Language evaluation in children with pre-lingual hearing loss and cochlear implant

Linguistic Intervention Strategies Speech-Language Pathologists Use With Children Using Cochlear Implants

The aim of this study was to explore the strategies that speech-language pathologists (SLPs) use during their linguistic interventions on children with cochlear implants (CIs). The sample comprised 7 SLPs in interactions with 62 children, 31 with CIs and 31 with typical hearing (TH), from 5 to 7 years of age. Two linguistic activities were used: conversation and naming. With children with CIs, the SLPs used 3.8 times more adaptation strategies and 5 times more educational strategies in the conversation activity, and 1.4 times more educational strategies in the naming activity than with children with TH. Communication strategies were significantly more frequent in the conversation activity than in the naming activity while educational strategies were more frequent in the naming activity than in the conversation activity. The auditory age of children with CIs also influenced the use of these two types of strategies, increasing the use of communication strategies by 0.6% and decreasing the use of educational strategies by 1.2% for each month of increase in the auditory age. In order to foster linguistic development, the SLPs used a wide variety of strategies with the children with CIs, adjusting them to the activity and the auditory age.

Cross-cultural adaptation of the new Reynell developmental language scales to Brazilian Portuguese

OBJECTIVE

Translation and cross-cultural adaptation of The New Reynell Developmental Language Scales (NRDLS) to Portuguese spoken in Brazil.

METHOD

We followed the steps recommended in the manual Multilingual Toolkit da NRDLS: translation of the test, adaptation of items from the scales, and use of NRDLS in a pilot study with Brazilian children. It was included a back-translation and analysis by a group of specialists in the area that helped to review the adapted version. A quantitative descriptive analysis of results from the pilot group was performed, and we used a one-way repeated measures ANOVA.

RESULTS

The Brazilian Portuguese version of the NRDLS seems very similar to the original NRDLS in terms of conceptual equivalence. The children understood well the translated and adapted words, and they had more difficulty in the last sessions. Some of the mistakes made by the children helped us to adapt specific items for a better evaluation of the abilities of Brazilian children.

CONCLUSION

The suggestions in the Multilingual Toolkit, the input from the group of specialists, and the experience with the children in the pilot group helped the adaptation of the NRDLS to Brazilian Portuguese. The adapted version of NRDLS was effective, it reflected the gradual evolution of complexity in the scales. We suggest the application of the adapted version in a large group of children with normal development to validate it.

Longitudinal Development of Verbal and Nonverbal Intelligence After Cochlear Implantation According to Wechsler Tests in German-speaking Children: A Preliminary Study

OBJECTIVES

Intelligence as a construct of cognitive abilities is the basis of knowledge and skill acquisition and the main predictor of academic achievement. As a broad construct, it is usually divided into subdomains, such as nonverbal and verbal intelligence. Verbal intelligence is one domain of intelligence but is not synonymous with specific linguistic abilities like grammar proficiency. We aim to address the general expectation that early cochlear implantation enables children who are hard of hearing to develop comprehensively, including with respect to verbal intelligence. The primary purpose of this study is to trace the longitudinal development of verbal and nonverbal intelligence in children with cochlear implants (CIs).

DESIGN

Sixteen children with congenital hearing loss who received unilateral or bilateral implants and completed at least two intelligence assessments around the age of school entrance were included in the study. The first assessment was performed around 3 years after CI fitting (chronological age range: 3.93 to 7.03 years). The second assessment was performed approximately 2 years after the first assessment. To analyze verbal and nonverbal IQ in conjunction and across children at different ages, we used corresponding standardized and normalized tests from the same test family (Wechsler Preschool and Primary Scale of Intelligence and/or Wechsler Intelligence Scale for Children).

