Achieving effective hearing aid fitting within one month after identification of childhood permanent hearing impairment

Diagnosis of child permanent hearing impairment (PHI) can be made with extreme timeliness compared to the past thanks to improvements in PHI identification through newborn hearing screening programmes. It now becomes essential to provide an effective amplification as quickly as possible in order to restore auditory function and favour speech and language development. The early fitting of hearing aids and possible later cochlear implantation indeed prompts the development of central auditory pathways, connections with secondary sensory brain areas, as well as with motor and articulatory cortex. The aim of this paper is to report the results of a strategic analysis that involves identification of strengths, weaknesses, opportunities and threats regarding the process of achieving early amplification in all cases of significant childhood PHI. The analysis is focused on the Italian situation and is part of the Italian Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children".

Achieving early functional auditory access in paediatric cochlear implantation

Cochlear implantation (CI) is a viable option for providing access to auditory stimulation in severe-to-profound hearing loss/impairment of cochlear origin. It has been demonstrated that CI is safe and effective for deaf children. Younger age at activation after CI is linked with better outcomes. It is important to study variables and issues that can interfere with an early fitting and access to sound after CI. They range from patient characteristics, family compliance and support, to technical, medical or organisational problems. A SWOT analysis and a subsequent TOWS matrix was conducted to discuss issues and propose recommendations to be considered when operating an early switch on of the CI.

Childhood hearing surveillance activity in Italy: preliminary recommendations

Following the positive outcomes of the newborn hearing screening programmes already underway in several Italian regions, it is now necessary to address the identification of childhood hearing impairments that missed the neonatal screening programme or have delayed onset. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for early Identification, Intervention and Care of Hearing Impaired Children", a group of professionals identified three main recommendations that can be useful to improve hearing surveillance activity within the regional and state Italian Health System. The family paediatrician is recognised as having a key role in ongoing monitoring of hearing capacity and development of the growing child.

Empowering the family during the first months after identification of permanent hearing impairment in children

The latest international guidelines highlight the importance of involving the family in the diagnositic and rehabilitation process of children affected by permanent hearing impairment. This emphasises how meaningful this approach is for the development of the deaf child. So far, there is very little evidence about this approach in Italy, and there are still some barriers to its practical management. The aim of this paper is to report the results of a strategic analysis, which identifies the strengths, weaknesses, opportunities and threats of the family empowerment process during early auditory diagnosis and rehabilitation. The audiology programme should have the goal to offer information and support to families in order to achieve a conscious decision about the use and type of auditory prosthesis and rehabilitation choice within three months after audiologic diagnosis. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children", a group of professionals identified three main recommendations that can be useful to foster the natural communicative development of the child by strengthening the therapeutic alliance and empowerment of the family. The recommendations obtained with this analysis can help to develop new Italian guidelines with the aim to foster natural communicative development of the child by strengthening the therapeutic alliance and empowerment of the family.

Pianificare su base regionale un programma di intervento audiologico precoce dell’ipoacusia infantile: introduzione a uno studio italiano

Una presa in carico non uniforme, tardiva o inappropriata dei bambini con deficit uditivo aumenta il rischio di sviluppare difficoltà comunicative-comportamentali e psicosociali che possono persistere fino all’adolescenza o all’età adulta. Nel Marzo 2014 il Centro di Controllo Malattie (CCM) del Ministero della Salute Italiano ha finanziato il progetto “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambini con deficit di udito”. Il progetto coinvolge 5 centri di III livello in cui il programma di screening uditivo neonatale è stato approvato dalla regione di appartenenza. Lo scopo principale del progetto è quello di definire e proporre un modello di salute pubblica su base regionale per l’identificazione delle ipoacusie infantili permanenti, la diagnosi e l’intervento. La prima fase del progetto prevede di indagare lo stato dell’arte e di produrre raccomandazioni che possano portare a cambiamenti positivi nell’identificazione, nella diagnosi, nella terapia e nella presa in carico dei bambini con deficit uditivo, tenendo presenti le innovazioni diagnostiche-riabilitative, il sostegno e l’alleanza terapeutica con la famiglia, un approccio interdisciplinare. Le raccomandazioni emerse da questa prima fase rappresenteranno le basi per un sistema regionale di intervento precoce che sia valido, integrato e condiviso da tutte le cinque regioni coinvolte.

Raccomandazioni per perfezionare i programmi regionali di screening uditivo neonatale universale in Italia

The Universal Newborn Hearing Screening (UNHS) programme aims at achieving early detection of hearing impairment. Subsequent diagnosis and intervention should follow promptly. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for early Identification, Intervention and Care of Hearing Impaired Children", the limitations and strengths of current UNHS programs in Italy have been analysed by a group of professionals working in tertiary centres involved in regional UNHS programmes, using SWOT analysis and a subsequent TOWS matrix. Coverage and lost-to-follow up rates are issues related to UNHS programmes. Recommendations to improve the effectiveness of the UNHS programme have been identified. The need for homogeneous policies, high-quality information and dissemination of knowledge for operators and families of hearing-impaired children emerged from the discussion.