Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss

Intelligence among ear deformities and cleft lip and/or alveolus and/or cleft palate patients during 50 years in Israel

PURPOSE

We evaluated hearing loss and general intelligence among persons with auricle anomalies and cleft lip and/or alveolus and/or cleft palate (CLAP).

METHODS

A nationwide cross-sectional study of data recorded during 1966-2019, as mandatory pre-military recruitment of individuals.

RESULTS

Of 3 182 892 adolescents, 548 were diagnosed with auricle anomalies and 2072 with CLAP. For the latter, the adjusted odds ratios for the low, low to medium and medium general intelligence categories compared to the highest category were 1.4 [95% CI 1.5-1.2], 1.2 [95% CI 1.4-1.1] and 1.1 [95% CI 1.2-0.9] respectively. The corresponding values for the auricle anomalies were not significant.

CONCLUSIONS

General intelligence was impaired among individuals with CLAP, but no significant correlation was found among individuals suffering from auricle anomalies.

Varying Syntax to Enhance Verb-Focused Intervention for 30-Month-Olds With Language Delay: A Concurrent Multiple Baseline Design

PURPOSE

The purpose of this study is to determine if 2.5-year-olds with language delay would learn verbs (spill) when presented with varying syntactic structure ("The woman is spilling the milk"/"The milk is spilling"; milk = patient or theme) in a therapeutic context. Children with language delay have proportionally small inventories of verbs, which limits expressive language development. Children who have typical language development learn verbs more robustly when presented with alternating arguments than with a single argument structure.

METHOD

Three toddlers with expressive language delay (29-30 months of age) participated in a verb-focused treatment study using a concurrent multiple baseline design. Participants were shown action videos accompanied by sentences with varied argument structure for each target verb. To assess learning pre- and posttreatment, participants were asked to demonstrate actions corresponding to each verb.

RESULTS

Visual inspection and tau analyses reveal significant posttreatment gains of target verbs taught with varying argument structures.

CONCLUSIONS

Our results indicate that learning verbs with high variability of argument roles may facilitate a strong link between lexical representations of verbs and their syntactic structures. Using argument structure variability to teach verbs as an intervention strategy has great potential and should be tested further in larger group studies.

Perception of voice cues in school-age children with hearing aids

The just-noticeable differences (JNDs) of the voice cues of voice pitch (F0) and vocal-tract length (VTL) were measured in school-aged children with bilateral hearing aids and children and adults with normal hearing. The JNDs were larger for hearing-aided than normal-hearing children up to the age of 12 for F0 and into adulthood for all ages for VTL. Age was a significant factor for both groups for F0 JNDs, but only for the hearing-aided group for VTL JNDs. Age of maturation was later for F0 than VTL. Individual JNDs of the two groups largely overlapped for F0, but little for VTL. Hearing thresholds (unaided or aided, 500-400 Hz, overlapping with mid-range speech frequencies) did not correlate with the JNDs. However, extended low-frequency hearing thresholds (unaided, 125-250 Hz, overlapping with voice F0 ranges) correlated with the F0 JNDs. Hence, age and hearing status differentially interact with F0 and VTL perception, and VTL perception seems challenging for hearing-aided children. On the other hand, even children with profound hearing loss could do the task, indicating a hearing aid benefit for voice perception. Given the significant age effect and that for F0 the hearing-aided children seem to be catching up with age-typical development, voice cue perception may continue developing in hearing-aided children.

Spoken Expressive Vocabulary in 2-Year-Old Children with Hearing Loss: A Community Study

Through a cross-sectional community study of 2044 children aged 2 years, we (1) examine the impact of hearing loss on early spoken expressive vocabulary outcomes and (2) investigate how early intervention-related factors impact expressive vocabulary outcomes in children with hearing loss predominantly identified through universal newborn hearing screening. We used validated parent/caregiver-reported checklists from two longitudinal cohorts (302 children with unilateral or bilateral hearing loss, 1742 children without hearing loss) representing the same population in Victoria, Australia. The impact of hearing loss and amplification-related factors on vocabulary was estimated using g-computation and multivariable linear regression. Children with versus without hearing loss had poorer expressive vocabulary scores, with mean scores for bilateral loss 0.5 (mild loss) to 0.9 (profound loss) standard deviations lower and for unilateral loss marginally (0.1 to 0.3 standard deviations) lower. For children with hearing loss, early intervention and amplification by 3 months, rather than by 6 months or older, resulted in higher expressive vocabulary scores. Children with hearing loss demonstrated delayed spoken expressive vocabulary despite whole-state systems of early detection and intervention. Our findings align with calls to achieve a 1-2-3 month timeline for early hearing detection and intervention benchmarks for screening, identification, and intervention.

Development of Social-Pragmatic Understanding in Children With Congenital Hearing Loss and Typical Hearing Between the Ages of 4 and 6 Years

PURPOSE

This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH.

METHOD

The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years.

RESULTS

The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context.

CONCLUSIONS

Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.

Features of Cognitive Ability and Central Auditory Processing of Preschool Children With Minimal and Mild Hearing Loss

OBJECTIVE

This study aimed to investigate the current status of cognitive development and central auditory processing development of preschool children with minimal and mild hearing loss (MMHL) in Nanjing, China.

METHOD

We recruited 34 children with MMHL and 45 children with normal hearing (NH). They completed a series of tests, including cognitive tests (i.e., Wechsler Preschool and Primary Scale of Intelligence and Continuous Performance Test), behavioral auditory tests (speech-in-noise [SIN] test and frequency pattern test), and objective electrophysiological audiometry (speech-evoked auditory brainstem response and cortical auditory evoked potential). In addition, teacher evaluations and demographic information and questionnaires completed by parents were collected.

RESULTS

Regarding cognitive ability, statistical differences in the verbal comprehensive index, full-scale intelligence quotient, and abnormal rate of attention test score were found between the MMHL group and the NH group. The children with MMHL performed poorer on the SIN test than the children with NH. As for the auditory electrophysiology of the two groups, the latency and amplitude of some waves of the speech-evoked auditory brainstem response and cortical auditory evoked potential were statistically different between the two groups. We attempted to explore the relationship between some key indicators of auditory processing and some key indicators of cognitive development.

CONCLUSIONS

Children with MMHL are already at increased developmental risk as early as preschool. They are more likely to have problems with attention and verbal comprehension than children with NH. This condition is not compensated with increasing age during the preschool years. The results suggest a possible relationship between the risk of cognitive deficit and divergence of auditory processing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22670473.

EEG Alpha Band Responses Reveal Amplification Benefits in Infants with Hearing Loss

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.

Delayed Lexical Access and Cascading Effects on Spreading Semantic Activation During Spoken Word Recognition in Children With Hearing Aids and Cochlear Implants: Evidence From Eye-Tracking

OBJECTIVE

The objective of this study was to characterize the dynamics of real-time lexical access, including lexical competition among phonologically similar words, and spreading semantic activation in school-age children with hearing aids (HAs) and children with cochlear implants (CIs). We hypothesized that developing spoken language via degraded auditory input would lead children with HAs or CIs to adapt their approach to spoken word recognition, especially by slowing down lexical access.

DESIGN

Participants were children ages 9- to 12-years old with normal hearing (NH), HAs, or CIs. Participants completed a Visual World Paradigm task in which they heard a spoken word and selected the matching picture from four options. Competitor items were either phonologically similar, semantically similar, or unrelated to the target word. As the target word unfolded, children's fixations to the target word, cohort competitor, rhyme competitor, semantically related item, and unrelated item were recorded as indices of ongoing lexical access and spreading semantic activation.

