Language development in children after receiving bilateral cochlear implants between 5 and 18 months

Objective

The objective of this study was to examine receptive and expressive language development in children who received simultaneous bilateral cochlear implants (CIs) between 5 and 18 months of age and to compare the results with language development in chronologically age-matched children with normal hearing.

Methods

The study used a prospective, longitudinal matched-group design. Data were collected in a clinical setting at postoperative cochlear implant check-ups after 3, 6, 9, 12, 18, 24, 36, and 48 months of implant use. The sample included 42 children: 21 cochlear implant users and 21 with normal hearing, matched pairwise according to gender and chronological age. Communication assessments included the LittlEARS questionnaire, the Mullen Scale of Early Learning, and the Minnesota Child Development Inventory.

Results

The cochlear implant users’ hearing function according to LittlEARS was comparable to that of normal-hearing children within 9 months post-implantation. The mean scores after 9 and 12 months were 31 and 33, respectively in the prelingually deaf versus 31 and 34 in the normal-hearing children. The children's receptive and expressive language scores showed that after 12-48 months with cochlear implants, 81% had receptive language skills within the normative range and 57% had expressive language skills within the normative range. The number of children who scored within the normal range increased with increasing CI experience.

Conclusions

The present study showed that prelingually deaf children's ability to develop complex expressive and receptive spoken language after early bilateral implantation appears promising.The majority of the children developed language skills at a faster pace than their hearing ages would suggest and over time achieved expressive and receptive language skills within the normative range.     

Measuring communicative performance with the German version of the FAPCI-instrument: normative data and longitudinal results

Objective

The German version of the Functioning after Paediatric Cochlear Implantation (FAPCI) inventory was designed to capture the communicative performance of cochlear implanted children. In order to be able to compare cochlear-implanted children to their normal hearing peers, normative growth curves were designed. Furthermore it was of interest how the communicative performance develops over time and whether it is influenced by age at implantation.

Method

A polynomial regression curve was fit to the data of 133 normal hearing children. This normative curve was compared to individual growth curves of 90 cochlear implanted children. The cochlear-implanted study sample was split up into four groups depending on the age at implantation.

Results

The normative growth curve increases from 1 year of age until saturation is reached with 3 years of age. The individual FAPCI trajectories of cochlear implanted children are heterogeneous, but in general they are delayed in comparison to the normative growth curve. “Early implanted children” follow the development of their normal hearing peers more closely than “later-implanted children”.

Conclusion

The German version of the FAPCI parental questionnaire constitutes an additional instrument in monitoring the communicative performance development of cochlear implanted children and allows for comparison to normal hearing peers.     

UK and Ireland experience of cochlear implants in children with Down Syndrome

Objectives

Down Syndrome (DS) is associated with a high incidence of hearing loss. The majority of hearing loss is conductive, but between 4 and 20% is sensorineural, which in the main is mild or moderate and is managed with conventional behind-the-ear hearing aids. Cochlear implantation is an elective invasive procedure, performed to provide some form of hearing rehabilitation in individuals with severe to profound sensorineural hearing loss, and initially candidacy criteria were strict—excluding patients with additional disabilities. With good results and expanding experience, more candidates with additional disabilities are now being implanted. A survey of UK and Ireland Cochlear Implant Programmes sought to identify the number of individuals with DS who have been implanted with a cochlear implant (CI) and to provide relevant information on outcomes of implantation in these individuals.

Methods

E-mail survey of all programmes within the British Cochlear Implant Group (BCIG). Postal questionnaire to programmes identified to have implanted a child with Down Syndrome, with data collection on pre-operative assessment, surgical and post-operative outcomes. Case series review.

Results

Three of 23 BCIG programmes have implanted a child with Down Syndrome. Four children have received implants. No intraoperative or post-operative surgical complications were encountered. All children had middle ear disease, but no problems with implantation were associated with their middle ear condition. All children remain implant users, 12 months to 4 years post-implantation.

Conclusion

Cochlear implantation is an option for a child with Down Syndrome and associated severe to profound sensorineural hearing loss. Clinicians caring for these children and their families should consider referral for assessment by a Cochlear Implant Programme.     

Parental and program's decision making in paediatric simultaneous bilateral cochlear implantation: Who says no and why?

Objective

To evaluate initial candidacy for bilateral simultaneous cochlear implantation in children.

Design

Prospective case series.

Setting

Tertiary academic pediatric hospital.

