Vocabulary development in Mandarin-speaking children with cochlear implants and its relationship with speech perception abilities

BACKGROUND

China has the largest population of children with hearing impairments and cochlear implantation is gaining popularity there. However, the vocabulary development in this population is largely unexplored.

AIMS

This study examined early vocabulary outcomes, factors influencing early vocabulary development and the relationship between speech perception and vocabulary development in Mandarin-speaking children during the first year of cochlear implant use.

METHODS AND PROCEDURES

A battery of vocabulary tests was administered to 80 children before implantation and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate their relationships with vocabulary outcomes.

OUTCOMES AND RESULTS

The Mandarin-speaking children, who received their cochlear implants before 3 years of age, developed vocabulary at a rate faster than that of their same-aged peers with normal hearing. Better pre-implant hearing levels, younger age at implantation, and higher maternal education level contributed to the early vocabulary development. The trajectories of speech perception development highly correlated with those of vocabulary development during 3 to 12 months of CI use.

CONCLUSIONS

and Implications: These findings imply that the vocabulary development of children implanted before 3 years of age may catch up with that of their hearing peers.

Early speech perception in Mandarin-speaking children at one-year post cochlear implantation

PURPOSE

The aim in this study was to examine early speech perception outcomes in Mandarin-speaking children during the first year of cochlear implant (CI) use.

METHOD

A hierarchical early speech perception battery was administered to 80 children before and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate its relationship with these outcomes.

RESULTS

Regardless of dialect exposure and whether a hearing aid was trialed before implantation, implant recipients were able to attain similar pre-lingual auditory skills after 12 months of CI use. Children speaking Mandarin developed early Mandarin speech perception faster than those with greater exposure to other Chinese dialects. In addition, children with better pre-implant hearing levels and younger age at implantation attained significantly better speech perception scores after 12 months of CI use. Better pre-implant hearing levels and higher maternal education level were also associated with a significantly steeper growth in early speech perception ability.

CONCLUSIONS

Mandarin-speaking children with CIs are able to attain early speech perception results comparable to those of their English-speaking counterparts. In addition, consistent single language input via CI probably enhances early speech perception development at least during the first-year of CI use.

[Universal screening program and early intervention (USPEI) in congenital bilateral sensorineural hearing loss in Chile]

Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.

Aetiology of congenital hearing loss: a cohort review of 569 subjects

OBJECTIVE

Newborn hearing screening was implemented in Flanders about fifteen years ago. The aim of this study was to determine the aetiology of hearing loss detected by the Flemish screening programme.

METHODS

From 1997 to 2011, 569 neonates were referred to our tertiary referral centre after failed neonatal screening with Auditory Brainstem Responses. In case hearing loss (HL) was confirmed, further diagnostic testing was launched. A retrospective chart review was performed analysing the degree of HL, risk factor and aetiology.

RESULTS

Metabolic disorders (0.5%), infectious diseases (35.8%), congenital malformations (6.1%) and genetic abnormalities (19.8%), whether or not syndromic, were retained. In 35% of the subjects no obvious aetiology could be determined in the current study.

CONCLUSION

In contrast to the literature findings, this series shows a genetic syndromic cause in 80% of the genetic bilateral HL cases. On the other hand connexin positive diagnoses were mostly underrepresented in this study, showing the need for better screening.

Outcome of a universal newborn hearing-screening programme based on multiple transient-evoked otoacoustic emissions and clinical brainstem response audiometry

CONCLUSION

This universal newborn hearing-screening (UNHS) programme revealed high efficacy. The proportion of congenital sensorineural hearing loss was higher in left ears and in males than in right ears and females, which was in line with the systematic ear asymmetries and sex differences in transient-evoked otoacoustic emission (TEOAE) pass percentage.

OBJECTIVES

To study the long-term outcome of a UNHS programme based on multiple TEOAEs and clinical click-evoked auditory brainstem response (ABR).

METHOD

The study included all the newborns that were screened during a 6-year period (n = 31 092). TEOAE pass/fail was analysed in detail. In an assessment performed 10 years after the start of the 6-year UNHS, prevalence, degree and type of congenital hearing loss were studied.

RESULTS

The proportion of screened newborns was high, i.e. 98%. Multiple TEOAE recordings minimized the need for clinical ABR. Fifty-seven (0.18%) subjects showed bilateral hearing loss (exceeding ≈ 30 dB HL); median ABR threshold = 60 dB nHL (at 2.5 months of age). Bilateral and unilateral sensorineural hearing loss was found in 0.17% (n = 52; 56% males) and 0.06% (n = 18; 61% left ears, 56% males) of the screened newborns, respectively. Higher TEOAE pass percentages (p < 0.01) were demonstrated in right ears and in females than in left ears and males.

[The results of audiological examination of children presenting with sensorineural loss of hearing due to GJB2 gene mutations during the first year of life]

One of the topical problems of modern pediatric audiology is early diagnostics of congenital sensorineural loss of hearing in children and their timely rehabilitation. The objective of the present study was to obtain audiological characteristics of sensorineural hearing impairment associated with GJB2 gene mutations in children during the first year of life. The methods used were registration of short-latency auditory evoked potentials (slAEP) and the otoacoustic emission (OAE) techniques. The study included 66 children at the age of several months presenting with bilateral sensorineural loss of hearing who were available for the examination by an otorhinolaryngologist, tympanometry, slAEP recording, delayed EOAE (dEOAE) and distortion-product frequency OAE (dpOAE) techniques, and genetic counseling. The examination was carried out in duplicate, with an interval of 3 months. The genotype containing GJB2 gene mutations was identified in 47 (71.2%) children. The 35delG mutation was found in 41; in 31 of them it occurred in the homozygous state and in 10 in the heterozygous state. In the latter group, 8 children had the 35delG mutation in the compound heterozygous state together with one more mutation. Six children turned out to carry a pathological genotype with other GJB2 gene mutations. It was shown that OAE fails to be recorded in most patients with hearing impairment due to GJB2 gene mutations during the first months of life. The authors conclude that these mutations usually lead to the development of persistent bilateral symmetric sensorineural loss of hearing.

