Perceptual Error Analysis of Korean Monosyllabic Word Recognition II: Similarity and Distance According to Hearing Level

Age-related hearing loss (HL) is a highly prevalent and undertreated disease that has long been considered an inconsequential result of aging, and at worst, a simple quality of life problem. Recent research suggests that HL may have significant implications for mental and neurocognitive health. Several studies have shown preliminary evidence associating HL and depression.1 Identifying modifiable risk factors for late-life depression is crucial because depression is relatively common and disabling in the elderly. Late-life depression is often resistant to medications such as antidepressants. Since HL is highly prevalent, severely undertreated, easily diagnosed, and treatable (by hearing aids or cochlear implants), establishing a link between HL and late-life depression may yield a strategy to prevent or treat depression in the sub-group of patients who also have HL.Latinos, depression, mental healthTable 1: Participant Demographics by Hearing Loss CategoryTable 2: Odds of Clinically Significant Depressive Symptoms by Category of Hearing Loss (adjusted model)A recent study2 by our team investigated whether an association between audiogram-measured HL and clinically significant depressive symptoms exists by using data from the Hispanic Community Health Study/Study of Latinos (HCHS). Determining whether this association exists in a racial/ethnic minority, such as the Hispanic population, was of specific interest for several reasons. Depression has been reported to be more common in the Hispanic population compared to other ethnic/racial groups.3 In addition, depression may be underdiagnosed in Hispanic individuals due to language, cultural, and literacy barriers to health care.4 Moreover, early studies evaluating this association have largely been limited to Caucasian cohorts.1 A finding in one race/ethnic group does not necessarily translate to another. STUDY METHOD The HCHS is a multicenter, prospective, community-based cohort study of Hispanic/Latino adults in the United States. This dataset includes information from audiograms, interviews, physical examinations, and tests, such as laboratory bloodwork and neuropsychological testing. This cohort also happens to have a large sample of Hispanic individuals with audiometric hearing data—in fact, the largest study to date (5,328 subjects compared with 1,332 in the previously largest study5). Importantly, this dataset included a measure of depressive symptoms known as the Center for Epidemiologic Studies Depression Scale, 10-item version (CESD-10, a 10-question yes/no survey). Data collected from a total of 5,328 individuals were included in the study after excluding data on those below 50 years old and those with early-onset hearing loss or missing key data, such as audiograms, CESD-10 scores, or demographics. In this cross-sectional study, hearing loss was assessed using pure-tone audiometry in soundproof booths. All individuals had pure-tone audiometry across frequencies 500 Hz to 8,000 Hz tested by trained technicians. The four-frequency pure-tone average (PTA) based on hearing thresholds at 500, 1,000, 2,000, and 4,000 Hz was calculated for each ear; HL was based on the PTA of the better ear, and unilateral HL was excluded. Severity of HL was categorized as follows: absent or normal, 0 to 25 dB; mild 26 to 40 dB; moderate, 41 to 55 dB; moderately severe, 56 to 70 dB; severe 71 to 90 dB; and profound, 91 dB or greater.2 Since few participants had severe or profound HL, individuals in these categories were combined with those in the moderately severe HL group to form a category of moderately severe or worse (56 dB or greater) HL. Depressive symptoms were measured using the CESD-10. Examples of questions include “I felt depressed” and “I felt that everything I did was an effort.” Clinically significant depressive symptoms were defined by a CESD-10 score of 10 or higher, a cutoff also used in prior research.6 The study also adjusted for other variables that may confound the association between HL and depression. By confound, we mean that these variables might create a seemingly false association between HL and depressive symptoms. For example, age can cause both HL and depression. By adjusting for age, we take this into account to reduce or eliminate the confounding effect of age. These other variables were adjusted for included use of hearing aids, demographics (age, sex, educational level, etc.), and cardiovascular disease. RESULTS Baseline participant characteristics listed by HL category are provided in Table 1. The median age of participants was 58 years old. Of the 5,328 participants, 62 percent were women. Most patients (82%) had no HL, 14 percent had mild HL, 2.7 percent had moderate HL, and 0.9 percent had moderately severe or worse HL. The mean CESD-10 score was 7.7. Clinically significant depressive symptoms (i.e., a CESD-10 score ≥10) were present in 32 percent of participants without HL, 34 percent with mild HL, 45 percent with moderate HL, and 57 percent with moderately severe or worse HL. When adjusting for other variables that might cause confounding, such as hearing aid use, demographic factors, cardiovascular disease, and antidepressants, the odds of clinically significant depressive symptoms (CESD-10 score ≥10) increased 1.44 times for every 20 dB increase in HL. This adjusted model was used to calculate the odds of clinically significant depressive symptoms in each category of HL compared to normal hearing (0 dB hearing loss; Table 2). The odds of clinically significant depressive symptoms were 1.81 times as high for mild HL, 2.38 times as high for moderate HL, 3.12 times as high for moderately severe HL, and 4.30 times as high for severe HL. DISCUSSION The association between HL and depression, both common conditions of older life, was not previously well established. This study shows a strong association between audiometric HL and clinically significant depressive symptoms using a large Hispanic study population. When accounting for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use, the odds of having clinically significant depressive symptoms increased nearly 1.5 times for every additional 20 dB of HL. This is clinically significant, as 20 dB is approximately the difference between each