Associations between childhood hearing loss and behavioural and academic difficulties: A Danish cohort study

Ear disease, hearing loss, and cognitive outcomes in high school children who were previous participants in a randomized placebo controlled trial of an 11 valent conjugate pneumococcal vaccine administered in infancy

Background

The WHO estimates that close to 1.7 billion people worldwide have hearing loss; 34 million of whom are children, with 90% residing in low- and middle-income countries. While the effects of ear disease and hearing loss on language, academic, and behavioral development are established, there is remarkably little data on intellectual and other cognitive differences.

Methods

Here we report results from an extension of a randomized controlled vaccination trial originally carried out between 2000 and 2004. Primary caregivers completed demographic and household questionnaires. Beginning in 2016, children were followed up for a hearing and ear disease evaluation. Participants also completed extensive cognitive testing, which included the domains of IQ, language, attention and processing speed, visual and visuospatial skills, and learning and memory. The association between ear disease and hearing loss and each of the cognitive outcomes was examined using multivariate linear regression models.

Findings

We followed up 8926 children ages 14-19 years old. Children with hearing loss or ear disease had lower socioeconomic status compared to children without. However, even after controlling for a high number of covariates, all levels of ear disease or hearing loss were associated with clinically relevant reductions across all cognitive domains, though effect sizes were small. Even mild ear disease or hearing loss was associated with a -0.15 (95% CI: -0.20, -0.11) and a -0.23 (95% CI: -0.32, -0.14) standard deviation reduction, respectively, in IQ. The effects of ear disease and hearing loss were additive as children with both had the lowest cognitive scores.

Interpretation

Untreated ear disease and hearing loss exert measurable effects on cognition that are able to be detected into the teenage years. Early identification of hearing loss and chronic ear disease may have lifelong benefits. Individuals with ear disease and/or hearing loss may require supports and services in addition to those related to speech and language therapy.

Funding

The Bill and Melinda Gates Foundation OPP1142570.

Hearing loss in school-aged children

BACKGROUND

Hearing loss is a common disability affecting 5% of the world's population. A lack of opportune diagnosis affects both the individual and society. In order to develop public health policies in the field of hearing health, countries must have information about epidemiology.

AIMS/OBJECTIVES

In this review, we describe the information available about prevalence and incidence of hearing loss in school-aged children.

MATERIAL AND METHODS

Review of the literature in PubMed.

RESULTS

Reported prevalence of hearing loss in school-aged children varied between 0.2% and 7.8%. Several factors could explain the discrepancy in numbers such as definition of hearing loss, cause, and the inclusion of high-frequency hearing loss. The rate of delayed-onset hearing loss at the age of six years old varied between 0.6 and 0.8 per 1000.

CONCLUSIONS AND SIGNIFICANCE

The prevalence of hearing loss in school-aged children varied between 0.2% and 7.8%, and the rate of delayed-onset hearing loss at the age of six years old varied between 0.6 and 0.8 per 1000.

Follow-up on children with suspected bilateral congenital hearing loss identified through universal newborn hearing screening program in Taiwan: A national-based population study

OBJECTIVE

This investigation was to ascertain the performance of the UNHS in Taiwan.

METHODS

The predefined questionnaire was delivered on the phone in 2016. The descriptive analysis was applied to the research data. 941 neonates in birth cohorts 2013-2014 who were documented as a bilateral referral in the national UNHS tracking system were targeted. The respondents were either caregivers or family members.

RESULTS

40.3% of 941 children were lost to follow-up, and 66.24% of 363 children were diagnosed with SNHL. 45.15% of 163 children used hearing amplification device(s). 77.46% of hearing amplification device users and 7.51% of non-users participated in the auditory training courses. By six months of age, 38.51% and 22.58% of children diagnosed with bilateral SNHL commenced the hearing amplification device fitting and the auditory training courses, respectively.

CONCLUSIONS

More efforts are needed to enhance the performance of the UNHS to achieve national goals stated in the 2014 Taiwan UNHS Revised Guidelines and the well-known benchmarks set by the JCIH in 2007. The development of an electronic tracking system for storing and sharing information on the follow-up on children with congenital hearing loss was as significant as the improvements in the understanding of early hearing detection and intervention of the public and stakeholders.

Sleep disturbance has the largest impact on children's behavior and emotions

OBJECTIVE

Children's behavior and emotions are affected by sleep disturbances, the parent-child relationship, media viewing time, and the social status of parents and caregivers. We conducted a questionnaire survey to identify the factors that have the greatest impact on children's behavior and emotions and how these factors relate to each other.

