Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS) Auditory Questionnaire

[The LittlEARS® Auditory Questionnaire : An analysis of multicentre data of children after early bilateral cochlear implant placement]

BACKGROUND

In order to optimise the support of children with cochlear implants (CI), it is very important to detect slow developmental processes as early as possible. Data from the LittlEARS® Auditory Questionnaire (LEAQ) from children with early bilateral CI are evaluated and presented in relation to age and hearing age and compared with language development data recorded later.

MATERIALS AND METHODS

This retrospective multicentre study included data from a total of 554 children for whom at least one LEAQ was completed during the course of CI rehabilitation. Children without additional disabilities who received bilateral simultaneous or sequential CI treatment were included.

RESULTS

As expected, there are high correlations between hearing age (HA) and the overall LEAQ total score. When analysed according to chronological age (CA), development runs roughly parallel to the development of children with normal hearing, albeit at a lower level. Children implanted early up to an age of ≤ 12 months consistently achieve approximately 7-8 raw points more. Only the LEAQ results of the later test times (from the age of 18 months) correlate with some areas of the speech development test for children (SETK; areas 3-5).

CONCLUSION

The earliest possible detection of critical developmental processes in children with CI is extremely important. In the case of very early CI fitting, the CA should be used as a reference measure in diagnostics. The LEAQ values determined for the group of children with CI are suitable to a limited extent as generally valid reference values for children with early bilateral CI. Further studies should continue to work out the correlations between early preverbal development and later speech development.

Longitudinal Changes in BDNF and MMP-9 Protein Plasma Levels in Children after Cochlear Implantation

Congenitally deaf children who undergo cochlear implantation before 1 year of age develop their auditory skills faster than children who are implanted later. In this longitudinal study, a cohort of 59 implanted children were divided into two subgroups according to their ages at implantation-below or above 1 year old-and the plasma levels of matrix metalloproteinase-9 (MMP-9), brain-derived neurotrophic factor (BDNF), and pro-BDNF were measured at 0, 8, and 18 months after cochlear implant activation, while auditory development was simultaneously evaluated using the LittlEARs Questionnaire (LEAQ). A control group consisted of 49 age-matched healthy children. We identified statistically higher BDNF levels at 0 months and at the 18-month follow-ups in the younger subgroup compared to the older one and lower LEAQ scores at 0 months in the younger subgroup. Between the subgroups, there were significant differences in the changes in BDNF levels from 0 to 8 months and in LEAQ scores from 0 to 18 months. The MMP-9 levels significantly decreased from 0 to 18 months and from 0 to 8 months in both subgroups and from 8 to 18 months only in the older one. For all measured protein concentrations, significant differences were identified between the older study subgroup and the age-matched control group.

Validation of LittleEARS questionnaire in Hindi language

Background

Subjective measures of auditory development are equally important as objective measures to obtain a realistic image of the hearing status in infants and toddlers.

Objectives

The objectives of the current study were to translate and validate the LittleEARS questionnaire into the Hindi language, to calculate its psychometric properties and establish a regression curve of the scores obtained as a function of age, to calculate the inter-test and test retest reliability of the same. The secondary objectives were to compare the scores obtained by the normal hearing children and those with hearing impairment and to plot a regression curve of total scores obtained by the hearing-impaired children as a function of the duration of auditory training attended since their first fit of the device.

Materials and methods

The procedures involved conventional translation, reverse translation, and content validation before administering the questionnaire. The translated version was administered to parents of 59 children with normal hearing and 41 children with hearing impairment.

Results

The finalized version had good reliability and efficient internal consistency with a Cronbach alpha value of 0.96. The mean scores obtained by the normal hearing children showed a progressive pattern as a function of age.

Conclusion

The LittleEARS questionnaire has been successfully translated and validated into the Hindi language with excellent validity and reliability and can be used for screening and early identification of hearing impairment and in evaluating the outcome of audiological treatment approaches.

Longitudinal assessment of listening skills in UK infants with hearing aids using the LittlEARS® auditory questionnaire

OBJECTIVE

To investigate listening skills in infant hearing aid users using the LittlEARS^® Auditory Questionnaire (LEAQ).

DESIGN

Caregivers completed the LEAQ, and hearing aid data logging was recorded, at infant age 3-7 months and 7-21 months.

STUDY SAMPLE

Seventy infant hearing aid users with permanent bilateral hearing loss, no developmental comorbidities, aged 3-7 months at first visit.

RESULTS

Infants with mild and moderate losses tended to have scores within the normative range at the early time point (88%), but 29% were below the normative range when older. Thirty percent of infants with severe hearing loss were outside the normative range at the early time point and 60% outside the normative range when older. Infants with profound loss were almost always (95%) outside the normative range. At the later time point, and for infants with severe-to-profound loss, low LEAQ scores were associated with fewer daily hours hearing aid use. Scores were poorer than previous reports in the literature for infant hearing aid users.

CONCLUSIONS

This study provides further knowledge on infant listening performance and hearing aid use over time that can be used to guide management of individual cases and to develop and audit service quality improvements.

Audiological and Speech Performance After Cochlear Implantation in Cochlear Aplasia Deformity

Inner ear malformation is a congenital anomaly associated with prelingual sensory neural hearing loss in the pediatric population. This is a case report of bilateral radiologically diagnosed cochlear aplasia in a child who underwent unilateral left cochlear implantation with audiological results at one-year follow-up after surgery. Sixteen months after the cochlear implantation surgery, the child could produce 200 words and say a sentence with two words. In certain cases of inner ear malformation, the subgrouping of cystic cavity can be difficult and should not delay the trial of cochlear implant provided an acceptable anatomical appearance of the inner ear with cochleovestibular nerve existence and a proper electrode used for implantation.

