Bilingual skills of deaf/hard of hearing children from Spain

Abstract

Background/aims

This study described the first language (L1) and second language (L2) skills of a group of Spanish deaf/hard of hearing (DHH) children who were bilingual.

Methods

Participants included parents of 51 DHH children from Spain. Parents completed an electronic survey that included questions on background, details on child's hearing loss, and bilingual status and L2 exposure. Parents also completed the Student Oral Language Observation Matrix, a rating scale that describes language skills.

Results

DHH bilingual children demonstrated L1 skills that were stronger than their monolingual DHH peers. Bilingual children demonstrated a wide range of L2 proficiency, and most were exposed to an L2 through parents and/or schooling. The majority of parents reported that their children demonstrated L2 skills that were either better than or at the level they had expected.

Conclusion

These results correspond with earlier studies that indicate the DHH children are capable of becoming bilingual. Implications for clinical practice are discussed.     

Aetiology of hearing disorders in children at the schools for the deaf

Ninety-three children attending the schools for the deaf in Copenhagen were examined in order to assess the aetiology of the hearing disorder and to compare the causing factors to those indicated in a previous investigation from 1953. Based on pre-existing investigations including both audiological and non-audiological procedures, the aetiology of the hearing impairment was known in 63% while in 37% the cause of the hearing disorder was unknown. A thorough examination programme was performed in 71 of the attending children whereby a reduction of ‘unknown cause’ of the hearing disorder could be obtained in half of these children. Compared to the previous investigation from 1953 the incidence of acquired hearing impairment had decreased in contrast to congenital severe hearing impairment. Based on the results of the present investigation it is concluded that an improved nosological classification can be obtained by re-evaluation of both the children and the parents; the physical examination is a long-standing dynamic process running over years; the increased incidence of congenital hearing impairment can be ascribed to prenatal infections, predominantly foetal rubella which is a preventative disease.     

Tinnitus with or without hearing loss: are its characteristics different?

The present study was carried out in order to analyze the clinical characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss. The study considered 520 consecutive tinnitus sufferers. The following parameters were considered: age, sex, subjective disturbance caused by tinnitus, subjective judgment of tinnitus intensity, tinnitus laterality, tinnitus duration, tinnitus measurements, normal hearing or associated hearing loss. Among the patients considered, 223 have normal hearing while 297 have a hearing deficit. The hearing impairment was found to be in most cases of sensorineural type. The subjective discomfort is higher in presence of hearing loss. Subjects with hearing loss needed significantly higher masking levels. No evident differences in the residual inhibition (RI) result between the two groups were found. The present study confirms that tinnitus is most frequently associated with hearing loss. The characteristics of tinnitus in normal hearing subjects, except for the subjective judgment of tinnitus intensity, the pitch and the RI, are significantly different for those observed in subjects with hearing loss. The association of tinnitus and hearing deficit seems to increase the perceived severity of the symptom.     

Does the prevalence of otolaryngological diseases in deaf children differ from children without hearing impairment?

There is no enough data about the prevalence of otorhinolaryngological (ORL) diseases in deaf children. In this study, we aimed to determine the prevalence of ORL diseases among deaf children and compare children from a school for the deaf with those attending regular primary schools for the presence of ear, nose and throat (ENT) problems. The subjects were 1,282 children attending three primary schools in the province of Duzce and 572 hearing-impaired children from eight schools for the deaf. Following ENT examinations, ORL findings were statistically compared between two groups using a Chi-square test and P values less than 0.05 were considered significant. Upper airway pathologies including chronic tonsillitis, rhinitis, septal deviation and tubal dysfunction, and chronic otitis media (COM) were found to be statistically higher in deaf children than in children without hearing impairment. Although the incidence of middle ear effusion was found to be higher in deaf children, it was not statistically significant. On the other hand, the incidence of impacted wax was lower in deaf children than others. In conclusion, we should have enough data on the prevalence of ORL diseases in deaf children to give a clue to help prevent ORL diseases and if we can detect them early, we can solve the problems before they become more complicated and we can rehabilitate these children better.     

