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Hearing loss prevalence and hearing health among school-aged children in the Canadian Arctic
Abstract
Objective: Hearing loss is an important health concern in Canada’s Arctic. The objective of this research was to provide information on the prevalence of childhood hearing loss in Nunavut.
Design: This cross-sectional study involved comprehensive audiologic assessments of school-aged children in six communities to determine overall and community-specific prevalence of hearing loss. Data were collected about hearing aid use and factors affecting use through a parent questionnaire.
Study sample: Assessments were completed for 644 children in kindergarten to grade 6.
Results: 124 (19.3%) children had hearing loss of ≥ 30 dB HL at one or more frequencies in at least one ear (93.5% conductive loss). Applying a Canadian prevalence study definition, 148 (23.5%) children had hearing loss. Tympanic membrane perforations were present in 36.8% (n = 28) of children with unilateral and 45.8% (n = 22) with bilateral loss.
Conclusions: The prevalence of hearing loss in Canada’s North was almost three times that reported for non-indigenous children. One in five school-aged children was found to have hearing loss that is likely to affect classroom learning and social/emotional development. A hearing health strategy tailored to this population is critically needed.
... Systems need to be in place that effectively prevent, identify, and treat childhood hearing loss to ensure children can reach their potential. This is especially important in rural Arctic and Alaska Native populations, where (1) historical data indicate a disproportionately high rate of childhood ear infections and hearing loss (Ayukawa et al. 2004;Langan et al. 2007;Singleton et al. 2009;Fitzpatrick et al. 2020), and (2) structural racism has contributed to such health disparities (Solomon et al. 2022). ...
... This is the first study to present an explanatory model of hearing loss in rural Arctic or Alaska Native populations, where data indicate a disproportionately high prevalence of ear infections and hearing loss in children (Ayukawa et al. 2004;Langan et al. 2007;Singleton et al. 2009;Fitzpatrick et al. 2020). Our study engaged a wide range of stakeholders, recognizing the multilevel socioecological influences that impact health behavior, both generally and within hearing loss in particular . ...
Objectives:
The aim of this study is to present an explanatory model of hearing loss in the Bering Strait region of Alaska in order to contextualize the results of a cluster randomized trial and propose implications for regional hearing-related health care.
Design:
To promote ecological validity, or the generalizability of trial findings to real world experiences, qualitative methods (focus groups and interviews) were used within a mixed methods cluster randomized trial evaluating school hearing screening and follow-up processes in 15 communities in the Bering Strait region of Alaska. Focus groups were held between April and August 2017, and semistructured interviews were conducted between December 2018 and August 2019. Convenience sampling was used for six of the 11 focus groups to capture broad community feedback. Purposive sampling was used for the remaining five focus groups and for all interviews to capture a variety of experiences with hearing loss. Audio recordings of focus groups and interviews were transcribed, and both notes and transcripts were deidentified. All notes and transcripts were included in the analysis. The constant comparative method was used to develop a codebook by iteratively moving between transcripts and preliminary themes. Researchers then used this codebook to code data from all focus groups and interviews using qualitative analysis software (NVIVO 12, QSR International) and conducted thematic analyses to distill the findings presented in this article.
Results:
Participants in focus groups (n = 116) and interviews (n = 101) shared perspectives in three domains: etiology, impact, and treatment of hearing loss. Regarding etiology, participants emphasized noise-induced hearing loss but also discussed infection-related hearing loss and various causes of ear infections. Participants described the impact of hearing loss on subsistence activities, while also detailing social, academic, and economic consequences. Participants described burdensome treatment pathways that are repetitive and often travel and time intensive. Communication breakdowns within these pathways were also described. Some participants spoke positively of increased access via onsite hearing health care services in "field clinics" as well as via telemedicine services. Others described weaknesses in these processes (infrequent field clinics and communication delays in telemedicine care pathways). Participants also described home remedies and stigma surrounding the treatment for hearing loss.
Conclusions:
Patient-centered health care requires an understanding of context. Explanatory models of illness are context-specific ways in which patients and their networks perceive and describe the experience of an illness or disability. In this study, we documented explanatory models of hearing loss to foster ecological validity and better understand the relevance of research findings to real-life hearing-related experiences. These findings suggest several areas that should be addressed in future implementation of hearing health care interventions elsewhere in rural Alaska, including management of repetitious treatments, awareness of infection-mediated hearing loss, mistrust, and communication breakdowns. For hearing-related health care in this region, these findings suggest localized recommendations for approaches for prevention and treatment. For community-based hearing research, this study offers an example of how qualitative methods can be used to generate ecologically valid (i.e., contextually grounded) findings.
... Authors reported several justifications for their research: (1) overcome knowledge gaps, 22 42 49 (2) describe disease burden, risk factors and adverse outcomes, [50][51][52][53][54][55][56][57] (3) explore and highlight health disparities, 49 58-63 (4) inform development or improvement of health services and programmes, 49 64-66 and (5) respond to local public health authorities/community requests and support Inuit-led research and programmes. [67][68][69][70][71][72][73][74] Implementation Inception, protocols and decision-making process Studies reported involvement of political and health authorities from the different Inuit regions. ...
Background:
The National Inuit Strategy on Research focuses on advancing Inuit governance in research, increasing ownership over data and building capacity. Responding to this call for Inuit self-determination in research, academic researchers should consider cultural safety in research and ways to promote Inuit-led methods.
Methods:
This scoping review collated academic literature on public health research in Inuit communities in Canada between 2010 and 2022. A critical assessment of methods used in public health research in Inuit communities examined cultural safety and the use of Inuit-attuned methods. Descriptive and analytical data were summarised in tables and figures. Knowledge user engagement in the research process was analysed with thematic analysis.
Results:
356 articles met the inclusion criteria. Much of the published research was in nutrition and mental health, and few initiatives reported translation into promotion programmes. Almost all published research was disease or deficit focused and based on a biomedical paradigm, especially in toxicology, maternal health and chronic diseases. Recent years saw an increased number of participatory studies using a decolonial lens and focusing on resilience. While some qualitative research referred to Inuit methodologies and engaged communities in the research process, most quantitative research was not culturally safe. Overall, community engagement remained in early stages of co-designing research protocols and interventions. Discussion on governance and data ownership was limited. Recent years saw emerging discussions on these issues. Knowledge user capacity-building was limited to brief training on conventional data collection methods.
Conclusions:
The last decade of published public health research has not responded to the National Inuit Strategy on Research. Participatory research is gaining ground, but has not reached its full potential. A shift from biomedical to decolonised methods is slowly taking place, and public health researchers who have not yet embraced this paradigm shift should do so.
... HL may affect all age groups with significant negative impacts on the physical, mental, and social health-related quality of life of patients (Ciorba et al., 2012;Punch et al., 2019). In children, it may adversely affect speech and language development, as well as intellectual and emotional growth (Fitzpatrick et al., 2021). Concerning elderlies, approximately one-third of people aged 65 years and old-er and 80% of those older than 85 years are affected by significant HL (World Health Organization, 2012). ...