category of HL; for example, moderate (41-55 dB) vs. mild (26-40 dB) HL. An individual with mild HL had almost twice the odds of having clinically significant depressive symptoms compared with someone with normal hearing (0 dB HL). An individual with moderate HL had nearly 2.5 times the odds and an individual with severe HL had over four times the odds of having clinically significant depressive symptoms. It is intuitive to hypothesize that HL may increase the risk for depression via the development of social isolation and loneliness, which themselves are associated with a higher risk of depression. HL treatments have been shown to improve loneliness,7 as well as social function and depressive symptoms.8 However, a key limitation of the study is that it does not prove that HL causes depression. This study was a cross-sectional, observational study that shows an association between HL and depression. As we know, association is not the same as causation; only a randomized controlled trial could show causation. This study adds to the growing literature examining HL and depression. It provides a more robust statistical analysis, includes data from multiple sites across the country, and is the largest to date examining HL and depression. The study also extends earlier findings9 to a different ethnic group. Given that the Hispanic population is the fastest growing ethnicity in the United States and depression may be more prevalent in this population compared to other ethnic/racial groups,3 identifying modifiable risk factors for depression in Hispanic/Latino individuals is crucial. This is especially important because Latino individuals are less likely to start medical (antidepressant) therapy and more likely to discontinue such therapy within the first 30 days of treatment.10 Depression in later life is a heterogeneous disorder with many risk factors, and results from this study suggest that HL may be one important pathway to becoming depressed. The high prevalence (80% in individuals older than 80 years of age) and infrequent treatment (<20% use hearing aids or cochlear implants) of HL amongst the elderly implies that recognizing and treating HL may have the potential to significantly improve health outcomes for older adults. While we don't know whether HL causes depression, nor do we know whether treating HL will prevent depression, it seems very reasonable to recommend treatment for older adults with HL given the low risk of hearing aid use and broad potential benefit. Future longitudinal studies and randomized controlled trials examining whether treating HL reduces the risk of late-life depression can help elucidate the relationship between HL and depression. Establishing a causal link between HL and depression may eventually guide clinical practice guidelines and treatment recommendations regarding HL as a modifiable risk factor for depression. Thoughts on something you read here? Write to us at [email protected]

Objective:To investigate the audiological characteristics and possible causes of unilateral hearing loss in infants and young children. Methods:105 infants from Beijing Maternal and Child Health Care Institution who failed the newborn hearing screening and were referred to the Children's Hearing Diagnosis Center of PLA General Hospital for hearing diagnosis. They were diagnosed with unilateral hearing loss and underwent clinical data collection. A full set of audiological examinations included ABR, 40 Hz auditory event related potential, ASSR, DPOAE, tympanometry. Results:①In initial diagnosis, 45 cases（42.86%） had mild hearing loss, 19 cases（18.10%） had moderate hearing loss, 14 cases（13.33%） had severe hearing loss, and 27 cases（25.71%） had severe hearing loss; Among them, 65 cases（61.90%） were conductive hearing loss or mixed hearing loss, and 40 cases（38.10%） were sensorineural hearing loss. ②83 of 105 cases had follow-up visits: 24 cases were normal, 15 cases with mild hearing loss, 4 cases with moderate hearing loss, 12 cases with severe hearing loss, and 26 cases with extremely severe hearing loss, 2 cases of hearing loss in both ears. ③From the initial diagnosis to the follow-up diagnosis, the change of mild hearing loss was the largest, followed by moderate hearing loss, severe and extremely severe hearing loss basically did not change; the number of mild and severe conductive hearing loss which recovered to normal hearing was most, the number of sensorineural hearing loss changed little. Conclusion:The infants who failed the newborn hearing screening and were diagnosed with unilateral hearing loss were mainly mild to moderate conductive hearing loss and severe to extremely severe sensorineural hearing loss. The hearing of children with hearing loss gradually improved, and severe and extremely severe sensorineural hearing loss remained unchanged.

Objective:The aim of this study is to analyze the variation characteristics of ABR wave latency and wave interval in different functional states of middle ear and different hearing levels, and to explore the value of ABR detection method in hearing assessment of infants. Methods:A total of 670 children were enrolled in the Pediatric Hearing Diagnosis and Treatment Center of the Department of Otolaryngology head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from May 2020 to April 2021. According to the hearing test results, they were divided into group A normal group（632 ears）. Group B consisted of normal middle ear function and abnormal hearing（157 ears）, further divided into mild hearing loss subgroup（49 ears）, moderate hearing loss subgroup（47 ears） and severe to very severe hearing loss subgroup（61 ears）. Group C was a group with abnormal middle ear function（551 ears）, which was further divided into normal hearing subgroup（307 ears）, mild hearing loss subgroup（110 ears）, moderate hearing loss subgroup（107 ears） and severe to very severe hearing loss subgroup（27 ears）. The differences of Ⅰ, Ⅲ, Ⅴ Wave Latency, Ⅰ-Ⅲ, Ⅰ-Ⅴ wave interval between subgroups B and C and Group A, and between subgroups B and C were analyzed. Results:When the stimulus intensity was 80 dB nHL, there was no significant difference in ABR latency and wave interval between group B and group A, and there was no significant difference between group B and group A（P>0.05）, nor between the two groups（P>0.05）. In the subgroup of severe to very severe