Effects of early auditory experience on the spoken language of deaf children at 3 years of age

A systematic review of altered resting-state networks in early deafness and implications for cochlear implantation outcomes

Auditory deprivation following congenital/pre-lingual deafness (C/PD) can drastically affect brain development and its functional organisation. This systematic review intends to extend current knowledge of the impact of C/PD and deafness duration on brain resting-state networks (RSNs), review changes in RSNs and spoken language outcomes post-cochlear implant (CI) and draw conclusions for future research. The systematic literature search followed the PRISMA guideline. Two independent reviewers searched four electronic databases using combined keywords: 'auditory deprivation', 'congenital/prelingual deafness', 'resting-state functional connectivity' (RSFC), 'resting-state fMRI' and 'cochlear implant'. Seventeen studies (16 cross-sectional and one longitudinal) met the inclusion criteria. Using the Crowe Critical Appraisal Tool, the publications' quality was rated between 65.0% and 92.5% (mean: 84.10%), ≥80% in 13 out of 17 studies. A few studies were deficient in sampling and/or ethical considerations. According to the findings, early auditory deprivation results in enhanced RSFC between the auditory network and brain networks involved in non-verbal communication, and high levels of spontaneous neural activity in the auditory cortex before CI are evidence of occupied auditory cortical areas with other sensory modalities (cross-modal plasticity) and sub-optimal CI outcomes. Overall, current evidence supports the idea that moreover intramodal and cross-modal plasticity, the entire brain adaptation following auditory deprivation contributes to spoken language development and compensatory behaviours.

Early-stage use of hearing aids preserves auditory cortical structure in children with sensorineural hearing loss

Hearing is critical to spoken language, cognitive, and social development. Little is known about how early auditory experiences impact the brain structure of children with bilateral sensorineural hearing loss. This study examined the influence of hearing aid use and residual hearing on the auditory cortex of children with severe to profound congenital sensorineural hearing loss. We evaluated cortical preservation in 103 young pediatric cochlear implant candidates (55 females and 48 males) by comparing their multivoxel pattern similarity of auditory cortical structure with that of 78 age-matched children with typical hearing. The results demonstrated that early-stage hearing aid use preserved the auditory cortex of children with bilateral congenital sensorineural hearing loss. Children with less residual hearing experienced a more pronounced advantage from hearing aid use. However, this beneficial effect gradually diminished after 17 months of hearing aid use. These findings support timely fitting of hearing aids in conjunction with early implantation to take advantage of neural preservation to maximize auditory and spoken language development.

Challenges and opportunities of tele-speech therapy: Before and during the COVID-19 pandemic

In 2020, with the onset of the COVID-19 pandemic, the treatment and rehabilitation process faced problems and challenges. One of the most efficient therapy approaches in this period was telerehabilitation. Telepractice in speech therapy presents many challenges and opportunities. In this article, we review published articles up to June 2023 and summarize the challenges and opportunities of the COVID-19 pandemic for speech therapy. Researchers and clinicians have found that tele-speech therapy is an effective tool for improving access to high-quality services and a viable mechanism for delivering speech and language interventions. The results of teletherapy or telepractice during the COVID-19 pandemic were divided into opportunities and challenges. Speech therapy has moved toward telerehabilitation to improve treatment competence during the pandemic. Finally, teletherapy methods were more suitable for speech and language pathology.

Sensorineural hearing loss among children at risk: A 16-year audiological records review in a tertiary referral center

OBJECTIVES

Hearing loss (HL) constitutes an increasing worldwide health problem. Neonatal hearing screening improved early detection and management to alleviate HL detriments on the person and society. Still, HL in childhood, beyond infancy, is under-investigated, especially in developing countries. This study aimed to explore the prevalence of HL in childhood amongst Jordanian children with HL risk factors and investigate the associated risk factors.

METHODS

Retrospective cross-sectional review of audiological records in a tertiary public and teaching hospital. The data of 1307 children aged 0-15 years who underwent audiological assessment from 2000 to 2016 were included. A review of diagnostic audiological and medical records was conducted to investigate the prevalence of sensorineural HL in high-risk (HR) children and the most contributing risk factors.

RESULTS

Descriptive statistical analysis showed that the prevalence of sensorineural HL was 29.2% in the study sample. The HL was bilateral in 95% and mild to moderate HL in 73%. The mean age at the diagnosis was around 4.5 years. The most common risk factors were parental concern about their child's hearing, ototoxic drug use, and developmental and speech delay. The Chi-squared test showed that parental concern and ototoxic drug use were associated with an increased probability of having HL.

CONCLUSION

The prevalence of HL amongst at-risk children in Jordan is relatively high, and the diagnosis is delayed. The results highlight the importance of implementing a hearing screening program in at-risk children. This needs to start from birth and include a serial follow-up to detect cases of delayed-onset HL.

Psychometric properties of the Arabic version of the meaningful use of speech scale (Arabic MUSS)

PURPOSE

To examine the construct, discriminative, and predictive validity, and the test-retest reliability of the Arabic Meaningful Use of Speech Scale (MUSS).

METHODS

Parents of 102 children with cochlear implantation (CI) with a matching control group of 102 children with normal hearing completed the Arabic-MUSS scale. A random subsample of 30 parents was interviewed after two weeks to examine the test-retest reliability.

RESULTS

the construct validity of the Arabic-MUSS was established by exploratory factor analysis that yielded a unidimensional scale and explained a total of 92.48% of the variance in the total score of the Arabic-MUSS. The internal consistency of the scale was excellent with Cronbach's alpha = 0.975. The Arabic-MUSS discriminative validity was supported by the significant difference between the total score of children with CI and children with normal hearing (p < 0.0001). The Arabic-MUSS has a moderate predictive validity as demonstrated by the moderate correlation between the total score and the time since cochlear implantation (p < 0.001). The Arabic-MUSS has excellent test-retest reliability.

CONCLUSION

The Arabic-MUSS is a valid and reliable measure that can be used to guide plans for auditory rehabilitation and monitor the progress of children with cochlear implantation over time.IMPLICATIONS FOR REHABILITATIONThe Arabic-Meaningful Use of Speech Scale is a valid and reliable parent-report assessment.The Arabic-Meaningful Use of Speech Scale evaluates functional speech in children with cochlear implantation.Clinicians can use the Arabic- Meaningful Use of Speech Scale to plan and monitor the progress of auditory rehabilitation programs.

Cochlear Implantation and Educational and Quality-of-Life Outcomes in Adolescence

Importance

Cochlear implants (CIs) have been shown to be effective in improving auditory skills and speech and language development. However, less is known about the long-term outcomes of CIs on educational functioning or quality of life.

Objective

To evaluate long-term educational outcomes and quality of life in adolescents over 13 years postimplantation.

Design, Setting, and Participants

This longitudinal cohort study included 188 children with bilateral severe to profound hearing loss with CIs from the Childhood Development After Cochlear Implantation (CDaCI) study from hospital-based CI programs; a cohort of 340 children with severe to profound hearing loss without CIs from a nationally representative survey (National Longitudinal Transition Study-2; NLTS-2), and results from the literature of comparable children without CIs.

