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Findlen UM, Gerth H, Zemba A, Schuller N, Guerra G, Vaughan C, Brimmer M, Benedict J. Examining Barriers to Early Hearing Diagnosis. Am J Audiol 2024; 33:369-378. [PMID: 38416788 DOI: 10.1044/2024_aja-23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
PURPOSE Many factors create barriers for early hearing detection and intervention (EHDI), especially those related to unfavorable social determinants of health (SDOH). The primary aim of this study was to evaluate diagnostic timing of infants at risk for congenital hearing loss in consideration of known barriers. Understanding the specific barriers to early diagnosis can inform interventions to improve timeliness of diagnosis and subsequent habilitation. METHOD A retrospective chart review was completed for infants referred for diagnostic audiologic testing at a tertiary urban-setting Children's Hospital from 2018 to 2021. After exclusion criteria were applied, 1,488 infants were included in the analysis. Various factors were recorded from electronic medical records including those specific to SDOH. Time to diagnosis was derived and compared across five factors of interest that have previously been shown to impact diagnostic timeline, including (a) insurance type, (b) race/ethnicity, (c) presence of middle ear dysfunction at first auditory brainstem response (ABR), (d) proximity to diagnostic center, and (e) diagnostic timing before and during/after the COVID-19 pandemic. RESULTS Across the study time period, 77% of infants referred for diagnostic testing had confirmed diagnosis by the EHDI benchmark of 3 months. Analysis of time to diagnosis across factors of interest revealed no clinically significant differences for insurance type, race/ethnicity, proximity to diagnostic center, or timing in reference to the COVID-19 pandemic. Presence of middle ear dysfunction on first ABR was found to significantly protract final diagnostic timing. CONCLUSIONS Although some known barriers for EHDI can be universal, other factors may have a differential impact on an infant's timeline to diagnosis based on their specific location, which can interact differently with additional known barriers. Understanding local challenges will serve to better guide programs in implementing facilitators that will address their specific needs for improved outcomes.
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Affiliation(s)
- Ursula M Findlen
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Holly Gerth
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Angie Zemba
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Nicole Schuller
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Gina Guerra
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Chloe Vaughan
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Madeline Brimmer
- Division of Clinical Therapies, Department of Audiology, Nationwide Children's Hospital, Columbus, OH
| | - Jason Benedict
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus
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Cree RA, Bitsko R, Grimm C, Nash A, Cahill ES, Dunham E, Logan N, McKay SL, Martinez DR, Gaffney M. Provider Perspectives: Identification and Follow-up of Infants who Are Deaf or Hard of Hearing. Am J Perinatol 2024; 41:e694-e710. [PMID: 36037854 PMCID: PMC10140186 DOI: 10.1055/a-1932-9985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1 vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas. STUDY DESIGN Data were collected through semistructured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach. RESULTS Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas. CONCLUSION These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services. KEY POINTS · Infants with suspected hearing loss may not receive timely diagnosis or early intervention.. · We interviewed healthcare providers in Texas along the hearing care continuum.. · Findings suggest strategies to increase the number of children with hearing loss identified early..
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Affiliation(s)
- Robyn A. Cree
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities (NCBDDD), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Rebecca Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities (NCBDDD), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Cheri Grimm
- Texas Early Hearing and Detection Intervention Program (TEHDI), Texas Department of State Health Services (TDSHS), Austin, Texas
| | - Ashley Nash
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities (NCBDDD), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Oak Ridge Institute for Science Education (ORISE), Oak Ridge, Tennessee
| | - Eric S. Cahill
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities (NCBDDD), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Eugenia Dunham
- Texas Early Hearing and Detection Intervention Program (TEHDI), Texas Department of State Health Services (TDSHS), Austin, Texas
| | - Naeemah Logan
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Global HIV and TB, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susannah L. McKay
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David R. Martinez
- Texas Early Hearing and Detection Intervention Program (TEHDI), Texas Department of State Health Services (TDSHS), Austin, Texas
| | - Marcus Gaffney
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities (NCBDDD), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Ren AZ, Sung V. Factors that influence health service access in deaf and hard-of-hearing children: a narrative review. Int J Audiol 2024; 63:171-181. [PMID: 37335176 DOI: 10.1080/14992027.2023.2223357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children. DESIGN A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022. STUDY SAMPLES Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies. RESULTS The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19. CONCLUSION This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access.
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Affiliation(s)
- Angela Z Ren
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Sung
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia
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Brunelli L, Sohn H, Brower A. Newborn sequencing is only part of the solution for better child health. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100581. [PMID: 37663526 PMCID: PMC10474049 DOI: 10.1016/j.lana.2023.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
Newborn screening (NBS) aims to detect newborns with severe congenital diseases before the onset of clinical manifestations. Advancements in genomic technologies have led to proposals for the development of genomic-based NBS (G-NBS) in concert with traditional NBS. Proponents of G-NBS highlight how G-NBS could expand the number of diseases screened at birth to thousands and spur the development of new drugs and treatments for rare diseases. Balancing the excitement, some experts have pointed to the ethical dilemmas linked to G-NBS. The dialog, however, has yet to engage with sufficient urgency on how the new G-NBS might chart a course for improving the health of all children. Our analysis of more than 130 million births in the United States between 1959 and 1995 shows that traditional NBS led to improvements in infant mortality and health equity only when it was implemented in association with measures to improve healthcare access for children. We suggest that the new G-NBS will lead to better child health only when the same degree of attention devoted to genomic technologies will be directed to the promotion of public health measures that facilitate access to high-quality healthcare for all children.
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Affiliation(s)
- Luca Brunelli
- Division of Neonatology, Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, and Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, United States
| | - Heeju Sohn
- Department of Sociology, Emory University, Atlanta, GA, United States
| | - Amy Brower
- American College of Medical Genetics and Genomics (ACMG), Bethesda, MD, United States
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Tang JZT, Ng PG, Loo JHY. Do all infants with congenital hearing loss meet the 1-3-6 criteria? A study of a 10-year cohort from a universal newborn hearing screening programme in Singapore. Int J Audiol 2023; 62:795-804. [PMID: 35830492 DOI: 10.1080/14992027.2022.2095537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate 1) the outcomes of a local universal newborn hearing screening (UNHS) programme and its audiological follow-ups at 3- and 6-month points, 2) the education outcomes of children with congenital hearing loss (CHL). DESIGN Retrospective study that analysed data containing hearing screening, diagnosis, intervention and schooling information from electronic databases. STUDY SAMPLE Children aged 5 to 15 years old who were born between 2004-2014 and underwent UNHS in a local hospital. RESULTS Over a 10-year cohort, 99.4% of 29,972 newborns underwent UNHS; approximately 90% of them were screened by 1 month of age. However, only 10% of the cohort strictly fulfilled the 1-3-6 criteria recommended by the Joint Committee on Infant Hearing. Lost to follow-up (LTF) rate was highest at post-diagnosis (35%). 80% of infants who were intervened between 6 and 48 months of age went to mainstream schools. The remaining 20% had additional disabilities or family factors. CONCLUSIONS A high UNHS coverage rate may not translate to meeting the 1-3-6 criteria. Despite ease of access to our healthcare system, LTF at post-diagnosis remained high. In the absence of additional disabilities or family factors, infants intervened during the sensitive window could still potentially make it into mainstream schools.
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Affiliation(s)
- Joanna Z T Tang
- Department of Otolaryngology, Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Otolaryngology, Head and Neck Surgery, National University Hospital, Singapore, Singapore
| | - Pick Gate Ng
- Department of Neonatology, National University Hospital, Singapore, Singapore
| | - Jenny H Y Loo
- Department of Otolaryngology, Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Otolaryngology, Head and Neck Surgery, National University Hospital, Singapore, Singapore
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McCreery RW, Grindle A, Merchant GR, Crukley J, Walker EA. Predicting wideband real-ear-to-coupler differences in children using wideband acoustic immittance. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:991-1002. [PMID: 37581511 PMCID: PMC10431946 DOI: 10.1121/10.0020660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 08/16/2023]
Abstract
Individual differences in ear-canal acoustics introduce variability into hearing aid output that can affect speech audibility. Measuring ear-canal acoustics in young children can be challenging, and relying on normative real-ear-to-coupler difference (RECD) transforms can lead to large fitting errors. Acoustic immittance measures characterize the impedance of the ear and are more easily measured than RECD. Using 226 Hz tympanometry to predict the RECD is more accurate than using age-based average RECD values. The current study sought to determine whether wideband acoustic immittance measurements could improve predictions of wideband real-ear-to-coupler difference (wRECD). 150 children ages 2-10 years with intact tympanic membranes underwent wRECD and wideband acoustic immittance measures in each ear. Three models were constructed to predict each child's measured wRECD: the age-based average wRECD, 226 Hz admittance wRECD, and wideband absorbance wRECD. The average age-based wRECD model predicted the child's measured wRECD within 3 dB in 62% of cases, but both the 226 Hz admittance and wideband absorbance wRECD were within 3 dB in 90% of cases. Using individual 226 Hz or wideband absorbance to predict wRECD improved the accuracy and precision of transforms used for pediatric hearing aid fitting.
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Affiliation(s)
- Ryan W McCreery
- Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Anastasia Grindle
- Pediatric Audiology, UW Health American Family Children's Hospital, Madison, Wisconsin 53792, USA
| | - Gabrielle R Merchant
- Translational Auditory Physiology and Perception Laboratory, Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Jeffery Crukley
- Faculty of Medicine, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario M5G 1V7, Canada
| | - Elizabeth A Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa 52242, USA
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7
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McCreery RW, Crukley J, Grindle A, Merchant GR, Walker E. Predicting children's real-ear-to-coupler differences based on tympanometric data. Int J Audiol 2023; 62:462-471. [PMID: 36752672 PMCID: PMC10159987 DOI: 10.1080/14992027.2023.2169200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Paediatric hearing-aid verification relies on measures of output obtained from the ear canal or in a coupler with the child's real-ear-to-coupler difference (RECD). Measured RECD cannot always be completed in children, leading to fitting inaccuracies. Audiologists often have tympanometry data that characterises the child's ear-canal acoustics. The goal of this study was to determine if tympanometry can be used to improve predictions of measured RECD. DESIGN A retrospective analysis of RECD and admittance, tympanometric peak pressure, and equivalent ear-canal volume from 226 Hz tympanometry collected as part of a longitudinal study of children with hearing loss were modelled with Bayesian hierarchical regression. STUDY SAMPLE Two-hundred sixty-six children with mild-to-severe hearing loss contributed data. RESULTS Age-based average RECD models were within 3 dB of measured RECD values in 54% of cases with normal middle ear status and 50.6% of cases with abnormal middle ear status. Immittance-predicted RECD were within 3 dB in 69.6% of cases with normal middle ear status and 74.4% of cases with abnormal middle ear status. CONCLUSION Immittance-predicted RECD was more accurate than age-based average RECD, particularly in children with abnormal middle ear status. The findings suggest that 226 Hz tympanometry could be used clinically to improve predictions of measured RECD when it cannot be measured.