METHODS

A parental questionnaire survey was performed at a public elementary school. The questionnaire comprised questions on the family environment (e.g., family structure, media and game exposure, after-school lessons, and caregiver's work schedule) and physical information, the Strengths and Difficulties Questionnaire (SDQ), the Children's Sleep Habits Questionnaire (CSHQ), and the Pittsburgh Sleep Quality Index (PSQI) for parents' sleep condition. A path diagram was drawn to hypothesize the complex interrelationships among factors, and structural equation modeling was used to estimate the path coefficients.

RESULT

We identified several factors that significantly affected the SDQ score. The CSHQ total score had the largest impact, followed by after-school lessons, single-mother families, and children's sex. In addition, several indirect pathways that led to the CSHQ score (i.e., a pathway from time spent watching television to CSHQ score via children's bedtime and a pathway from single-mother family to CSHQ score via PSQI total score) significantly affected the SDQ score.

CONCLUSION

Children's sleep habits that were influenced by several environmental factors had the greatest impact on children's behavior and emotions, which suggested that children's behavioral problems can be improved by interventions focused on sleep habits, such as sleep hygiene instructions.

Youth with hearing loss: Emotional and behavioral problems and quality of life

OBJECTIVES

To compare parent- and self-reported emotional and behavioral problems and quality of life (QoL) among youth with hearing loss (HL) to norms, and to investigate possible associations between emotional and behavioral problems and QoL among youth with HL.

METHODS

We used the Strengths and Difficulties questionnaire (SDQ) and the Inventory of Life Quality in Children and Adolescents (ILC) to measure emotional and behavioral problems and QoL in youth with HL (n = 317, ages 6-18), where 78% had bilateral HL, 22% unilateral HL, 16% had cochlear implants, and 59% conventional hearing aids.

RESULTS

The youth with HL had significantly more parent-reported (but not self-reported) emotional and behavioral problems and poorer parent- and self-reported QoL than hearing youth. SDQ and ILC total scores were significantly correlated (-0.47 to -0.63). Conclusion Emotional and behavioral problems and poor QoL appear closely related in youth with HL, suggesting that attending to these problems may improve QoL.

Cognitive effects of low dose of ionizing radiation - Lessons learned and research gaps from epidemiological and biological studies

The last decades have seen increased concern about the possible effects of low to moderate doses of ionizing radiation (IR) exposure on cognitive function. An interdisciplinary group of experts (biologists, epidemiologists, dosimetrists and clinicians) in this field gathered together in the framework of the European MELODI workshop on non-cancer effects of IR to summarise the state of knowledge on the topic and elaborate research recommendations for future studies in this area. Overall, there is evidence of cognitive effects from low IR doses both from biology and epidemiology, though a better characterization of effects and understanding of mechanisms is needed. There is a need to better describe the specific cognitive function or diseases that may be affected by radiation exposure. Such cognitive deficit characterization should consider the human life span, as effects might differ with age at exposure and at outcome assessment. Measurements of biomarkers, including imaging, will likely help our understanding on the mechanism of cognitive-related radiation induced deficit. The identification of loci of individual genetic susceptibility and the study of gene expression may help identify individuals at higher risk. The mechanisms behind the radiation induced cognitive effects are not clear and are likely to involve several biological pathways and different cell types. Well conducted research in large epidemiological cohorts and experimental studies in appropriate animal models are needed to improve the understanding of radiation-induced cognitive effects. Results may then be translated into recommendations for clinical radiation oncology and imaging decision making processes.

Bullying and Children who are Deaf or Hard-of-hearing: A Scoping Review

OBJECTIVE/HYPOTHESIS

The goal of this scoping review is to evaluate and synthesize the published research regarding bullying and children who are deaf or hard-of-hearing (DHH).

STUDY DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) statement was used as the guideline for conducting this review.

METHODS

This review included studies assessing pediatric (0-21 years) DHH children. Seventy records underwent the initial title-abstract screening, 33 underwent full-text review, and 23 studies met inclusion criteria. During the data extraction process, an additional six were excluded, resulting in a total of 17 evaluated studies.

RESULTS

Of the 17 studies assessed, nine compared peer victimization of DHH children and their hearing peers. Of those, seven studies reported that hearing loss (HL) is significantly associated with increased victimization. Two studies found that HL is significantly associated with decreased bullying perpetration. Notably, bullying in DHH children was not associated with a visible sign of disability, such as a hearing assistive device. Rather, variables such as educational setting, parental, and peer support are more likely to mediate bullying in this population.