RESULTS

Children with HAs and children with CIs showed slower fixations to the target, reduced fixations to the cohort competitor, and increased fixations to the rhyme competitor, relative to children with NH. This wait-and-see profile was more pronounced in the children with CIs than the children with HAs. Children with HAs and children with CIs also showed delayed fixations to the semantically related item, although this delay was attributable to their delay in activating words in general, not to a distinct semantic source.

CONCLUSIONS

Children with HAs and children with CIs showed qualitatively similar patterns of real-time spoken word recognition. Findings suggest that developing spoken language via degraded auditory input causes long-term cognitive adaptations to how listeners recognize spoken words, regardless of the type of hearing device used. Delayed lexical access directly led to delays in spreading semantic activation in children with HAs and CIs. This delay in semantic processing may impact these children's ability to understand connected speech in everyday life.

Complex Language Use in Children With Hearing Loss: A Scoping Review

PURPOSE

Understanding what is known about the language profiles of children with hearing loss (CHL) is vital so that researchers and teachers can identify the specific complex syntactic structures that CHL may struggle to master. An understanding of which aspects of complex syntax pose difficulties for CHL is necessary to inform the kind of intervention that will facilitate learning complex syntax for this cohort of children. This scoping review aims to identify what is currently known about the complex syntax use of CHL who communicate through spoken language, and uncover gaps in the literature to guide further research.

METHOD

Ascoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The Covidence software was utilized to manage the initial and full-text screening process for the search.

RESULTS

From a total of 304 studies, 42 studies were identified that met the eligibility criteria. The review highlights the use of broad-based language assessments and limited use of specific descriptions of the types of complex syntactic structures and skills.

CONCLUSIONS

Findings highlight the need for assessment protocols and analysis methods that better support the description of complex syntax profiles for CHL. School-age CHL continue to display challenges with complex syntax development. The review highlighted the need for further research to improve understanding of the complex syntax strengths and vulnerabilities of CHL. Further investigation is needed to better understand their ability to combine ideas and build complexity in their language use, which in turn can inform teaching in schools and interventions for children who require support.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21980177.

Reading Comprehension of Chinese-Speaking Children With Hearing Loss: The Roles of Metalinguistic Awareness and Vocabulary Knowledge

PURPOSE

This study aims to explore the contributions of phonological awareness (PA) and morphological awareness (MA) to the reading comprehension skills of Chinese-speaking children with hearing loss (HL) and examine the possible mediation effect of vocabulary knowledge on the relationships of PA and MA with their reading comprehension.

METHOD

The participants were 28 Chinese-speaking children with HL, who were followed from Grade 1 through Grade 2. They were administered a series of tests that measured their PA and MA at the beginning of Grade 1, vocabulary knowledge at the end of Grade 1, and reading comprehension at the end of Grade 2.

RESULTS

MA significantly accounted for additional variance in reading comprehension beyond the effect of PA but not vice versa. Both PA and MA contributed uniquely to vocabulary knowledge, which completely mediated the relationships of PA and MA with reading comprehension.

CONCLUSIONS

PA and MA are both essential to the development of vocabulary knowledge and reading comprehension in Chinese-speaking children with HL; however, MA seems to be more important than PA in their reading comprehension. PA and MA significantly affect children's reading comprehension through their influence on vocabulary knowledge. This study has replicated previous evidence on the importance of PA, MA, and vocabulary knowledge in the reading comprehension of children with typical hearing, and has extended its significance to children with HL. In addition, the findings have the potential to inform educational practitioners regarding the importance of teaching essential reading skills to Chinese-speaking children with HL.

Is Early Cochlear Implantation Leads to Better Speech and Language Outcomes?

A cochlear implant is an electronic sensory system that converts mechanical energy into coded electrical signals that directly activate the auditory nerve fibers. Present review article investigates the findings of previous research papers which have assessed speech and language outcome in children who underwent early cochlear implantation. Several databases, including PubMed, Google, Google Scholar, and Medline, were investigated for research papers on the speech and language outcomes of children who had early-life implants. According to previous research, early detection and intervention of hearing loss are critical for the growth of speech and language skills. The effect of early detection of hearing loss and early cochlear implantation on a child's overall speech-language and auditory growth is highlighted in this article.

Association of Developmental Language Disorder With Comorbid Developmental Conditions Using Algorithmic Phenotyping

IMPORTANCE

Developmental language disorder (DLD) is a common (with up to 7% prevalence) yet underdiagnosed childhood disorder whose underlying biological profile and comorbidities are not fully understood, especially at the population level.

OBJECTIVE

To identify clinically relevant conditions that co-occur with DLD at the population level.

DESIGN, SETTING, AND PARTICIPANTS

This case-control study used an electronic health record (EHR)-based population-level approach to compare the prevalence of comorbid health phenotypes between DLD cases and matched controls. These cases were identified using the Automated Phenotyping Tool for Identifying Developmental Language Disorder algorithm of the Vanderbilt University Medical Center EHR, and a phenome enrichment analysis was used to identify comorbidities. An independent sample was selected from the Geisinger Health System EHR to test the replication of the phenome enrichment using the same phenotyping and analysis pipeline. Data from the Vanderbilt EHR were accessed between March 2019 and October 2020, while data from the Geisinger EHR were accessed between January and March 2022.

MAIN OUTCOMES AND MEASURES

Common and rare comorbidities of DLD at the population level were identified using EHRs and a phecode-based enrichment analysis.

RESULTS

Comorbidity analysis was conducted for 5273 DLD cases (mean [SD] age, 16.8 [7.2] years; 3748 males [71.1%]) and 26 353 matched controls (mean [SD] age, 14.6 [5.5] years; 18 729 males [71.1%]). Relevant phenotypes associated with DLD were found, including learning disorder, delayed milestones, disorders of the acoustic nerve, conduct disorders, attention-deficit/hyperactivity disorder, lack of coordination, and other motor deficits. Several other health phenotypes not previously associated with DLD were identified, such as dermatitis, conjunctivitis, and weight and nutrition, representing a new window into the clinical complexity of DLD.

CONCLUSIONS AND RELEVANCE

This study found both rare and common comorbidities of DLD. Comorbidity profiles may be leveraged to identify risk of additional health challenges, beyond language impairment, among children with DLD.

Expressive vocabulary of school-age children with mild to moderately severe hearing loss

OBJECTIVES

The main goal of this study was to describe the expressive vocabulary of school-age children with mild to moderately severe hearing loss (CHL group) and to compare their performance with children with normal hearing (CNH group) of the same age. Another aim was to examine the interaction between nonword repetition and expressive vocabulary size. Furthermore, the interaction between results on vocabulary tests and background factors, such as the age of diagnosis, age of hearing aid fitting, and amount of hearing aid use, was explored.

METHOD

School-aged children with mild to moderately severe, permanent bilateral hearing loss and children with normal hearing were included in this cross-sectional study. The children participated in assessments of naming pictures, defining words, and repetition of nonwords and sentences. Results of the CHL group and the CNH group were compared. The analysis also included the degree of hearing loss, the age of diagnosis, amount of hearing aid use, and level of parental education.

