Effectiveness of child-health screening

Screening for sensory problems in pre-school children often fails to detect a significant number of hearing problems sufficiently early. Evidence suggests neonatal screening is more effective and cost-effective than the infant distraction test at detecting congenital hearing loss. It is not yet clear how best to identify children with speech and language delay who will fail to progress without treatment.     

The assembly of Ni2+-actin: some peculiarities

Cochlear implants have been very successful in restoring partial hearing to profoundly deaf people. Many individuals with implants are now able to communicate and understand speech without lip-reading, and some are able to talk over the phone. Children with implants can develop spoken-language skills and attend normal schools (i.e., schools with normal-hearing children). The greatest benefits with cochlear implantation have occurred in patients who (1) acquired speech and language before their hearing loss, and (2) have shorter duration of deafness. Gradual, but steady, improvements in speech production and speech perception have also occurred in prelingually deafened adults or children.     

Improvements in speech perception by children with profound prelingual hearing loss: effects of device, communication mode, and chronological age

The present investigation expanded on an earlier study by Miyamoto, Osberger, Todd, Robbins, Karasek, et al. (1994) who compared the speech perception skills of two groups of children with profound prelingual hearing loss. The first group had received the Nucleus multichannel cochlear implant and was tested longitudinally. The second group, who were not implanted and used conventional hearing aids, was tested at a single point in time. In the present study, speech perception scores were examined over time for both groups of children as a function of communication mode of the child. Separate linear regressions of speech perception scores as a function of age were computed to estimate the rate of improvement in speech perception abilities that might be expected due to maturation for the hearing aid users (n=58) within each communication mode. The resulting regression lines were used to compare the estimated rate of speech perception growth for each hearing aid group to the observed gains in speech perception made by the children with multichannel cochlear implants. A large number of children using cochlear implants (n=74) were tested over a long period of implant use (m=3.5 years) that ranged from zero to 8.5 years. In general, speech perception scores for the children using cochlear implants were higher than those predicted for a group of children with 101-110 dB HL of hearing loss using hearing aids, and they approached the scores predicted for a group of children with 90-100 dB HL of hearing loss using hearing aids.     

Speech perception test in Italian language for profoundly deaf children

Speech perception tests are an important part of procedures for diagnosing pre-verbal hearing loss. Merely establishing a child's hearing threshold with and without a hearing aid is not sufficient to ensure an adequate evaluation with a view to selecting cases suitable for cochlear implants because it fails to indicate the real benefit obtained from using a conventional hearing aid reliably. Speech perception tests have proved useful not only for patient selection, but also for subsequent evaluation of the efficacy of new hearing aids, such as tactile devices and cochlear implants. In clinical practice, the tests most commonly adopted with small children are: The Auditory Comprehension Test (ACT), Discrimination after Training (DAT), Monosyllable, Trochee, Spondee tests (MTS), Glendonald Auditory Screening Priocedure (GASP), Early Speech Perception Test (ESP), Rather than considering specific results achieved in individual cases, reference is generally made to the four speech perception classes proposed by Moog and Geers of the CID of St. Louis. The purpose of this classification, made on the results obtained with suitably differentiated tests according to the child's age and language ability, is to detect differences in perception of a spoken message in ideal listening conditions. To date, no italian language speech perception test has been designed to establish the assessment of speech perception level in children with profound hearing impairment. We attempted, therefore, to adapt the existing English tests to the Italian language taking into consideration the differences between the two languages. Our attention focused on the ESP test since it can be applied to even very small children (2 years old). The ESP is proposed in a standard version for hearing-impaired children over the age of 6 years and in a simplified version for younger children. The rationale we used for selecting Italian words reflect the rationale established for the original version, but the choice of single words follows different criteria from the original version. In fact, the two languages differ in important linguistic features so that the test can not be not adapted to the Italian language by simply translating the words involved. As currently there is no children's language dictionary in Italian arranged according to age bracket, we chose words used in children and in pre-school reading material.     