CONCLUSIONS

DHH children have a higher risk of peer victimization and may bully others less often than their hearing peers. Studies described the health consequences of bullying in children who are DHH, including sleep issues and anxiety. These consequences may have implications for the patients' overall HL management. Additional research regarding bullying interventions and prevention in this population should be conducted.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:1884-1892, 2021.

An evaluation of the Hear Glue Ear mobile application for children aged 2-8 years old with otitis media with effusion

Objectives

To evaluate the acceptability and usability of the Hear Glue Ear mobile application to guide families and support speech and language development in children with otitis media with effusion (OME). To assess the validity of the app’s game-based hearing test to estimate changes in hearing levels between audiology appointments.

Method

This evaluation examined 60 children aged 2–8 with and without OME, attending Cambridge Community Audiology clinics. Children’s performance in the app’s hearing test was compared to their pure tone average (PTA) obtained in clinic. Children and caregivers completed questionnaires after their first interaction with the app, and after one week of using it at home. 18 clinicians completed anonymous questionnaires after trialling the app.

Results

Results from the app’s hearing test show a significant correlation with clinic PTA values (r22=−0.656,p=0.000251). 73.1% of caregivers supported their child using the app regularly and 85% thought it enabled them to give more accurate reports to clinicians. After one week, 87.0% of families downloaded and used the app at home, and 85.7% of these felt it provided strategies to help their child. 100% of children liked the app and 93.3% found it easy to use. 77.8% of clinicians supported patients using the app regularly.

Conclusions

Hear Glue Ear is acceptable to children, caregivers and clinicians as part of OME management. The app’s hearing test provides a valid estimate of fluctuating hearing levels. Hear Glue Ear is a free, accessible and family-centred intervention to provide trusted information and support development, as NICE guidance recommends.

Childhood Sensorineural Hearing Loss and Educational Attainment in Adulthood: Results From the HUNT Study

OBJECTIVES

Although the educational achievement gap between people without hearing loss and people with hearing loss is well-documented, few studies are based on large, nonclinical samples. The present study aims to investigate the educational attainment among Norwegian adults diagnosed with sensorineural hearing loss as children, compared with a matched control group of people without hearing loss.

DESIGN

A prospective cohort design was applied. Between 1954 and 1986, the children in the first, fourth, and/or seventh grade in all primary schools in Nord-Trøndelag County participated in the School Hearing Investigation in Nord-Trøndelag, in which they underwent audiometric screening. Those with positive results had their hearing further tested by means of pure tone audiometry at 0.25, 0.5, 1, 2, 4, and 8 kHz with air- and bone-conduction thresholds, as well as a full examination by an ear, nose, and throat (ENT) specialist. In the present study, 216 persons were classified with moderate-severe hearing loss (41 to 100 dB HL), 293 with mild hearing loss (26 to 40 dB HL), and 240 with slight hearing loss (16 to 25 dB HL). Age-matched controls were recruited from the Norwegian Health Study, which was conducted in the same county. A total of 48,606 people participated in the present study. Data on educational attainment up to 2014 was provided by Statistics Norway. Control variables comprised sex, age, mothers', and fathers' education. The relation between childhood sensorineural hearing loss and educational attainment was tested by means of multinomial logistic regression models; first for the total sample (born between 1941 and 1979), and then for two different birth cohorts born between 1941 and 1959 and between 1960 and 1979.

RESULTS

Percentwise, the educational attainment level in general has increased, both among people without hearing loss and people with hearing loss, and especially for women. However, 27.5% of people without hearing loss obtained higher education, whereas the corresponding numbers for those with mild or moderate-severe hearing loss were 18.8%, and 21.3%, respectively. The results from the regression analyses showed that in the total sample, compared with having primary education, people with moderate-severe or mild hearing loss were about half as likely to achieve higher education as people without hearing loss (odds ratio (OR) = 0.63 and 0.49, respectively). An interaction term between sensorineural hearing loss and sex was specified but it was not significant. In the older cohort, we found a significant association between mild hearing loss and higher education (OR = 0.40), and between moderate-severe hearing loss and secondary education (OR = 0.65). In the younger cohort, there was a significant association between mild hearing loss and higher education (OR = 0.56) and between slight hearing loss and secondary education (OR = 0.61).

CONCLUSIONS

The results from this study indicate that the achievement gap between people without hearing loss and those with hearing loss remains. Future studies should try to pinpoint what might be hindering people with slight, mild, moderate, or severe hearing loss in pursuing higher education. Parents, health personnel, institutions for higher education, and policy makers alike should take this into consideration when making plans and policies.