Reading skills in Persian deaf children with cochlear implants and hearing aids

ObjectivesReading skills are necessary for educational development in children. Many studies have shown that children with hearing loss often experience delays in reading. This study aimed to examine reading skills of Persian deaf children with cochlear implant and hearing aid and compare them with normal hearing counterparts.MethodThe sample consisted of 72 s and third grade Persian-speaking children aged 8–12 years. They were divided into three equal groups including 24 children with cochlear implant (CI), 24 children with hearing aid (HA), and 24 children with normal hearing (NH). Reading performance of participants was evaluated by the “Nama” reading test. “Nama” provides normative data for hearing and deaf children and consists of 10 subtests and the sum of the scores is regarded as reading performance score.ResultsResults of ANOVA on reading test showed that NH children had significantly better reading performance than deaf children with CI and HA in both grades (P < 0.001). Post-hoc analysis, using Tukey test, indicated that there was no significant difference between HA and CI groups in terms of non-word reading, word reading, and word comprehension skills (respectively, P = 0.976, P = 0.988, P = 0.998).ConclusionConsidering the findings, cochlear implantation is not significantly more effective than hearing aid for improvement of reading abilities. It is clear that even with considerable advances in hearing aid technology, many deaf children continue to find literacy a challenging struggle.     

Autism and peripheral hearing loss: A systematic review

Objective

To systematically review the literature describing the relationship between autism spectrum disorder (ASD) and peripheral hearing loss including literature recommendations for audiological assessment and auditory habilitation in cases where peripheral hearing loss and ASD coexist.

Data sources

Published studies indexed in MEDLINE (1948–2011).

Review methods

The search strategy identified 595 potential studies. After a review of the titles, 115 abstracts were reviewed and 39 articles were retrieved and assessed independently by at least two authors for possible inclusion. 22 articles pertained to children with ASD and peripheral hearing loss, hearing assessment in children with ASD, audiological habilitation for children with ASD or hyper-responsiveness in children with ASD. 17 further studies were garnered from the reference section of the 22 papers.

Results

Controversy exists in the literature regarding prevalence of hearing impairment among individuals with ASD. In cases where ASD and hearing impairment co-exist, diagnosis of one condition often leads to a delay in diagnosing the other. Audiological assessment can be difficult in children with ASD and test–retest reliability of behavioural thresholds can be poor. In cases where hearing impairment exists and hearing aids or cochlear implantation are recommended, devices are often fit with special considerations for the child with ASD. Hyper-responsiveness to auditory stimuli may be displayed by individuals with ASD. Evidence or the suspicion of hyper-responsiveness may be taken into consideration when fitting amplification and planning behavioural intervention.

Conclusions

Prevalence rates of hearing impairment among individuals with ASD continue to be debated. At present there is no conclusive evidence that children with ASD are at increased risk of peripheral hearing loss. A complete audiological assessment is recommended in all cases where ASD is suspected so as not to delay the diagnosis of hearing impairment in the event that hearing loss and ASD co-exist. Objective assessment measures should be used to confirm behavioural testing in order to ensure reliability of audiological test results. Fitting of hearing aids or cochlear implantation are not contraindicated when hearing loss is present in children with ASD; however, success with these devices can be variable.     

Assessing spoken word recognition in children who are deaf or hard of hearing: a translational approach

Under natural conditions, listeners use both auditory and visual speech cues to extract meaning from speech signals containing many sources of variability. However, traditional clinical tests of spoken word recognition routinely employ isolated words or sentences produced by a single talker in an auditory-only presentation format. The more central cognitive processes used during multimodal integration, perceptual normalization, and lexical discrimination that may contribute to individual variation in spoken word recognition performance are not assessed in conventional tests of this kind. In this article, we review our past and current research activities aimed at developing a series of new assessment tools designed to evaluate spoken word recognition in children who are deaf or hard of hearing. These measures are theoretically motivated by a current model of spoken word recognition and also incorporate "real-world" stimulus variability in the form of multiple talkers and presentation formats. The goal of this research is to enhance our ability to estimate real-world listening skills and to predict benefit from sensory aid use in children with varying degrees of hearing loss.     