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Affiliation(s)
- Ryan W. McCreery
- Audibility, Perception, and Cognition Laboratory at Boys Town National Research Hospital, Omaha, NE, United States of America
| | - Jeffery Crukley
- Faculty of Medicine, Department of Speech-Language Pathology, University of Toronto, Canada
| | - Anastasia Grindle
- Pediatric Audiology, UW Health American Family Children’s Hospital, Madison, WI, United States of America
| | - Gabrielle R. Merchant
- Translational Auditory Physiology and Perception Laboratory at Boys Town National Research Hospital, Omaha, NE, United States of America
| | - Elizabeth Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, United States of America
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Uhler K, Tollin DJ, Gilley PM. EEG Alpha Band Responses Reveal Amplification Benefits in Infants with Hearing Loss. CHILDREN (BASEL, SWITZERLAND) 2023; 10:600. [PMID: 36980158 PMCID: PMC10047398 DOI: 10.3390/children10030600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Our objective was to examine the effects of hearing aid amplification on auditory detection and discrimination in infants who were hard of hearing (IHH) using a physiological measure of auditory perception. We recorded EEG from 41 sleeping IHH aged 1.04 to 5.62 months while presenting auditory stimuli in a mismatch response paradigm. Responses were recorded during two listening conditions for each participant: aided and unaided. Temporal envelopes of the mismatch response in the EEG alpha band (6-12 Hz) were extracted from the latent, time-frequency transformed data. Aided alpha band responses were greater than unaided responses for the deviant trials but were not different for the standard trials. Responses to the deviant trials were greater than responses to the standard trials for the aided conditions but were not different for the unaided conditions. These results suggest that the alpha band mismatch can be used to examine both detection and discrimination of speech and non-speech sounds in IHH. With further study, the alpha band mismatch could expand and refine our abilities to validate hearing aid fittings at younger ages than current clinical protocols allow.
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Affiliation(s)
- Kristin Uhler
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine & Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Daniel J Tollin
- Department of Physiology and Biophysics, University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA
| | - Phillip M Gilley
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine & Children's Hospital Colorado, Aurora, CO 80045, USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO 80309, USA
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Barriers to and Facilitators of Early Hearing Detection and Intervention in the United States: A Systematic Review. Ear Hear 2023; 44:448-459. [PMID: 36579673 DOI: 10.1097/aud.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Early hearing detection and intervention (EHDI) is guided by the 1-3-6 approach: screening by one month, diagnosis by 3 mo, and early intervention (EI) enrollment by 6 mo. Although screening rates remain high, successful diagnosis and EI-enrollment lag in comparison. The aim of this systematic review is to critically examine and synthesize the barriers to and facilitators of EHDI that exist for families, as they navigate the journey of congenital hearing loss diagnosis and management in the United States. Understanding barriers across each and all stages is necessary for EHDI stakeholders to develop and test novel approaches which will effectively reduce barriers to early hearing healthcare. DESIGN A systematic literature search was completed in May and August 2021 for empirical articles focusing on screening, diagnosis, and EI of children with hearing loss. Two independent reviewers completed title and abstract screening, full-text review, data extraction, and quality assessments with a third independent reviewer establishing consensus at each stage. Data synthesis was completed using the Framework Analysis approach to categorize articles into EHDI journey timepoints and individual/family-level factors versus system-level factors. RESULTS Sixty-two studies were included in the narrative synthesis. Results revealed that both individual/family-level (e.g., economic stability, medical status of the infant including middle ear involvement) and system-level barriers (e.g., system-service capacity, provider knowledge, and program quality) hinder timely diagnosis and EI for congenital hearing loss. Specific social determinants of health were noted as barriers to effective EHDI; however, system-level facilitators such as care coordination, colocation of services, and family support programs have been shown to mitigate the negative impact of those sociodemographic factors. CONCLUSIONS Many barriers exist for families to obtain appropriate and timely EHDI for their children, but system-level changes could facilitate the process and contribute to long-term outcomes improvement. Limitations of this study include limited generalizability due to the heterogeneity of EHDI programs and an inability to ascertain factor interactions.
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Mazlan R, Raman K, Abdullah A. A 10-year retrospective analysis of newborn hearing screening in a tertiary hospital in Malaysia. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00331-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abstract
Background
Universal newborn hearing screening (UNHS) has been widely adopted worldwide as a standard of care because it enables the detection of congenital hearing loss early in life. Therefore, the concepts of regular measurement of performance using pre-determined quality measures are recommended for continuous improvement of the program. This study aimed to evaluate and update the performance of a UNHS program by measuring the recommended quality measures between 2010 and 2019. A retrospective study analyzing data of 50569 babies screened between January 2010 and December 2019 was performed. The pre-determined quality measures of coverage rate, initial referral rate, return to follow-up rate, diagnosis rate, and age at diagnosis were measured.
Results
The average coverage rate was 95.5%, with all years achieving the recommended benchmark of ≥ 95% except 2014 (91.8%) and 2019 (89.5%). Generally, the initial referral rate (10%) exceeded the benchmark of ≤ 4%. The program only managed to reach the benchmark for initial referral rate in 2013, 2014, and 2015. Both quality indicators for return to follow-up and diagnosis rates also did not meet the ≥ 95% and ≥ 90% standards, respectively. The return to follow-up ranged from 62 to 72.7%, while the average diagnosis rate was 73.4% (60–100%). One hundred thirty-seven infants were diagnosed with hearing loss at a median age of 3.8 months (± 0.4 months), resulting in a prevalence of 0.27%.
Conclusion
The findings demonstrated an excellent coverage rate but unsatisfactory performance for other quality indicators. Hence, the current program needs to be revisited to remain relevant and effective.
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Brodie KD, David AP, Chan DK. The Early-Childhood Hearing Screening Program in a Low-Income Setting-Reply. JAMA Otolaryngol Head Neck Surg 2022; 148:1080-1081. [PMID: 36136340 DOI: 10.1001/jamaoto.2022.2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kara D Brodie
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Abel P David
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Dylan K Chan
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California
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Farquharson K, Oleson J, McCreery RW, Walker EA. Auditory Experience, Speech Sound Production Growth, and Early Literacy in Children Who Are Hard of Hearing. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2092-2107. [PMID: 36037481 PMCID: PMC9907434 DOI: 10.1044/2022_ajslp-21-00400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Children who are hard of hearing (CHH) are at risk for literacy difficulties. Speech sound production is related to literacy skills in typically hearing children. Speech sound production abilities can also be markedly weak in CHH due to inconsistent access to the speech signal. We longitudinally examined relations between auditory experience, speech sound production abilities, and literacy (i.e., nonword reading and spelling in second grade) in CHH. METHOD Participants included 166 CHH. All participants used hearing aids (HAs). Auditory experience is a weighted measure of the number of hours of daily HA use and the amount of audibility with and without their HAs. Children's speech sound production was tested 2-3 times between the ages of 3 and 9 years. At age 5 years and again in second grade, children were tested on a battery of language and literacy measures. RESULTS Auditory experience was significantly correlated with speech sound production abilities, but age at HA fitting was not. Speech sound production abilities at age 5 years did not predict nonword reading in second grade but did predict spelling skills in second grade. CONCLUSIONS Our results support the importance of auditory experience and speech sound production for later literacy abilities. Specifically, we found that speech sound production abilities and print knowledge at age 5 years are related to second grade spelling outcomes. Interestingly, we found that morphological knowledge at age 5 years was more predictive of decoding in second grade than was speech sound production. Although there are multiple factors that contribute to literacy success, our results underscore the unique contributions of speech sound production abilities in CHH.
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Affiliation(s)
- Kelly Farquharson
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City
| | - Ryan W. McCreery
- Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
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Grey B, Deutchki EK, Lund EA, Werfel KL. Impact of Meeting Early Hearing Detection and Intervention Benchmarks on Spoken Language. JOURNAL OF EARLY INTERVENTION 2022; 44:235-251. [PMID: 36072546 PMCID: PMC9447840 DOI: 10.1177/10538151211025210] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study compared preschool spoken language outcomes for children with hearing loss who met Early Hearing Detection and Intervention (EHDI) guidelines to those who did not, as well as to compare outcomes for those who met current EHDI guidelines to those who met earlier benchmarks. Finally, the predictive role of meeting each component of the guidelines was evaluated relative to language outcomes. Children who met the EHDI guidelines had higher language scores than those who did not; however, there was no difference between children who met the current guidelines and those who met the earlier benchmarks. Entering early intervention by six months of age was the only unique predictor of spoken language outcomes. The findings suggest that EHDI programs should target increasing the number of children with hearing loss who meet the current 1-3-6 benchmarks with a particular focus on enrollment in early intervention by six months.
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Kingsbury S, Khvalabov N, Stirn J, Held C, Fleckenstein SM, Hendrickson K, Walker EA. Barriers to Equity in Pediatric Hearing Health Care: A Review of the Evidence. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:1060-1071. [PMID: 36275486 PMCID: PMC9585532 DOI: 10.1044/2021_persp-21-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE We review the evidence regarding barriers to hearing health care for children who are deaf or hard of hearing. BACKGROUND There are considerable data to suggest that hearing health care disparities constitute a major factor in loss to follow-up or documentation for children going through the Early Hearing Detection and Intervention process. Families are affected by a combination of factors underlying these disparities, resulting in delayed care and suboptimal developmental outcomes for children who are deaf or hard of hearing. CONCLUSIONS To address the socioeconomic, cultural, and linguistic inequities seen in the diagnosis and management of childhood hearing loss, pediatric audiologists and speech-language pathologists have a responsibility to provide culturally responsive practice to their individual clients and their families, as well as advocate for substantive changes at the policy level that impact their clients' daily lives.
