Barriers to early cochlear implantation

Abstract

Objective: Identify variables associated with paediatric access to cochlear implants (CIs). Design: Part 1. Trends over time for age at CI surgery (N?=?802) and age at hearing aid (HA) fitting (n?=?487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. Results: Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. Conclusion: NHS implementation was associated with reductions in age at device intervention in this cohort.     

Knowledge and attitude of mothers regarding infant hearing loss in Changsha,Hunan province,China

Objective: The objective of this study was to explore the knowledge and attitude among mothers of newborns regarding infant hearing loss (HL) in Changsha, Hunan province, China. Design: A questionnaire including 18 items was given to mothers. Study sample: A total of 115 mothers participated in the study. Results: Seven risk factors for hearing loss were identified correctly by above 60% of respondents and the top three were prolonged noise (88.7%), high fever (82.6%) and ear discharge (82.6%). Poor knowledge was demonstrated on risk factors jaundice (20.0%), measles (22.6%), convulsion (33.0%) and traditional Chinese medicine (39.1%). Maternal knowledge scores in identification and intervention (2.68?±?0.31) was slightly higher than the score in risk factors (2.47?±?0.34). Ninety-nine per cent of the mothers expressed the willingness to test baby’s hearing soon after birth and concern about hearing. Conclusions: Mothers were concerned about baby’s hearing and the attitude was positive. However, the correct recognition rate towards some risk factors for HL was low. Action needs to be taken to raise awareness about ear and hearing care, prevent HL caused by preventable causes and prompt early identification, early diagnosis and intervention of HL.     

Maintaining acceptably low referral rates in teoae-based newborn hearing screening programs

This article describes factors that can affect the refer rate for otoacoustic emission (OAE) based newborn hearing screening, including the population of infants being screened, the adequacy of probe fit, software options used, external ear conditions, screener training, and baby handling. The effect of the infant’s age on screening outcomes is also discussed using results of screening for 1328 regular nursery newborns, ranging in age from 6 to 60 hours, who were screened with transient evoked otoaoustic emissions (TEOAE) prior to hospital discharge. The youngest infants (6–9 hours old) were as likely to pass (90% pass rate) as the infants who were 24–27 hours old (94% pass rate). The results of this study are consistent with reports from many TEOAE-based screening programs that have demonstrated that acceptably low refer rates (mean = 6.9%) can be obtained when appropriate screening procedures are followed.     

Applying Rasch model analysis in the development of the cantonese tone identification test (CANTIT)

Abstract

Objective: Applying Rasch analysis to evaluate the internal structure of a lexical tone perception test known as the Cantonese Tone Identification Test (CANTIT). Design: A 75-item pool (CANTIT-75) with pictures and sound tracks was developed. Respondents were required to make a four-alternative forced choice on each item. A short version of 30 items (CANTIT-30) was developed based on fit statistics, difficulty estimates, and content evaluation. Internal structure was evaluated by fit statistics and Rasch Factor Analysis (RFA). Study Sample: 200 children with normal hearing and 141 children with hearing impairment were recruited. Results: For CANTIT-75, all infit and 97% of outfit values were <?2.0. RFA revealed 40.1% of total variance was explained by the Rasch measure. The first residual component explained 2.5% of total variance in an eigenvalue of 3.1. For CANTIT-30, all infit and outfit values were <?2.0. The Rasch measure explained 38.8% of total variance, the first residual component explained 3.9% of total variance in an eigenvalue of 1.9. Conclusions: The Rasch model provides excellent guidance for the development of short forms. Both CANTIT-75 and CANTIT-30 possess satisfactory internal structure as a construct validity evidence in measuring the lexical tone identification ability of the Cantonese speakers.     