hearing loss, some ABRⅠ, Ⅲ and Ⅴwaves could not be elicited, only Ⅲ and Ⅴ waves were elicited from 4 ears and Ⅴ waves were elicited from 7 ears. The mean latency of 11 ear Ⅲ and Ⅴ waves was （5.20±0.44） ms and （6.80±0.75） ms, respectively, which was longer than that of mild and moderate hearing loss subgroups. Compared with group A, the latency of normal hearing subgroup in group C was significantly prolonged only for wave Ⅰ, and the latency of wave I, Ⅲ and Ⅴin other subgroups was significantly prolonged（P<0.01）. In terms of Ⅰ-Ⅲ and Ⅰ-Ⅴ wave intervals, there was no significant difference between group C and group A in normal hearing subgroup and mild loss subgroup. The subgroup of moderate hearing loss and the subgroup of severe to very severe hearing loss were significantly shorter than the group A（P<0.01）. Compared with the normal group, the latency of Ⅰ, Ⅲ and Ⅴ waves in group C were significantly longer（P<0.01）. The latency of wave Ⅰ, in the moderate hearing loss group was significantly longer than that in the mild hearing loss group（P<0.001）. The latency of each wave in severe to very severe hearing loss subgroup was significantly longer than that in mild and moderate hearing loss subgroup（P<0.001）. There was no difference between mild hearing loss subgroup and normal hearing subgroup（P>0.05）. The subgroup of moderate hearing loss and severe to very severe hearing loss were significantly shorter than the subgroup of normal hearing and the subgroup of mild hearing loss, and there was a significant difference between the two groups（P<0.01）. Conclusion:In sensorineural hearing loss, mild and moderate hearing loss had no significant effect on the latency and interwave period of ABR. The latency of each wave in severe to very severe hearing loss cannot be elicited normally or only Ⅲ and Ⅴ waves can be elicited, and it is significantly prolonged. The latency of ABR Ⅰwave was significantly prolonged when middle ear function was abnormal. The latency of each wave was significantly prolonged when middle ear function was abnormal and hearing was abnormal. When hearing loss reaches a certain degree, the interwave period is shortened significantly. Therefore, for mild to moderate hearing loss, the prolonged latency of ABRⅠ wave is of certain value for the qualitative diagnosis of hearing loss, and the prolonged latency of ABR Ⅰwave is of significance for judging middle ear dysfunction in infants.

This study examined the relationship between behavioural thresholds as measured by pure tone audiometry and electrophysiological thresholds measured by the Auditory Steady-State Response (ASSR) in children with normal hearing and sensorineural hearing loss. After being assessed, 45 children of both sexes, ranging in age from 5 to 15, were split into four groups: 10 with moderate to moderately severe sensorineural hearing loss (G2M); 10 with steeply sloping sensorineural hearing loss (G2D); 10 with profound and severe sensorineural hearing loss (G2S); and 15 with normal hearing (G1). ASSR, tympanometry, acoustic reflex testing, pure tone audiometry, and speech audiometry (SRT and SDT) were performed. The electrophysiological maximum in the group with normal hearing thresholds varied from 19 to 27 dB NA. The correlation in the group with moderate to moderately severe hearing loss was 0.42-0.74. The correlation in the steeply sloping hearing loss group was 0.68-0.94. The correlation in the group of people with profound and severe hearing loss was 0.59-0.86. The normal hearing group's mean differences in ASSR threshold and audiometric threshold ranged from -0.3 to 12 dB, in the moderate and moderately severe hearing loss group from -9 to 2 dB, in the steeply sloping hearing loss group from 1.4 to 7.5 dB, and in the severe and profound hearing loss group from -0.40 to 8.5 dB. As expected, there was no strong relationship between behavioural and electrophysiological thresholds in the group with normal hearing. But in children with hearing loss, there was a strong correlation between electrophysiological and behavioural thresholds; this relationship was especially evident in children with severe and profound hearing loss and those with steeply sloping hearing loss.

Purpose: This study aims to analyze the error rates and types of Korean monosyllabic word perception according to hearing level, providing detailed insight into phoneme-specific error patterns among elderly individuals with varying degrees of hearing loss. Methods: Seventy-two elderly participants were assigned to four hearing groups: normal hearing, mild, moderate, and severe hearing loss. Each completed a monosyllabic word discrimination task using 726 Korean monosyllabic stimuli, presented at their most comfortable listening level. Error rates were calculated for onset consonant, vowel, and coda positions, and errors were classified by segmental pattern (substitution, addition, omission, compound). Data were analyzed using one-way analysis of variance and post-hoc tests for group differences. Results: Total error rates increased according to hearing loss severity, from 18.3% in normal listeners to 80.4% in severe loss. Initial consonant errors were notably high, with severe-impaired participants showing over 80% errors in high-frequency onset consonants. Substitution errors predominated in all groups but decreased as hearing loss worsened; omission and compound errors correspondingly increased, especially in severe cases. Compound segmental errors became more common as hearing deteriorated, signifying much global breakdowns in word perception. Conclusion: Age-related hearing loss leads to a marked shift from single-segment errors toward frequent multisegment and compound errors in monosyllabic word perception. These findings highlight the need for detailed error analysis in clinical speech tests and endorse individualized rehabilitation approaches tailored for older adults’ auditory-perceptual profiles.

Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited. To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization. This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022. Audiometric hearing loss severity and participant-reported hearing aid use. The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement. Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92). In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.