Evaluation of Parent-Researcher Agreement on the Vocal Development Landmarks Interview

Purpose Parent report was compared to judgments made by a trained researcher to determine the utility of the Vocal Development Landmarks Interview (VDLI) for monitoring development of vocal behaviors in very young children. Method Parents of 40 typically developing children, ages 6-21 months, provided full-day naturalistic audio recordings of their children's vocalizations after completing the VDLI. Six 5-min segments of highly voluble periods were selected from each recording and were analyzed, coded, and scored by the researcher. These data were then compared to the parents' VDLI responses. Parent-researcher agreement was examined using two methods and a generalized linear mixed model. Patterns of disagreement were explored descriptively to gain insights regarding potential sources of parent-researcher differences. Finally, developmental patterns in the researcher-observed vocal behaviors were examined as a function of children's age. Results No significant differences in parent-researcher agreement were found for the Canonical and Word subscales of the VDLI; however, significant differences in agreement were found for the Precanonical subscale. Mean percentages of agreement were high overall for both scoring methods evaluated. Additionally, the researcher's categorization and quantification of vocal behaviors for each age group aligned well with developmental trajectories found in the literature. Conclusion Results provide further support for use of parent report to assess early vocal development and use of the VDLI as a clinical measure of vocal development in infants and toddlers ages 6-21 months.

Can Differences in Early Hearing Development Be Distinguished by the LittlEARs Auditory Questionnaire?

OBJECTIVE

This study asks whether the LittlEARs Auditory Questionnaire (LEAQ), a caregiver measure, can differentiate between the early auditory development of children with bilateral cochlear implants (CIs), bilateral hearing aids (HAs), and children with Auditory Neuropathy Spectrum Disorder (ANSD) who wear CIs or HAs. The LEAQ is sensitive to impaired auditory development but has not previously been used to distinguish developmental changes between groups of children using different hearing technologies or with different types of hearing loss.

DESIGN

We collected retrospective longitudinal LEAQ results from 43 children with HAs, 43 with CIs, and 18 with ANSD. The children with ANSD wore hearing technology. They were a similar age to the children without ANSD (23 months; SD = 15), while the CI group (14 months; SD = 8) was younger than the HA group (24 months; SD = 18) [F(2,98.48) = 3.4; p = 0.04]. The CI group often participated in their first LEAQ pretreatment. Participants completed between one and seven LEAQs. Scores ranged between zero and 35 (mean = 18.36). We conducted a linear mixed-effects analysis, which included age or time since device fitting, hearing type (HA, CI, or ANSD), and presence of a comorbidity as fixed effects. A secondary analysis assessed effects of device audibility, measured by the Speech Intelligibility Index or Articulation Index, and consistency of device use obtained from device datalogs.

RESULTS

Children with CIs progressed faster than their peers with HAs or ANSD [χ2(8) = 24.51; p = 0.002]. However, within a subsample that included consistency of device use (β7 = -0.20 ± 0.38, t = -0.52; β8 = 0.93 ± 0.82, t = 1.13) and audibility (β6 = -0.70 ± 1.45, t = -1.87; β7 = 0.87 ± 0.89, t = 0.98), study group did not significantly influence rate of improvement on the LEAQ. In addition, children with developmental delays in all three study groups demonstrated significantly slower LEAQ score improvement [χ2(6) = 23.60; p < 0.001] and a trend toward decreased consistency of device use [F(1) = 3.31; p = 0.07]. As we expected, children in the CI and HA groups were more likely to achieve auditory skills indicated in early rather than later LEAQ questions. There was less variability in the responses of the ANSD group [CI: interquartile range (IQR) = 9; HA: IQR = 8; ANSD: IQR = 1]. There was no connection between LEAQ growth and speech perception outcomes in a subsample [r(6) = 0.42; p = 0.30].

CONCLUSIONS

The LEAQ is a useful tool for monitoring initial auditory development in very young children and can inform early treatment decisions.

Functional Polymorphism of MMP9 and BDNF as Potential Biomarker of Auditory Neuroplasticity in Prelingual Deafness Treatment With Cochlear Implantation-A Retrospective Cohort Analysis

Genetic biomarkers of neuroplasticity in deaf children treated with cochlear implantation (CI) might facilitate their clinical management, especially giving them better chances of developing proficient spoken language. We investigated whether carrying certain variants of the genes encoding matrix metalloproteinase MMP9 and neurotrophin brain-derived neurotrophic factor (BDNF), involved in synaptic plasticity, can be taken as prognostic markers of how well auditory skills might be acquired. Association analysis of functional MMP9 rs3918242 and BDNF rs6265 variants and the child’s auditory development measured at CI activation and 1, 5, 9, 14, and 24 months post CI activation with LittlEARS Questionnaire (LEAQ) was conducted in a group of 100 children diagnosed with DFNB1-related deafness, unilaterally implanted before the age of 2 years. Statistical analysis in the subgroup implanted after 1 year of life (n = 53) showed significant association between MMP9 rs3918242 and LEAQ scores at 1 month (p = .01), at 5 months (p = .01), at 9 months (p = .01), and at 24 months (p = .01) after CI activation. No significant associations in the subgroup implanted before 1 year of life were observed. No significant associations between the BDNF rs6265 and LEAQ score were found. Multiple regression analysis (R² = .73) in the subgroup implanted after 1 year of life revealed that MMP9 rs3918242 was a significant predictor of treatment outcome. In conclusion, C/C rs3918242 MMP9 predisposes their deaf carriers to better CI outcomes, especially when implanted after the first birthday, than carriers of C/T rs3918242MMP9.

Translation and validation of the LittlEars auditory questionnaire in Kannada

OBJECTIVE

The aim of the study was to translate and validate the LittlEARS Auditory Questionnaire (LEAQ) in Kannada.

