The causes of profound hearing impairment in a school for the deaf--a longitudinal study

Use of Virtual Reality-Based Games to Improve Balance and Gait of Children and Adolescents with Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis

BACKGROUND

Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population.

OBJECTIVE

The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL.

METHODS

A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes.

RESULTS

Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; p = 0.37; I² = 0%).

CONCLUSION

Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.

Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss

OBJECTIVE

The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system.

METHODS

This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function.

RESULTS

The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF).

CONCLUSION

The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study.

IMPACT

Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.

Deafblindness: a review of the literature

BACKGROUND

Deafblindness or dual sensory loss is a rare condition among young people, but more frequent among older people. Deafblindness is a heterogeneous condition that varies with regard to time of onset and degree of vision and hearing impairment, as well as communication mode, medical aetiology, and number and severity of co-morbidity.

METHOD

We conducted a comprehensive review of public health issues related to deafblindness.

RESULTS

Deafblindness often lead to barriers in language and communication, access to information and social interaction, which can lead to a number of health-related difficulties. Some of the reported consequences are a higher risk of depression, cognitive decline, developmental disorder in children and psychological distress.

CONCLUSIONS

Deafblindness is associated with a number of health-related issues and more knowledge is needed about the impact of dual sensory loss to be able to offer the best support.

Prevalence and aetiology of congenitally deafblind people in Denmark

A study of prevalence and aetiology was performed on 63 children and 127 adults in Denmark with congenital deafblindness. Using a Scandinavian definition of deafblindness, the prevalence of congenital deafblindness was found to be 1:29 000. Thirty-five different aetiological causes of deafblindness were found. Causes of congenital deafblindness were different among adults compared to causes among children. Rubella syndrome (28%, n = 36) and Down syndrome (8%. n = 10) were the largest groups among people above 18 years of age. Among children CHARGE syndrome (16%, n = 13) was the largest group. Ethnicity was also evaluated. Among children 72% were Danish, but among the adults 98% were Danish. Implications of difference in aetiology and ethnicity are discussed in relation to the Scandinavian traditions of clinical practice and identification of congenital deafblindness.

Reduced fetal movements and maternal medication - new pregnancy risk factors for neurodevelopmental disability in childhood

A case-control study was undertaken of 471 children on the Nottingham Special Needs Register (SNR) who were born in one of the two maternity units in the city between 1987 and 1993 (inclusive). Controls were selected as the next infant born at the same hospital following each index case. The aim of the study was to identify risk factors on the Nottingham Obstetric Database for a baby subsequently appearing on the SNR. Disability was analysed by both ICD-9 coding and functional assessment. Factors which independently and significantly predicted a child's likelihood of being on the SNR were breech presentation (adjusted odds ratio (OR) = 4.0), congenital abnormality (OR=4.9), intrapartum fetal distress (OR=1.7), fetal growth restriction (OR=2.0), socioeconomic deprivation (OR=1.8), prematurity (OR=2.2), reduced fetal movements (OR=2.5) and medication in pregnancy (OR=10.4). To our knowledge the last two factors have not previously been reported as risk predictors for neurodevelopmental disability.

Prevalência de indicadores de risco para surdez em neonatos em uma maternidade paulista

OBJETIVO: identificar os indicadores de risco para perda auditiva em recém-nascidos de um hospital da rede pública de Campinas - São Paulo, no período de julho de 2007 a janeiro de 2008. MÉTODOS: a amostra foi composta por 589 protocolos de neonatos avaliados no Programa de Triagem Auditiva Neonatal Universal, no período. RESULTADOS: do total de protocolos estudados, 152 (25,8%) evidenciaram presença de indicadores de risco para surdez em neonatos. Dentre eles, os mais prevalentes, em ordem decrescente, foram: antecedentes familiares (26,3%), boletim Apgar de 0 a 4 no primeiro minuto (23,6%), uso de medicamentos ototóxicos (23,6%), permanência em incubadora (22,3%), hiperbilirrubinemia (21,7%) e permanência em Unidade de Terapia Intensiva Neonatal (18,4%). CONCLUSÃO: o número de indicadores de risco encontrados por neonato variou de um a seis. Dentre os neonatos com indicadores de risco, apenas um bebê falhou nas três avaliações realizadas na triagem auditiva, sendo que, de acordo com seu protocolo, ele apresentava três indicadores de risco para surdez.

Systematic review of the etiology of bilateral sensorineural hearing loss in children

OBJECTIVE

Identification of the etiology of sensorineural hearing loss (SNHL) in children facilitates management and provides important prognostic information. In recent years, the etiology of bilateral SNHL in children has changed due to advances in genetic testing and treatment of perinatal infections. The objective of this study was to determine the frequency of etiologies of moderate-profound bilateral sensorineural hearing loss (SNHL) in children.