RESULTS

Regarding longitudinal development, both verbal and nonverbal IQ increased, but verbal IQ increased more substantially over time. At the time of the second measurement, verbal and nonverbal IQ were on a comparable level. Nevertheless, we also observed strong inter-individual differences. The duration between both assessments was significantly associated with verbal IQ at the second measurement time point and thus with verbal IQ gain over time. Education mode (regular vs. special kindergarten/school) was significantly correlated with nonverbal IQ at the second assessment time point.

CONCLUSIONS

The results, despite the small sample size, clearly suggest that children with CIs can achieve intellectual abilities comparable to those of their normal-hearing peers by around the third year after initial CI fitting, and they continue to improve over the following 2 years. We recommend further research focusing on verbal IQ assessed around the age of school entrance to be used as a predictor for further development and for the establishment of an individual educational program.

Follow-up of children diagnosed with deafness in a neonatal hearing screening program in Manaus

OBJECTIVE

To evaluate the follow-up of children diagnosed with deafness in neonatal hearing screening and risk factors for hearing loss.

METHODS

Quantitative, cross-sectional, and retrospective study to evaluate factors associated with hearing loss and the follow-up of cases of children diagnosed with audiological dysfunction, by analyzing electronic medical records of 5,305 children referred to a Specialized Center in Type I Rehabilitation, from January/2016 to February/2020, in the city of Manaus, Amazonas. The statistical study used Pearson's chi-square test and binary logistic regression in which odds ratio scans were obtained with reliability intervals of 95%.

RESULTS

Of the 5,305 children referred for the otoacoustic emission retest, 366 (6.9%) failed the retest. Children diagnosed with sensorineural hearing loss continued in the study, totaling 265 (72.4%). Only 58 (21.9%) children continued in the study to its end, of these 39 had received hearing aids at that point; and 16 (41%) had surgical indication for cochlear implants, of which only 3 (18.7%) had undergone surgery. Among the risk factors for hearing loss, we found 2.6 times more chance of failure in the otoacoustic emissions retest in those children who had a family history of hearing loss and ICU stay.

CONCLUSION

Although the screening flow reaches a large part of live births, the dropout rates during the process are high, therefore, the socioeconomic and geographic characteristics of regions such as the Amazon should be considered as relevant factors to the evasion of rehabilitation programs of these children. Hospitalization in the neonatal ICU and family history of hearing loss in the investigations could be identified as the main and most important factors for alteration of the otoacoustic emissions retests.

Trajectories of receptive and expressive vocabulary in Mandarin speaking children under 4 years of age fitted with cochlear implants: a 12-month longitudinal study

OBJECTIVE

To explore trajectories of receptive and expressive vocabulary in Mandarin-speaking children under the age of 4 years, fitted with cochlear implants (CIs).

DESIGN

Vocabulary trajectories were measured at baseline, 3, 6, and 12 months after implantation using the Chinese version of the MacArthur-Bates Communicative Development Inventory.

STUDY SAMPLE

There were 216 children with CIs in West China Hospital who took part and were divided into three groups based on age at first CI.

RESULTS

Receptive and expressive vocabulary scores of the younger implantation group were significantly different from the older groups at baseline. After 12 months of implant use, there were no significant differences between all groups. Furthermore receptive vocabulary trajectories for all children with CIs were not significantly different from those of children with normal hearing. However, expressive vocabulary trajectories were poorer when compared to children with normal hearing. Significant differences were seen between receptive and expressive vocabulary in all age groups.

CONCLUSIONS

This study suggests no differences in vocabulary trajectories in Mandarin-speaking children whether they received their first CI at 1, 2, or 3 years of age. It is important that clinicians convey realistic expectations about potential differences in receptive vs. expressive trajectories for Mandarin-speaking children fitted with CIs.

Auditory and verbal skills development post-cochlear implantation in Mandarin children with auditory neuropathy: a follow-up study

BACKGROUND

Cochlear implant (CI) is commonly used as one of the interventions in auditory neuropathy (AN) children. However, there are limited studies regarding the efficiency of CI in AN children.