Exposure(s)

Cochlear implantation (early and late).

Main Outcomes and Measures

Adolescent performance on measures of academic achievement (Woodcock Johnson), language (Comprehensive Assessment of Spoken Language), and quality of life (Pediatric Quality of Life Inventory, Youth Quality of Life Instrument-Deaf and Hard of Hearing).

Results

The CDaCI cohort included 188 children, 136 of whom completed the wave 3 postimplantation follow-up visits (77 [55%] female) with CIs; mean [SD] age was 11.47 [1.27] years. The NLTS-2 cohort included 340 children (50% female) with severe to profound hearing loss without CIs. Children with CIs had better academic performance compared with children without CIs with similar levels of hearing loss. The largest benefits were seen for children who received implants early (prior to age 18 months), who performed at or above age and gender norms for language and academic achievement. Similarly, adolescents with CIs reported better quality of life on the Pediatric Quality of Life Inventory compared with children without CIs. On a condition-specific measure (Youth Quality of Life Instrument-Deaf and Hard of Hearing), children who received implants early scored higher across all 3 domains than comparisons without CIs.

Conclusions and Relevance

To our knowledge, this is the first study to evaluate long-term educational outcomes and quality of life in adolescents using CIs. This longitudinal cohort study showed better outcomes of CIs in terms of language, academic performance, and quality of life. While the greatest benefits were observed for children who received implants before age 18 months, benefits were also noted for children who received implants later, providing evidence that children with severe to profound hearing loss with CIs can achieve at or above expected levels compared with hearing peers.

Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids

OBJECTIVES

The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child's unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child's hearing technology or intervention plan.

DESIGN

The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay.

RESULTS

Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals.

CONCLUSIONS

Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child's hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation.

Intelligibility of Word-Initial Obstruent Consonants in Mandarin-Speaking Prelingually Deafened Children With Cochlear Implants

PURPOSE

This study assessed the intelligibility of obstruent consonants in prelingually deafened Mandarin-speaking children with cochlear implants (CIs).

METHOD

Twenty-two Mandarin-speaking children with normal hearing (NH) aged 3.25-10.0 years and 35 Mandarin-speaking children with CIs aged 3.77-15.0 years were recruited to produce a list of Mandarin words composed of 17 word-initial obstruent consonants in different vowel contexts. The children with CIs were assigned to chronological age-matched (CA) and hearing age-matched (HA) subgroups with reference to the NH controls. One hundred naïve NH adult listeners were recruited for a consonant identification task that consisted of a total of 2,663 stimulus tokens through an online research platform. For each child speaker, the consonant productions were judged by seven to 12 different adult listeners. An average percentage of consonants correct was calculated across all listeners for each consonant.

RESULTS

The CI children in both the CA and HA subgroups showed lower intelligibility in their consonant productions than the NH controls. Among the 17 obstruents, both CI subgroups showed higher intelligibility for stops, but they demonstrated major problems with the sibilant fricatives and affricates and showed a different confusion pattern from the NH controls on these sibilants. Of the three places (alveolar, alveolopalatal, and retroflex) in Mandarin sibilants, both CI subgroups showed the lowest intelligibility and the greatest difficulties with alveolar sounds. For the NH children, there was a significant positive relationship between overall consonant intelligibility and chronological age. For the children with CIs, the best fit regression model revealed significant effects of chronological age and age at implantation, with their quadratic terms included.

CONCLUSIONS

Mandarin-speaking children with CIs experience major challenges in the three-way place contrasts of sibilant sounds in consonant production. Chronological age and the combined effect of CI-related time variables play important roles in the development of obstruent consonants in the CI children.

Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language

PURPOSE

The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL-English bilingual deaf and hard of hearing (DHH) children.

METHOD

This cross-sectional study of vocabulary size included 56 DHH children between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were independently assessed via parent report checklists.

RESULTS

ASL vocabulary size positively correlated with spoken English vocabulary size. Spoken English vocabulary sizes in the ASL-English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL-English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the average range based on norms for hearing monolingual children.

CONCLUSIONS

Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when considering the entirety of their language skills. We found no evidence to support recommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English.

Does the duration matter? Effect of cochlear implantation on language development in Mandarin-speaking children with hearing loss

OBJECTIVE

Several studies have shown that cochlear implantation (CI) can influence language development in children with severe-to-profound hearing loss. However, whether the age of implantation and duration of CI use influence language development remains unclear, particularly in Mandarin-speaking children with hearing loss. Therefore, this study investigated the effects of CI-related variables on language development in these children.

METHODS

The present study recruited 133 Mandarin-speaking children with hearing loss, aged between 36 and 71 months chronologically, from a nonprofit organisation in Taiwan. The Revised Preschool Language Assessment (RPLA) was used to evaluate the children's language performance.

RESULTS

Children with hearing loss demonstrated delayed language comprehension and oral expression. Among them, 34% achieved age-appropriate language development. The duration of CI use had a significant direct effect on language-related abilities. Conversely, the age of implantation did not have a significant direct effect. Furthermore, the age of initial interventions (auditory-oral) had a significant direct effect only on language comprehension. Compared with the age of implantation, the duration of CI use was a significant mediator of language-related abilities.

CONCLUSION

In Mandarin-speaking children with late CIs, the duration of CI use is a more effective mediator of language development than the age of implantation.

The Effect of Universal Newborn Hearing Screening on Spoken Language after Cochlear Implantation

BACKGROUND

The universal newborn hearing screening (UNHS) was fully implemented across New Zealand by 2010 to improve outcomes for children with prelingual deafness. A previous audit undertaken by our center, the Southern Cochlear Implant Programme (SCIP), demonstrated that UNHS has significantly reduced the time to referral and surgery for cochlear implants in these children.

AIMS

This study aims to evaluate the relationship between earlier implantation and language development, the time taken to achieve age-appropriate language, and the effect of socioeconomic status on language skills.

METHODS

This is a retrospective cohort study comparing prelingual children with severe to profound bilateral hearing loss who underwent cochlear implantation in SCIP before and after the introduction of the UNHS. The language outcomes were assessed using the Preschool Language Scale and/or the Peabody Picture Vocabulary Test. For the purpose of our study, the standard scores of these tests were expressed as global language scores (GLS). GLSs between 85 and 115 are considered within normal range for age. The socioeconomic status was categorized based on the New Zealand Index of Deprivation (NZDep).

RESULTS

Children in the post-UNHS group (46/95 children) were referred to SCIP and received CI at a significantly earlier age (mean = 7 vs 20 mo, p = 8.95E-10, and mean = 13 vs. 24.7 mo, p = 1.43E-07). At 2 years postimplantation, the GLS was significantly higher in the post-UNHS group (mean scores = 93.3 vs. 79.1, p = 0.0213). The scores remained statistically higher in the post-UNHS group when assessed at 3 and 4 years postimplantation. At 2, 3, and 4 years postimplantation, there is a significant linear decrease in GLS with increasing age at cochlear implantation. We found no correlation between NZDep and GLS.

