Bone-anchored hearing aid A single-stage procedure in children

Conclusion
Our results show that a single-stage technique is associated with a low rate of early complications, with no reports of fixture loss due to osseointegration failure.

from the International Journal of Pediatric Otorhinolaryngology

Permanent Bilateral Sensory and Neural Hearing Loss of Children After Neonatal Intensive Care Because of Extreme Prematurity: A Thirty-Year Study

CONCLUSIONS. Permanent hearing loss remains an adverse outcome of extreme prematurity, complicated by significant delayed-onset and progressive loss. Prolonged supplemental oxygen use is a marker for predicting permanent hearing loss; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of permanent hearing loss.

from Pediatrics

Expressive spoken language development in deaf children with cochlear implants who are beginning formal education

This paper assesses the expressive spoken grammar skills of young deaf children using cochlear implants who are beginning formal education, compares it with that achieved by normally hearing children and considers possible implications for educational management. Spoken language grammar was assessed, three years after implantation, in 45 children with profound deafness who were implanted between ten and 36 months of age (mean age = 27 months), using the South Tyneside Assessment of Syntactic Structures (Armstrong and Ainley, 1983) which is based on the Language Assessment and Remediation Screening Procedure (Crystal et al., 1976). Of the children in this study aged between four and six years, 58 per cent (26) were at or above the expressive spoken language grammatical level of normally hearing three year olds after three years of consistent cochlear implant use: however, 42 per cent (19) had skills below this level. Aetiology of deafness, age at implantation, educational placement, mode of communication and presence of additional disorders did not have a statistically significant effect (accepted at p 0.05) on the development of expressive spoken grammar skills. While just over half of the group had acquired spoken language grammar skills equivalent to or above those of a normally hearing three year old, there remains a sizeable group who, after three years of cochlear implant use, had not attained this level. Spoken language grammar therefore remains an area of delay for many of the children in this group. All the children were attending school with hearing children whose language skills are likely to be in the normal range for four to six year olds. We therefore need to ensure that the ongoing educational management of these deaf children with implants addresses their spoken grammar delay in order that they can benefit more fully from formal education. Copyright © 2009 John Wiley & Sons, Ltd.

from Deafness and Education International

Speech discrimination skills in deaf infants before and after cochlear implantation

The benefit of early cochlear implantation (CI) to later speech perception outcomes in prelingually deaf (PLD) children is well established and implantation of infants has become more prevalent. The aim of this study was to determine whether or not deaf infants could discriminate audiovisual non-words shortly after CI and whether their attention to speech and non-speech audiovisual stimuli was similar to infants with normal hearing (NH). Three groups of participants were tested: PLD infants tested prior to CI (pre-CI), PLD infants tested post-implantation (post-CI), and a group of age-matched NH infants. A novel version of the visual habituation (VH) procedure was used. Infants were presented repetitions of an audiovisual non-word until their looking-time decreased to a predetermined criterion. They were then presented two types of test trials: repetitions of the old word (non-alternating (NA) trials) and repetitions of a novel non-word alternating with the old word (alternating (A) trials). Longer looking times to the A relative to the NA trials was taken as evidence of discriminating the non-words. An audiovisual non-speech trial was presented at the beginning and the end of each experiment and looking times between speech and non-speech trials were compared. Analyses revealed that pre- and post-CI infants had significantly shorter looking times than NH infants for speech but not non-speech trials. Furthermore, deaf infants often did not look long enough to be exposed to the novel non-word during the A trials. When trials with less than three seconds of looking were removed, analyses revealed that both NH infants and post-CI infants discriminated the non-words but pre-CI infants did not. Pre-implant hearing, age at implantation, and length of CI use were not related to visual preference for A trials. These results suggest that PLD infants show less visual interest in speech stimuli than NH infants. Despite this, PLD infants appear to be able to discriminate audiovisual non-words within three months after implantation.

from Audiological Medicine

Exploration of the cognitive and behavioural consequences of paediatric cochlear implantation

from Cochlear Implants Internations

This study followed the progress of young deaf children undergoing cochlear implantation, in terms of their non-verbal cognitive abilities and their emotional/behavioural development. A consecutive series of 20 children, between the ages of 2 and 5 years, were assessed using the Leiter International Performance Scale – Revised (LIPS-R) and the Child Behaviour Checklist (CBCL), prior to receiving a Nucleus 24 cochlear implant. They were assessed again one year after the device was switched on. Scores on seven of the 13 subtests and composite scales of the LIPS-R increased significantly during the first year of cochlear implant use. Cognitive functions post-implant (Sequential Order, Fluid Reasoning, Full IQ and Attention Sustained) were positively related to behavioural outcomes. These results may be explained by an increased capacity of the implanted children to use verbal concepts to encode visual material. There was also evidence for a reduction in internalizing behaviour problems. The results are discussed in the context of previous research, clinical and theoretical perspectives. Copyright © 2006 John Wiley & Sons, Ltd.