Participants

As part of our research protocol all children eligible for cochlear implantation were assessed for suitability to receive a simultaneous bilateral implant. Over a 12-month period (January to December 2007) 78 children received a total of 95 cochlear implants. Children with sequential second implants (24), revision cases (4), and out of province recipients (4) were excluded. The remaining 46 patients were assessed for bilateral simultaneous implantation.

Main outcome measures

Team/parental decision to proceed with bilateral simultaneous implantation.

Results

17 children (37%) received simultaneous bilateral implants. 29 children (63%) were not considered suitable for simultaneous bilateral implantation. Reasons included developmental delay (10), residual borderline hearing in the second ear (9), parental/patient refusal (6), abnormally poor speech development for age (2), and abnormal cochlear anatomy precluding implantation (2). None were considered unsuitable for the more prolonged operative procedure on medical grounds.

Conclusions

Although bilateral implantation is thought to produce the optimal auditory outcome, not all patients are suitable, nor do all parents wish to proceed, when assessed for simultaneous implantation. Some of these patients are likely to be candidates for sequential bilateral implantation in due course.     

Children with hearing impairment--living with cochlear implants or hearing aids

Objective

The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

Methods

Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

Results

Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

Conclusions

Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.     

Cochlear implantation under the first year of age—The outcomes. A critical systematic review and meta-analysis

Objective

To review the current knowledge on cochlear implantation in infancy, regarding auditory perception/speech production outcomes.

Study-design

Meta-analysis. EBM level: II.

Methods

Literature-review from Medline and database sources. Related books were also included.

Results

The number of cohort-studies comparing implanted infants with under 2-year-old children was five; three represented type-III and two type-II evidence. No study was supported by type I evidence. Overall, 125 implanted infants were identified. Precise follow-up period was reported in 82. Median follow-up duration ranged between 6 and 12 months; only 17 children had follow-up duration equal or longer than 2 years. Reliable outcome measures were reported for 42 infants; 15 had been assessed with open/closed-set testing, 14 with developmental rating scales, and 13 with prelexical speech discrimination tools.Ten implanted infants assessed with open/closed-set measures had been compared with under 2-year-old implanted children; 4 had shown better performance, despite the accelerated rate of improvement after the first postoperative year.

Conclusion

Neuroplasticity/neurolinguistic issues have led cochlear implant centers to implant deaf children in infancy; however, widespread policies regarding the aforementioned issue are still not justified. Evidence of these children's outperformance regarding auditory perception/speech production outcomes is limited. Wide-range comparisons between infant implantees and under 2-year-old implanted children are lacking. Longer-term follow-up outcomes should be also made available. There is a need to develop and validate robust measures of monitoring implanted infants. Potential factors of suboptimal outcomes (e.g. misdiagnosis, additional disorders, device tuning, parental expectations) should also be weighted, when considering cochlear implantation in infancy.     

Infants versus older children fitted with cochlear implants: performance over 10 years

Objectives

To investigate the efficacy of cochlear implants (CIs) in infants versus children operated at later age in term of spoken language skills and cognitive performances.

Method

The present prospective cohort study focuses on 19 children fitted with CIs between 2 and 11 months (X = 6.4 months; SD = 2.8 months). The results were compared with two groups of children implanted at 12-23 and 24-35 months. Auditory abilities were evaluated up to 10 years of CI use with: Category of Auditory Performance (CAP); Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS); Peabody Picture Vocabulary Test (PPVT-R); Test of Reception of Grammar (TROG) and Speech Intelligibility Rating (SIR). Cognitive evaluation was performed using selected subclasses from the Griffiths Mental Development Scale (GMDS, 0-8 years of age) and Leiter International Performance Scale-Revised (LIPS-R, 8-13 years of age).

Results

The infant group showed significantly better results at the CAP than the older children from 12 months to 36 months after surgery (p < .05). Infants PPVT-R outcomes did not differ significantly from normal hearing children, whereas the older age groups never reached the values of normal hearing peers even after 10 years of CI use. TROG outcomes showed that infants developed significantly better grammar skills at 5 and 10 years of follow up (p < .001). Scores for the more complex subtests of the GMDS and LIPS-R were significantly higher in youngest age group (p < .05).

Conclusion

This study demonstrates improved auditory, speech language and cognitive performances in children implanted below 12 months of age compared to children implanted later.     