RESULTS

The CHL group performed significantly below the CNH group on all measures: picture naming, defining words, nonword repetition, and repetition of sentences. The proportion of words pronounced with correct phonological structure when picture naming was more limited in the CHL group than in the CNH group. There was a significant positive correlation between the amount of hearing aid use and nonword repetition ability in the CHL group. Age of diagnosis and age of hearing aid fitting was not significantly correlated with the outcomes of the vocabulary assessments in this study.

CONCLUSION

Despite the technological advancement of hearing aids, the expressive vocabulary in school-aged children with mild to moderately severe, permanent bilateral, hearing impairment does not reach the same level as for children with normal hearing, although there is a variation in performance within the group. The variation in the CHL group was not uniquely impacted by either age, degree of hearing loss, or the age of diagnosis. The amount of hearing aid use seems to impact the perception of new words. More studies of expressive vocabulary are needed, because they capture a dimension of word learning that seems particularly sensitive to hearing loss and hearing aid use.

Communication abilities in children with hearing loss - views of parents and daycare professionals

INTRODUCTION

Today, children with hearing loss (HL) are diagnosed and fitted with hearing devices at an early age. However, HL may still influence their communicative development. Thus, we need up-to-date research on how children perform in their everyday environments, such as at home or daycare. This study provides an overview of the communication abilities of early-diagnosed children with HL reported by parents and daycare professionals. The first aim of the study is to compare the results of children with bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) with those of children with normal hearing (NH) and with each other. The second aim of the study is to compare the views of the two respondents, parents and the daycare professionals. In addition, the effects of gender and nonverbal intelligence quotient (IQ) on the responses are explored.

METHODS

The participants, aged 4;0-6;9, were 25 children with BiHAs, 29 children with BiCIs, and 64 children with NH. The Finnish version of the Children's Communication Checklist-2 (CCC-2) was used to assess the communication skills of the participants.

RESULTS

Group and nonverbal IQ had a significant effect on the General Communication Composite (GCC) score. Both groups of children with HL had poorer GCC scores than the children with NH, apart from the respondent. The BiHA-group had significantly lower scores than the NH-group on Speech, Syntax, Semantics, and Coherence subscales. The BiCI-group had significantly lower scores than the NH-group across all subscales of the CCC-2. The parents rated the participants significantly higher than the daycare professionals in Speech and Social Relations. In contrast, the daycare professionals rated the participants higher than the parents in Coherence, Inappropriate Initiation, Stereotyped Language, and Use of Context. Furthermore, gender influenced Coherence, Nonverbal Communication, Social Relations, and Interests, for which the girls performed better than the boys. The nonverbal IQ had an effect on Syntax, Semantics, and Use of Context, for which higher nonverbal IQ was associated with better performance.

CONCLUSIONS

On average the children with HL had poorer communication skills than the children with NH. Pragmatic difficulties were more common in the BiCI-group than in the BiHA-group. The respondents were not completely unanimous, which may be because of the different demands of different environments.

Speech, language, and literacy outcomes for children with mild to moderate hearing loss: A systematic review

PURPOSE

To systematically review the current literature to describe the speech, language, and literacy skills of children with mild to moderate hearing loss (MMHL).

METHOD

Systematic searching of seven online databases identified 13 eligible studies examining speech, language, and literacy outcomes for children with MMHL. Studies were rated for quality. Findings were reported via narrative synthesis.

RESULTS

Many studies reported no significant differences between children with MMHL and hearing peers on speech, language, and literacy measures. Studies that did report significant differences reported that children with MMHL performed significantly more poorly than hearing peers in speech production, receptive morphology, following directions, recalling sentences, expressive morphology, and word and non-word reading.

CONCLUSIONS

Due to the heterogeneity in participant characteristics, moderating factors reported, and measures used, clear patterns in the outcomes were difficult to find. Further research into speech, language and literacy outcomes for children with MMHL from early childhood to adolescence (longitudinal studies) are required to describe possible trajectories for children with MMHL including how moderating factors (such as age of hearing aid fitting, duration of use, and access to early intervention) may be contributing to these trajectories.

Working Memory-Based Cognitive Rehabilitation: Spoken Language of Deaf and Hard-of-Hearing Children

This research examined the effect of the Working Memory-based Cognitive Rehabilitation (WMCR) intervention on the spoken language development of deaf and hard-of-hearing (DHH) children. In this clinical trial study, 28 DHH children aged between 5 and 6 years were selected by random sampling method. The participants were randomly assigned to experimental and control groups. The experimental group participated in the WMCR intervention involving 11 sessions. All participants were assessed pre-and postintervention. Data were collected by the Newsha Development Scale and analyzed through MANCOVA. The results revealed a significant difference between the scores of the receptive and expressive language of the experimental group that were exposed to the WMCR intervention compared with the control group. The receptive and expressive language skills of the experimental group indicated a significant improvement after the intervention. Therefore, the WMCR intervention is an effective method that affects the spoken language skills of DHH children. These findings have critical implications for teachers, parents, and therapists in supporting DHH young children to develop their language skills.

The relationships between language, working memory and rapid naming in children with mild to moderate hearing loss

OBJECTIVE

Hearing loss is associated with reduced quality and quantity of auditory input, and difficulty in cognitive and language skills. This study aimed to investigate the relationship between language, working memory, and rapid naming skills in children with mild to moderate sensorineural hearing loss (MMHL).

METHODS

Twenty children with MMHL with the same auditory experience and demographical conditions using bilateral hearing aids were included. Verbal memory subscale of the Working Memory Scale (WMS), consisting of verbal short-term memory (V-STM) and verbal working memory (V-WM) subtests, was administered to all participants. They also completed rapid automatized naming tasks and standardized language measures.

RESULTS

The language score showed a moderate and significant correlation with verbal memory (VM) score (p = 0.03, r = 0.48) and a moderate and negative correlation with rapid automatized naming (RAN) duration (p = 0.06, r = -0.61). The VM score showed a moderate and significant negative correlation with RAN duration (p = 0.01, r = -0.67). The language level has a strong and significant positive correlation with V-STM (p = 0.007, r = 0.60), V-WM (p = 0.009, r = 0.58), and VM level (p = 0.003, r = 0.65). VM subtests levels have a strong and significant positive correlation with each other (p = 0.017, r = 0.53). RAN level has a strong and significant negative correlation with VM (p = 0.001, r = -0.70), V-WM (p = 0.001, r = -0.76), V-STM (p = 0.001, r = -0.69), and language level (p = 0.001, r = -0.77).

CONCLUSION

The results suggest that the language, verbal working memory, and rapid naming skills of children with MMHL are closely related. It is recommended that the relationship between verbal short-term memory, verbal working memory, rapid naming skills, and language skills should be considered in therapeutic and educational settings. To the best of our knowledge, this is the first study to examine the relationships between verbal-short-term -working memory, duration of rapid automatized naming, and language skills in children with MMHL.

Phoneme acquisition in French-speaking children with moderate hearing loss

The current study aims to provide a more precise understanding of phoneme acquisition by children with moderate hearing loss (MHL), since they have been an under-studied population among children with hearing loss. The acquisition of sounds by 15 children with MHL (mean: 3;11 year-old) was compared to that by six younger normal-hearing (YNH) children (mean: 2;8 year-old). All the children were video- and audio-recorded in interaction with one or both parents in two semi-spontaneous tasks, and during a naming task. All their productions were analysed in terms of percentage of accuracy and substitution patterns. Similarities and differences between the two populations were observed. Globally, the phoneme level of accuracy of children with MHL was similar to that of YNH, but with a general delay. The observation of substitution patterns revealed differences between the two populations, such as prevalent fortition of fricatives and /ʁ/ by children with MHL, which was unusual among YNH children. Another difference was the prevalent posteriorization of coronal fricatives by children with MHL, whereas anteriorization of post-alveolar fricatives was more common in YNH children. These findings highlight the role of perception and language experience in phonological acquisition, showing that an atypical hearing experience may not only cause a delay, but also the emergence of a specific developmental path.