Ear selection and pediatric cochlear implants: A preliminary examination of speech production outcomes

from the International Journal of Pediatric Otorhinolaryngology

Objective
The goal of the current study was to examine whether ear selection (left versus right) for cochlear implantation results in significant differences in speech production outcomes.

Methods
Ten children with right-ear implants were compared to five children with left-ear implants on intelligibility of speech produced in single words, sentences, and conversation as well as on accuracy of speech sounds produced during administration of a single word articulation test and in conversational speech.

Results
The children with right-ear implants performed significantly better than those with left-ear implants but only on the single word tasks. No significant differences were observed at the sentence or conversational speech levels.

Conclusion
Findings are discussed relative to the possibility that the obtained ear of implantation differences (if real) may disappear over time. Such a conclusion is quite tentative however given the small sample size in the current study. Such a limitation may also explain why no differences were obtained for the connected speech measures. Further study of ear selection outcomes is clearly indicated.

Congenital auditory meatal atresia: a numerical review

from the European Archives of Oto-Rhino-Laryngology

Abstract Congenital auditory meatal atresia (CAMA) is an uncommonly encountered disorder. Though a rare condition, CAMA poses multiple problems for affected children. Recent management of CAMA in developed countries rests on osseo-integrated prostheses and bone-anchored hearing aids. The situation is different in developing countries where aesthetic and otologic surgeries are the available lines of management. Surgical management of CAMA has been staged into reconstructive surgery for auricular deformity followed by external and middle ear reconstruction either via anterior or transmastoid approaches. Multiple case series describing the outcomes and complications of both approaches have been published, but no authors have attempted to compare either. We have attempted to compare the outcomes and complications of both approaches by analyzing published medical articles concerning surgical management of CAMA identified by searching the Medline database using “congenital aural atresia” and “external auditory canal atresia” as keywords. A total of 923 ears were reported by 13 articles included in this study. The transmastoid approach is shown, by multiple linear regression, to have better postoperative hearing gain and less likely restenosis.

Digital noise reduction: Outcomes from laboratory and field studies

from the International Journal of Audiology

The purpose of this study was to determine the impact of a digital noise reduction (DNR) scheme implemented in a current commercial hearing aid. In a double-blinded design, three conditions of onset time (4, 8, 16 seconds) were randomly assigned to the 25 subjects, plus one condition wherein the noise-reduction feature was disengaged. Subsequently, a fifth trial/condition, wherein the subject had access to three memories in which the different onsets were programmed, was carried out. For each of the five conditions, the subjects had an at-home trial, prior to obtaining self-report measures. Laboratory measures of speech perception showed no effect of the DNR, with or without the provision of visual cues. Laboratory-based ratings of ease of listening showed DNR-on (all onset times) to be rated significantly better than DNR-off; for ratings of listening comfort, the 4-second onset time was rated significantly lower (poorer) than the 8-second onset or the DNR-off condition; for ratings of sound quality, DNR-on or -off had no differential effect. Self-report measures indicated significantly higher aversiveness in the DNR-off condition compared to the pre-test scores

Using Therapeutic Sound With Progressive Audiologic Tinnitus Management

from Trends in Amplification

Management of tinnitus generally involves educational counseling, stress reduction, and/or the use of therapeutic sound. This article focuses on therapeutic sound, which can involve three objectives: (a) producing a sense of relief from tinnitus-associated stress (using soothing sound); (b) passively diverting attention away from tinnitus by reducing contrast between tinnitus and the acoustic environment (using background sound); and (c) actively diverting attention away from tinnitus (using interesting sound). Each of these goals can be accomplished using three different types of sound—broadly categorized as environmental sound, music, and speech—resulting in nine combinations of uses of sound and types of sound to manage tinnitus. The authors explain the uses and types of sound, how they can be combined, and how the different combinations are used with Progressive Audiologic Tinnitus Management. They also describe how sound is used with other sound-based methods of tinnitus management (Tinnitus Masking, Tinnitus Retraining Therapy, and Neuromonics).

