Brainstem auditory evoked response (BER) in paedaudiological diagnosis (author's transl)

Intention of paedaudiology is to detect and to evaluate hearing loss in children. In new born and small infants, in children with behavioral disorders and multiple disabilities, the clinical techniques of audiometry are often not useful. The brainstem audiometry is a reliable alternative and not so cost intensive and time consuming as it is often assumed. Encouraging is this technique in regard of hearing aids: prevention of attaching unnecessary hearing aids, ruling out not appropriate fitted hearing aids and proper habilitation of unilateral hearing loss.     

A modification of play audiometry to assess speech discrimination ability in severe-profoundly deaf 2- to 4-year-old children

OBJECTIVE: The aim was to develop an assessment procedure that was independent of language and speech production ability, to test speech feature discrimination in severe-profoundly deaf children 2 to 4 yr of age. DESIGN: The procedure being trialed was adapted from existing procedures. The child was required to respond with a game-like motor response to a "change" in a speech stimulus that was being presented repeatedly through a speaker. The change occurred at randomly determined times, and false alarm responses were measured during the waiting periods (while the child waited for the change). Two- to four-yr-old normally hearing children and hearing-impaired children using hearing aids and a group of 4-yr-old hearing-impaired children using cochlear implants were assessed on the task. RESULTS: More than 82% of the 3- and 4-yr-old normally hearing and hearing-impaired children were able to complete the testing for the eight speech sound contrasts within three 20 minute sessions. Fifty percent of the 2-yr-old normally hearing and hearing-impaired children were able to condition and complete the task. All of the normally hearing children who completed the task successfully discriminated all speech sound contrasts. The performance of the hearing-impaired children using hearing aids was influenced by the degree of hearing loss and the type of speech contrast being tested. Similarly, the average performance of the children using cochlear implants was better for easier contrasts such as /ba/bi/ with contrasting vowel formant cues. CONCLUSIONS: This procedure has potential for use as a reliable clinical and research tool for assessing the development of auditory discrimination ability in 2- to 4-yr-old severe-profoundly deaf children.     

Tympanometry at a health center

We wanted to assess how much additional information could be gained from the results of tympanometry after first performing a clinical hearing examination at a mother and child clinic. 182 children aged from six months up to four years, had their hearing first examined clinically and afterwards by tympanometry. Pathological tympanograms were seen in 39% of the ears we examined, but most of them reverted to normal spontaneously at a later stage. There was little concordance between tympanometry and BOEL test in children aged six months and one year. Concordance between tympanometry and audiometry was fairly good in four-year old children. 27 children were referred to an ear, nose and throat specialist for evaluation, 11 of them as a result of tympanometry. Operative treatment was recommended for 17 of the children. In the anamnesis there was a connection between the parents perception of their child's hearing and the child having a cold and referral to an ear, nose and throat specialist. Tympanometry contributes to an early diagnosis of secretory otitis media, as well as being a means of helping parents understand the periodically poor middle ear function of their child.     

Mobile hearing program in central rural Manitoba

A mobile hearing program was developed to detect and alleviate deafness and rehabilitate deaf individuals in rural Manitoba. The first project was established in central Manitoba in December 1973 for children, whose school performance can be affected by minimal hearing loss. Volunteers from the community, trained by an audiologist, conduct screening procedures, and children with possible hearing impairment receive audiologic and otolaryngologic assessment. Close clinical liaison between audiologist and otologist is important.     

Effect of a hearing aid on progressive hearing loss

A group of 72 children with hearing aids followed in 4 different clinical settings presented progressive increase in sensorineural hearing loss. The mean hearing loss over time, the duration of hearing aid use and the gain were studied to test the hypothesis that continued progression in hearing loss was due to overly powerful amplification. No correlation was found between the progressive increased gain levels were associated with less progression in hearing loss than at lower gain levels. Therefore, the use of hearing aids was not directly and significantly related to the increase in hearing loss in the population studied. However according to the above criteria a few cases (4%) of progressive hearing loss did seem to be associated with hearing aid use.     

Sibling relationships for deaf children: The impact of child and family characteristics.