Auditory experience modulates frontoparietal theta activity serving fluid intelligence

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.

Functional Brain Connections Identify Sensorineural Hearing Loss and Predict the Outcome of Cochlear Implantation

Identification of congenital sensorineural hearing loss (SNHL) and early intervention, especially by cochlear implantation (CI), are crucial for restoring hearing in patients. However, high accuracy diagnostics of SNHL and prognostic prediction of CI are lacking to date. To diagnose SNHL and predict the outcome of CI, we propose a method combining functional connections (FCs) measured by functional magnetic resonance imaging (fMRI) and machine learning. A total of 68 children with SNHL and 34 healthy controls (HC) of matched age and gender were recruited to construct classification models for SNHL and HC. A total of 52 children with SNHL that underwent CI were selected to establish a predictive model of the outcome measured by the category of auditory performance (CAP), and their resting-state fMRI images were acquired. After the dimensional reduction of FCs by kernel principal component analysis, three machine learning methods including the support vector machine, logistic regression, and k-nearest neighbor and their voting were used as the classifiers. A multiple logistic regression method was performed to predict the CAP of CI. The classification model of voting achieves an area under the curve of 0.84, which is higher than that of three single classifiers. The multiple logistic regression model predicts CAP after CI in SNHL with an average accuracy of 82.7%. These models may improve the identification of SNHL through fMRI images and prognosis prediction of CI in SNHL.

Association between hearing impairment, school performance and cognitive function in children and adolescents with sickle cell disease

OBJECTIVE

To investigate the association among hearing impairment, school performance, and cognitive function in children and adolescents with sickle cell disease.

METHODS

Thirty-one participants with sickle cell disease (SCD) and 31 healthy participants in the control-comparison group (CG), both aged 8-17 years underwent auditory system evaluation (pure tone audiometry and acoustic reflex), were screened for the risks of (central) auditory processing disorder and dysfunction of cognitive function using the Scale of Auditory Behaviors (SAB) and the Mini-Mental State Examination (MMSE), respectively, and were interviewed to obtain clinical data and data on school performance.

RESULTS

In the SCD group, eight (25.8%) participants presented with sensorineural hearing loss (SNHL). The group with SCD and SNHL presented a higher occurrence of poor school performance than the group of participants with SCD without SNHL (p= 0.016). The MMSE score for aspects related to attention and calculation in the SCD group with SNHL was lower than in the SCD group without SNHL (p= 0.016). In the SAB, the SCD group with SNHL presented a lower score than the SCD group without SNHL in aspects related to academic performance and attention.

CONCLUSION

Hearing impairment in children and adolescents with SCD, specifically SNHL, is associated with poor school performance and enhances the risk of cognitive impairment in terms of attention and calculation.

Social communication and quality of life in children using hearing aids

OBJECTIVES

This study compared the parent-reported structural language and social communication skills-measured with the Children's Communication Checklist-2 (CCC-2)-and health-related quality of life (HR-QOL)-measured with the Pediatric Quality of Life Inventory (PedsQL)-of children who use hearing aids (HAs) and their typical-hearing (TH) peers.

DESIGN

The participants were 88 children (age range of 5; 6 to 13; 1 (years; months)) and their parents: 45 children with bilateral moderate to severe hearing loss using HAs who had no additional disabilities and 43 children with typical hearing. The groups were matched based on chronological age, gender, nonverbal IQ, and parental education level. The parents completed questionnaires related to their children's communication skills, including subdomains structural language and social communication, and HR-QOL.

RESULTS

The HA group had significantly poorer overall communication skills than the TH group (r = 0.49). The children in the HA group scored significantly lower than the TH group on both structural language (r = 0.37) and social communication (r = 0.41). Half of the children in the HA group had overall communication scores that either indicated concern or required further investigation according to the instrument's manual. In terms of psychosocial functioning, which was measured as HR-QOL, the subdomain school functioning was the main driver of the difference between groups, with the HA group being at least twice as likely (OR = 2.52) as the TH group to have poor HR-QOL in the school domain. Better parent-reported social communication was associated with better parent-reported psychosocial functioning in the children using HAs-even when background variables were taken into account.

CONCLUSION

The results suggest that traditional assessments and interventions targeting structural aspects of language may overlook social communication difficulties in children with HAs, even those with no additional disabilities. As school functioning stood out as the most problematic domain for children with HAs, efforts to improve the well-being of these children should focus on this area.

Comprehensive medical evaluation of pediatric bilateral sensorineural hearing loss

Children with bilateral sensorineural hearing loss (SNHL) should undergo a comprehensive medical evaluation to determine the underlying etiology and help guide treatment and counseling. In this article, we review the indications and rationale for medical evaluation of pediatric bilateral SNHL, including history and physical examination, imaging, genetic testing, specialist referrals, cytomegalovirus (CMV) testing, and other laboratory tests. Workup begins with a history and physical examination, which can provide clues to the etiology of SNHL, particularly with syndromic causes. If SNHL is diagnosed within the first 3 weeks of life, CMV testing should be performed to identify patients that may benefit from antiviral treatment. If SNHL is diagnosed after 3 weeks, testing can be done using dried blood spots samples, if testing capability is available. Genetic testing is oftentimes successful in identifying causes of hearing loss as a result of recent technological advances in testing and an ever-increasing number of identified genes and genetic mutations. Therefore, where available, genetic testing should be performed, ideally with next generation sequencing techniques. Ophthalmological evaluation must be done on all children with SNHL. Imaging (high-resolution computed tomography and/or magnetic resonance imaging) should be performed to assess for anatomic causes of hearing loss and to determine candidacy for cochlear implantation when indicated. Laboratory testing is indicated for certain etiologies, but should not be ordered indiscriminately since the yield overall is low.

Clinical utility of smartphone-based audiometry for early hearing loss detection in HIV-positive children: A feasibility study

BACKGROUND

Paediatric human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) often manifests with hearing loss (HL). Given the impact of HL, early detection is critical to prevent its associated effects. Yet, the majority of children living with HIV/AIDS (CLWHA) cannot access hearing healthcare services because of the scarcity of audiologists and expensive costs of purchasing screening equipment. Alternative solutions for early detection of HL are therefore necessary.

AIM

The overall aim of this study was to assess the feasibility of using self-administered smartphone-based audiometry for early HL detection amongst CLWHA.

SETTING

This study was conducted at the paediatrics department of a state hospital in the Eastern Cape province, South Africa.

METHODS

This was a feasibility study conducted amongst twenty-seven (27) CLWHA who were in the age group of 6-12 years. The participants self-administered hearing screening tests using a smartphone-based audiometric test. The primary end-points of this study were to determine the sensitivity, specificity and test-retest reliability of self-administered hearing screening.

RESULTS

The sensitivity and specificity for self-administered screening were 82% and 94%, respectively, with positive and negative predictive values of 90% and 88%, respectively. Moreover, a strong positive test-retest reliability (r = 0.97) was obtained when participants self-administered the screening test.

CONCLUSION

Six- to 12-year-old CLWHA were able to accurately self-administer hearing screening tests using smartphone-based audiometry. These findings show that self-administered smartphone audiometry can be used for serial hearing monitoring in at-risk paediatric patients.