Speech discrimination skills in deaf infants before and after cochlear implantation

from Audiological Medicine

Abstract
The benefit of early cochlear implantation (CI) to later speech perception outcomes in prelingually deaf (PLD) children is well established and implantation of infants has become more prevalent. The aim of this study was to determine whether or not deaf infants could discriminate audiovisual non-words shortly after CI and whether their attention to speech and non-speech audiovisual stimuli was similar to infants with normal hearing (NH). Three groups of participants were tested: PLD infants tested prior to CI (pre-CI), PLD infants tested post-implantation (post-CI), and a group of age-matched NH infants. A novel version of the visual habituation (VH) procedure was used. Infants were presented repetitions of an audiovisual non-word until their looking-time decreased to a predetermined criterion. They were then presented two types of test trials: repetitions of the old word (non-alternating (NA) trials) and repetitions of a novel non-word alternating with the old word (alternating (A) trials). Longer looking times to the A relative to the NA trials was taken as evidence of discriminating the non-words. An audiovisual non-speech trial was presented at the beginning and the end of each experiment and looking times between speech and non-speech trials were compared. Analyses revealed that pre- and post-CI infants had significantly shorter looking times than NH infants for speech but not non-speech trials. Furthermore, deaf infants often did not look long enough to be exposed to the novel non-word during the A trials. When trials with less than three seconds of looking were removed, analyses revealed that both NH infants and post-CI infants discriminated the non-words but pre-CI infants did not. Pre-implant hearing, age at implantation, and length of CI use were not related to visual preference for A trials. These results suggest that PLD infants show less visual interest in speech stimuli than NH infants. Despite this, PLD infants appear to be able to discriminate audiovisual non-words within three months after implantation.

Outcomes and Efficacy of Newborn Hearing Screening: Strengths and Weaknesses (Success or Failure?)

from Laryngoscope

Abstract:
Objective: To assess the outcomes of neonatal hearing screening with regard to the final diagnosis in a very large number of newborns and investigate related strengths and weaknesses of the program.

Subjects: In this study, 76,560 newborns were assessed.

Method: All neonates were assessed using transient evoked otoacoustic emissions (TEOAEs).

Results: From the 76,560 neonates screened, 1,564 (2%) failed the test. According to the screening protocol, all parents of failed neonates were asked to bring their children 1 month following discharge to repeat the test. Of the 541 (34.6%) newborns who repeated the test, 303 (56%) were found normal and 238 (44%) again failed TEOAE. The latter children were referred to two special public centers for full audiology evaluation. In addition, 124 neonates were also referred due to other reasons revealed in the screening process (family history, high levels of bilirubin, etc.). Of the 362 children who were referred to the two special audiology centers, 113 (31.2%) were evaluated by these two centers. In addition, 42 children who had failed initial screening and did not show up for a follow-up appointment to repeat TEOAE were also assessed in the same centers. Of the 155 children who had a special audiologic evaluation, 56 (36.1%) were found to have hearing loss (HL) and 99 (63.9%) normal hearing. In detail, 28 had bilateral sensorineural HL greater than 40 dB, 10 had unilateral sensorineural HL greater than 40 dB, and 18 had otitis media with effusion or other conductive HL.

Conclusions: Derived from the present study: 1) repeated testing of “failed” newborns in the maternity hospital and before discharge leads to an acceptable referral rate of 2%; 2) the 1-month follow-up of “failed” newborns further limits the false positive results but leads to high rate of newborns lost to follow-up; 3) a dedicated secretariat system should be implemented to follow-up each “failed” newborn and remind parents about their follow-up appointments; and 4) additional measures such as detailed educational material and parental friendly approach should also be implemented.

Outcomes in a Population of Healthy Term and Near-Term Infants With Serum Bilirubin Levels of 325 µmol/L (19 mg/dL) Who Were Born in Nova Scotia, Canada, Between 1994 and 2000

from Pediatrics

OBJECTIVE. The goal was to study the incidence of kernicterus, developmental delay, autism, cerebral palsy, and hearing loss in infants with peak total serum bilirubin levels of 325 µmol/L (19 mg/dL), compared with infants with less-severe or no hyperbilirubinemia, in a population of healthy term and late preterm infants.

METHODS. Prospectively gathered, standardized, maternal and neonatal data for infants at 35 weeks of gestation who were born between January 1, 1994, and December 31, 2000, were extracted from the Nova Scotia Atlee Perinatal Database. Infants with Rh factor isoimmunization, significant congenital or chromosomal abnormalities, or severe peripartum asphyxia were excluded. Comparisons were made on the basis of peak total serum bilirubin levels. Diagnoses were obtained through data linkage with the Medical Services Insurance Database for office visits and the Canadian Institute for Health Information Database for hospital admissions. The registration file provided information allowing calculation of follow-up times, which were determined for each separate outcome. Follow-up periods ranged from 2 to 9 years, with the end point being the first time the diagnostic code was encountered in either database. Cox proportional-hazards regression analyses were used to examine the relationships between outcomes and total serum bilirubin levels.

RESULTS. Of 61238 infants included in the study cohort, 4010 (6.7%) did not have linkage data, which left 56019 infants for analysis. There were no cases of kernicterus and no significant differences in rates of cerebral palsy, deafness, developmental delay, or visual abnormalities between the groups. There were suggestions of associations with attention-deficit disorder in the severe hyperbilirubinemia group and with autism in the combined moderate and severe hyperbilirubinemia group.

