Screening for pre-school and school-age hearing problems: European Consensus Statement

Objectives

To formulate consensus statement and policies on structured hearing screening programs in pre-school and school-age children in Europe. This consensus will be brought before the European Union's Member States as a working and effective program with recommendations for adoption.

Methods

A distinguished panel of experts discussed hearing screening of pre-school and school-age children during the 10th Congress of European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on June 22, 2011. The panel included experts in audiology, otolaryngology, communication disorders, speech language pathology, education and biomedical engineering.

Results

Consensus was reached on thirteen points. Key elements of the consensus, as described herein, are: (1) defining the role of pre-school and school screening programs in the identification and treatment of hearing problems; (2) identifying the target population; (3) recognizing the need for a quality control system in screening programs.

Conclusions

The European Consensus Statement on Hearing Screening of Pre-school and School-age Children will encourage the appropriate authorities of the various countries involved to initiate hearing screening programs of pre-school and school-age children.     

Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation

Abstract

Objective: Establish up-to-date evidence-based guidelines for recommending cochlear implantation for young children. Design: Speech perception results for early-implanted children were compared to children using traditional amplification. Equivalent pure-tone average (PTA) hearing loss for cochlear implant (CI) users was established. Language of early-implanted children was assessed over six years and compared to hearing peers. Study sample: Seventy-eight children using CIs and 62 children using traditional amplification with hearing losses ranging 25–120?dB HL PTA (speech perception study). Thirty-two children who received a CI before 2.5 years of age (language study). Results: Speech perception outcomes suggested that children with a PTA greater than 60?dB HL have a 75% chance of benefit over traditional amplification. More conservative criteria applied to the data suggested that children with PTA greater than 82?dB HL have a 95% chance of benefit. Children implanted under 2.5 years with no significant cognitive deficits made normal language progress but retained a delay approximately equal to their age at implantation. Conclusions: Hearing-impaired children under three years of age may benefit from cochlear implantation if their PTA exceeds 60?dB HL bilaterally. Implantation as young as possible should minimize any language delay resulting from an initial period of auditory deprivation.     

Preliminary results of objective audiological assessment of children with hearing impairment selected in neonatal hearing screening

The aim of the paper was to present the results of the objective audiological assessment of 48 babies and infants at the age of 1-16 months, referred the Department of Phoniatrics and Audiology in Poznań (Poland) from January 2001 to July 2002. The children were selected in neonatal hearing screening, based on the OAE, questionnaire of hearing loss with high risk factors. We discuss high percentage of false positive results of OAE, late referrals for hearing screening, difficulties of follow-up.     

A comparison of two methods of hearing screening in the preschool population

The outcome of hearing screening using conventional pure tone behavioral testing was compared with the outcome employing measures of transient otoacoustic emissions (TEOAEs) in a preschool population under conditions typical of educational settings. Two hundred children ranging in age from 2 years 1 month to 5 years 10 months were screened. Nearly equal numbers of children were referred from the two types of screening activities. The majority of referrals from the pure tone screening were due to an inability to condition the children to respond. Only 10% of the children referred from the TEOAE screening received a referral due to an inability to cooperate. Approximately 44% of the children referred from the pure tone screening also failed the immittance screening, whereas 62% of those who referred from the TEOAE screening also failed immittance screening.

Learning outcomes: As a result of completing this activity, the learner will obtain information about vocabulary development in children with hearing loss, referral rates from preschool hearing screening programs and the influence of middle ear status on referrals.     

Pervasive Developmental Delay in Children Presenting As Possible Hearing Loss

Objective/Hypothesis: Children who fail to develop adequate language skills and/or appropriate social skills by age 2 years often are referred to the department of otolaryngology for otolaryngologic examination and evaluation of possible hearing deficits. Discovering a gross disparity between hearing function and language ability often uncovers an underlying developmental disorder satisfying criteria for diagnosis on the spectrum of autism and pervasive developmental delay (PDD). The otolaryngologist has a unique opportunity to identify these autistic children and initiate their evaluation and management. Study Design: Retrospective review. Methods: Review of charts of children referred over the past 4 years to the Department of Otolaryngology for possible hearing loss identified 15 children who were later diagnosed with PDD. Results: Fifteen children initially referred for hearing evaluation were subsequently identified with a diagnosis of PDD. Males outnumbered females 4 to 1, with the average age of referral being 2 years. One third of the patients displayed middle ear disease that improved with PE tube placement. One third of the patients showed brainstem conduction dysfunction on auditory brainstem evoked response testing. Conclusions: Children with developmental delays, especially higher functioning ones, may present with a myriad of language and communication deficits that are often mistakenly attributed to hearing loss. Otolaryngologists and audiologists can assist in their early identification and appropriate referral for therapy.     