Knowledge, attitude and management of hearing screening in children among family physicians in the Kingdom of Saudi Arabia

BACKGROUND

Early detection and management of hearing loss are important to develop ordinary speaking language and academic skills during childhood. Lack of knowledge by either parents or health care providers could hinder the process of hearing loss diagnosis, such that the intervention will be less effective. There is little evidence about the knowledge and practice of family physicians regarding hearing screening in Saudi Arabia and worldwide.

OBJECTIVES

This study aimed to assess family physicians' knowledge, attitudes, and practices related to hearing loss in children. This in turn will help policy makers and educational institutions to establish and promote a program concerned with screening, diagnosis and intervention of paediatric hearing loss.

METHODS

A cross-sectional descriptive study enrolled 133 family physicians working at primary health centres in Saudi Arabia from March 2020 to September 2020. A self-reported questionnaire was used to assess the knowledge, attitudes, and practices of family physicians concerning hearing loss in children.

RESULTS

The majority of the participants were working under the umbrella of the Ministry of Health and around half of them did not screen any child for hearing loss. Despite that, 91.7% indicated the importance of neonatal hearing screening, 70.7% indicate infant candidacy for cochlear implant and only 33.1% know about the existence of the early hearing detection and intervention (EHDI) governmental program in kingdom of Saudi Arabia (KSA). Participants were able to identify factors associated with hearing loss such as a family history of hearing loss (85.6%), meningitis (75%) and craniofacial anomalies (51.5%). The most frequent specialists for patient referrals were ear nose and throat ENT (75.2%) and audiologists (67.7%).

CONCLUSION

This study shows that family physicians have good general background about the benefits of EHDI programs and the management of hearing loss in the paediatric population. However, it also indicated insufficient knowledge in other domains of hearing loss, including assessments and the presence of the EHDI governmental program in KSA. Further actions on the involvement of family physicians in the process of neonatal hearing screening, diagnosis and intervention for hearing impairment are needed.

Assessment of Receptive and Expressive Language Skills Among Young Children With Prelingual Single-Sided Deafness Managed With Early Cochlear Implantation

IMPORTANCE

Pediatric single-sided deafness (SSD) can seriously affect development, causing impaired spatial hearing skills, speech-language delays, and academic underachievement. Early cochlear implantation likely improves hearing-related outcomes, but its association with language development remains unclear.

OBJECTIVE

To investigate whether early cochlear implantation is associated with language outcomes for children with prelingual SSD.

DESIGN, SETTING, AND PARTICIPANTS

The Cochlear Implant for Children and One Deaf Ear study was initiated in 2015 and recruited participants at 4 academic hospitals in Flanders, Belgium, through 2019. This cohort study included 3 groups of children aged 2 to 5 years: children with SSD and a cochlear implant, children with SSD without a cochlear implant, and a control group with normal hearing. Language and hearing skills were assessed 1 to 2 times per year until the age of 10 years. Study completion rates were high (82%). Data analysis was performed from October to December 2020.

EXPOSURE

Unilateral cochlear implant.

MAIN OUTCOMES AND MEASURES

Longitudinal vocabulary, grammar, and receptive language scores. The implanted group was hypothesized to outperform the nonimplanted group on all language tests.

RESULTS

During the recruitment period, 47 children with prelingual SSD without additional disabilities were identified at the participating hospitals. Fifteen of the 34 children with an intact auditory nerve received a cochlear implant (44%, convenience sample). Sixteen of the remaining children were enrolled in the SSD control group (50%). Data from 61 children (mean [SD] age at the time of enrollment, 2.08 [1.34] years; 26 girls [42%]) were included in the analysis: 15 children with SSD and a cochlear implant, 16 children with SSD without a cochlear implant, and 30 children with normal hearing. Children with SSD and a cochlear implant performed in line with their peers with normal hearing with regard to grammar. In contrast, children with SSD without a cochlear implant had worse grammar scores than the group with implants (-0.76; 95% CI, -0.31 to -1.21; P = .004) and the group with normal hearing (-0.53; 95% CI, -0.91 to -0.15; P = .02). The 3 groups had similar vocabulary and receptive language abilities.

CONCLUSIONS AND RELEVANCE

These findings suggest that early cochlear implantation is associated with normal grammar development in young children with prelingual SSD. Although further follow-up will reveal the long-term outcomes of the cochlear implant for other skills, the current results will help clinicians and policy makers identify the best treatment option for these children.

Nonverbal Intelligence Predicts Performance of Preschool Children With Hearing Loss on Norm-Referenced Language Measures But Not Language Sample Analysis

OBJECTIVES

The purpose of this study was to explore the effects of nonverbal intelligence on spoken language performance in children with hearing loss who use amplification and spoken language. Specifically, we compared language performance measured by norm-referenced measures compared with spontaneous language sample measures.

DESIGN

Nonverbal intelligence and spoken language skills were analyzed using norm-referenced nonverbal intelligence and language assessments and language sample analyses in 92 children ages 3 to 6 who varied by hearing and nonverbal intelligence status. All children had nonverbal intelligence within the average or above-average range.

RESULTS

Regression analyses revealed that, after controlling for maternal education and hearing status, nonverbal intelligence contributed unique variance to norm-referenced language measures but not spontaneous language measures.

CONCLUSIONS

Performance on norm-referenced language measures is influenced by nonverbal intelligence, whereas functional language use measured by spontaneous language samples is not. These findings suggest that spontaneous language measures may contribute additional value to language assessment batteries that are independent of nonverbal intelligence.

Best ear hearing level, time factors and language outcome in Swedish children with mild and moderate hearing loss with hearing aids

AIM

The risk for language disorder is high in children with all levels of hearing loss (HL). Early identification and intervention should be as important for children with mild HL as for those with more severe HL. Despite new-born hearing screening, a recent survey of speech language therapist services in southern Sweden indicates that children with mild and moderate HL are severely neglected when it comes to language assessment and language intervention. In this study we explore associations between Best Ear Hearing Level (BEHL), time factors and language skills in Swedish children with HL with hearing aids (HA).

METHOD

Participants were 19 children with mild HL (BEHL 23-39) and 22 children with moderate HL (BEHL 40-70) aged 5-15 years. Information on age at diagnosis and at HA fitting were collected. The children performed a nonword repetition and a sentence comprehension task.

RESULTS

The time elapsed between diagnosis and fitting with HA was longer for the children with mild HL.Participants with mild HL received their HA significantly later than children with moderate HL. No association between BEHL and the two language measures was found, and language skills were not better in children with mild than moderate HL. 17% of participants performed below cut-off for language disorder on both language measures.

CONCLUSION

Given the risk for long-term academic and social consequences of even mild HL delayed HA intervention for children with HLleads to serious concerns by families, clinicians, and pedagogues.

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes.

