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

Effectiveness of Tympanostomy Tubes for Otitis Media

Tympanostomy tube placement is the most common ambulatory surgery performed on children in the United States| Pediatrics

Objectives: The goal of this study was to synthesize evidence for the effectiveness of tympanostomy tubes in children with chronic otitis media with effusion and recurrent acute otitis media.

Results: Children with chronic otitis media with effusion treated with tympanostomy tubes compared with watchful waiting had a net decrease in mean hearing threshold of 9.1 dB (95% credible interval: −14.0 to −3.4) at 1 to 3 months and 0.0 (95% credible interval: −4.0 to 3.4) by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after placement of tympanostomy tubes. Associated adverse events are poorly defined and reported.

Conclusions: Tympanostomy tubes improve hearing at 1 to 3 months compared with watchful waiting, with no evidence of benefit by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after tympanostomy tube placement, but the evidence base is severely limited. The benefits of tympanostomy tubes must be weighed against a variety of associated adverse events.

Full reference: Steele, D.W. (2017) Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics. 139 (6) e20170125

Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma

Outcomes for endoscopic ear surgery (EES) for pediatric cholesteatoma at a tertiary pediatric hospital.

Methods: Retrospective case series of 65 pediatric cholesteatoma cases in 38 ears. Subgrouping based on cholesteatoma type and EES type. Surgical findings, outcomes, and demographic data were evaluated.

Results: Endoscopes were used in 65 pediatric cholesteatoma cases in 38 primary ears (34 patients), followed for an average of 2.6 years (9 months to 4.6 years). The endoscope was used as the primary visualization tool in 31 (81.6%) ears (EES 2 or 3), and as an adjunct to the microscope in seven ears (EES 1). Twenty-two (57.9%) ears and 35 (53.4%) cases were transcanal endoscopic ear surgery (EES 3 or TEES). Overall, there was recurrence in five (13.2%) ears and residual in four (10.5%) ears. Cholesteatoma was acquired in 27 ears, with average age 10.9 years; and congenital in 11 ears, with average age 3.8 years. Surgical time was longer for acquired cases (226 vs. 154 minutes). Hearing outcomes were comparable for both cholesteatoma types. Residual disease was seen in three (11.1%) acquired ears and one (9.1%) congenital ear. Overall, the lowest rates of recurrent and residual disease were seen in EES 3 cases, and relatively low rates in EES 2 and 3 ears, including four (12.9%) recurrences and two (6.5%) ears with residual disease.

Conclusion: The endoscopes are a viable tool for resection of pediatric cholesteatoma and provide excellent visualization of the middle ear and associated recesses.

Full reference: Ghadersohi, S. et al. (2017) Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma. The Laryngoscope. Published online: 23 May 2017

Paediatric hearing loss

Nieto, H. et al. (2017) BMJ. 356:j803

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What you need to know:

  • Take paediatric hearing loss seriously, especially if neonatal screening has been missed

  • Conductive hearing loss is most commonly caused by glue ear, usually a transient disease

  • All children who have had bacterial meningitis should have a follow-up hearing test

Paediatric hearing loss is a common problem; diagnosis and appropriate intervention are central to the child’s development. It is estimated that one in five children of around 2 years will have been affected by glue ear and eight in 10 will have been affected once or more by the age of 10.

Read the full ’10-Minute Consultation’ article here

Service Delivery to Children With Mild Hearing Loss

Walker, E.A. et al. (2017) American Journal of Audiology. Vol. 26(3) pp. 38-52

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Purpose: This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL).

Conclusion:s Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

Read the abstract here

Pre- and post-admission antibiotic treatment in paediatric acute mastoiditis

Carmel, E. et al. (2017) The Journal of Laryngology & Otology. 131(S1) pp. S12-S17

Aim: To evaluate the effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis.

Conclusion: Paediatric acute mastoiditis patients treated with antibiotic therapy prior to admission are at higher risk for complication development. The advised time period for oral antibiotic therapy following hospital discharge remains as 10 days in all cases of uncomplicated acute mastoiditis.

Read the abstract here