CONCLUSION

Children identified through UNHS have the advantage of earlier diagnosis, earlier hearing intervention, and longer duration with the implants, and they can achieve age-appropriate spoken language after 2 years of implantation.

Teleintervention for users of augmentative and alternative communication devices: A systematic review

AIM

To synthesize existing evidence on the effectiveness of speech-language teleinterventions delivered via videoconferencing to users of augmentative and alternative communication (AAC) devices.

METHOD

A systematic literature search was conducted in 10 electronic databases, from inception until August 2021. Included were speech-language teleinterventions delivered by researchers and/or clinicians via videoconferencing to users of AAC devices, without restrictions on chronological age and clinical diagnosis. The quality of the studies included in the review was appraised using the Downs and Black checklist and the Single-Case Experimental Design Scale; risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies - of Interventions and the single-case design risk of bias tools.

RESULTS

Six teleinterventions including 25 participants with a variety of conditions, such as Down syndrome, autism, Rett syndrome, and amyotrophic lateral sclerosis met the inclusion criteria. Five studies used a single-case experimental design and one was a cohort study. Teleinterventions included active consultation (n = 2), functional communication training (n = 2), brain-computer interface (n = 1), and both teleintervention and in-person intervention (n = 1). All teleinterventions reported an increase in participants' independent use of AAC devices during the training sessions compared to baseline, as well as an overall high satisfaction and treatment acceptability.

INTERPRETATION

Speech-language teleinterventions for users of AAC devices show great potential for a successful method of service delivery. Future telehealth studies with larger sample sizes and more robust methodology are strongly encouraged to allow the generalization of results across different populations.

WHAT THIS PAPER ADDS

Individuals can learn to use augmentative and alternative communication (AAC) devices independently during tele-AAC interventions. Service providers and recipients reported an overall high satisfaction and acceptability for AAC services delivered via teleinterventions. Speech-language teleinterventions may be an effective method of providing AAC intervention services.

The 100 Most-Cited Manuscripts in Hearing Implants: A Bibliometrics Analysis

The aim of the study was to characterise the most frequently cited articles on the topic of hearing implants. A systematic search was carried out using the Thomson Reuters Web of Science Core Collection database. Eligibility criteria restricted the results to primary studies and reviews published from 1970 to 2022 in English dealing primarily with hearing implants. Data including the authors, year of publication, journal, country of origin, number of citations and average number of citations per year were extracted, as well as the impact factors and five-year impact factor of journals publishing the articles. The top 100 papers were published across 23 journals and were cited 23,139 times. The most-cited and influential article describes the first use of the continuous interleaved sampling (CIS) strategy utilised in all modern cochlear implants. More than half of the studies on the list were produced by authors from the United States, and the Ear and Hearing journal had both the greatest number of articles and the greatest number of total citations. To conclude, this research serves as a guide to the most influential articles on the topic of hearing implants, although bibliometric analyses mainly focus on citations. The most-cited article was an influential description of CIS.

Translation, adaptation, and validation of the Arabic version of the meaningful auditory integration scale

OBJECTIVES

The main objectives of this study were to translate and adapt the infant-toddler meaningful integration scale (IT-MAIS) into Arabic and to establish the psychometric properties of the translated scale in children with a cochlear implant.

METHODS

The translation and cross-cultural adaptation of this questionnaire were completed in multiple steps and following standard translation protocols. In total, twenty-eight parents of young cochlear implant recipients completed IT-MAIS. Data were collected postoperatively and at 3-, 6-, 9-, and 12-month post-device activation. Data were examined for the validity and reliability of the scale. The internal consistency and reliability of the scale were analyzed using Cronbach α, split-half reliability, and the corrected item-total correlation coefficients.

RESULTS

Findings demonstrated that the scale exhibited good face and content validity, suggesting that the scale is a one-dimensional measure. Additionally, the reliability analysis for the scale indicated high reliability and correlation among test items. IT-MAIS scores consistently improved over time for all participants and this improvement. correlated negatively with the duration of deafness.

CONCLUSION

Current findings indicated that the translated Arabic version of the IT-MAIS scale could serve as a valid instrument for assessing the development of auditory skills in Arabic-speaking children with cochlear implants.

Psychoacoustic abilities in pediatric cochlear implant recipients: The relation with short-term memory and working memory capacity

OBJECTIVE

The aim was to investigate school-age children with cochlear implants (CIs) and their typically developing peers in terms of auditory short-term memory (ASTM), auditory working memory (AWM), visuospatial short-term memory (VSTM), visuospatial working memory (VWM), spectral resolution and monosyllabic word recognition in noise.

METHODS

Twenty-three prelingually deaf CI users and twenty-three typically developing (TD) peers aged 7-10 years participated. Twelve children with CI were earlier-implanted (i.e., age at implantation ≤24 months). Children with CIs were compared to typically developing peers and correlations between cognitive and psychoacoustic abilities were computed separately for the groups. Besides, regression analyses were conducted to develop models that could predict SMRT (spectral-temporally modulated ripple test) and speech recognition scores.

RESULTS

The AWM scores of the later-implanted group were significantly lower than both earlier-implanted and TD groups. ASTM scores of TD children were significantly higher than both earlier-implanted and later-implanted participants. There was no statistically significant difference between groups in terms of VSTM and VWM. AWM performance was positively correlated with ASTM, SMRT scores, and speech recognition under noisy conditions for pediatric CI recipients. The AWM was a statistically significant predictor of the SMRT score and the SMRT score was an indicator of speech recognition score under 0 dB SNR condition.

CONCLUSION

Most of children using CI are at risk for clinically remarkable deficits across cognitive abilities such as AWM and ASTM. While evaluating cognitive and psychoacoustic abilities in the clinic routine, it should be kept in mind that they can be influenced by each other.

Perspectives of D/HH-Students on Mainstream Higher Education: A Qualitative Study

Social, contextual, and technological changes affected the educational context for students who are deaf or hard of hearing (D/HH) in higher education in many countries. Although, several barriers to academic success already have been identified, the perspectives of D/HH-students on inclusion, educational facilities, and support are important to overcome them. This interview-based qualitative study describes the perspectives of 32 D/HH-students in mainstream higher education in The Netherlands. Within the dichotomy of environmental factors and personal factors, data have been analysed. Students experienced social acceptance by others with typical hearing, although participating in social events sometimes caused feelings of loneliness or separation. Access arrangements and adjustments in educational programs were necessary to cope with the experienced fatigue, participate during lectures or increase speech intelligibility of the lecturer. Especially poor classroom acoustics and limited intelligibility of speech hampered students during lectures. Students expressed their dissatisfaction about the way access arrangements and adjustments were arranged, yet at the same time, they do not know what the requested help should look like. A co-created policy in which D/HH-students, student support officers, and institutional policy makers are involved, would support D/HH-students in mainstream higher education in The Netherlands and abroad in their needs.

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.