OBJECTIVE

This study aimed to compare the auditory and verbal skills development between the AN and typically developing (TD) children with CI.

METHODS

The follow-up study compared the post-CI scores of questionnaires of AN and TD children about auditory and verbal skills development at 0, 1, 2, 3, 6, 9, 12, and 18 months of CI use.

RESULTS

The results of auditory perception in AN and TD groups showed a significant improvement after first 3 months. Furthermore, the score was significantly lower in AN group after 18 months of CI use. The results of verbal skills in AN group showed a progressive trend after 9 months of CI use. Besides, the scores were significantly lower in AN group after 12 months of CI use.

CONCLUSION AND SIGNIFICANCE

The auditory perception development in AN children with CI was rapidly improved during first 3 months, and verbal skills showed a trend of improvement after 9 months of CI use. However, the differences in auditory and verbal skills between AN and TD groups increased over time.

Uso de dispositivos auxiliares da audição e fluência na Libras e na língua oral de estudantes surdos

RESUMO Objetivo: avaliar a relação entre fluência na Libras, fluência na língua oral e o uso de dispositivos auxiliares para audição de estudantes surdos. Métodos: participaram 112 profissionais tradutores, intérpretes ou instrutores de Libras que informaram as características auditivas, fluência na Libras e língua oral dos estudantes acompanhados por eles, matriculados na rede municipal de uma cidade brasileira. A análise da associação entre fluência na Libras, fluência na língua oral, grau da perda auditiva e uso de dispositivo foi realizada por meio do teste qui-quadrado ou teste exato de Fisher, consideraram-se significantes valores de p<0,05. Resultados: as respostas dos profissionais referiram-se a 88% (n=126) do total de estudantes surdos matriculados na rede municipal. A média de idade dos estudantes foi de 13 anos, sendo 72 (57%) meninos, 98 (78%) com perda auditiva severa ou profunda, 57 (45%) usuários de dispositivos eletrônicos auxiliares para audição, 83 (66%) fluentes somente na Libras, 12 (10%) fluentes apenas na língua oral e 18 (14%) fluentes na Libras e língua oral. Estudantes que utilizavam dispositivo auxiliar para audição apresentaram melhor fluência oral (p<0,001). Dos estudantes que apresentavam fluência oral (n=30), 18 (60%) eram fluentes em Libras (p<0,001). Conclusão: a Libras foi a modalidade comunicativa utilizada majoritariamente pelos estudantes surdos, mesmo por aqueles que utilizavam também a língua oral e dispositivos eletrônicos, o que pode indicar mudança de percepção social em relação ao surdo, à sua língua e cultura.

Use of hearing devices and fluency in Brazilian Sign Language and oral language in deaf students

ABSTRACT Purpose: to assess the relationship between deaf students’ fluency in Brazilian Sign Language (BSL) and oral language and hearing aid use. Method: the sample comprised 112 professional BSL translators, interpreters, and instructors. They answered a questionnaire on hearing characteristics and BSL and oral language fluency of students accompanied by them, who attended municipal schools in a Brazilian city. Association analysis between oral language fluency, BSL fluency, the degree of hearing loss, and device use was made with the chi-square test or Fisher’s Exact test. The significance level was set at p<0.05. Results: the professionals’ responses referred to 88% (n = 126) of all deaf students enrolled in municipal schools. The students’ mean age was 13 years; 72 (57%) were males, 98 (78%) had severe or profound hearing loss, 57 (45%) used electronic hearing devices, 83 (66%) were fluent only in BSL, 12 (10%) were fluent only in oral language, and 18 (14%) were fluent in both BSL and oral language. Hearing device use was statistically associated with oral fluency (p < 0.001). Of all students fluent in oral language (n = 30), 18 (60%) were also fluent in BSL (p < 0.001). Conclusion: BSL was the communication modality most used by students, including those who also used oral language and electronic hearing devices. This may indicate a change in the social perception of deaf people, their language, and their culture.