METHOD

The translation procedure followed a traditional translation, back translation, and content validity process before administering. The finalized version was administered on 87 children with 67 normal hearing children and 20 hearing-impaired children.

RESULTS

The tool had good internal consistency, good reliability, and a norm curve could be established. The Cronbach alpha value for item correlation ranged from 0.26 to 0.79. A significant difference was found between normal hearing individuals and hearing impaired.

CONCLUSION

The LEAQ tool has been translated and validated for the Kannada speaking population and can be used as a screening tool for children up to two years of age and as a subjective outcome measuring tool for hearing aid and Cochlear Implant user.

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.

[Common tools of auditory function assessment in infants and toddlers]

With the prevalence of early hearing detection and intervention program in China, more and more infants and toddlers with hearing loss can be diagnosed and treated timely. During the process, evaluation of auditory function is of great importance, which can fully reflect the outcomes of auditory intervention. With the variety of auditory function evaluation tools, we should concern the psychometric properties and clinical applications of each tool before application.

Cochlear Implantation Outcome in Children with DFNB1 locus Pathogenic Variants

Almost 60% of children with profound prelingual hearing loss (HL) have a genetic determinant of deafness, most frequently two DFNB1 locus (GJB2/GJB6 genes) recessive pathogenic variants. Only few studies combine HL etiology with cochlear implantation (CI) outcome. Patients with profound prelingual HL who received a cochlear implant before 24 months of age and had completed DFNB1 genetic testing were enrolled in the study (n = 196). LittlEARS questionnaire scores were used to assess auditory development. Our data show that children with DFNB1-related HL (n = 149) had good outcome from the CI (6.85, 22.24, and 28 scores at 0, 5, and 9 months post-CI, respectively). A better auditory development was achieved in patients who receive cochlear implants before 12 months of age. Children without residual hearing presented a higher rate of auditory development than children with responses in hearing aids over a wide frequency range prior to CI, but both groups reached a similar level of auditory development after 9 months post-CI. Our data shed light upon the benefits of CI in the homogenous group of patients with HL due to DFNB1 locus pathogenic variants and clearly demonstrate that very early CI is the most effective treatment method in this group of patients.

Validation of the Persian version of the LittlEARS® auditory questionnaire for assessment of auditory development in children with normal hearing

OBJECTIVES

To adapt the LittlEARS^® Auditory Questionnaire into Persian and evaluate the psychometric properties of the Persian version of the questionnaire for children with normal hearing.

METHODS

A "back-translation" method was used to translate and adapt the LittlEARS Auditory Questionnaire into Persian. The translated version was first evaluated by means of an expert-appraisal method. After having improved the Persian version of LittlEARs with the results obtained from that evaluation, various psychometric analyses were carried out to determine the validity and reliability. A group of 240 Persian speaking parents of children below 24 months of age with normal hearing completed the LittlEARS^® Auditory Questionnaire. Various psychometric analyses (scale analysis and item analysis) were conducted.

RESULTS

In the current study, the following scale and item characteristics were investigated: Corrected item-total correlations ranged from 0.14 to 0.74; Cronbach's alpha coefficient value was 0.960; the split-half reliability r was 0.734; predictive accuracy Guttman's lambda was 0.965; the correlation between the overall score and age of the children was 0.808 (p < 0.001). The regression curve, which reflects the age-dependence of auditory behavior, was produced. The regression analysis that was conducted to obtain normative data showed that 80% of the variance in the total scores could be explained by age.

CONCLUSION

The data obtained from psychometric analysis support the use of the Persian version of the LittlEARS Auditory Questionnaire as a reliable and valid tool to assess the development of auditory behavior in Persian speaking children who are 24 months old or younger.

A new adhesive bone conduction hearing system effectively treats conductive hearing loss in children

OBJECTIVES

Bone conduction hearing devices integrated in softbands (BCDSs) are frequently not well accepted by children with conductive hearing loss due to pressure on the head, sweating, or cosmetic stigma. A non-surgical hearing system (ADHEAR) uses a new bone conduction concept consisting of an audio processor connected to an adhesive adapter fixed behind the ear. This study is the first to evaluate the audiological and clinical outcome of this novel system, comparing it with conventional BCDSs in a short- and mid-term follow-up in children under 10 years of age.

METHODS

The ADHEAR was compared to a BCDS in 10 children with conductive hearing loss (age: 0.7-9.7 years). Aided and unaided pure tone/behavioral observational audiometry and, if applicable, speech audiometry in quiet and noise were performed initially with both devices and after 8 weeks with the ADHEAR alone. The subjective hearing gain and usage of the new hearing system, as well as patients' and parents' satisfaction were assessed using questionnaires.

RESULTS

The functional gain with the ADHEAR averaged over 0.5, 1, 2, and 4 kHz exceeded that of the conventional BCDS (35.6 dB ± 15.1 vs. 29.9 dB ± 14.6, p = .001, n = 9 ears). Speech perception in quiet and noise (n = 8) improved in the aided situation similarly for both hearing devices. The parents of 8 of 10 children evaluated the ADHEAR system as being useful. Minor wearing problems occurred occasionally. Eight children continued using the ADHEAR after the study, one received an active middle ear implant and one continued to use a BCDS.

CONCLUSION

The ADHEAR system is a promising solution for children with conductive hearing loss or chronically draining ears.

Cranial orthosis after cochlear implantation in an infant: Helmet modifications

We present an infant with bilateral sensorineural hearing loss caused by bacterial meningitis, and moderate/severe plagiocephaly requiring simultaneous treatment of cochlear implantation for hearing loss and cranial orthosis for plagiocephaly. A helmet modification was created, so that the infant was able to be treated for his plagiocephaly while bilateral cochlear implants were in place, bringing attention to serve needs of those patients requiring cochlear implant and cranial orthosis concurrently. While this case was the first time such a modification was required, which was due to the young age at implantation, the occurrence of the concurrent need may increase as we continue to push the boundaries of early implantation.