Pediatric hearing impairment caregiver experience: impact of duration of hearing loss on parental stress

OBJECTIVES: Caregivers of children who are deaf/hard of hearing have been reported to have greater stress than caregivers of children with normal hearing. The time of diagnosis is a particularly stressful time and stress levels may change over time based on varying needs at different life events. Thus, we hypothesized that stress experienced by caregivers evolves over time and is impacted by the duration since the diagnosis of hearing loss. METHODS: The 68-item pediatric hearing impairment caregiver experience (PHICE) is a validated questionnaire used to measure stress. The PHICE was administered to 152 caregivers of children with permanent hearing loss. Domain scores were converted into z-scores for analysis of trends of stress over time. RESULTS: Parents of children whose hearing loss was identified more than 60 months ago reported higher stress levels regarding educational aspects of their child's needs as compared to parents of children with less than 24 months or 24-60 months duration since diagnosis. Parents of children diagnosed with hearing loss within the preceding 24 months reported higher stress levels in the area of healthcare than parents of children diagnosed greater than 24 months ago. CONCLUSIONS: Parental stressors change over time with respect to the time of diagnosis of hearing impairment. This phenomenon was observed irrespective of the age of diagnosis of hearing loss. As professionals serving families of children with hearing loss, we should be aware of changing stressors over time and identify the appropriate support services for families to meet those changing needs. By addressing those evolving stressors, the families' ability to support and improve the outcomes for their children who are deaf or hard of hearing may be enhanced.     

Characteristics of tinnitus with or without hearing loss: Clinical observations in Sicilian tinnitus patients

Objective

To analyze the clinical characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss.

Methods

The study considered 312 tinnitus sufferers, 176 males and 136 females, ranging from 21 to 83 years of age, who were referred to the Audiology Section of the Department of Bio-technology of Palermo University. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into two groups: Group 1 (G1) subjects with normal hearing; Group 2 (G2) subjects with hearing loss.

Results

Among the patients considered, 115 have normal hearing while 197 have a hearing deficit. There is a slight predominance of males respect to females that is more evidenced in G2 (61.42% of males vs. 38.58% of females). The highest percentage of tinnitus results in the decades 41–50 for G1 and >70 for G2 with a statistically significant difference between the two groups (P < 0.0001).The hearing impairment results in most cases of sensorineural type (74.62%) and limited to the high frequencies (58.50%), moreover the 72.10% of the patients with SNHL had a high-pitched tinnitus while the 88.37% of the patients high-frequency sensorineural hearing loss had a high-pitched tinnitus (P < 0.0001). As for the subjective discomfort, the catastrophic category resulted most representative among subjects with normal hearing with a statistically significant difference between the two groups but no significant correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias that do not allow the phenomenon of the ‘habituation’.

Conclusion

This work, according to literature data, suggests that the hearing status and the elderly represent the principal tinnitus related factors; moreover tinnitus characteristics differ in the two groups for tinnitus pitch. There is, in fact, a statistically significant association between high-pitched tinnitus and high-frequency SNHL suggesting that the auditory pathway reorganization induced by hearing loss could be one of the main source of the tinnitus sensation.     

Advantages of a new miniature hearing aid for mild to moderate hearing loss

OBJECTIVES/HYPOTHESIS: To evaluate the performance of a new, miniature, behind-the-ear hearing aid designed for individuals with mild to moderate high-frequency hearing loss who need an aid but are reluctant to try one. The aid is essentially invisible, leaves the ear canal open, and can be fit in less than 30 minutes without an ear impression. The cost is less than $500. STUDY DESIGN: A 4-week trial of the aid in 63 ears (62 subjects) with mild to moderate bilateral hearing loss. METHODS: A questionnaire was completed at the end of the study by each subject asking them to evaluate several features of the aid (cosmesis, comfort, understanding speech, amplification, and so forth) and to compare their unaided performance in quiet and in noise with the test hearing aid. A rating scale of 1 to 10 was used, with 10 being excellent and 1 poor. RESULTS: Subjective improvement in understanding speech in both quiet (5.8-->7.3) and noise (4.6-->5.9) occurred with the aid. Cosmesis, comfort, and appearance were highly rated (mean scores, > 8). CONCLUSIONS: This aid appears to have several features (comfort, cost, performance, and cosmesis) that make it ideal as a first aid for patients with mild to moderate losses.     