Cochlear Implants: Evaluation of Effects of Various Parameters on Outcomes in Pediatric Patients at a Tertiary Care Centre for Unilateral Ear Implantation

To determine whether variables such as Age, Gender, Demographic background of the patient and Pre-operative usage of hearing aids affect the outcomes of pediatric cochlear implant surgery when modified; in terms of speech and hearing gain. A hospital based retrospective-prospective type of cohort study was conducted over a period of 5 years at a Tertiary care Teaching hospital and referral centre covering a population of about 68.9 million. Candidates selected were 1-5 years of age with bilateral congenital severe-profound sensori-neural hearing loss. 50 patients were selected and were operated using VERIA technique of Cochlear Implant Surgery. Intraoperative testing of electrode functioning was done in all patients using NRT technique. The switching on of implant was done after 1 month, following which patients underwent 100 sessions of auditory verbal therapy and training. Outcomes were evaluated in terms of hearing and speech gain by using Revised CAP scores, ITMAIS scores and PEACH scores in the loco-regional language. Those implanted at a younger age and with at least 3 months of hearing aid usage pre-operatively had better outcomes measures. There was no effect on outcomes when the gender and demographic origin of the patient were compared. Candidates implanted before 3 years age give better results and they should be encouraged to use hearing aid regularly and continuously before the surgery and should be advised trial and fitting as soon as CI planning begins. Also, gender and demographic background should not be considered when planning CI as these have no significant effect on outcomes.

An Adaptation and Validation Study of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) in Italian Normal-Hearing Children

This study aimed to translate and adapt the English version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) for children and for parents into the Italian language; validate SSQ for hearing children and their parents; and evaluate the discriminant validity of the instrument. A group of 102 normal-hearing Italian children, aged between 9 and 16 years, and their parents were included in this study. A group of 31 parents of normal-hearing Italian children aged between 6 and 8 years was also included. A group of 57 hearing-impaired Italian children aged between 9 and 16 years, and their parents were also included, as well as a group of 30 parents of hearing-impaired Italian children aged between 6 and 8 years. Cronbach’s alpha in the SSQ for parents was 0.92; it was 0.95 in the SSQ for children. Guttmann’s split-half coefficient in SSQ for children for both λ4 and λ6 was 0.98; in SSQ for parents in λ4 was 0.96 and λ6 was 0.95. These data provide evidence for the discriminant validity of the SSQ scale (p-value < 0.001). Italian SSQ scales for children and for parents are now available.

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

OBJECTIVE

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

DESIGN

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

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

Application of Digital Games for Speech Therapy in Children: A Systematic Review of Features and Challenges

Introduction

Treatment of speech disorders during childhood is essential. Many technologies can help speech and language pathologists (SLPs) to practice speech skills, one of which is digital games. This study aimed to systematically investigate the games developed to treat speech disorders and their challenges in children.

Methods

A comprehensive search was conducted in four databases, including Medline (through PubMed), Scopus, Web of Science, and IEEE Xplore, to retrieve English articles published by July 14, 2021. The articles in which a digital game was developed to treat speech disorders in children were included in the study. Then, the features of the designed games and their challenges were extracted from the studies.

Results

After reviewing the full texts of 69 articles and assessing them in terms of inclusion and exclusion criteria, 27 articles were included in the systematic review. In these articles, 59.25% of the games had been developed in English language and children with hearing impairments had received much attention from researchers compared to other patients. Also, the Mel-Frequency Cepstral Coefficients (MFCC) algorithm and the PocketSphinx speech recognition engine had been used more than any other speech recognition algorithm and tool. In terms of the games, 48.15% had been designed in a way that children could practice with the help of their parents. The evaluation of games showed a positive effect on children's satisfaction, motivation, and attention during speech therapy exercises. The biggest barriers and challenges mentioned in the studies included sense of frustration, low self-esteem after several failures in playing games, environmental noise, contradiction between games levels and the target group's needs, and problems related to speech recognition.

Conclusion

The results of this study showed that the games positively affect children's motivation to continue speech therapy, and they can also be used as the SLPs' aids. Before designing these tools, the obstacles and challenges should be considered, and also, the solutions should be suggested.

Hearing Parents' Voices: Parental Refusal of Cochlear Implants and the Zone of Parental Discretion

It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear implantation. While I conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam's concept of the zone of parental discretion.

Impact of Auditory-Oral Education on Device Use in Children With Hearing Loss

PURPOSE

This study examined changes in datalogging for children attending an auditory-oral educational program with integrated audiology services versus children attending a mainstream or nonspecialized program.

METHOD

Eighty children participated in this study, half of which were enrolled in an auditory-oral educational program versus the nonspecialized or mainstream setting. Datalogging for cochlear implant and hearing aid users was obtained via retrospective medical and educational chart review from 2016 to 2019.

RESULTS

Results demonstrated that at post-enrollment, children attending the auditory-oral educational program significantly increased device wear time (as measured by average hours/day) when compared to the control group. Children using hearing aids enrolled in the specialized educational program obtained the largest improvement in overall wear time, averaging an increase of 5 hr/day of device use from pre- to post-enrollment.

CONCLUSIONS

This is the first study to document the association of specialized educational programs on device use. Clinical and educational programs should collaborate to provide integrated services to lessen family burden and increase a child's device use and retention.

Development and psychometric evaluation of a scale to measure telepractice among speech and language pathologists during COVID-19 pandemic

PURPOSE

With the outbreak of the COVID-19 and the need for physical distancing, the provision of Speech-Language Pathology (SLP) services via telepractice has been essential. One of the first steps in this field is the need to study telepractice among Speech and Language Pathologists (SLPs). However, there is currently no specific instrument to measure telepractice in SLP to achieve this aim. The present study was conducted to develop and evaluate the psychometric properties of a questionnaire to investigate telepractice among SLPs during the COVID-19 pandemic.

MATERIALS AND METHODS

The study comprised of two stages: (1) development of the questionnaire according to an in-depth literature review and (2) evaluation of the validity and reliability of the questionnaire. The content validity of the instrument was determined by 10 experts in the field of SLP. To check the face validity of the questionnaire, 10 SLPs were interviewed and their opinions were incorporated in the questionnaire. A total of 221 SLPs completed the questionnaire to determine the construct validity and the internal consistency. To evaluate the test-retest reliability, 30 SLPs completed the questionnaire twice with two weeks of interval.

RESULTS

The final version of the questionnaire comprised of three sections and 31 items. The Cronbach's alpha coefficients for different sections of the questionnaire ranged between 0.902 and 0.92 and the Intra-class Correlation coefficients of the sections were found to be between 0.9 and 0.96 in the test-retest reliability.

CONCLUSIONS

The questionnaire developed in the study is a valid and reliable scale to measure telepractice among SLPs for educational or research purposes.

Vocal Turn-Taking in Families With Children With and Without Hearing Loss

OBJECTIVE

Vocal turn-taking is an important predictor of language development in children with and without hearing loss. Most studies have examined vocal turn-taking in mother-child dyads without considering the multitalker context in a child's life. The present study investigates the quantity of vocal turns between deaf and hard-of-hearing children and multiple members of their social environment.