Adaptation, validity, and reliability of the Preschool Language Scale-Fifth Edition (PLS-5) in the Turkish context: The Turkish Preschool Language Scale-5 (TPLS-5)

INTRODUCTION

Speech and language assessment is very important in early diagnosis of children with hearing and speech disorders. Aim of this study is to determine the validity and reliability of Preschool Language Scale (5th edition) test with its Turkish translation and adaptation.

METHODS AND MATERIALS

Our study is conducted on 1320 children aged between 0-7 years 11 months. While 1044 of these children have normal hearing, language and speech development, 276 of them have receptive and/or expressive language disorder. After the English-Turkish and Turkish-English translations of PLS-5 made by two experts command of both languages, some of the test items are reorganized because of the grammatical features of Turkish and the cultural structure of the country. The pilot study was conducted with 378 children. The test which is reorganized in the light of data obtained in pilot application, is applied to children chosen randomly with layering technique from different regions of Turkey, then 15 days later the first test applied again to 120 children.

RESULTS

While 1044 of 1320 children aged between 0 and 7 years 11 months are normal, 276 of them have receptive and/or expressive language disorder. While 98 of 103 healthy children of 120 taken under the second evaluation have normal language development, 8 of 9 who used to have language development disorder in the past still remaining (Kappa coefficient:0,468, p<0,001). Pearson correaltion coefficient for TPLS-5 standard gauge are; IA raw score:0,937, IED raw score: 0,908 and TDP: 0,887 respectively. Correlation coefficient for age equivalance is found as IA:0,871, IED: 0,896, TDP: 0,887.

CONCLUSIONS

TPLS-5 is the first and only language test in our country that can evaluate receptive and/or expressive language skills of children aged between 0-7 years 11 months. Results of the study show that TPLS-5 is a valid and reliable language test for the Turkish children.

Validation of the LittlEARS Auditory Questionnaire in cochlear implanted infants and toddlers

OBJECTIVES

The LittlEARS Auditory Questionnaire (LEAQ) has so far been validated to assess auditory development in groups of normal-hearing children in over 20 different languages. Considering the huge variability in auditory development of CI children, especially since candidacy criteria have been relaxed, additional evidence to validate the use of LEAQ scores in this particular population is needed. The aim of this study is to provide evidence for the reliability and validity of LEAQ scores for assessing the auditory development of CI infants and toddlers based on an evaluation of LEAQ's internal structure and its relation to other variables.

METHODS

The study was prospective, with sequential enrolment and within-subject repeated measures. It included 122 children with profound bilateral sensorineural hearing loss implanted at 6-22 months of age. All children were evaluated with the Polish version of LEAQ on the first day of CI activation and at each of four follow-up visits related to sound processor fitting. The study was undertaken in the light of current psychometric thinking about how assessment instruments should be validated. The main aim of the study was to obtain evidence for the validity of interpreting LEAQ measures from CI children in terms of auditory development. First, in order to collect evidence for score reliability and validity based on LEAQ's internal structure, the psychometric properties of LEAQ scores from CI children were determined. A second step was to confirm validity by investigating the effect of concomitant variables on LEAQ scores. Correlations between LEAQ score and duration of hearing aid (HA) use, and between LEAQ score and duration of CI use, were investigated. Additionally, group differences in LEAQ scores between: 1) early and late implanted children; 2) children with long and short HA experience prior to implantation; and 3) children who showed responses over a wide frequency range from using their HAs (prior to implantation) vs those who did not.

RESULTS

On each of the five administrations of LEAQ, the item difficulty indices increased (meaning the items became easier) and over the series they progressively increased with a range of: 0.01-0.62, 0.03-0.92, 0.09-1.00, 0.26-1.00, and 0.52-1.00. At the same time, item-total correlations were in the ranges: 0.09-0.77, 0.26-0.62, 0.00-0.65, 0.00-0.65, and 0.00-0.67. Cronbach's alpha values were above 0.80 for all administrations. A positive correlation between LEAQ score and duration of HA use, and subsequent duration of CI use (hearing experience) was found. When the children were stratified into groups according to age at cochlear implantation, duration of HA use before implantation, and audibility provided by HAs prior to implantation, the differences between the groups were reflected in both their rate of auditory development and their LEAQ score.

CONCLUSION

The interpretation of LEAQ scores from CI children in terms of auditory development was supported by the validity evidence of internal structure and from a logical relationship to other variables. (1) Psychometric properties - item difficulty, item-total correlations, and Cronbach's alpha values - indicate that LEAQ measures are highly consistent and reliably gauge the level of a CI child's auditory development. (2) There was a positive correlation between LEAQ scores and the duration of hearing experience with HAs and a later CI; similarly, there were significant differences between groups of children stratified according to the age at cochlear implantation, duration of HA use before implantation, and audibility provided by HAs prior to implantation, all of which demonstrate the expected relation between LEAQ score and concomitant variables.

A Comprehensive Study on the Etiology of Patients Receiving Cochlear Implantation With Special Emphasis on Genetic Epidemiology

Objective:

Cochlear implantation is the most important treatment currently available for profound sensorineural hearing loss. The aim of this study was to investigate the etiology of hearing loss in patients with cochlear implantation, and to compare outcomes.

Methods:

Japanese hearing loss patients who received cochlear implants (CIs) or electric acoustic stimulation (EAS) in Shinshu University hospital (n = 173, prelingual onset: 92, postlingual onset: 81) participated in this study. Invader assay followed by the targeted exon-sequencing of 63 deafness genes using Massively parallel DNA sequencing (MPS) was applied. For prelingual patients, additional imaging examination, cCMV screening, and pediatric examination were performed for precise diagnosis.

