with severe developmental delay

INTRODUCTION & OBJECTIVE

Children with cognitive delay often experience challenges with obtaining hearing thresholds through behavioral audiometry (BA). This necessitates sedated Auditory Brainstem Response (sABR) testing. This study aimed to evaluate diagnostic and hearing patterns in children with Down Syndrome (DS), Autism Spectrum Disorder (ASD), Global Developmental delay (GDD), and Cerebral Palsy (CP) who were unable to complete reliable BA testing due to severe cognitive delay.

METHODS

Retrospective chart review on a cohort of children aged 0.5-18 years with a diagnosis of DS, ASD, GDD, or CP who underwent sABR due to unsuccessful BA testing. This was performed at a tertiary care institution from 2014 to 2019. Testing patterns and audiometric data were collected.

RESULTS

Across 15 DS, 39 ASD, 10 GDD, and 11 CP patients, the average time from first nondiagnostic BA to sABR ranged from 8.6 months (in GDD) to 21.8 months (in DS). The average number of BAs performed before sABR ranged from 1.6 (in ASD and GDD) to 2.7 (in DS). Hearing loss (HL) was diagnosed in 10%, 13%, 36% and 46% of patients with GDD, ASD, CP and DS respectively. Up to 75% of the HL was sensorineural (in CP patients).

CONCLUSION

In children with significant cognitive delays, a high incidence of HL (especially SNHL) was identified, therefore high suspicion for HL should be held in these patients. Multiple unsuccessful BAs contribute to prolonged time to diagnosis and treatment, thus prompt sABR should be performed in patients whose severe cognitive delay inhibits reliable testing with BA.

Prevalence of hearing loss in school aged Nepalese children

OBJECTIVES

The main objective of this study is to identify the prevalence of hearing loss in school aged children of Nepal.

METHODS

This cross-sectional study was carried out on school aged children attending the government run schools of Nepal. A total of 79,340 children from grades 1 through 10 were included in the study. After taking brief history about ear diseases and hearing loss, children were screened for ear diseases in their respective classroom by otoscope. Hearing evaluation was carried out by pure tone audiometer and hearing threshold was obtained at 0.5-4 kHz. The results were then documented and analyzed.

RESULTS

The prevalence of hearing impairment in school aged children in Nepal is found to be 5.73% (4551 of 79,340). Conductive hearing loss was the most common type of hearing loss and was observed in 70.47% (n = 3207) of the children.

CONCLUSIONS

This study shows that hearing loss is a common problem in children of Nepal. With the main cause of hearing loss due to preventable conditions such as chronic otitis media, it is believed that early standardized screening, detection and timely management of chronic otitis media in these children can prevent hearing loss and its impact on their educational, social and language development. School based ear health programs are a useful community-oriented solution for prevention of deafness. It shows how important it is to introduce hearing screening for primary school aged children to prevent hearing loss.

Factors Affecting Neonatal Hearing Screening Follow-up in Developing Countries: One Insitution Prospective Pilot Study

Objective

To detect factors related with loss to follow-up (LTF) in neonatal hearing screening (NHS) program of one institution in a developing country.

Methods

A prospective study was planned based on the data collected in a pilot study conducted a year before in the same institution. In this pilot study, hearing screening was performed before hospital discharge for every infant (1217 newborns) in six months period. Total referral rate was 19.1% (223/1217). Loss to follow-up (LTF) was 38.1% (85/223). Telephonic interviews were done with 50 parents who had not come with their child to the second hearing test. For these telephonic interviews the questionnaire with four sections (socio-demographic information; information about pregnancy, birth, and present health condition of the child; caregiver knowledge of neonatal hearing screening, and reasons for default on follow-up) was created.

Results

The mothers participated in this study were 29.1 years (±5.2 SD) of age in average. Place of residence was mostly rural (64%; n=32) with 39.4 Km (±24.8 SD) away from from the rescreen referral center. Their knowledge on neonatal hearing screening, hearing impairment incidence or treatment opportunities was at a very low level. Caregivers’ perceptions that follow-up was unnecessary (50%; n=25), was most frequently given reason for follow-up default, followed by newborns bad health condition (12%; n=6) and forgetting about the follow-up visits (8%; n=6).

Conclusion

The main reason for default in follow-up in our study was caregiver’s poor knowledge about this topic.

Translation and validation of the revised version of the LittlEARS® early speech production questionnaire (LEESPQ®), in Dutch-speaking children with normal hearing

INTRODUCTION

With the introduction of newborn hearing screening, children with different degrees of hearing loss can receive hearing aids and cochlear implants in the early months after birth, which is also the case in the Netherlands and in Flanders, the Dutch speaking part of Belgium.

MATERIALS AND METHODS

This has intensified the need for a validated questionnaire in the Dutch language to assess the speech development of children under the age of two. The LittlEARS Early Speech Production Questionnaire® (LEESPQ®), which was originally developed and validated in German language, was translated and validated into the Dutch language. Questionnaires of 355 normal hearing children were analysed.

RESULTS

Total score was highly correlated with age (r = .775) and a normative curve was created. Internal consistency was reached with a high value of α = 0.870, which indicates that the questionnaire almost exclusively assesses speech production ability. The Dutch version of the LEESPQ®, is reliable, consistent and independent of gender or lingual status. As such, the Dutch LEESPQ®, may be a useful tool for language monitoring for children from birth to 18 months of age.

CONCLUSION

The Dutch LittlEARS Early Speech Production Questionnaire®, was found to be a reliable and valid tool to assess and monitor the early speech and language production skills in children up to 18 months of age.

Validation of a Hearing-Related Quality-of-Life Questionnaire for Parents and Deaf or Hard-of-Hearing Infants and Toddlers

OBJECTIVE

To design and validate a hearing-related quality-of-life questionnaire targeted toward parents and deaf or hard-of-hearing infants and toddlers: the Hearing-Related Infant/Toddler and Parent Quality of Life (HIP-QL) questionnaire.