In the last years, important innovations in technologies, diagnostics, and rehabilitative techniques have led to significant improvements in the quality of life of patients affected by hearing loss (HL). While many clinical studies on HL have been performed, less attention has been paid to the organizational and cultural context around it. For this reason, the Audiological Foundation of Varese (Fondazione Audiologica Varese, FAV) decided in 2018 to start collecting information about all 360 degrees of deafness. We share the results of three cross-sectional surveys investigating the experiences and perspectives on HL of citizens, patients, caregivers, voluntary association representatives, and health professionals. In total, 2828 Italian and international respondents were involved. Our findings might provide some valuable practitioner-and policy-oriented suggestions for changes and improvements to address the specific needs and interests of the involved stakeholders. This study was part of the initiative "A Global Overview On Deafness" (GOOD) organized by the FAV, which brought together different actors working toward the common goal of "hearing life": hearing specialists, technicians, educators, speech and behavioral therapists, researchers, patients, associations, and families. Always looking to a brighter and louder future.
Objective:
Describe the ear and hearing outcomes in Aboriginal infants in an Australian urban area.
Design:
Aboriginal infants enrolled in the Djaalinj Waakinj prospective cohort study had ear health screenings at ages 2-4, 6-8 and 12-18 months and audiological assessment at ∼12 months of age. Sociodemographic, environmental characteristics, otoscopy, otoacoustic emissions, tympanometry and visual reinforcement audiometry data were collected.
Study sample:
125 infants were enrolled in the study; 67 completed audiological assessment, 62, 54, and 58 of whom attended ear screenings at 2-4, 6-8 and 12-18 months.
Results:
Of the children that attended the audiological assessment, 36.5%, 50% and 64.3% of infants had otitis media (OM) at 2-4, 6-8 and 12-18 months. Using a 10 dB correction factor, 44.8% of infants had hearing loss (HL) (≥ 25 dB HL) at ∼ 12 months of age. More males (X2=5.4 (1df, p = 0.02)) and infants with OM at audiological assessment (X2=5.8 (1df, p = 0.02)) had HL. More infants that used a pacifier at 12-18 months of age had HL (X2=4.7 (1df, p = 0.03)).
Conclusion:
Aboriginal infants in an urban area have high rates of HL and OM, which requires early surveillance and timely treatment to reduce the medical and developmental impacts of OM and HL.
Introduction
Conductive hearing loss (CHL) attenuates the ability to transmit air conducted sounds to the ear. In humans, severe hearing loss is often accompanied by alterations to other neural systems, such as the vestibular system; however, the inter-relations are not well understood. The overall goal of this study was to assess vestibular-related functioning proxies in a rat CHL model.
Methods
Male Sprague–Dawley rats ( N =134, 250g, 2months old) were used in a CHL model which produced a >20dB threshold shift induced by tympanic membrane puncture. Auditory brainstem response (ABRs) recordings were used to determine threshold depth at different times before and after CHL. ABR threshold depths were assessed both manually and by an automated ABR machine learning algorithm. Vestibular-related functioning proxy assessment was performed using the rotarod, balance beam, elevator vertical motion (EVM) and Ferris-wheel rotation (FWR) assays.
Results
The Pre-CHL (control) threshold depth was 27.92dB±11.58dB compared to the Post-CHL threshold depth of 50.69dB±13.98dB (mean±SD) across the frequencies tested. The automated ABR machine learning algorithm determined the following threshold depths: Pre-CHL=24.3dB, Post-CHL same day=56dB, Post-CHL 7 days=41.16dB, and Post-CHL 1 month=32.5dB across the frequencies assessed (1, 2, 4, 8, 16, and 32kHz). Rotarod assessment of motor function was not significantly different between pre and post-CHL (~1week) rats for time duration (sec) or speed (RPM), albeit the former had a small effect size difference. Balance beam time to transverse was significantly longer for post-CHL rats, likely indicating a change in motor coordination. Further, failure to cross was only noted for CHL rats. The defection count was significantly reduced for CHL rats compared to control rats following FWR, but not EVM. The total distance traveled during open-field examination after EVM was significantly different between control and CHL rats, but not for FWR. The EVM is associated with linear acceleration (acting in the vertical plane: up-down) stimulating the saccule, while the FWR is associated with angular acceleration (centrifugal rotation about a circular axis) stimulating both otolith organs and semicircular canals; therefore, the difference in results could reflect the specific vestibular-organ functional role.
Discussion
Less movement (EVM) and increase time to transverse (balance beam) may be associated with anxiety and alterations to defecation patterns (FWR) may result from autonomic disturbances due to the impact of hearing loss. In this regard, vestibulomotor deficits resulting in changes in balance and motion could be attributed to comodulation of auditory and vestibular functioning. Future studies should manipulate vestibular functioning directly in rats with CHL.
Otitis media akut (OMA) adalah infeksi pada telinga tengah yang disebabkan oleh virus atau bakteri. OMA memiliki lima stadium, yaitu stadium oklusi, stadium hiperemis, stadium supuratif, stadium perforasi, dan stadium resolusi. Penurunan pendengaran adalah salah satu gejala klinis dari OMA. Tujuan penelitian ini untuk mencari apakah ada hubungan antara stadium OMA dengan derajat gangguan dengar dan bagaimana hubungan antara kedua variabel tersebut. Metode: Desain penelitian ini menggunakan metode cross sectional yang melibatkan rekam medis untuk menyeleksi kriteria eksklusi, setelah itu pasien yang sudah sesuai dengan kriteria inklusi akan dilakukan pemeriksaan audiometri nada murni. Hasil analisis hubungan antara stadium OMA dengan derajat gangguan dengar menggunakan uji Chi Square Pearson dengan nilai p= 0,001. Hasil analisis hubungan setiap stadium OMA dengan derajat gangguan dengar, memiliki nilai nilai p berbeda-beda. Stadium oklusi memiliki nilai p= 0,000, stadium hipermis memiliki nilai p= 0,000, stadium supuratif memiliki nilai p= 0,007, stadium perforasi memiliki nilai p= 0,000, dan stadium resolusi memiliki nilai p= 0,000. Dapat disimpulkan bahwa hubungan semua stadium OMA dengan derajat gangguan pendengaran di klinik Telinga Hidung Tenggorokan (THT) RS Dustira adalah signifikan karena nilai p< 0,05. Hubungan yang terjadi antara stadium OMA dengan derajat gangguan dengar disebabkan oleh gangguan hantar gelombang suara. Kesimpulan penelitian ini adalah gangguan hantaran gelombang suara ini dipengaruhi oleh beberapa komponen yang terganggu proses fisiologisnya. Komponen tersebut yaitu membran timpani, tekanan di telinga tengah, dan tulang-tulang di telinga tengah.
Objectives: The aim of the study was to investigate the long-term effects of early conductive hearing loss on binaural processing in school-age children.
Design: One hundred and eighteen children participated in the study, 82 children with a documented history of conductive hearing loss associated with otitis media and 36 controls who had documented histories showing no evidence of otitis media or conductive hearing loss. All children were demonstrated to have normal hearing acuity and middle ear function at the time of assessment. The Listening in Spatialized Noise (LiSN-S) task and the Masking Level Difference (MLD) task were used as the two different measures of binaural interaction ability.
