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Hearing loss prevalence and hearing health among school-aged children in the Canadian Arctic

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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.

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... 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). ...
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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.
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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.
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Article
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.
Chapter
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
• 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)
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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