Remote microphone systems for preschool-age children who are hard of hearing: access and utilization

Objectives: Children who are hard of hearing (CHH) have restricted access to auditory-linguistic information. Remote-microphone (RM) systems reduce the negative consequences of limited auditory access. The purpose of this study was to characterise receipt and use of RM systems in young CHH in home and school settings.

Design: Through a combination of parent, teacher, and audiologist report, we identified children who received RM systems for home and/or school use by 4?years of age or younger. With cross-sectional surveys, parents estimated the amount of time the child used RM systems at home and school per day.

Study Sample: The participants included 217 CHH.

Results: Thirty-six percent of the children had personal RMs for home use and 50% had RM systems for school. Approximately, half of the parents reported that their children used RM systems for home use for 1–2?hours per use and RM systems for school use for 2-4?hours per day.

Conclusions: Results indicated that the majority of the CHH in the current study did not receive RM systems for home use in early childhood, but half had access to RM technology in the educational setting. High-quality research studies are needed to determine ways in which RM systems benefit pre-school-age CHH.     

Tone identification in Mandarin-speaking children with profound hearing impairment

ObjectivesLittle is known about the tone identification ability of Mandarin-speaking children with profound hearing impairment (HI) and fitted with hearing aids (HAs). The present study aimed to evaluate the Mandarin tone identification ability in children with profound HI and fitted with HAs, and explore the effects of hearing thresholds, the age of first HA fitting and the duration of HA use on Mandarin tone identification ability.MethodsSubjects were Mandarin-speaking children aged 5;4–12;6 years with profound HI (n = 41). The Mandarin Tone Identification Test was administered in five test conditions: in −10, −5, 0 and 5 dB signal-to-noise ratios (S/Ns) and quiet. Hearing aids were in the usual user's settings, optimized for the best speech reception, and the volume was set to comfortable listening level.ResultsTwo-way repeated measures ANOVA showed significant effects of test conditions and tone contrasts in Mandarin tone identification. Post-hoc pairwise comparisons showed significant difference in performance among the five test conditions. Results also indicated that, among the six tone contrasts, the Tone 1/Tone 2 and Tone 2/Tone 3 contrasts were the most difficult tone contrasts in quiet. No significant difference in performance was found among the six tone contrasts in noise. Pearson product-moment correlation showed that the age of first HA fitting, the duration of HA use, aided and unaided average thresholds as well as the aided hearing thresholds in the low frequency region were not significantly correlated with tone identification ability in the five test conditions.ConclusionsConsistent with previous findings, the Tone 1/Tone 2 and Tone 2/Tone 3 contrasts were the most difficult to identify in quiet; but the presence of noise resulted in these tone contrasts being equally difficult. Findings also suggest that the tone identification ability of children with profound HI needs to be improved. Although the age of first HA fitting and the duration of HA use were not significantly correlated with tone identification performance in children with profound HI, this finding does not preclude the importance of early HA fitting.     

Prediction of the use of conventional hearing aids in Korean adults with unilateral hearing impairment

Objective: To determine the use of a hearing aid at six months post-fitting and to evaluate the predictors of its ongoing use in Korean adults with unilateral hearing impairment (HI). Design: Retrospective study at a secondary referral hospital over a 15-year period. Study sample: This study analysed 119 adults with unilateral HI who had been recommended for hearing amplification (55 men and 64 women, mean age, 58.0 ± 11.7 years). Six months after the fitting, all of the participants were surveyed regarding subsequent decisions and actions about obtaining hearing aids. Results: General uptake rate for a hearing aid was 68.1% (58.0% of participants surveyed were successful users, and 10.1% were intermittent users). The most significant parameter associated with hearing-aid use was social and/or work activities (R² = 0.457), and the significant predictors for successful hearing-aid use were social and/or work activities and method of signal processing (discriminatory power = 56.3%). Conclusions: Six months post-fitting, 68.1% of Korean adults with unilateral HI who had agreed to try a hearing aid continued to use it regularly. The predictors for hearing-aid use six months post-fitting included social and/or work activities and digital signal processing.     