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Affiliation(s)
- Sarah Kingsbury
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Nicole Khvalabov
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Jonathan Stirn
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Cara Held
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | | | - Kristi Hendrickson
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
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15
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Petrarca KA, Worthington M. Pediatric Amplification: A Proposed Protocol for In-Person Hearing Aid Fittings and Virtual Follow-Ups. Am J Audiol 2022; 31:864-875. [PMID: 35868291 DOI: 10.1044/2022_aja-21-00192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Children with hearing loss and their families face many financial and logistical barriers to accessing audiological care. At Rush University's Student Community Outreach Program of Excellence (SCOPE), a pediatric hearing loss outreach program is under development to address and overcome those barriers through in-person hearing aid fittings and virtual follow-up appointments. OBJECTIVES The goal of this clinical focus article was to develop a proposed protocol for SCOPE's pediatric hearing loss outreach program that would detail the use of a bimodal model of service delivery for pediatric amplification services. This clinical focus article provides a general description of the proposed protocol. METHOD The proposed protocol was developed as a guideline for future service delivery within SCOPE's pediatric hearing loss outreach program. Categories and details within the protocol were derived from previously published protocols and clinically relevant research. RESULTS The final protocol is composed of six sections, which detail the rationale and target population, necessary equipment, procedures for in-person hearing aid fittings, procedures for virtual follow-ups, outcome measures, and schedule of appointments. DISCUSSION On the national level, access to audiological care for pediatric patients and their families is restricted by both financial and logistical barriers. A telehealth model of service delivery has been shown to be effective in providing high-quality patient care while addressing these barriers. A clinical program using a bimodal model of service delivery will be implemented to address these barriers in Chicago, Illinois. Future investigation is required to monitor the efficacy of the program and develop program-specific materials.
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Affiliation(s)
- Kirsten A Petrarca
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL
| | - Megan Worthington
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL
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16
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Hsieh WH, Lin HC. Follow-up on children with suspected bilateral congenital hearing loss identified through universal newborn hearing screening program in Taiwan: A national-based population study. Int J Pediatr Otorhinolaryngol 2022; 157:111141. [PMID: 35461145 DOI: 10.1016/j.ijporl.2022.111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Wen Hui Hsieh
- Department of Audiology and Speech - Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Hung Ching Lin
- Department of Audiology and Speech - Language Pathology, Mackay Medical College, New Taipei City, Taiwan; Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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17
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Nicholson N, Rhoades EA, Glade RE. Analysis of Health Disparities in the Screening and Diagnosis of Hearing Loss: Early Hearing Detection and Intervention Hearing Screening Follow-Up Survey. Am J Audiol 2022; 31:764-788. [PMID: 35613624 DOI: 10.1044/2022_aja-21-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to (a) provide introductory literature regarding cultural constructs, health disparities, and social determinants of health (SDoH); (b) summarize the literature regarding the Centers for Disease Control and Prevention (CDC) Early Hearing Detection and Intervention (EHDI) Hearing Screening Follow-Up Survey (HSFS) data; (c) explore the CDC EHDI HSFS data regarding the contribution of maternal demographics to loss-to-follow-up/loss-to-documentation (LTF/D) between hearing screening and audiologic diagnosis for 2016, 2017, and 2018; and (d) examine these health disparities within the context of potential ethnoracial biases. METHOD This is a comprehensive narrative literature review of cultural constructs, hearing health disparities, and SDoH as they relate to the CDC EHDI HSFS data. We explore the maternal demographic data reported on the CDC EHDI website and report disparities for maternal age, education, ethnicity, and race for 2016, 2017, and 2018. We focus on LTF/D for screening and diagnosis within the context of racial and cultural bias. RESULTS A literature review demonstrates the increase in quality of the CDC EHDI HSFS data over the past 2 decades. LTF/D rates for hearing screening and audiologic diagnostic testing have improved from higher than 60% to current rates of less than 30%. Comparisons of diagnostic completion rates reported on the CDC website for the EHDI HSFS 2016, 2017, and 2018 data show trends for maternal age, education, and race, but not for ethnicity. Trends were defined as changes more than 10% for variables averaged over a 3-year period (2016-2018). CONCLUSIONS Although there have been significant improvements in LTF/D over the past 2 decades, there continue to be opportunities for further improvement. Beyond neonatal screening, delays continue to be reported in the diagnosis of young children with hearing loss. Notwithstanding the extraordinarily diverse families within the United States, the imperative is to minimize such delays so that all children with hearing loss can, at the very least, have auditory accessibility to spoken language by 3 months of age. Conscious awareness is essential before developing a potentially effective plan of action that might remediate the problem.
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Affiliation(s)
| | | | - Rachel E. Glade
- Communication Science and Disorders, University of Arkansas, Fayetteville
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18
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Heinrichs-Graham E, Walker EA, Taylor BK, Menting SC, Eastman JA, Frenzel MR, McCreery RW. Auditory experience modulates frontoparietal theta activity serving fluid intelligence. Brain Commun 2022; 4:fcac093. [PMID: 35480224 PMCID: PMC9039508 DOI: 10.1093/braincomms/fcac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/15/2022] [Accepted: 04/01/2022] [Indexed: 12/04/2022] Open
Abstract
Children who are hard of hearing are at risk for developmental language and academic delays compared with children with normal hearing. Some work suggests that high-order cognitive function, including fluid intelligence, may relate to language and academic outcomes in children with hearing loss, but findings in these studies have been mixed and to date, there have been no studies of the whole-brain neural dynamics serving fluid intelligence in the context of hearing loss. To this end, this study sought to identify the impact of hearing loss and subsequent hearing aid use on the neural dynamics serving abstract reasoning in children who are hard of hearing relative to children with normal hearing using magnetoencephalography. We found significant elevations in occipital and parietal theta activity during early stimulus evaluation in children who are hard of hearing relative to normal-hearing peers. In addition, we found that greater hearing aid use was significantly related to reduced activity throughout the fronto-parietal network. Notably, there were no differences in alpha dynamics between groups during later-stage processing nor did alpha activity correlate with hearing aid use. These cross-sectional data suggest that differences in auditory experience lead to widespread alterations in the neural dynamics serving initial stimulus processing in fluid intelligence in children.
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Affiliation(s)
- Elizabeth Heinrichs-Graham
- Institute for Human Neuroscience, Boys Town National Research Hospital (BTNRH), Omaha, NE, USA
- College of Medicine, Creighton University, Omaha, NE, USA
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Elizabeth A. Walker
- Wendell Johnson Speech and Hearing Center, Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Brittany K. Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital (BTNRH), Omaha, NE, USA
- College of Medicine, Creighton University, Omaha, NE, USA
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Sophia C. Menting
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
- Department of Psychology, University of Nebraska—Lincoln, Lincoln, NE, USA
| | - Jacob A. Eastman
- Institute for Human Neuroscience, Boys Town National Research Hospital (BTNRH), Omaha, NE, USA
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Michaela R. Frenzel
- Institute for Human Neuroscience, Boys Town National Research Hospital (BTNRH), Omaha, NE, USA
- Center for Magnetoencephalography (MEG), University of Nebraska Medical Center (UNMC), Omaha, NE, USA
| | - Ryan W. McCreery
- Audibility, Perception, and Cognition Laboratory, BTNRH, Omaha, NE, USA
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19
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Fitzpatrick EM, Jiawen W, Janet O, JoAnne W, Flora N, Isabelle G, Andrée DS, Doug C. Parent-Reported Stress and Child Behavior for 4-Year-Old Children with Unilateral or Mild Bilateral Hearing Loss. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2022; 27:137-150. [PMID: 35156118 PMCID: PMC8929680 DOI: 10.1093/deafed/enab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 05/15/2023]
Abstract
Children with unilateral or mild bilateral hearing loss are increasingly identified in early childhood. Relatively little is known about how hearing loss affects their developmental trajectory or whether it contributes to parenting stress for these parents. This study aimed to examine child behavior and parenting stress in parents of children with unilateral/mild bilateral hearing loss compared to children with typical hearing. This prospective study involved 54 children with unilateral/mild bilateral hearing loss identified at a median age of 4.5 months (IQR 2.6, 6.5) and 42 children with typical hearing. At age 48 months, child behavior and parenting stress were measured. Auditory and language results were also analyzed in relation to child behavior and parenting stress. Parents of these children did not report significantly more parenting stress or behavior problems than parents of children with typical hearing. However, both parenting stress and child behavior were related to functional hearing in noise.
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Affiliation(s)
- Elizabeth M Fitzpatrick
- Correspondence should be addressed to Elizabeth M. Fitzpatrick, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada. E-mail:
| | - Wu Jiawen
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Olds Janet
- Child Hearing Lab, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Audiology Clinic, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Whittingham JoAnne
- Child Hearing Lab, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nassrallah Flora
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Child Hearing Lab, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Gaboury Isabelle
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Durieux-Smith Andrée
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Child Hearing Lab, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Coyle Doug
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada
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20
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Holzinger D, Hofer J, Dall M, Fellinger J. Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model. J Clin Med 2022; 11:jcm11061548. [PMID: 35329873 PMCID: PMC8949393 DOI: 10.3390/jcm11061548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.
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Affiliation(s)
- Daniel Holzinger
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, 4020 Linz, Austria; (J.H.); (M.D.); (J.F.)
- Institute of Neurology of Senses and Language, Hospital of St. John of God, 4020 Linz, Austria
- Institute of Linguistics, University of Graz, 8010 Graz, Austria
- Correspondence: or
| | - Johannes Hofer
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, 4020 Linz, Austria; (J.H.); (M.D.); (J.F.)
- Institute of Neurology of Senses and Language, Hospital of St. John of God, 4020 Linz, Austria
- Department of Paediatrics I, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Magdalena Dall
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, 4020 Linz, Austria; (J.H.); (M.D.); (J.F.)
| | - Johannes Fellinger
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, 4020 Linz, Austria; (J.H.); (M.D.); (J.F.)
- Institute of Neurology of Senses and Language, Hospital of St. John of God, 4020 Linz, Austria
- Division of Social Psychiatry, University Clinic for Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
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21
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Faistauer M, Silva AL, Dominguez DDOR, Bohn R, Félix TM, Costa SSD, Rosito LPS. Does universal newborn hearing screening impact the timing of deafness treatment? J Pediatr (Rio J) 2022; 98:147-154. [PMID: 34166624 PMCID: PMC9432161 DOI: 10.1016/j.jped.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the Universal Neonatal Hearing Screening (UNHS) on the age at diagnosis, beginning of treatment, and first cochlear implant surgery. METHODS A retrospective cohort study with children up to 12 years old with bilateral hearing loss were divided into two groups: patients who underwent UNHS and the ones who didn't. The groups were compared according to their age at the beginning of the evaluation at a specialized center, at the beginning of the intervention, and, for the ones who had indication, at the cochlear implant surgery. The group who underwent UNHS was divided between the ones who passed the screening test and the ones who didn't. They were compared according to their ages at the same moments as the first two groups. RESULTS 135 patients were included. The median age at the first appointment in a specialized center was 1.42 (0.50 and 2.50) years, at the beginning of treatment 2.00 (1.00 and 3.52) years, and the cochlear implant surgery 2.83 (1.83 and 4.66) years. Children who underwent UNHS were younger than those who didn't, at the three evaluated moments (p < 0.001). In a subanalysis, children who passed the UNHS but were later diagnosed with hearing loss reached the first appointment with a specialist and started treatment older than those who failed the tests. CONCLUSION Performing UNHS interfered with the timing of deafness diagnosis and treatment. However, children who passed the screening but were later diagnosed with hearing loss were the category with the most important delay.