Real and Imagined Smellscapes

The smellscape is the olfactory environment as perceived and understood, consisting of odours and scents from multiple smell sources. To what extent can audiovisual information evoke the smells of a real, complex, and multimodal environment? To investigate smellscape imagination, we compared results from two studies. In the first, onsite participants (N = 15) made a sensory walk through seven locations of an open-air market. In the second, online participants (N = 53) made a virtual walk through the same locations reproduced with audio and video recordings. Responses in the form of free-form verbal annotations, ratings with semantic scales, and a 'smell wheel', were analysed for environmental quality, smell source type and strength, and hedonic tone. The degree of association between real and imagined smellscapes was measured through canonical correlation analysis. Hedonic tone, as expressed through frequency counts of keywords in free-form annotations was significantly associated, suggesting that smell sources might generally be correctly inferred from audiovisual information, when such imagination is required. On the other hand, onsite ratings of olfactory quality were not significantly associated with online ratings of audiovisual reproductions, when participants were not specifically asked to imagine smells. We discuss findings in the light of cross-modal association, categorisation, and memory recall of smells.

Association between Hyperbilirubinemia and Hearing Screen Failure in the Neonatal Intensive Care Unit in Infants Born Preterm

OBJECTIVE

To characterize the association between hyperbilirubinemia and a failed newborn hearing screen in infants born at 22-32 weeks of gestation.

STUDY DESIGN

We included infants with gestational ages of 22-32 weeks who were discharged from neonatal intensive care units in the US from 2002 to 2017 with available newborn hearing screen results obtained after 34 weeks postmenstrual age. We excluded infants with severe birth asphyxia or craniofacial abnormalities. We identified 95 672 infants from 313 neonatal intensive care units. We used multivariable logistic regression to examine the association between maximum total bilirubin at <21 days postnatal age with failed hearing screen, adjusting for important demographic and clinical risk factors.

RESULTS

The median gestational age and birth weight were 30 weeks (IQR, 28-32 weeks) and 1330 g (IQR, 1010-1630 g), respectively. The median maximum total bilirubin was 8.3 mg/dL (IQR, 6.7-10.0 mg/dL), and 5275 infants (6%) failed their newborn hearing screen. On adjusted analysis, each 1 mg/dL increase in maximum total bilirubin was associated with a small, but significant, increase in odds of a failed hearing screen (OR, 1.03; 95% CI, 1.02-1.04).

CONCLUSIONS

An increased maximum total bilirubin level was independently associated with hearing screen failure. Further prospective studies are needed to understand whether this increased risk of hearing screen failure translates to increased risk of hearing loss.

Analysis of the developmental trajectory and influencing factors of auditory and speech functions after cochlear implantation in Mandarin Chinese speaking children

Background: The auditory and speech development of the children with cochlear implants (CIs) are influenced by many factors.Objective: To study the developmental trajectory and influencing factors of auditory and speech functions for the Mandarin Chinese speaking children with CIs.Material and methods: The children with CIs undergoing rehabilitation in the same institution from June 2016 to June 2019 were followed up. Their closed monosyllables and disyllables recognition rate, closed average language age, categories of auditory performance (CAP) and speech intelligibility rating (SIR) were evaluated at 0, 1, 3, 6, 12 and 24 months of rehabilitation. The results were analyzed by SPSS 23.0.Results: 49 children were followed up for 1 year, 29 children for 2 years. The evaluated indicators of auditory and speech functions were improved with the prolongation of rehabilitation and influenced by the age of cochlear implantation, the use of hearing aids before surgery, guardian's educational degree, the relationship between guardian and child.Conclusions and significance: The auditory and speech functions of the children with CIs were improved significantly with the prolongation of rehabilitation and influenced by many factors, which can help us to predict the effect of CI more accurately and develop an individualized rehabilitation program.