Assessment of Mandarin-speaking pediatric cochlear implant recipients with the Mandarin Early Speech Perception (MESP) test

Objective

The primary purpose of the current study was to evaluate the Mandarin Early Speech Perception (MESP) test for use in objective outcome assessment of pediatric CI recipients in China. Although almost 5000 pediatric CIs have been implanted in China, very little is known about the speech perception abilities of these recipients, in large part because of the previous unavailability of objective outcome assessment tools for Mandarin-speaking children.

Method

The Mandarin Early Speech Perception (MESP) test was administered to 25 pediatric Mandarin-speaking cochlear implant (CI) recipients implanted under the age of 10 years at West China Hospital of Sichuan University.

Results

Data from 22 children reaching MESP Categories 3 (Spondee Perception), 5 (Consonant Perception), and 6 (Tone Perception) were analyzed. The 5 children reaching Category 6 were significantly younger at implantation than children reaching the other two categories. Comparison of MESP scores for CI recipients and normally hearing children revealed that scores for the majority of CI recipients reaching Categories 3 and 5 fell within the range of normal performance, while scores for all CI recipients reaching Category 6 exceeded the average normal performance. MESP scores for Mandarin-speaking CI recipients and ESP scores for English-speaking CI recipients [1] fell on a common trajectory that, after slightly more than 3 years of age, exceeded the ceiling defined by the first four categories common to both tests. After 4 years of age, most Mandarin-speaking had reached Category 6.

Conclusions

These results provide preliminary validation of the MESP test for use in evaluation of Mandarin-speaking pediatric CI recipients. Use of objective outcome assessment tools such as the MESP following early cochlear implantation can be used to document the progress of CI recipients and identify those recipients who may need additional rehabilitative intervention.     

Auditory, speech and language development in young children with cochlear implants compared with children with normal hearing

Objective

This study had two aims: (1) to document the auditory and lexical development of children who are deaf and received the first cochlear implant (CI) by the age of 16 months and the second CI by the age of 31 months and (2) to compare these children's results with those of children with normal hearing (NH).

Methods

This longitudinal study included five children with NH and five with sensorineural deafness. All children of the second group were observed for 36 months after the first fitting of the device (cochlear implant). The auditory development of the CI group was documented every 3 months up to the age of two years in hearing age and chronological age and for the NH group in chronological age. The language development of each NH child was assessed at 12, 18, 24 and 36 months of chronological age. Children with CIs were examined at the same age intervals at chronological and hearing age.

Results

In both groups, children showed individual patterns of auditory and language development. The children with CIs developed differently in the amount of receptive and expressive vocabulary compared with the NH control group. Three children in the CI group needed almost 6 months to make gains in speech development that were consistent with what would be expected for their chronological age. Overall, the receptive and expressive development in all children of the implanted group increased with their hearing age.

Conclusion

These results indicate that early identification and early implantation is advisable to give children with sensorineural hearing loss a realistic chance to develop satisfactory expressive and receptive vocabulary and also to develop stable phonological, morphological and syntactical skills for school life. On the basis of these longitudinal data, we will be able to develop new diagnostic tools that enable clinicians to assess child's progress in hearing and speech development.     

Measuring communicative performance with the FAPCI instrument: preliminary results from normal hearing and cochlear implanted children

Objective

: To develop preliminary “growth curves” of Functioning after Pediatric Cochlear Implantation (FAPCI) scores using a cross-sectional sample of normal hearing children and to compare these curves to trajectories of FAPCI scores in children receiving cochlear implants.

Methods

: Quantile regression was used to develop growth curves from the FAPCI scores of a cross-sectional sample of 82 normal hearing children (age range 7 months-5 years). Trajectories of FAPCI scores from a longitudinal cohort of 75 children with cochlear implants (age range 1-5 years) were compared to these growth curves.

Results

: FAPCI scores were positively associated with increasing age in normal hearing children with a rapid increase in scores observed at earlier ages followed by a plateau at age 3 years. FAPCI trajectories for cochlear-implanted children varied with age at implantation and did not reach a plateau until age 5-6 years.

Conclusion

: Normal hearing children demonstrated increasing FAPCI scores with age, and these preliminary growth curves allow for the interpretation of a cochlear-implanted child's FAPCI scores in comparison to normal hearing children. Additional research using a larger, longitudinal cohort of normal hearing children will be needed to develop definitive normative FAPCI trajectories.     