Results: Children with a history of conductive hearing loss performed significantly poorer than controls on all LiSN-S conditions relying on binaural cues (DV90 p=<0.001 and SV90 p=0.003). No significant difference was found between the groups in listening conditions without binaural cues. Fifteen children with a conductive hearing loss history (18%) showed results consistent with a spatial processing disorder (SPD). No significant difference was observed between the conductive hearing loss group and the controls on the MLD task. Furthermore, no correlations were found between LiSN-S and MLD.
Conclusions: Results show a relationship between early conductive hearing loss and listening deficits that persist once hearing has returned to normal. Results also suggest the two binaural interaction tasks (LiSN-S and MLD) may be measuring binaural processing at different levels. Findings highlight the need for a screening measure of functional listening ability in children with a history of early otitis media.
Objectives:
Otitis media with effusion (OME) is the presence of non-purulent inflammation in the middle ear. Hearing impairment is frequently associated with OME. Pure tone audiometry and speech audiometry are two of the most primarily utilised auditory assessments and provide valuable behavioural and functional estimation on hearing loss. This paper was designed to review and analyse the effects of the presence of OME on children's listening abilities.
Design:
A systematic and descriptive review.
Study sample:
Twelve articles reporting frequency-specific pure tone thresholds and/or speech perception measures in children with OME were identified using PubMed, Ovid, Web of Science, ProQuest and Google Scholar search platforms.
Results:
The hearing loss related to OME averages 18-35 dB HL. The air conduction configuration is roughly flat with a slight elevation at 2000 Hz and a nadir at 8000 Hz. Both speech-in-quiet and speech-in-noise perception have been found to be impaired.
Conclusions:
OME imposes a series of disadvantages on hearing sensitivity and speech perception in children. Further studies investigating the full range of frequency-specific pure tone thresholds, and that adopt standardised speech test materials are advocated to evaluate hearing related disabilities with greater comprehensiveness, comparability and enhanced consideration of their real life implications.
The crosscheck principle is just as important in pediatric audiology as it was when first described 40 years ago. That is, no auditory test result should be accepted and used in the diagnosis of hearing loss until it is confirmed or crosschecked by one or more independent measures. Exclusive reliance on only one or two tests, even objective auditory measures, may result in a auditory diagnosis that is not clear or perhaps incorrect. On the other hand, close and careful analysis of findings for a test battery consisting of objective procedures and behavioral tests whenever feasible usually leads to prompt and accurate diagnosis of auditory dysfunction. This paper provides a concise review of the crosscheck principle from its introduction to its clinical application today. The review concludes with a description of a modern test battery for pediatric hearing assessment that supplements traditional behavioral tests with a variety of independent objective procedures including aural immittance measures, otoacoustic emissions, and auditory evoked responses.
Objectives
There are no nationally representative hearing loss (HL) prevalence data available for Canadian youth using direct measurements. The present study objectives were to estimate national prevalence of HL using audiometric pure-tone thresholds (0.5 to 8 kHz) and or distortion product otoacoustic emissions (DPOAEs) for children and adolescents, aged 3 to 19 years.
Design
This cross-sectional population-based study presents findings from the 2012/2013 Canadian Health Measures Survey, entailing an in-person household interview and hearing measurements conducted in a mobile examination clinic. The initial study sample included 2591 participants, aged 3 to 19 years, representing 6.5 million Canadians (3.3 million males). After exclusions, subsamples consisted of 2434 participants, aged 3 to 19 years and 1879 participants, aged 6 to 19 years, with valid audiometric results. Eligible participants underwent otoscopic examination, tympanometry, DPOAE, and audiometry. HL was defined as a pure-tone average >20 dB for 6- to 18-year olds and ≥26 dB for 19-year olds, for one or more of the following: four-frequency (0.5, 1, 2, and 4 kHz) pure-tone average, high-frequency (3, 4, 6, and 8 kHz) pure-tone average, and low-frequency (0.5, 1, and 2 kHz) pure-tone average. Mild HL was defined as >20 to 40 dB (6- to 18-year olds) and ≥26 to 40 dB (19-year olds). Moderate or worse HL was defined as >40 dB (6- to 19-year olds). HL in 3- to 5-year olds (n = 555) was defined as absent DPOAEs as audiometry was not conducted. Self-reported HL was evaluated using the Health Utilities Index Mark 3 hearing questions.
Results
The primary study outcome indicates that 7.7% of Canadian youth, aged 6 to 19, had any HL, for one or more pure-tone average. Four-frequency pure-tone average and high-frequency pure-tone average HL prevalence was 4.7 and 6.0%, respectively, whereas 5.8% had a low-frequency pure-tone average HL. Significantly more children/adolescents had unilateral HL. Mild HL was significantly more common than moderate or worse HL for each pure-tone average. Among Canadians, aged 6 to 19, less than 2.2% had sensorineural HL. Among Canadians, aged 3 to 19, less than 3.5% had conductive HL. Absent DPOAEs were found in 7.1E% of 3- to 5-year olds, and in 3.4E% of 6- to 19-year olds. Among participants eligible for the hearing evaluation and excluding missing data cases (n = 2575), 17.0% had excessive or impacted pus/wax in one or both ears. Self-reported HL in Canadians, aged 6 to 19, was 0.6 E% and 65.3% (aged 3 to 19) reported never having had their hearing tested. E indicates that a high sampling variability is associated with the estimate (coefficient of variation between 16.6% and 33.3%) and should be interpreted with caution.
Conclusions
This study provides the first estimates of audiometrically measured HL prevalence among Canadian children and adolescents. A larger proportion of youth have measured HL than was previously reported using self-report surveys, indicating that screening using self-report or proxy may not be effective in identifying individuals with mild HL. Results may underestimate the true prevalence of HL due to the large number excluded and the presentation of impacted or excessive earwax or pus, precluding an accurate or complete hearing evaluation. The majority of 3- to 5-year olds with absent DPOAEs likely had conductive HL. Nonetheless, this type of HL which can be asymptomatic, may become permanent if left untreated. Future research will benefit from analyses, which includes the slight HL category, for which there is growing support, and from studies that identify factors contributing to HL in this population.
To assess the performance of the universal newborn hearing screen in England.
Retrospective analysis of population screening records.
A total of 4 645 823 children born 1 April 2004 to 31 March 2013.
97.5% of the eligible population complete screening by 4/5 weeks of age and 98.9% complete screening by three months of age. The refer rate for the 12/13 birth cohort is 2.6%. The percentage of screen positive (i.e. referred) babies commencing follow up by four weeks of age and six months of age is 82.5% and 95.8% respectively. The yield of bilateral PCHL from the screen is around 1/1000. For bilateral PCHL in the 12/13 birth cohort the median age is nine days at screen completion, 30 days at entry into follow up, 49 days at confirmation, 50 days at referral to early intervention, and 82 days at hearing-aid fitting.
The performance of the newborn hearing screening programme has improved continuously. The yield of bilateral PCHL from the screen is about 1/1000 as expected. The age of identification and management is well within the first six months of life, although there remains scope for further improvement with respect to timely entry into follow up.