BOOK REVIEWS

Book reviews in this article: The Development of Hearing: It's Progress and Problems, Studies in Developmental Paediatrics, Volume 2, by Sybil Yeates. Chronic Ear Disease by Gordon D. L. Smyth. A Casebook of Diagnosis and Evaluation in Speech Pathology and Audiology by Lon L. Appraisal and Diagnosis of Speech and Language Disorders by H. A. Peterson & T. P.     

Newborn hearing screening in youth health care in the Netherlands: National results of implementation and follow-up

Abstract

Objective: The aim of this study is to investigate whether the quality of the Dutch, community based, universal newborn hearing screening programme is consistent over time. Design: Universal newborn hearing screening data from three cohorts are compared on a number of quality targets concerning the outcome of the screening and the process of the screening in a three stage, community based, hearing screening programme. Study sample: A total of 552 820 children entered the study (189 794 in 2002–2006; 181 574 in 2008, and 181 452 in 2009). Results: Participation in the programme is high from implementation onwards and increases over time for all screen stages to percentages above 99%. Refer rates are within quality targets and they are consistent over time. The screening is completed within 42 days of birth for 91.5% of the children in the last cohort. Of all children screened, 0.29% to 0.30% are referred to a speech and hearing centre. Participation in diagnostic testing is 93.3% to 95.2%. Of all referred children 77% to 85% receive a diagnosis within 122 days of birth. Conclusions: A good quality neonatal hearing screening programme in youth health care has been established in the Netherlands. However, both participation in diagnostic testing after a positive screen result and the timing of the diagnostic testing can still be improved.     

Predictive value of hearing assessment by the auditory brainstem response following universal newborn hearing screening

Abstract

Objective: This study set out to determine the accuracy with which tone pip ABR and click ABR, carried out in babies referred from universal newborn hearing screening, is able to predict the hearing outcome as determined by follow-up hearing tests. Study sample: The cohort of babies studied were all babies referred for hearing assessment from the universal newborn hearing screen in Sheffield, UK for the period January 2002 to September 2007, who were found to have a significant hearing impairment. Design: The results of hearing assessment following referral from the newborn hearing screen were collected together with those of follow-up tests carried out up to an age when behavioural testing had established ear- and frequency-specific thresholds at 0.5, 1, 2 and 4 kHz. Results: The standard deviation of the difference between the follow up and the tone pip ABR thresholds was 10.5 dB for the 4-kHz tone pip, 16.8 dB for the 1-kHz tone pip, and ranged between 21.7 and 24.7 dB for click ABR. Conclusions: The results of the study show that tone pip ABR following referral from newborn hearing screening has a similar accuracy to that reported in older subjects, and is a much better predictor compared to click ABR.     

Pediatric phoniatry outpatient ward: clinical and epidemiological characteristics

Children with language or learning impairment and normal hearing need phoniatric assessment to analyse various communication and development aspects targeting the differential diagnosis and therapeutic indications.ObjectiveCharacterize clinical and epidemiological features of a pediatric population treated in a phoniatric outpatient clinic.MethodA cross-sectional historical cohort study (retrospective study) was performed involving 68 patients undergoing phoniatric consultation. Outcome measures were age, gender, source of referral for phoniatric consultation, phoniatric diagnosis, mean age at diagnosis, neonatal risks, family history of communication disorders and referrals.Results70.58% were male and 29.42% female, mean age 6.85 ± 2.49 years. 63.23% from external services and 45.59% had no hearing diagnosis. 14 different diagnoses were performed: 50% had Cerebral Palsy, Specific Language Impairment and Pervasive Developmental Disorder. The difference between the average ages was statistically significant (F = 4.369 p = 0.00). 50% had a family history of communication disorders and 51.47% history of neonatal risk. 51.47% were referred for neurological consultation and 79.41% for therapies.ConclusionThe population seen was predominantly male, with more complex language development deviations probably due to multiple etiologies. Many of them had no hearing diagnosis.     