DESIGN

Participants were 52 families with children who used hearing aids (HA, mean age 26.3 mo) or cochlear implants (CI, mean age 63.2 mo) and 27 families with normal-hearing (NH, mean age 26.6 mo) children. The Language ENvironment Analysis system estimated the number of conversational turns per hour (CTC/hr) between all family members (i.e., adult female, adult male, target child, and other child) during full-day recordings over a period of about 1 year.

RESULTS

The CTC/hr was lower between the target child and the adult female or adult male in the CI compared with the HA and NH groups. Initially, CTC/hr was higher between the target child and the adult female than between the adult male or the other child. As the child's age increased, turn-taking between the target child and the adult female increased in comparison to that between the target child and the adult male. Over time, turn-taking between the target child and the other child increased and exceeded turn-taking between the target child and the adult caregivers. The increase was observed earlier in families with siblings compared with those without.

CONCLUSIONS

The quantity of vocal turn-taking depends on the degree of child hearing loss and the relationship between the children and the members of their social environment. Longitudinally, the positive effect of an assistive device on the quantity of turns between the children and their family members was found. The effect was stronger in families with siblings.

Vocabulary Development and the Shape Bias in Children With Hearing Loss

Purpose Although children with hearing loss (HL) can benefit from cochlear implants (CIs) and hearing aids (HAs), they often show language delays. Moreover, little is known about the mechanisms by which children with HL learn words. One mechanism by which typically hearing (TH) children learn words is by acquiring word learning biases such as the "shape bias," that is, generalizing the names of novel solid objects by similarity in shape. In TH children, the shape bias emerges out of regularities in the early vocabulary and, once acquired, has consequences for subsequent vocabulary development. Method Here, we ask whether children with HL exhibit similar word learning biases as TH children. In the current study, nineteen 2- to 3.5-year-old children with HL generalized the names of novel objects by similarity in shape or material. We compared their performance to that of 20 TH children matched on age and 20 TH children matched on vocabulary size. Results Children with HL were significantly less likely than age-matched TH children and vocabulary-matched TH children to generalize novel names to objects of the same shape. However, there was also an interaction such that vocabulary has a stronger effect on novel noun generalization for those with HL than for those who are TH. Exploratory analyses of children with HL reveal similar novel noun generalization and vocabulary sizes in children who use CIs and those who use HAs, regardless of hearing age or degree of HL. Conclusion Together, the results suggest that, although vocabulary knowledge drives development of the shape bias in general for all children, it may be especially important for children with HL, who are at risk for language delays.

[Impact of the COVID-19 pandemic on speech therapy for children with Speech and Language Disorders]

OBJECTIVE

 In December 2019, the COVID-19 pandemic began to spread around the world and caused massive restrictions in our daily life. Many educational facilities and practices delivering speech therapy were temporally closed (so-called lockdown). Children with a speech and language disorder were forced to pause their therapy. The aim of this study was to describe if and how speech therapy was delivered during lockdown and what psychological burden was associated to affected parents.

MATERIAL AND METHODS

 Parents of children with a speech and language disorder were asked about their child´s therapy during lockdown and about their fears and worries associated with it.

RESULTS

 For 17 patients speech therapy was paused during lockdown while 20 patients could continue their therapy. Children speaking a language other than German had a higher risk for having their therapy paused during lockdown (Odds ratio = 5.11, with 95 % confidence interval = 1.09-32.54). Parents whose children did not receive speech therapy during lockdown were more worried about their child's development.

CONCLUSIONS

 There is no common concept on how speech therapy can be delivered safely during lockdown. Possible barriers to healthcare might be more pronounced during the pandemic and parents experience a high psychosocial burden.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

Age-related and noise-induced hearing loss alters grasshopper mouse (Onychomys) vocalizations

Age-related and noise-induced hearing loss disorders are among the most common pathologies affecting Americans across their lifespans. Loss of auditory feedback due to hearing disorders is correlated with changes in voice and speech-motor control in humans. Although rodents are increasingly used to model human age- and noise-induced hearing loss, few studies have assessed vocal changes after acoustic trauma. Northern grasshopper mice (Onychomys leucogaster) represent a candidate model because their hearing sensitivity is matched to the frequencies of long-distance vocalizations that are produced using vocal fold vibrations similar to human speech. In this study, we quantified changes in auditory brainstem responses (ABRs) and vocalizations related to aging and noise-induced acoustic trauma. Mice showed a progressive decrease in hearing sensitivity across 4-32 kHz, with males losing hearing more rapidly than females. In addition, noise-exposed mice had a 61.55 dB SPL decrease in ABR sensitivity following a noise exposure, with some individuals exhibiting a 21.25 dB recovery 300-330 days after noise exposure. We also found that older grasshopper mice produced calls with lower fundamental frequency. Sex differences were measured in duration of calls with females producing longer calls with age. Our findings indicate that grasshopper mice experience age- and noise- induced hearing loss and concomitant changes in vocal output, making them a promising model for hearing and communication disorders.

Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions

Recently, a novel virus has spread worldwide causing the disease called COVID-19. In addition to putting people's lives at risk and causing mortality, various problems have occurred due to the negative effects of the COVID-19 pandemic. Quarantine, social distancing, and the obligation to use protective tools have led to sometimes long term closing of various jobs and services, including rehabilitation services. For instance, the disease has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes. Therefore, here, we described the quality of providing SLP services during the COVID-19 pandemic and the negative effects of the disease on the provision of SLP services. In addition, we made an attempt to explain concerns and problems raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the outbreak of COVID-19.

Phonological Awareness Skills in Children With Early and Late Cochlear Implantation: Effects of Task and Phonological Unit

Purpose Phonological awareness (PA) skills are critical for spoken language acquisition and literacy. PA manifests in various skills that can be identified based on task performance and speech sound unit size. This study compared the PA skills of children with early cochlear implantation (E-CI), children with late cochlear implantation (L-CI), and children with typical hearing (TH) in relation to task and phonological unit. It also attempted to identify the significant predictors of PA skills in each CI and TH group. Method Twenty children with E-CI, 20 children with L-CI, and 20 children with TH participated in this study. PA skills were assessed using elision, blending, and segmenting tasks at both the syllabic and phonemic levels. Results The E-CI and L-CI groups performed significantly less well than the TH group on the elision and blending tasks at the syllabic level. However, the E-CI group performed at a similar level as the TH group in the segmenting tasks at both the syllabic and phonemic levels. The regression analysis identified age at implantation and receptive vocabulary scores as significant predictors of PA skills in children with CIs. Conclusions Although all the children with CIs had age-appropriate receptive vocabulary skills, the PA skills of both the E-CI and L-CI groups tended to lag behind those of the TH group in the elision and blending tasks at the syllabic level. Age at implantation and receptive vocabulary skills affected the development of PA skills in children with CIs.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves?

Introduction

Cochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance.

Objective

To investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance.

Methods

30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance.

Results

The mean diameter of the cochlear nerve on the ipsilateral side was 718.4 μm (504.5 − 904.3 μm) and mean cross sectional area was 0.015 cm² (0.012 − 0.018 cm²). On the contralateral side the mean cochlear nerve diameter was 714.4 μm (502.6 − 951.4 μm) and mean cross sectional area was 0.014 cm² (0.011 − 0.019 cm²). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 − 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 − 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 − 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 − 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve.