Age and outcome of cochlear implantation for patients with bilateral congenital deafness in a Cantonese-speaking population

OBJECTIVE

To evaluate the effect of age at implantation by assessment of speech perception in cochlear implant users with bilateral congenital deafness.

DESIGN

A retrospective cohort analysis of 60 cochlear implant users (age at implantation, 1.01 to 22.0 yr) who have at least 2 yr of experience. Their outcome performance was defined by the change in i) speech perception category (SPC) score based on postoperative assessment results and ii) the type of education attended after implantation. The association of age at implantation with SPC scores was analyzed at different ages at implantation (2, 3, 4, 5, and 6 yr old). The SPC scores for a particular age at implantation were compared at 6, 12, and 24 mo after implantation. The impact of age at implantation on choice of education was evaluated by analyzing the transition from a school for the deaf to mainstream education for the 45 children who were operated on before the age of 10, because older children are less likely to make such a change.

RESULTS

Children implanted at the ages of 2, 3, 4, 5, and 6 yr all obtained significant improvements in SPC scores 24 mo after implantation. The greatest improvement was noted at 24 mo after implantation among those operated on before age 3. For all age groups, improvement at 24 mo after implantation is greater than at 12 mo, whereas the latter is greater than the improvement noted at 6 mo after implantation. Comparison of children implanted before the age of 3 and between ages 3 and 10 showed a significant difference in the choice of education after implantation. Children who were implanted before the age of 3 were more likely to attend mainstream education after implantation.

CONCLUSION

Results from the present study are consistent with the current belief that implantation at a younger age provides greater benefit. The proportion of children attending mainstream education was significantly higher for those implanted before age 3, which may be a potential benefit to early implantation for relieving the burden of governments in providing special education.

Evaluation of Cochlear Nerve Imaging in Severe Congenital Sensorineural Hearing Loss

The route of the cochlear nerve can be imaged using computed tomography (CT) or magnetic resonance imaging (MRI). To gain information about the cochlear nerve, we conducted a trial measuring the width of the cochlear nerve canal (CNC) using CT. When we examined images of the route of the cochlear nerve on MRI, both in ears with congenital sensorineural hearing loss (SNHL) and normal ones, we found that in ears in which the CNC was narrower than 1.5 mm with CT, images of cochlear nerve deficiency could be seen in that ear with MRI.

Autosomal recessive nonsyndromic deafness locus DFNB63 at chromosome 11q13.2–q13.3

A genome wide linkage analysis of nonsyndromic deafness segregating in a consanguineous Pakistani family (PKDF537) was used to identify DFNB63, a new locus for congenital profound sensorineural hearing loss. A maximum two-point lod score of 6.98 at theta = 0 was obtained for marker D11S1337 (68.55 cM). Genotyping of 550 families revealed three additional families (PKDF295, PKDF702 and PKDF817) segregating hearing loss linked to chromosome 11q13.2-q13.3. Meiotic recombination events in these four families define a critical interval of 4.81 cM bounded by markers D11S4113 (68.01 cM) and D11S4162 (72.82 cM), and SHANK2, FGF-3, TPCN2 and CTTN are among the candidate genes in this interval. Positional identification of this deafness gene should reveal a protein necessary for normal development and/or function of the auditory system.

Age at diagnosis of deaf babies: a retrospective analysis highlighting the advantage of newborn hearing screening

OBJECTIVE

Aim of the study was to assess the mean age at diagnosis of bilateral congenital hearing loss in the Audiology and Phoniatry Centre of the University of Turin, pointing out, by North-West Italy experience, the role of the newborn hearing screening in anticipating the age of diagnosis.

METHODS

This was a retrospective study. Forty-six congenital deaf babies were reviewed and age at diagnosis was assessed for each, taking in consideration the role of hearing loss risk factors. Eighteen babies (39%) were sent by the centres that participate to the newborn hearing screening program while 28 (61%) came for parental or pediatrician suspicion of hearing loss and for general language delay. Sixteen babies (35%) presented risk factors for hearing loss.

RESULTS

The mean age of identification of severe to profound hearing loss was 20.5 months (S.D.=15.3) in the whole group; considering the group of 28 babies not screened the mean age was 29.3 months (S.D.=13.4). This value decreased to 6.8 months (S.D.=3.6) in the group which underwent screening programme. This difference was statistically significant at Student's t-test (p<0.001). The average ages of diagnosis for healthy versus high risk children were significantly different only in the group of screened babies (p<0.05).

CONCLUSIONS

Childhood hearing impairment is one of the most common of congenital disorders, and even though there is a general trend of early identification, in reality age of diagnosis is as yet still too late even in developed countries. Our results show that newborn hearing screening could reduce the age at which infants with hearing loss are diagnosed and treated; this would improve speech, language, auditory outcome and the quality of parents and infant life.

Effectiveness of population-based newborn hearing screening in England: ages of interventions and profile of cases

OBJECTIVE

The objective of this study was to determine the effectiveness in routine practice of the first phase of a national population-based newborn hearing screening and follow-up program that seeks to identify infants with bilateral permanent hearing loss of > or =40-dB hearing loss.

METHODS

The study was a part of the independent evaluation of the 23 first phase sites (annual birth population approximately 120,000) of the national newborn hearing screening program in England. For each infant identified with the defined hearing loss, the measures of interest were degree and type of hearing loss, presence of risk factors, age of first audiologic assessment, age of identification of hearing loss, age of enrollment in an early support program, and age of hearing aid fitting. Data collection took place over the first 2 years of the program.