To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway. This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017-2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants' hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16-25 dB), mild (PTA4, 26-40 dB), moderate (PTA4, 41-55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates. The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants' hearing status with performance on the MoCA test. While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

To investigate the efficacy of early intervention on language, pronunciation and cognitive developments of infants and toddlers with hearing loss and to build up an early intervention model. Fifty-six children with moderate to profound sensorineural hearing loss aged 10 months to 2 years were divided into two groups. 20 children, aged 10 months to 2 years, received early intervention services after wearing hearing aids for 6 - 18 months, and 36 children, aged 11 months to 2 years, didn't receive any intervention. The type and degree of hearing loss were measured by a series of auditory tests. Language and cognitive developments of the children with hearing loss and 28 age, and sex-matched children with normal hearing, aged 10 to 23 months, were evaluated by the Gesell developmental schedules. The results were expressed as developmental quotient (DQ). Pronunciation test in mandarin Chinese was adopted to evaluate the speech development of the 56 children with hearing loss. (1) The language DQ according the Gesell developmental schedules of the children with hearing loss who received early intervention was (92.25 +/- 17.32), significantly higher than those children with hearing loss who didn't receive intervention (70.44 +/- 29.99, P = 0.00), whish was significantly lower than that of the normal hearing children (P = 0.00). However, there was no significant difference in language DQ between the children who received early intervention and the normal hearing children. There was no significant correlation between the degree of hearing loss and language DQ in the children who received early intervention (P = 0.27). (2) The personal-social developmental quotient (DQ) of the children who received intervention was (101.40 +/- 7.66), significantly higher than that of the children who didn't receive intervention (83.94 +/- 22.09, P = 0.00), that were significantly lower than that of the children with normal hearing (P = 0.00). However, there were no significant difference in the personal-social DQ between the children who received early intervention and the children with normal hearing. No significant differences in the gross motor ability, fine motor ability and adaptive ability were observed between the two groups of children with hearing loss and normal hearing children. (3) The consonant pronunciation of the children with moderate to severe hearing loss who received early intervention was normal. Among those children only one case with profound hearing loss had/d/error. The consonant pronunciation of the children with moderate hearing loss who didn't receive early intervention of those was normal. One case with moderate-severe hearing loss and one case with severe hearing loss had/d/errors. Six cases with profound hearing loss had/d, m/errors. The tone of the children with moderate to severe hearing loss who received early intervention was normal. Three cases with profound hearing loss exhibited tone errors. Among the children who didn't receive early intervention, tone errors were found in two cases with moderate hearing loss, one case with moderate-severe hearing loss, one case with severe hearing loss, and twelve cases with profound hearing loss showed. The language, pronunciation and cognitive developments of the children who don't receive early intervention are significantly lower than those of the children with normal hearing. Early intervention can significantly improve the language, speech and cognitive abilities of children with hearing loss.

Lexical content is commonly understood to refer to the various categories of words that children produce and has been studied extensively in children with normal hearing. Unlike the hearing child, however, little is known about the word categories that make up the first lexicon of children with hearing loss (HL). Knowledge of the first lexicon is increasingly important, as infants with HL are now being detected through universal newborn hearing screening programs and fitted with hearing aids and cochlear implants in before 12 months of age. For these children, emergence of the first spoken words is a major milestone eagerly awaited by parents and one of the first verbal language goals of teachers and therapists working with such children. The purpose of this study was to evaluate the lexical content of the first 50 and 100 words produced by children with HL and to contrast this with that of a group of hearing children. Lexical content was compared in two groups of children: one group composed of 24 participants with severe profound or profound HL and a second group composed of 16 participants with normal hearing. Twenty-three participants in the HL group were fitted with a cochlear implant and one with bilateral hearing aids. All were "switched on" or fitted before 30 months of age. The Diary of Early Language (Di-EL) was used to collect a 100-word lexicon from each participant. All single word and frozen phrase data from each child's Di-EL were allocated to 1 of 15 word types grouped into four word categories (noun, predicate, grammatical, and paralexical), and the results were compared for both groups. The hearing and HL groups showed similar distributions of word categories, with nouns constituting the largest portion of the lexicon followed by predicates and paralexicals. Grammaticals made up the smallest portion of the lexicon. However, several significant differences were evident between the two groups. In both the 50- and 100-word lexicons, the hearing group used proportionately more nouns, fewer predicates, more common nouns, and fewer onomatopoeic words compared with the HL group. Further, more participants in the hearing group used grammatical word types other than adverbs (including pronouns) compared with the HL group. Overall, lexical content of the HL group was similar to that of the hearing group for both the 50- and 100-word lexicons, although some differences in proportional use were noted across word categories and types. It is suggested that differences in the quantity and diversity of language experienced by children with normal hearing compared with those with HL, together with differences in the input they receive, might in part explain these differences. The effect of quality of speech input and therapy method on the emerging lexicon and subsequent language development will be particularly important in informing appropriate intervention strategies for children with HL.