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Affiliation(s)
- Marina Faistauer
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Alice Lang Silva
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | | | - Renata Bohn
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Têmis Maria Félix
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Sady Selaimen da Costa
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
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22
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Reid A, Firns S, Tao K, Maywood E, Herbert H, Mulders WAM, Kuthubutheen J, Brennan-Jones C. Early detection of hearing loss for infants in Western Australia: Comparison to international benchmarks. J Paediatr Child Health 2022; 58:422-426. [PMID: 34516698 DOI: 10.1111/jpc.15733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
AIM To assess the degree to which timely audiological assessment of congenital hearing loss is achieved at our institution - Perth Children's Hospital, Western Australia, and to review cases which breached this timeframe in order to address barriers to timely assessment. The benchmark used to determine timely assessment is that set out by The Joint Committee on Infant Hearing (JCIH) in which diagnostic audiological testing occurs by three months of age for those who do not pass newborn hearing screening. METHODS A retrospective chart review of infants who underwent diagnostic auditory assessment at Perth Children's Hospital between 2016-2019. A total of 151 children were identified as meeting the inclusion criteria and their medical files were reviewed. Time to first dABR was the time point for whether testing was achieved within the 3 month timeframe. RESULTS Of the 151 children who underwent dABR assessments, 1 was identified as having breached the 90 day time limit (tested on day 91) for which no valid reason for delay could be identified. The timely delivery of dABR assessments in 99.3% of cases within this cohort compares favourably with the literature. CONCLUSIONS Conclusion Timely diagnostic audiological assessment is achievable for children with congenital hearing loss. The reasons for patients breaching this timeframe are explored in the paper along with factors which may help avoid delays.
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Affiliation(s)
- Allison Reid
- Ear, Nose and Throat Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Firns
- Department of Audiology, The University of Western Australia, Perth, Western Australia, Australia
| | - Karina Tao
- Department of Hearing Research, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Audiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Erin Maywood
- Department of Audiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Hayley Herbert
- Ear, Nose and Throat Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wilhemina A M Mulders
- Clinical Audiology and Audiological Sciences, School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Jafri Kuthubutheen
- Ear, Nose and Throat Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Brennan-Jones
- Department of Audiology, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Ear Health, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Paediatrics, The University of Western Australia, Medical School, Perth, Western Australia, Australia
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23
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Walker EA, Ward C, Oleson J, Sapp C, McCreery RW, Tomblin JB, Moeller MP. Language Growth in Children with Mild to Severe Hearing Loss who Received Early Intervention by 3 Months or 6 Months of Age. JOURNAL OF EARLY HEARING DETECTION AND INTERVENTION 2022; 7:1-10. [PMID: 38737914 PMCID: PMC11087018 DOI: 10.26077/e97b-7add] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Purpose To evaluate the impact of hearing screening, diagnosis, and early intervention (EI) by 3 months or 6 months of age on language growth trajectories for children with hearing loss (HL) relative to children with normal hearing (NH). Method We recruited 133 children with mild to severe HL through universal newborn hearing screening records and referrals from audiologists in the United States and 116 children with NH who served as a comparison group. Examiners administered a battery of developmentally appropriate language measures between 12 months and 8 years of age. We constructed latent growth curve models of global language, grammar, and vocabulary using Bayesian statistics. Results Children with HL demonstrated no significant differences in initial language skills compared to children with NH. Children in the 1-3-6 group also showed no difference in language growth compared to children with NH. The slope for the 1-2-3 group was significantly steeper than children with NH for global language and grammar. Conclusions This study documents the positive impact of EI on language outcomes in children with congenital HL. It is among the first to provide evidence to support the potential effects of very early intervention by 3 months of age.
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24
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Wiseman K, Sapp C, Walker E, McCreery R. Comprehensive Audiological Management of Hearing Loss in Children, Including Mild and Unilateral Hearing Loss. Otolaryngol Clin North Am 2021; 54:1171-1179. [PMID: 34774229 PMCID: PMC8594741 DOI: 10.1016/j.otc.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Management of hearing loss in infants and young children has evolved rapidly with the formation of universal newborn hearing screening and early intervention programs. This review describes the management process for children with hearing loss, including determining candidacy for amplification, selection of amplification devices, electroacoustic verification, and outcomes validation. The importance of a coordinated, evidence-based approach can help to ensure the best communication outcomes for children with hearing loss.
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Affiliation(s)
- Kathryn Wiseman
- Boys Town National Research Hospital, 555 N 30th Street, Omaha, NE 68131, USA
| | - Caitlin Sapp
- University of North Carolina Medical Center, 435 Meadowmont Village Circle, Chapel Hill, NC 27517, USA
| | - Elizabeth Walker
- University of North Carolina Medical Center, 435 Meadowmont Village Circle, Chapel Hill, NC 27517, USA
| | - Ryan McCreery
- Boys Town National Research Hospital, 555 N 30th Street, Omaha, NE 68131, USA.
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25
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Huyck JJ, Anbuhl KL, Buran BN, Adler HJ, Atcherson SR, Cakmak O, Dwyer RT, Eddolls M, El May F, Fraenzer JT, Funkhouser R, Gagliardini M, Gallun FJ, Goldsworthy RL, Gouin S, Heng J, Hight AE, Jawadi Z, Kovacic D, Kumar R, Kumar S, Lim SR, Mo C, Nolan LS, Parbery-Clark A, Pisano DV, Rao VR, Raphael RM, Reiss LAJ, Spencer NJ, Tang SJ, Tejani VD, Tran ED, Valli M, Watkins GD, Wayne RV, Wheeler LR, White SL, Wong V, Yuk MC, Ratnanather JT, Steyger PS. Supporting Equity and Inclusion of Deaf and Hard-of-Hearing Individuals in Professional Organizations. FRONTIERS IN EDUCATION 2021; 6:755457. [PMID: 34790885 PMCID: PMC8594914 DOI: 10.3389/feduc.2021.755457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Disability is an important and often overlooked component of diversity. Individuals with disabilities bring a rare perspective to science, technology, engineering, mathematics, and medicine (STEMM) because of their unique experiences approaching complex issues related to health and disability, navigating the healthcare system, creatively solving problems unfamiliar to many individuals without disabilities, managing time and resources that are limited by physical or mental constraints, and advocating for themselves and others in the disabled community. Yet, individuals with disabilities are underrepresented in STEMM. Professional organizations can address this underrepresentation by recruiting individuals with disabilities for leadership opportunities, easing financial burdens, providing equal access, fostering peer-mentor groups, and establishing a culture of equity and inclusion spanning all facets of diversity. We are a group of deaf and hard-of-hearing (D/HH) engineers, scientists, and clinicians, most of whom are active in clinical practice and/or auditory research. We have worked within our professional societies to improve access and inclusion for D/HH individuals and others with disabilities. We describe how different models of disability inform our understanding of disability as a form of diversity. We address heterogeneity within disabled communities, including intersectionality between disability and other forms of diversity. We highlight how the Association for Research in Otolaryngology has supported our efforts to reduce ableism and promote access and inclusion for D/HH individuals. We also discuss future directions and challenges. The tools and approaches discussed here can be applied by other professional organizations to include individuals with all forms of diversity in STEMM.
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Affiliation(s)
- Julia Jones Huyck
- Speech Pathology and Audiology, Kent State University, Kent, OH, United States
| | - Kelsey L. Anbuhl
- Center for Neural Science, New York University, New York, NY, United States
| | - Brad N. Buran
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Henry J. Adler
- Center for Hearing and Deafness, State University of New York at Buffalo, Buffalo, NY, United States
| | | | - Ozan Cakmak
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Robert T. Dwyer
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Morgan Eddolls
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Fadhel El May
- University Medical Center Göttingen, Göttingen, Germany
| | | | - Rebekah Funkhouser
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | | | - Frederick J. Gallun
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Raymond L. Goldsworthy
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Joseph Heng
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Ariel Edward Hight
- NYU Langone Medical Center, New York University, New York, NY, United States
| | - Zina Jawadi
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Damir Kovacic
- Faculty of Science, University of Split, Split, Croatia
| | - Rachit Kumar
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Santosh Kumar
- National Centre for Cell Science, S. P. Pune University Campus, Pune, India
| | - Stacey R. Lim
- Department of Audiology, Central Michigan University, Mount Pleasant, MI, United States
| | - Chengeng Mo
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lisa S. Nolan
- Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom
| | | | - Dominic V. Pisano
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, United States
| | | | - Robert M. Raphael
- Department of Bioengineering, Rice University, Houston, TX, United States
| | - Lina A. J. Reiss
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Nathaniel J. Spencer
- Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH, United States
| | - Stephen J. Tang
- Legacy Good Samaritan Medical Center, Portland, OR, United States
| | - Viral D. Tejani
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University, Cleveland, OH, United States
| | - Emma D. Tran
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Mikaeel Valli
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Greg D. Watkins
- School of Biomedical Engineering, The University of Sydney, Darlington, NSW, Australia
| | | | | | - Stephanie L. White
- School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, United States
| | - Victor Wong
- Weill Cornell Medical College, New York, NY, United States
| | - M. Caroline Yuk
- Department of Chemistry and Biochemistry, University of Alabama, Tuscaloosa, AL, United States
| | - J. Tilak Ratnanather
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Peter S. Steyger
- Translational Hearing Center, Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
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Assessing Loss to Follow-up After Newborn Hearing Screening in the Neonatal Intensive Care Unit: Sociodemographic Factors That Affect Completion of Initial Audiological Evaluation. Ear Hear 2021; 43:577-581. [PMID: 34524152 DOI: 10.1097/aud.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Neonatal intensive care unit (NICU) patients are at high risk for congenital hearing loss. Previous studies have found sociodemographic factors associated with loss to follow-up for newborn hearing screening, but none have specifically studied the NICU population. Our objective is to determine if demographics and socioeconomic status is associated with loss to follow-up in a newborn population with extended NICU stay. DESIGN A retrospective cohort study was conducted on 443 NICU infants with extended NICU stay utilizing data extracted from infant and maternal medical records at an urban safety-net hospital. RESULTS Younger maternal age (adjusted odds ratio [OR] 0.95, confidence interval [CI] 0.91 to 0.99), higher gravidity (adjusted OR 1.39, CI 1.12 to 1.72), and former smoking status (adjusted OR 2.57, CI 1.07-6.18) were identified as independent predictors of loss to follow-up for NHS after conducting a multivariable logistic regression. Demographic and socioeconomic variables, such as sex, parity, birth weight, mode of birth, highest level of maternal education, maternal race/ethnicity, zip code metrics, and maternal language were not found to be associated with loss to follow-up. CONCLUSIONS Maternal age, gravidity, and smoking status are risk factors for loss to follow-up for NHS in newborns with extended NICU stay, a group at high risk for hearing loss. Our findings demonstrate that socioeconomic and demographic factors for loss to follow-up in the extended-stay NICU population are distinct from the well-baby population. Further investigation of these patients will allow prioritization of limited resources to subgroups within the extended-stay NICU population at risk for loss to follow-up for newborn hearing screening.