It has been ∼25 years since Bess published his first work on unilateral hearing loss in children. Those early articles triggered considerable interest in the audiology and medical communities and represented an expansion of our focus at that time on children with severe to profound degrees of hearing loss to include those with lesser degrees of hearing loss. Before Bess' work, professionals were of the opinion that minimal degrees of hearing loss were of little consequence to a child's development. However, these early studies demonstrated that children with minimal degrees of permanent hearing loss were, in fact, at considerable risk for academic and behavioral problems. Today those problems persist, and we are still wrestling with which children with minimal degrees of hearing loss require intervention, what type(s) of intervention is most effective, and whether preventive measures exist to avoid the commonly reported problems known to plague some of these children. This article reviews the early studies conducted by Bess and his colleagues documenting the psychoeducational, audiological, and behavioral difficulties experienced by children with permanent unilateral and minimal bilateral hearing loss. In addition, contemporary studies are reported along with a summary of current thinking on the appropriate management of these populations.
Studies of children with minimal hearing loss have included children with varying degrees of hearing loss, ranging from 16 dB hearing level (HL) to 44 dB HL. Because children with unilateral, high-frequency, and mild bilateral hearing loss have not previously been identified in the newborn period, it has been difficult to describe the developmental progress of these children. With the early hearing detection and intervention programs, a significant population of very young children is being identified with mild bilateral hearing loss and unilateral hearing loss, some of whom are receiving no intervention services, whereas others begin using amplification and are enrolled in varying intensities and types of intervention services. Although not all children with mild bilateral hearing loss and unilateral hearing loss have significantly delayed development compared with their peers with normal hearing, approximately one third evidence significant difficulties in their language, academic, and social-emotional development. Researchers are striving to identify those characteristics of the children with minimal hearing loss at greatest risk for developmental delay. For a significant portion of children with minimal hearing loss, a hearing loss of any degree appears sufficient to interrupt the normal continuum of communication development and academic skills.
This article will present a summary of the current body of literature that has found that children with mild bilateral hearing loss and unilateral hearing loss have significant developmental delays in language, academic, and social-emotional development when compared with typically hearing peers, as well as some studies that have not found such delays. The reasons for these discrepancies will be discussed.
Inuit Canadians are on average about 20 years younger and have a 10-year lower life expectancy than other Canadians. While there have been improvements in Inuit health status over time, significant health disparities still remain. This paper will review the peer-reviewed literature related to Inuit child, youth, and maternal health between 2000 and 2010, investigate which thematic areas were examined, and determine what proportion of the research is related to each group. Establishing areas of research concentrations and scarcities may help direct future research where it is needed. We followed a systematic literature review and employed peer-reviewed research literature on child, youth, and maternal health which were selected from 3 sources, MEDLINE, CINAHL, and the Circumpolar Health Bibliographic Database. The resulting references were read, and summarized according to population group and thematic area. The thematic areas that emerged by frequency were: infectious disease; environment/environmental exposures; nutrition; birth outcomes; tobacco; chronic disease; health care; policy, human resources; interventions/programming; social determinants of health; mental health and wellbeing; genetics; injury; and dental health. The 72 papers that met the inclusion criteria were not mutually exclusive with respect to group studied. Fifty-nine papers (82%) concerned child health, 24 papers (33%) youth health, and 58 papers (81%) maternal health. The review documented high incidences of illness and significant public health problems; however, in the context of these issues, opportunities to develop research that could directly enhance health outcomes are explored.
Children with unilateral hearing loss (UHL) have been found to have lower language scores, and increased rate of speech therapy, grade failures, or needing Individualized Education Plans (IEPs). The objective of this study was to determine whether language skills and educational performance improved or worsened over time in a cohort of children with UHL.
Prospective longitudinal cohort study.
Forty-six children with permanent UHL, ages 6 to 12 years, were studied using standardized cognitive, achievement, and language testing at yearly intervals for 3 years. Using standardized test scores allowed implicit comparison to norms established by national cross-sectional samples. Secondary outcomes included behavioral issues, IEPs, receipt of speech therapy, or teacher report of problems at school. Analysis utilized repeated measures analysis of variance and multilevel random regression modeling.
Several cognitive and language mean standardized scores increased over time. Possible predictors of increase with time included higher baseline cognitive levels and receipt of interventions through an IEP. However, standardized achievement scores and indicators of school performance did not show concomitant improvements. Rates of IEPs remained >50% throughout, and rates of speech therapy were consistently about 20%.
Children with UHL demonstrated improvement in oral language and verbal intelligence quota scores over time, but not improvements in school performance. Parents and teachers reported persistent behavioral problems and academic weaknesses or areas of concern in about 25%. The provision of IEPs for children with UHL, and acknowledging UHL as a hearing disability, may be an effective intervention to improve language skills over time.
The noise-excluding properties of a standard supra-aural audiometric earphone, a widely used circumaural-supra-aural combination, and an insert earphone sealed to the ear with a vinyl foam eartip were measured in a diffuse-field room complying with ANSI S12.6-1984. Data on attenuation were obtained monaurally with the nontest ear plugged and muffed. Results for the supra-aural earphones generally agreed well with previously reported measurements. A broadband masking noise was used to directly test the ANSI S3.1-1977 permissible background noise levels for measuring to audiometric zero using standard audiometric earphones. This "ANSI noise" raised the average thresholds of 15 normal-hearing test subjects by 3 to 5 dB at the octave frequencies from 500 to 4000 Hz. With a noise conforming to the less stringent OSHA-1983 regulation, average thresholds were elevated 9 to 17 dB. An "ENT office noise" with an overall sound level of 54 dBA raised average thresholds even further, by as much as 29 dB at 500 Hz. Use of the circumaural system in the office noise limited the threshold elevation to 11, 5, 2, and 0 dB at the four octave frequencies tested. With the fully ("deeply") inserted foam eartips, the threshold elevation in the simulated office noise was 2 dB or less at all test frequencies. Actual threshold elevations agreed closely with predictions based on a critical ratio calculation utilizing measured sound field noise levels and measured earphone attenuation values.
To compare the language abilities of earlier- and later-identified deaf and hard-of-hearing children.
We compared the receptive and expressive language abilities of 72 deaf or hard-of-hearing children whose hearing losses were identified by 6 months of age with 78 children whose hearing losses were identified after the age of 6 months. All of the children received early intervention services within an average of 2 months after identification. The participants' receptive and expressive language abilities were measured using the Minnesota Child Development Inventory.
Children whose hearing losses were identified by 6 months of age demonstrated significantly better language scores than children identified after 6 months of age. For children with normal cognitive abilities, this language advantage was found across all test ages, communication modes, degrees of hearing loss, and socioeconomic strata. It also was independent of gender, minority status, and the presence or absence of additional disabilities.
Significantly better language development was associated with early identification of hearing loss and early intervention. There was no significant difference between the earlier- and later-identified groups on several variables frequently associated with language ability in deaf and hard-of-hearing children. Thus, the variable on which the two groups differed (age of identification and intervention) must be considered a potential explanation for the language advantage documented in the earlier-identified group.
Inuit infants throughout the Arctic experience higher mortality and poorer health than their non-Inuit counterparts, and suffer disproportionately from bacterial and viral infections.
This review examines the health status of these infants, with a focus on Canadian Inuit communities and reference to other circumpolar regions, as appropriate. It is based on a Medline search (1965 to present), special analyses of the 1996 Canadian Census and various national surveys, and selected government reports and documents.