Low birthweight and neuromotor development: a population based, controlled study

The aims of the study were to investigate: (a) the relationship between low birthweight (LBW) and pre-school neuromotor development; and (b) the predictive value of various pre-, peri-, and neonatal factors for neuromotor development in LBW pre-school children. A population based sample of 144 5-year-old LBW children (birthweight < 2000 g) with no major handicaps was compared with a random sample of 163 normal birthweight term controls. Using the Peabody Developmental Motor Scales, impaired performance on the balance scale was seen more often in LBW boys than in controls (odds ratio 5.5, 95% CI 1.5-20.3), while performance on the eye-hand coordination and locomotor scales was comparable for the two groups. LBW girls were comparable to controls on all these scales. On neurological examination, an increased frequency of minor neurological signs was found in LBW boys, while increased ankle tone and/or leg hyperreflexia was more common in LBW girls compared to controls. Small head circumference at birth was associated with an increased frequency of minor neurological signs in LBW boys, and lack of breastmilk in the neonatal period with impaired balance in LBW boys. None of the other pre-, peri- or neonatal factors were predictive of neuromotor development. We conclude that motor functions essential for daily activities are intact in most LBW preschoolers.     

Expression of the human dystrophin gene in mdx mouse skeletal muscles after ballistic transfection

OBJECTIVE: This study aimed to determine the prevalence of sensorineural hearing loss (SNHL) in 2-5-year-old survivors with neonatal respiratory failure due to congenital diaphragmatic hernia (CDH) with or without the need for extracorporeal membrane oxygenation (ECMO). STUDY DESIGN: The study design was a prospective, multicenter, longitudinal outcome study of consecutively surviving neonates admitted to a single tertiary intensive care unit. SETTING: The study was conducted at four audiologic departments affiliated with tertiary-level intensive care follow-up programs. PATIENTS: Thirty-seven surviving children receiving neonatal intensive care from February 1989 through January 1995 for neonatal respiratory failure due to CDH were studied. Excluded were 15 children with early death and I child lost to follow-up. INTERVENTION: The initial treatment depended on the severity of neonatal respiratory failure: ECMO-treated (n=31, 20 survivors) (death before ECMO initiation, 2) and non-ECMO treated (n=20, 17 survivors, another survivor lost to follow-up). MAIN OUTCOME MEASURE: Early childhood audiologic test results were measured. RESULTS: Sensorineural hearing loss was found in almost 60% of subjects: ECMO-treated, 12 (60%) of 20; non-ECMO-treated, 10 (59%) of 17. Of the 22 children with SNHL, 16 had mild- to-moderate low-frequency sloping to moderate-to-severe high-frequency loss. Of the remaining, six had severe-to-profound loss at 500 Hz and above. Seventeen children had normal responses to sound as newborns or in infancy. Five children were not tested. Documented progression was found in nine children. Twenty children currently are using amplification, and 2 have had cochlear implantation. CONCLUSIONS: Of children with CDH in this area presenting early with severe neonatal respiratory failure, SNHL developed in 60% by 2-5 years of life. Ongoing monitoring of the hearing status of children with CDH is imperative.     

Audiologic evaluation of deaf children

This paper describes an audiologic test battery for hearing-impaired children which includes otoscopic examination, tympanometry, pure-tone audiometry, speech perception testing, and hearing aid evaluation. Several of the procedures and modifications to apparatus have been developed specifically for use with deaf children. Clinical data are presented from 160 hearing-impaired children (age range three-16 years). Eighteen percent of their ears were found to contain excessive cerumen and to require ear canal irrigation. The incidence of abnormal tympanograms was high for young children but decreased with increasing age. A simple auditory speech perception test designed for use with both severely and profoundly deaf children is described, which provides for evaluation of a child's ability to recognize words, categorize them into stress patterns, or both. The children's word recognition and word categorization scores were found to relate to their audiometric averages. The overall test battery is easy to administer and also is efficient, in that considerable audiologic information can be obtained quickly.     