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Sapp C, Stirn J, O'Hollearn T, Walker EA. Expanding the Role of Educational Audiologists After a Failed Newborn Hearing Screening: A Quality Improvement Study. Am J Audiol 2021; 30:631-641. [PMID: 34269595 DOI: 10.1044/2021_aja-21-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Lack of timely and proximal access to diagnostic hearing evaluation using auditory brainstem response (ABR) testing hampers the effectiveness of Early Hearing Detection and Intervention (EHDI) programs in the United States. This study measured the impact of a state-based quality-improvement (QI) project that provided diagnostic ABR equipment and training to educational audiologists distributed throughout Iowa in regional special education centers. Method We used de-identified administrative data generated by the state EHDI program to analyze markers of access to early hearing health care for infants in a preproject condition ("Baseline") compared to the implementation of diagnostic ABRs at the regional special education centers ("QI Project"). Results Our findings revealed that the QI Project was associated with improvements in timeliness of first hearing evaluation, distance traveled for first hearing evaluation, and likelihood of receiving on-guideline audiology care during the first hearing evaluation. Conclusions Following the onset of the QI Project, infants and their families had greater access to initial hearing evaluation after failed newborn hearing screening. This improvement could have cascading effects on timeliness of later intervention among those with confirmed permanent childhood hearing loss.
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Affiliation(s)
- Caitlin Sapp
- University of North Carolina Medical Center, Chapel Hill
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Amount of Hearing Aid Use Impacts Neural Oscillatory Dynamics Underlying Verbal Working Memory Processing for Children With Hearing Loss. Ear Hear 2021; 43:408-419. [PMID: 34291759 PMCID: PMC8770672 DOI: 10.1097/aud.0000000000001103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with hearing loss (CHL) may exhibit spoken language delays and may also experience deficits in other cognitive domains including working memory. Consistent hearing aid use (i.e., more than 10 hours per day) ameliorates these language delays; however, the impact of hearing aid intervention on the neural dynamics serving working memory remains unknown. The objective of this study was to examine the association between the amount of hearing aid use and neural oscillatory activity during verbal working memory processing in children with mild-to-severe hearing loss. DESIGN Twenty-three CHL between 8 and 15 years-old performed a letter-based Sternberg working memory task during magnetoencephalography (MEG). Guardians also completed a questionnaire describing the participants' daily hearing aid use. Each participant's MEG data was coregistered to their structural MRI, epoched, and transformed into the time-frequency domain using complex demodulation. Significant oscillatory responses corresponding to working memory encoding and maintenance were independently imaged using beamforming. Finally, these whole-brain source images were correlated with the total number of hours of weekly hearing aid use, controlling for degree of hearing loss. RESULTS During the encoding period, hearing aid use negatively correlated with alpha-beta oscillatory activity in the bilateral occipital cortices and right precentral gyrus. In the occipital cortices, this relationship suggested that with greater hearing aid use, there was a larger suppression of occipital activity (i.e., more negative relative to baseline). In the precentral gyrus, greater hearing aid use was related to less synchronous activity (i.e., less positive relative to baseline). During the maintenance period, hearing aid use significantly correlated with alpha activity in the right prefrontal cortex, such that with greater hearing aid use, there was less right prefrontal maintenance-related activity (i.e., less positive relative to baseline). CONCLUSIONS This study is the first to investigate the impact of hearing aid use on the neural dynamics that underlie working memory function. These data show robust relationships between the amount of hearing aid use and phase-specific neural patterns during working memory encoding and maintenance after controlling for degree of hearing loss. Furthermore, our data demonstrate that wearing hearing aids for more than ~8.5 hours/day may serve to normalize these neural patterns. This study also demonstrates the potential for neuroimaging to help determine the locus of variability in outcomes in CHL.
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Abstract
OBJECTIVES There are very limited data regarding the spoken language and academic outcomes of children with mild to severe hearing loss (HL) during the elementary school years, and the findings of these studies are inconsistent. None of these studies have examined the possible role of aided hearing in these outcomes. This study used a large cohort of children to examine these outcomes and in particular to examine whether aided hearing moderates the effect of HL with regard to these outcomes. DESIGN The spoken language, reading, writing, and calculation abilities were measured after second and fourth grades in children with mild to severe HL (children who are hard of hearing; CHH, n = 183) and a group of children with normal hearing (CNH, n = 91) after the completion of second and fourth grades. Also, among the CHH who wore hearing aids, aided better-ear speech intelligibility index values at the age of school entry were obtained. RESULTS Oral language abilities of the CHH with mild and moderate HL were similar to the CNH at each grade. Children with moderately-severe HL (better-ear pure tone threshold >59 but <76 dB HL) had significantly poorer oral language and reading skills than the CNH at each grade. The children with mild and moderate HL did not differ from the CNH in oral language or reading. No differences were found between the CHH regardless of severity and CNH with regard to spelling, passage writing, or calculation. The degree to which hearing aids provided audible speech information played a moderating role in the oral language outcomes of CHH and this moderation of language mediated the relationship between the unaided hearing ability of the CHH and their academic outcomes. CONCLUSIONS As a group, children with mild and moderate HL have good outcomes with regard to language and academic performance. Children with moderately-severe losses were less skilled in language and reading than the CNH and CHH children with mild and moderate losses. Audibility provided by hearing aids was found to moderate the effects of HL with respect to these outcomes. These findings emphasize the importance of including the effects of clinical interventions such as aided hearing when examining outcomes of CHH.
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Bhuskute A, Page N. Congenital and Neonatally Acquired Sensorineural Hearing Loss. Pediatr Ann 2021; 50:e292-e296. [PMID: 34264799 DOI: 10.3928/19382359-20210629-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hearing loss is one of the most common congenital diagnoses, recognized in large part by a robust newborn hearing screening program. Ensuring appropriate follow-up of failed newborn hearing screening is crucial to avoid delay in initiation of treatment for hearing loss. The most common etiology for congenital hearing loss is genetic, but some cases can be acquired. Understanding of the etiology aids in counseling for the family and in direction of treatment. Early diagnosis and treatment results in dramatically improved speech and developmental outcomes for affected children. Treatment including amplification, speech therapy, adaptations in the classroom, and family support leads to gains in academic performance, parental satisfaction, and quality of life. Early cochlear implantation has been shown to be beneficial in obtaining speech and language skills in patients with severe to profound sensorineural hearing loss and should be considered in the appropriate patient population. [Pediatr Ann. 2021;50(7):e292-e296.].
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Zeitlin W, McInerney M, Aveni K, Scheperle R, Chontow K. Better late than never? Maternal biopsychosocial predictors of late follow-up from new Jersey's early hearing detection and intervention program. Int J Pediatr Otorhinolaryngol 2021; 145:110708. [PMID: 33882338 DOI: 10.1016/j.ijporl.2021.110708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/16/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Early hearing detection and intervention programs are designed to mitigate consequences of hearing loss in infants. Most research examining compliance with program protocols has examined factors related to being lost to follow-up. Another group that warrants study are babies who return for follow-up outside the timelines recommended by public health organizations. This research seeks to identify maternal factors that are associated with late follow-up at the point of diagnosis of hearing loss. STUDY DESIGN The sampling frame for this study included all babies born in New Jersey in a two-year period. Our final sample consisted of 716 babies who needed diagnostic evaluations and completed them. Five hundred twenty-six babies completed their exams on-time while 190 completed them late. Logistic regression was completed to identify maternal factors related to late follow-up, and additional statistics were utilized to understand characteristics of babies who were late. RESULTS In the final modeling, maternal education (OR = 0.52), WIC participation (OR = 2.11), and health insurance status (OR = 2.04) were significantly predictive of being late (X2 (6) = 77.71; p < 0.01). Mothers for whom postpartum depression (OR = 1.89) was a concern were more also likely to have babies who were late. Needing to repeat a diagnostic audiologic exam was most predictive of lateness (OR = 5.32). Over one-third of babies who had confirmed hearing loss completed their testing late. CONCLUSIONS Late completion of diagnostic hearing tests may contribute to delays in children hitting developmental milestones in a timely manner. Low socioeconomic status mothers and those with postpartum depression may have difficulty following up with recommended hearing tests. Limitations include data quality issues inherent in using administrative data.
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Affiliation(s)
- Wendy Zeitlin
- Montclair State University, Department of Social Work and Child Advocacy, 1 Normal Avenue, Montclair, NJ, 07043, USA.
| | - MaryRose McInerney
- Montclair State University, Department Communication Science and Disorders, USA
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Holzinger D, Hofer J, Dall M. Frühe Prädiktoren der Sprachentwicklung von Kindern mit permanenter Hörstörung. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Sprachentwicklungsverläufe bei Kindern mit Hörstörungen zeigen eine hohe und überwiegend ungeklärte Varianz. Fragestellung und Methode: Unsere Übersichtsarbeit präsentiert aktuelle Evidenz zu frühen Prädiktoren der Sprachentwicklung. Ergebnisse und Diskussion: Trotz deutlicher positiver Trends erreicht nur jedes zweite Kind ein Sprachentwicklungsniveau im Normbereich. Der Literaturüberblick ergibt signifikante kindbezogene und familiäre Prädiktoren mit eher geringer Beeinflussbarkeit. Als hoch prädiktiv für sprachliche Ergebnisse und zudem der Intervention zugänglich erweisen sich die frühe Erkennung und technische Versorgung mit Hörgeräten oder -implantaten und Aufnahme in die Frühförderung, konsistente Hörtechnikverwendung und/oder früher Zugang zur Gebärdensprache. Zudem zeigt sich die Qualität der täglichen Eltern-Kind-Interaktion als hocheffektiv für die Sprachentwicklung. Schlussfolgerung: Es bestätigt sich die Wirksamkeit aktueller Best Practice früher Erkennung, Versorgung und familienzentrierter Frühförderung.