STUDY DESIGN

Cross-sectional questionnaire and prospective instrument validation.

SETTING

Academic pediatric otolaryngology clinic.

METHODS

A 67-question questionnaire developed from constructs of a grounded theory analysis was administered to parents of 31 deaf or hard-of-hearing children and 14 typically hearing children. Questionnaire construct validity, reliability, and discriminant validity were tested.

RESULTS

Based on exploratory factor analysis, a 32-item construct composed of developmentally appropriate questions was reduced to a 17-item construct with 4 domains addressing quality of life for both child (auditory/communication behavior, temperament) and parent (management, parent-directed factors). Internal consistency measures were appropriate (Cronbach's alpha = 0.65), and test-retest reliability was high (intraclass correlation coefficient = 0.73). Total HIP-QL scores correlated significantly with related total PedsQL scores (r = 0.57, P < .001). As predicted, parents of children who are deaf or hard of hearing reported significantly lower mean HIP-QL scores but not mean PedsQL scores. HIP-QL was more sensitive than PedsQL for predicting case versus control membership (86.7% vs 76.9%). Multivariable regression confirmed a negative relationship between severity of hearing loss and HIP-QL score after controlling for age, sex, income, and maternal education.

CONCLUSIONS

This context-specific questionnaire is the first validated quality-of-life instrument for parents and deaf or hard-of-hearing infants and toddlers. Previously, parental stress and functional disability questionnaires were used as proxies; therefore, this questionnaire has the potential to serve as an important tool for patient- and caregiver-centered outcomes research.

Kindergarten Readiness in Children Who Are Deaf or Hard of Hearing Who Received Early Intervention

BACKGROUND

Children who are deaf or hard of hearing (D/HH) have improved language outcomes when enrolled in early intervention (EI) before the age of 6 months. Little is understood about the long-term impact of EI on outcomes of kindergarten readiness (K-readiness). The study objective was to evaluate the impact of EI before the age of 6 months (early) versus after 6 months (later) on K-readiness in children who are D/HH.

METHODS

In this study, we leveraged data from the Ohio Early Hearing Detection and Intervention Data Linkage Project, which linked records of 1746 infants identified with permanent hearing loss born from 2008 to 2014 across 3 Ohio state agencies; 417 had kindergarten records. The Kindergarten Readiness Assessment was used to identify children as ready for kindergarten; 385 had Kindergarten Readiness Assessment scores available. Multiple logistic regression was used to investigate the relationship between K-readiness and early EI entry while controlling for confounders (eg, hearing loss severity and disability status).

RESULTS

Children who were D/HH and entered EI early (n = 222; 57.7% of the cohort) were more likely to demonstrate K-readiness compared with children who entered EI later (33.8% vs 20.9%; P = .005). Children who entered early had similar levels of K-readiness as all Ohio students (39.9%). After controlling for confounders, children who entered EI early were more likely to be ready for kindergarten compared with children who entered later (odds ratio: 2.02; 95% confidence interval 1.18-3.45).

CONCLUSIONS

These findings support the sustained effects of early EI services on early educational outcomes among children who are D/HH. EI entry before the age of 6 months may establish healthy trajectories of early childhood development, reducing the risk for later academic struggles.

How do Italian-speaking children handle wh-questions? A comparison between children with hearing loss and children with normal hearing

In this paper, we analyse how Italian-speaking children with cochlear implants produce subject and object questions introduced by who and which+NP. The aim of the study is to analyse whether a correlation exists between the accuracy of the responses of an elicitation task of wh-questions and clinical variables (i.e. age of hearing aid fitting; age of cochlear implantation; duration of hearing experience) in a group of children with cochlear implants, in order to provide new evidences in support of the efficacy of early intervention in Italian-speaking children with hearing loss. The experimental group was composed of 10 children fitted with a cochlear implant, who were diagnosed and promptly fitted with hearing aids within the first year of life. All these participants received a cochlear implant when hearing aids did not provide enough auditory input anymore. Indeed, while the hearing aids only amplify sounds, cochlear implants directly stimulate the auditory nerve providing better auditory perception. Results were compared with those of two control groups. The first group was composed of 10 children with normal hearing and comparable chronological age, while the second group was composed of 10 children with normal hearing matched on comparable hearing experience. Children were assessed with a test for the elicitation of subject and object who and which+NP questions. Results show that the two control groups performed better than the experimental group. Moreover, some correlations were found between the accuracy of the production of complex structures and the age of fitting of the hearing aids and the hearing experience.

Oral Language Performance of Deaf and Hard-of-Hearing Students in Mainstream Schools

In Hong Kong, students are expected to speak fluent Cantonese, Putonghua, and English. However, the curriculum does not include Cantonese studies, as children are expected to have already acquired Cantonese by the age of school entry. This study examined the language outcomes of Cantonese-speaking deaf or hard-of-hearing children who attend primary schools within the Hong Kong educational system and considered whether the system currently meets the needs of these children. The Hong Kong Cantonese Oral Language Assessment Scale, which comprises six subtests, was used to assess 98 children with mild to profound hearing loss. A regression analysis was used to examine the influences of various variables on oral language performance in these children. Notably, 41% of the participants had achieved age-appropriate oral language skills, while 18% and 41% exhibited mild-to-moderate or severe oral language impairment, respectively. The degree of hearing loss and the use of speech therapy were identified as significant negative predictors of oral language performance. The issues of a relatively late diagnosis and device fitting, as well as the very poor oral language outcomes, strongly emphasize the need for policy makers to reconsider the existing educational approaches and support for deaf or hard-of-hearing children.

Predictors of Vocabulary Outcomes in Children Who Are Deaf or Hard of Hearing From Spanish-Speaking Families

Purpose

The goal of this study was to identify predictors of expressive vocabulary in young Spanish-speaking children who are deaf or hard of hearing living in the United States.