Results:

Genetic screening successfully identified the causative mutation in 60% of patients with prelingual onset hearing loss and in 36% of those with postlingual hearing loss. Differences in the kinds of genes identified were observed between the two groups. Although there were marked variations in the outcome of cochlear implantation, patients with specific deafness gene mutations showed relatively good results.

Conclusion:

The present study showed genetic etiology is a major cause of hearing loss in CI/EAS patients. Patients possessing mutations in a number of deafness genes known to be expressed within inner ear have achieved satisfactory auditory performance, suggesting that the identification of the genetic background facilitates the prediction of post-CI performance. MPS is a powerful tool for the identification of causative deafness genes in patients receiving cochlear implantation. Therefore, determination of the involved region inside/outside of the cochlea by identification of the responsible gene is essential.

Production and evaluation of a Spanish version of the LittlEARS(®) Auditory Questionnaire for the assessment of auditory development in children

BACKGROUND AND AIMS

To adapt the LittlEARS(®) Auditory Questionnaire (LEAQ) into Spanish and evaluate the psychometric properties of the Spanish version of the questionnaire.

METHODS

The LEAQ was translated into Spanish by a back-translation design. Following the Guidelines for Adapting Tests of the International Test Commission (ITC), for the first time with the LEAQ adaptations, two qualitative methods were used to evaluate the translated version of the LEAQ: an expert appraisal method followed by cognitive interviewing. Having improved the Spanish version of the LEAQ with these evaluations, a psychometric analysis was conducted. 215 parents of children with normal hearing aged between 1.7 and 24.0 months participated in the study. Corrected item-total correlations were calculated to analyze to what extent items distinguish levels of auditory development of assessed children. Cronbach's alpha coefficient - to evaluate internal consistency across items - was also calculated. To obtain validity evidence, correlations between item-total score and age were calculated. A non-linear regression model was also estimated to obtain normative data for expected and minimum value of total scores from the questionnaire according to age.

RESULTS

Expert appraisal and cognitive interviewing pointed out some translation errors and difficulties parents had while responding to the Spanish LEAQ. Such errors and difficulties were fixed in the Spanish LEAQ version applied for psychometric analysis. Corrected item-total correlations ranged from 0.15 to 0.75. Cronbach's alpha coefficient value was 0.92, indicating that the measurements are highly reliable. The value of the correlation between total scores and age was 0.86 (p<001). The regression analysis conducted to obtain normative data shows that 79% of the variation in the total scores can be explained by age.

CONCLUSIONS

The results of psychometric analyses provide evidence supporting the use of the Spanish version of the LEAQ as a valid and culturally appropriate tool to assess the development of auditory behaviour in Spanish children who are 24 months old or younger.

Prelingual auditory-perceptual skills as indicators of initial oral language development in deaf children with cochlear implants

OBJECTIVES

To assess when prelingually deaf children with a cochlear implant (CI) achieve the First Milestone of Oral Language, to study the progression of their prelingual auditory skills in the first year after CI and to investigate a possible correlation between such skills and the timing of initial oral language development.

METHODS

The sample included 44 prelingually deaf children (23 M and 21 F) from the same tertiary care institution, who received unilateral or bilateral cochlear implants. Achievement of the First Milestone of Oral Language (FMOL) was defined as speech comprehension of at least 50 words and speech production of a minimum of 10 words, as established by administration of a validated Italian test for the assessment of initial language competence in infants. Prelingual auditory-perceptual skills were assessed over time by means of a test battery consisting of: the Infant Toddler Meaningful Integration Scale (IT-MAIS); the Infant Listening Progress Profile (ILiP) and the Categories of Auditory Performance (CAP).

RESULTS

On average, the 44 children received their CI at 24±9 months and experienced FMOL after 8±4 months of continuous CI use. The IT-MAIS, ILiP and CAP scores increased significantly over time, the greatest improvement occurring between baseline and six months of CI use. On multivariate regression analysis, age at diagnosis and age at CI did not appear to bear correlation with FMOL timing; instead, the only variables contributing to its variance were IT-MAIS and ILiP scores after six months of CI use, accounting for 43% and 55%, respectively.

CONCLUSION

Prelingual auditory skills of implanted children assessed via a test battery six months after CI treatment, can act as indicators of the timing of initial oral language development. Accordingly, the period from CI switch-on to six months can be considered as a window of opportunity for appropriate intervention in children failing to show the expected progression of their auditory skills and who would have higher risk of delayed oral language development.

Simultaneous bilateral cochlear implantation in a five-month-old child with Usher syndrome

OBJECTIVE

To report a rare case of simultaneous bilateral cochlear implantation in a five-month-old child with Usher syndrome.

METHOD

Case report.

RESULTS

A five-month-old boy with Usher syndrome and congenital profound bilateral deafness underwent simultaneous bilateral cochlear implantation. The decision to perform implantation in such a young child was based on his having a supportive family and the desire to foster his audiological development before his vision deteriorated. The subject experienced easily resolvable intra- and post-operative adverse events, and was first fitted with an externally worn audio processor four weeks after implantation. At 14 months of age, his audiological development was age-appropriate.

CONCLUSION

Simultaneous bilateral cochlear implantation is possible, and even advisable, in children as young as five months old when performed by an experienced implantation team.

Early auditory preverbal skills development in Mandarin speaking children with cochlear implants

OBJECTIVE

The purpose of this study was to investigate the development of auditory preverbal skills in Mandarin speaking infants/toddlers with cochlear implants (CIs).

METHODS

Participants were recruited from the Pediatric Audiology Center of Beijing Children's Hospital, Capital Medical University. A total of 33 children with severe-to-profound hearing loss who received CIs participated in the study. The evaluation tools were LittlEARS(®) Auditory Questionnaire (LEAQ) and self-designed demographic information questionnaire. Evaluations were administrated immediately after the CI was switched on (0-month), and at 1, 3, 6, 9, 12, 18, and 24-month intervals of CI use.