A wide range of inter-related factors affect the health of Inuit infants: their demographic, social, economic and physical environment, as well as personal health practices and the availability of high quality, culturally appropriate health services. Some of these factors may influence the susceptibility of Inuit infants to infection. Smoking is highly prevalent in Inuit communities, and its indisputable negative effects on health, including increased risk of respiratory tract infection in infants, represent an urgent public health challenge.
Locally driven, focused and methodologically sound epidemiological research that addresses key gaps in knowledge could lead to more appropriate and effective preventive strategies to improve health in northern communities.
Better language outcomes are reported for preschool children with hearing impairment (HI) diagnosed very early, irrespective of severity. However, population studies of older children are required to substantiate longer term benefits of early detection.
To study impact of age of diagnosis and severity of HI in a population cohort of 7-8 year old children.
Eighty eight 7-8 year old children born in Victoria, who were (a) fitted with hearing aids for congenital HI by 4.5 years and (b) did not have intellectual or major physical disability were studied. Main outcome measures were Clinical Evaluation of Language Fundamentals (CELF) and Peabody Picture Vocabulary Test (PPVT). Predictors were pure tone average (0.5, 1, 2 kHz) in better ear at diagnosis and age at diagnosis. Marginal (adjusted) means were estimated with general linear models.
Response rate was 67% (n = 89; 53 boys). Mean age at diagnosis was 21.6 months (SD 14.4); 21% had mild, 34% moderate, 21% severe, and 24% profound HI; mean non-verbal IQ was 104.6 (SD 16.7). Mean total CELF score was 76.7 (SD 21.4) and mean PPVT score 78.1 (SD 18.1). Age of diagnosis, adjusted for severity and IQ, did not contribute to language scores. In contrast, adjusted mean CELF and PPVT language scores fell sequentially with increasing severity of HI.
More severe HI, but not later diagnosis, was strongly related to poorer language outcomes at 7-8 years. Further systematic study is needed to understand why children with hearing impairment have good or poor outcomes.
Children with bilateral permanent hearing impairment often have impaired language and speech abilities. However, the effects of universal newborn screening for permanent bilateral childhood hearing impairment and the effects of confirmation of hearing impairment by nine months of age on subsequent verbal abilities are uncertain.
We studied 120 children with bilateral permanent hearing impairment identified from a large birth cohort in southern England, at a mean of 7.9 years of age. Of the 120 children, 61 were born during periods with universal newborn screening and 57 had hearing impairment that was confirmed by nine months of age. The primary outcomes were language as compared with nonverbal ability and speech expressed as z scores (the number of standard deviations by which the score differed from the mean score among 63 age-matched children with normal hearing), adjusted for the severity of the hearing impairment and for maternal education.
Confirmation of hearing impairment by nine months of age was associated with higher adjusted mean z scores for language as compared with nonverbal ability (adjusted mean difference for receptive language, 0.82; 95 percent confidence interval, 0.31 to 1.33; and adjusted mean difference for expressive language, 0.70; 95 percent confidence interval, 0.13 to 1.26). Birth during periods with universal newborn screening was also associated with higher adjusted z scores for receptive language as compared with nonverbal ability (adjusted mean difference, 0.60; 95 percent confidence interval, 0.07 to 1.13), although the z scores for expressive language as compared with nonverbal ability were not significantly higher. Speech scores did not differ significantly between those who were exposed to newborn screening or early confirmation and those who were not.
Early detection of childhood hearing impairment was associated with higher scores for language but not for speech in midchildhood.
The goal was to determine the prevalence and effects of slight/mild bilateral sensorineural hearing loss among children in elementary school.
A cross-sectional, cluster-sample survey of 6581 children (response: 85%; grade 1: n = 3367; grade 5: n = 3214) in 89 schools in Melbourne, Australia, was performed. Slight/mild bilateral sensorineural hearing loss was defined as a low-frequency pure-tone average across 0.5, 1, and 2 kHz and/or a high-frequency pure-tone average across 3, 4, and 6 kHz of 16 to 40 dB hearing level in the better ear, with air/bone-conduction gaps of < 10 dB. Parents reported children's health-related quality of life and behavior. Each child with slight/mild bilateral sensorineural hearing loss, matched to 2 normally hearing children (low-frequency pure-tone average and high-frequency pure-tone average of < or = 15 dB hearing level in both ears), completed standardized assessments. Whole-sample comparisons were adjusted for type of school, grade level, and gender, and matched-sample comparisons were adjusted for nonverbal IQ scores.
Fifty-five children (0.88%) had slight/mild bilateral sensorineural hearing loss. Children with and without sensorineural hearing loss scored similarly in language (mean: 97.2 vs 99.7), reading (101.1 vs 102.8), behavior (8.4 vs 7.0), and parent- and child-reported child health-related quality of life (77.6 vs 80.0 and 76.1 vs 77.0, respectively), but phonologic short-term memory was poorer (91.0 vs 102.8) in the sensorineural hearing loss group.
The prevalence of slight/mild bilateral sensorineural hearing loss was lower than reported in previous studies. There was no strong evidence that slight/mild bilateral sensorineural hearing loss affects adversely language, reading, behavior, or health-related quality of life in children who are otherwise healthy and of normal intelligence.
According to population-based prevalence data, more than 40% of children diagnosed with a hearing impairment have a mild to moderate bilateral or unilateral hearing loss. Prior to newborn hearing screening, these degrees of loss were not identified until early school-age. While studies highlight the challenges of late-identified children with such a loss, little is known about the effects of early identification. This descriptive study explored the impact of mild to moderate bilateral and unilateral hearing loss on children in the early school years. Thirty-two children (aged 5–9 years) were evaluated cross-sectionally with a battery of tests to measure speech-language, phonology, and components of literacy skills. Parents also completed a questionnaire on functional auditory skills. Most outcomes were within the range of expected scores for children with typical hearing. In most cases, however, parent-reported functional auditory skills were lower than published norms. Some phonological processing skills were also below the average expected for children with typical hearing. In particular, 46.4% of children were below one standard deviation of the normative mean on the phonological memory score. Subgroup comparisons between children with unilateral (n = 17) and bilateral (n = 15) hearing loss showed no difference on all outcomes (p > 0.05). While scores should be interpreted with caution given the small sample size, findings reinforce the need for additional research on children with mild to moderate bilateral and unilateral hearing loss who benefit from early identification.
The aim of this article was to (1) provide a scoping review of the literature addressing speech, auditory, language, and literacy interventions in multilingual children with hearing loss, and (2) identify future research directions. The search conducted for this scoping review yielded a total of 27 sources describing 58 intervention approaches for a range of grade levels (from preschool age through school age). The majority of interventions were obtained from sources describing children with hearing loss (n = 35), followed by multilingual children (n = 32), multilingual children with additional needs (n = 22), and finally multilingual children with hearing loss (n = 17). The scope of the interventions identified and the strength of intervention recommendations are discussed. This scoping review identified a number of compelling and promising research-based interventions from the best available evidence currently available, and this review confirmed the need for more intervention studies with multilingual children with hearing loss. © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Objectives:
Children with unilateral hearing loss (UHL) are being diagnosed at younger ages because of newborn hearing screening. Historically, they have been considered at risk for difficulties in listening and language development. Little information is available on contemporary cohorts of children identified in the early months of life. We examined auditory and language acquisition outcomes in a contemporary cohort of early-identified children with UHL and compared their outcomes at preschool age with peers with mild bilateral loss and with normal hearing.