Hearing aids: family practitioner referral patterns

This study aims to determine whether the implementation of a direct referral service in which family practitioners received feedback on the appropriateness of their patient selection had any impact on the referral pattern. Six months after the establishment of such a service to which general practitioners were requested to refer patients who satisfied the Hearing Aid Council and Therapist Technicians and Scientists in Audiology group criteria, 40 consecutive patients were analysed. 40 age matched controls referred concurrently to the routine ENT clinic for hearing aid provision were compared. In the 80 ears seen in each group, the number of perforations infected or otherwise were 2 and 7 respectively (P < 0.01). Conductive hearing losses were more common in the control group (P < 0.05). The degree of patient selection was higher than noted in the first 6 months of the service when the prevalence of perforations in the direct sample was 7%. It appears that the practice of selective referral has developed.     

A qualitative investigation of decision making during help-seeking for adult hearing loss

Objective: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. Design: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. Study sample: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. Results: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. Conclusions: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss.     

Performance and characteristics of the Newborn Hearing Screening Programme in England: The first seven years

Objective: To assess the performance of the universal newborn hearing screen in England. Design: Retrospective analysis of population screening records. Study sample: A total of 4 645 823 children born 1 April 2004 to 31 March 2013. Results: 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. Conclusion: 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.     

Hearing aids--a case for review

An analysis of a series of 100 patients aged 60 years or over, referred by their General Practitioner to the Department of Otolaryngology, Addenbrooke's Hospital, specifically for the provision of a hearing aid, is presented. Forty-six per cent of patients failed to satisfy the criteria suggested by the Technicians, Therapists and Scientists in Audiology as a screening for treatable pathology. This study has shown that the existing referral pattern of general practitioner to consultant otolaryngologist for the provision of a hearing aid reflects the highest quality of care for the patient. Direct referral or open access of patients for hearing aid fitting may risk failure to diagnose early and treatable conditions.     

Hearing threshold assessment in young children with electrocochleograpy (EcochG) and auditory brainstem responses (ABR): Experience at the University Hospital of Ferrara

Objective

Electrophysiological evaluation is a fundamental procedure for the diagnostic assessment of hearing loss during infancy; in these cases, information concerning threshold level and auditory perception is particularly useful to establish a correct hearing rehabilitation program (hearing aids and cochlear implants).Purpose of this study is to underline the role of auditory brainstem responses (ABR) and electrocochleography (EcochG) in the definition of hearing loss in a selected group of children, referred to the Audiology Department of the University Hospital of Ferrara, for a tertiary level audiological assessment.

Methods

A retrospective study of the paediatric patient database at the Audiology Department of the University Hospital of Ferrara has been performed. In a period between January 2000 and December 2007, a total of 272 paediatric cases have been identified (544 ears).An EM 12 Mercury apparatus has been used for the electrophysiological threshold identification (ABR and EcochG). Recordings were carried out under general anaesthesia, in a protected enviroment.

Results

In 19 of the 272 paediatric cases selected—38 ears (7%), the results of threshold evaluation through ABR were uncertain. The Ecochg recording resulted crucial for the final diagnosis in terms of definition of the hearing threshold level, and it was then possible to ensure the better hearing rehabilitation strategy.

Conclusions

ABR has to be considered the first choice in hearing assessment strategy, either for screening or for diagnosis in newborns as well as in non-collaborating children; ECochG still may be considered a reliable diagnostic tool.     

Etiologies of hearing impairment among infants and toddlers: 1986-1987 versus 2001