RESULTS

Data were provided on 169 infants with permanent bilateral moderate or greater hearing loss identified through screening 169487 infants. Fifty-four percent of all cases were from an "at-risk" population. Three fourths of these "at-risk" infants spent > or =48 hours in the NICU. For the whole sample, the median age at first audiologic assessment was 5 weeks; the median age of identification of the hearing loss and of enrollment in early support program was 10 weeks irrespective of the degree of hearing loss; and the median age at hearing aid fitting was 16 weeks. Infants with moderate hearing loss were fitted with hearing aids significantly later than those with severe and profound hearing loss.

CONCLUSIONS

Properly implemented, a newborn hearing screening program based on whole populations and routine service provision can deliver satisfactory outcomes in terms of age of referral, identification, and intervention. The distribution of degree and type of hearing loss and proportion with risk factors was similar to that expected. The numbers identified were such as to suggest that very few cases were missed by the screening program.

Universal newborn hearing screening and postnatal hearing loss

OBJECTIVE

The goal of this study was to determine the percentage of children who have a postnatal permanent childhood hearing impairment (PCHI) and the percentage thereof who have risk indicators for a postnatal hearing loss.

METHODS

Data were drawn retrospectively from the clinical charts of children who had bilateral PCHI (>40 dB hearing level, better ear, unaided) and had undergone universal newborn hearing screening (UNHS) between 1995 and 2000 in various Austrian hospitals. A hearing loss was recognized as postnatal when a child passed UNHS but was later found to have a hearing impairment. The presence of risk indicators, as suggested by the Year 2000 Statement of the American Joint Committee on Infant Hearing (JCIH), was assessed by reviewing the children's clinical charts.

RESULTS

Of a total of 105 children with bilateral PCHI, 23 (22%) showed postnatal impairment. After correction of this number for underascertainment, postnatal impairment was estimated to account for 25% of all bilateral PCHI at age 9 years. Risk indicators were found in 17 children but did not fully correspond to those proposed by the JCIH. The risk factors found were a family history of hearing loss (3 children), meningitis (2), craniofacial malformation (2), persistent pulmonary hypertension (1), congenital cytomegaly infection (1), extracorporeal membrane oxygenation (1), recurrent otitis media with effusion (1), and, in addition to the JCIH list, ototoxic therapy (5), and birth before 33rd gestational week (2) (1 child had a combination of the last 2). Six children showed no risk indicators for the postnatal hearing loss.

CONCLUSIONS

Our findings suggest that approximately 25% of bilateral childhood hearing loss is postnatal, which supports the leading role of UNHS in detecting PCHI. Provisions for also identifying postnatal cases nevertheless are justified. Because in some of these children no risk indicators are detectable and in others the hearing deterioration starts after age 3 years, audiologic monitoring of at-risk children up to this age may not be sufficient. Additional methods, such as hearing screening at nursery schools or schools, are recommended.

The economic costs of congenital bilateral permanent childhood hearing impairment

OBJECTIVE

The objective of this study was to estimate the economic costs of bilateral permanent childhood hearing impairment (PCHI) in the preceding year of life for children aged 7 to 9 years.

METHODS

A cost analysis was conducted by using a birth cohort of children born between 1992 and 1997 in 8 districts of Southern England, of which half had been born into populations exposed to universal newborn screening (UNS). Unit costs were applied to estimates of health, social, and broader resource use made by 120 hearing-impaired children and 63 children in a normally hearing comparison group. Associations between societal costs per child and severity of hearing impairment, language ability score, exposure to UNS, and age of confirmation were analyzed, including adjustment for potential confounders in a linear regression model.

RESULTS

The mean societal cost in the preceding year of life at 7 to 9 years of age was 14092.5 pound sterling for children with PCHI, compared with 4206.8 pound sterling for the normally hearing children, a cost difference of 9885.7 pound sterling. After adjusting for severity and other potential confounders in a linear regression model, mean societal costs among children with PCHI were reduced by 2553 pound sterling for each unit increase in the z score for receptive language. Using similar regression models, exposure to a program of UNS was associated with a smaller cost reduction of 2213.2 pound sterling, whereas costs were similar between children whose PCHI was confirmed at <9 or >9 months. CONCLUSIONS. The study provides rigorous evidence of the annual health, social, and broader societal cost of bilateral PCHI in the preceding year of life at 7 to 9 years of age and shows that it is related to its severity and has an inverse relationship with language abilities after adjustment for severity.

The BAHA Softband. A new treatment for young children with bilateral congenital aural atresia

OBJECTIVE

To evaluate the validity of a bone-anchored hearing aid (BAHA) Softband (fitted unilaterally and bilaterally) in young children with bilateral congenital aural atresia.

SUBJECTS

Two children with severe bilateral congenital conductive hearing loss, who had been fitted with a transcutaneous BAHA Softband at the age of 3 and 28 months, respectively. The latter child had been fitted with a conventional bone-conduction hearing aid at the age of 3 months; at 28 months, this child had received the BAHA Softband and after 5 months of unilateral application, the BAHA Softband was fitted bilaterally. Follow-up in the two children was 31 and 17 months, respectively.

METHODS

Using the artificial mastoid, gain and maximum output were studied in this new transcutaneous application of the BAHA, with the BAHA Classic and the BAHA Compact as sound processor. Results were compared to those obtained with a conventional bone-conduction device (Oticon E 300 P). Aided thresholds and sound lateralization scores were assessed with double visual reinforcement audiometry (VRA). To test the validity of the BAHA Softband, the speech and language development of the children was assessed by means of age-appropriate tests (the preverbal Symbolic play test and the Dutch non-speech test for receptive and expressive language and the Dutch version of the Reynell language test).

RESULTS

The electro-acoustic measurements showed minor differences in gain between the three devices. At a reduced volume setting, the mean input level at which the output levelled off was largely comparable between the BAHA Classic and the conventional device, but somewhat poorer with the BAHA Compact. Both children showed speech and language development that was in accordance with their cognitive development.

