Hearing aid outcome measures for children

The provision of appropriate amplification for a young hearing-impaired child is critical as the aided speech signal will be used for the development of speech and language. The purpose of this paper is to provide an overview of the complex issues surrounding the documentation of hearing aid outcomes in the pediatric population. In the first two sections of the paper, the unique characteristics and needs of the pediatric population and factors complicating the measurement of outcome are described in detail. The third section provides a review of literature on existing outcome measures for children and the fourth section is devoted to a discussion of alternative approaches. The final section is an overview of clinical and research needs in the area of hearing aid outcome measures for children.     

Hearing research career development for deaf students

One goal of the Americans with Disabilities Act is to enhance access to career opportunities for individuals with hearing loss. Hearing-impaired professionals are woefully underrepresented among the cadre of scientists currently involved in hearing and deafness research. Information was obtained by questionnaire from 190 consecutive attendees (13 through 17 years of age) at a summer program for gifted hearing-impaired adolescents regarding career goals, attitudes toward academic and extracurricular activities, educational placement, primary communication modality, and parental hearing status. A follow-up questionnaire completed by 80 of these youth, presently attending college, provided comparison data regarding type of college attended and academic major. Males were significantly more likely to select majors in mathematics and science-related disciplines. The percentage of college attendees majoring in the sciences was much lower than the percentage of high school students who aspired to a scientific career. Strategies for attracting qualified hearing-impaired students into science majors should include educational efforts directed at students, parents, and academic advisors.     

The clinical picture of acute appendicitis in children

The authors describe 3860 child patients operated on account of acute appendicitis and analyse the data with regard to age, sex, year of incidence and surgical finding. The highest incidence of acute appendicitis is between 8 and 11 years with a peak at the age of 10 years. It is more frequent in boys (58.3%) than in girls (43.7%), the ratio being 1.3:1. It occurs more often during the cold months (46.5%), in autumn (27.3%) and in winter (25.7%). The number of gangrenous appendicitis is 34.7%-56.7% in boys and 43.5% in girls. The highest rate of missed appendicitis is at the age of the highest incidence (15.2%) with a peak at the age of 10 years (17.8%) and in January (13.3%). The highest incidence of perforated appendicitis is also at the age of the highest incidence (14.9%) with the peak at the age of 8 years (15.6%) and in June (13.5%). Perforation is more frequent in boys (58.1%) than in girls (49.9%). The number of "negative" appendicitis is 15.8%. Prevention of acute appendicitis still remains open due to lack of knowledge of its etiopathogenesis.     

The clinical picture and diagnosis of diphtheritic carditis in children

During 1992 1996 we observed 122 children with diphtheria, 49 with the toxic form, in the region of Nizhny Novgorod in Russia. Sixty-four patients suffered from diphtheric carditis, 9 died. The clinical picture was characterized by a rapid development of heart and circulatory failure. ECG showed QRS alterations with intraventricular conduction impairment, sinus node dysfunction, ectopic rhythm disturbances and repolarization disturbances in all patients with carditis. Infarction-like ECG changes were typical for the pseudocoronary form with the worst prognosis. Echocardiographically there was left ventricular (LV) dilatation and depressed LV function, whereas LV muscle mass was increased. Myoglobin, LDH and CPK levels were elevated in each patient demonstrating significant differences between the various courses of disease. CONCLUSION: In diphtheria, the extent of hypermyoglobinaemia (> 2000 ng/ml) and an increased LDH1/LDH2 (> 1) ratio are reliable markers for the development of carditis indicating a poor prognosis.     

Video as a medium of oral health education for children with mental handicaps

This study assessed the usefulness, appropriateness, and relevance of a video as an oral health education medium for children with mental handicaps and for preschool groups where children with mental handicaps and healthy children are taught together. The evaluated video was designed for children with mental handicaps but was also recommended for integrated groups. Forty children with mental handicaps from four special education classes and two nursery school groups, 151 normal children from 11 nursery school groups, and the teachers of these classes and groups evaluated the material. The assessment of the material's value was based on the teachers' records of their experiences with the material, their records of the children's opinions and discussions about the material, and their records of drawing interviews with the children. Based on the evaluation, it is apparent that, when used by trained teachers, professionally made videos designed for children with mental handicaps can be useful and valuable aids in educating children of different levels of mental and social development about oral health. Integrated groups need videos featuring both children with mental handicaps and normal role models and with a diversity of contents that will interest and challenge both types of audiences.E.     