Method

This cross-sectional study considered 53 children with bilateral hearing loss between 8 and 34 months of age ( M = 24, SD = 6.9). Demographic variables, variables related to the hearing loss, and intervention variables were included in a hierarchical regression analysis to predict expressive vocabulary quotients from the MacArthur Inventario del Desarrollo de Habilidades Comunicativas (Communicative Development Inventories; Jackson-Maldonado et al., 2003 ).

Results

Chronological age, degree of hearing loss, functional hearing ability ratings, age of enrollment in early intervention, and the interaction between chronological age and age of intervention accounted for 61.5% of the vocabulary variance. Children who received intervention by 6 months of age achieved significantly higher vocabulary outcomes than children who started intervention later.

Conclusion

The children's mean vocabulary outcomes were below average when compared with hearing peers. This was especially true for older children, children with moderately-severe-to-profound hearing loss, and children who began intervention after 6 months of age. This delay in vocabulary outcomes has the potential to interfere with future reading and academic outcomes.

Societal costs of permanent childhood hearing loss at teen age: a cross-sectional cohort follow-up study of universal newborn hearing screening

OBJECTIVE

To investigate the effects in adolescence of bilateral permanent childhood hearing loss (PCHL) > 40 dB and of exposure to universal newborn hearing screening (UNHS) on societal costs accrued over the preceding 12 months.

DESIGN SETTING PARTICIPANTS

An observational cohort study of a sample of 110 adolescents aged 13-20 years, 73 with PCHL and 37 in a normally hearing comparison group (HCG) closely similar in respect of place and date of birth to those with PCHL, drawn from a 1992-1997 cohort of 157 000 births in Southern England, half of whom had been exposed to a UNHS programme.

INTERVENTION

Birth in periods with and without UNHS.

OUTCOME MEASURES

Resource use and costs in the preceding 12-month period, estimated from interview at a mean age of 16.9 years and review of medical records. Effects on costs were examined in regression models.

RESULTS

Mean total costs for participants with PCHL and the HCG were £15 914 and £5883, respectively (difference £10 031, 95% CI £6460 to £13 603), primarily driven by a difference in educational costs. Compared with the HCG, additional mean costs associated with PCHL of moderate, severe and profound severity were £5916, £6605 and £18 437, respectively. The presence of PCHL and an additional medical condition (AMC) increased costs by £15 385 (95% CI £8532 to £22 238). An increase of one unit in receptive language z-score was associated with £1616 (95% CI £842 to £2389) lower costs. Birth during periods of UNHS was not associated with significantly lower overall costs (difference £3594, 95% CI -£2918 to £10 106).

CONCLUSIONS

The societal cost of PCHL was greater with more severe losses and in the presence of AMC and was lower in children with superior language scores. There was no statistically significant reduction in costs associated with birth in periods with UNHS.

TRIAL REGISTRATION NUMBER

ISRCTN03307358, pre-results.

Everyday Stressors in Deaf and Hard of Hearing Adolescents: The Role of Coping and Pragmatics

The current mixed-methods study examined everyday problems among deaf and hard of hearing (DHH) adolescents across various life domains. To better understand the factors influencing levels of perceived stress, the impact of DHH adolescents' coping and pragmatic abilities was also examined. Thirty DHH adolescents completed questionnaires about everyday stressors and coping, and 13 of these respondents were interviewed regarding their everyday problems. All participants used spoken language and attended mainstream high schools. Teachers evaluated the pragmatic skills of each participant through a communication assessment tool. The quantitative-based results showed that DHH adolescents perceived greatest stress related to the future, peers, and school, in that order. Considerably less stress was experienced with regard to parents, leisure, and romantic relationships. The qualitative data reflected the context-specific everyday stressors experienced by DHH adolescents and suggested they have been generated by problems related to having a hearing loss, experiences in social interactions, classroom environment, and academic challenges. Importantly, lower pragmatic abilities and increased level of withdrawal coping style were found to be associated with higher perceived stress. The conclusions focused on ways in which schools, teachers, and professionals can implement prevention and intervention efforts to adequately support DHH adolescents in facing everyday challenges.

Unique Approach to Dental Management of Children with Hearing Impairment

The number of deaf children has dramatically increased in the past few decades. These children present to the pediatric dentist a unique set of challenges mostly pertaining to the establishment of communication with them. There have been very few attempts in the past to break down these challenges and formulate a strategy on how to manage them effectively. This is a case report of a child who was successfully managed using two different modes of communication. Finally, the advantages and disadvantages are mentioned, and a common strategy incorporating the positives of both the methods has been devised.

Hearing loss and speech perception in noise difficulties in Fanconi anemia

OBJECTIVES/HYPOTHESIS

Fanconi anemia is a hereditary chromosomal instability disorder. Hearing loss and ear abnormalities are among the many manifestations reported in this disorder. In addition, Fanconi anemia patients often complain about hearing difficulties in situations with background noise (speech perception in noise difficulties). Our study aimed to describe the prevalence of hearing loss and speech perception in noise difficulties in Dutch Fanconi anemia patients.

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective chart review was conducted at a Dutch tertiary care center. All patients with Fanconi anemia at clinical follow-up in our hospital were included. Medical files were reviewed to collect data on hearing loss and speech perception in noise difficulties.

RESULTS

In total, 49 Fanconi anemia patients were included. Audiograms were available in 29 patients and showed hearing loss in 16 patients (55%). Conductive hearing loss was present in 24.1%, sensorineural in 20.7%, and mixed in 10.3%. A speech in noise test was performed in 17 patients; speech perception in noise was subnormal in nine patients (52.9%) and abnormal in two patients (11.7%).

CONCLUSIONS

Hearing loss and speech perception in noise abnormalities are common in Fanconi anemia. Therefore, pure tone audiograms and speech in noise tests should be performed, preferably already at a young age, because hearing aids or assistive listening devices could be very valuable in developing language and communication skills.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:2358-2361, 2017.