METHODS

The English literature was searched in Medline for articles published between 1966 and 2002. The inclusion criteria were studies involving bilateral SNHL >/=40dB in children less than 18 years of age. The studies were required to account for all patients, and provide a breakdown of etiologic factors. Etiologies investigated included genetic and non-genetic (prenatal, perinatal, postnatal). To compare differences between the frequencies of etiologies a two-sample t-test was performed assuming unequal variance. Studies were stratified according to perceived confounders: start date of study, study design, and degree of hearing loss.

RESULTS

Seven hundred and eighty abstracts were screened for relevancy. Forty-three studies satisfied the inclusion criteria. The common etiologies of bilateral SNHL were unknown (41.5%), genetic non-syndromic (27.2%), prenatal (11.5%), perinatal (9.7%), postnatal (6.6%), and genetic syndromic (3.5%). Unknown and Rubella were significantly less frequent etiologies in the more recent studies, while genetic non-syndromic, asphyxia and prematurity were more common. Genetic non-syndromic hearing loss was more frequent in the prospective studies compared to the population and retrospective studies, but this difference was not significant. Genetic non-syndromic hearing loss was more common among patients with profound hearing loss.

CONCLUSION

Accounting for the recent decline in infectious etiologies, the most common causes of bilateral SNHL are unknown (37.7%), genetic non-syndromic (29.2%), prenatal (12%), perinatal (9.6%), postnatal (8.2%), and genetic syndromic (3.2%).

Changes in the aetiology of hearing impairment in deaf-blind pupils and deaf infant pupils at an institute for the deaf

An aetiological study was performed on 57 pupils at the deaf-blind department of the Institute for the Deaf at Sint-Michielsgestel, The Netherlands, in the school year 1998-1999 and on 49 deaf-blind pupils at the same department in the school year 1986-1987. The pupils were 5-20 years of age. In addition, the aetiologies were studied in 55 deaf infant pupils in 1998 and compared with those of 68 deaf infant pupils in 1988. Their age was 1-5 years. All the pupils showed hearing impairment with thresholds of >60 dB HL. Among the deaf-blind pupils and deaf infant pupils, there were several cases with rare hereditary syndromes. The prevalence of acquired causes of deafness, especially congenital rubella, had decreased over the years, whereas perinatal causes of deafness had increased. Chromosomal anomalies were found in 15% of the infant pupils in 1998. Over the study period, the percentage of pupils with multiple handicaps increased from 25 to 38%.

Prevalence and etiology of bilateral sensorineural hearing impairment in a Finnish childhood population

A retrospective study was performed on the prevalence and etiology of bilateral sensorineural hearing impairment (> 25 dB at 0.5-4 kHz in the better ear) among children born 1974-1987 in a province of eastern Finland. A total of 98 children with hearing impairment were identified, which gave a prevalence of 2.1 per 1000 live births. This prevalence was higher than reported form most of other developed countries but slightly lower than reported from Sweden. A slight decline from the prevalence of 2.3 per 1000 in the 1970s to the prevalence of 1.9 per 1000 in the 1980s was observed. Contrary to several earlier studies, no male predominance was noted, there were even slightly more females than males (52 vs. 46). Etiology of the hearing loss was estimated to be genetic in 41%, congenital nongenetic in 13%, delayed-onset nongenetic in 16% and remained unknown in 30%. On average, children with a congenital disorder had more severe hearing impairment than those with delayed-onset hearing loss, e.g. 31% of the former patients had profound (> 95 dB) hearing loss compared to 6% of the latter. A very gratifying finding was that no case of congenital hearing impairment caused by maternal rubella was identified after 1982, obviously due to general vaccinations. Also, a decline in cases of hearing loss attributed to perinatal and neonatal complications was observed.

Management and outcome: children fitted with hearing aids in Ireland

The Republic of Ireland has a total population of 3.5 million people, mainly rural or in small towns, a rapidly declining birthrate during 1984 to 1991, and a geographically stable children's population. A unified Audiology Service is provided by the National Rehabilitation Board for the fitting of hearing aids to all children deemed to require them. The current study outlines a database analysis of all children fitted with hearing aids for the first time in 1984 or 1991. Follow-up information on the status (in 1991-1992) of those fitted in 1984 was obtained, with regard to hearing loss, schooling and changes in aiding. Data on severe/profound losses in particular, and the trends in service provision are examined. Similar numbers of children were fitted with hearing aids in the two years sampled, even though the overall degree of hearing loss amongst this population had fallen.