Initial classification of pediatric hearing impairment using behavioral measures of early prelingual auditory development

[Diagnostic value of IT-MAIS scores by logistic regression and ROC curve in predicting the degree of hearing loss in infants and toddlers aged 0-36 months]

Objective:This study is inorder to compare the early prelingual auditory development trajectory of infants and toddlers with normal hearing and different degrees of hearing loss, and to explore the value of the Infant-Toddler Meaningful Auditory Integration Scale （IT-MAIS） scores in the diagnosis of hearing loss severity in infants and toddlers aged 0-36 months. Methods:Eight hundred and forty-two cases of infant-toddler from March 2009 to March 2021 were selected as participants, including 231 cases with normal hearing and 611 cases with hearing loss. The IT-MAIS scores of participants with different degrees of hearing loss were fitted with nonlinear regression with age. By respectively constructing three logistic regression models of IT-MAIS total scores, perception scores, discrimination scores and evaluation age, the ROC curve was drawn to evaluate the diagnostic efficacy. Results:The IT-MAIS scores of children with mild, moderate, severe, and profound hearing loss participants changes with age are similar to the development of infants with normal hearing, and they all increase with age. And the more severe the hearing loss, the slower the growth rate, and the lower the peak value that can be reached. The logistic model constructed by combining IT-MAIS total score and evaluation age is the best to distinguish mild and above, moderate and above, severe and above, and profound hearing loss, whose AUC are 0.827, 0.889, 0.948, 0.946. The diagnostic efficiency is the best for infant-toddlers with profound hearing loss, with a sensitivity of 89.6% and a specificity of 88.4%. The more severe the hearing loss, the higher the discrimination accuracy of IT-MAIS and the better the diagnostic efficiency. Conclusion:The logistic model based on the IT-MAIS scale and the ROC curve method have a good efficiency in the diagnosis of hearing loss severity in infants and toddlers aged 0-36 months. When the child cannot cooperate with behavioral audiometry, the results of behavioral audiometry are unreliable, and there is no electrophysiological condition, the IT-MAIS scale is expected to evaluate the degree of infants' hearing loss as an auxiliary tool. It can understand the children's auditory function state more and provides a basis for the subsequent formulation of rehabilitation intervention strategies with certain clinical application value.

Early Prelingual Auditory Development of Infants and Toddlers With Unilateral Hearing Loss

OBJECTIVE

To assess the influence of congenital and permanent unilateral hearing loss (UHL) on early prelingual auditory development (EPLAD) of infants and toddlers.

STUDY DESIGN

A cross-sectional and case-controlled design.

SETTING

Tertiary referral center.

PATIENTS

Sixty-five young children (median with interquartile ranges: 4.4 [3.3, 7.7] mo) with UHL, 70 children (6.0 [3.8, 9.0] mo) with bilateral normal hearing (BNH) and 32 children (5.8 [3.9, 12.1] mo) with bilateral mild hearing loss (BMHL) were enrolled and grouped. Children with UHL were further grouped according to the severity of impairment and the ear that was impaired.

INTERVENTIONS

Children involved were assessed by the 9-item Infant-toddler Meaningful Auditory Integration Scale (ITMAIS).

MAIN OUTCOME MEASURES

1) EPLAD assessed by ITMAIS, 2) functions of sound detection, sound discrimination and identification and preverbal vocalization assessed by dividing ITMAIS into three sections, 3) trajectories of EPLAD estimated by ITMAIS.

RESULTS

Compared with BNH, children with UHL lagged behind in the function of sound discrimination and identification, preverbal vocalization, as well as trajectory of EPLAD. Children with severe to profound UHL exhibited more severe EPLAD handicaps than children with mild to moderate losses. The auditory functions and EPLAD trajectory of children with UHL were similar to those with BMHL.

CONCLUSIONS

Children with congenital and permanent UHL demonstrate delays in EPLAD, which are evident soon after birth before initial development of speech and language. The ITMAIS is an appropriate tool to identify these delays both in children with unilateral and bilateral hearing impairment.

Modification and verification of the Infant-Toddler Meaningful Auditory Integration Scale: a psychometric analysis combining item response theory with classical test theory

Background

Early prelingual auditory development (EPLAD) is a fundamental and important process in the speech and language development of infants and toddlers. The Infant–Toddler Meaningful Auditory Integration Scale (ITMAIS) is a widely used measurement tool for EPLAD, however it has not yet undergone a comprehensive psychometric analysis. The aim of this research was to modify and verify the psychometric properties of ITMAIS using a combination of Item Response Theory (IRT) and Classical Test Theory (CTT).

Methods

Stage 1—1730 children were retrospectively recruited to enable the application of an IRT model, specifically the graded response model, to modify the ITMAIS. Stage 2—another 450 infants and toddlers with normal hearing or permanent hearing loss before auditory intervention were recruited to verify the psychometric properties of the modified ITMAIS (ITMAIS-m) using the CTT method.

Results

Using the metric of the graded response model, by removing item 2 from the ITMAIS, ITMAIS-m demonstrated discrimination parameters ranging from 3.947 to 5.431, difficulty parameters from − 1.146 to 1.150, item information distributed between 4.798 and 9.259 and a test information score of 48.061. None of the items showed differential item functioning. ITMAIS-m was further verified in Stage 2, showing Cronbach’s α of 0.919 and item-total correlations ranging from 0.693 to 0.851. There was good convergent validity of ITMAIS-m with other auditory outcome measure (r = 0.932) and pure tone average thresholds (r ranging from − 0.670 to − 0.909), as well as a high ability to discriminate between different hearing grades (Cohen d ranging from 0.41 to 5.83).

