关于学龄听障儿童听觉言语康复训练的思考

基于家庭的经济状况和家长的文化程度及对残疾子女的重视程度等原因,欠发达地区听障儿童的入学往往偏迟。如何对这些有一定残余听力却错过语言发展关键期的学龄听障儿童进行科学、系统、有效的听觉言语康复训练,使他们更快、更好地发展语言,值得广大特教工作者深思。     

Tinnitus in children without hearing impairment

ObjectiveTinnitus is not an uncommon symptom in the pediatric population and, despite its incidence, is still an unrecognized problem, particularly in normal hearing children. As tinnitus is frequently described by adults without evidence of ear disease, reports of tinnitus can be obtained also from a group of children without otological pathology. The present review has been performed in order to emphasize the great importance to try to identify children suffering from tinnitus and to recognize the difference between the tinnitus characteristics in children with ear pathology and those one without otological problems.MethodsA review of the literature regarding the nature of pediatric tinnitus and the practical diagnostic approach to this symptom has been carried out.ResultsChildren rarely complain spontaneously of tinnitus but are able to describe it when questioned. In our experience the total percentage of children with tinnitus rises from 6.5% (tinnitus reported spontaneously), to 34% when children are specifically questioned.Most children, more than 50%, have normal hearing; in those with hearing impairment, no particular type or severity of hearing loss has been found.An important point that must be considered much more seriously is tinnitus sequela following head injuries to which children are particularly exposed during their daily activities.Due to the serious consequences that may be caused by tinnitus, it is of great importance to identify and analyze it, so as to minimize its damage, utilizing a protocol of study of pediatric tinnitus which allows to collect interesting informations about tinnitus characteristics.ConclusionsIn considering that tinnitus in children exists and may provoke serious consequences, even in absence of ear pathology, it is necessary to investigate and understand more about this symptom in children. From this viewpoint, it is very important to recognize the value of a global evaluation of a child suffering from tinnitus.There is no reason why such an important symptom well reported in adults should not be investigated in the pediatric population in which it seems to be as frequent as in the adult one.It is reasonable to believe that also in children tinnitus may have significant implications for medical and rehabilitative management.     

Sensorineural hearing impairment in children with Chiari I malformation

OBJECTIVES: We describe the prevalance of Chiari I malformation in children presenting to a pediatric tertiary care hearing loss clinic, characterize the phenotype of hearing loss in children with Chiari I malformation, and discuss the potential pathophysiology of sensorineural hearing impairment (SNHI) related to Chiari I malformation. METHODS: This study was a retrospective case series of patients seen in a pediatric tertiary care hearing loss clinic affiliated with an academic medical center. We considered 481 patients with SNHI who had radiographic imaging as part of the evaluation for the cause of their hearing impairment. Hearing impairment was determined by behavioral audiogram and/or auditory brain stem response testing. Radiographic imaging was performed with computed tomography and/or magnetic resonance imaging. RESULTS: Six children with SNHI also had a diagnosis of Chiari I malformation. Four of these 6 children had unilateral hearing impairment. One child had asymmetric bilateral impairment; 1 child had symmetric bilateral impairment. The severity of hearing impairment varied from mild to profound. All children were referred to the neurosurgery department. None underwent surgical decompression. CONCLUSIONS: Chiari I malformation may be associated with SNHI. Central nervous system imaging for the evaluation of children with SNHI may be indicated, particularly in individuals with negative results on temporal bone computed tomography and genetic testing.     

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.     

Neuropsychologic function of children with severe hearing impairment.

A neuropsychologic and medical study was carried out on a selected sample of 34 hearing-impaired children aged seven to 10 years at the onset of the study. In 16 children the cause of the hearing loss was thought to be exogenous. Eight of these had evidence for organic brain dysfunction. Nine children were thought to have genetic etiologies, and in nine no cause could be determined (sporadic hearing loss). Medical examination revealed several unsuspected abnormalities, particularly visual ones. Motor and visual motor deficits were frequent among hearing-impaired children with brain damage. The Performance Scale of the Wechsler Intelligence Scale for Children, and Raven's Coloured Progressive Matrices, as well as the Paper Folding item of the Hiskey-Nebraska Test of Learning Aptitude appeared sensitive to the presence of brain damage. The mean score for the WISC Performance Scale fell within the average range for hearing children, supporting previous findings of cognitive competence of the deaf. In this sample, Hiskey-Nebraska scores tended to be lower than WISC scores. Reasons for this discrepancy were suggested and did not appear to be accounted for by brain damage. Deficits in items requiring visual memory, sequencing, and categorization were relatively prevalent but showed no etiologic predilection. They were thought to be related to the consequence of hearing loss rather than to brain damage. Difficulty with stereognosis highlighted the problem of deciding why a hearing-impaired child might fail a particular task. This difficulty suggested that failure might not indicate a deficit in the function the task was designed to measure, but rather, reliance on an inefficient strategy for success.     

Otitis media with effusion in children with congenital or early-onset hearing impairment

OBJECTIVE: The purpose of this study was to examine the incidence of otitis media with effusion (OME) among children with bilateral congenital or early-onset hearing impairment (CEHI) and to assess whether the diagnosis of OME had any effect on the detection of CEHI. METHODS: The study population consisted of all patients diagnosed in a Finnish university hospital between 1976 and 1995 as having CEHI (> 25 dB, 0.5-4 kHz, in the better hearing ear). Early-onset hearing impairments were defined as losses attributed to perinatal or neonatal complications. Otitis media with effusion was assigned when asymptomatic middle ear effusion had lasted at least 2 months and tympanocentesis had yielded mucous effusion. RESULTS: A total of 184 child patients with CEHI were identified. Of these, OME was diagnosed and treated in 28 (15%) patients. Of the patients with OME, diagnosis of CEHI was made before the occurrence of OME in 7 (25%) and at the same time in 10 (36%) but was delayed at least 6 months after the treatment of OME in 11 (39%) patients. CONCLUSION: It is suggested that all children undergoing ventilation tube placement should have age-appropriate hearing examination to exclude coexisting sensorineural hearing loss.     

大龄听障儿童听力语言康复训练的个案研究

通过对1名大龄听障儿童进行听力语言康复的个案研究,探讨对7岁以上听障儿童进行康复训练的方法和意义。根据研究情况,笔者提出了有针对性的建议,希望对大龄听障儿童的听力语言康复训练工作有一定的帮助和促进。     

听力障碍儿童的言语异常与言语矫治

言语异常是大多数听力障碍儿童在进行听觉言语康复过程中遇到的主要问题，言语矫治是听力障碍儿童全面康复内容的必要组成部分。目前，聋儿康复临床只把言语矫治简单地归为正音的做法，使得言语矫治工作不能得到规范而系统地开展，势必会影响到聋儿康复整体专业水平的提升。目的本文试图凭借言语病理学的相关理论和知识，对听力障碍儿童言语中存在的异常现象进行生理病理机制的探讨，有针对性地介绍几种常用的言语矫治的专业方法，以期唤醒读者对言语矫治工作的专业认知，在临床实践中逐步规范原有的康复行为，切实提高言语矫治工作的专业水平。     

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.     

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.     

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.