Point-light facial displays enhance comprehension of speech in noise

Seeing a talker's face can improve the perception of speech in noise. There is little known about which characteristics of the face are useful for enhancing the degraded signal. In this study, a point-light technique was employed to help isolate the salient kinematic aspects of a visible articulating face. In this technique, fluorescent dots were arranged on the lips, teeth, tongue, cheeks, and jaw of an actor. The actor was videotaped speaking in the dark, so that when shown to observers, only the moving dots were seen. To test whether these reduced images could contribute to the perception of degraded speech, noise-embedded sentences were dubbed with the point-light images at various signal-to-noise ratios. It was found that these images could significantly improve comprehension for adults with normal hearing and that the images became more effective as participants gained experience with the stimuli. These results have implications for uncovering salient visual speech information as well as in the development of telecommunication systems for listeners who are hearing impaired.     

Response latencies in auditory sentence comprehension: Effects of linguistic versus perceptual challenge.

Older adults with good hearing and with mild-to-moderate hearing loss were tested for comprehension of spoken sentences that required perceptual effort (hearing speech at lower sound levels), and two degrees of cognitive load (sentences with simpler or more complex syntax). Although comprehension accuracy was equivalent for both participant groups and for young adults with good hearing, hearing loss was associated with longer response latencies to the correct comprehension judgments, especially for complex sentences heard at relatively low amplitudes. These findings demonstrate the need to take into account both sensory and cognitive demands of speech materials in older adults' language comprehension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speech and language outcomes in preschool-aged survivors of neonatal intensive care

This paper reports on the second stage of a longitudinal follow-up of the speech and language outcomes in a cohort of children who required neonatal intensive care. From 3 years of age, when the first stage was completed, to preschool age, the rate for major overall communication problems rose from 13% to 17%. However, when children with frank neurological or intellectual problems were excluded, this figure dropped to 8%. The impact of perinatal, medical and environmental variables on speech and language outcomes was again investigated. Differences were found between those that were important at 3 years of age and those that were important at preschool age. New variables emerged as contributing to language expression, including gender and the perinatal variables, gestational age and respiratory distress syndrome. Maternal education level was even more important to language comprehension at preschool age than at 3 years of age. Factors that might explain improvement, or lack of improvement, in speech and language skills are discussed.     

Differential effects of preterm birth and small gestational age on cognitive and motor development

AIMS: To determine the differential effects of preterm birth and being small for gestational age on the cognitive and motor ability of the child. METHODS: A longitudinal cohort of all infants of gestational age < or = 32 weeks born to mothers resident in the counties of Cheshire and Merseyside in 1980-1 was studied. The children were assessed at the age of 8 to 9 years using the Wechsler Intelligence Scale for Children, the Neale analysis of reading ability, and the Stott-Moyes-Henderson test of motor impairment. Adequacy of fetal growth was determined by the birthweight ratio--that is, the ratio of the observed birthweight to the expected birthweight for a given gestational age. Children with clinically diagnosed motor, learning or sensory disabilities were excluded. Information on social variables was obtained by a questionnaire completed by the parents. Of the 182 children, 158 were assessed. RESULTS: IQ was positively correlated with birthweight ratio but not with birthweight or gestational age. Motor ability was associated with birthweight, gestational age, and birthweight ratio. Reading comprehension was associated with birthweight ratio, but reading rate and accuracy were best explained by social variables and sex. IQ remained associated with birthweight ratio, after adjusting for maternal education, housing status, and number of social service benefits received. Reading ability was related to these social variables but motor ability was not. CONCLUSIONS: The effects of SGA and preterm birth differed: SGA was associated with cognitive ability, as measured by IQ and reading comprehension; motor ability was additionally associated with preterm birth. Reading rate and accuracy were not associated with SGA or preterm birth but were socially determined.     