Conclusions

The ITMAIS-m is a reliable and valid tool for evaluating EPLAD in infants and toddlers, which can be efficiently and precisely applied in clinical practice. The combined use of IRT and CTT provides a powerful means to modify psychometrically robust scales aimed at childhood auditory outcome measurements.

[Common tools of auditory function assessment in infants and toddlers]

With the prevalence of early hearing detection and intervention program in China, more and more infants and toddlers with hearing loss can be diagnosed and treated timely. During the process, evaluation of auditory function is of great importance, which can fully reflect the outcomes of auditory intervention. With the variety of auditory function evaluation tools, we should concern the psychometric properties and clinical applications of each tool before application.

Trajectory of auditory and language development in the early stages of pre-lingual children post cochlear implantation: A longitudinal follow up study

OBJECTIVES

The aim of this longitudinal follow-up study was to explore the trajectories of early auditory and language development in Mandarin speaking children younger than 3 years of age following switch-on of their cochlear implants (CIs).

METHODS

Early auditory and language development was measured longitudinally using the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), which is a commonly used tool for assessing early prelingual auditory development (EPLAD) in children, and the subtest (Words and Gestures, W&G) of the simplified short form version of the Mandarin Communicative Development Inventory (SSF-MCDI) to assess receptive and expressive vocabulary growths of children in 24 pediatric cochlea implant recipients at baseline, 3, 6, and 12 months following switch-on. Age at switch-on ranged from 1 to 3 years of age. Participants were divided into two groups based on age at switch-on. The IT-MAIS and SSF-MCDI (W&G) scores were analyzed with comparison to normal children, unaided hearing-impaired children, and CI children.

RESULTS

Significant improvements in IT-MAIS and SSF-MCDI (W&G) scores from baseline to 12 months were seen after switch-on in both CI groups and were comparable to the normal hearing children in the first year of age. The IT-MAIS scores of CI children in both groups at 12 months after switch-on surpassed the average level of unaided peers with profound hearing loss and were similar to the average level of unaided peers with mild hearing loss. SSF-MCDI (W&G) scores in word comprehension and expression were significantly different between groups at some intervals.

CONCLUSIONS

Children younger than 3 years of age with cochlear implants have similar trajectories in early auditory and language developments to normally hearing children. Moreover, early implantation is an important factor for the early auditory development when comparing EPLAD results between CI children and unaided peers with different hearing loss. Finally, it is noteworthy that CI children master the skill of word comprehension before the skill of word expression, and that word comprehension may be the basis of word expression.

The Effects of Stimulus Rate on ABR Morphology and its Relationship to P1 CAEP Responses and Auditory Speech Perception Outcomes in Children with Auditory Neuropathy Spectrum Disorder: Evidence from Case Reports

OBJECTIVE

Auditory Neuropathy Spectrum Disorder (ANSD) affects approximately 5-15% of children with sensorineural hearing loss. ANSD is characterized by the presence of otoacoustic emissions (OAE) and an absent or abnormal auditory brainstem response (ABR). The purpose of this study was to investigate the prognostic value of slow-rate ABR in predicting the auditory cortical development and auditory speech perception outcomes in case studies of children with ANSD.

DESIGN

ABR waveform characteristics were collected at slow stimulation rates (5.1 clicks/second) and a fast stimulation rates (>11-31.1 clicks/second, rates typically used in a clinical setting) in 3 case reports of children with ANSD. P1 CAEP responses and measures of auditory speech perception using the Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS) were also collected in these children. Retrospective analysis was performed to evaluate the prognostic value of slow- versus fast-rate ABR in predicting P1 CAEP responses and auditory speech perception outcomes in these children.

STUDY SAMPLE

Participants included case reports of 3 pediatric participants with a clinical diagnosis of ANSD.

RESULTS

Slow-rate ABR did not elicit significant improvements in waveform morphology compared to fast-rate ABR. P1 CAEP results were present in 2 out of 3 cases and were consistent with auditory speech perception outcomes.

CONCLUSIONS

Even when ABR stimulation rates were slowed, ABR responses in these children with ANSD did not display any characteristic or replicable pattern, and ABR responses were not predictive of cortical auditory maturation or behavioral performance. In contrast, P1 CAEP responses provided valuable information regarding the maturational status of the auditory cortex and P1 CAEP responses were consistent with behavioral measures of auditory speech perception. Overall, results highlight the high prognostic value of P1 CAEP testing when used in conjunction with behavioral measures of auditory speech perception in children with ANSD.

Air and Bone Conduction Frequency-specific Auditory Brainstem Response in Children with Agenesis of the External Auditory Canal

Introduction  The tone-evoked auditory brainstem responses (tone-ABR) enable the differential diagnosis in the evaluation of children until 12 months of age, including those with external and/or middle ear malformations. The use of auditory stimuli with frequency specificity by air and bone conduction allows characterization of hearing profile.

Objective  The objective of our study was to compare the results obtained in tone-ABR by air and bone conduction in children until 12 months, with agenesis of the external auditory canal.

Method  The study was cross-sectional, observational, individual, and contemporary. We conducted the research with tone-ABR by air and bone conduction in the frequencies of 500 Hz and 2000 Hz in 32 children, 23 boys, from one to 12 months old, with agenesis of the external auditory canal.

Results  The tone-ABR thresholds were significantly elevated for air conduction in the frequencies of 500 Hz and 2000 Hz, while the thresholds of bone conduction had normal values in both ears. We found no statistically significant difference between genders and ears for most of the comparisons.

Conclusion  The thresholds obtained by bone conduction did not alter the thresholds in children with conductive hearing loss. However, the conductive hearing loss alter all thresholds by air conduction. The tone-ABR by bone conduction is an important tool for assessing cochlear integrity in children with agenesis of the external auditory canal under 12 months.