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.     

Hearing aid rehabilitation of hearing disorders in adults

Hearing-aid provision is still partly a medical task, in spite of technological progress and a confusing variety of types and models of devices. The diagnosis of the underlying disease, the appreciation of the consequences of hearing loss and the counseling of the hearing impaired person are prerequisites of the treatment. The physician should try to determine the etiology of the hearing loss. Also, a state-of-the-art otologic examination should be performed and the physician should be sensitive to the psychological and social consequences of the patient's hearing loss. For the assessment of fitted hearing aids, basic knowledge of the technical background is required. To measure hearing-aid benefit in the ENT office, suprathreshold and speech audiometry are indispensable tools.     

Hearing evaluation in children with bacterial meningitis

Twenty four children with bacterial meningitis were studied prospectively to ascertain the incidence, type and severity of hearing loss. The incidence of sensorineural hearing loss was 20.8%. Patients with hearing loss were followed-up audiologically for six months to find out the progress of hearing impairment. Of the five patients with sensorineural hearing loss only one showed partial recovery while the other three did not show any improvement. Of the five patients with sensorineural hearing loss only one showed partial recovery while the other three did not show any improvement. One patient was lost to follow-up, therefore, recovery was not known. The degree of hearing loss varied form mild to moderate. Antibiotic treatment and laboratory data were analysed to identify the high risk factors predisposing to hearing impairment. The presence of low CSF sugar level, high protein at the initial lumbar puncture and presence of neurological deficits was associated with a significantly higher risk of hearing loss. However, the nature of antibiotic therapy, duration of illness, age and sex of the patients were not significant risk factors in the development of hearing impairment.     

Hearing aid use and benefit and uptake of aural rehabilitation services by New Zealand hearing aid wearers

AIM: To provide the first extensive survey in New Zealand of hearing aid use and benefit and the accessibility of Hearing Association services. METHOD: A mail-out questionnaire was used to survey 197 Auckland adult hearing aid wearers regarding patterns of hearing aid use and benefit and the accessibility of Hearing Association aural rehabilitation services. RESULTS: Hearing aid benefit was moderate and was not related to age or hearing aid use variables. Knowledge and usage of local rehabilitation services was limited. Perceived functions of the Hearing Association included adult audiometry and counselling. Respondents wanted assistance with hearing aid management and assistive listening devices. Physical access, financial and time constraints were seen as barriers to using rehabilitative services. DISCUSSION: It appears that there is not a simple relationship between perceived benefit or satisfaction and the amount of time people wear their hearing aids. The low level of awareness and participation in Hearing Association services is consistent with the underutilisation of such services found previously.     

Factor analysis of WISC—R with deaf and hard-of-hearing children.

The Wechsler Intelligence Scale for Children—Revised (WISC—R) was factor analyzed on a sample of 368 hard-of-hearing and deaf children (aged 6–16 yrs). Two factors emerged and were labeled Language Comprehension and Visual-Spatial Organization. The factor structure for the hard-of-hearing (n?=?77) and deaf (n?=?291) groups was identical. Deaf children of deaf parents earned significantly higher Verbal IQ and Performance IQ scores than did deaf children of hearing parents. There were no differences in IQ or subtest scores in interpreted vs signed administrations. Implications for assessing the cognitive abilities of hearing-impaired children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication between parents and deaf children: implications for social-emotional development

We have developed a mouse monoclonal antibody against rat/mouse islet amyloid polypeptide (IAPP). The antibody recognises an epitope in the N-terminal part of the molecule, which is conserved between different species. The antibody immunohistochemically labelled beta cells in normal islets of most different mammalian species including man and in one avian species. Previous immunohistochemical studies of human pancreatic tissue from individuals with non-insulin-dependent diabetes mellitus (NIDDM) have revealed a paradoxical and unexplained lack of IAPP immunoreactivity in beta cells close to amyloid in spite of the presence of IAPP mRNA. In contrast to these findings we show that the newly developed monoclonal IAPP antibody strongly labels such beta cells while islet amyloid deposits which are labelled by polyclonal antisera do not bind the monoclonal antibody. These findings with the polyclonal antisera and the monoclonal antibody indicate that IAPP undergoes one or several structural changes during the amyloidogenesis. Knowledge of these structural changes that may include abnormal folding or chemical modification of IAPP is probably important for the understanding of the amyloidogenesis and the pathogenesis of the islet lesion in NIDDM.     