OBJECTIVE: This study compares etiological factors for hearing loss, relevant neuro-sensory impairments and demographics between two groups of children referred for early hearing habilitation in Israel. Group I was referred in the years 1986-1987 (n=73) and group II was referred during 2001 (n=73). METHODS: Family history, pregnancy, risk factors, developmental milestones, medical history, auditory brainstem response, tympanometry, otoacoustic emissions and behavioral audiometric results were retrospectively retrieved in 2003 from medical records at the MICHA Society for Deaf Children in Israel. RESULTS: New referrals per year have doubled themselves over the 15 years that elapsed between 1986-1987 and 2001. No changes in gender and age at time of admission were found. The prevalence of mild-to-moderate hearing loss was higher in Group II while severe and profound hearing loss was more prevalent in Group I. Assisted reproductive technologies were involved only in Group II. There were more twin births and post-natal hypoxia in Group II. Rh incompatibility was reported only in Group I. Severe hearing loss was associated with younger age at admission. No significant associations were found between age at admission and etiology with the exception of the fact that children with genetic background were admitted at an earlier age. Since no significant association between genetic background and severity of hearing loss was found, it is conclude that the association between severity of hearing loss and age at admission did not account for changes in etiology in our sample. CONCLUSIONS: Classic risk factors for hearing loss among infants and toddlers have not changed much over time, and the few changes that have been noticed are probably due to expanded medical knowledge and improved technologies.     

Landau-Kleffner syndrome: a rare auditory processing disorder series of cases and review of the literature

Objective

To describe the clinical presentation and treatment of 3 children with an Auditory Processing Disorder with an identifiable neurological cause: Landau-Kleffner syndrome [3]. This classical syndrome is well recognized in pediatric neurology but the diagnosis is less well known to Pediatric Otolaryngology, Speech Language Pathology and Audiology services.

Methods

Retrospective chart review of three patients with Landau-Kleffner syndrome.

Results

In all cases, pharmacological intervention led to clinical and electroencephalographic improvement, but all patients had long-term difficulty with understanding sounds in a noisy environment. Magnetic Resonance Imaging (MRI) of the brain was normal in all three patients. Their language disturbance improved over time. Speech language intervention was helpful in addressing communication difficulties arising from the auditory processing/receptive and expressive language disorder.

Conclusion

A multidisciplinary assessment is the key for early diagnosis, treatment and follow-up in patients with this syndrome.     

Hearing of 75-year old persons over three decades: Has hearing changed?

Abstract

Objective: The state of hearing in 75-year old persons was measured in a population based epidemiological study with the aim of studying if hearing had changed during a time span of 29 years. Design: An epidemiological study of generational effects in three age cohorts. Study sample: Three age cohorts were included: cohort 1 (n: 267) born in 1976–77, cohort 4 (n: 197) in 1990–91, and cohort 6 (n: 570) in 2005. The same test procedures using pure-tone audiometry and a short questionnaire were applied to the three cohorts of 75-year old residents in the same city. Results: The hearing was essentially unchanged during the span of the investigation—almost three decades. Low-frequency hearing was up to about 10 dB poorer in the most recently studied cohort compared to the previously studied cohorts. The reason for this difference is considered to depend on methodological factors. Self-assessed hearing and tinnitus was mainly unchanged, or had minor changes both to the better and to the worse. Conclusions: The hearing, both measured with pure-tone audiometry and with a short questionnaire, of 75-year old persons has not changed at all, or only marginally, over three decades.     

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment

Objective: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. Design: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. Study sample: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65?dB?HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. Results: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. Conclusions: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.     

Clients’ perspective on quality of audiology care: Development of the Consumer Quality Index (CQI) ‘Audiology Care’ for measuring client experiences

Objective: Clients’ perspective on the quality of audiology care has not been investigated thoroughly. Research has focused primarily on satisfaction with, and limitations of hearing aids. We developed a Consumer Quality Index (CQI) questionnaire ‘Audiology Care’ to systematically assess client experiences with audiology care. Design: The CQI Audiology Care was developed in three steps: (1) posing open-ended questions through e-mail (n?=?14), (2) two small-scale surveys assessing psychometric properties of the questionnaire (n?=?188) and importance of quality aspects (n?=?118), and (3) a large-scale survey (n?=?1793) assessing psychometric properties and discriminatory power of the questionnaire. Study sample: People with complex hearing impairments and/or balance and communicative disorders who visited an audiology care centre during the past year. Results: Important quality aspects were translated into seven reliable scales: accommodation and facilities, employees’ conduct and expertise, arrangement of appointments, waiting times, client participation and effectiveness of treatment. Client experiences differed among the participating centres concerning accommodation and facilities, arrangement of appointments, waiting times and client participation. Conclusion: The CQI Audiology Care is a valid and reliable instrument to assess clients’ experiences with audiology care. Future implementation will reveal whether results can be used to monitor and improve the quality of audiology care.