Objective: To examine factors that affect relationships between deaf children who use cochlear implants or hearing aids and their hearing siblings. Study Design: Qualitative analysis of interview data from parents of deaf children. Participants: Parents of 29 deaf children with at least 1 sibling; 20 children used cochlear implants and 9 used hearing aids. Main Outcome Measure: Quality of deaf-hearing sibling relationships as assessed by an ordinal scale developed by the authors. Results: Birth order, family size, parents' anxiety about deafness, and negative comparisons by parents of hearing and deaf siblings were key factors in sibling relationships. Conclusions: Family context is important in understanding experiences of deaf children and their hearing siblings. The model replaces assumptions of hearing loss as individual disability with an emphasis on the social determinants of managing differences in siblings' hearing status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communicative interactions of deaf and hearing children in a day care center. An exploratory study

Interactions were observed in a day care center serving deaf and hearing children. Observations focused on eight children (two deaf with deaf parents, two deaf with hearing parents, two hearing with deaf parents and two hearing with hearing parents) between 2 and 3 years of age. Center classes included deaf and hearing teachers and all children were encouraged to sign. Deaf and hearing children alike frequently interacted with other children and teachers whose hearing status differed from their own. However, each group showed a stronger tendency to initiate communication with same hearing status peers. Hearing children displayed the ability to modify their communications modes to match the hearing status of their intended communication partner. Language ability, not hearing status, was associated with the frequency of communication experienced by each child.     

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.     

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.     

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.     

Audiometric and ophthalmological findings in rubella deafness

In an attempt to study the relevance of ophthalmological changes to the diagnosis of cochlear hearing impairment due to fetal rubella infection, a survey of the literature combined with a clinical investigation was carried out. Based on the investigation of 57 patients, 31% had congenital hearing impairment due to fetal rubella infection. Of these patients, 61% had typical rubella retinal changes. In the remaining 69%, ophthalmoscopy revealed no abnormality, except in 1 patient. As the cause of the hearing impairment in this patient was unknown, it was concluded that the mother had suffered from subclinical rubella infection in the first trimester of her pregnancy. It is concluded that rubella retinitis is found with such a high incidence in rubella children that it can be used as a tool in the diagnosis of cochlear hearing impairment due to fetal rubella infection. Patients with congenital hearing impairment ought to undergo a routine ophthalmoscopy which will detect eventual pigmentary changes.     

Mother father deaf: the heritage of difference

Almost 90% of the children born to life-long profoundly deaf parents are hearing. Within this extraordinary family setting, hearing children of deaf parents are exposed to and interact with two differing cultural, social and linguistic systems: that of their deaf parents and the Deaf community, and that of hearing peers and adults. The present paper focuses on cultural identity and affiliation of hearing children of deaf parents--a population whose lives incorporate the paradox of being culturally 'Deaf' and yet functionally hearing. Data reported here are primarily based on interviews and life histories with 150 adult hearing children of deaf parents throughout the United States. The informants in this study provide an opportunity to explore the parameters and norms of Deaf culture as it contrasts and conflicts with those of Hearing culture.     

Management of otitis media in a high risk population

BACKGROUND: Rural and remote Aboriginal and Torres Strait Islander children have extremely high rates of otitis media and hearing loss. Despite considerable evidence, clinical practice continues to vary. This may be partly related to the failure of recent guidelines to be explicit about which factors should influence decision making. OBJECTIVE: To provide rural and remote GPs caring for young Aboriginal and Torres Strait Islander children with an evidence based guide to the principles that determine the clinical management of otitis media and hearing loss. DISCUSSION: While population health strategies are extremely important, the GP also needs to be able to advise families of affected children of the benefits and risks of the medical, surgical and audiological interventions available. The key to this process is the ability to distinguish between suppurative and non-suppurative disease, and a familiarity with the natural history and the likely hearing loss associated with different disease states in high risk populations.     

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.     