The Transition From Early Intervention to School for Children Who Are Deaf or Hard of Hearing: Administrator Perspectives

Although the transition from early intervention (EI) to school is a significant milestone in the lives of young children, little research to date has investigated this transition among children who are deaf or hard of hearing (D/HH). The aims of this study were to investigate the organizational policies, procedures, and guidelines that facilitate or hinder the transition from the EI system to the school system for children who are D/HH from the perspective of program administrators. Using the Enhanced Critical Incident Technique methodology, 146 incidents were extracted from 10 interviews and sorted into 10 helping, 9 hindering, and 5 wish list categories. Findings are consistent with the Ecological and Dynamic Model of Transition (Rimm-Kaufman & Pianta, 2000), which conceptualizes the transition to school as being influenced by the pattern of interactions between the individuals, groups, and institutions connected to the child.

Language and hearing outcomes of preterm infants

Multiple factors including degree of prematurity, neonatal morbidities, illness severity, hearing status, gender, language environment in the neonatal intensive care unit and in the home, maternal education level, social and environmental status of the family, and access to early intervention all contribute to the language outcomes of extremely preterm infants with and without hearing loss. Early screening, early diagnosis, and early intervention services by 6 months of age are necessary to optimize the language outcomes of preterm infants with permanent hearing loss. There is increasing evidence of the potential for improved language skills with increasing age of extreme preterm infants and infants with hearing loss.

Longitudinal Predictors of Aided Speech Audibility in Infants and Children

OBJECTIVES

Amplification is a core component of early intervention for children who are hard of hearing, but hearing aids (HAs) have unique effects that may be independent from other components of the early intervention process, such as caregiver training or speech and language intervention. The specific effects of amplification are rarely described in studies of developmental outcomes. The primary purpose of this article is to quantify aided speech audibility during the early childhood years and examine the factors that influence audibility with amplification for children in the Outcomes of Children with Hearing Loss study.

DESIGN

Participants were 288 children with permanent hearing loss who were followed as part of the Outcomes of Children with Hearing Loss study. All of the children in this analysis had bilateral hearing loss and wore air-conduction behind-the-ear HAs. At every study visit, hearing thresholds were measured using developmentally appropriate behavioral methods. Data were obtained for a total of 1043 audiometric evaluations across all subjects for the first four study visits. In addition, the aided audibility of speech through the HA was assessed using probe microphone measures. Hearing thresholds and aided audibility were analyzed. Repeated-measures analyses of variance were conducted to determine whether patterns of thresholds and aided audibility were significantly different between ears (left versus right) or across the first four study visits. Furthermore, a cluster analysis was performed based on the aided audibility at entry into the study, aided audibility at the child's final visit, and change in aided audibility between these two intervals to determine whether there were different patterns of longitudinal aided audibility within the sample.

RESULTS

Eighty-four percent of children in the study had stable audiometric thresholds during the study, defined as threshold changes <10 dB for any single study visit. There were no significant differences in hearing thresholds, aided audibility, or deviation of the HA fitting from prescriptive targets between ears or across test intervals for the first four visits. Approximately 35% of the children in the study had aided audibility that was below the average for the normative range for the Speech Intelligibility Index based on degree of hearing loss. The cluster analysis of longitudinal aided audibility revealed three distinct groups of children: a group with consistently high aided audibility throughout the study, a group with decreasing audibility during the study, and a group with consistently low aided audibility.

CONCLUSIONS

The current results indicated that approximately 65% of children in the study had adequate aided audibility of speech and stable hearing during the study period. Limited audibility was associated with greater degrees of hearing loss and larger deviations from prescriptive targets. Studies of developmental outcomes will help to determine how aided audibility is necessary to affect developmental outcomes in children who are hard of hearing.

The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study

OBJECTIVE

To determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8 years persist through the second decade.

DESIGN

Prospective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17 years since birth in periods with (or without) UNHS.

SETTING

Birth cohort of 100 000 in southern England.

PARTICIPANTS

114 teenagers aged 13-19 years, 76 with PCHI and 38 with normal hearing. All had previously their reading assessed aged 6-10 years.

INTERVENTIONS

Birth in periods with and without UNHS; confirmation of PCHI before and after age 9 months.

MAIN OUTCOME MEASURE

Reading comprehension ability. Regression modelling took account of severity of hearing loss, non-verbal ability, maternal education and main language.

RESULTS

Confirmation of PCHI by age 9 months was associated with significantly higher mean z-scores for reading comprehension (adjusted mean difference 1.17, 95% CI 0.36 to 1.97) although birth during periods with UNHS was not (adjusted mean difference 0.15, 95% CI -0.75 to 1.06). The gap between the reading comprehension z-scores of teenagers with early compared with late confirmed PCHI had widened at an adjusted mean rate of 0.06 per year (95% CI -0.02 to 0.13) during the 9.2-year mean interval since the previous assessment.

CONCLUSIONS

The benefit to reading comprehension of confirmation of PCHI by age 9 months increases during the teenage years. This strengthens the case for UNHS programmes that lead to early confirmation of permanent hearing loss.

TRIAL REGISTRATION NUMBER

ISRCTN03307358.

Factors Affecting Early Services for Children Who Are Hard of Hearing

PURPOSE

To describe factors affecting early intervention (EI) for children who are hard of hearing, we analyzed (a) service setting(s) and the relationship of setting to families' frequency of participation, and (b) provider preparation, caseload composition, and experience in relation to comfort with skills that support spoken language for children who are deaf and hard of hearing (CDHH).

METHOD

Participants included 122 EI professionals who completed an online questionnaire annually and 131 parents who participated in annual telephone interviews.

