Early Hearing Detection and Vocabulary of Children With Hearing Loss.

The primary purpose of the current study was to examine the impact of the current EHDI 1-3-6 policy on vocabulary outcomes across a wide geographic area | Pediatrics

Background: To date, no studies have examined vocabulary outcomes of children meeting all 3 components of the Early Hearing Detection and Intervention (EHDI) guidelines (hearing screening by 1 month, diagnosis of hearing loss by 3 months, and intervention by 6 months of age). A secondary goal was to confirm the impact of other demographic variables previously reported to be related to language outcomes.

Results: The combination of 6 factors in a regression analysis accounted for 41% of the variance in vocabulary outcomes. Vocabulary quotients were significantly higher for children who met the EHDI guidelines, were younger, had no additional disabilities, had mild to moderate hearing loss, had parents who were deaf or hard of hearing, and had mothers with higher levels of education.

Conclusions: Vocabulary learning may be enhanced with system improvements that increase the number of children meeting the current early identification and intervention guidelines. In addition, intervention efforts need to focus on preventing widening delays with chronological age, assisting mothers with lower levels of education, and incorporating adults who are deaf/hard-of-hearing in the intervention process.

Yoshinaga-Itano, C. et al. (2017) Early Hearing Detection and Vocabulary of Children With Hearing Loss. Pediatrics. Vol. 140 (no. 2) e20162964

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Hearing aids for otitis media with effusion: Do children use them?

This study investigated what proportion of children referred for hearing aids actually receive them, and whether children use them | International Journal of Pediatric Otorhinolaryngology

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Image source: Kristof Borkowski – Flickr // CC BY-NC 2.0

ENT surgeons may refer children with otitis media with effusion (OME) to audiology for consideration of hearing aids. They are an option for the treatment of OME, but are only effective if the child actually wears them.

During the study period, there were 202 referrals of children to audiology, of which 70 (34.7%) were for consideration of hearing aids for OME. Of these 70 referred children, 37 (52.9%) were not fitted with hearing aids due to normal audiometry (23), asymptomatic mild hearing loss (7), nonattendance (3), clinical decision to just monitor hearing (1), parental decline (2), and unrecorded reason (1). A total of 38 children (including direct access patients) were fitted with hearing aids for OME. Majority (36/38) of children issued aids used them, 16 all day, 7 only at school, 1 only at home, 3 only when needed, and 9 used them for an unspecified duration; 1 child’s use of hearing aids was unrecorded, and 1 child refused to use it. 21 were fitted bilaterally and 17 unilaterally. 37 were behind the ear aids and 1 a BAHA softband.

A third of referrals to paediatric audiology by ENT are for consideration of hearing aids for OME. Only about half of children referred to audiology for hearing aids for OME actually receive them, as by the time they see audiology the hearing loss has frequently resolved or is asymptomatic so that aiding is unwarranted. Once fitted, they appear to be well accepted. Hearing aids have fair utilization in children fitted with them for OME.

Full reference: Gan, R.W.C. et al. (2017) Hearing aids for otitis media with effusion: Do children use them? International Journal of Pediatric Otorhinolaryngology. Vol. 99 (August) pp. 117–119.

Bilateral congenital cholesteatoma: Surgical treatment and considerations.

A multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition | International Journal of Pediatric Otorhinolaryngology

In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain.

From 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described.

The median age at presentation was 4 years (range 2-7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months.

When both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.

Full reference: Marchioni, D. et al. (2017) Bilateral congenital cholesteatoma: Surgical treatment and considerations. International Journal of Pediatric Otorhinolaryngology. Vol. 99. (no. 08) pp. 146–151

Ear Care for the Most Vulnerable Infants

Each year, approximately 6,000 newborns-of the nearly 4 million births in the U.S.-are diagnosed with permanent hearing loss, and premature infants are 50 percent more likely than full-term infants to develop hearing loss | ASHA Leader

Infants’ experiences in the neonatal intensive care unit (NICU) are highly variable, depending on the complexity of their cases and degree of prematurity. Those with more severe or chronic medical and neurodevelopmental conditions present particular challenges to the audiology team.

Complications of their conditions can delay hearing screening, and the medical equipment helping to support them may interfere with the screening itself. The NICU environment can also be noisy for this vulnerable population. Yet another challenge is the emotional fragility of these infants’ parents.