Conclusion

Measuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.

Risk factors for non-participation in the Danish universal newborn hearing screening program: A population-based cohort study

OBJECTIVE

To explore risk factors for non-participation for the Danish universal newborn hearing screening program, including socioeconomic demographic and peripartum conditions. Furthermore, the participation rate between children with medical risk factors for congenital hearing loss and healthy newborns was analyzed.

METHODS

The study was register-based and included all live births in Denmark between January 1st, 2008 and December 31st, 2011, in total 251,081 children. Potential risk factors were extracted from eight Danish national registers and analyzed via logistic regression models.

RESULTS

With respect to the participation rate, the strongest predictors of non-participation were increased maternal parity (from OR: 0.85; 95% CI: 0.82-0.89; p<0.0001 to OR: 0.43; 95% CI: 0.38-0.47; P<0.0001), low socio-economic status, including income, (from OR: 1.16; 95% CI: 1.09-1.23; p<0.0001 to OR: 1.46; 95% CI: 1.37-1.56; p<0.0001) and home birth (OR: 0.58; 95% CI: 0.42-0.80; p=0.001). Children with a medical risk factor for congenital hearing loss had a 1.97% lower participation rate. Assisted ventilation and admission to a newborn intensive care unit for > 48 hours were identified as independent risk factors of non-participation for this group (OR: 0.65; 95% CI: 0.52-0.80; p<0.0001 and OR: 0.92; 95% CI: 0.85-0.99; p=0.036, respectively).

CONCLUSION

In order to improve the participation rate, a national screening database in conjunction with a stronger collaboration between screening units and other health care professionals who are in contact with the family during the newborn period is warranted.

The influence of age and language on developmental trajectory of theory of mind in children with cochlear implants

OBJECTIVE

The present study investigates if children with cochlear implants (CI) are associated with delayed development of Theory of Mind (ToM) and the differences in gain of ToM ability with respect to age, language and other aspects of CI.

METHODS

One-hundred-eleven children with participation of their hearing parents, aged between 36 months and 132 months, who had congenital profound bilateral deafness and were unilateral CI users; plus 99 healthy children underwent 'Peabody Picture Vocabulary' and 'Sally-Anne' tests. A total of 77 children with CI (mean age: 76.51 months, 31 girls and 46 boys) and 82 healthy children (mean age: 72.41 months, 47 girls and 35 boys) were included in the analyses. Analytic comparisons were created between the controls and children with CI and between subgroups of CI users by univariate and multivariate analysis. The effects of age of hearing aid use, age of CI surgery, duration of CI use, language scores and the presence of risk factors, early rehabilitation with hearing aid and CI on the ToM development were analyzed.

RESULTS

The Sally-Anne test success rates of 67.1% were significantly higher in controls than that of children with CI (49.4%) (p < 0.05). The mean age difference of the children, who were successful in Sally-Anne test was 5.33 months in favor of healthy controls. The ToM task success rates were 57.1% (24/42) and 40% (14/35) in children with early CI and late CI respectively. The children, who were good at language, were also better in Sally-Anne tests, but the mean Peabody Picture Vocabulary test scores were indifferent in the same age group with respect to the presence of CI use (p > 0.05). However, multivariate analysis presented the higher language scores as the only significant independent variable that has impact on the success in Sally-Anne test (p < 0.05).

CONCLUSION

The results revealed that among all children, who did better in ToM were older in age and better in language skills. Children with CI also performed better in false-belief test depending on their language scores. Early CI surgery, older age, and hence longer CI use can provide a well-developed ToM for children with CI.

Comparison of Expressive Spoken Language Skills in Children With Cochlear Implants and Children With Typical Hearing

When children start formal education, they are expected to be able to express complex thoughts. However, in order to do so, they need to be able to use both complex grammatical structures and a variety of words. One group that is at risk of having a delay in terms of their expressive language ability is children with cochlear implants (CI). In this study, we evaluated whether children with CI perform comparably to children with typical hearing (TH) on a standard expressive spoken grammar and a standard expressive spoken vocabulary task when the groups were matched on non-verbal intelligence and working memory capacity. It was found that the children with CI in this study performed more poorly on a standard expressive spoken vocabulary task but not on a standard expressive spoken grammar task when compared to the children with TH. Differences in terms of expressive spoken vocabulary do not seem to be explained by differences in cognitive ability. In addition, the variation in terms of expressive spoken language ability was larger in the children with CI compared to the children with TH. This might be explained by additional confounding factors, like the time of language deprivation or by a greater influence of cognitive differences for the acquisition of spoken language for children with CI.

Hearing and speech benefits of cochlear implantation in children: A review of the literature

Cochlear implantation is a safe and reliable treatment for children with severe to profound hearing loss. The primary benefit of these medical devices in children is the acquisition of hearing, which promotes development of spoken language. The present paper reviews published literature demonstrating predictive effects of a number of factors on acquisition of hearing development and speech recognition. Of the many variables that contribute to an individual child's development after implantation, age at implantation, the presence of medical comorbidities, social determinants of health, and the provision of bilateral versus unilateral hearing are those that can vary widely and have consistently shown clear impacts. Specifically, age of implantation is crucial to reduce effects of deafness on the developing auditory system and capture the remarkable plasticity of early development. Language development after cochlear implantation requires therapy emphasizing hearing and oral communication, education, and other support which can be influenced by known social determinants of health; specifically, outcomes in children decline with reductions in socioeconomic status and levels of parental education. Medical co-morbidities also slow rates of progress after cochlear implantation. On the other hand, benefits of implantation increase in children who are provided with access to hearing from both ears. In sum, cochlear implants promote development of hearing in children and the best outcomes are achieved by providing early access to sound in both ears. These benefits can be limited by known social determinants of health which restrict access to needed support and medical comorbidities which add further complexity in care and outcome.

Data logging variables and speech perception in prelingually deafened pediatric cochlear implant users

OBJECTIVES

To investigate the relationship among objectively gathered data logging measurements, patient-related variables, and speech recognition performance of pediatric CI users.

METHODS AND MATERIALS

Thirty-two prelingually implanted children who have the ability to perform word discrimination test were included in this study. To reveal the relationship between speech perception abilities and auditory exposure, seven data logging variables were analyzed: "on-air," "off-air," "coil-off," "speech," "speech in noise," "music" and "noise. In addition, implantation age (months) and CI usage duration (months) were taken into account. Finally, it was investigated the differences between unilateral, sequential bilateral, and simultaneous bilateral CI users in terms of all study variables.

RESULTS

The average on-air time ranged between 10.52 and 12.30 in the groups. In the case of sequential implantation, smaller on-air and higher coil off values were observed with the second CI. In the case of simultaneous bilateral implantation, data logging measurements were almost the same in both implants. WRS was significantly correlated (p < 0.05) with on-air time (r = 0.62), coil-off count (r = -0.48), chronological age (r = 0.48), and CI duration (r = 0.44). Multiple linear regression model was fit to predict the WRS, with on-air time, CI duration, and chronological age as predictors.