Harderian gland-derived stem cells as a cytotherapy in a guinea pig model of carboplatin-induced hearing loss

BACKGROUND

Stem cells therapy of hearing loss is a challenging field due to lacking self-regenerative capacity of cochlea. Harderian gland of guinea pigs was thought to harbour a unique type of progenitors which could restore the damaged cochlear tissues.

THE AIM

of this study was to isolate Harderian gland derived stem cells (HG-SCs) and investigate their efficacy in restoring the damaged cochlear tissue in carboplatin-induced hearing loss.

METHODOLOGY

Sixty female and 10 male pigmented guinea pigs were used; the male animals were HG-SCs donors, while the females were assigned into 3 groups; control, hearing loss (HL) and HG-SC-treated groups. Auditory reflexes were assessed throughout the study. The animals were euthanized 35 days after HG-SCs transplantation, the cochleae were extracted and processed for assessment by light microscope and scanning electron microscope. Morphometric assessment of stria vascularis thickness, hair cells and spiral ganglia neuronal number and optical density of TLR4 expression were done.

RESULTS

The isolated HG-SCs had the same morphological and phenotypical character as mesenchymal stem cells. HL group revealed destruction of organ of Corti, stria vascularis and spiral ganglion with decreased morphometric parameters. Restoration of both cochlear structure and function was observed in HG-SC-treated group along with a significant increase in IHCs, OHCs numbers, stria vascularis thickness and spiral ganglionic cell count to be close to the values of control group.

CONCLUSION

The isolated HG-SCs were proved to restore structure and function of cochlea in guinea pig model of hearing loss.

Impact of co-occurring hearing and visual difficulties in childhood on educational outcomes: a longitudinal cohort study

BACKGROUND

Mild hearing and visual difficulties are common in childhood, and both may have implications for educational achievement. However, the impact of co-occurring common hearing and visual difficulties in childhood is not known.

OBJECTIVE

To determine the prevalence and impact of co-occurring common hearing and visual difficulties of childhood on educational outcomes in primary and secondary school.

METHODS

The sample was drawn from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort study in England. The exposures were hearing and visual difficulties at age 7 (defined as conductive hearing loss or otitis media with effusion, and amblyopia, strabismus or reduced visual acuity, respectively). The outcomes measured were achievement of level 4 or above at Key Stage 2 (KS2) in English, Maths and Science, respectively, at age 11, and attainment of five or more General Certificate of Secondary Education (GCSEs) at grades A*-C at age 16. Multiple logistic regression models assessed the relationship between hearing and visual difficulties and educational outcomes, adjusting for potential confounding factors.

RESULTS

2909 children were included in the study; 261 had hearing difficulties, 189 had visual difficulties and 14 children had co-occurring hearing and visual difficulties. Children with co-occurring hearing and visual difficulties were less likely to achieve the national target at KS2 compared with children with normal hearing and vision, even after adjustment for confounding factors (OR 0.30, CI 0.15 to 0.61 for KS2 English). Differences in IQ, behaviour, attention and social cognition did not account for this relationship. The impact of co-occurring hearing and visual difficulties on GCSE results was explained largely by poor performance at KS2.

CONCLUSIONS

Co-occurring hearing and visual difficulties in childhood have an enduring negative impact on educational outcomes. Identification of affected children and early intervention in primary school is essential.

Recent Advancements in the Regeneration of Auditory Hair Cells and Hearing Restoration

Neurosensory responses of hearing and balance are mediated by receptors in specialized neuroepithelial sensory cells. Any disruption of the biochemical and molecular pathways that facilitate these responses can result in severe deficits, including hearing loss and vestibular dysfunction. Hearing is affected by both environmental and genetic factors, with impairment of auditory function being the most common neurosensory disorder affecting 1 in 500 newborns, as well as having an impact on the majority of elderly population. Damage to auditory sensory cells is not reversible, and if sufficient damage and cell death have taken place, the resultant deficit may lead to permanent deafness. Cochlear implants are considered to be one of the most successful and consistent treatments for deaf patients, but only offer limited recovery at the expense of loss of residual hearing. Recently there has been an increased interest in the auditory research community to explore the regeneration of mammalian auditory hair cells and restoration of their function. In this review article, we examine a variety of recent therapies, including genetic, stem cell and molecular therapies as well as discussing progress being made in genome editing strategies as applied to the restoration of hearing function.