Blog Archives

Testing and Beyond: Strategies and Tools for Evaluating and Assessing Infants and Toddlers

Implications: The article provides important and timely information for professionals and families related to the screening, evaluation, and assessment of infants and toddlers with, or at risk for, communication deficits. Speech-language pathologists, other professionals, and family members can use the information to implement recommended and evidence-based practices when screening, evaluating, and assessing young children for communication deficits.

from Language, Speech and Hearing Services in Schools

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Screening for Alzheimer’s Disease Among Illiterate Elderly: Accuracy Analysis for Multiple Instruments

One of the challenges in screening for dementia in developing countries is related to performance differences due to educational and cultural factors. This study evaluated the accuracy of single screening tests as well as combined protocols including the Mini-Mental State Examination (MMSE), Verbal Fluency animal category (VF), Clock Drawing test (CDT), and Pfeffer Functional Activities Questionnaire (PFAQ) to discriminate illiterate elderly with and without Alzheimer’s disease (AD) in a clinical sample. Cross-sectional study with 66 illiterate outpatients diagnosed with mild and moderate AD and 40 illiterate normal controls. Diagnosis of AD was based on NINCDS-ADRDA. All patients were submitted to a diagnostic protocol including a clinical interview based on the CAMDEX sections. ROC curves area analyses were carried out to compare sensitivity and specificity for the cognitive tests to differentiate the two groups (each test separately and in two by two combinations). Scores for all cognitive (MMSE, CDT, VF) and functional assessments (PFAQ) were significantly different between the two groups (p < 0.001). The best screening instruments for this sample of illiterate elderly were the MMSE and the PFAQ. The cut-off scores for the MMSE, VF, CDT, and PFAQ were 17.5, 7.5, 2.5, and 11.5, respectively. The most sensitive combination came from the MMSE and PFAQ (94.1%), and the best specificity was observed with the combination of the MMSE and CDT (89%). Illiterate patients can be successfully screened for AD using well-known screening instruments, especially in combined protocols.

from the Journal of Alzheimer’s Disease

Risk factors associated with hearing loss in infants: An analysis of 5282 referred neonates

Conclusion
Our results indicate that syndromes associated with hearing loss and mechanical ventilation for more than 5 days were statistically significant risk factors in the occurrence of hearing loss. The most common risk factors are ototoxic medications, premature birth, low birth weight, and intensive care in excess of 7 days. As the number of risk factors an infant is exposed to grows, the probability of hearing impairment increases. The large percentage of children with sensorineural hearing loss in the absence of any known risk factors demonstrates the necessity of hearing examinations in all neonates.

from the International Journal of Pediatric Otorhinolaryngology

TEN-YEAR QUALITY ASSURANCE OF THE NATIONWIDE HEARING SCREENING PROGRAMME IN DUTCH NEONATAL INTENSIVE CARE UNITS

Conclusion:  The NHS in Dutch NICUs is effective. Timely identification of hearing loss is improving over time.

from Acta Paediatrica

Sensorineural hearing loss in pediatric celiac patients

Conclusion
The present study showed a higher prevalence of sensory neural hearing loss in pediatric celiac patients than in healthy controls, suggesting an association between CD and SNHL. The findings of this study suggest that hearing impairment should be searched in newly diagnosed pediatric CD patients. Further longitudinal investigations on a larger sample size will be necessary to confirm the present data and to search the immunological processes which could be the basis of the association between CD and SNHL.

from the International Journal of Pediatric Otorhinolaryngology

Neonatal hearing screening in Benin City

The screening tests suggest a high crude prevalence (6.5%) of bilateral neonatal hearing impairment in Benin City necessitating confirmation and intervention. The study fortifies the need for hearing screening among all new born in developing countries.

from the International Journal of Pediatric Otorhinolaryngology

A pilot study to evaluate a new early screening instrument for speech and language delays

The early identification of speech and language delays is a crucial first step in the effective prevention of developmental and socioemotional problems. Children’s early cognitive and language development has bearing on later development and readiness for learning and social competence. The Speech and Language Pathology Early Screening Instrument (SLPESI) was developed to identify possible speech and language delays in 18 to 21-month-old children. The purpose of the present study was to pilot the SLPESI and assess its ability to identify speech and language delays in children of this age group. A total of 252 children, aged 17-23 months, participated in the SLPESI. The test took less than five minutes to administer. Of the 252 children screened, 56 (22%) were recommended for assessment by a Speech and Language Pathologist (S-LP) based on the results of the questionnaire. Of those recommended, 34 came in for assessment and 31 (91%) were assessed and diagnosed with speech and language delays ranging from mild to severe. In order to examine the reliability of the SLPESI, 19 children who passed the initial screening procedure were brought in for a follow-up assessment. Of these, 18 had age-appropriate speech and language skills and one had a mild to moderate speech and language delay. The SLPESI proved to be a quick and effective screening instrument that may help predict speech and language delays in children 18-21 months of age.

from the Canadian Journal of Speech-Language Pathology and Audiology

Self-reported impact of dysphonia in a primary care population: An epidemiological study

Conclusions:
At the time one in 13 primary care patients had dysphonia resulting in significant functional impairment with reduced voice-specific QOL and greater depression scores. Risk factors for dysphonia and voice-specific QOL impairment were identified and might be useful for identifying patients at risk for dysphonia. Barriers exist that prevent dysphonic patients from receiving evaluation and treatment. Whether improved methods of dysphonia screening leads to better outcomes and reduced societal impact needs investigation.