RESULTS

Most families received EI in the home. Family participation in this setting was significantly higher than in services provided elsewhere. EI professionals were primarily teachers of CDHH or speech-language pathologists. Caseload composition was correlated moderately to strongly with most provider comfort levels. Level of preparation to support spoken language weakly to moderately correlated with provider comfort with 18 specific skills.

CONCLUSIONS

Results suggest family involvement is highest when EI is home-based, which supports the need for EI in the home whenever possible. Access to hands-on experience with this population, reflected in a high percentage of CDHH on providers' current caseloads, contributed to professional comfort. Specialized preparation made a modest contribution to comfort level.

Translation into British Sign Language and validation of the Strengths and Difficulties Questionnaire

Background

There are an estimated 125,000 deaf people in the UK who use British Sign Language (BSL) as their main form of communication, but there are no child mental health screening instruments that are accessible to deaf children whose first or main language is BSL (or to deaf adults reporting on children). This study sought to develop a new BSL translation of a commonly used mental health screening tool (Strengths and Difficulties Questionnaire, SDQ), with versions available for deaf young people (aged 11–16 years), parents and teachers. The psychometric properties of this translation, and its validity for use with the deaf signing UK population, were also investigated.

Objectives

(1) To translate the SDQ into BSL; and (2) to use this new version with a cohort of deaf children, deaf parents and deaf teachers fluent in BSL across England, and validate it against a ‘gold standard’ clinical interview.

Methods

This study was split into two broad phases: translation and validation. The BSL SDQ was developed using a rigorous translation/back-translation methodology with additional checks, and we have defined high-quality standards for the translation of written/oral to visual languages. We compared all three versions of the SDQ (deaf parent, deaf teacher and deaf young person) with a gold standard clinical interview by child mental health clinicians experienced in working with deaf children. We also carried out a range of reliability and validity checks.

Results

The SDQ was successfully translated using a careful methodology that took into account the linguistic and cultural aspects of translating a written/verbal language to a visual one. We recruited 144 deaf young people (aged 11–16 years), 191 deaf parents of a child aged either 4–10 or 11–16 years (the child could be hearing or deaf) and 77 deaf teachers and teaching assistants. We sought deaf people whose main or preferred language was BSL. We also recruited hearing participants to aid cross-validation. We found that the test–retest reliability, factor analysis and internal consistency of the three new scales were broadly similar to those of other translated versions of the SDQ. We also found that using the established multi-informant SDQ scoring algorithm there was good sensitivity (76%) and specificity (73%) against the gold standard clinical interview assessment. The SDQ was successfully validated and can now be used in clinical practice and research. Factor analysis suggests that the instrument is good for screening for mental health problems but not for the identification of specific disorders, and so should be used as a screening instrument. It will also enable outcomes to be monitored.

Conclusions

A BSL version of the SDQ can now be used for national studies screening for mental health problems in deaf children. This will help us better understand the needs of deaf children and will enable earlier detection of mental health difficulties. It can also be used within clinical settings to monitor outcomes.

Future work

Future work may focus on using the SDQ in epidemiological research, and developing new assessment instruments for deaf children to improve assessment methods in the deaf population.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

National survey of paediatric audiological services for diagnosis and intervention in the South African private health care sector

OBJECTIVE

A national survey of early hearing detection and intervention services was undertaken to describe the current status of diagnostic and intervention services in the South African private health care sector.

METHODS

All private hospitals with obstetric units (n = 166) were surveyed telephonically. The data was integrated with data collected from self-administered questionnaires subsequently distributed nationally to private audiology practices providing hearing screening at the respective hospitals reporting hearing screening services (n = 87). Data was analysed descriptively to yield national percentages and frequency distributions.

RESULTS

Average reported age at diagnosis was 11 months. Most participants (74%) indicated that less than 20% of infants fitted with hearing aids received amplification before the age of 6 months. Most (64%) participants indicated that the average period between confirmed diagnosis and hearing aid fitting was 1 month, on par with international benchmarks. Only 16%-23% of participants included all diagnostic procedures recommended by the Health Professions Council of South Africa's 2007 position statement for minimum diagnostic test batteries for infants and young children.

CONCLUSIONS

Diagnosis of hearing loss, hearing aid fitting and audiological intervention is delayed significantly in the South African private health care sector. Improved services should include integrated systematic hospital-based screening as part of birthing packages with diagnostic referral to specialist paediatric audiologists for accurate assessment and management of patients in a timely manner.

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.

Observation of permeability of blood-labyrinth barrier during cytomegalovirus-induced hearing loss

OBJECTIVE

Congenital cytomegalovirus (CMV) infection is the most common infectious cause of sensorineural hearing loss in children. This study aims to investigate the pathogenesis CMV-induced hearing loss from the view of integrity of blood-labyrinth-barrier (BLB).

METHODS

Newborn BALB/c mice were randomly divided into three groups (n=22, respectively): CMV group, control group and normal group. The CMV group and control group were intracerebrally injected with equal volume (15 μl) of murine CMV (MCMV; 10(4)IU/0.1 ml) and PBS, respectively, and normal group did not receive any treatment. After three weeks, auditory-evoked brainstem response was assessed, and permeability of BLB was evaluated by Evans blue method. Means between groups were compared using t-test.

RESULTS

We observed that mice injected with MCMV had a hearing loss and it was connected with the permeability changes of BLB. Besides, using hematoxylin-eosin staining, we noticed hyperaemia in stria vascularis and spiral ligament and bleeding in scala vestibule and scala tympani in CMV group.

CONCLUSION

All these data indicated the possible association between CMV-induced hearing loss and BLB dysfunction with the characteristics of inflammation. Our data provide a possible path to investigate the mechanism of CMV-induced hearing damage.

Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study

OBJECTIVE

To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment.

DESIGN

All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes.

RESULTS

Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age.

CONCLUSIONS

Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.