Design:
As part of the Mild and Unilateral Hearing Loss in Children Study, we collected auditory and spoken language outcomes on children with unilateral, bilateral hearing loss and with normal hearing over a four-year period. This report provides a cross-sectional analysis of results at age 48 months. A total of 120 children (38 unilateral and 31 bilateral mild, 51 normal hearing) were enrolled in the study from 2010 to 2015. Children started the study at varying ages between 12 and 36 months of age and were followed until age 36-48 months. The median age of identification of hearing loss was 3.4 months (IQR: 2.0, 5.5) for unilateral and 3.6 months (IQR: 2.7, 5.9) for the mild bilateral group. Families completed an intake form at enrolment to provide baseline child and family-related characteristics. Data on amplification fitting and use were collected via parent questionnaires at each annual assessment interval. This study involved a range of auditory development and language measures. For this report, we focus on the end of follow-up results from two auditory development questionnaires and three standardized speech-language assessments. Assessments included in this report were completed at a median age of 47.8 months (IQR: 38.8, 48.5). Using ANOVA, we examined auditory and language outcomes in children with UHL and compared their scores to children with mild bilateral hearing loss and those with normal hearing.
Results:
On most measures, children with UHL performed poorer than those in the mild bilateral and normal hearing study groups. All children with hearing loss performed at lower levels compared to the normal hearing control group. However, mean standard scores for the normal hearing group in this study were above normative means for the language measures. In particular, children with UHL showed gaps compared to the normal hearing control group in functional auditory listening and in receptive and expressive language skills (three quarters of one standard deviation below) at age 48 months. Their performance in receptive vocabulary and speech production was not significantly different from that of their hearing peers.
Conclusions:
Even when identified in the first months of life, children with UHL show a tendency to lag behind their normal hearing peers in functional auditory listening and in receptive and expressive language development.
Research on bilingualism in children with developmental language and communication disorders has focused primarily on children with specific language impairment (SLI), but some recent research has emerged on children with Autism Spectrum Disorder (ASD). In this chapter we review research on bilingual development in children with SLI and ASD organized around the following topics: (1) The capacity for successful bilingualism in children with developmental disorders; (2) The linguistic profiles of bilinguals with SLI across different languages and linguistic subdomains; (3) Crosslinguistic influence in bilingual development with SLI; (4) Development of a minority/heritage language in children with developmental disorders, and (6) Challenges and strategies in assessment and intervention practices with bilingual children.
Objective:
Conductive hearing loss simulations have attempted to estimate the speech-understanding difficulties of children with otitis media with effusion (OME). However, the validity of this approach has not been evaluated. The research aim of the present study was to investigate whether a simple, frequency-specific, attenuation-based simulation of OME-related hearing loss was able to reflect the actual effects of conductive hearing loss on speech perception.
Design:
Forty-one school-age children with OME-related hearing loss were recruited. Each child with OME was matched with a same sex and age counterpart with normal hearing to make a participant pair. Pure-tone threshold differences at octave frequencies from 125 to 8000 Hz for every participant pair were used as the simulation attenuation levels for the normal-hearing children. Another group of 41 school-age otologically normal children were recruited as a control group without actual or simulated hearing loss. The Mandarin Hearing in Noise Test was utilized, and sentence recall accuracy at four signal to noise ratios (SNR) considered representative of classroom-listening conditions were derived, as well as reception thresholds for sentences (RTS) in quiet and in noise using adaptive protocols.
Results:
The speech perception in quiet and in noise of children with simulated OME-related hearing loss was significantly poorer than that of otologically normal children. Analysis showed that RTS in quiet of children with OME-related hearing loss and of children with simulated OME-related hearing loss was significantly correlated and comparable. A repeated-measures analysis suggested that sentence recall accuracy obtained at 5-dB SNR, 0-dB SNR, and -5-dB SNR was similar between children with actual and simulated OME-related hearing loss. However, RTS in noise in children with OME was significantly better than that for children with simulated OME-related hearing loss.
Conclusions:
The present frequency-specific, attenuation-based simulation method reflected the effects of OME-related hearing loss on speech perception impairment in quiet environments. In noisy environments, the simulation method could only approximately estimate the effects of OME-related hearing loss on speech perception in typical classroom noise levels. Children with OME-related hearing loss may develop compensatory strategies to reduce the effects of hearing loss in adverse listening environments.
Objective:
This study investigated the factors influencing 5-year language, speech and everyday functioning of children with congenital hearing loss.
Design:
Standardised tests including PLS-4, PPVT-4 and DEAP were directly administered to children. Parent reports on language (CDI) and everyday functioning (PEACH) were collected. Regression analyses were conducted to examine the influence of a range of demographic variables on outcomes.
Study sample:
Participants were 339 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study.
Results:
Children's average receptive and expressive language scores were approximately 1 SD below the mean of typically developing children, and scores on speech production and everyday functioning were more than 1 SD below. Regression models accounted for 70-23% of variance in scores across different tests. Earlier CI switch-on and higher non-verbal ability were associated with better outcomes in most domains. Earlier HA fitting and use of oral communication were associated with better outcomes on directly administered language assessments. Severity of hearing loss and maternal education influenced outcomes of children with HAs. The presence of additional disabilities affected outcomes of children with CIs.
Conclusions:
The findings provide strong evidence for the benefits of early HA fitting and early CI for improving children's outcomes.
Objective
Unilateral hearing loss has been shown to have negative consequences for speech and language development in children. The objective of this study was to systematically review the current literature to quantify the impact of unilateral hearing loss on children, with the use of objective measures of speech and language.
Data Sources
PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to March 2015. Manual searches of references were also completed.
Review Methods
All studies that described speech and language outcomes for children with unilateral hearing loss were included. Outcome measures included results from any test of speech and language that evaluated or had age-standardized norms. Due to heterogeneity of the data, quantitative analysis could not be completed. Qualitative analysis was performed on the included studies. Two independent evaluators reviewed each abstract and article.
Results
A total of 429 studies were identified; 13 met inclusion criteria and were reviewed. Overall, 7 studies showed poorer scores on various speech and language tests, with effects more pronounced for children with severe to profound hearing loss. Four studies did not demonstrate any difference in testing results between patients with unilateral hearing loss and those with normal hearing. Two studies that evaluated effects on speech and language longitudinally showed initial speech problems, with improvement in scores over time.
Conclusions
There are inconsistent data regarding effects of unilateral hearing loss on speech and language outcomes for children. The majority of recent studies suggest poorer speech and language testing results, especially for patients with severe to profound unilateral hearing loss.
Background:
Access to hearing health care is limited in many parts of the world, creating a lack of prompt diagnosis, which further complicates treatment. The use of portable audiometry for hearing loss testing can improve access to diagnostics in marginalized populations. Our study objectives were twofold: (1) to determine the prevalence of hearing loss in children aged 4 to 11 years in Iqaluit, Nunavut, and (2) to test and demonstrate the use of our tablet audiometer as a portable hearing-testing device in a remote location.
Study design:
Prospective cross-sectional observational.
Setting:
Remote elementary schools in 3 Canadian Northern communities.