Sweep frequency impedance measures in young infants: developmental characteristics from birth to 6 months

Objective: International Journal of Audiology To study the developmental characteristics of sweep frequency impedance (SFI) measures in healthy infants from birth to 6 months. Design: All infants were assessed using high-frequency tympanometry (HFT), distortion product otoacoustic emission (DPOAE) and SFI tests. SFI measures consisted of measurement of resonance frequency (RF) and mobility (ΔSPL) of the outer and middle ear. A mixed model analysis of variance was applied to the SFI data to examine the effect of age on RF and ΔSPL. Study sample: Study included 117 ears from 83 infants of different age groups from birth to 6 months. Results: The mean RF of the outer ear increased from 279?Hz at birth to 545?Hz at 4 months, whereas mean ΔSPL of the outer ear decreased from 7.9?dB at birth to 3.7?dB at 4 months of age. In contrast, the mean RF and ΔSPL of the middle ear did not change significantly with age up to 6 months. Conclusions: Developmental characteristics should be considered when evaluating the function of the outer and middle ear of young infants (≤6 months) using the SFI. The preliminary normative SFI data established in this study may be used to assist with the evaluation.     

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta?

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta? The aim of the study was to assess the necessity of a screening service to detect early hearing loss in the paediatric population with osteogenesis imperfecta. Twenty‐two children were assessed over a 5‐year period. Five children (22.7%) had normal hearing. Fourteen (63.6%) had conductive hearing loss, with 12 children in this group having otitis media with effusion (OME); all had resolution of hearing loss with appropriate therapy. Two children had persistent conductive losses unrelated to OME. Three children (13.6%) had sensorineural hearing loss, with one being detected at the age of 1 year. Existing evidence suggests that hearing loss associated with osteogenesis imperfecta has its onset in the second to third decade of life. Contrary to this, hearing loss was detected in 77.3% (17) of this population with a median and mean age of 9 years. This study would suggest that routine screening is worthwhile in children with osteogenesis imperfecta.     

Neonatal Hearing Screening: failures,hearing loss and risk indicators

To check the rate of failure, hearing loss and its association with demographic variables and risk indicators for hearing loss in newborns submitted to the Newborn Hearing Screening in a secondary hospital.Materials and MethodsCross-sectional and retrospective study, involving 1,570 newborns submitted to the different stages of the Newborn Hearing Screening Program. Initially, we carried out otoacoustic emission tests (ILO Echocheck) and the cochlear-eyelid reflex. Afterwards, we analyzed the demographic and clinical characteristics of the newborns, screening rate of failure, hearing loss and its association with demographic variables and risk indicators.ResultsTwenty-six newborns had failures in the first stages of the Program (1.7%), who were then referred to diagnostic evaluation. Of these, 16 (61.5%) did not come, two (7.7%) had normal results and eight (30.8%) were diagnosed with hearing disorders. The screening failure rate was 1.7% and the frequency of hearing disorders was 0.5%.ConclusionsPre-term newborns of very low birth weights had higher rates of screening failures and a greater occurrence of hearing changes. The factors associated with screening failure and hearing changes were similar to the ones described in the literature.     

Universal neonatal hearing screening program in Shanghai,China: An inter-regional and international comparison