Speech and language outcomes of very preterm infants

Speech and language impairments of both simple and complex language functions are common among former preterm infants. Risk factors include lower gestational age and increasing illness severity including severe brain injury. Even in the absence of brain injury, however, altered brain maturation and vulnerability imposed by premature entrance to the extrauterine environment is associated with brain structural and microstructural changes. These alterations are associated with language impairments with lasting effects in childhood and adolescence and increased needs for speech therapy and education supports. Studies are needed to investigate language interventions which begin in the neonatal intensive care unit.

Auditory-verbal therapy for promoting spoken language development in children with permanent hearing impairments

BACKGROUND

Congenital or early-acquired hearing impairment poses a major barrier to the development of spoken language and communication. Early detection and effective (re)habilitative interventions are essential for parents and families who wish their children to achieve age-appropriate spoken language. Auditory-verbal therapy (AVT) is a (re)habilitative approach aimed at children with hearing impairments. AVT comprises intensive early intervention therapy sessions with a focus on audition, technological management and involvement of the child's caregivers in therapy sessions; it is typically the only therapy approach used to specifically promote avoidance or exclusion of non-auditory facial communication. The primary goal of AVT is to achieve age-appropriate spoken language and for this to be used as the primary or sole method of communication. AVT programmes are expanding throughout the world; however, little evidence can be found on the effectiveness of the intervention.

OBJECTIVES

To assess the effectiveness of auditory-verbal therapy (AVT) in developing receptive and expressive spoken language in children who are hearing impaired.

SEARCH METHODS

CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, speechBITE and eight other databases were searched in March 2013. We also searched two trials registers and three theses repositories, checked reference lists and contacted study authors to identify additional studies.

SELECTION CRITERIA

The review considered prospective randomised controlled trials (RCTs) and quasi-randomised studies of children (birth to 18 years) with a significant (≥ 40 dBHL) permanent (congenital or early-acquired) hearing impairment, undergoing a programme of auditory-verbal therapy, administered by a certified auditory-verbal therapist for a period of at least six months. Comparison groups considered for inclusion were waiting list and treatment as usual controls.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed titles and abstracts identified from the searches and obtained full-text versions of all potentially relevant articles. Articles were independently assessed by two review authors for design and risk of bias. In addition to outcome data, a range of variables related to participant groups and outcomes were documented.

MAIN RESULTS

Of 2233 titles and abstracts searched, only 13 abstracts appeared to meet inclusion criteria. All 13 full-text articles were excluded following independent evaluation by two review authors (CGBJ and JW), as they did not meet the inclusion criteria related to the research design. Thus, no studies are included in this review.

AUTHORS' CONCLUSIONS

This review confirms the lack of well-controlled studies addressing the use of AVT as an intervention for promoting spoken language development in children with permanent hearing impairments. Whilst lack of evidence does not necessarily imply lack of effect, it is at present not possible for conclusions to be drawn as to the effectiveness of this intervention in treating children with permanent hearing impairments.

The importance of language in the home for school-age children with permanent hearing loss

AIM

To determine the characteristics of the natural spoken language environment associated with better language skills at school age of children with permanent hearing loss (HL) screened in a newborn hearing screen programme.

METHODS

A language processor recorded language environment including child vocalisations (CVs), conversational turns (CTs), adult word count (AWC), percentage of language and percentage of silence in 23 children with HL and 41 hearing controls. Relationships of language environment scores with Reynell language scores were analysed.

RESULTS

Children with HL had significantly lower Reynell comprehension scores (15-25 points; p = 0.0001) and expressive scores (7-12 points; NS) than hearing children. In regression analyses for the children with HL, after adjusting for age of entry to early intervention and stay in a NICU, every increase in ten percentage points of language in the home was associated with 7.2 points higher comprehension score (p = 0.027) and 9.99 points higher expressive score (p = 0.006). After adjusting for nonverbal intelligence, similar independent effects of the language environment on both comprehension (p = 0.027) and expressive scores (p = 0.006) were identified.

CONCLUSION

A rich language environment in the home is associated with better language abilities, which are necessary for academic success for children with permanent HL at school age.

Assessing language and language environment of high-risk infants and children: a new approach

Language delays are common among premature infants and children with hearing loss. There are multiple tools and reports for assessing language in young children. Assessing early language and providing intervention is key to improving outcomes.

CONCLUSION

We conclude that utilization of a new tool, Language Environment Analysis digital language processor (LENA™), to assess the natural language environment of high-risk infants and children in a variety of settings including the neonatal intensive care unit and home, provides the opportunity to access and identify key features of the early language environment.

Universal newborn hearing screening in Zefat, Israel: the first two years

OBJECTIVE

Unidentified hearing loss at birth can adversely affect speech and language development as well as academic achievement and social-emotional development. Historically, moderate-to-severe hearing loss in young children was not detected until well beyond the newborn period. Around 0.5 to 5 in every 1000 neonates and infants have congenital or early childhood onset sensorineural hearing impairment. When identification and intervention occur at no later than 6 months of age, the infants perform much higher on school-related measures. Therefore, early detection is vitally important. Toward the end of 2009, the Israeli ministry of health issued a directive establishing a universal newborn hearing screening program in all hospitals in the country from 01.01.10. The objectives of this study are to evaluate a newly established universal newborn hearing screening program, to assess performance and to compare measurements of performance to performance benchmarks representing a consensus of expert opinion. The benchmarks are the minimal requirements that should be attained by high-quality early hearing detection programs.

METHODS

As specified by the ministry of health, a two-stage screening protocol was implemented using otoacoustic emissions and automated auditory brainstem response. Screening results of all neonates born from the initiation of the program on 15th March 2010 until the end of 2011 were reviewed.

RESULTS

The total number of live births during the study period was 5496. Of these, 5334 (97%) started screening for hearing loss but only 5212 completed the screening process, giving a screening coverage of 94.8%. Of the 5212 neonates completing the screening process, 270 (5.18%) were referred for full diagnostic testing.