RESULTS

The mean total scores of the LEAQ in 0, 1, 3, 6, 9, 12, 18, and 24-month were 1, 5, 10, 15, 21, 24, 30, and 33 points, respectively. The developmental trajectory of early auditory preverbal skills in the CI children was consistent with the published norm data of the LEAQ, and the expected value even slightly higher than the norms. Analysis showed that the parents' level of education and age of implantation influenced the final LEAQ score significantly (ANOVA, p<0.0001).

CONCLUSIONS

Auditory preverbal skills improved dramatically after cochlear implantation in the first 2 years of implant use. Early implanted children exhibited a steeper and faster improvement in auditory preverbal developmental compared to the later implanted peers. This study described the developmental trajectories of preverbal auditory skills and confirmed the effectiveness of early implantation on the development of auditory preverbal skills. The results could provide guidance for auditory/speech rehabilitation in Mandarin speaking infants/toddlers who received CIs in their early age.

Methods and preliminary outcomes of pediatric auditory brainstem implantation

OBJECTIVE

The objective was to provide information about methods used and preliminary outcomes for pediatric ABI (auditory brainstem implant).

STUDY DESIGN

An analysis of outcome was performed in children who received an ABI.

METHODS

Twelve children received a MED-EL ABI system. Progress in audition and language was monitored through parental reports, questionnaires, profiles, and closed-set tests.

RESULTS

The median number of active electrodes was 9 of 12. Seven of 12 users consistently respond to sound, and 5 of 12 do not. Highest performers can recognize words in small sets and have begun to use some words.

CONCLUSION

Auditory brainstem implants appear to be beneficial for some pediatric patients who cannot benefit from traditional cochlear implant surgery. Benefits in the short-term can be recognition of environmental sounds, recognition of some words and very commonly used phrases, and the beginning use of words. Although some of our ABI users demonstrate no response to sound, they do want to wear their sound processors all waking hours. The cause of lack of response may be related to the second intervention, which might have led to displacement of the electrode array, or presence of additional handicaps or syndromes. However, the results are less than optimal. The relatively short postoperative follow-up duration is a considered weakness of this study.

Assessment of early auditory development of very young Finnish children with LittlEARS(®) Auditory Questionnaire and McArthur Communicative Developmental Inventories

OBJECTIVES

We analysed the Finnish version of the LittlEARS(®) Auditory Questionnaire as a method for assessing very young children's early auditory, pre-verbal and emerging verbal development. We also examined whether any background factors exist that influence the results and thus the usability of this method. To determine its potential in assessment, the Finnish version of the LittlEARS(®) Auditory Questionnaire was analysed in relation to the Finnish McArthur Communicative Developmental Inventories. The latter is currently the method most commonly used together with parental interviews. However, this method is neither designed for infants younger than 8 months nor is its main emphasis on auditory development. Thus, we investigated whether the Finnish version of LittlEARS(®) Auditory Questionnaire could supplement the Finnish McArthur Communicative Developmental Inventories and thereby help in detecting children with hearing impairments.

METHODS

Normative data were collected for Finnish children with normal hearing (N=318) using the LittlEARS(®) Auditory Questionnaire and an abridged version of the Finnish McArthur Communicative Developmental Inventories. In addition, background information was collected with a questionnaire designed for this study. The results of these questionnaires were analysed in relation to each other.

RESULTS

Statistical analysis showed that the results gained with the Finnish version of LittlEARS(®) Auditory Questionnaire and the abridged version of the Finnish McArthur Communicative Developmental Inventories are closely related. However, the LittlEARS(®) Auditory Questionnaire manages to capture the earlier and subtler changes that occur in infancy, therefore making a good continuum with McArthur Communicative Developmental Inventories. Also, most background factors, such as parents' educational level, did not affect the results significantly, rendering the LittlEARS(®) Auditory Questionnaire a valuable method for assessment of early auditory development in very young children.

CONCLUSIONS

The Finnish version of the LittlEARS(®) Auditory Questionnaire is a reliable assessment tool with no confounding background factors. It enables evaluation of the early auditory development in even the youngest of children.

RAPID ASSESSMENT OF BILATERAL COCHLEAR IMPLANTATION FOR CHILDREN IN KAZAKHSTAN

Objectives:The aim of this study was to evaluate the effectiveness of bilateral cochlear implantation (CI) compared with unilateral CI for deaf children in the context of the Republic of Kazakhstan health system.

Methods.A literature search was conducted, using the PubMed, Cochrane, and Embase data bases for studies that compared the effectiveness of bilateral and unilateral CI in children. The search included English language, publications from 2002–2012. Two reviewers independently evaluated all relevant studies. Administrative data relevant to CI in Kazakhstan were obtained from the Ministry of Health.

Results: Three relevant systematic reviews and an health technology assessment report were found. There was evidence of incremental benefits from bilateral CI but the quality of the available studies was poor and there was little information on longer term outcomes. No conclusions could be drawn regarding later incremental improvements to speech perception, learning, and quality of life. To date, in the Republic of Kazakhstan there is not full coverage of audiological screening due to the lack of medical equipment. This leads to late detection of hearing-impaired children and a long rehabilitation period, requiring more resources. Age of implantation in children is late and only a small minority attend general schools.

Conclusions:The clinical effectiveness of bilateral CI, an expensive health technology, requires further study. Given the current situation in Kazakhstan with audiological screening and access to unilateral CI, there appeared to be other priorities for improving services for children with profound hearing impairment.

Factors that influence the participation of parents in the oral rehabilitation process of children with cochlear implants: a systematic review

PURPOSE

To identify and analyze factors that influence the participation of parents in the rehabilitation process of children with cochlear implants (CI).