ObjectiveBy comparing the Universal Neonatal Hearing Screening (UNHS) program as implemented in Shanghai and other regions in China and countries around the world, this study makes an assessment of the Shanghai model and summarizes the experiences implementing the UNHS program, so as to provide a valuable reference for other countries or regions to carry out UNHS more effectively. Since Shanghai is one of the most developed regions in China, we also examined the relationship between economic development and the UNHS starting year and coverage rate.MethodsThe study conducted a systematic review of published studies in Chinese and English on the program status of neonatal hearing screening to compare and analyze the implementation of the UNHS program in 20 cities or provinces in China and 24 regions or countries around the world. The literature search in Chinese was conducted in the three most authoritative publication databases, CNKI (China National Knowledge Infrastructure), WANFANGDATA, and CQVIP (http://www.cqvip.com/). We searched all publications in those databases with the keywords “neonatal hearing screening” (in Chinese) between 2005 and 2014. English literature was searched using the same keywords (in English). The publication database included Medline and Web of Science, and the search time period was 2000–2014.ResultsShanghai was one of the first regions in China to implement UNHS, and its coverage rate was among the top regions by international comparison. The starting time of the UNHS program had no relationship with the Gross Domestic Product (GDP) per capita in the same year. Economic level serves as a threshold for carrying out UNHS but is not a linear contributor to the exact starting time of such a program. The screening coverage rate generally showed a rising trend with the increasing GDP per capita in China, but it had no relationship with the area's GDP per capita in selected regions and countries around the world. The system design of UNHS is the key factor influencing screening coverage. Policy makers, program administrators, and cost-sharing structures are important factors that influence the coverage rates of UNHS.ConclusionWhen to carry out a UNHS program is determined by the willingness and preference of the local government, which is influenced by the area's social, political and cultural conditions. Mandatory hearing screening and minimal-cost to no-cost intervention are two pillars for a good coverage rate of UNHS. In terms of system design, decision-making, implementation, funding and the concrete implementation plan are all important factors affecting the implementation of the UNHS.     

Why parents refuse newborn hearing screening and default on follow-up rescreening—A South African perspective

Objectives

This study describes screen refusal and follow-up default characteristics together with caregiver reasons for screen refusal and follow-up default in two South African universal newborn hearing screening programs.

Methods

A retrospective record review of universal newborn hearing screening conducted at two hospitals (Hospital A n = 954 infants; Hospital B n = 2135) over a 31–33 month period. Otoacoustic emission screening was conducted with rescreen recommended within six weeks for a uni- or bilateral refer. Program efficacy was described according to coverage, referral and follow-up rates. A prospective telephonic interview with caregivers who declined the initial screen (n = 25) and who defaulted on follow-up (n = 25) constituted the next study component. Caregivers were randomly selected from the screening programs for a survey related to reasons for newborn hearing screening refusal and follow-up default.

Results

Screening coverage (89.3% Hospital A; 57.4% Hospital B), initial referral rates (11.6% Hospital A; 21.2% Hospital B) and follow-up return rates (56.1% Hospital A; 35.8% Hospital B) differed significantly between hospitals and were below benchmarks. The most frequent reasons for screen refusal were related to costs (72%), caregiver knowledge of newborn hearing screening (64%) and health care professional knowledge and team collaboration (16%). Almost all caregivers (96%) indicated that if costs had been included in the birthing package or covered by medical insurance they would have agreed to newborn hearing screening. Reasons for follow-up default were most commonly related to caregiver knowledge of newborn hearing screening (32%) and costs (28%). One in four caregivers (24%) defaulted on follow-up because they forgot to bring their infant for a rescreen. Only half of caregivers (48%) who defaulted on follow-up reported being aware of initial screen results while 60% reported being aware of the recommended follow-up rescreen.

Conclusion

Caregivers most commonly refused screening due to associated costs and mostly defaulted on follow-up due to an apparent lack of knowledge regarding initial screen outcome and recommendations made for follow-up. Including NHS as a mandated birthing service is essential if coverage is to be increased, while reducing follow-up defaults requires proactive reminders and improved communication with caregivers.     

Introduction to the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: Background,design, sample characteristics

Abstract

Objective: This article describes the background and the design of the longitudinal outcomes of children with hearing impairment (LOCHI) study, and the characteristics of the study cohort. Design: Children born between 2002 and 2007 who were identified with hearing loss and received audiological intervention by 3 years of age in Australia enrolled in the study. Their demographic characteristics are described. Study sample: Four hundred and fifty-one children in New South Wales, Victoria, and Southern Queensland. Results: Data on age at first hearing-aid fitting for different degrees of hearing loss are reported together with demographic characteristics of the cohort. Conclusion: A unique environment in Australia where all children with varied access to universal newborn hearing screening received the same consistent hearing services from a national hearing service provider makes it possible to investigate the effects of access to early auditory intervention on children's outcomes at a population level.     