CONCLUSIONS

The newly established universal newborn hearing screening program at the Ziv Medical Center in Zefat closely approaches, but does not yet meet the minimal requirements that should be attained by high-quality early hearing detection programs. Every effort should be made to complete the screening tests before discharge from hospital. Screening staff should actively encourage parents to participate in all stages of early detection.

Language ability in the intermediate-scoring group of hearing-impaired children

OBJECTIVES

Language development is a key issue in hearing-impaired children. However, interpersonal differences complicate our understanding of the situation. The bimodal or trimodal distribution of language scores in our other reports in this publication imply the presence of fundamental differences among these groups. The characteristic aspects of each group were profiled according to language data.

METHODS

We divided 268 children with prelingual severe to profound hearing impairment into 3 groups according to their trimodal distribution observed on histogram-based analysis of their responses to the Test of Question-Answer Interaction Development. Test results in several language domains, including productive and comprehensive vocabulary, productive and comprehensive syntax, and academic achievement, were profiled and compared among these 3 groups.

RESULTS

Significant differences were observed in the results of the Word Fluency Test, the Picture Vocabulary Test-Revised, and the Syntax Test of Aphasia among the 3 groups. No significant difference was observed between groups who were lower-scoring and intermediate-scoring on the academic achievement tests referred to as Criterion Referenced Test-II and the Standardized Comprehension Test for Abstract Words. Only the higher-scoring group showed excellent results. The demographic factors were not significantly different among the 3 groups.

CONCLUSIONS

Relatively poor academic achievement despite fair language production was the dominant feature of the intermediate-scoring group. This profile might correlate with academic failure in school.

Language outcomes and service provision of preschool children with congenital hearing loss

BACKGROUND

Children with congenital hearing loss (HL) are at increased risk of speech and language delays and require increased resource needs.

METHODS

Assessments of language, adaptive behavior, and resource needs at mean age of 60±5 months. Effects of age of enrollment in Early Intervention (EI) and degree of HL were evaluated.

RESULTS

Children with HL had lower Reynell verbal comprehension scores (77.6±18 versus 94.8±15; p=0.0001) and expressive language scores (85.9±19 versus 97.4±15; p=0.0051) than hearing children. Children with HL enrolled in EI ≤3 months versus >3 months had higher verbal comprehension (86.6±21 versus 70.3±12; p=0.0143) and expressive language scores (92.1±12 versus 80.5±21; p=0.0601), respectively. Children with bilateral moderate to profound HL and children with unilateral or bilateral mild HL were more likely to have low verbal comprehension scores versus children with hearing (75.8±17 and 81.0±22 versus 94.8±15; p=0.001), and receive more special educational services (100% and 100% versus 42%) respectively. After adjusting for degree of HL and Vineland adaptive scores <70, entry to EI ≤3 months was associated with a 13.8 point higher verbal comprehension score (p=0.047) for children with HL. The model accounted for 26% of variance.

CONCLUSIONS

Persistent beneficial effects of early age of entry to EI on verbal comprehension scores are observed for children with congenital HL at preschool age. Children with HL continue to need comprehensive education services.

Pediatric primary care physicians' practices regarding newborn hearing screening

OBJECTIVE

Approximately 2 to 3 out of 1000 infants are born with hearing loss in the United States each year. Pediatric primary care physicians (PCPs) can play an important role in ensuring that infants with hearing loss are identified early and provided appropriate services. In this study, pediatric PCPs were surveyed about their practices regarding early hearing detection and intervention.

METHODS

Responses from the 2008 DocStyles survey were used to examine patient, physician, and practice variables associated with actions consistent with the 2007 Joint Committee on Infant Hearing position statement, which includes follow-up protocols for medical home providers.

RESULTS

Pediatricians working in a group setting were more likely to receive hearing screening results than were those in individual practices or hospitals and clinics. Family/general physicians with heavier caseloads were more likely to receive hearing screening results for their pediatric patients than were those with lighter caseloads. Few pediatric PCPs reported contacting their state's early hearing detection and intervention program if they knew that an infant failed the newborn hearing screening. Although high proportions of pediatric PCPs reported referring an infant with hearing loss to an otolaryngologist, only about half reported referring a child with risk factors for hearing loss for audiological and speech-language assessment, even if the parents expressed concern or if the results of a developmental screening indicated a possible delay. Few respondents reported referring an infant with hearing loss under their care to an ophthalmologist.

CONCLUSIONS

This study highlights the need to improve infrastructure for pediatric PCPs to receive and request infant hearing screening results to facilitate reporting and coordinate follow-up services for infants identified with hearing loss.

Hearing impairment in otitis media with effusion: a cross-sectional study based in Pokhara, Nepal

OBJECTIVE

Otitis media with effusion (OME) is a major cause of childhood hearing impairment (HI) in the developing world, but its prevalence has never been quantified in Nepal. This study therefore set out to determine the proportion of cases of OME complicated by HI and to identify associated factors.

METHODS

This was a cross-sectional prevalence survey carried out in rural, urban and Tibetan schools in and around Pokhara, Nepal. HI was the primary outcome, and was defined as a middle-frequency pure tone average >25 dB on audiological testing. The study population was defined as children aged four years and older, attending primary school and with a diagnosis of OME.

RESULTS

One hundred and eleven schoolchildren with a combined total of 172 ears affected by OME underwent audiometric assessment. HI was most prevalent in the rural Nepali population; 27% (95%CIs 18-38%) had HI, with a mean hearing loss of 22 dB (15-25 dB). In the Tibetan population, 16% (8-29%) had HI, with a mean loss of 17 dB (12-22 dB). The urban Nepali population had the least HI; 4% (1-13%) were affected, with a mean loss of 16 dB (15-19 dB). The difference in prevalence between the urban and rural Nepali populations was statistically significant (p>0.05). Logistic regression analysis did not identify any associated factors.