CONCLUSIONS

The BAHA Softband was a valid intervention in children with congenital bilateral aural atresia who were too young for percutaneous BAHA application.

Sudden Sensorineural Hearing Loss Associated with Inner Ear Anomaly

OBJECTIVE

This study was conducted to evaluate the frequency of inner ear anomaly in patients with sudden sensorineural hearing loss and in control subjects.

STUDY DESIGN

Retrospective case review.

SETTING

A tertiary referral center.

PATIENTS AND INTERVENTION

We evaluated 366 patients (165 men and 201 women; age range, 3-91 yr) with sudden sensorineural hearing loss and 228 control subjects without sensorineural hearing loss using magnetic resonance imaging. Three hundred fifty-six patients had unilateral and 10 patients had bilateral sudden sensorineural hearing loss.

RESULTS

Eleven (2.9%) of 376 ears with sudden sensorineural hearing loss had inner ear anomaly. Nine patients (2.5%) had inner ear anomaly associated with sudden sensorineural hearing loss, but none of the 228 control subjects had the anomaly. The current study demonstrated that the frequency of inner ear anomaly in patients with sudden sensorineural hearing loss was significantly higher than in control subjects.

CONCLUSION

Our study reveals that inner ear anomaly may be associated with sudden sensorineural hearing loss in 2.5% of patients.

Niikawa-Kuroki-Syndrom

Niikawa-Kuroki syndrome (Kabuki make-up syndrome) is a congenital disorder with characteristic facial features and possibly anomalies of the skeletal system and internal organs. There is an increasing number of reports of patients with combined hearing impairment, inner ear deformities or sensorineural hearing impairment. In addition, the patients often suffer from therapy-resistant chronic otitis media. In addition to multiple cardiac and renal deformities, our 3 year old patient has a hearing impairment due to chronic otitis media with chronic otorrhea, and requires a hearing aid. A high-definition CT scan of the petrosal bone revealed, for the first time in a patient with Niikawa-Kuroki syndrome, a large vestibular aqueduct syndrome and deformities of the vestibular system. We examine the problems involved with treating chronic otorrhea in chronic otitis media and providing patients with BTE hearing aids.

Recurrent multiple hepatic abscesses, hepatic calcification and congenital hearing loss in a child with chronic granulomatous disease

Chronic granulomatous disease (CGD) is a rare inherited primary immunodeficiency in which phagocytes cannot destroy catalase-positive bacteria and fungi. In this article, we describe a 6-year-old boy with CGD associated with recurrent multiple hepatic abscesses, hepatic calcification and congenital hearing loss because of rare presentation. To the best of our knowledge, congenital hearing loss in CGD has not been reported in the literature. In the treatment of our patient, a combination of antibiotherapy, percutaneous drainage and surgical intervention was used, but multiple hepatic abscesses recurred during the follow-up. On account of this case, we would like to reemphasize that recurrent hepatic abscesses are frequently observed and difficult to treat in patients with CGD. Additionally, we would like to state that congenital hearing loss may be a part of the disease, or it may be coincidental. To clarify the last point, we suggest that all patients with CGD should be tested for hearing impairment.

Binaural interaction of bone-conducted auditory brainstem responses in children with congenital atresia of the external auditory canal

Bilateral bone-conducted auditory brainstem responses (BC-ABRs) were recorded in children with atresia of the external auditory canal bilaterally (AECB) in order to compare the response characteristics to normal hearing adults. The binaural interaction component (BIC) of the ABR occurs when the sum of the monaural-evoked ABR amplitudes are different in amplitude when compared to the binaural-evoked ABR amplitude. Previous electrophysiological work from our lab has shown that children with AECB lateralize bone-conducted (BC) sound. Furthermore, we have found in normal-hearing adults that BICs exist using BC clicks. In adults, BC-BIC occurred in the latency region corresponding to waves IV-VI, whereas for children with AECB corresponding peak latencies occurred earlier. Same as normal-hearing adults, BC-ABR IV-V complex peak amplitudes for sum of the BC-monaural right and BC-monaural left ears were different from binaural response amplitude. Individual peak latencies were similar in children with AECB when compared to normal-hearing adults except for shorter latencies for BIC. These results indicate that: (1) BC-BI is present in children with AECB as well as normal-hearing adults; (2) the gross response properties of BIC are similar in children with AECB and normal-hearing adults; (3) fitting of a bilateral BC hearing aid might be a feasible method to optimize binaural hearing and sound lateralization.

[Benefit of bilateral cochlear implantation on congenital prelingually deafened Chinese-speaking children]

OBJECTIVE

To evaluate the benefit of bilateral cochlear implants (BCIs) in prelingually deafened children on hearing rehabilitation as well as on speech and language development.

METHOD

Two cases of congenital profound deaf children, who received unilateral cochlear implantation (CI, MEDEL C40+) on the age of 2 and 7.5, respectively, were performed secondary CI in the contralateral ear on their age of 5 and 9.5, respectively. One year after the secondary CI, the cochlear implant aided hearing threshold and speech discrimination rate were tested for both ears separately and together. The pronounce/speech distinct rate of the BCIs users were evaluated by their parents, surgeon and audiologist.

RESULT

In comparison to unilateral aided ear, the mean hearing threshold at the frequency 250-4,000 Hz of the 2 cases with BCIs decreased by 13 dB and 11 dB, respectively. The speech discrimination rate of the BCIs users increased by 9% and 10%, respectively. The speech recognition in noise was improved. And their pronounce/speech distinct was improved.

CONCLUSION

BCIs can provide a significant benefit in hearing, speech understanding, language development and pronounce/speech rehabilitation for prelingually deafened children.