A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment

BACKGROUND: This review was commissioned because of the increasing doubt about the ability of existing screening programmes (mainly the health visitor distraction test (HVDT) at 7-8 months) to identify children with congenital hearing impairment, and technological advances which have made neonatal hearing screening an alternative option. OBJECTIVES: To review the available literature on the screening of permanent childhood hearing impairment. To provide commissioners and providers of health care with information about how to deliver a more uniform service, better outcomes, and more cost-effective screening. To identify areas for further research and service development. HOW THE RESEARCH WAS CONDUCTED: The research involved a review of the available published and unpublished literature, and a comprehensive survey of current pre-school hearing screening provision in the UK coupled with a health economics study of hearing screening costs. The research also included a number of focus groups and visits to key centres in the UK and North America. RESEARCH FINDINGS: EPIDEMIOLOGY OF PERMANENT CHILDHOOD HEARING IMPAIRMENT: There are approximately 840 children a year born in the UK with significant permanent hearing impairment likely to affect their own and their family's quality of life. Present services will miss about 400 of these children by 1 1/2 years of age, and about 200 of these children by 3 1/2 years of age. Such late identification of hearing impairment greatly reduces the responsiveness of the services for individual children. EVIDENCE FOR IMPROVED OUTCOMES WITH EARLIER IDENTIFICATION: Hearing-impaired children identified late are at risk of substantial delay in their acquisition of language and communication skills, with consequent longer-term risk to education achievement, mental health and quality of life. Theoretical arguments on neural development support the limited evidence here for the increased benefit for child and family associated with very early identification. In general, parents and professionals want very early identification, which, if implemented properly, does not cause undue anxiety. CURRENT UK PRACTICE: The survey of current practice indicated a major problem with poor information systems. This problem was further highlighted as a major concern by the multi-disciplinary focus groups. Practice varies. There are two District-wide programmes in which all newborn babies are neonatally screened, a large number of ad hoc programmes for neonatal screening of 'at-risk' babies, a variety of early surveillance programmes, and widespread use of the HVDT. Intervention and habilitation for the majority of those screened neonatally is routinely undertaken within 6 months of birth. For those screened only by the health visitor, identification was on average at about 26 months of age with intervention at about 32 months on average. (ABSTRACT TRUNCATED)     

Evoked otoacoustic emissions in children in relation to middle ear impedance

The influence of changes in middle ear impedance with and without serotympanon on the measurement of evoked otoacoustic emissions (EOAE) was investigated in 108 children between 3 and 12 years of age. Children with proven serotympanon never showed good EOAE. In those who only had changes in middle ear impedance without a serotympanon, the decrease in EOAE amplitude was more related to the magnitude of conductive hearing loss than to the change in impedance itself. These results are compared with those of a neonatal screening project in which some of the 532 healthy fullterm newborns showed poor emissions in the first days of life. It seems reasonable to assume that this is due to incomplete pneumatization of the middle ears of these children, especially as a control audiogram later in their lives showed normal hearing thresholds.     

Communication of oral deaf and normally hearing children at 36 months of age

Eighteen orally educated deaf and 18 normally hearing 36-month-old children were observed in a play session with their mother. Communicative behavior of the child was coded for modality and communicative function. Although the oral deaf children used a normal range of functions, both the quantity and proportions differed from normally hearing children. Whereas the normally hearing 3-year-olds used speech almost exclusively, the deaf children exhibited about equal use of speech, vocalizations, and gestures. Spoken language scores of the deaf children at 5 years of age were best predicted by (a) more frequent use of speech at age 36 months, (b) more frequent use of the Statement function, and (c) relatively infrequent use of the Directive function. It is suggested that some communicative functions are more informative or heuristic than others, and that the early use of these functions is most likely to predict later language competence.     

Self-reported hearing problems in daily life throughout adulthood

The authors assessed age differences on self-reported hearing problems on the performance of auditory tasks in the natural environment. The Your Hearing questionnaire was administered to 265 respondents (aged 20-94 years). Both the degree and variability of self-reported hearing problems were found to increase significantly with age, including those associated with listening to speech under conditions of background noise, the perception of normal and distorted speech, and the perception of short segments of speech and the perception of high-pitched sounds. Experienced hearing problems were greater for Ss who judged their hearing as being of poor quality. Findings suggest that self-report measures can provide valuable insights into the impact of age-related hearing disability on daily life that are not provided by more traditional laboratory-based studies.     

Implant cochléaire et développement des échanges conversationnels.