CONCLUSIONS

HI is a common complication of OME in Nepal. There is hitherto-unreported variation between populations in the number of cases of OME complicated by HI. This study identified higher rates of morbidity amongst rural populations but was unable to identify associated factors.

The effect of early confirmation of hearing loss on the behaviour in middle childhood of children with bilateral hearing impairment

AIM

To determine if the benefit of early confirmation of permanent childhood hearing impairment (PCHI) on children's receptive language development is associated with fewer behavioural problems.

METHOD

Follow-up of a total population cohort of 120 children with PCHI of moderate or greater severity (≥ 40 decibels relative to hearing threshold level) (67 males, 53 females; mean age 7 y 11 mo, range 5 y 5 mo-11 y 8 mo) and 63 hearing children (37 males, 26 females; mean age 8 y 1 mo, range 6 y 4 mo-9 y 10 mo). The main outcome measures were the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents and the Vineland Adaptive Behaviour Scales (VABS) which are completed on the basis of a parental interview.

RESULTS

Children with PCHI had lower standard scores than hearing children on the Daily Living Skills (p=0.001) and the Socialisation (p=0.001) scales of the VABS. They had significantly higher Total Behaviour Problem scores on the parent-rated (p=0.002) and teacher-rated SDQ (p=0.03). Children for whom PCHI was confirmed by 9 months did not have significantly fewer problems on the behavioural measures than those confirmed after that age (p=0.635 and p=0.196).

INTERPRETATION

Early confirmation has a beneficial effect on receptive language development but no significant impact in reducing behavioural problems in children with PCHI.

Early onset of family centred intervention predicts language outcomes in children with hearing loss

OBJECTIVE

To investigate the impact of age at diagnosis and age at onset of intervention on language outcomes in children with hearing impairments.

METHODS

Receptive and expressive language outcomes of a sample of 63 children (mean age 5;1 years) with hearing loss (mean 78dB, SD 25.3) enrolled in the only specific early intervention program in Upper Austria were assessed. The sample can be regarded as representative for children with significant hearing loss. For 89% the hearing loss was congenital. Language results were related to age at diagnosis, age at first fitting of hearing aids and age at enrolment in the intervention program. Confounding variables such as IQ, degree of hearing loss and family parameters were controlled for in regression analyses.

RESULTS

Early commencement of family centred intervention had a significant impact on language outcomes as opposed to age at diagnosis and age at fitting of hearing aids.

CONCLUSION

In managing intervention in children with hearing loss, time between diagnosis and onset of early intervention should be kept as short as possible. However, age of entry to early intervention explained only about 4% of the variance in language outcomes.

Narrative skills following early confirmation of permanent childhood hearing impairment

AIM

the aim of this study was to compare spoken language production in children with permanent childhood hearing impairment (PCHI) whose PCHI was confirmed either early or late.

METHOD

audio-taped spoken narrative was assessed for syntax, phonology, morphology, and narrative in transcripts from a population-based sample of 89 children (49 males, 40 females; age mean age 7y 7mo, SD1y 1mo, range 6y 6mo-10y 9mo) with bilateral PCHI (≥ 40dB hearing loss) and a comparison group of 63 children (37 males, 26 females; mean age 8y 1mo; SD 1y) with normal hearing. Of the 89 children with PCHI, 41 (21 males, 20 females) had their hearing impairment confirmed by the age of 9 months. All children with PCHI were tested with hearing aids in place, including 16 with cochlear implants. The group of children whose PCHI had been confirmed by age 9 months was compared with the group with later confirmation of PCHI using regression models on the outcome measures.

RESULTS

compared with those with late-confirmed PCHI, children with early-confirmed PCHI used significantly more sentences (mean difference 2.7; 95% confidence interval [CI] 0.49-5.24; p=0.019) and categories of high-pitched morphological markers (mean difference 6.64; 95% CI 1.96-11.31; p=0.006). The number of categories of low-pitched morphological markers, phonological simplifications, and sentences with multiple clauses did not differ between groups. The odds ratios (95% CI) of superior narrative structure and narrative content in children whose PCHI was confirmed early were 3.03 (1.09-8.46; p=0.034) and 4.43 (1.52-12.89; p=0.006) respectively.

INTERPRETATION

early confirmation compared with late confirmation of PCHI was associated with benefit to narrative skills and to certain expressive aspects of syntax and morphology, but not expressive phonology.

Hearing impairment and poverty: the epidemiology of ear disease in Peruvian schoolchildren

OBJECTIVES

1) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2) To identify risk factors for HI and assess its impact on academic performance.

STUDY DESIGN

Cross-sectional.

SETTING

Elementary schools in an asentimiento humano (shantytown) near Lima, Peru, October 2008 to March 2009.

SUBJECTS

Schoolchildren (n = 335), ages six to 19 years.

METHODS

Audiological health was assessed with pure-tone audiometry, tympanometry, and otoscopy. The primary outcome was HI, defined as average threshold >25 dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for chi(2) values and odds ratios (ORs), and multivariate logistic regression.

RESULTS

HI prevalence: 6.9 percent (95% confidence interval [CI] 4.2%-9.6%). Risk factors for HI (OR, 95% CI, P value): neonatal jaundice (5.59, 1.63-19.2, 0.015), seizure (7.31, 2.50-21.4, 0.0013), hospitalization (4.01, 1.66-9.68, 0.003), recurrent otitis media (5.06, 1.98-12.9, 0.002), past otorrhea (4.70, 1.84-12.0, 0.003), family history of HI at <35 years (2.91, 1.19-7.14, 0.026), tympanic membrane abnormality (13.8, 4.48-42.7, <0.001), cerumen impaction (15.8, 4.71-53.1, <0.001), and eustachian tube dysfunction (4.87, 1.74-13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15-9.82, 0.03).

CONCLUSIONS

Impoverished Peruvian schoolchildren were four to seven times more likely to experience HI than children living in higher-income countries. Untreated middle ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.