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Affiliation(s)
- Daniel Holzinger
- Forschungsinstitut für Entwicklungsmedizin, Johannes Kepler Universität Linz
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz
- Institut für Sprachwissenschaft, Karl-Franzens-Universität Graz
| | - Johannes Hofer
- Forschungsinstitut für Entwicklungsmedizin, Johannes Kepler Universität Linz
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, Linz
- Abteilung für Pädiatrie I, Medizinische Universität Innsbruck
| | - Magdalena Dall
- Forschungsinstitut für Entwicklungsmedizin, Johannes Kepler Universität Linz
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Kamenov K, Chadha S. Methodological quality of clinical guidelines for universal newborn hearing screening. Dev Med Child Neurol 2021; 63:16-21. [PMID: 32981050 DOI: 10.1111/dmcn.14694] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 01/10/2023]
Abstract
AIM To review existing guidelines for universal newborn hearing screening (UNHS), identify those that provide comprehensive and clear recommendations on the subject, and provide a brief overview. METHOD A scoping literature review was performed in PubMed, the Guidelines International Network library, and national guideline databases to identify guidelines on newborn hearing screening developed or updated between 2004 and 2019. The quality of the guidelines was checked with the Checklist for the Quality Assessment of Guidelines (AGREE II). RESULTS Six guidelines met all the inclusion criteria. All six were based on the 1-3-6 benchmark (screening completed by 1mo, audiological diagnosis by 3mo, enrolment in early intervention by 6mo). However, the guidelines varied in terms of their recommendations for the application of screening methods, role of health professionals in the screening process, and quality. Based on the AGREE II score, flexibility, adaptability, and foundation role for all other guidelines, the 2019 guidelines of the Joint Committee on Infant Hearing position statement were identified as the most appropriate to be recommended for adaptation by countries or programmes. INTERPRETATION The diversity in the existing guidance can be confusing for countries and institutions that are planning to develop universal hearing screening programmes. As more countries and organizations develop their newborn hearing screening programmes, they will need examples to emulate. This review provides an evaluation of the quality, comprehensiveness, and applicability of existing clinical guidelines that can serve as a facilitator for countries, institutions, or organizations in their planning and implementation of a UNHS programme.
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Affiliation(s)
- Kaloyan Kamenov
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Shelly Chadha
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Chen PH, Lim TZ. Newborn hearing screening and early auditory-based treatment in Taiwan: action trends of families with children who are hearing impaired. Int J Audiol 2020; 60:514-520. [PMID: 33124479 DOI: 10.1080/14992027.2020.1837970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the trends in actions and factors influencing families of children with hearing loss, regarding early treatment following the implementation of a newborn hearing screening (NHS) in Taiwan. DESIGN A retrospective study was conducted by extracting data from the treatment histories of families with children who had hearing loss and who were contacted and assessed by the non-profit organisation (NPO). Children born between 2012 and 2018 were included. The time lapse between initial NHS and early treatment sought by each family was documented and the factors predicting the timing of those actions were identified. STUDY SAMPLE Data of 2095 families of children with hearing loss and who received treatment from an NPO for the annual birth cohort of 2012 through 2018 were included. RESULTS The median age at treatments initiation improved through the years. Parental educational level and the child's degree of hearing loss were significant indicators of the child's initial age at treatment intervention, age when hearing aids were fitted, and days taken to contact the organisation. CONCLUSION The NHS in Taiwan promoted earlier treatment for children with hearing loss. Furthermore, patient instructions and education may be important to enable parents to take actions for early intervention.
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Affiliation(s)
- Pei-Hua Chen
- Speech and Hearing Science Research Institute, Children's Hearing Foundation, Taipei, Taiwan
| | - Tang-Zhi Lim
- Speech and Hearing Science Research Institute, Children's Hearing Foundation, Taipei, Taiwan
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Loss to Follow-Up After Newborn Hearing Screening: Analysis of Risk Factors at a Massachusetts Urban Safety-Net Hospital. Ear Hear 2020; 42:173-179. [PMID: 32740299 DOI: 10.1097/aud.0000000000000915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study examines the unique factors that influence loss to follow-up after newborn hearing screening for patients at a Massachusetts urban safety-net hospital. We seek to characterize our patient population, investigate correlations between patient factors and rates of follow-up, and understand gaps in care. DESIGN A retrospective chart review was conducted of patients born at an urban safety-net hospital from January 2015 through May 2018 who did not pass the newborn hearing screening in one or both ears. A total of 197 infants were included in our study. Outcomes of interest included rates and latency of follow-up appointments, infant demographics (sex, race, birth weight, risk factors for hearing loss), and maternal factors (age, marital status, smoking status, number of children). RESULTS From January 2015 through May 2018, 17% (n = 34) of infants were lost to follow-up. Of those who attended an initial audiology evaluation, the median time between screening and appointment was 29 days. Newborns were 3.5 times at risk of being lost to follow-up if their mothers smoked during pregnancy compared to those whose mothers did not smoke. Further, newborns with multiple siblings in the home were less likely to utilize any audiological services. High-risk infants, such as those with an extended stay in the neonatal intensive care unit, were found to have higher rates of loss to follow-up. CONCLUSIONS Our results indicate that patients at urban safety-net hospitals require increased support to decrease rates of loss to follow-up. In particular, strategies to aid mothers who smoke, have multiple children, or have high-risk infants can address gaps in care for newborns after hearing screening.
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Perspectives of newborn hearing screening in resource constrained settings. J Otol 2020; 15:174-177. [PMID: 33293921 PMCID: PMC7691834 DOI: 10.1016/j.joto.2020.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/21/2022] Open
Abstract
Newborn hearing screening is an effective strategy for early identification of hearing loss in the newborn which result in early intervention and best outcome. However implementing universal screening strategy is a challenge in many resource constrained settings. There are various limitations towards successful implementation of hearing screening program in the developing countries. The cost effectiveness of the screening program also needs to be considered in a resource constrained settings. We attempt to provide a viewpoint that can be potentially helpful for the successful implementation of hearing screening in a resource constrained settings of the developing countries.
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Kolethekkat AA, Al Abri R, Hlaiwah O, Al Harasi Z, Al Omrani A, Sulaiman AA, Al Bahlani H, Al Jaradi M, Mathew J. Limitations and drawbacks of the hospital-based universal neonatal hearing screening program: First report from the Arabian Peninsula and insights. Int J Pediatr Otorhinolaryngol 2020; 132:109926. [PMID: 32036167 DOI: 10.1016/j.ijporl.2020.109926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the efficacy of the current universal neonatal hearing screening program in a tertiary medical institution in Oman, identify its limitations and drawbacks, and explore their causative factors. METHODS A retrospective review was carried out to analyse the hearing screening of 12,743 live babies born between January 2016 and December 2018. Screen coverage, drop outs, follow up rate, and age at completion of screening, diagnosis, and intervention were analysed. The results were compared with the Joint Committee on Infant Hearing (JCIH) performance quality indices. Prospective questionnaire-based telephonic interviews were then conducted with the parents or caregivers of neonates with hearing loss. Finally, the causes of loss to follow up or delays in hearing screenings, diagnosis, and/or early intervention were studied. RESULTS The true prevalence of hearing loss was 4.0 in 1000. The coverage of first-stage screening was 90% whereas the compliance with the second stage was 88.04%. 22.8% of the patients eventually obtained final diagnostic confirmation. The overall compliance with amplification was 30.2%. The completion ages of primary screening and final confirmation were 7.98 and 17.3 weeks respectively. The importance of hearing screening is well received by parents, but problems related to communication, delays in the appointment system, and inefficient follow up tracking were identified as the main limitations and drawbacks of the program. CONCLUSION The coverage of the neonatal hearing screening program had not yet reached the required goal of 95%. The performance indicators also fell below the international benchmark. There is a need to address the identified causative factors. Effective communication and well-maintained tracking systems need to be implemented.
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Affiliation(s)
| | | | - Omar Hlaiwah
- ENT Division, Department of Surgery, SQU Hospital, Oman
| | | | | | | | | | | | - John Mathew
- ENT Division, Department of Surgery, SQU Hospital, Oman
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McInerney M, Scheperle R, Zeitlin W, Bodkin K, Uhl B. Adherence to follow-up recommendations for babies at risk for pediatric hearing loss. Int J Pediatr Otorhinolaryngol 2020; 132:109900. [PMID: 32006864 DOI: 10.1016/j.ijporl.2020.109900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to evaluate the families' compliance with recommendations for continued monitoring of babies with high-risk factors for hearing loss. METHODS Hearing screening and follow-up results from 604 babies were tracked across a five-year period. Bivariate analysis, including chi-square analysis, t-tests, and one-way analyses of variance were conducted to test whether various factors predicted likelihood of follow up. RESULTS Although 86% of the babies returned for the initial follow-up appointment, few completed the protocol or were diagnosed with hearing loss (10.3%). Excluding the babies who never returned, the average age for initial assessment was near the recommended 3-month target (3.5 months). However, babies were last seen at 9.4 months on average, which is earlier than recommended. Some factors positively predicted follow-up: receipt of ototoxic medication, hyperbilirubinemia requiring transfusion, ECMO, syndromes associated with hearing loss, craniofacial anomalies, and passing the newborn hearing screening. Others were negatively predictive: NICU stay >5 days, younger maternal age, and failing the newborn screening. There was no relationship between the results of the last test and whether the families continued with monitoring. Babies with risks categorized as more likely to be associated with delayed onset hearing loss were more often late to the initial follow up, but also followed up for a longer period of time. CONCLUSIONS These results demonstrate the need to focus on the barriers unique to babies with risk factors for late onset/progressive hearing loss in addition to those barriers that generally affect loss to follow up. Tools for parental engagement are recommended.
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Affiliation(s)
- Maryrose McInerney
- Montclair State University, 1 Normal Ave, Montclair, NJ, 07043, USA; Hackensack Meridian Health, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, 30 Prospect Ave., Hackensack, NJ, 07601, USA.
| | - Rachel Scheperle
- Montclair State University, 1 Normal Ave, Montclair, NJ, 07043, USA; St. Louis Children's Hospital, One Children's Place, St. Louis, MO, 63110, USA.
| | - Wendy Zeitlin
- Montclair State University, 1 Normal Ave, Montclair, NJ, 07043, USA.
| | - Kenneth Bodkin
- Hackensack Meridian Health, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, 30 Prospect Ave., Hackensack, NJ, 07601, USA.
| | - Barbara Uhl
- Hackensack Meridian Health, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, 30 Prospect Ave., Hackensack, NJ, 07601, USA.