RESEARCH STRATEGY

Question formulation and articles selection in three databases using the following keywords: cochlear implant (implante coclear) and parents (pais).

SELECTION CRITERIA

Complete original articles published in Brazilian Portuguese or English, with direct participation of parents of children with CI.

DATA ANALYSIS

Articles were fully read. Data regarding characterization of the centers, research methodology and content were analyzed.

RESULTS

Thirteen articles were selected based on the established criteria. The types of studies were cross-sectional and case-control (interview technique). The following influential factors were identified: pre-CI surgery factors (knowledge about CI, quality and quantity of information, specialist's advices, ethical and biomedical aspects, rehabilitation engagement, contact with experienced families, social service support and overall costs); rehabilitation aspects (CI use, oral communication modality, regular school, other disabilities, social and demographic aspects and rehabilitation program's effectiveness); other important influential processes (communication modality, auditory and language development, second oral language learning, as well as parent's behavior and satisfaction).

CONCLUSION

The engagement of parents in the rehabilitation process of children with CI depends on several distinct influential factors which audiologists should understand and consider when elaborating a rehabilitation program.

Sensitivity of ABR based newborn screening with the MB11 BERAphone(®)

OBJECTIVES

The aim of this study is to evaluate the sensitivity of our hearing screening program. The evaluation was done using a questionnaire for parents of children who participated in the NHS for a targeted time frame of two years. A survey was accomplished to identify children who passed our screening protocol in the newborn period, but who were later identified to have hearing loss.

METHODS

For the survey a one-year cohort was established in 2008 which included 500 children who received a hearing screening at our Center with the ABR newborn screener, MB11 BERAphone(®), two years before. Two hearing questionnaires were chosen for the survey. The LittlEARS questionnaire (MED-EL Medical Electronics GmbH) for investigating the hearing behavior of the children during the first two years of life and a second, custom-developed questionnaire (Würzburger questionnaire) investigating some aspects which are not included in the LittlEARS tool, such as speech/language development, general development as well as pathological factors that might eventually lead to a temporary hearing loss.

RESULTS

Analysis of the Würzburger questionnaires revealed normal speech development for 92.9% of the children. For 4.7% male and 2.4% female children delayed speech development was reported. Although twice as many males were found, the statistical comparison showed no significant difference according to gender. The results of the LittlEARS questionnaire are identical to those of the Würzburger questionnaire in 98.3% of the investigated cases and in 1.7% of the cases slightly different results but on borderline: The LittlEAR scores showed normal auditory development for the childrens' age but the Würzburger questionnaire results showed delayed speech development.

CONCLUSIONS

Based on the follow-up analysis and the results from the two questionnaires, no permanent hearing loss was found in any child two years after they passed the newborn hearing screening. Thus, we conclude that the sensitivity of the screening test was 100%, based on survey results 2 years post screening.

Transient Hearing Loss Within a Critical Period Causes Persistent Changes to Cellular Properties in Adult Auditory Cortex

Sensory deprivation can induce profound changes to central processing during developmental critical periods (CPs), and the recovery of normal function is maximal if the sensory input is restored during these epochs. Therefore, we asked whether mild and transient hearing loss (HL) during discrete CPs could induce changes to cortical cellular physiology. Electrical and inhibitory synaptic properties were obtained from auditory cortex pyramidal neurons using whole-cell recordings after bilateral earplug insertion or following earplug removal. Varying the age of HL onset revealed brief CPs of vulnerability for membrane and firing properties, as well as, inhibitory synaptic currents. These CPs closed 1 week after ear canal opening on postnatal day (P) 18. To examine whether the cellular properties could recover from HL, earplugs were removed prior to (P17) or after (P23), the closure of these CPs. The earlier age of hearing restoration led to greater recovery of cellular function, but firing rate remained disrupted. When earplugs were removed after the closure of these CPs, several changes persisted into adulthood. Therefore, long-lasting cellular deficits that emerge from transient deprivation during a CP may contribute to delayed acquisition of auditory skills in children who experience temporary HL.

Acquisition of early auditory milestones with a cochlear implant

OBJECTIVE

Speech acquisition after cochlear implant is a long process. Various studies have followed the auditory milestones in the early period after implantation. The aim of the present study was to track the development of hearing skills in the early period after cochlear implantation and evaluate which factors influence the process.

METHODS

195 records of children implanted in the Hadassah Medical Center were examined retrospectively. Data on etiology, age at implantation and type of implant were collected. In addition, information on the rate of progress was measured: the first time that there was detection and identification of Ling sounds, the first time it was possible to obtain SDT (speech detection threshold), SRT (speech reception threshold) and an audiogram, and the first accurate repetition of VCV (vowel consonant vowel) sounds.

RESULTS

Results show a consistent pattern of auditory milestone acquisition similar to that of normal development, from milestones that do not require decoding beginning with SDT, detection of Ling sounds followed by an audiogram which requires cooperation, to tasks that involve decoding starting with SRT and repetition of Ling sounds and finally VCV repetition. The children implanted before 24 months of age achieved the auditory milestones later than children implanted between 2 and 6 years, apparently since these tasks involve cognitive abilities which are not yet developed in the youngest children. Previous hearing experience improved the rate of acquisition of the auditory milestones and progress was faster in the second implanted ear compared to the first implanted ear.

CONCLUSION

More research is needed to address the relationship between acquisition of early auditory milestones and performance with the cochlear implant later on in life.

Validation of the Mandarin version of the LittlEARS® Auditory Questionnaire

OBJECTIVES

To evaluate the psychometric properties of the Mandarin version of the LittlEARS(®)Auditory Questionnaire and to compare the parameters with those of the original German version of the questionnaire. The results would indicate whether the Mandarin version of the questionnaire can be applied in Mandarin speaking children or not.

