Kids with cochlear implants since infancy more likely to speak, not sign

Science Daily | March 2019 | Kids with cochlear implants since infancy more likely to speak, not sign

A US study from researchers at a Chicago hospital reports that deaf children who received cochlear implants (implanted electronic hearing device) before 12 months of age learn to more rapidly understand spoken language and are more likely to develop spoken language as their exclusive form of communication- this was true even for children with additional conditions often associated with language delay, such as significantly premature birth.

In their findings, which have been published in  Otology and Neurotology, researchers also showed that implantation surgery and anesthesia were safe in young children, including infants (via Science Daily).

Full news story from Science Daily

Full reference: Hoff, S. et al | 2019 | Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions|Otology & Neurotology | Publish Ahead of Print MAR 2019 |DOI: 10.1097/MAO.0000000000002156

Objective: Determine safety and effectiveness of cochlear implantation of children under age 37 months, including below age 12 months.  Study Design: Retrospective review. Setting:Tertiary care children’s medical center.Patients:219 children implanted before age 37 mos; 39 implanted below age 12 mos and 180 ages 12–36 mos. Mean age CI = 20.9 mos overall; 9.4 mos (5.9–11.8) and 23.4 mos (12.1–36.8) for the two age groups, respectively. All but two more than or equal to 12 mos (94.9%) received bilateral implants as did 70.5% of older group. Mean follow-up = 5.8 yrs; age last follow-up = 7.5 yrs, with no difference between groups.Interventions:Cochlear implantation.Main outcome measures:Surgical and anesthesia complications, measurable open-set speech discrimination, primary communication mode(s). Results: Few surgical complications occurred, with no difference by age group. No major anesthetic morbidity occurred, with no critical events requiring intervention in the younger group while 4 older children experienced desaturations or bradycardia/hypotension. Children implanted under 12 mos developed open-set earlier (3.3 yrs vs 4.3 yrs, p  more than  0.001) and were more likely to develop oral-only communication (88.2% vs 48.8%, p more than or equal to  0.001). A significant decline in rate of oral-only communication was present if implanted over 24 months, especially when comparing children with and without additional conditions associated with language delay (8.3% and 35%, respectively).Conclusions:Implantation of children under 37 months of age can be done safely, including those below age 12 mos. Implantation below 12 mos is positively associated with earlier open-set ability and oral-only communication. Children implanted after age 24 months were much less likely to use oral communication exclusively, especially those with complex medical history or additional conditions associated with language delay.  

 

Advertisements

Visual habituation in deaf and hearing infants

Monroy, C., Shafto, C., Castellanos, I. Bergeson, T .& Houston, D. |2019| Visual habituation in deaf and hearing infants|PLoS ONE |14|2|| e0209265| https://doi.org/10.1371/journal.pone.0209265

A study involving researchers from The Ohio State University Wexner Medical Center aimed to compare visual habituation in infants with prelingual hearing loss and infants with typical hearing. Habituation is one of the earliest cognitive processes to emerge in development. 

By testing 23 young infants prior to the onset of advanced language development, alongside a control group of hearing infants. they  also intended to add to the discussion of whether performance differences in deaf children may be due to domain-general processing or language experiences.

Abstract 

Early cognitive development relies on the sensory experiences that infants acquire as they explore their environment. Atypical experience in one sensory modality from birth may result in fundamental differences in general cognitive abilities. The primary aim of the current study was to compare visual habituation in infants with profound hearing loss, prior to receiving cochlear implants (CIs), and age-matched peers with typical hearing. Two complementary measures of cognitive function and attention maintenance were assessed: the length of time to habituate to a visual stimulus, and look-away rate during habituation. Findings revealed that deaf infants were slower to habituate to a visual stimulus and demonstrated a lower look-away rate than hearing infants. For deaf infants, habituation measures correlated with language outcomes on standardized assessments before cochlear implantation. These findings are consistent with prior evidence suggesting that habituation and look-away rates reflect efficiency of information processing and may suggest that deaf infants take longer to process visual stimuli relative to the hearing infants. Taken together, these findings are consistent with the hypothesis that hearing loss early in infancy influences aspects of general cognitive functioning.

The full article is available to download from PLOS One 

In the news:

Science Daily Hearing and deaf infants process information differently

Parent challenges, perspectives and experiences caring for children who are deaf or hard-of-hearing with other disabilities: a comprehensive review

Objective: The purpose of this literature review was to explore parent challenges in caring for children who are deaf or hard of hearing with other disabilities and discuss implications for audiologists related to supporting families.

Design: A comprehensive literature review was conducted, and through qualitative analysis, emergent themes were identified, and a narrative summary generated.

Study sample: Nine research studies were included in this review. Combined, these studies reflect a sample of 111 children, 23 families and 41 parents.

Results: Three broad themes were identified, and include parent-reported challenges related to family, professional and child variables. Sub-themes were identified within each broad theme to further describe parent experiences, such as challenges related to decision-making and planning, interprofessional collaboration, and child communication and behaviours.

Conclusions: Parents of children with hearing loss and additional disabilities face unique challenges related to family, professional and child variables that could impact how they manage their child’s hearing care.