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Shirane M, Ganaha A, Nakashima T, Shimoara S, Yasunaga T, Ichihara S, Kageyama S, Matsuda Y, Tono T. Comprehensive hearing care network for early identification and intervention in children with congenital and late-onset/acquired hearing loss: 8 years' experience in Miyazaki. Int J Pediatr Otorhinolaryngol 2020; 131:109881. [PMID: 31978747 DOI: 10.1016/j.ijporl.2020.109881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In 2010, we established the Miyazaki Comprehensive Hearing Care Network (MCHCN) for early identification and intervention in children with congenital and late-onset/acquired hearing loss with the cooperation of related administrative bodies in Miyazaki prefecture. The central roles of the MCHCN program are played by the Hearing Care Center (HCC) at the University of Miyazaki Hospital established in 2010 to facilitate audiological diagnoses, hearing aid interventions, and educational efforts, as well as linkage with the Department of Otolaryngology for surgical interventions. Herein, we aimed to present the main outcomes of the MCHCN program organized by the HCC at the University of Miyazaki Hospital. METHODS The MCHCN consists of two different networks, the Newborn Hearing Screening Network (NHSN) and the Pediatric Hearing Care Network (PHCN). All children suspected of having hearing loss by Newborn Hearing Screening (NHS) are referred to the HCC via the NHSN. In addition, children suspected of late-onset/acquired hearing loss by municipality-led health checkups, pediatricians, public health nurses, and childcare workers are referred to the HCC via the PHCN. Children who were born in Miyazaki prefecture between January 2010 and December 2017 and referred to the HCC for detailed hearing examination were included in this study. RESULTS Within the study period, 89,390 infants were born in Miyazaki prefecture, and 84,737 (94.9%) of them underwent NHS. A total of 698 infants and 182 children with suspected hearing loss were referred to the HCC via the NHSN and PHCN, respectively. Of the 880 referrals, 169 were diagnosed with hearing loss, which included 80 children with bilateral hearing loss and 89 children with unilateral hearing loss. Of the 80 children with bilateral hearing loss, 76 began wearing hearing aids and 15 had cochlear implants in the follow-up period. In children with bilateral conductive hearing loss, 4 children with bilateral middle ear anomalies underwent ossiculoplasty, following which two of these children no longer required hearing aids. Imaging assessments performed on 71 of the 89 children with unilateral hearing loss revealed that 20 of the 30 (66%) children who underwent CT exhibited ossicular anomalies and 28 out of the 48 (58%) children who underwent MRI were found to have ipsilateral cochlear nerve hypoplasia. Among the 169 children with hearing loss, no follow-up loss was observed during the period of this study. CONCLUSION The MCHCN that was organized at the initiative of the HCC at the University of Miyazaki Hospital has enabled the provision of comprehensive and continuous support, ranging from diagnosis to intervention, not only for children with suspected hearing loss referred based on their NHS results but also for those who pass the screening. Via this system, children with late-onset/acquired hearing loss can be identified early and can receive medical interventions tailored to the cause of their hearing loss while simultaneously avoiding a loss to follow-up.
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Affiliation(s)
- Miho Shirane
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Akira Ganaha
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Takahiro Nakashima
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Shoken Shimoara
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Taro Yasunaga
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Sakura Ichihara
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Saki Kageyama
- National Hospital Organization Miyakonojo Medical Center, 5033-1 Iwayoshi, Miyakonojo, 885-0014, Japan.
| | - Yusuke Matsuda
- Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760, Japan.
| | - Tetsuya Tono
- Miyazaki University Hospital Hearing Care Center, Miyazaki, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
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McCreery RW, Walker EA, Stiles DJ, Spratford M, Oleson JJ, Lewis DE. Audibility-Based Hearing Aid Fitting Criteria for Children With Mild Bilateral Hearing Loss. Lang Speech Hear Serv Sch 2020; 51:55-67. [PMID: 31913801 PMCID: PMC7251589 DOI: 10.1044/2019_lshss-ochl-19-0021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 11/09/2022] Open
Abstract
Purpose Because of uncertainty about the level of hearing where hearing aids should be provided to children, the goal of the current study was to develop audibility-based hearing aid candidacy criteria based on the relationship between unaided hearing and language outcomes in a group of children with hearing loss who did not wear hearing aids. Method Unaided hearing and language outcomes were examined for 52 children with mild-to-severe hearing losses. A group of 52 children with typical hearing matched for age, nonverbal intelligence, and socioeconomic status was included as a comparison group representing the range of optimal language outcomes. Two audibility-based criteria were considered: (a) the level of unaided hearing where unaided children with hearing loss fell below the median for children with typical hearing and (b) the level of unaided hearing where the slope of language outcomes changed significantly based on an iterative, piecewise regression modeling approach. Results The level of unaided audibility for children with hearing loss that was associated with differences in language development from children with typical hearing or based on the modeling approach varied across outcomes and criteria but converged at an unaided speech intelligibility index of 80. Conclusions Children with hearing loss who have unaided speech intelligibility index values less than 80 may be at risk for delays in language development without hearing aids. The unaided speech intelligibility index potentially could be used as a clinical criterion for hearing aid fitting candidacy for children with hearing loss.
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Affiliation(s)
- Ryan W. McCreery
- Audibility, Perception and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | | | - Meredith Spratford
- Audibility, Perception and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
| | - Jacob J. Oleson
- Department of Biostatistics, The University of Iowa, Iowa City
| | - Dawna E. Lewis
- Audibility, Perception and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
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Walker EA, Sapp C, Oleson JJ, McCreery RW. Longitudinal Speech Recognition in Noise in Children: Effects of Hearing Status and Vocabulary. Front Psychol 2019; 10:2421. [PMID: 31708849 PMCID: PMC6824244 DOI: 10.3389/fpsyg.2019.02421] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/11/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aims of the current study were: (1) to compare growth trajectories of speech recognition in noise for children with normal hearing (CNH) and children who are hard of hearing (CHH) and (2) to determine the effects of auditory access, vocabulary size, and working memory on growth trajectories of speech recognition in noise in CHH. Design: Participants included 290 children enrolled in a longitudinal study. Children received a comprehensive battery of measures annually, including speech recognition in noise, vocabulary, and working memory. We collected measures of unaided and aided hearing and daily hearing aid (HA) use to quantify aided auditory experience (i.e., HA dosage). We used a longitudinal regression framework to examine the trajectories of speech recognition in noise in CNH and CHH. To determine factors that were associated with growth trajectories for CHH, we used a longitudinal regression model in which the dependent variable was speech recognition in noise scores, and the independent variables were grade, maternal education level, age at confirmation of hearing loss, vocabulary scores, working memory scores, and HA dosage. Results: We found a significant effect of grade and hearing status. Older children and CNH showed stronger speech recognition in noise scores compared to younger children and CHH. The growth trajectories for both groups were parallel over time. For CHH, older age, stronger vocabulary skills, and greater average HA dosage supported speech recognition in noise. Conclusion: The current study is among the first to compare developmental growth rates in speech recognition for CHH and CNH. CHH demonstrated persistent deficits in speech recognition in noise out to age 11, with no evidence of convergence or divergence between groups. These trends highlight the need to provide support for children with all degrees of hearing loss in the academic setting as they transition into secondary grades. The results also elucidate factors that influence growth trajectories for speech recognition in noise for children; stronger vocabulary skills and higher HA dosage supported speech recognition in degraded situations. This knowledge helps us to develop a more comprehensive model of spoken word recognition in children.
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Affiliation(s)
- Elizabeth A. Walker
- Pediatric Audiology Laboratory, Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, United States
| | - Caitlin Sapp
- Pediatric Audiology Laboratory, Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, United States
| | - Jacob J. Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA, United States
| | - Ryan W. McCreery
- Center for Hearing Research, Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE, United States
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Readability of online patient education materials for parents after a failed newborn hearing screen. Int J Pediatr Otorhinolaryngol 2019; 125:168-174. [PMID: 31326734 DOI: 10.1016/j.ijporl.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE A cross-sectional study design was utilized to evaluate the readability of patient education materials on the newborn hearing screen from Google and major institutions. METHODS The top 55 websites from the Google search "failed newborn hearing screen" and websites from major institutions (the U.S. News & World Report ranked top 10 children's hospitals, the top 5 pediatric otolaryngology fellowships as ranked by Doximity Residency Navigator, the Centers for Disease and Control, the American Academy of Pediatrics and the American Academy of Otolaryngology-Head and Neck Surgery) were compiled. Text from each website was edited to remove extraneous text. Readability grade was calculated using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score, Gunning-Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index, and Automated Readability Index. Intra- and inter-observer reliability were assessed. RESULTS 26 websites from Google and 29 websites from major institutions were evaluated. From Google, provider-oriented websites (n = 2) were more difficult to read than patient-oriented websites (n = 24) with statistical significance for FKGL (p < 0.001), GFI (p < 0.013) and SMOG (p < 0.001). From the major institutions, more than half were at a reading level that exceeded the average American adult with an average FKGL 9.71 ± 2.69. Intra- and inter-observer reliability were both excellent with an intra-class correlation coefficient for each readability tool ≥0.950 (p < 0.001). CONCLUSION Online patient education materials about the newborn hearing screen may be too difficult for the average reader. Revisions to these materials and redirection to more readable online resources may be necessary to benefit a more inclusive patient population.
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D'Aguillo C, Bressler S, Yan D, Mittal R, Fifer R, Blanton SH, Liu X. Genetic screening as an adjunct to universal newborn hearing screening: literature review and implications for non-congenital pre-lingual hearing loss. Int J Audiol 2019; 58:834-850. [PMID: 31264897 DOI: 10.1080/14992027.2019.1632499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: Universal newborn hearing screening (UNHS) uses otoacoustic emissions testing (OAE) and auditory brainstem response testing (ABR) to screen all newborn infants for hearing loss (HL), but may not identify infants with mild HL at birth or delayed onset HL. The purpose of this review is to examine the role of genetic screening to diagnose children with pre-lingual HL that is not detected at birth by determining the rate of children who pass UNHS but have a positive genetic screening. This includes a summary of the current UNHS and its limitations and a review of genetic mutations and screening technologies used to detect patients with an increased risk of undiagnosed pre-lingual HL.Design: Literature review of studies that compare UNHS with concurrent genetic screening.Study sample: Infants and children with HLResults: Sixteen studies were included encompassing 137,895 infants. Pathogenic mutations were detected in 8.66% of patients. In total, 545 patients passed the UNHS but had a positive genetic screening. The average percentage of patients who passed UNHS but had a positive genetic screening was 1.4%.Conclusions: This review demonstrates the positive impact of concurrent genetic screening with UNHS to identify patients with pre-lingual HL.