Articulation skills in Turkish speaking children with cochlear implant

Objective

The benefits of using cochlear implant (CI) on speech perception and production have been documented. The aim of this study is to investigate the effect of age of cochlear implantation performed and length of auditory experience with CI on the development of articulation skills in prelingual children with CI.

Methods

For this purpose, 14 children with CI were administered through the standardized articulation test named AAT (Ankara Articulation Test). In order to evaluate the development of articulation skills, AAT was applied to each child with CI at the first and the fourth years of CI. The test group was selected among those congenitally hearing impaired children who had used hearing aids bilaterally before the age of one and a half, and received intervention after fitting hearing aids. The test group was divided into two subgroups: Group 1 consisted of the children implanted at and below the age of 3 and Group 2 consisted of the children implanted after the age of 3. Evaluations of articulation skills between groups and within groups were performed in the first and fourth years of implantation. In the study, nonparametric statistics have been used to compare the test scores. Mann-Whitney U-test and Wilcoxon test have been used in the comparisons made between groups and within groups, respectively.

Results

While there has not been observed any statistically significant difference between the first year articulation skills of children with CI at and below the age of three and children with CI above the age of 3, for the fourth year this difference has been found to be statistically significant.

Conclusions

The results demonstrate the importance of the early application of CI and length of auditory experience with CI in the development of articulation skills.     

Parent versus child assessment of quality of life in children using cochlear implants

Objective

Children with hearing loss who use cochlear implants have lower quality of life (QoL) in social situations and lower self-esteem than hearing peers. The child's QoL has been assessed primarily by asking the parent rather than asking the child. This poses a problem because parents have difficulty judging less observable aspects like self-esteem and socio-emotional functioning, the domains most affected by hearing loss.

Methods

This case-control study evaluated QoL in 50 preschoolers using a cochlear implant and their parents with the Kiddy KINDL^®, an established QoL measure. Children's responses were compared to a hearing control group and correlated with demographic variables. We used a questionnaire for parents and a face-to-face interview with children. T-tests were used to compare (a) paired parent-child ratings and (b) children with cochlear implants versus normal hearing. Pearson rank correlations were used to compare QoL with demographic variables.

Results

Children using cochlear implants rated overall QoL significantly more positively than their parents (M_Difference = 4.22, p = .03). Child rating of QoL did not differ significantly by auditory status (cochlear implant (82.8) vs. hearing (80.8), p = .42). Overall QoL correlated inversely with cochlear implant experience and chronologic age, but did not correlate with implantation age.

Conclusions

Preschool children using cochlear implants can assess adequately their own QoL, but parents afford valuable complementary perspective on the child's socio-emotional and physical well-being. Preschool children using cochlear implants rate overall QoL measures similar to hearing peers. A constellation of QoL measures should be collected to yield a better understanding of general QoL as well as specific domains centered on hearing loss.     

Exploring factors that affect the age of cochlear implantation in children

Objective

Early access to sound through early cochlear implantation has been widely advocated for children who do not derive sufficient benefit from acoustic amplification. Early identification through newborn hearing screening should lead to earlier intervention including earlier cochlear implantation when appropriate. Despite earlier diagnosis and the trend towards early implantation, many children are still implanted well into their preschool years. The purpose of this study was to examine the factors that affected late cochlear implantation in children with early onset permanent sensorineural hearing loss.

Methods

Data were examined for 43 children with cochlear implants who were part of a group of 71 children with hearing loss enrolled in a Canadian outcomes study. Eighteen (41.9%) of the 43 children were identified through newborn screening and 25 (58.1%) through medical referral to audiology. Medical chart data were examined to determine age of hearing loss diagnosis, age at cochlear implant candidacy, and age at cochlear implantation. Detailed reviews were conducted to identify the factors that resulted in implantation more than 12 months after hearing loss confirmation.

Results

The median age of diagnosis of hearing loss for all 43 children was 9.0 (IQR: 5.1, 15.8) months and a median of 9.1 (IQR: 5.6, 26.8) months elapsed between diagnosis and unilateral cochlear implantation. The median age at identification for the screened groups was 3.3 months (IQR: 1.4, 7.1) but age at implantation (median 15.8 months: IQR: 5.6, 37.1) was highly variable. Eighteen of 43 children (41.9%) received a cochlear implant more than 12 months after initial hearing loss diagnosis. For many children, diagnosis of hearing loss was not equivalent to the determination of cochlear implant candidacy. Detailed reviews of audiologic profiles and study data indicated that late implantation could be accounted for primarily by progressive hearing loss (11 children), complex medical conditions (4 children) and other miscellaneous factors (3 children).