METHODS

A "back-translation" method was used to translate and adapt the LittlEARS(®) Auditory Questionnaire into Mandarin. A group of 157 Mandarin speaking parents of children below 24 months of age with normal hearing completed the LittlEARS(®) Auditory Questionnaire. Various psychometric analyses (scale analysis and item analysis) were conducted and compared with the original German version.

RESULTS

The following scale characteristics were found with the above sample: internal consistency: Cronbach's alpha = 0.945; reliability: split-half r = 0.914; predictive accuracy: Guttman's lambda = 0.882; correlation between overall score and age of the children: r = 0.841. Several parameters (correlation between age and item score, index of difficulty, discrimination coefficient) of each item were also calculated. The regression curve, which reflects the age-dependence of auditory behavior, was produced. All parameters above had no significant differences with the corresponding ones of the original German version. Standardized values (expected and minimum values) of the Mandarin LittlEARS(®) Auditory Questionnaire were provided.

CONCLUSION

The Mandarin version of the LittlEARS(®) Auditory Questionnaire is reliable and valid as a sensitive tool to assess the development of auditory behavior in Mandarin speaking children up to 24 months of age. The Mandarin standardized values are helpful for clinicians to reach a preliminary judgment in children's hearing screening or for parents to monitor the auditory development of their hearing-impaired children.

Young cochlear implant users' auditory development as measured and monitored by the LittlEARS® Auditory Questionnaire: a Turkish experience

OBJECTIVE

This study aims to assess the usefulness of the LittlEARS(®) Auditory Questionnaire (LEAQ) in determining the audiological development of Turkish children who have received a cochlear implant.

METHODS

20 children received a cochlear implant before their 3rd birthday. Each child's progress was evaluated with the LittlEARS(®) Auditory Questionnaire at first device fitting and then at 3-month intervals for 2 years. Scores were compared with the age-related norms established by hearing children.

RESULTS

All children showed a significant increase in LittlEARS(®) Auditory Questionnaire scores over time. Nearly all children showed a growth in auditory skills similar to that of hearing children. Children without additional needs showed more development than did children with additional needs.

CONCLUSIONS

The LittlEARS(®) Auditory Questionnaire is useful for monitoring the audiological development of young children with a cochlear implant. Confirmation that a cochlear implant user is achieving typical auditory milestones serves to boost parental morale during a child's pre-verbal stage when parents may be anxious about their child's ability to talk. The questionnaire could also be useful as an early warning system. Poor scores likely indicate that something is impeding the child's development. This should prompt professionals to try to identify the impediment, whether technical, medical, social or educational and, possibly, eliminate/mitigate its effects while the child is still in his/her critical development stages.

The Hebrew and the Arabic version of the LittlEARS® auditory questionnaire for the assessment of auditory development: results in normal hearing children and children with cochlear implants

OBJECTIVE

With more children receiving cochlear implants at an early age, there is a need for evaluation and assessment of early auditory behavior. We present the translation of the LittlEARS® Auditory Questionnaire into Hebrew and into Arabic. First the validation of the LittlEARS® Auditory Questionnaire in normal hearing children was evaluated. Second, the auditory behavior and the progress in hearing skills of a group of children with cochlear implants were assessed.

METHODS

A "back-translation" method was used to translate and adapt the LittlEARS® Auditory Questionnaire into Hebrew and into Arabic. Normal hearing participants included 70 Hebrew speaking and 97 Arabic speaking parents of children from 1 to 24 months of age with normal hearing. An additional group of 42 parents of children with cochlear implants with a hearing age of up to 24 months completed the LittlEARS® Auditory Questionnaire. 27 of them completed the questionnaire more than once at intervals, so that change and development could be recorded. Scores on the LittlEARS® Auditory Questionnaire were compared to results of SIR and CAP scales and other available auditory data.

RESULTS

The results of the first study show that the curves found for the Hebrew and the Arabic translations of the LittlEARS® Auditory Questionnaire are essentially similar to those previously found for other languages. These curves reflect the age dependency of auditory skills. Furthermore, in the group with cochlear implants the developmental pattern was different than that of the normal hearing group, with an initial steep increase and a later slower improvement. This trend appeared both in curves of groups and in curves of individuals (individuals whose parents completed the questionnaire at several points in time). There was a high correlation between scores on the LittlEARS® Auditory Questionnaire and results of other audiologic tests, showing validity of results with the LittlEARS® Auditory Questionnaire.

CONCLUSION

Both the Hebrew and Arabic versions of the LittlEARS® Auditory Questionnaire were found to be reliable and valid tools for assessment of the development of auditory behavior in children up to the age of 24 months. Furthermore, the LittlEARS® Auditory Questionnaire in both languages is useful in monitoring the progress of children with cochlear implant.

Measuring communicative performance with the German version of the FAPCI-instrument: normative data and longitudinal results

OBJECTIVE

The German version of the Functioning after Paediatric Cochlear Implantation (FAPCI) inventory was designed to capture the communicative performance of cochlear implanted children. In order to be able to compare cochlear-implanted children to their normal hearing peers, normative growth curves were designed. Furthermore it was of interest how the communicative performance develops over time and whether it is influenced by age at implantation.

METHOD

A polynomial regression curve was fit to the data of 133 normal hearing children. This normative curve was compared to individual growth curves of 90 cochlear implanted children. The cochlear-implanted study sample was split up into four groups depending on the age at implantation.

RESULTS

The normative growth curve increases from 1 year of age until saturation is reached with 3 years of age. The individual FAPCI trajectories of cochlear implanted children are heterogeneous, but in general they are delayed in comparison to the normative growth curve. "Early implanted children" follow the development of their normal hearing peers more closely than "later-implanted children".

CONCLUSION

The German version of the FAPCI parental questionnaire constitutes an additional instrument in monitoring the communicative performance development of cochlear implanted children and allows for comparison to normal hearing peers.