The Production of Complex Syntax in Spontaneous Language by 4-Year-Old Children With Hearing Loss

Purpose Proficiency with complex syntax is important for language and reading comprehension, and production of complex syntax begins to emerge shortly after a young child begins using two-word combinations. Complex syntax production in preschool children with hearing loss who use spoken language has been explored minimally. The purpose of this study was to compare complex syntax production of 4-year-old children with hearing loss to age-matched and language-matched peers with normal hearing. Method Seventy-two children completed a language assessment battery, including a structured language sample. Complex syntax density and number and accuracy of productions of particular types of complex syntax were compared across three groups: 4-year-old children with hearing loss, an age-matched group of children with normal hearing, and an mean length of utterance (MLU)-matched group of children with normal hearing. Results Children with hearing loss had lower complex syntax density and fewer correct productions of coordinated clauses, subordinate clauses, and simple infinitives than their age-matched, but not language-matched, peers. Furthermore, children with hearing loss had lower accuracy than the age-matched group on simple infinitives and lower accuracy than both the age- and MLU-matched groups on full propositional complements and subject relative clauses. Conclusion Children with hearing loss exhibit delays in complex syntax acquisition as compared to their same-age peers and disruptions in development on some complex structures as compared to MLU-matched, younger children. Supplemental Material https://doi.org/10.23641/asha.14080193.

Developmental Outcomes in Early-Identified Children Who Are Hard of Hearing at 2 to 3 Years of Age

OBJECTIVES

This study examined the psychosocial, adaptive behavior, and language outcomes of young children who are hard of hearing (HH) without additional disabilities or neurocognitive impairments. Relations between early developmental outcomes and child and parent demographic variables, and parenting stress and self-efficacy were also explored.

DESIGN

Participants were 39 children with early identified, permanent mild to severe hearing loss, between the ages of 2 and 3 years, and a comparison group of 47 children with normal hearing (NH). Developmental outcomes were measured using clinician-administered standardized tests and parent-completed behavior rating instruments specific to language, psychosocial functioning, and adaptive behavior. Mothers completed self-report measures that assess parenting stress and maternal self-efficacy.

RESULTS

The children who are HH were similar to the children with NH in terms of their psychosocial functioning and adaptive behavior, with the exception of their socialization skills. As a group, the children who are HH performed significantly worse than their peers with NH on all measures of language ability. Among the children who are HH, maternal self-efficacy showed a strong positive correlation with adaptive behavior outcomes; however, it failed to contribute unique variance above that explained by language ability and gender. Maternal self-efficacy was also significantly correlated with better psychosocial outcomes, but only parenting stress proved to be a significant predictor of child behavioral problems once other variables considered were in the model.

CONCLUSIONS

Early-identified young children who are HH can demonstrate age-appropriate development in multiple domains, including language, psychosocial, and adaptive behavior. However, mild to severe hearing loss places young children with no additional disabilities or neurocognitive impairments at risk for language delays. Although the children who are HH demonstrated no more emotional or behavioral problems than their same-age peers with NH, results suggest that language delays increase their vulnerability for delays in various aspects of social competence.

Role of Subtitles in L2 Acquisition and Comprehension: A Pilot Study of Hearing-Impaired Students

The purpose of this study was to investigate whether subtitles can facilitate language processing in English as a second language (L2) and, if so, which subtitles would be more beneficial for hard-of-hearing students with Norwegian as their first language. In total, 14 advanced learners of L2 English were recruited and tested on English comprehension and target vocabulary items based on video material provided with subtitles in English or Norwegian in comparison to no subtitles (control condition). Subtitles aided comprehension of the plot, tested immediately after clip presentation, with an advantage for English subtitles over Norwegian subtitles and no subtitles. Furthermore, subtitles were found to enhance the performance of the participants with moderate hearing loss more than they did for mild hearing loss participants. The inclusion of English subtitles only marginally enhanced vocabulary understanding for both mild and moderate hearing loss students. The findings of this study can be transferred to classrooms and may supplement other methods of adjusting the academic environment, in order to meet the need of students with hearing loss.

Knowledge and Practice of Hearing Screening and Hearing Loss Management among Ear, Nose, and Throat Physicians in Jordan

Introduction  One of the main factors that affect the early diagnosis and intervention of hearing loss is inadequate knowledge by the health care workers. Ear, nose, and throat (ENT) specialists are the main source of information about hearing loss and its management in most developing countries, such as Jordan. Objective  The purpose of the present study is to explore the level of knowledge and the practice of hearing screening and hearing loss management for children among ENT physicians in Jordan as an example of health care providers in developing countries of the Middle East. Methods  This was a cross-sectional study, adapting a questionnaire of knowledge and the practice of hearing screening and hearing loss management for children. The questionnaire consisted of 2 sections with 20 questions. A total of 40 ENT physicians completed the questionnaire. Results  The majority of the respondents acknowledged the importance of hearing screening for children; however, there was limited knowledge regarding hearing loss management and testing. Only 10 of the ENT physicians believed that a referral to an audiologist is warranted, and the majority of the respondents were not aware that a child with a confirmed permanent hearing loss should be referred to a speech pathologist or to a rehabilitation center. Managing unilateral and mild sensorineural hearing loss (SNHL) was another area about which ENT physicians have limited knowledge. Conclusion  There is a strong need for professional intervention programs, providing the latest updates and standardizations in the field of audiology and pediatric rehabilitation for ENT physicians.

Audiological and otologic manifestations of glutaric aciduria type I

Background

Glutaric aciduria type 1 (GA-1) is a rare disease connected with speech delay and neurological deficits. However, the audiological and otologic profiles of GA-1 have not yet been fully characterized. To our knowledge, this is the largest study of comprehensive audiological and otologic evaluation in patients with GA-1 to date.

Methods

Thirteen patients diagnosed with GA-1 between January 1994 and December 2019 with audiological, radiological and genetic manifestations were retrospectively analyzed. Hearing tests were performed in all patients. MRI was performed for radiological evaluation.

Results

Hearing loss was found in 76.9% (10/13) of GA-1 patients, including slight hearing loss in 46.1% (6/13) of patients, mild hearing loss in 15.4% (2/13) of patients, and moderate hearing loss in 7.7% (1/13) of patients. Normal hearing thresholds were seen in 23% (3/13) of patients. Patients with intensive care unit (ICU) admission history showed significantly worse hearing than those without (29.17 ± 12.47 vs 13.56 ± 3.93 dB HL, 95% CI 2.92–24.70, p = 0.0176). One patient had moderate sensorineural hearing loss and a past history of acute encephalopathic crisis. No usual causative gene mutations associated with hearing loss were found in these patients. MRI showed a normal vestibulocochlear apparatus and cochlear nerve. One patient with extensive injury of the basal ganglia on MRI after acute encephalopathic crisis was found to have moderate sensorineural hearing loss. Two patients with disability scores above 5 were found to have mild to moderate hearing impairment. No obvious correlation between macrocephaly and hearing loss was found.

Conclusion

A high prevalence of hearing impairment is found in GA-1 patients. Adequate audiological evaluation is essential for these patients, especially for those after encephalopathic crises or with ICU admission history.

Relationship between sensitivity to temporal fine structure and spoken language abilities in children with mild-to-moderate sensorineural hearing loss

Children with sensorineural hearing loss show considerable variability in spoken language outcomes. The present study tested whether specific deficits in supra-threshold auditory perception might contribute to this variability. In a previous study by Halliday, Rosen, Tuomainen, and Calcus [(2019). J. Acoust. Soc. Am. 146, 4299], children with mild-to-moderate sensorineural hearing loss (MMHL) were shown to perform more poorly than those with normal hearing (NH) on measures designed to assess sensitivity to the temporal fine structure (TFS; the rapid oscillations in the amplitude of narrowband signals over short time intervals). However, they performed within normal limits on measures assessing sensitivity to the envelope (E; the slow fluctuations in the overall amplitude). Here, individual differences in unaided sensitivity to the TFS accounted for significant variance in the spoken language abilities of children with MMHL after controlling for nonverbal intelligence quotient, family history of language difficulties, and hearing loss severity. Aided sensitivity to the TFS and E cues was equally important for children with MMHL, whereas for children with NH, E cues were more important. These findings suggest that deficits in TFS perception may contribute to the variability in spoken language outcomes in children with sensorineural hearing loss.