Most researches conducted in the field of postimplant assessment have focused on the restoration of perceptual capabilities and the development of verbal language. In contrast, only very few studies have examined the impact of a cochlear implantation on children's overall development and, in particular, on their conversational language abilities. However, some previous works on the preverbal development revealed the recurrent difficulties experienced by deaf children in acquiring knowledge of social rules and social skills relative to speech activities. In children with profound bilateral deafness, a conventional hearing aid is not enough to provide sufficiently relevant information for a satisfactory development of oral communication. In such situations, the most suitable way of improving hearing is the use of a cochlear implant. The authors therefore hypothesized that access to oral perception will not only improve implanted children's social skills, but will also increase their rate of participation and the use of verbal language in their interaction with a familiar adult (mother or father). Their communication skills profile would resemble that of younger normal hearing children. Using conversational samples from a video-filming protocol at specific intervals, the authors monitored the development of communication skills in a group of 20 prelingually, profoundly deaf children (mean age: 3.7 years). Results corroborated our hypothesis. They indicated that children using cochlear implants increased their overall performance in communication skills, quantitatively and qualitatively speaking, even at the first year postimplantation stage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical diagnostic procedures: whispered speech and tuning fork test]

Hearing impairment occurs in 10% of the Dutch population and may lead to major communication problems and even social isolation. A good method to detect hearing loss in a general practice is the screening audiometer. The treating physician may further use the whispered speech test and tuning fork tests which together give a good impression of the severity and the nature of the hearing loss if any. The whispered speech test is best performed in the standardized form according to the guideline 'Slechthorendheid' [hardness of hearing] of the Dutch College of General Practitioners (NHG), in which certain combinations of letters are recommended. The tuning fork tests according to Rinne and Weber indicate a difference in perception and conduction deafness, and are decisive for any hearing asymmetry. Use of the whispered speech test and of the tuning fork tests is recommended for adults and children from the age of 7.     

Predictive factors for speech perception in patients with cochlear implant

Cochlear implant therapy is an epoch-making advance in artificial sensory organ transplants, but the positive effects on speech perception vary. Quantification theory type I, a multivariate analysis, was used to determine predictive factors for speech perception in patients with cochlear implants. Fifty-one postlingual deaf adults (18 male and 33 female, mean age, 53.4, mean duration of deafness, 8.6 years) were tested for speech perception three or more months after a Nucleus 22 channels cochlear implant. The cause of deafness in nine patients was labyrinthitis, ototoxicity in five, meningitis in three and unknown in the remaining 34. Speech perception was measured by vowel, consonant and word recognition using a live voice, and monosyllable, word and sentence recognition using a videodisc. All tests were administered in a sound only condition. Results of the univariate analysis indicated that age at implantation was correlated with monosyllable recognition, and duration of deafness was correlated with live voice word recognition. Residual hearing and coding strategy were both correlated with all outcome measures. The multivariate analysis revealed that coding strategy, duration of deafness, residual hearing and the number of electrodes were significant predictors of live voice word recognition in that order.     

Symptomatic treatment of neurolathyrism with tolperisone HCL (Mydocalm): a randomized double blind and placebo controlled drug trial

Birth hypoxia, asphyxia and ischemia have often been thought to be major causes of early hearing loss or deafness. The purpose of the present review is to focus on the role of these particular factors for perinatal auditory disorders. On the whole, only a small proportion of neonatal hearing loss is caused by perinatal factors. The exact etiology of neonatal hearing loss in children with complicated deliveries is difficult to evaluate due to the large number of causative factors that might be involved. After reviewing the literature covering the past 15-20 years, it is not possible to say that we understand the relative importance of different factors and their interactions. However, in the majority of studies, birth asphyxia is not correlated with hearing loss in babies with complicated deliveries Prolonged artificial ventilation, the presence of severe hypoxic ischemic encephalopathy or persistent pulmonary hypertension are important factors. The brain is more susceptible to anoxia than the ear and both are more likely to be damaged after prolonged pre-, peri- and postnatal hypoxia-ischemia than pure hypoxia during delivery. Perinatal hypoxia is more likely to cause a temporary hearing loss than a permanent one. Preterm babies are more vulnerable than term babies. The total number of risk factors, e.g. medicated by total length of stay in the neonatal intensive care unit and length of artificial ventilation, is the best predictor of risk for hearing loss of perinatal origin. The similarities between hearing loss and cerebral palsy are pointed out; only 8% of the cases of cerebral palsy are considered to be caused by conditions during delivery.