 

Rotherham NHS staff can request this article here

Oral steroids do not help hearing for children with glue ear

NIHR | November 2018 | Oral steroids do not help hearing for children with glue ear

An NIHR-funded trial demonstrates that oral steroids do not improve hearing, symptoms, or quality of life in children with glue ear. This NIHR-funded trial compared oral steroids with placebo for 389 children with otitis media with effusion,  and found no significant effect on those outcomes.

ear-42411_640.png

 

The study shows that many children will improve spontaneously, even after three months of glue ear and confirms that steroids are not useful, even though they are well tolerated. Surgery to place ventilation tubes known as grommets is an option for children with persistent glue ear in and hearing loss in both ears. This evidence supports more informed discussions with parents about watchful waiting and the surgical options available.

 

Abstract 

Background: Children with persistent hearing loss due to otitis media with effusion are commonly managed by surgical intervention. A safe, cheap, and effective medical treatment would enhance treatment options. Underpowered, poor-quality trials have found short-term benefit from oral steroids. We aimed to investigate whether a short course of oral steroids would achieve acceptable hearing in children with persistent otitis media with effusion and hearing loss.

Methods: In this individually randomised, parallel, double-blinded, placebo-controlled trial we recruited children aged 2-8 years with symptoms attributable to otitis media with effusion for at least 3 months and with confirmed bilateral hearing loss. Participants were recruited from 20 ear, nose, and throat (ENT), paediatric audiology, and audiovestibular medicine outpatient departments in England and Wales. Participants were randomly allocated (1:1) to sequentially numbered identical prednisolone (oral steroid) or placebo packs by use of computer-generated random permuted block sizes stratified by site and child’s age. The primary outcome was audiometry-confirmed acceptable hearing at 5 weeks. All analyses were by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN49798431.

Findings: Between March 20, 2014, and April 5, 2016, 1018 children were screened, of whom 389 were randomised. 200 were assigned to receive oral steroids and 189 to receive placebo. Hearing at 5 weeks was assessed in 183 children in the oral steroid group and in 180 in the placebo group. Acceptable hearing was observed in 73 (40%) children in the oral steroid group and in 59 (33%) in the placebo group (absolute difference 7% [95% CI -3 to 17], number needed to treat 14; adjusted odds ratio 1.36. There was no evidence of any significant differences in adverse events or quality-of-life measures between the groups.

Interpretation: Otitis media with effusion in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. A short course of oral prednisolone is not an effective treatment for most children aged 2-8 years with persistent otitis media with effusion, but is well tolerated. One in 14 children might achieve improved hearing but not quality of life. Discussions about watchful waiting and other interventions will be supported by this evidence.

Full reference: Francis, N. A., et al | 2018|  Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial | Lancet | 392 | 10147| 10.3310/signal-000674

Full signal from NIHR 

The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

A new article published in the journal Ear and Hearing considers how a hearing aid contributes to the ability to perceive a gap in noise for children and adults with hearing loss.

blur-brunette-cap-163375

ObjectivesThe objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing losschildren with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience.

DesignThe ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification.

ResultsWhen fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds.

ConclusionThese findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech.

Full reference: Brennan, M. A., McCreery, R. W., Buss, E., & Jesteadt, W. |2018| The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss|Ear and hearing| Vol. 39|(5)| P. 969-979.

This article can be requested by Rotherham NHS staff here 

Tinnitus Week

Tinnitus Week takes place from 5-11 February 2018 and is an international awareness initiative led by a group of organisations, including the British Tinnitus Association, American Tinnitus Association, Tinnitus Hub and the Tinnitus Research Initiative.

tinitus

The aim of the week is to raise awareness of the condition, which affects approximately 1 in 10 of the population. The British Tinnitus Association campaign for the week will focus on children and young people.

The ‘Kids Talk Tinnitus’ campaign will engage with children, parents and schools to raise awareness of tinnitus amongst young people and drive the use of relevant support and resources. These can be found at www.tinnitus.org.uk/Pages/Category/tinnitus-in-children.

A new website has been set up, as a central resource collecting all the initiatives which will be taking place in 2018. This website can be found at www.tinnitusweek.com.

Find out more about Tinnitus Week  here.

Majority of UK parents are unaware children can have tinnitus

A survey by the British Tinnitus Association (BTA)  found just under a third of UK parents (32%) think children under the age of 10 can have tinnitus; and just 37% think it can affect children aged 10 to 16

Research commissioned by the BTA has revealed the worrying statistic, which the charity says reinforces the misconception that the hearing condition only affects older people.

The research also revealed many parents are unaware of the common signs of the hearing condition in children, such as anxiety or difficulty concentrating.
To help tackle the problem, the charity has created guidance for both parents and teachers:

  • Tinnitus: A Parents Guide:
    Includes the signs and symptoms to look out for, as well as advice on the best places to get help and support if parents suspect their child has tinnitus
  • Tinnitus: A Teachers Guide:
    Provides practical steps for use in the classroom.

Full BTA Press release here