Adjustment of children with invisible and visible handicaps: Congenital heart disease and facial burns.

26 11-15 yr old children with congenital heart disease and 22 with facial burns were compared on 10 measures of adjustment to test the effects of invisible and visible disability upon social and psychological development. Interview data were coded and submitted to analysis of covariance, using sex, grade, and age as covariates. The invisible disability group (the heart group) was higher in adjustment in all 10 measures. Significant differences (p     

Research-based language intervention strategies adapted for deaf and hard of hearing children

Strategies found to facilitate the language development of young, hearing children are reviewed in this paper, and adaptations and examples for use with deaf and hard-of-hearing children are provided as alternatives to simply advising professionals and parents to increase the quantity of conversation with these children. It is suggested that adults accelerate the language acquisition of deaf and hard-of-hearing students by capitalizing on the linguistic opportunities provided in particular environments, rearranging environments, being responsive to indications that children have comprehended messages and are open to risk communication, and specifically by intervening on form, content, and use skills. The author challenges professionals to document empirically the usefulness of each language intervention technique presented here.     

Cerebral laterality in deaf and hearing children.

Studied the development of lateralization of cerebral function in 20 hearing and 20 prelingually deaf children using the concurrent task paradigm. Ss were aged 5–6 and 11–12 yrs; all were right-handed. Concurrent processing of a nonverbal task did not cause a selective hand impairment monitored by a manual tapping task. However, deaf Ss were more impaired than hearing Ss in both age groups. Using a concurrent verbal task, both groups manifested a selective impairment of right-hand performance. The deaf also showed a greater left-hand decrement than did the hearing Ss. This result suggests that hemispheric specialization may be less apparent in the deaf than in hearing children. The factor of cognitive task difficulty is suggested as an explanation of these results. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Factor analysis of the WISC–III with deaf and hard-of-hearing children.

The Wechsler Intelligence Scale for Children—Third Edition (WISC–III; D. Wechsler, 1991 ) was factor analyzed on a sample of 106 deaf and hard-of-hearing children, ages 6 to 16 years. Two factors emerged and were labeled Language Comprehension (l) and Visual–Spatial Organization (v–s). There were no differences in Verbal, Performance, or Full Scale IQs between children attending mainstreamed vs. residential schools; children who were administered the test through an interpreter or by an examiner who used sign language or the oral-only directions; children whose communication mode was oral, American Sign Language (ASL), or signed English (SE); boys and girls; or children with moderate-to-severe or profound hearing impairments. Children with known etiologies of hearing loss (i.e., meningitis, perinatal complications, rubella, cytomegaloviral inclusion, or genetic anomalies) earned significantly lower Performance IQs and Object Assembly scores than children with unknown etiologies. Implications and future directions for the intellectual assessment of deaf and hard-of-hearing children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educational placement of deaf children following cochlear implantation

The insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene has been postulated to be associated with CAD in some populations of European descent. As part of a study investigating metabolic and genetic factors in subjects with premature coronary artery disease (CAD), we examined the I/D polymorphism of the ACE gene in 134 subjects with premature CAD (105 men and 29 women, mean age 49 +/- 6 years) and 116 control subjects selected for health (71 men, 45 women; mean age 39 +/- 7 years). Both patients and controls were of French Canadian descent. As expected, significant differences were found between cases and controls with respect to age, plasma lipoprotein cholesterol, presence of smoking, diabetes and high blood pressure after correction for age. Multivariate analysis confirms the importance of age, HDL-C levels, smoking and apo B levels as determinants of CAD. Allele frequencies of the I and D polymorphism were 43.1% and 57.9% in controls, and 48.5% and 51.5% in CAD cases (chi 2 = 0.622, p = 0.430). No significant association between the I/D polymorphism and conventional cardiovascular risk factors, including plasma levels of lipids, lipoprotein cholesterol, diabetes or smoking, was found in cases or controls. Furthermore, the presence of the I/D polymorphism did not correlate with a history of hypertension or a family history of premature CAD in CAD patients. We conclude that, in our selected population, the I/D polymorphism of the ACE gene is not associated with CAD, conventional risk factors, or a family history of CAD. Although our sample size does not allow sufficient power to ascertain that the ACE I/D polymorphism is not associated with CAD, we do not recommend the routine measurement of the ACE polymorphism in our population to determine cardiovascular risk.