Multiple-channel non-linear power hearing instruments for children with severe hearing impairment: long-term follow-up

The long-term benefits of multiple-channel non-linear technology for children with severe hearing impairment have yet to be fully investigated over the longer term. Twenty-one children with severe hearing loss participated in a study comparing performance on measures of audibility, speech understanding (in quiet and noise) and listening situations between the children's current analog hearing aids and a test hearing aid with multiple-channel non-linear compression (DigiFocus II Compact Power). Results were obtained from the children at 2 weeks, 8 weeks, 6 months and 12 months following the fitting of a multiple-channel non-linear hearing instrument. Compared with the children's own hearing instruments, the test instruments provided improved audibility, improvement in speech understanding in quiet and noise, and an improvement in listening skills. The gains in speech understanding were greater in noise than in quiet, suggesting that the test hearing instrument provided greatest improvement when listening to speech in noise. While performance increased over time, there was no statistically significant evidence to support continued acclimatization.     

Epidemiology of hearing loss in childhood

During a 20-year period, half a million screening audiograms have been obtained on children at schools in Stockholm. The incidence of hearing loss in children of a particular age did not differ appreciably over the 14-year period analysed. In the age groups from 4 to 16, the incidence of temporary conductive hearing impairment decreased with age, whereas the incidence of permanent defects and particularly sensorineural high-frequency loss showed an increase with age.

For conductive hearing impairments there was no sex difference but for sensorineural defects there was a definite prepoderance of boys which was observed as early as 7 years of age.

The results of this general survey of the total material are supplemented and verified by the findings recorded in a more thorough examination at schools in Stockholm of all 13-year-old children born in 1948. The discussion of the results leads to the opinion that high-frequency loss in children would seem to be to a large extent of genetic origin.     

Hearing devices for children with unilateral hearing loss: Patient- and parent-reported perspectives

ObjectiveManagement of children with unilateral hearing loss is not standardized. The primary goal of this study was to elicit patient- and parent-reported perspectives regarding usage of hearing devices in pediatric UHL and to suggest a basic algorithmic approach to management.MethodsOur tertiary care center recruited families of youth ages 5–19 years with unilateral hearing loss from January 2014 through October 2015. Parents of all youths completed a 36-item survey, and some youth ages 11–19 years participated in hour-long interviews. We assessed patterns of hearing device usage among participants, and performed qualitative data analysis to understand factors considered by youths when deciding whether or not to use a hearing device.ResultsSurvey information was collected for 50 patients. Distribution of hearing loss severity in affected ear was mild 14%, moderate 26%, severe 22%, and profound 38%. The majority of children had sensorineural hearing loss (57%), followed by mixed (32%), and then conductive (11%). 34 children (68%) had tried a hearing device; 20 continued to use the device. Retention rates were similar among children with different degrees of hearing loss: mild 66%, moderate 50%, severe 60%, profound 64%. Sixteen children tried a wireless contralateral routing of signal (CROS) device, and 15 tried a behind-the-ear (BTE) hearing aid. Retention rates for CROS and BTE devices were 69% and 47%, respectively. The most common reason for cessation of use was discomfort, followed by lack of benefit.ConclusionA majority of children with unilateral hearing loss who tried a hearing device continued to use it, and retention rates were similar across all degrees of hearing loss. These findings suggest that personal hearing devices should be included in management protocols.     

Abutment-free bone-anchored hearing devices in children: Initial results and experience

Objectives

Bone-anchored implantable hearing devices are widely accepted as a surgical option for certain types of hearing loss in both adults and children. Most commercially available devices involve a percutaneous abutment to which a sound processor attaches. The rate of complications with such bone conduction systems is greater than 20%. Most complications arise from the abutment. Recently, the Sophono (Boulder, CO) Alpha 1, an abutment-free system, has been introduced.

Study design and methods

We conducted a retrospective chart review of the first five patients who underwent implantation with the Sophono abutment-free bone conduction hearing system with the Alpha 1 processor at our institution and report here on these patients’ pre- and postoperative audiometric data and clinical courses.

Results

Average improvement in pure-tone average was 32 dB hearing loss and average improvement in speech response threshold was 28 dB hearing loss. All patients were responding in the normal to mild hearing loss range in the operated ear after device activation. Average improvement across individual frequencies was between 17 and 37 dB (SD 5.5–11 dB).

Conclusion

Our audiometric results to date are promising and have been consistent with published data on other bone-anchored hearing devices.