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Affiliation(s)
- Christine D'Aguillo
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sara Bressler
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Denise Yan
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rahul Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Fifer
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan H Blanton
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Human Genetics, Dr. John T. Macdonald Foundation, Miami, FL, USA.,John P Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Xuezhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Human Genetics, Dr. John T. Macdonald Foundation, Miami, FL, USA.,John P Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.,Tsinghua University School of Medicine, Beijing, PR China
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Awad R, Oropeza J, Uhler KM. Meeting the Joint Committee on Infant Hearing Standards in a Large Metropolitan Children's Hospital: Barriers and Next Steps. Am J Audiol 2019; 28:251-259. [PMID: 31084570 PMCID: PMC6802868 DOI: 10.1044/2019_aja-18-0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 08/15/2018] [Accepted: 01/07/2019] [Indexed: 11/09/2022] Open
Abstract
Purpose The aim of this study was to determine how a large metropolitan children's hospital's practices align with the Joint Committee on Infant Hearing (JCIH) 1-3-6 guidelines (diagnose hearing loss by 3 months of age, fitted with hearing aids within 1 month of diagnosis, and enroll in early intervention by 6 months of age) and examine variables that have impacted meeting these guidelines. This hospital is not a birthing hospital. Therefore, the first recommendation (hearing screen by 1 month of age) was not evaluated. Method One hundred forty-one auditory evoked potential evaluations for infants under the age of 6 months were reviewed for this study. Data were only gathered for infants identified with a bilateral hearing loss ( n = 34). The following was recorded: degree of hearing loss, number of diagnostic sessions over time, the percentage of infants who transitioned to hearing aid fittings, and the age at which JCIH benchmarks were accomplished. Results Sixty-two percent of infants were diagnosed with hearing loss by 3 months of age, 48% of infants were fitted with hearing aids by 4 months of age, and the average age of infants enrolled in early intervention was 4.58 months. Seventy percent of infants were fitted within 1 month of the diagnosis of hearing loss. The identified variables that led to the hearing aids being fitted greater than 1 month after the diagnosis are as follows: cancellations/missed appointments, middle ear involvement, and mild hearing loss. Conclusions Results of this internal audit revealed opportunities for growth in better meeting and exceeding JCIH recommendations of diagnosis by 3 months of age and hearing aid fitting within 1 month of diagnosis. Adjustments in the scheduling process and appointment options have been implemented in response to these results. Additional examination of why these recommendations are not being met and what can be done to achieve them is needed.
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Affiliation(s)
- Rebecca Awad
- Department of Audiology, Speech, and Learning, Children's Hospital Colorado, Aurora
| | - Johanna Oropeza
- Department of Audiology, Speech, and Learning, Children's Hospital Colorado, Aurora
| | - Kristin M. Uhler
- Department of Audiology, Speech, and Learning, Children's Hospital Colorado, Aurora
- Department of Physical Medicine and Rehabilitation, Otolaryngology, & Psychiatry, University of Colorado School of Medicine, Aurora
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Service Preferences of Parents of Children With Mild Bilateral or Unilateral Hearing Loss: A Conjoint Analysis Study. Ear Hear 2019; 40:671-679. [DOI: 10.1097/aud.0000000000000651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evaluation of Speed and Accuracy of Next-Generation Auditory Steady State Response and Auditory Brainstem Response Audiometry in Children With Normal Hearing and Hearing Loss. Ear Hear 2019; 39:1207-1223. [PMID: 29624540 DOI: 10.1097/aud.0000000000000580] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The first objective of this study was to compare the predicted audiometric thresholds obtained by auditory steady state response (ASSR) and auditory brainstem response (ABR) in infants and toddlers when both techniques use optimal stimuli and detection algorithms. This information will aid in determining the basis for large discrepancies in ABR and ASSR measures found in past studies. The hypothesis was that advancements in ASSR response detection would improve (lower) thresholds and decrease discrepancies between the thresholds produced by the two techniques. The second objective was to determine and compare test times required by the two techniques to predict thresholds for both ears at the 4 basic audiometric frequencies of 500, 1000, 2000, and 4000 Hz. DESIGN A multicenter clinical study was implemented at three university-based children's hospital audiology departments. Participants were 102 infants and toddlers referred to the centers for electrophysiologic testing for audiometric purposes. The test battery included wideband tympanometry, distortion-product otoacoustic emissions, and threshold measurements at four frequencies in both ears using ABR and ASSR (randomized) as implemented on the Interacoustics Eclipse systems with "Next-Generation" ASSR detection and FMP analysis for ABR. Both methods utilized narrow band CE-Chirp stimuli. Testers were trained on a specialized test battery designed to minimize test time for both techniques. Testing with both techniques was performed in one session. Thresholds were evaluated and confirmed by the first author and correction factors were applied. Test times were documented in system software. RESULTS Corrected thresholds for ABR and ASSR were compared by regression, by the Bland-Altman technique and by matched pairs t tests. Thresholds were significantly lower for ASSR than ABR. The ABR-ASSR discrepancy at 500 Hz was 14.39 dB, at 1000 Hz was 10.12 dB, at 2000 Hz was 3.73 dB, and at 4000 Hz was 3.67 dB. The average test time for ASSR of 19.93 min (for 8 thresholds) was found to be significantly lower (p < 0.001) than the ABR test time of 32.15 min. One half of the subjects were found to have normal hearing. ASSR thresholds plotted in dB nHL for normal-hearing children in this study were found to be the lowest yet described except for one study which used the same technology. CONCLUSIONS This study found a reversal of previous findings with up to 14 dB lower thresholds found when using the ASSR technique with "Next-Generation" detection as compared with ABR using an automated detection (FMP). The test time for an audiogram prediction was significantly lower when using ASSR than ABR but was excellent by clinical standards for both techniques. ASSRs improved threshold performance was attributed to advancements in response detection including utilization of information at multiple harmonics of the modulation frequency. The stimulation paradigm which utilized narrow band CE-Chirps also contributed to the low absolute levels of the thresholds in nHL found with both techniques.
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Curran M, Walker EA, Roush P, Spratford M. Using Propensity Score Matching to Address Clinical Questions: The Impact of Remote Microphone Systems on Language Outcomes in Children Who Are Hard of Hearing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:564-576. [PMID: 30950736 PMCID: PMC6802899 DOI: 10.1044/2018_jslhr-l-astm-18-0238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 06/09/2023]
Abstract
Purpose Children who are hard of hearing (CHH) have restricted access to acoustic and linguistic information. Increased audibility provided by hearing aids influences language outcomes, but the benefits of hearing aids are often limited by acoustic factors and distance. Remote microphone (RM) systems further increase auditory access by reducing the negative consequences of these factors. The purpose of this article was to identify factors that influence likelihood of RM system receipt and to investigate the effects of RM systems in home settings on later language outcomes. We used propensity score matching to compare language outcomes between children with and without access to personal RM systems in home settings. This article provides a description of how and why to perform propensity score-matching analyses with clinical populations. Method Participants were 132 CHH. Through parent report, we identified children who received RM systems for home use by 4 years of age. Logistic regression was used to determine factors that predict likelihood of RM system receipt in home settings. Propensity score matching was conducted on a subgroup of 104 participants. Performance on language measures at age 5 years was compared across propensity-matched children who did and did not receive RMs for personal use. Results Likelihood of RM receipt was associated with degree of hearing loss, maternal education, and location (recruitment site). Comparisons between matched pairs of children with and without RM systems in early childhood indicated significantly better discourse skills for children whose families owned RM systems, but no significant differences for vocabulary or morphosyntax. Conclusion Results provide preliminary evidence that the provision of personal RM systems for preschool-age CHH enhances higher-level language skills. The propensity score-matching technique enabled us to use an observational, longitudinal data set to examine a question of clinical interest.
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Affiliation(s)
- Maura Curran
- Department of Communication Sciences and Disorders, University of Delaware, Newark
| | - Elizabeth A. Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Patricia Roush
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Meredith Spratford
- Audibility, Perception, and Cognition Laboratory, Boys Town National Research Hospital, Omaha, NE
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Walker EA, Redfern A, Oleson JJ. Linear Mixed-Model Analysis to Examine Longitudinal Trajectories in Vocabulary Depth and Breadth in Children Who Are Hard of Hearing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:525-542. [PMID: 30950738 PMCID: PMC6802902 DOI: 10.1044/2018_jslhr-l-astm-18-0250] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/20/2018] [Accepted: 09/25/2018] [Indexed: 05/31/2023]
Abstract
Purpose Children who are hard of hearing (CHH) tend to have reduced vocabularies compared to children with normal hearing (CNH). Prior research on vocabulary skills in children with hearing loss has focused primarily on their breadth of knowledge (how many words are known). Depth of vocabulary knowledge (how well words are known) is not well documented for CHH. The current study used linear mixed models (LMMs) to investigate growth trajectories of vocabulary depth and breadth in CHH relative to age-matched CNH. Method Participants for this study included 155 children (93 CHH, 62 CNH) enrolled in a longitudinal study. Examiners administered a standardized measure of vocabulary knowledge at ages 7, 8, and 9 years. We constructed multiple LMMs with fixed effects for group and age. The models included various combinations of random intercepts for subject and item and random slope for age. Results For depth, CHH showed significant and stable deficits compared to CNH over time. For breadth, CNH showed greater vocabulary breadth, but the group differences diminished with age. For CHH, higher aided audibility, age, and maternal educational level were associated with greater vocabulary breadth and depth. Age at hearing aid fitting was not. Conclusions A major advantage of using LMM is that it allowed us to cope with missing data points while still accounting for variability within and across participants. Assessment of both vocabulary breadth and depth may be useful in identifying school-age CHH who are at risk of delays in language outcomes.
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Affiliation(s)
- Elizabeth A. Walker
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Alexandra Redfern
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Jacob J. Oleson
- Department of Biostatistics, The University of Iowa, Iowa City
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Runnion E, Gray S. What Clinicians Need to Know About Early Literacy Development in Children With Hearing Loss. Lang Speech Hear Serv Sch 2019; 50:16-33. [PMID: 30950774 DOI: 10.1044/2018_lshss-18-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Children with hearing loss may not reach the same level of reading proficiency as their peers with typical development. Audiologists and speech-language pathologists (SLPs) have important roles to play in preventing this problem early in children's development. In this tutorial, we aim to communicate how the habilitation practices of audiologists and intervention services of SLPs can support early literacy skill development in children with hearing loss. Method We describe key findings from peer-reviewed research articles to provide a review of early literacy skill development, to explain the relationship between early literacy skills and conventional reading skills, and to highlight findings from early literacy skill intervention studies that included children with hearing loss who use spoken language. We conclude with a hypothetical case study to illustrate how audiologists and SLPs can support early literacy acquisition in children with hearing loss. Conclusion Findings from studies of young children with hearing loss suggest that a promising approach to improving reading outcomes is to provide explicit early literacy instruction and intervention.
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Affiliation(s)
- Elizabeth Runnion
- Department of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Shelley Gray
- Department of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
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