[Electrophysiologic tests of the auditory apparatus and vestibular organ in Usher syndrome]

Usher syndrome is a congenital autosomal dominant inherited disease characterised by hearing, balance and vision problems. The aim of the work was an evaluation of hearing and vestibular organ in the chosen group of patients with Usher syndrome diagnosed. Material consisted of 10 persons (5 males and 5 females) aged from 16 to 46 years with Usher syndrome diagnosed. All the patients have been in constant ENT and Ophthalmology Clinics' care. Complex hearing and balance organ, including posturography, as well as complex ophthalmologic examination were performed in each case. Medium or severe perceptive cochlear hearing loss, proper function of vestibular organ and slight elevation of stabilograms parameters were found in 6 cases. In 4 cases there were severe bilateral hearing loss, lack of vestibular function and considerable worsening of stabilograms parameters. In ophthalmologic examination in all the cases there was bilateral symmetrical dystrophy of the retina of various intensification. We concluded that hearing and balance organ examination in Usher syndrome can state accessory diagnostic aspect that might help to distinguish subtypes of the syndrome. In this way audiologic and otoneurologic tests could help to define prognosis of the disease in the individual cases. A necessity of close co-operation of genetics, ophthalmologists and ENT doctors as well as psychologists was stressed.

Congenital bifurcation of the intratemporal facial nerve

Anomalies of the course of the facial nerve have been reported in association with middle and inner ear malformations. Bifurcation of its intratemporal portion is a rare malformation in which focal splitting of one or more facial nerve segments occurs. We describe the CT appearance of this anomaly and discuss its possible embryology. Facial nerve bifurcation is important to recognize in patients undergoing evaluation for congenital hearing loss and other congenital ear malformations.

Bilateral Congenital Absence of Stapes and Oval Window in 2 Members of a Family: Etiology and Management

OBJECTIVE: To date, bilateral congenital absence of stapes and oval window in 2 members (brother and sister) of a family has not been reported in the literature. Carhart's notch as one of the indications for the diagnosis of this disease is proposed. The etiology and management of this condition are discussed.

MATERIALS AND METHODS: The older brother and younger sister of a family had severe bilateral hearing loss and concomitant speech disability since early childhood. Their parents are first cousins and have 2 sons and 1 daughter, but the younger son is in good health with normal hearing. No similar disease was found among other relatives. Physical examination showed that the older brother and the younger sister had normal external ears and tympanic membranes. Congenital bilateral absence of stapes and oval window were confirmed by history, audiologic examination, high-resolution computed tomography scanning, and/or surgery. The modified Lempert's fenestration operation on the horizontal semicircular canal was performed on 1 ear of each patient.

RESULTS: Postoperative hearing threshold was 25 dB for speech frequencies with a gain of 47 dB for the older brother and 28 dB for speech frequencies with a gain of 52 dB for the younger sister. Follow up at 5 to 13 years individually, their hearing gains were steady. Both sister and brother now enjoy a normal life.

CONCLUSIONS: Bilateral congenital absence of stapes and oval window in the 2 family members may be related to inheritance. This report points out Car-hart's notch as noted in otosclerosis as an important indication for diagnosis of this disease. The modified Lempert's fenestration operation of the horizontal semicircular canal is a safe and good choice for these patients and a better choice than a hearing aid throughout life.

Correlación entre emisiones otoacústicas y petc. la importancia de su empleo combinado

Auditory Brainstem Response (ABR) of 50 newborn with negative transient evoked acoustic emissions (OEAT) was performed. 54% of them had no family history of sensorineural hearing loss (SHNL) and no risk factors were found. In 70% of cases ABR recording was negative. Follow up did show that 60% of them had normal recordings of hearing and in a 40% different stages of hearing loss were seen. To establish a definitive diagnosis a 1 to 9 month period is necessary.

[Universal neonatal hearing screening of infants with otoacoustic emissions]

BACKGROUND

The incidence of congenital hearing impairment is 1-2/1,000--higher than for congenital hypothyroidism and phenylketonuria combined. Universal screening of hearing impairment has been introduced in many countries with portable otoacoustic emission (OAE) and/or automated auditory brainstem response (AABR), but not in Norway. This is the first Norwegian report on universal hearing screening of newborns before hospital discharge.

MATERIALS AND METHODS

All newborns in Østfold County (n = 5,712) in 2000 and 2001 were offered an OAE test on the second day in nursery by a two-step model. After two tests without OAE signals bilaterally, the infants were referred to the audiology clinic.

RESULTS

98.8% of the newborns were tested. Of these, 97.0% had a pass response after two tests. 169 (3.0%) were referred to the audiology clinic; 15 were withdrawn from follow-up examination by their parents. 23 infants had auditory brainstem response audiometry done, and sensorineural hearing impairment was found in six (1.0/1,000). Three infants (0.6/1,000) had conductive hearing impairment.

INTERPRETATION

Our screening model was appropriate and cost-effective. The incidence of congenital hearing impairment was similar to that reported by others. The number of parental refusals should be reduced. This may be achieved by adding an AABR to the two OAE tests.

[Screening for congenital hearing loss--a pilot project]

BACKGROUND

Until recently in Norway, congenital hearing loss has on average been diagnosed at 2.8 years of age. Delayed diagnosis is associated with loss of valuable opportunities for auditory habilitation and speech development.

MATERIAL AND METHODS

Since September 1999 we have carried out universal screening for congenital hearing loss in both healthy and sick newborns. During the first screening period, all newborns were screened with automated auditory brainstem response audiometry. In the second period all healthy infants were screened primarily with otoacoustic emission audiometry, with automated auditory brainstem response audiometry as a second stage screening for those who failed the otoacoustic emission test. 3,996 infants were screened from start-up until December 2001.

RESULTS

Hearing loss was confirmed in 25 patients (11 unilateral and 14 bilateral). A further two patients were referred but found to have normal hearing. The incidence of congenital hearing loss was 0.16% in presumed healthy infants and 2.2% in infants admitted to the intensive care nursery.