The purpose of this study was to examine age- and hearing-related differences in school-age children's benefit from visual speech cues. The study addressed three questions: (1) Do age and hearing loss affect degree of audiovisual (AV) speech enhancement in school-age children? (2) Are there age- and hearing-related differences in the mechanisms underlying AV speech enhancement in school-age children? (3) What cognitive and linguistic variables predict individual differences in AV benefit among school-age children? Forty-eight children between 6 and 13 years of age (19 with mild to severe sensorineural hearing loss; 29 with normal hearing) and 14 adults with normal hearing completed measures of auditory and AV syllable detection and/or sentence recognition in a two-talker masker type and a spectrally matched noise. Children also completed standardized behavioral measures of receptive vocabulary, visuospatial working memory, and executive attention. Mixed linear modeling was used to examine effects of modality, listener group, and masker on sentence recognition accuracy and syllable detection thresholds. Pearson correlations were used to examine the relationship between individual differences in children's AV enhancement (AV-auditory-only) and age, vocabulary, working memory, executive attention, and degree of hearing loss. Significant AV enhancement was observed across all tasks, masker types, and listener groups. AV enhancement of sentence recognition was similar across maskers, but children with normal hearing exhibited less AV enhancement of sentence recognition than adults with normal hearing and children with hearing loss. AV enhancement of syllable detection was greater in the two-talker masker than the noise masker, but did not vary significantly across listener groups. Degree of hearing loss positively correlated with individual differences in AV benefit on the sentence recognition task in noise, but not on the detection task. None of the cognitive and linguistic variables correlated with individual differences in AV enhancement of syllable detection or sentence recognition. Although AV benefit to syllable detection results from the use of visual speech to increase temporal expectancy, AV benefit to sentence recognition requires that an observer extracts phonetic information from the visual speech signal. The findings from this study suggest that all listener groups were equally good at using temporal cues in visual speech to detect auditory speech, but that adults with normal hearing and children with hearing loss were better than children with normal hearing at extracting phonetic information from the visual signal and/or using visual speech information to access phonetic/lexical representations in long-term memory. These results suggest that standard, auditory-only clinical speech recognition measures likely underestimate real-world speech recognition skills of children with mild to severe hearing loss.

Introduction: Hearing impairments are often associated with communication difficulties, which can hinder effective health education and the implementation of programs for proper oral hygiene and dental disease prevention. Aim: To assess the impact of oral hygiene, dietary patterns, and socioeconomic factors on dental caries prevalence in children with varying grades of hearing impairment Materials and methods: The objects of the study were 58 children (7 to 10 years) – 21 healthy children without hearing impairment,19 with mild and moderate hearing loss (they can't hear sounds below 20- 65 dB), 18 with severe and profound hearing loss (65 + dB). A comprehensive dental examination and professional oral hygiene were carried out on each child, during which the social status and eating habits were assessed through responses to a structured questionnaire administered in simple language and suitable formats. Data were collected and analyzed to identify the main factors influencing the prevalence of oral diseases in this special care need group. Results: In the control group, 52.4% had a high socioeconomic status. In the mild to moderate hearing loss group, 84% had a medium status, and in the severe hearing loss group, 44.4% had a low status. Children with hearing impairments, particularly those with severe hearing loss, exhibit significantly higher DMF scores, with the severe hearing loss group and poor oral hygiene having a DMF of 8.31 ± 2.93, compared to 5.29 ± 0.49 in the control group with poor hygiene. Children with frequent carbohydrate intake, reported by 67.7% of children with severe hearing loss, exhibit the highest mean DMF score (8.1), while those with limited intake, mostly from the control group (52.4%), show the lowest DMF score (2.4). Conclusion: The results of this study emphasize the heightened oral health risks in children with hearing impairments, particularly those with severe hearing loss. Addressing socioeconomic, hygiene, and dietary factors through targeted interventions is essential for improving oral health outcomes in this vulnerable group.

On the basis of strong research, universal newborn screening should be performed before age 1 month with repeat or follow-up testing for those who do not pass performed before age 3 months and intervention started before age 6 months. On the basis of strong research and consensus statement, tympanostomy tubes should be considered for individuals with bilateral persistent middle ear effusion for 3 months or greater and a documented conductive hearing loss. On the basis of consensus statement, all children with suspected hearing loss should have an age appropriate hearing test. On the basis of strong research, the most common form of congenital hearing loss is genetic. Most of this is nonsyndromic hearing loss.

The leading nonhereditary cause of childhood sensorineural hearing loss has been attributed to congenital cytomegalovirus (cCMV). Sensorineural hearing loss can be unilateral (UHL) or bilateral (BHL), and may be progressive. Our objective was to describe the characteristics, clinical nature and follow-up of ears in cCMV-associated UHL. This 16-year retrospective study was performed at Schneider's Medical Center, Israel. Data were collected from all cCMV infants with UHL at birth who were treated with antiviral treatment initiated within the first 4 weeks of life and had a follow-up period of at least 1 year. We enrolled 67 infants diagnosed with UHL at birth: 17 (25%) with mild hearing loss, 22 (33%) with moderate hearing loss and 28 (42%) with severe hearing loss. At the last follow-up visit, 7 (41%) ears in the mild hearing loss group improved to normal hearing, 8 (47%) ears exhibited no change and 2 (12%) ears deteriorated. In the moderate hearing loss group, 9 (41%) ears improved, 7 (32%) remained static and 6 (27%) deteriorated to the severe hearing loss group. One (4%) ear in the severe hearing loss group showed improvement. Of the 67 ears with normal hearing at birth, 4 (6%) ears deteriorated. This study assessed and elucidated the characteristics, clinical nature and long-term follow-up of both the affected and unaffected ears diagnosed with UHL due to cCMV. These data are crucial when medical and/or surgical interventions are considered.