Detectability of newborn chirp-evoked ABR in the frequency domain at different stimulus rates

Abstract

Objective: The present paper reports the results of a study on a group of newborns whose chirp-evoked auditory brainstem responses (ABR) were recorded at different repetition rates. The study was aimed at finding an optimum repetition rate for the chirp stimulus that facilitates a short response detection time in the frequency domain. Design: Chirp-evoked ABR were recorded at six different stimulation rates between 20/s and 100/s. The stimulation level was 35 dB nHL. The mean harmonic related SNR was calculated, and the response detection time and rate were assessed using a detection algorithm. Study sample: A group of 80 sleeping and 27 awake newborns with normal hearing were included. Results: The highest mean harmonic-related SNR in both groups was found at 60/s. The signal-to-noise ratio (SNR) was significantly smaller for the awake newborns. A significantly shorter detection time can be achieved for both newborn groups at 60/s compared to the other rates tested. Response detection in the group of awake newborns profited more from the change to 60/s compared to the sleeping newborns. Conclusions: It can be expected that with this optimized stimulus paradigm a shorter test time and a higher specificity of the hearing screening can be reached.     

Cost analysis of teoae-based universal newborn hearing screening

Although more and more hospitals are implementing universal newborn hearing screening programs, there is still very little information available about the costs of newborn hearing screening programs. The few articles which have been published evaluate technologies or protocols which are no longer used, are incomplete, or are based on hypothetical estimates of the costs and time necessary to do screening. After briefly reviewing the extant literature, this article describes a cost analysis of a TEOAE-based universal newborn hearing screening program. Reasons why the cost per baby ($7.42) is lower than in previous reports are explained, and the benefits of having accurate cost analysis data are summarized.     

Comparison between hearing screening-detected cases and sporadic cases of delayed-onset hearing loss in preschool-age children

Abstract

Objective: This study aimed to compare the diagnosis and ages of intervention for cases of delayed-onset hearing loss identified sporadically or via a preschool hearing screening program. Design: Retrospective study with the comparative analysis of two groups of children. Study sample: Cases identified from screening were selected from 34 321 preschool children who underwent screening for delayed-onset hearing loss between October 2009 and May 2011. Sporadic cases of delayed-onset hearing loss were selected from pediatric clinical records. Cases from the first group were excluded from the latter to avoid duplication. Two groups were given the same questionnaire to record risk indicators, diagnosis, and age at intervention. Results: The average age of 26 children at the time of diagnosis in the screening group (52.81 ± 13.23 months) was significantly earlier than in the 33 cases identified in the sporadic group (62.03 ± 12.86 months; p < 0.05). The age at intervention of children with bilateral moderate to severe hearing loss in the screening group (50.40 ± 10.76 months) was also earlier than in the sporadic group (62.73 ± 13.77 months; p < 0.05). Conclusions: Improved rates of early diagnosis could therefore be achieved with hearing screening for preschool children with no significant symptoms of delayed-onset hearing loss.     

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.     

感音神经性耳聋的早期识别与临床干预

感音神经性耳聋是临床常见问题,若不能及时发现和正确干预,可导致儿童听觉言语发育迟缓,以及情感、心理和社会交往等综合能力的发展。新生儿听力筛查与新生儿基因筛查使得感音神经性耳聋的早期发现成为可能。儿童期的听力筛查工作很大程度上弥补了因迟发性、渐进性或获得性听力损失导致的新生儿听力筛查漏诊的不足。感音神经性耳聋通过主客观听力检测技术可获得早期诊断,通过药物治疗、选配助听装置等获得早期干预。永久性感音神经性听力损失作为一种慢性疾病,传统的以医生为中心的医疗服务模式不足以满足患者需求,以患者、家庭或社区为中心的医疗服务模式逐渐被重视。