Conclusions

This study suggests that a substantial number of children will continue to receive cochlear implants well beyond their first birthday primarily due to progressive hearing loss. In addition, other medical conditions may contribute to delayed decisions in pediatric cochlear implantation.     

The relativity of integrity testing by telemetry in the diagnosis of cochlear implant defect: A case study and literature review

Objective

This paper report a rare case that showed the limitation of integrity testing by telemetry in detecting the cause of cochlear implant defect.

Method

We are reporting the case of a 45-year-old female who received a cochlear implant 10 years ago, owing to a profound bilateral sensorineural hearing loss. Following the cochlear implant the patient's speech discrimination threshold improved dramatically.In March 2009, after a car accident, the patient was unable to hear. The clinical and radiological examination revealed no abnormality, nor did the telemetry test, with normal implant function and normal NRT. The proceeding medical treatment with a corticosteroid therapy and hearing rehabilitation brought no improvement. Thus we decided to revise both implantations.

Result

The cochlear reimplantation was postoperatively found to have brought a marked improvement in the hearing and speech discrimination threshold. Conclusively we chose to perform a second cochlear reimplantation on the opposite side which after surgery revealed the same postoperative result.

Conclusion

The telemetry test does not always enable one to discover the cause of the cochlear implant failure.     

Cochlear implant outcomes in children with motor developmental delay

Introduction

Multiple handicapped children and children with syndromes and conditions resulting additional disabilities such as cerebral palsy, global developmental delay and autistic spectrum disorder, are now not routinely precluded from receiving a cochlear implant. The primary focus of this study was to determine the effect of cochlear implants on the speech perception and intelligibility of deaf children with and without motor development delay.

Method

In a cohort study, we compared cochlear implant outcomes in two groups of deaf children with or without motor developmental delay (MDD). Among 262 children with pre-lingual profound hearing loss, 28 (10%) had a motor delay based on Gross Motor Function Classification (GMFC). Children with severe motor delays (classification scale levels 4 and 5) and cognitive delays were excluded. All children completed the Categories of Auditory Perception Scales (CAP) and Speech Intelligibility Rating (SIR) prior to surgery and 24 months after the device was activated.

Result

The mean age for the study population was 4.09 ± 1.86 years. In all 262 patients the mean CAP score after surgery (5.38 ± 0.043) had a marked difference in comparison with the mean score before surgery (0.482 ± 0.018) (P = 0.001). The mean CAP score after surgery for MDD children was 5.03, and was 5.77 for normal motor development children (NMD). The mean SIR score after surgery for MDD children was 2.53, and was 2.66 for NMD children. The final results of CAP and SIR did not have significant difference between NMD children versus MDD children (P > 0.05).

Conclusion

Regarding to the result, we concluded that children with hearing loss and concomitant MDD as an additional disabilities can benefit from cochlear implantation similar to those of NMD.     

Speech production intelligibility of early implanted pediatric cochlear implant users

Objectives

To investigate the influence of age, and age-at-implantation, on speech production intelligibility in prelingually deaf pediatric cochlear implant recipients.

Methods

Forty prelingually, profoundly deaf children who received cochlear implants between 8 and 40 months of age. Their age at testing ranged between 2.5 and 18 years. Children were recorded repeating the 10 sentences in the Beginner's Intelligibility Test. These recordings were played back to normal-hearing listeners who were unfamiliar with deaf speech and who were instructed to write down what they heard. They also rated each subject for the intelligibility of their speech production on a 5-point rating-scale. The main outcome measures were the percentage of target words correctly transcribed, and the intelligibility ratings, in both cases averaged across 3 normal-hearing listeners.

Results

The data showed a strong effect of age at testing, with older children being more intelligible. This effect was particularly pronounced for children implanted in the first 24 months of life, all of whom had speech production intelligibility scores of 80% or higher when they were tested at age 5.5 years or older. This was true for only 5 out of 9 children implanted at age 25-36 months.

Conclusions

Profoundly deaf children who receive cochlear implants in the first 2 years of life produce highly intelligible speech before the age of 6. This is also true for most, but not all children implanted in their third year.     