You have accessThe ASHA LeaderFeature1 Mar 2005Aural Habilitation Update: The Role of Speech Production Skills of Infants and Children With Hearing Loss Sheila R. Pratt Sheila R. Pratt Google Scholar More articles by this author https://doi.org/10.1044/leader.FTR2.10042005.8 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In It is well known that the development of speech is extremely limited without adequate auditory input and feedback. An obvious example is that hearing loss in infancy and early childhood usually affects all as pects of speech production unless there is early and consistent use of sensory aids as well as substantive sensorimotor and linguistic training. The speech development of infants and children with hearing loss hinges on their abilities to use audition not only to learn the sounds of their language, but also to use their articulators to produce those sounds and make use of auditory feedback to refine their speech over time. As such, the speech of children with prelingual hearing loss is particularly susceptible to delay and disorder, es pecially if the severity of the hearing loss is substantial and intervention is delayed or inadequate. Speech Development During the first six months of life (and possibly in utero) auditory perceptual learning is vital for acquiring oral language and speech, although the maturation timeline for the speech production in normal-hearing children is relatively lengthy. This protracted timeline may account for the long-term training and treatment needs of many children with hearing loss, even those identified and fitted early with sensory aids (Yoshinaga-Itano & Sedey, 2000). Young children with normal hearing typically begin babbling around 5–6 months of age and start verbal expression around 12 months of age. However, their speech production skills continue to be refined through the school-age years and well beyond when their basic phonological inventories have been established. For example, vowel space, voice-onset times, and vocal control adjust throughout early childhood (Assmann & Katz, 2000; Koenig, 2001; Lee, Pontamianos, & Naray anan, 1999). Furthermore, substantial acoustic variability is a hallmark of children’s speech production until late childhood. Although the research is somewhat mixed on the development of coarticulation, children appear to be less able than adults to coarticulate their speech gestures in a consistent manner, and as a consequence, their speech is less intelligible than that of adults (Katz, Kripke, & Tallal, 1991; Nittrouer, 1993). The refinement of auditory processing of speech has a similar developmental timeline. Child ren may apply different rules or weights to speech cues than adults, and these weights change throughout childhood (Nittrouer, 2003; Nit trouer, Crowther, & Miller, 1998). Their auditory processing of speech also appears to be more susceptible to acoustic and linguistic perturbations than is observed with adults. Children are more adversely affected than adults by background noise, reverberation, talker variability, re ductions in signal bandwidth, and the number of signal channels (Eisenberg et al., 2000; Ryalls & Pisoni, 1997; Kortekaas & Stelmachowicz, 2000). The Role of Audition in Speech Development and Production For mature speakers, audition acts as an error detector and a means of monitoring speaking conditions. It is considered to be slower than other forms of sensory information (i.e., proprioception) generated during speech, and therefore is likely limited to a feedback role (Perkell et al., 1997). Speakers use audition to determine if their articulators have produced sounds that are acoustically off-target. Audition also provides information for corrective adjustments, and as a consequence, is a contributor to the maintenance of speech integrity. Studies of frequency and spectrally shifted speech feedback have shown that adults rapidly adjust to minor acoustic perturbations with compensatory and/or matching strategies (Bauer & Larson, 2003; Houde & Jordan, 2002; Jones & Munhall, 2002, 2003). They appear to adjust their articulators so that their speech productions match their internal representations. In addition to acting as an error detector, hearing is used by mature speakers to determine how they should adjust their speech in various acoustic, linguistic, and social environments. For example, adults know when to speak slower, louder, softer, or more precisely in order to accommodate their listener or the environmental conditions (Perkell et al., 1997). In contrast, many young children are unable to adjust the clarity of their speech, even when explicitly directed to do so (Ide-Helvie et al., 2004). Audition also allows the development of articulatory organization by providing information about how to position, move, and coordinate the articulators for speech, movements that can differ from those associated with vegetative functions of the mechanisms (Moore & Ruark, 1996). For ex ample, infants use audition to learn how to shift from a vegetative breathing pattern to a pattern that can support speech. They learn how to position and move their tongues and to judge the acoustic consequences of those gestures. Coord ination of the larynx with the vocal tract and upper airway articulators is refined over years but requires an intact auditory system (Koenig, 2001; Tye-Murray, 1992). The lip and jaw movements associated with speech in infants and young children are highly variable but distinct from sucking, chewing, and smiling (Green et al., 2000; Green, Moore, & Reilly, 2002; Moore & Ruark, 1996). The implication is that although the same peripheral mechanisms are used across oral and respiratory functions, the differing goals require substantially distinct coordination and feedback efforts. The coordination needed to chew and swallow efficiently develops over early childhood but is largely independent of hearing, whereas the coordination required to move between vowel and consonant gestures, particularly in a coordinated and coarticulated manner, is strongly influenced by hearing (Baum & Waldstein, 1991; Guenther, 1995; Tye-Murray, 1992; Waldstein & Baum, 1991). Audition has a primary sensorimotor role in the development of speech, but it also is fundamental to infants and young children learning the sounds of their language. Furthermore, it helps them learn how specific speech events relate to their phonology, so that with development, young children become more able to use their hearing to inform them about the sequencing of speech gestures and the correctness of subsequent productions. Over time children learn to use audition to monitor ongoing speech, detect errors, and make corrective adjustments. Hearing Loss and Speech Production Hearing loss is common in the general population but its effects on speech production are most pronounced with individuals whose hearing loss is congenital or acquired in early childhood. Most adults who acquire their hearing losses later in life suffer