The pattern and progression of hearing loss in Marfan Syndrome: A study of children and young adults

OBJECTIVE

(s): To describe the prevalence, type, severity, and progression of hearing loss (HL) in children and young adults with Marfan Syndrome (MFS), and to evaluate the influence of comorbidities on HL.

STUDY DESIGN

Retrospective database analysis.

RESULTS

Of 70 patients with MFS, 52.8% (N = 37) had HL. Within the HL group, 75.7% (N = 28) had bilateral HL, while 24.3% (N = 9) had unilateral HL. 21.4% (N = 15) had moderate or more severe HL. The overall prevalence of CHL was 40.5% (N = 15), SNHL 13.5% (N = 5), and mixed HL 37.8% (N = 14). The mean initial age of HL was 8.4 years (range 0.8-24.0). HL was more prevalent in patients with MFS who also experienced chronic otitis media (ES 1.00, 95% CI, 0.32-1.68) and skull anomalies (ES 0.75, 95% CI, 0.07-1.44) as well as for patients with hypertension (ES 2.17, 95% CI, -1.29-5.64).

CONCLUSIONS

Children and young adults with Marfan syndrome have a high likelihood of hearing loss, with high rates of CHL, chronic otitis media, and Eustachian tube dysfunction. SNHL is also prevalent in this syndrome; hypertension increased the likelihood of SNHL. Early audiologic screening is needed to ascertain type of HL and to efficiently direct patient care in this population.

Schoolchildren with unilateral or mild to moderate bilateral sensorineural hearing loss should be screened for neurodevelopmental problems

AIM

The aim was to assess the rate and overlap of language and other neurodevelopmental problems in children aged 9-12 years with unilateral or mild to moderate bilateral sensorineural hearing loss.

METHODS

Caregivers of 24 of the 58 eligible children, born 2004-2007, registered at the regional audiology department in Gothenburg, Sweden, with these types of hearing loss completed the Five-to-Fifteen questionnaire, a comprehensive screening instrument for neurodevelopmental problems. Of these 24 children, 21 were assessed with the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). Children with scores indicating definite problem on the Five-to-Fifteen questionnaire and their parents were invited to a clinical neuropaediatric assessment.

RESULTS

Of the 24 children, 13 (54%) screened positive for definite neurodevelopmental problems. Clinical assessments confirmed the presence of at least one neurodevelopmental disorder in eight of these 24, corresponding to 33%. Seven (33%) of the 21 children participating in the CELF-4 had scores indicating a language disorder, of whom four children had a neurodevelopmental disorder according to the neuropaediatric assessment.

CONCLUSION

The results support that schoolchildren with unilateral or mild to moderate bilateral sensorineural hearing loss should undergo neurodevelopmental screening to identify possible coexisting neurodevelopmental problems or disorders.

Listening-Related Fatigue in Children With Unilateral Hearing Loss

Purpose Listening-related fatigue is an understudied construct that may contribute to the auditory, educational, and psychosocial problems experienced by children with unilateral hearing loss (UHL). Herein, we present an overview of listening-related fatigue in school-age children with hearing loss (CHL), with a focus on children with UHL. Method Following a review of research examining listening-related fatigue in adults and CHL, we present preliminary findings exploring the effects of unilateral and bilateral hearing loss on listening-related fatigue in children. For these exploratory analyses, we used data collected from our ongoing work developing and validating a tool, the Vanderbilt Fatigue Scale, for measuring listening-related fatigue in children. Presently, we are assessing 3 versions of the fatigue scale-child self-report, parent proxy, and teacher proxy. Using these scales, data have been collected from more than 900 participants. Data from children with unilateral and bilateral hearing loss and for children with no hearing loss are compared with adult Vanderbilt Fatigue Scale data. Results Results of our literature review and exploratory analyses suggest that adults and CHL are at increased risk for listening-related fatigue. Importantly, this increased risk was similar in magnitude regardless of whether the loss was unilateral or bilateral. Subjective ratings, based on child self-report and parent proxy report, were consistent, suggesting that children with unilateral and bilateral hearing loss experienced greater listening-related fatigue than children with no hearing loss. In contrast, results based on teacher proxy report were not sensitive to the effects of hearing loss. Conclusions Children with UHL are at increased risk for listening-related fatigue, and the magnitude of fatigue is similar to that experienced by children with bilateral hearing loss. Problems of listening-related fatigue in school-age CHL may be better identified by CHL themselves and their parents than by teachers and specialists working with the children.

Impaired frequency selectivity and sensitivity to temporal fine structure, but not envelope cues, in children with mild-to-moderate sensorineural hearing loss

Psychophysical thresholds were measured for 8-16 year-old children with mild-to-moderate sensorineural hearing loss (MMHL; N = 46) on a battery of auditory processing tasks that included measures designed to be dependent upon frequency selectivity and sensitivity to temporal fine structure (TFS) or envelope cues. Children with MMHL who wore hearing aids were tested in both unaided and aided conditions, and all were compared to a group of normally hearing (NH) age-matched controls. Children with MMHL performed more poorly than NH controls on tasks considered to be dependent upon frequency selectivity, sensitivity to TFS, and speech discrimination (/bɑ/-/dɑ/), but not on tasks measuring sensitivity to envelope cues. Auditory processing deficits remained regardless of age, were observed in both unaided and aided conditions, and could not be attributed to differences in nonverbal IQ or attention between groups. However, better auditory processing in children with MMHL was predicted by better audiometric thresholds and, for aided tasks only, higher levels of maternal education. These results suggest that, as for adults with MMHL, children with MMHL may show deficits in frequency selectivity and sensitivity to TFS, but sensitivity to the envelope may remain intact.

Are French Fries a Vegetable? Lexical Typicality Judgement Differences in Deaf and Hearing Learners

Deaf and hard-of-hearing (DHH) learners are known to have vocabulary knowledge and language outcomes more heterogeneous than their hearing peers, with a greater incidence of difficulties presumably related (both as cause and effect) to documented challenges in academic domains. In particular, there is increasing evidence that differences may exist in the ways that semantic networks are structured and accessed in DHH and hearing learners. Individuals' judgments of word typicality offers a window into their semantic networks, revealing internal relationships in the mental lexicon. In the present study, 90 DHH and hearing college-aged learners provided typicality ratings at two points in time for 120 words common words considered to be central, borderline, or non-members of six categories. DHH and hearing participants differed in terms of their word knowledge, rating consistency, and rating magnitudes. Relative to hearing peers, DHH participants reported not knowing more of the words, but rated all words as being more typical than did hearing participants and rated the typicality of items more consistently over time. Implications of these findings for understanding mental lexicon structure for DHH and hearing learners, interpreting previous research, and constructing stimuli for future research are discussed.