Subjects and methods:
Tablet audiometers were used to test hearing in 218 children. Air conduction pure tones thresholds were obtained at 500, 1000, 2000, and 4000 Hz. Children with hearing loss ≥30 dB in either ear were referred for audiology services.
Results:
Tablet audiometry screening testing revealed abnormal results in 14.8% of the study participants. No significant difference in the rate of hearing loss was seen by sex; however, the rate of hearing loss decreased significantly with increasing age. The median duration of the hearing test was 5 minutes 30 seconds.
Conclusions:
Of the study population, 14.8% tested positive for hearing loss based on our interactive tablet audiometer. In this setting, the tablet audiometer was both time efficient and largely language independent. This type of testing is valuable for providing much-needed hearing health care for high-risk populations in rural and remote areas where audiology services are often unavailable.
Children with minimal/mild hearing loss make up approximately 5% of the school-age population. While there is considerable research indicating that these children experience difficulties in a number of areas, there also is research indicating that they perform similarly to their peers with normal hearing. Understanding the potential difficulties that these children may experience and how their communication access needs may differ from those of their peers with normal hearing is important for habilitation. A lack of clear consensus could negatively impact provision of habilitation services. Awareness of factors that may affect that consensus can be useful in interpreting findings. This paper will address a number of those potential factors.
Purpose:
This pilot study investigated the potential benefits of sound field amplification for Inuit first and second language learners in a remote community of Nunavik, Northern Québec. Hearing screening results showed that 26% of students attending the local school had hearing loss due to otitis media. The study used speech intelligibility and attending behavior measures, as well as interviews, to examine the appropriateness of sound field amplification in the multilingual and multilevel instructional contexts found in the classrooms of Nunavik.
Method:
Sound field amplification systems were installed in three representative classrooms for a period of 3 months. Speech intelligibility of Inuttitut syllables was compared in amplified versus non-amplified conditions for 10 students with hearing loss and 10 age-matched normal hearing peers. Observations of four categories of attending behaviors for a separate set of seven students were carried out prior to the installation of the systems and with the systems in place. Teacher and student comments were collected during the study and after the study was completed.
Results:
Results showed significant improvements in speech intelligibility scores for students with hearing impairment and normal hearing in the amplified condition. Total scores for on-task behavior improved for six of the seven students observed; all students demonstrated improvement in at least one category of attending behavior. Teacher and student comments identified numerous advantages of the amplification systems.
Implications:
Results point to the potential benefits of sound field amplification for multicultural populations that are similarly challenged by high rates of hearing loss, as well as for second language learners.
Objective: To determine if adolescents with unilateral hearing loss (UHL) demonstrate worse language skills than their siblings with normal hearing (NH). Design: Case-control study of 12-17-year-old adolescents with UHL (20 cases) compared with sibling controls with NH (13 controls). Methods: Scores on the oral portion of the Oral and Written Language Scales (OWLS) and the Clinical Evaluation of Language Fundamentals (CELF) were the primary outcome measure. Wechsler's Abbreviated Scales of Intelligence (WASI) scores were also used as an outcome measure. Results: Adolescents with UHL demonstrated worse overall and expressive language scores than controls, (98 vs. 114, P = 0.001; 100 vs. 114, P = 0.006) and had significantly lower full scale (98 vs. 112, P = 0.017), verbal (101 vs. 113, P = 0.032), and performance IQ (95 vs. 107, P = 0.037). Conclusions: These findings suggest that UHL in adolescents is associated with a negative effect on standardized language scores and IQ. They also demonstrate that the developmental gap between children with UHL and children with NH does not resolve as the children progress into adolescence and may even widen as the children grow older. Therefore, these results strongly encourage implementation of early intervention for children with UHL to prevent speech-language delays. More studies in adolescents are warranted to evaluate educational outcomes.
Impedance audiometry was performed as part of the routine clinical examination in a consecutive series of more than 400 patients with various types and degrees of hearing impairment. An electroacoustic bridge (Madsen, ZO 70) was used to carry out the measurement of tympanometry, acoustic impedance, and threshold for the acoustic reflex. Results indicate that, while individual components of the total impedance battery lack diagnostic precision, the overall pattern of results yielded by the complete battery can be of great diagnostic value, especially in the evaluation of young children.
Inuits of the Arctic experience very high rates of chronic suppurative otitis media (CSOM), yet world-wide, very little is known about the epidemiology of CSOM. The study aims were to determine incidence, median age at debut, risk factors, and associated population attributable risks for CSOM in young children in Sisimiut, the second biggest town of Greenland (population 5400), where living conditions are relatively western and approximately 90% are Inuits.
A population-based birth cohort of 465 children aged between 0 and 4 years was followed for a 2-year period (1996 to 1998), and cases of CSOM were registered based on medical history and clinical examinations. Kaplan-Meier curves were used for estimations of cumulative risk and Cox regression analyses for hazard rates associated with risk factors.
Cumulative risk of CSOM at 4 years of age was 14%, and median age at debut was 336 days. Risk factors were attending childcare centers (hazard ratio [HR]: 3.18, 95% confidence interval [CI]: 1.53- 6.61), having smokers in the household (HR: 4.56, 95% CI: 1.07-19.4), having a mother who reported a history of purulent ear discharge (3.27, 95% CI: 1.74-6.13), having a high burden of upper respiratory tract infections (HR: 1.19, 95% CI: 1.03-1.37), and being Inuit (HR: 5.56, 95% CI: 0.78-50).
Greenlandic children have high rates of CSOM with debut early in life, but the identified risk factors and the associated population attributable risks indicate that preventive measures regarding use of childcare centers and passive smoking may reduce the high frequency of CSOM in this high-risk population.
Hearing loss ranks high among disabilities in the United States. The epidemiologic parameters of hearing impairment in the United States have not been systematically studied and important historic data have not diffused to relevant stakeholders; even otolaryngologists are unfamiliar with epidemiologic data. We wished to compile known studies to establish an epidemiologic baseline beginning with pediatric data.
Relevant literature was retrieved from medical databases and Centers for Disease Control and Prevention reports.
Candidate articles and national data sets encompassing pediatric hearing loss were analyzed and compared. Whenever possible, group analyses were performed.
The average incidence of neonatal hearing loss in the United States is 1.1 per 1000 infants, with variation among states (0.22 to 3.61 per 1000). Childhood and adolescent prevalence rates demonstrate variability. The prevalence of mild hearing impairment or worse (>20 dB) is 3.1 percent based on the average of comparable audiometric screening studies; self-reporting prevalence is 1.9 percent. Hispanic Americans demonstrate a higher prevalence of hearing impairment than other children. Low-income households demonstrate a higher prevalence of hearing loss compared to households with higher income levels. Genetic causes were attributed to 23 percent across studies.
Analysis of the data reveals gaps in our knowledge of the epidemiology of hearing loss and stresses the importance of consistent definitions of hearing impairment for systematic assessment of changes over time. Hearing loss in childhood deserves further epidemiologic investigation and elevated awareness among health care professionals and the public. Genetic etiologies are likely underestimated in this review.
• We discuss a method of pediatric audiologic assessment that employs the "cross-check principle." That is, the results of a single test are cross-checked by an independent test measure. Particularly useful in pediatric evaluations as cross-checks of behavioral test results are impedance audiometry and brainstem-evoked response audiometry (BSER). We present five cases highlighting the value of the cross-check principle in pediatric audiologic evaluation.