INTERPRETATION

Screening for congenital hearing loss can be carried out with a very low rate of referrals and a low rate of false positive tests, particularly if there is access to otoacoustic emission as well as automated auditory brainstem response testing. In our opinion, Norway now needs to legislate for universal screening for congenital hearing loss in the neonatal period. Our departments of audiology should be given the opportunity and resources to upgrade their skills in relation to this new group of patients.

Newborn hearing screening in Western Australia

AIM

To report the preliminary findings of a pilot program to screen newborn babies for congenital bilateral permanent hearing loss.

SETTING

The five largest maternity hospitals in Perth, Western Australia. Screening was gradually introduced over seven months from February to August 2000.

PARTICIPANTS

All babies born at these hospitals after the introduction of hearing screening until 30 June 2001.

METHODS

One or both of two automated screening devices were used: one measuring transient evoked otoacoustic emissions (TEOAE) and the other automated auditory brainstem responses (AABR). If a "pass" was not obtained in both ears, screening was repeated. All babies who did not obtain a pass in either ear at follow-up were referred for audiological assessment.

MAIN OUTCOME MEASURES

Prevalence of permanent bilateral hearing loss.

RESULTS

Of 13 214 eligible babies, 12 708 (96.2%) received screening. The main reason for missing screening was early hospital discharge (309; 2.3%). Of the screened babies, 99% had a pass response in both ears at either the initial or follow-up screen. Twenty-three babies were referred for audiological assessment, and nine were diagnosed with bilateral permanent hearing loss (0.68/1000; 95% CI, 0.31-1.28).

CONCLUSIONS

Despite our program meeting process quality indicators, our detection rate was low. Before extending the program to smaller hospitals, we need to validate our screening instruments and put in place a system to monitor false negative results.

Cochlear implantation in prelingually deafened children with residual hearing

OBJECTIVE

The purpose of this study was to examine the speech perception skills of prelingually deafened French children with preoperative residual hearing who received multichannel cochlear implants.

DESIGN

The design of the study incorporated a within-subject, repeated measures design for assessing speech perception skills.

SETTING

Montpellier, Toulouse and Lyon Pediatric Cochlear Implant Centers.

SUBJECTS

Seven prelingually deafened children demonstrating marginal benefit from conventional amplification prior to implantation with a Nucleus multichannel cochlear implant, served as subjects for the speech perception assessment (a speech recognition score less than 30% defines marginal benefit from acoustic amplification on open set materials). The mean age at implantation was 7 years, 9 months.

OUTCOME MEASURES

Speech perception skills were assessed using open set materials and the MUSS and MAIS questionnaires.

RESULTS

Open-set speech recognition averaged 21.4% before implantation, and 83.6% after 1 year's cochlear implant experience. All children demonstrated an open-set score over 60% after 12 months of CI use. MAIS test scores averaged 18.1/40 before implantation and 35.1/40 after 9 months of CI use. MUSS test scores averaged 24.4/40 before implantation and 34.1/40 after 9 months of CI use.

CONCLUSIONS

Cochlear implantation should be considered for prelingually hearing impaired children demonstrating marginal benefit from hearing aids, with a speech recognition score less than 30% on open set materials, in order to improve their speech discrimination skills.

[Arguments in favor of hearing loss screening programs]

In recent years criteria for the cochlear implant candidacy have been widened to childhood, therefore we are compelled to look for the earlier possible diagnosis of deafness. With this aim the AA. have reviewed the diagnostic process of hearing loss made during the last two decades and, consequently, be aware of the problems and planning solutions to avoid unnecesary delays in the treatment.

Bone-conducted sound lateralization of interaural time difference and interaural intensity difference in children and a young adult with bilateral microtia and atresia of the ears

Bone-conducted sound lateralization tests to determine interaural time difference (ITD) and interaural intensity difference (IID) were conducted by means of a self-recording apparatus in 20 children and a young adult with bilateral microtia and atresia of the ear. This apparatus changes ITD automatically from 0 to 2,000 micros at 50 micros/s and IID from 1 to 40 dB at 1 dB's. When ITD exceeds approximately 200 micros/s and IID exceeds 5 dB in normal subjects the sounds are recognized separately. The test stimulus was a continuous narrow-band noise at 500 Hz and 30 dB SL applied to the right and left mastoids through bone vibrators. In the patients with bilateral atresia of the ears, ITD results revealed approximately normal thresholds of discrimination in half the patients and IID results revealed threshold elevation in only 10%. It is noted that bone-conducted sound lateralization abilities of ITD or IID are maintained in many of these patients.

Severe intrauterine growth retardation, aged facial appearance, and congenital heart disease in a newborn with Johanson-Blizzard syndrome

We report a female newborn with Johanson-Blizzard syndrome associated with extreme intrauterine growth retardation, aged facial appearance, and atrial septal defect. Other features are microcephaly, prominent veins over the scalp, alopecia over the vertex, wide-open fontanelle, high forehead, antimongoloid slant, edematous eyelids, the absence of eyebrows and eyelashes, beaked nose with alae nasi, low-set ears, thin lips, and micrognathia. Investigations revealed deafness and congenital hypothyroidism. We believe that this association of severe intrauterine growth retardation and congenital heart disease represents the components of this syndrome.

Discordant Hirschsprung's disease in monozygotic twins with concordant congenital deafness

Discordant Hirschsprung's disease in monozygotic twins is extremely rare. A pair of monozygotic twins with congenital deafness and discordant colonic aganglionosis is presented and genetic and prenatal environmental factors are discussed.

Congenital trigeminal anesthesia in two siblings and their long-term follow-up

PURPOSE

To alert ophthalmologists to congenital trigeminal anesthesia as a cause of corneal scarring and amblyopia and its effective treatment with tarsorrhaphies.