from The Laryngoscope

Problems and limitations in studies on screening for language delay

This study discusses six common methodological limitations in screening for language delay (LD) as illustrated in 11 recent studies. The limitations are (1) whether the studies define a target population, (2) whether the recruitment procedure is unbiased, (3) attrition, (4) verification bias, (5) small sample size and (6) inconsistencies in choice of “gold standard”. It is suggested that failures to specify a target population, high attrition (both at screening and in succeeding validation), small sample sizes and verification bias in validations are often caused by a misguided focus on screen positives (SPs). Other limitations are results of conflicting methodological goals. We identified three such conflicts. One consists of a dilemma between unbiased recruitment and attrition, another between the comprehensiveness of the applied gold standard and sample size in validation and the third between the specificity of the gold standard and the risk of not identifying co-morbid conditions.

from Research in Developmental Disabilities

Voice-quality Abnormalities as a Sign of Dysphagia: Validation against Acoustic and Videofluoroscopic Data

In this study we explored the validity of clinician judgments of voice abnormalities as indicators of penetration-aspiration or other swallowing abnormalities. Voice samples were collected using a high-quality microphone from 40 adults during videofluoroscopy (VFSS), at baseline and following each of four thin liquid swallows. Blinded speech-language pathologists (SLPs) rated the audio recordings for voice quality using the GRBAS scale and the VFSS recordings for abnormal swallow onset, penetration-aspiration, airway closure, and pharyngeal residues. Acoustic measures of % jitter, % shimmer, and signal-to-noise ratio were calculated using two /a/ vowel segments spliced from each voice recording. Preswallow to postswallow measures of voice-quality change were derived and the data were compared to determine the correspondence between perceived voice abnormalities, acoustic voice parameters, and radiographically confirmed swallowing abnormalities. The sensitivity of perceived postswallow changes in voice quality to dysphagia and penetration-aspiration was poor, ranging from 8 to 29%. Specificity was stronger for both penetration-aspiration (75–94%) and dysphagia (59–86%). Acoustic measures of voice quality had moderate sensitivity and specificity for both dysphagia and penetration-aspiration. Overall, perceptual judgments of postswallow wet voice showed the strongest potential for detecting penetration-aspiration (relative risk = 3.24). We conclude that a clear postswallow voice quality provides reasonable evidence that penetration-aspiration and dysphagia are absent. However, observations of abnormal postswallow voice quality can be misleading and are not a valid indication that penetration-aspiration or dysphagia exists.

from Dysphagia

Vestibular schwannoma: when to look for it?

As regards vestibular schwannoma screening protocols, the best compromise between sensitivity and screening rate was offered by a criterion comprising either: (1) ≥20 dB asymmetry at two neighbouring frequencies, or unilateral tinnitus, or (2) ≥15 dB asymmetry at two frequencies between 2 and 8 kHz.

from the Journal of Laryngology and Otology

Newborn hearing screening on infants at risk

Conclusion
Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.

from the International Journal of Pediatric Otorhinolaryngology

Identifying Learning Problems in Children Evaluated for ADHD: The Academic Performance Questionnaire

CONCLUSIONS: The APQ may be a useful screening tool to identify children being evaluated for ADHD who need additional testing for learning problems. Although the predictive value of a negative screen on the APQ is good, the predictive value of a positive test is relatively low.

from Pediatrics

Systematic Review of Physicians’ Knowledge of, Participation in, and Attitudes toward Hearing and Balance Screening in the Elderly Population

Physicians play an important role in screening for hearing loss and balance system disorders in elderly patients and in making appropriate referrals for diagnostic testing and treatment. Physicians are uniquely positioned to influence elderly patients about the importance of having good hearing and balance and to encourage them to accept these problems and to seek further testing and treatment when they exist. The segment of the U.S. population >65 years of age is expected to grow dramatically over the next few decades, which will undoubtedly increase both the incidence and prevalence of these disorders. Early detection of and intervention for these health-care conditions should improve the health-related quality of life for elderly patients and their families. Therefore, it is important to determine physicians’ knowledge of, attitudes toward, and efforts to screen for hearing loss and balance system disorders in this population. This study used a systematic review as part of an evidence-based practice process to determine what types of information physicians might need to enhance their screening of hearing and falls risk in elderly patients. The results revealed that physicians could benefit from having additional information about this subject. Audiologists and their professional organizations should conduct physician outreach efforts to remind them of the important role they play in helping elderly persons deal with hearing and balance problems and provide physicians with basic knowledge and updates in preferred, time-sensitive formats.

from Seminars in Hearing

National Newborn Hearing Screening Program in Turkey: Struggles and implementations between 2004 and 2008

After five years of carrying out the program (between 2004 and 2008) a total number of 764,352 newborns were screened for hearing impairment. In the year 2008, National Newborn Hearing Screening Program (NNHSP) had given the chance for 2136 children with various types of hearing loss (320 with unilateral and 417 with bilateral hearing loss) to detect and refer to more experienced centers for further treatment.

Conclusions
Our results indicate that the necessity of newborn hearing screening is an indispensable issue. We have been targeted to develop National Newborn Hearing Screening Program (NNHSP) till given chance to access for every newborn in Turkey in next five years.

from the International Journal of Pediatric Otorhinolaryngology