(Arch Otolaryngol 102:614-620, 1976)
Ear disease and associated hearing loss were studied in 194 Eskimo children aged 4-14 yr attending the Frobisher Bay Elementary School. Two otologic and audiologic examinations were made on each child, the second 14 mth after the first. Results of the 2 sets of examinations were compared. They showed no increase in the prevalence of chronic otitis media, which affected about 30% of boys and 15% of girls. Changes in the condition of ears and the degree of hearing loss were analysed in relation to age and sex of the children. For the majority, findings of the second visit were similar to those of the first, but changes either for the better or for the worse were found in a significant proportion of cases. Factors relating to the prevention and treatment of chronic otitis media and the implications of hearing loss on education are discussed.
A survey was undertaken to determine the amount of ear disease and hearing loss present in the native population of the Baffin Zone. Survey teams visited 12 of the 13 settlements in this Zone and examined 3,770 of the 4,962 Eskimos living in these settlements. Results, analyzed by age, sex and settlement, show that most chronic otitis media and conductive hearing loss is found among children in the southern settlements, where from 13 to 19% of the school population suffer from the disease. Chronic otitis media was infrequently seen in adults, but sensorineural hearing loss secondary to noise exposure was found in up to 85% adult males. Details of findings are presented and the implications of the survey discussed.
The aim of this prospective study was to estimate the prevalence of different types of eardrum pathology in a cohort of children and teenagers up to the age of 16. Among this initial group of 373 subjects, repetitive screening trials including otomicroscopy and tympanometry were performed from age 5 to 16 years. All clinical pathology of Shrapnell's membrane and the pars tensa was recorded systematically. At age 5 years, pathology of the eardrum was found in 19% of ears examined. At succeeding follow-ups until the age of 16 years, the prevalence of eardrum pathology increased to 33%. The tympanometric profile improved significantly from 49% of children with negative middle ear pressure at age 5 years to 4% at age 16 years. The patency of the eustachian tube was estimated in the group with eardrum pathology and compared to the group with no eardrum pathology. Our findings show that, despite improvement of middle ear ventilation through childhood, the prevalence of pathological changes of the eardrum seems to increase. The reason for this increase is discussed.
Despite advances in public health and medical care, chronic suppurative otitis media is still prevalent around the world. It is most common in developing countries and in certain high risk populations in developed nations, as well as among children who have tympanostomy tubes inserted. Since this chronic infection is caused by persistent acute otorrhea, which in turn is usually secondary to acute otitis media, prevention should be directed toward prompt and appropriate treatment of the acute middle-ear infection. Repair of chronic perforations should prevent recurrence, since reinfection is due either to reflux of pathogenic organisms from the nasopharynx into the middle ear, or water contamination from the external canal. Information from epidemiological studies, which show that populations can be categorized into highest, high, low and lowest prevalence, can be helpful in setting national priorities for prevention and treatment.
Clinical observations made on the Inuit in the Eastern Canadian Arctic during the past three decades support that the current high prevalence of chronic otitis media among their children is a relatively new phenomenon. It is a social/economic disease related to their urbanization that occurred following World War II when the vast majority of the Inuit abandoned their isolated nomadic way of life and moved into permanent settlements. The disease, in a great many, runs a natural course with spontaneous healing. There is evidence that as the new millennium approaches the prevalence of the disease among the children is decreasing.
Otitis media (OM) is the most frequently diagnosed disease in infants and young children. Large, prospective studies suggest an increase in incidence of this disease during the past 10 to 20 years, possibly reflecting a change in host and environmental risk factors for the development of OM. Good knowledge of host (intrinsic) and environmental (extrinsic) risk factors for the development of otitis media is important in identifying a child at risk for recurrent and persistent OM. This could result in primary and/or secondary prevention of OM and a decrease in complications and sequelae.
Chronic otitis media (COM) and associated hearing loss is a frequent problem for many Inuit children in Canada. In this study, we evaluated individuals aged 12-16 years living in Inukjuak, to determine the prevalence of middle ear disease and hearing loss, and the effect of hearing loss on academic performance.
Otological examination, hearing test, medical and school file review were performed in November 1997. 88 individuals were seen.
Otological examination revealed maximal scarring in 1.8%, minimal scarring in 34.9%, normal eardrums in 49.1% and chronic otitis media in 16.9%. There were 62 individuals whose ear exams could be directly compared with a previous exam done in 1987. Of those, there were three ears that had developed COM and 4/13 ears with COM in 1987 that had healed. Hearing tests found bilateral normal hearing in 80% (PTA <20dB), unilateral loss in 15% and bilateral loss in 5%. Hearing loss was associated with poorer academic performance in Language (p<.05). A similar trend was found in Mathematics but not in Inuttitut.
Chronic otitis media remains a significant problem among the Inuit, with a prevalence of 16.9% in individuals aged 12-16 years. One in five in this age group has hearing loss, and this hearing loss impacts on academic performance.
Otitis media is endemic among Inuit, First Nations and Métis children in northern Canada, with prevalence rates in some communities as high as 40 times that found in the urban south. Hearing impairment, much of it attributable to chronic otitis media, is the most common health problem in parts of the arctic, and conductive hearing loss among children may affect as many as two-thirds.
There is a need for systematic data based on consistent disease definitions and measures, and taking account of cross-cultural methodological issues and sampling.
Otitis media is most likely to develop in infancy. Susceptibility has been linked to immune defects and to a variety of environmental factors. Among the most significant are diet, the decline in initiation and maintenance of breastfeeding, and exposure to cigarette smoke. Hearing loss has been related to difficulties in language acquisition, and to subsequent issues with literacy and school achievement, including learning disabilities and attention deficits. The economic and social costs of otitis media are substantial.
Approaches to treatment and prevention have enjoyed limited success. Public health and medical practice need to be informed by the traditional knowledge and practices of indigenous peoples.
Implementation of systematic programs for early identification of hearing impairment in the newborn and infant is increasing in Canada and worldwide. This article outlines the rationale for these programs, methods of screening, audiologic assessment and intervention, program outcomes and the crucial role of physicians. Sources of high-quality, current evidence on key aspects of these programs are identified. There is an emerging, evidence-based consensus that a systematic approach based on universal newborn hearing screening (UNHS) and timely, appropriate follow-up services is practicable and will yield substantial net benefit for many affected children and families. Early identification programs lead to physicians being faced with infants under six months of age who already have detailed and accurate audiometry. Important challenges include a systematic approach to etiologic evaluation of the young infant with permanent hearing impairment and the facilitation of prompt, non-medical interventions.
The purpose of this paper is to provide a review of past and current research regarding language and literacy development in children with mild to severe hearing impairment. A related goal is to identify gaps in the empirical literature and suggest future research directions. Included in the language development review are studies of semantics (vocabulary, novel word learning, and conceptual categories), morphology, and syntax. The literacy section begins by considering dimensions of literacy and the ways in which hearing impairment may influence them. It is followed by a discussion of existing evidence on reading and writing, and highlights key constructs that need to be addressed for a comprehensive understanding of literacy in these children.
Bilingualism and Children with Developmental Language and Communication Disorders
- J Paridis
- K Govindarajan