Validation of the LittlEARS Auditory Questionnaire in children with normal hearing

Objectives

With more children receiving cochlear implants during infancy, there is a need for validated assessments of pre-verbal and early verbal auditory skills. The LittlEARS^® Auditory Questionnaire is presented here as the first module of the LittlEARS^® test battery. The LittlEARS^® Auditory Questionnaire was developed and piloted to assess the auditory behaviour of normal hearing children and hearing impaired children who receive a cochlear implant or hearing aid prior to 24 months of age. This paper presents results from two studies: one validating the LittlEARS^® Auditory Questionnaire on children with normal hearing who are German speaking and a second validating the norm curves found after adaptation and administration of the questionnaire to children with normal hearing in 15 different languages.

Methods

Scores from a group of 218 German and Austrian children with normal hearing between 5 days and 24 months of age were used to create a norm curve. The questionnaire was adapted from the German original into English and then 15 other languages to date. Regression curves were found based on parental responses from 3309 normal hearing infants and toddlers. Curves for each language were compared to the original German validation curve.

Results

The results of the first study were a norm curve which reflects the age-dependence of auditory behaviour, reliability and homogeneity as a measure of auditory behaviour, and calculations of expected and critical values as a function of age. Results of the second study show that the regression curves found for all the adapted languages are essentially equal to the German norm curve, as no statistically significant differences were found.

Conclusions

The LittlEARS^® Auditory Questionnaire is a valid, language-independent tool for assessing the early auditory behaviour of infants and toddlers with normal hearing. The results of this study suggest that the LittlEARS^® Auditory Questionnaire could also be very useful for documenting children's progress with their current amplification, providing evidence of the need for implantation, or highlighting the need for follow-up in other developmental areas.     

Characteristics of hearing impairment in Yemeni children with chronic suppurative otitis media: A case-control study

Background

Chronic suppurative otitis media (CSOM) is a serious disorder particularly in low resource settings. It can lead to disabling hearing impairment and sometimes life-threatening infective complications.

Objective

The aim of the present study was to describe the characteristics of hearing impairment associated with CSOM in Yemeni children.

Methods

A case-control study of 75 children with CSOM and 74 healthy controls. Hearing was assessed by behavioural testing and audiometry.

Results

Cases had lower academic performance than controls (OR 15.31, 95% CI 1.99-322.14, p < 0.001). Disabling hearing impairment >30 dB was present in 51.5% (right ear) and 66.7% (left ear) of children with CSOM.

Conclusion

Disabling hearing impairment was identified as a major health problem in these Yemeni children with CSOM. There is a need for investment to reduce the burden of CSOM and its complications in these communities. Greater attention to the chronic disabling effects of CSOM in children is required in poor communities and low resource settings.     

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.     

Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS Auditory Questionnaire

Background and Aims

Newborn hearing screening and early intervention for congenital hearing loss have created a need for tools assessing the hearing development of very young children. A multidisciplinary evaluation of children's development is now becoming standard in clinical practice, though not many reliable diagnostic instruments exist. For this reason, the LittlEARS^® Auditory Questionnaire (LEAQ) was created to assess the auditory skills of a growing population of infants and toddlers who receive hearing instruments. The LEAQ relies on parent report, which has been shown to be a reliable way of assessing child development. Results with this tool in a group of children who received very early cochlear implantation are presented.

Methods

The LEAQ is the first module of the LittlEARS^® comprehensive test battery for children under the age of two who have normal hearing (NH), cochlear implants (CIs) or hearing aids (HAs). The LEAQ is a parent questionnaire comprised of 35 “yes/no” questions which can be completed by parents in less than 10 min. Sixty-three children who received unilateral CIs at a young age were assessed longitudinally and their performance was compared to that of a NH group.

Results

All CI children reached the maximum possible score on the LEAQ on average by 22 months of hearing age, i.e. 38 months of chronological age. In comparison, the NH group reached the maximum score by 24 months of age demonstrating that auditory skills of CI children often develop quicker than those of NH children. In the two comparison groups of children aged (a) younger and older than 12 months, and (b) between 6-9 and 21-24 months at first fitting, the early implanted children reached the highest scores faster than the later implanted children. Furthermore, three children with additional needs were tested. They showed slower growth over time but also received benefits from early implantation.

Conclusions

The LEAQ is a quick and effective tool for assessing auditory skills of very young children with or without hearing loss. In our study, the auditory skills of children with CI progressed very quickly after implantation and were comparable with those of NH peers.