little or no deterioration in intelligibility, likely because their residual hearing provides sufficient feedback since their mature speech production systems rely more on orosensory than auditory information to maintain proper control (Guenther, 1995; Goehl & Kaufman, 1984; Perkell et al., 1997). The speech differences that they do exhibit are subtle and usually imperceptible, even in cases of complete or nearly complete adventitious hearing loss. Nonetheless, some adventitiously deafened adults exhibit reduced speaking rate, and compromised articulatory and phonatory precision (Kishon-Rabin et al., 1999; Lane & Webster, 1991; Lane et al., 1995; Leder et al., 1987; Waldstein, 1990; Perkell et al., 1992). These speech differences are similar in nature, but not in severity, to those observed with prelingually deafened speakers. Most infants and young children with hearing loss demonstrate disordered phonation and articulation, as well as delays in the acquisition of sound categories. The entire speech production system can be affected, from respiratory support to the coarticulation of ongoing speech (Pratt & Tye-Murray, 1997). This is especially true if the hearing loss is identified late or after a period of protracted hearing loss. Furthermore, the overlap and interaction of disordered sound production and linguistic delay contribute to poor speech integrity and restricted speech development. Babbling generally does not appear before 12 months of age (Oller & Eilers, 1988; Oller et al., 1985) and canonical babbling has been observed as late as 31 months in this population (Lynch, Oller, & Steffens, 1989). Infants also produce fewer instances of canonical babble and include a more limited range of consonants in their babble (Stoel-Gammon, 1988; Stoel-Gammon & Otomo, 1986; Wallace, Menn, & Yoshinaga-Itano, 2000). However, later speech intelligibility is better predicted by the consonant inventory used in emerging spoken language during the second year of life than during babble (Obenchain, Menn, & Yoshinaga-Itano, 2000). The phonetic repertoires of infants with severe-to-profound hearing loss often are restricted when compared to their normal-hearing peers, although there is abundant individual variability (Lach, Ling, Ling & Ship, 1970; Stoel-Gammon & Otomo, 1986; Wallace et al., 2000; Yoshinaga-Itano & Sedey, 2000). The early speech inventories of infants with severe-to-profound hearing loss predominately consist of motorically easy sounds such as vowels and bilabial consonants. The sounds of their inventories also contain more low frequency information, which is more audible. For example, the babbling of infants with hearing loss often has a high concentration of nasals and glides, which include low-frequency continuant cues (Stoel-Gammon & Otomo, 1986). Without early intervention and appropriate fitting of sensory aids the speech-sound inventories of many children with hearing loss usually do not attain full maturity. Yoshinaga-Itano and Sedey (2000) found that children with moderate-to-severe hearing losses did not reach an age-appropriate complement of vowel and consonant sounds until about 4 and 5 years respectively, and many children with profound hearing loss had restricted inventories even at 5 years of age. Children with profound hearing loss often reach an early plateau in their speech skill development. For instance, the speech characteristics of many children with severe-to-profound hearing loss demonstrate little improvement in sound inventory and intelligibility after 8 years of age, even with the initiation of extensive training (Hudgins & Number, 1942, McGarr, 1987; Smith, 1975). Such results imply that, like auditory and language interventions, speech production therapy should be an important component of early intervention, and that the common practice of delaying speech training in children with hearing loss until they have functional language is developmentally untenable if the goal is for them to be oral communicators. In addition to the relationship between age-of-onset and speech impairment severity, there also is a moderately positive relationship between the severity of hearing loss and the extent of the associated speech difficulties (Boothroyd, 1969; Levitt, 1987; Smith, 1975). For example, children with mild-to-moderate hearing loss, particularly if well aided, tend to exhibit speech differences that are mild (Elfenbein, Hardin-Jones, & Davis, 1994; Oller & Kelly, 1974; West & Weber, 1973). Elfenbein and colleagues found that children with mild-to-moderate hearing loss exhibit good intelligibility but had higher than normal rates of affricate and fricative substitutions. Mild hoarseness and resonance problems also are present in 20% to 30% of this group of children. Moreover, they tend to have increased rates of voicing irregularities, difficulties with /r/ production, and omissions of back and word-final consonants. Early studies of children with profound prelingual hearing loss showed that most rarely acquired speech skills sufficient to interact easily using spoken language. On average, less than 20% of their words were intelligible to listeners who were not familiar with their speech (Hidgins & Numbers 1942; Markides, 1970; Smith, 1975). Smith (1975) evaluated 40 children with varying levels of hearing loss and, on average, only 18.7% (0% to 76%) of their words could be identified by inexperienced listeners. As expected, overall intelligibility was inversely related to the frequency of segmental and suprasegmental errors. However, with early identification of hearing loss and early intervention (i.e., fitting of sensory devices, behavioral training, and parent counseling), the numbers of children with severe-to-profound hearing loss and intelligible speech has increased (Uchanski & Geers, 2003). Many more children are developing sufficient speech perception to support development of speech production and oral language, but these advances may have added to the overall heterogeneity of the population (Higgins et al., 2003). Other factors contribute to the diversity of speech production skills observed with these children. For instance, cognitive skill (particularly nonverbal intelligence) has been found to be an important predictor of functional speech and oral language in children with hearing loss (Geers et al., 2002; Tobey et al., 2003). Auditory experience in infancy and early childhood, even of limited duration, positively influences the speech production skills of children who have severe-to-profound hearing loss (Geers, 2004). The use of sensory aids has a substantial impact on speech outcomes, but somewhat surprisingly, the age at which infants and young children are fitted with cochlear implants has not surfaced in studies of speech production as a significant predictor of later speech intelligibility (Geers et al., 2002; Tobey et al., 2003). Early implantation (less than 2 years) is, however, related to more normal oral communication development as a whole (both