CONCLUSIONS. There was no increase in adverse effects reported previously to be associated with bilirubin toxicity. Associations with developmental delay, attention-deficit disorder, and autism were observed.

——————————————————————————–

Key Words: hyperbilirubinemia • outcomes • population-based

Long-Term Hearing Results in Gamma Knife Radiosurgery for Acoustic Neuromas

from Laryngoscope

Abstract:
Objectives: There are many studies that have examined functional outcomes following Gamma Knife treatment; however, few have reported long-term audiometric data. This study analyzed the long-term hearing results of Gamma Knife radiosurgery in the treatment of acoustic neuromas.

Study Design: Retrospective cohort study.

Methods: Seventeen patients were selected from our acoustic neuroma Gamma Knife registry of 113 patients treated from 1991 to 2005. Pretreatment audiograms were analyzed for pure-tone average and word recognition scores and assigned a Gardner-Robertson classification score (GRC). Either a current audiogram was obtained or the most recent audiogram (if the patient was lost to follow-up) was reviewed from clinic charts and these were compared with the preoperative results. Audiometric data of the pre- and posttreatment normal ear were obtained and used as the patient’s own control.

Results: The tumor size ranged from 0.5 to 2.8 cm (mean, 1.33 cm) and patients received a range of 12.5-16 Gy (mean, 13.82 Gy) to 50% isodose line. Patient follow-up ranged from 3 to 82 months with a mean of 33.6 months. Pretreatment pure-tone average for the involved side group was 30.6 dB HL with a word recognition score of 74%. Pretreatment mean GRC was 1.76. posttreatment pure-tone average for the group was 59.7 dB HL with a word recognition score of 37%. posttreatment mean GRC was 3.29. Comparing pre- versus post-Gamma Knife radiosurgery results on the treatment ear, means were statistically significantly different for both pure-tone average and word recognition scores, based on a paired-samples t test (P < .001 for both). The group “normal” ear pure-tone average was 14 dB HL and 17.75 dB HL pre- and posttreat-ment, respectively. Normal ear pre- and posttreatment word recognition score and GRC were 93% and 98%, and 1.13 and 1.31, respectively.

Conclusion: Gamma Knife radiosurgery remains a noninvasive treatment option for patients with acoustic neuromas; however, they may experience a delayed hearing loss. Of those patients with useful audition pretreatment, 42% maintained useful hearing posttreatment.

(C) The American Laryngological, Rhinological

Reliability and validity of the Functional Outcome Questionnaire for Aphasia (FOQ-A).

from Rehabilitation Psychology

Objective: To perform a psychometric evaluation of the Functional Outcome Questionnaire for Aphasia (FOQ-A), a 32-item instrument designed to assess the extent to which a person who has had a stroke performs several important functional communication behaviors. Research Design: The FOQ-A was administered to family caregivers of persons with a history of left hemisphere stroke (N = 91) undergoing a comprehensive screening assessment to determine their eligibility for participation in research trials for novel stroke rehabilitation interventions. Results: Statistical analyses provided strong support for the internal consistency reliability and the convergent and discriminant validity of the FOQ-A. An exploratory factor analysis revealed a two-factor solution, Basic Verbal Expression and Conversational Response Skills. Conclusions: The present findings build on earlier evidence indicating that the FOQ-A has good psychometric properties and considerable promise as a measure of functional communication in aphasia rehabilitation. Future research will focus on the test-retest reliability, criterion-oriented validity, and predictive validity of the instrument. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Bilateral Cochlear Implantation: Candidacy, Outcomes, Research

from the National Library for Health

Special Guest Presenter: Susan B. Waltzman, Professor of Otolaryngology NYU School of Medicine

Abstract: The benefits of binaural hearing including speech understanding in noise and localization have been well documented and confirmed in many bilateral hearing aid and cochlear implant users. These positive results have led many unilateral cochlear implant users to explore the viability of a second implant. This talk will review the benefits of binaural hearing with sensory aids and, more specifically, examine speech perception outcomes in sequentially implanted children, adolescents and adults and explore the variables affecting post-implantation performance.

Biography: Susan B. Waltzman, PhD is Professor of Otolaryngology and Co-Director of the Cochlear Implant Center at NYU School of Medicine. Dr. Waltzman has been involved in research related to cochlear implantation for 20 years and has published books, book chapters and numerous articles in peer-reviewed journals on outcomes with cochlear implants She is also a frequent contributor and invited speaker at national and international conferences. Her research interests are focused on outcome studies with cochlear implants.

When: Thursday 26th June 2008 at 5.30 pm UK Time

Time Zone: (Note this is UK time-please convert as necessary) please go to http://www.worldtimezone.com/ for conversion

To register for this event, please go the following link:

http://www.hearingseminars.com/swaltzman0608/event/registration.html