CONCLUSIONS

The critical importance of early intervention and long-term use of CI is well-established in the literature and is also corroborated by our findings. However, the key findings of the present study are that consistent CI use and the quality of daily listening environment also exerted a major and positive effect on the speech recognition performance of pediatric CI users. Therefore, during the monitoring of pediatric CI recipients, it is important to know the device usage data in order to detect problems in the early stages after CI.

Regulation of auditory plasticity during critical periods and following hearing loss

Sensory input has profound effects on neuronal organization and sensory maps in the brain. The mechanisms regulating plasticity of the auditory pathway have been revealed by examining the consequences of altered auditory input during both developmental critical periods—when plasticity facilitates the optimization of neural circuits in concert with the external environment—and in adulthood—when hearing loss is linked to the generation of tinnitus. In this review, we summarize research identifying the molecular, cellular, and circuit-level mechanisms regulating neuronal organization and tonotopic map plasticity during developmental critical periods and in adulthood. These mechanisms are shared in both the juvenile and adult brain and along the length of the auditory pathway, where they serve to regulate disinhibitory networks, synaptic structure and function, as well as structural barriers to plasticity. Regulation of plasticity also involves both neuromodulatory circuits, which link plasticity with learning and attention, as well as ascending and descending auditory circuits, which link the auditory cortex and lower structures. Further work identifying the interplay of molecular and cellular mechanisms associating hearing loss-induced plasticity with tinnitus will continue to advance our understanding of this disorder and lead to new approaches to its treatment.

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During CPs, brain plasticity is enhanced and sensitive to acoustic experience.

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Enhanced plasticity can be reinstated in the adult brain following hearing loss.

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Molecular, cellular, and circuit-level mechanisms regulate CP and adult plasticity.

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Plasticity resulting from hearing loss may contribute to the emergence of tinnitus.

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Modifying plasticity in the adult brain may offer new treatments for tinnitus.

Validation of the Manchester spoken language development scale (MSLDS)

Introduction: Standardized outcome measures are importantfor accurately monitoring the language development of pre-lingually deaf children receiving auditory implants. Current commonly used outcome measures are time-consuming,limiting the practicality of regular testing. To address these limitations, the Manchester Spoken Language Development Scale (MSLDS) was developed as a quick and easily applicable interim measurement. This is an 11-point scale designed to provide a streamlined overview of a child's expressive language development. This study describes the MSLDS, evaluates its ease of use and inter-rater reliability, and outlines its application in the paediatric auditory implant population. Methods: Sixteen speech therapists and teachers for the deaf reviewed videos of paediatric cochlear implant assessmentsand rehabilitation sessions at a UK auditory implant centre. Twenty-five videos from fourteen children were used in this validation study. Reviewers were asked to evaluate a child's language development using the MSLDS by assigning a score for each video and to evaluate the ease of use of the scale. Each video wasrated by three different reviewers. Results: MSLDS scores showed a high degree of consistency between raters for each child. 8/25 (32%) videos demonstrated perfect agreement on the MSLDS. In 15/25 (60%) videos, there was a one-point difference between MSLDS scores. The remaining 2/25 (8%) videos varied by 2 points. Statistical analysis demonstrated an intra-class correlation coefficient (ICC) of 0.987, indicating a high level of agreement between users of the scale. Qualitative feedback from the raters suggested further modifications which have been incorporated into the scale. Conclusion: The high inter-rater agreement reflects the potential for the MSLDS to be a reliable tool for monitoring language development in the paediatric auditory implant population.

Academic Performance, Communication, and Psychosocial Development of Prelingual Deaf Children with Cochlear Implants in Mainstream Schools

BACKGROUND AND OBJECTIVES

To assess the academic performance, communication skills, and psychosocial development of prelingual deaf children with cochlear implants (CIs) attending mainstream schools, and to evaluate the impact of auditory speech perception on their classroom performance. Subjects and.

METHODS

As participant, 67 children with CI attending mainstream schools were included. A survey was conducted using a structured questionnaire on academic performance in the native language, second language, mathematics, social studies, science, art, communication skills, self-esteem, and social relations. Additionally, auditory and speech performances on the last follow-up were reviewed retrospectively.

RESULTS

Most implanted children attending mainstream school appeared to have positive self-esteem and confidence, and had little difficulty in conversing in a quiet classroom. Also, half of the implanted children (38/67) scored above average in general academic achievement. However, academic achievement in the second language (English), social studies, and science were usually poorer than general academic achievement. Furthermore, half of the implanted children had difficulty in understanding the class content (30/67) or conversing with peers in a noisy classroom (32/67). These difficulties were significantly associated with poor speech perception.

CONCLUSIONS

Improving the listening environment for implanted children attending mainstream schools is necessary.

Developing a functional assessment tool for the auditory performance of Arabic-speaking Egyptian hearing impaired children

BACKGROUND

Auditory performance outcome of children with hearing impairment has been widely studied, and the related factors of the performance have been explored among different age groups for English speaking hearing impaired children.

OBJECTIVES

The objective of this study was to construct Arabic questionnaires for the evaluation of the auditory abilities of hearing impaired Egyptian Arabic-speaking children.

METHODS

Three Arabic questionnaires targeting the auditory abilities were constructed by selecting items from different English-based questionnaires and translating them into Arabic and adapted to Egyptian culture. The questionnaires were administered to 210 Arabic-speaking Egyptian children in the age range 1-12 years who were divided into three age groups. They included 90 hearing impaired children fitted with hearing aids and 30 hearing impaired children with a cochlear implant and 90 children with normal hearing (as a control group). Participants' responses were statistically analyzed to assess the validity and reliability of the questionnaires and to compare hearing impaired children with normal hearing children.

RESULTS

There were non-significant differences between cochlear implanted children and children with hearing aids regarding auditory abilities performances. Language age and aided pure tone audiometry were considered the best predictors of auditory abilities of hearing impaired Egyptian children.

CONCLUSION

The constructed Arabic questionnaires proved to be reliable and valid functional assessment tools that provide information about auditory behaviors of hearing impaired Egyptian children in everyday life and would complement other objective test results in evaluating and monitoring the performance of these children.

Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence

Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.

Effects of children's hearing loss on the synchrony between parents' object naming and children's attention

Children's attentional state during parent-child interactions is important for word learning. The current study examines the real-time attentional patterns of toddlers with and without hearing loss (N = 15, age range: 12-37 months) in parent-child interactions. High-density gaze data recorded from head-mounted eye-trackers were used to investigate the synchrony between parents' naming of novel objects and children's sustained attention on the named objects in joint play. Results show that the sheer quantities of parents' naming and children's sustained attention episodes were comparable in children with hearing loss and their peers with normal hearing. However, parents' naming and children's sustained attention episodes were less synchronized in the hearing loss group compared to children with normal hearing. Possible implications are discussed.

Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients

Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients-specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5-9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03-9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.