The Contribution of Individual Differences in Memory Span and Language Ability to Spatial Release From Masking in Young Children

Purpose Working memory capacity and language ability modulate speech reception; however, the respective roles of peripheral and cognitive processing are unclear. The contribution of individual differences in these abilities to utilization of spatial cues when separating speech from informational and energetic masking backgrounds in children has not yet been determined. Therefore, this study explored whether speech reception in children is modulated by environmental factors, such as the type of background noise and spatial configuration of target and noise sources, and individual differences in the cognitive and linguistic abilities of listeners. Method Speech reception thresholds were assessed in 39 children aged 5-7 years in simulated school listening environments. Speech reception thresholds of target sentences spoken by an adult male consisting of number and color combinations were measured using an adaptive procedure, with speech-shaped white noise and single-talker backgrounds that were either collocated (target and back-ground at 0°) or spatially separated (target at 0°, background noise at 90° to the right). Spatial release from masking was assessed alongside memory span and expressive language. Results and Conclusion Significant main effect results showed that speech reception thresholds were highest for informational maskers and collocated conditions. Significant interactions indicated that individual differences in memory span and language ability were related to spatial release from masking advantages. Specifically, individual differences in memory span and language were related to the utilization of spatial cues in separated conditions. Language differences were related to auditory stream segregation abilities in collocated conditions that lack helpful spatial cues, pointing to the utilization of language processes to make up for losses in spatial information.

Functional brain alterations following mild-to-moderate sensorineural hearing loss in children

Auditory deprivation in the form of deafness during development leads to lasting changes in central auditory system function. However, less is known about the effects of mild-to-moderate sensorineural hearing loss (MMHL) during development. Here, we used a longitudinal design to examine late auditory evoked responses and mismatch responses to nonspeech and speech sounds for children with MMHL. At Time 1, younger children with MMHL (8-12 years; n = 23) showed age-appropriate mismatch negativities (MMNs) to sounds, but older children (12-16 years; n = 23) did not. Six years later, we re-tested a subset of the younger (now older) children with MMHL (n = 13). Children who had shown significant MMNs at Time 1 showed MMNs that were reduced and, for nonspeech, absent at Time 2. Our findings demonstrate that even a mild-to-moderate hearing loss during early-to-mid childhood can lead to changes in the neural processing of sounds in late childhood/adolescence.

Unilateral congenital hearing loss in children: Challenges and potentials

The estimated incidence of sensorineural hearing impairment (>40 dB HL) at birth is 1.86 per 1000 newborns in developed countries and 30-40% of these are unilateral. Profound sensorineural unilateral hearing impairment or single sided deafness (SSD) can be treated with a cochlear implant. However, this treatment is costly and invasive and unnecessary in the eyes of many. Very young children with SSD often do not exhibit language and cognitive delays and it is hard to imagine that neurocognitive skills will present difficulties with one good ear. In the current paper we review the most recent evidence on the consequences of unilateral hearing impairment for auditory and neurocognitive factors. While data of both adults and children are discussed, we focus on developmental factors, congenital deafness and a window of opportunity for intervention. We discuss which etiologies qualify for a cochlear implant and present our multi-center prospective study on cochlear implants in infants with one deaf ear. The large, state-of-the art body of research allows for evidence-based decisions regarding management of unilateral hearing loss in children.

Early Literacy Predictors and Second-Grade Outcomes in Children Who Are Hard of Hearing

This study contrasted the early literacy outcomes of children who are hard of hearing (CHH) with children with normal hearing (CNH). At age 5, prereading skills of oral language, phonological processing, and print knowledge were examined in CHH (N = 180) and CNH (N = 80). The CHH had poorer oral language and phonological processing abilities than the CNH but comparable knowledge of print. At age 8, measures of word reading, and reading comprehension yielded no differences between CHH (N = 108) and CNH (N = 62) except for reading comprehension for the moderately severe CHH. Reading achievement in CHH was found to exceed predictions based on prereading performance. This resilience was associated with gains in oral language during the early school years.

Health Burden and Socioeconomic Disparities From Hearing Loss: A Global Perspective

OBJECTIVES/HYPOTHESIS

To characterize the disability-related health burden of hearing loss (HL) at a global level, with a focus on socioeconomic health disparities.

METHODS

The global burden of HL, as calculated by disability-adjusted life years (DALYs) per 100,000 individuals, was evaluated for 184 countries. Data from 5-year intervals encompassing 1990 to 2015 were organized by human development index (HDI) categorizations as specified by the U.N. Development Program (UNDP). Gini coefficients and concentration indices were used to evaluate global inequality in HL burden over this time period.

RESULTS

There was a global lack of improvement in hearing loss burden over 25 years. National HL burden, as measured by age-standardized DALYs, had an inverse relationship with successive level of development (p < 0.0001). Global inequalities in HL burden as measured by the concentration index decreased from 1990 to 2005, remained stable between 2005 and 2010, and slightly increased from 2010 to 2015. Central Sub-Saharan Africa, followed by Eastern Sub-Saharan Africa and South Asia, had the greatest rates of disease burden in 2015.

CONCLUSIONS

To our knowledge, this analysis is the first to investigate socioeconomic-related inequalities in hearing loss burden using statistical tools such as the Gini coefficient and concentration index. Although inequalities have largely decreased in recent decades, the global burden of hearing loss remains high and there are recent signs of increased inequality. These data suggest that a greater distribution of hearing care resources may need to be directed towards developing countries to combat global hearing loss burden.

LEVEL OF EVIDENCE

III.

Prosodic and segmental aspects of nonword repetition in 4- to 6-year-old children who are deaf and hard of hearing compared to controls with normal hearing

Children who are deaf or hard of hearing (DHH) are at an increased risk of speech and language deficits. Nonword repetition (NWR) is a potential predictor of problems with phonology, grammar and lexicon in DHH children. The aim of the present study was to examine repetition of prosodic features and segments in nonwords by DHH children compared to children with normal hearing (NH) and to relate NWR performance to measures of language ability and background variables. In this cross-sectional study, 14 Swedish-speaking children with mild-profound sensorineural hearing loss, aged 4-6 years, and 29 age-matched controls with NH and typical language development participated. The DHH children used cochlear implants (CI), hearing aids or a combination of both. The assessment materials included a prosodically controlled NWR task, as well as tests of phonological production, expressive grammar and receptive vocabulary. The DHH children performed below the children with NH on the repetition of tonal word accents, stress patterns, vowels and consonants, with consonants being hardest, and tonal word accents easiest, to repeat. NWR performance was also correlated with language ability, and to hearing level, in the DHH children. Both prosodic and segmental features of nonwords are problematic for Swedish-speaking DHH children compared to children with NH, but performance on tonal word accent repetition is comparably high. NWR may have potential as a clinically useful tool for identification of children who are in need of speech and language intervention.

Speech recognition for school-age children and adults tested in multi-tone vs multi-noise-band maskers

The present study set out to test whether greater susceptibility to modulation masking could be responsible for immature recognition of speech in noise for school-age children. Listeners were normal-hearing four- to ten-year-olds and adults. Target sentences were filtered into 28 adjacent narrow bands (100-7800 Hz), and the masker was either spectrally matched noise bands or tones centered on each of the speech bands. In experiment 1, odd- and even-numbered bands of target-plus-masker were presented to opposite ears. Performance improved with child age in all conditions, but this improvement was larger for the multi-tone than the multi-noise-band masker. This outcome is contrary to the expectation that children are more susceptible than adults to masking produced by inherent modulation of the noise masker. In experiment 2, odd-numbered bands were presented to both ears, with the masker diotic and the target either diotic or binaurally out of phase. The binaural difference cue was particularly beneficial for young children tested in the multi-tone masker, suggesting that development of auditory stream segregation may play a role in the child-adult difference for this condition. Overall, results provide no evidence of greater susceptibility to modulation masking in children than adults.