METHODS

Case reports. A 2-month-old infant presented with bilateral corneal erosions and complete corneal anesthesia. Her sister presented at age 3 years with a corneal ulcer and corneal hypoesthesia (sensation markedly decreased). The father and paternal grandmother of the siblings also had corneal hypoesthesia.

RESULTS

Further investigation of the infant revealed bilateral hearing loss, swallowing difficulties, and decreased sensation in the trigeminal nerve distribution. A diagnosis of congenital trigeminal anesthesia was made. The corneal erosions of the patient resolved with bilateral two-thirds width tarsorrhaphies. The girl continues to do well now at 10 years of age with ocular lubrication and superficial corneal scar removal. Her older sister initially required antibiotic ointment for her corneal ulcer but now requires only ocular lubrication for congenital trigeminal anesthesia.

CONCLUSION

This study describes the earliest reported use of tarsorrhaphies in an infant with congenital trigeminal anesthesia. The presence of this condition in her sister and relatives makes it one of the few reports of congenital trigeminal anesthesia in more than two generations. Early recognition of this condition is essential in the preservation of useful vision.

Useful residual hearing despite radiological findings suggestive of anacusis

A severe malformation of the inner ear, often referred to as severe labyrinthine dysplasia or common cavity deformity, consists of an absent or dilated cochlear basal coil, wide communication with the vestibule and a tapered internal acoustic meatus and can be associated with absent hearing. We discuss two children with severe labyrinthine dysplasia as shown by computed tomography (CT) scans and, in the first case, an absent VIIIth nerve bilaterally shown by magnetic resonance imaging (MRI). In 1995, both cases were precluded from cochlear implantation, on the basis of the absent VIIIth nerve (first case) and increased risk of CSF leak during operation (second case). However, audiometric results and vocalization patterns of both children suggested the presence of some residual hearing function, while recently reported specific surgical techniques have been found to be safe and effective in the cochlear implantation of the common cavity deformity. The management of such cases should be decided on the grounds of a full audiological assessment in conjunction with the radiological features, in the light of current surgical trends shown to be safe and effective.

Pili torti with congenital deafness (Bjornstad syndrome): a case report

We report Bjornstad syndrome in a 5-year-old girl with severe bilateral congenital loss of hearing and pili torti. The mode of inheritance of this rare syndrome seems to be heterogeneous. A maternal uncle of the patient was deaf from birth and his hair had shown the same abnormalities at the same age; an autosomal recessive transmission can be assumed.

Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment. Wessex Universal Neonatal Hearing Screening Trial Group

BACKGROUND

Congenital permanent childhood hearing impairment (PCHI) impairs communication skills and, possibly, mental health and employment prospects. Management within 1 year of birth can alleviate most of its adverse effects. Neonatal screening for this disorder is feasible but its benefit for all babies is disputed. We investigated whether neonatal screening of all babies born in hospital, in addition to the standard health visitor distraction test, would increase the rates of early referral, confirmation, and management.

METHODS

Between 1993 and 1996, two teams of four part-time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screening and four without neonatal screening, each of 4-6 months' duration. Babies did or did not undergo neonatal screening dependent on during which periods they were born. We used a transient evoked otoacoustic emissions test and, in babies who failed this test, an automated auditory brainstem response test on the same day. We referred babies with positive results for audiological assessment.

FINDINGS

53,781 babies were included in the trial, and 25,609 were born during periods with neonatal screening. Neonatal screening achieved 87% coverage of births, with a false-alarm rate of 1.5%, and an overall yield of 90 cases of bilateral PCHI of 40 dB or more relative to hearing threshold level per 100,000 target population, equivalent to 80% of the expected prevalence of the disorder in the population. 71 more babies with moderate or severe PCHI per 100,000 target population were referred before age 6 months during periods with neonatal screening than during periods without. Early confirmation and management of PCHI were significantly increased. The rate of false-negative results from neonatal screening was significantly lower than that for the distraction test (4 vs 27% p=0.041).

INTERPRETATION

Neonatal screening is effective in identification of congenital PCHI early and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benefit.

[Early diagnosis of congenital hearing loss. Use of oto-acoustic emission tests in newborn infants with increased risk of hearing impairment]

With the use of today's screening programme children with congenital hearing losses (prevalence about 1/1,000) get their diagnosis unacceptably late (median age 28 months). Newer screening methods as oto-acoustic emissions and auditory brain stem responses have been in use, separately or as combined tests. The methods are used both as universal screening and as screening of selected children with increased risk of congenital hearing impairment. On the basis of ten risk factors for congenital hearing loss, we present our results from screening in the neonatal period. 283 out of 8,980 children (3.2%) born in Ostfold county over a period of three years have been examined with the use of oto-acoustic emissions. 16 children had pathological emission tests bilaterally on repeated testing and underwent further examination in the ear-nose-and-throat department. One of these children has turned out to have hearing loss.

Ear advantage in dichotic listening after correction for early congenital hearing loss

Twelve patients who had undergone surgical correction for either unilateral or bilateral congenital hearing loss were given a postoperative dichotic listening test for consonant vowel-consonant (CVC) words. Four normal hearing control subjects were also tested. Patients were first given a test of subjective loudness, and the level of presentation of stimuli in the atretic ear was adjusted accordingly. In the dichotic condition all controls exhibited a right ear advantage, and all unilateral atresia patients showed an ear advantage favouring the non-atretic ear. Patients with bilateral atresia essentially exhibited no ear advantage. Patients had the same error rate as controls in the dichotic condition, which suggests that ear advantage was not due to increased errors in the atretic ear. For patients there was a significant relationship between ear advantage and both preoperative interaural asymmetry in hearing loss and age at operation. Results suggest that a sensitive and critical period for development of the ear is complete by 5 years of age. Results also suggest some limited ability to adjust to permanent change in stimulation levels until, but not after, puberty.