The effectiveness of cognitive rehabilitation program on auditory perception and verbal intelligibility of deaf children

Linguistic information and cognitive rehabilitation has more related with auditory perception and verbal intelligibility. The aim of the present study was to assessment of the effectiveness of cognitive rehabilitation program on the auditory perception and verbal intelligibility of deaf children. This study was a quasi-experimental study with pre-test, post-test and control group design. Participants were 24 deaf children from Ava rehabilitation center of mother child in Isfahan city, Iran. Participants were selected by convenient sampling method. They were randomly divided into experimental and control groups, each group consisted of 12 children. The experimental group participated in the cognitive rehabilitation training program in 10 sessions for 45 min, while control group did not participate this program. The instruments of present research were Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). The data were analyzed using multivariate analysis of covariance (MANCOVA) in 24th version of SPSS. The results of MANCOVA showed that cognitive rehabilitation program had significant effect on the auditory perception and verbal intelligibility in the experimental group at post intervention stage (P < 0/0001). There was a positive and significant increase in auditory perception and verbal intelligibility of experimental group. Our findings showed that Cognitive rehabilitation program training led to promote of auditory perception and verbal intelligibility of deaf children.

Preserving Inhibition during Developmental Hearing Loss Rescues Auditory Learning and Perception

Transient periods of childhood hearing loss can induce deficits in aural communication that persist long after auditory thresholds have returned to normal, reflecting long-lasting impairments to the auditory CNS. Here, we asked whether these behavioral deficits could be reversed by treating one of the central impairments: reduction of inhibitory strength. Male and female gerbils received bilateral earplugs to induce a mild, reversible hearing loss during the critical period of auditory cortex development. After earplug removal and the return of normal auditory thresholds, we trained and tested animals on an amplitude modulation detection task. Transient developmental hearing loss induced both learning and perceptual deficits, which were entirely corrected by treatment with a selective GABA reuptake inhibitor (SGRI). To explore the mechanistic basis for these behavioral findings, we recorded the amplitudes of GABA_A and GABA_B receptor-mediated IPSPs in auditory cortical and thalamic brain slices. In hearing loss-reared animals, cortical IPSP amplitudes were significantly reduced within a few days of hearing loss onset, and this reduction persisted into adulthood. SGRI treatment during the critical period prevented the hearing loss-induced reduction of IPSP amplitudes; but when administered after the critical period, it only restored GABA_B receptor-mediated IPSP amplitudes. These effects were driven, in part, by the ability of SGRI to upregulate α1 subunit-dependent GABA_A responses. Similarly, SGRI prevented the hearing loss-induced reduction of GABA_A and GABA_B IPSPs in the ventral nucleus of the medial geniculate body. Thus, by maintaining, or subsequently rescuing, GABAergic transmission in the central auditory thalamocortical pathway, some perceptual and cognitive deficits induced by developmental hearing loss can be prevented.SIGNIFICANCE STATEMENT Even a temporary period of childhood hearing loss can induce communication deficits that persist long after auditory thresholds return to normal. These deficits may arise from long-lasting central impairments, including the loss of synaptic inhibition. Here, we asked whether hearing loss-induced behavioral deficits could be reversed by reinstating normal inhibitory strength. Gerbils reared with transient hearing loss displayed both learning and perceptual deficits. However, when animals were treated with a selective GABA reuptake inhibitor during or after hearing loss, behavioral deficits were entirely corrected. This behavioral recovery was correlated with the return of normal thalamic and cortical inhibitory function. Thus, some perceptual and cognitive deficits induced by developmental hearing loss were prevented with a treatment that rescues a central synaptic property.

Speech Perception Growth Patterns in Prelingual Deaf Children With Bilateral Sequential Cochlear Implantation

OBJECTIVE

To evaluate speech perception following the first (CI-1) and second (CI-2) cochlear implantation (CI) in children with sequential bilateral CI.

STUDY DESIGN

Retrospective.

PATIENTS

Seventy children with follow-up for 60 months post CI-1 and 36 months post CI-2.

MAIN OUTCOME MEASURES

Word recognition score (WRS) was the main outcome. WRSs were compared by age at CI operation (group A ≤ 3.5 yr, B 3.6-8.6, for CI-1; group I ≤ 3.5 yr, II 3.6-7.0, III 7.1-13, IV > 13, for CI-2).

RESULTS

For CI-1, the WRS of group A exceeded 80% at 24 months post procedure, earlier than group B (54 mo). Group A also had a shorter period of CI-1 use up to the WRS plateau than group B. CI-2 showed an initial burst of WRS growth much earlier than CI-1. This initial burst was most robust within 3 months in group II, but modest in group IV. The periods of CI-2 use (11-17 mo) up to the WRS plateau were much shorter than CI-1 (40-64 mo). Group I did not show the best WRS at 1 month post CI but later exceeded the other groups.

CONCLUSION

Children received an immediate benefit by a burst of WRS growth from CI-2 earlier than CI-1, even within 3 months, suggesting that CI-1 gets the auditory cortex ready to foster speech processing from CI-2. The CI-2 performance depends on age at CI-2 implantation and on CI-1 performance. Our current findings will be relevant for clinicians who are counselling parents on CI-2 surgery.

Preimplant Hearing Aid Fittings and Aided Audibility for Pediatric Cochlear Implant Recipients

BACKGROUND

Audibility of speech for children with hearing loss (HL) depends on the degree of HL and the fitting of the hearing aids (HAs) themselves. Many studies on cochlear implant (CI) users have demonstrated that preimplant hearing is associated with postimplant outcomes, but there have been very few reports on the fitting of HAs before surgery.

PURPOSE

The aims of this study were to characterize HA fittings and aided audibility of speech for pediatric HA users with severe to profound HL and to examine the relation between preimplant aided audibility and postimplant speech perception.

RESEARCH DESIGN

A descriptive/observational and correlational study. Audiologic records of pediatric CI participants involved in a larger study examining the effects of early acoustic hearing were analyzed retrospectively; when available, these records included HA verification and speech recognition performance.

STUDY SAMPLE

The CI participants were enrolled in audiology centers and oral schools for the deaf across the United States.

DATA COLLECTION AND ANALYSIS

To determine whether deviations from prescribed DSL target were significantly greater than zero, 95% confidence intervals of the mean deviation were calculated for each frequency (250, 500, 1000, 2000, and 4000 Hz). Correlational analyses were used to examine the relationship between preimplant aided Speech Intelligibility Indices (SIIs) and postimplant speech perception in noise. Correlational analyses were also used to explore the relationship between preimplant aided SIIs and demographic data. T-tests were used to compare preimplant-aided SIIs of HAs of listeners who later became users of either sequential CIs, simultaneous CIs, or bimodal devices.

RESULTS

Preimplant fittings of HAs were generally very close to prescriptive targets, except at 4000 Hz for those HAs with active frequency-lowering processing, and preimplant SIIs, albeit low, were correlated with postimplant speech recognition performance in noise. These results suggest that aided audibility should be maximized throughout the HA trial for later speech recognition purposes.

CONCLUSIONS

It is recommended that HA fittings be optimized to support speech audibility even when considering implantation. In addition to the age at which HA use begins, the aided audibility itself is important in determining CI candidacy and decisions regarding bimodal HA use.