Although audiology isn’t part of the primary NICU care team, every infant receives a hearing screen, and any infant with a failed screen receives diagnostic audiological testing. This means the hearing-screening staff and audiology team play an important role, particularly after a baby does not pass the hearing screening. Audiologists can also play a key role in the development, implementation and oversight of the newborn hearing program (see more on newborn hearing screening on the ASHA Practice Portal: on.asha. org/newborn-screening). In these cases, the audiologist serves as the primary source of hearing-related information for the parents and the medical team.

To address the particular challenges of the NICU population, audiologists need to communicate and work closely with the NICU staff as soon as it’s appropriate, consider the effects of medical equipment, communicate with parents with a great deal of sensitivity, and work at coordinating discharge planning and follow-up care with the infant’s parents and other providers.

Full reference: McGrath, A. P., & Vohr, B. R. (2017). Ear care for the most vulnerable infants. ASHA Leader, 22(8), 20-22.

 

Cochlear implantation – which child when?

In the last 30 years, the field of cochlear implantation has rapidly evolved | Paediatrics and Child Health

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Technological advances in hardware and corresponding developments in surgical techniques, along with new sound processing strategies and innovative rehabilitation, have combined to maximise functional outcomes. Informed by the evidence base of such outcomes, the inclusion criteria for children who might benefit from a cochlear implant (CI) has been refined and expanded. CIs are now the standard of care for children with severe to profound hearing loss where the desired outcome is spoken language. There are several emerging trends within the field of paediatric CIs that have already translated into clinical practice in some countries, but have not yet been universally adopted.

These include, but are not limited to, the expansion of audiometric CI candidacy criteria for cohorts with:

  • (1) more residual hearing;
  • (2) partial hearing which may benefit from electric-acoustic stimulation (EAS)
  • (3) asymmetric hearing levels. This review will describe the historical context and provide an overview of the candidacy trends as they relate to children.

Full reference: Maggs, J. et al. (2017) Cochlear implantation – which child when? Paediatrics and Child Health. Published online: July 12, 2017

Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants

Deaf children with cochlear implants (CIs) are at risk for psychosocial adjustment problems, possibly due to delayed speech–language skills | The Journal of Deaf Studies and Deaf Education

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This study investigated associations between a core component of spoken-language ability—speech intelligibility—and the psychosocial development of prelingually deaf CI users. Audio-transcription measures of speech intelligibility and parent reports of psychosocial behaviors were obtained for two age groups (preschool, school-age/teen). CI users in both age groups scored more poorly than typically hearing peers on speech intelligibility and several psychosocial scales.

Among preschool CI users, five scales were correlated with speech intelligibility: functional communication, attention problems, atypicality, withdrawal, and adaptability. These scales and four additional scales were correlated with speech intelligibility among school-age/teen CI users: leadership, activities of daily living, anxiety, and depression.

Results suggest that speech intelligibility may be an important contributing factor underlying several domains of psychosocial functioning in children and teens with CIs, particularly involving socialization, communication, and emotional adjustment.

Full reference: Freeman, V. et al. (2017) Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants. The Journal of Deaf Studies and Deaf Education. 22(3) pp.278-289.

Risk Factors Associated With Early Childhood Hearing Loss

In this study, we examined the association between risk factors for hearing loss and early childhood hearing status (normal hearing, congenital hearing loss, or delayed-onset hearing loss) | American Journal of Audiology

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Method: A retrospective data review was completed on 115,039 children born from 2010 to 2012. Data analyses included prevalence rates, odds ratios, and Fisher exact tests of statistical significance.

Results: Ninety percent of children were born with no risk factors for hearing loss; of those, 99.9% demonstrated normal hearing by 3 years of age. Of the 10% of children born with risk factors, 96.3% demonstrated normal hearing by age 3, 1.4% presented with congenital hearing loss, and 2.3% demonstrated permanent hearing loss by age 3. Factors that placed children at the highest risk of congenital hearing impairment were neurodegenerative disorders, syndromes, and congenital infections. Factors that placed children at the highest risk of developing permanent postnatal hearing loss were congenital cytomegalovirus, syndromes, and craniofacial anomalies.

Conclusions: Certain risk factors place a child at significantly greater risk of congenital hearing impairment or developing permanent hearing loss by age 3. Follow-up diagnostic testing should remain a priority for children with certain risk factors for hearing loss.

Full reference: Dumanch, K.A. et al. (2017) High Risk Factors Associated With Early Childhood Hearing Loss: A 3-Year Review. American Journal of Audiology, June 2017, Vol. 26, 129-142