Universal infant hearing screening by automated auditory brainstem response measurement

BACKGROUND

Our purpose was to identify infants with a bilateral, permanent, handicapping hearing loss and to provide them with amplification before age 6 months.

METHODOLOGY

The study population consisted of 10,372 infants born during a 5-year period. Universal hearing screening by automated auditory brainstem response was done in the nursery. Infants who failed the screening test were followed up diagnostically. Infants who were not tested in the nursery were followed up as outpatients. Hearing aids were recommended for those infants who had bilateral hearing loss.

RESULTS

Successful screening in the nursery was achieved for 96% of infants. The failure rate was 4%. The incidence of bilateral loss requiring amplification was 1.4/1000. The false-positive rate was 3.5% after the initial screening and .2% when a two-stage screening procedure was used. The incidence of congenital bilateral hearing loss in the well population was 1/1000, and in the neonatal intensive care unit population, 5/1000. The cost of screening was $17 per infant, and the cost to identify each true bilateral hearing loss was $17,750. Amplification was recommended for 15 infants; well infants who used hearing aids before age 6 months achieved age-appropriate speech and language development.

CONCLUSIONS

Mild, moderate, and severe bilateral, persistent hearing loss can be identified in the nursery by automated auditory brainstem response measurement to provide amplification before age 6 months and thus optimize speech and language development.

Congenital and early-onset bilateral hearing impairment in children: the delay in detection

A retrospective review of 168 consecutive children with congenital or early-onset bilateral hearing impairment (> 25 dB, 0.5-4 kHz, in the better hearing ear) was conducted. Only 39 per cent of the hearing-impaired children were diagnosed within the first two years of life. The age at diagnosis was related to the severity of hearing loss with profound (> 95 dB) hearing losses being detected earlier than the other degrees. However, 37 per cent of children with severe to profound (> 70 dB) hearing loss were still not diagnosed until after two years of age. Children with severe to profound hearing loss and with known risk factors were diagnosed earlier than children with the same hearing status but with no known risk factors. It was concluded that the behavioural hearing screening tests used in our well-baby clinics are insufficient and, therefore, more reliable methods, preferably evoked otoacoustic emissions, should be used for universal hearing screening of infants and young children in spite of the great cost.

Construction of P1-derived artificial chromosome and yeast artificial chromosome contigs encompassing the DFNB7 and DFNB11 region of chromosome 9q13-21

DFNB7 and DFNB11, two loci for autosomal recessive nonsyndromic hearing loss (ARNSHL), have been mapped to chromosome 9q13-21 in separate consanguineous families. Using a radiation hybrid map, we have determined the correct marker order in the DFNB7/11 region and have demonstrated that the DFNB11 locus resides within a redefined DFNB7 interval. The gene(s) responsible for ARNSHL at these loci resides within an approximately 1 cM interval bounded by markers D9S1806 (centromeric) and D9S769 (telomeric). A recently discovered Indian family confirms the new telomeric boundary. To assist in the identification and cloning of candidate genes, YAC and PAC contigs were constructed. A total of 19 YAC and 23 PAC clones were utilized to span the affected region and ensure double coverage throughout. Twenty-two previously published STSs and 21 new STSs were used to determine marker order and confirm the integrity of the contig. Using a positional cloning strategy we have identified three cochlear expressed genes that map to the DFNB7/11 interval.

Isolated congenital internal auditory canal atresia with normal facial nerve function

The internal auditory canal forms as a result of mesoderm enveloping the eighth cranial nerve in the developing embryo. The mesoderm eventually transforms into cartilage and ultimately ossifies around the nerve, forming the internal auditory canal. It is theorized that atresia or stenosis of the internal auditory canal results from altered cochleovestibular nerve development secondary to faulty chemotactic mechanisms or a lack of end organ targets. Unilateral internal auditory canal anomalies are frequently seen in conjunction with other inner ear anomalies and occasionally with middle or external ear anomalies. Infrequently, it will occur as either an isolated or bilateral finding, but rarely simultaneously. The few citations of isolated, unilateral or bilateral internal auditory canal anomalies that are reported in the literature are usually associated with other systemic developmental anomalies, such as, cardiac septal defects, polycystic kidney disease, skeletal deformities and duodenal atresia. We present a case report of a patient with bilateral, congenital, internal auditory canal atresia and cochleovestibular deficits but, normal facial nerve function. A review of the literature is discussed as well as diagnostic considerations and treatment options including audiologic and communication rehabilitation.

Neonatal otoacoustic emission screening and the identification of deafness

Using transient evoked otoacoustic emissions (TEOAEs), a two stage screen with the testing of failures by auditory brainstem response (ABR), has been implemented in Whipps Cross Hospital in East London. From January 1992 to 1995, 11,606 infants received an initial TEOAE test. Once initial difficulties were resolved, coverage of district residents remained stable at 91.5%. Long term follow up of the cohort is being undertaken. Of those receiving an initial test, 13% failed in both ears. Only 1.75% of the cohort failed both stages of the TEOAE screen bilaterally. These infants were tested by ABR. The yield of infants with a bilateral permanent hearing loss of moderate or worse degree was 2/1000. The overall cost of implementing the programme was not prohibitive and the cost per hearing impaired child detected was little more than the widely accepted notional cost of identifying such children through targeted at risk screens. The screen was clearly sensitive. The priority for such universal TEOAE programmes, however, is to increase specificity without losing this sensitivity.

Usher syndrome. A temporal bone report

The bilateral temporal bones of a deceased 84-year-old man who had been suffering from Usher syndrome were examined using light microscopy. Histopathologic examination disclosed degeneration of the organ of Corti that was most profound in the basal turn, degeneration of cochlear neurons in all of the turns, and severe loss of spiral ganglia in both cochleas. Endolymphatic hydrops of unknown cause and a functionally unimportant pit malformation in the macular utricle were observed in the right cochlea. We compared the aforementioned findings with temporal bone reports cited in the literature.