speech and oral language) (Geers, 2004). It may be that the age of implantation is not easily separated from other influences of intervention, like the orientation of the habilitation program and parent involvement, which relate strongly to children being auditory perceptual learners and users of auditory feedback. Another consideration is that many early-implanted children may be implanted too late to observe a clear impact on speech production. The critical ages at which hearing aids should be fitted has not been investigated, but like cochlear implants, it is assumed that earlier is better. The oromotor integrity and language skills are additional factors that often are neglected in studies of speech development in children with hearing loss. A substantial number of infants and children with hearing loss present with secondary handicapping conditions, such as neurological disorders. When these neurological disorders include the speech mechanism, the development of functional speech is difficult even if audition is optimized. As such, is it not unusual for a child with hearing loss to have a coexisting dysarthria along with the speech impairment secondary to the hearing loss. A subset of children with hearing loss also may have an apraxia of speech, but separating the impact of hearing loss from an apraxia of speech is difficult because the associated speech characteristics overlap (McNeil, Robin & Schmidt, 1997). Language disorders also are commonly observed in children with hearing loss, and are frequently evidenced in phonological disorder and lexical delay. As a result, extricating the sensorimotor impact of hearing loss on speech production from the influences of language disorder in individual children is not always straightforward (Peng et al., 2004). Habilitation: Sensory Aids and Treatment Most speech training approaches are dependent on optimizing the use of residual hearing although some approaches use other modalities (Pratt, Heintzelman, & Deming, 1993; Pratt & Tye-Murray, 1997). Correspondingly, it is generally believed that speech is learned most easily if infants and children learn and monitor their speech through their auditory systems. Therefore, the proper and early fitting, and consistent use of sensory aids, along with auditory and language training are important components of speech production training. In support of this auditory-based approach is the relationship between the severity of prelingual hearing loss and the extent of speech delay/disorder found in children (Boothroyd, 1969; Levitt, 1987; Smith, 1975), as well as any history of previous hearing (Geers, 2004). The relationship between audiometric configuration and speech intelligibility also argues for the importance of audition if the goal for a child is oral communication (Levitt, 1987; Osberger, Maso, & Sam, 1993). There is a growing literature supporting the positive impact of cochlear implants on speech development, as well as the role that auditory-oral-based training programs play in communication outcomes of children fitted with cochlear implants (Geers et al., 2002; Tobey et al., 2003). There is, however, limited efficacy data for children with less severe hearing loss who are typically fitted with hearing aids. The lack of research in this area is glaring because wearable electroacoustic hearing aids have been available for more than 50 years (Lybarger, 1988) and are a fundamental component of treatment approaches for most children with hearing loss. Furthermore, more infants and children are fitted with hearing aids than cochlear implants. Preliminary data reported by Stemachowicz and her colleagues (2004) on three infants fitted early with hearing aids suggested delays in sound category acquisition consistent with patterns previously reported in the literature. Sound inventories were impoverished, consonants were more affected than vowels, and sound containing high-frequency cues were particularly limited. Additional data by Pittman and colleagues (2003) observed that the amplitude of high-frequency speech cues directed to and produced by children wearing hearing aids may not be sufficient, although they did not connect their results directly to speech production outcomes. Pratt, Grayhack, Palmer, and Sabo (2003) found that differences in hearing aid configuration could alter vowel spacing of children even though the children in their study had intelligible speech, and the speech tokens measured were limited to acceptable productions. Their data indicated that hearing aids could alter the speech of children, but provided little information about the impact that hearing aids may have on speech development. Given the paucity of data-as well as the expansion of universal infant hearing screening programs-it is critical that more research be done in this area. 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Background: Hearing loss in children can significantly impact language development and social interaction. Hypertrophic adenoids are a common pediatric condition that can contribute to hearing impairments. Understanding the prevalence and severity of hearing loss in this demographic is crucial for effective management and intervention strategies. Objective: The study aimed to determine the prevalence and severity of hearing loss among children with hypertrophic adenoids, assessing the demographic characteristics and the types of hearing loss observed in this population. Methods: This observational cross-sectional survey was conducted over nine months at the Children's Hospital and Institute of Child Health, University of Lahore Teaching Hospital. The study included a sample size of 339 children aged 5-13 years, calculated based on a prevalence rate of 67.3% for mild hearing loss. Children with comorbidities like Down syndrome, Autism, ADHD, and other disabilities were excluded. Hearing assessments were conducted using an otoscope, a tympanometer, and a diagnostic audiometer (MAICO MA41 model). Data were analyzed using SPSS Version 25.0, focusing on the frequency and percentage of various types of hearing loss. Results: The study included 183 males (54%) and 156 females (46%), with a higher representation from rural areas (60%, n=203). Tympanometric analysis revealed 51.9% (n=176) with Type A tympanograms, 43.1% (n=146) with Type B, and 5% (n=17) with Type C. Audiometric results showed that 53.1% (n=180) of participants had normal hearing levels, while 27.1% (n=92) experienced mild hearing loss, 16.2% (n=55) had moderate hearing loss, 3.5% (n=12) had moderately severe hearing loss, 1.5% (n=5) had sensorineural hearing loss, and 2.1% (n=7) had mixed hearing loss. Conclusion: The study demonstrates a significant occurrence of mild to moderate conductive hearing loss in children with hypertrophic adenoids, particularly in rural settings. These findings highlight the need for regular auditory screening and early intervention strategies in this demographic to prevent long-term speech and language complications.