Results of cochlear implantation in patients with severe to profound hearing loss--implications for patient selection

In patients with some residual hearing and minor benefit from conventional hearing aids, the benefits of cochlear implantation have to be weighed carefully against eventual adverse effects. In this study, pre- and post-operative thresholds as well as functional results after cochlear implantation are reported; 17 of 44 implanted adults had residual hearing pre-operatively (mean threshold(250 to 4000 Hz): 106 dB HL) in the implanted ear. Residual hearing in the implanted ear could not, in general, be preserved post-operatively. Seventeen of 44 implanted children had some amount of residual hearing in the implanted ear pre-operatively (implanted ear: 114 dB HL; contralateral ear: 109.9 dB HL; mean thresholds(250 to 4000 Hz))). Contrary to the results in adults, residual hearing in the implanted ear remained statistically unchanged. Hearing in the contralateral ear increased significantly from 109.9 to 101.9 dB HL post-operatively. This increase was mainly attributed to maturation of the central auditory pathway. In adults with residual hearing, the monosyllable word recognition scores increased significantly from 9 per cent pre-operatively to 42 per cent post-operatively. Children with residual hearing tended to perform better on speech-related test material compared to children without prior auditory experience. Cochlear implantation is indicated in adults and children with residual hearing and minor benefit from conventional amplification. The contralateral ear in children should be considered for additional acoustical stimulation.     

Hearing capacity and speech production in 417 children with facial cleft abnormalities

Children with cleft palates often suffer from chronic conductive hearing losses, delayed language acquisition and speech disorders. This study presents results of speech and language outcomes in relation to hearing function and types of palatal malformations found. 417 children with cleft palates were examined during followup evaluations that extended over several years. Disorders were studied as they affected the ears, nose and throat, audiometry and speech and language pathology. Children with isolated cleft lips were excluded. Among the total group, 8% had normal speech and language development while 92% had speech or language disorders. 80% of these latter children had hearing problems that predominantly consisted of fluctuating conductive hearing losses caused by otitis media with effusion. 5% had sensorineural hearing losses. Fifty-eight children (14%) with rhinolalia aperta were not improved by speech therapy and required velopharyngoplasties, using a cranial-based pharyngeal flap. Language skills did not depend on the type of cleft palate presents but on the frequency and amount of hearing loss found. Otomicroscopy and audiometric follow-ups with insertions of ventilation tubes were considered to be most important for language development in those children with repeated middle ear infections. Speech or language therapy was necessary in 49% of the children.     

Peer interaction in young deaf children: The effect of partner hearing status and familiarity.

14 deaf 54–83 mo olds were videotaped playing once with each of 4 partners: a familiar deaf playmate, a familiar hearing playmate, an unfamiliar hearing child who was a playmate of another deaf child, and an unfamiliar hearing child who had little experience playing with deaf children. 21 hearing and 7 deaf playmates participated. Deaf Ss rarely used language, and formal language use was not related to measures of interaction or play even when playing with another deaf child. Instead, interaction and pretense seemed to be related to the deaf Ss' nonlinguistic communication abilities. Partner hearing status primarily affected communication, with communication between deaf playmates being more visual (both linguistic and nonlinguistic) and less object-based than communication between deaf and hearing playmates. Familiarity played a larger role than experience in improving interaction between deaf and hearing children. The hearing children were more responsive to and used more visual communication devices with their deaf playmate than an unfamiliar deaf child. But the hearing playmates were no better at playing with an unfamiliar deaf child than were hearing children who had little experience playing with deaf children. Implications for the understanding of young children's communication abilities and for deaf educational programs are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication between deaf children and their hearing mothers: the role of language, gesture, and vocalizations

In the present longitudinal study, 20 deaf and 20 hearing children were observed during free play with their hearing mothers when the children were 22 months and 3 years of age. Compared to hearing children, deaf children were severely language delayed, with deaf 3-year-olds using less language (speech or sign) than hearing 22-month-olds. Deaf children communicated primarily through nonlinguistic vocalizations, with increasing use of gesture from 22 months to 3 years of age. Although mothers of deaf children used more visual communication than mothers of hearing children, they still primarily communicated through speech. In addition, deaf children did not visually attend to much of their mothers' communication. Therefore, deaf children received much less communication than hearing children. These results suggest that intervention efforts should be focused on increasing the quantity of perceived linguistic input by the child.