Play Audiometry Research Articles

App-Based Hearing Screenings in Preschool Children With Different Types of Headphones: Diagnostic Study.

Hearing disability in preschool children can delay or impact oral communication and social skills. Provision of hearing screening tests by standard audiometry in low- to middle-income countries is problematic due to a lack of pediatric audiologists, standard hearing equipment, and standard soundproof rooms. Therefore, an innovative hearing screening tool that is easily accessible and inexpensive such as a mobile app should be considered. Headphones have been a crucial part of hearing screenings. Audiometric headphones, which serve as the reference standard, have been used in most studies. However, since audiometric headphones are not accessible in rural areas, we hypothesized that generic headphones can also be used in hearing screenings. This study aimed to determine the sensitivity, specificity, κ coefficiency, and time consumption of the PASS-Pro (Preschool Audiometry Screening System-Pro) app when using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones compared to standard conditioned play audiometry. We recruited preschool children aged 4 to 5 years to participate in this study. The children received 3 PASS-Pro screening tests using different types of headphones in a quiet room and 1 standard conditioned play audiometry in a soundproof room. All tests were administered in random order. The agreement coefficient, sensitivity, specificity, and mean test duration were determined. A total of 44 children participated in this study. For mild hearing loss screening, the κ coefficients between standard conditioned play audiometry and the PASS-Pro app using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones were 0.195, 0.290, and 0.261 (P=.02, P=.002, and P=.004), respectively. The sensitivity for all headphones was 50% and the specificity was more than 88%. For moderate hearing loss screening, the κ coefficients were 0.206, 0.272, and 0.235 (all Ps=.001), respectively. The sensitivity for all headphones was 100% and the specificity was more than 92%. There were no statistical differences in sensitivity and specificity between the reference headphone (TDH39), Beyerdynamic DT 770 PRO headphone, and generic earmuff headphones (all Ps >.05). The PASS-Pro app used significantly less time to carry out hearing tests than conditioned play audiometry (P<.001). The PASS-Pro app, used with generic headphones, is effective for conducting hearing screening tests in preschool children with high sensitivity and specificity.

Hearing Loss among Children Treated with Chemotherapy at Paediatric Oncology Department in Tanzania

Chemotherapy-induced hearing loss bears significant impairment of skills, language development, and cognitive performance in children. Hearing loss pattern is mostly bilateral and sensorineural, affecting high frequencies above 8 kHz, which is important in speech discrimination and background noise perception. Pathophysiology is related to damage to the basal cochlea outer hair cell, which can progress to those in the apical turn. Despite challenges encountered during monitoring chemotherapy ototoxicity in children, monitoring is very advantageous since it guides in the early identification of hearing loss and provides proper intervention such as treatment interruption, dose modification, and suspension of drugs. This study aimed to determine the prevalence and pattern of hearing loss among children treated with chemotherapy at the paediatric department in a Tertiary hospital. This was a prospective longitudinal study. A total of 52 participants were enrolled, whereby hearing assessment was done before and after receiving two cycles of chemotherapy. Tympanometry was done after otoscopic examination in all participants, play and pure tone audiometry for participants aged 2 to 6 years and 7 years, respectively, and a destruction test for those below 2 years of age. Statistical Package for Social Science (SPSS) version 26 was used to obtain cross-tabulations. Fifty-two participants with a mean age of 6.6±2.3 years were enrolled in the study. There was a male preponderance with a male-to-female ratio of 3:1. Prevalence of hearing loss after chemotherapy was 15.4%. The pattern of hearing loss was predominantly bilateral, high frequency, and sensorineural type of hearing loss. Nasopharyngeal tumours were related to hearing loss as compared to other tumour sites. Hearing loss was frequently associated with the use of cisplatin as compared to vincristine and carboplatin. The commonly used chemotherapies such as cisplatin, carboplatin, and vincristine can cause hearing loss, which can affect the quality of life and therefore require audiological monitoring

Application of behavioral audiometry in subjective hearing assessment of children

Objective:To explore the value and influencing factors of behavioral audiometry in subjective hearing assessment of children. Methods:The results of behavioral audiometry（visual reinforcement audiometry or play audiometry） of 1944 children（3888 ears） in the outpatient department from January 2012 to December 2015 were retrospectively analyzed. The subjective performance（" good ", "moderate", "poor", " unfinished "） was compared according to age and hearing level. SPSS 27.0 software was used for statistical analysis. Results:The subjective performance of children was "good" in 2791 ears（71.8%）, "moderate" in 411 ears（10.6%）, "poor" in 309 ears（7.9%） and " unfinished " in 377 ears（9.7%）. In visual reinforcement audiometry, the proportion of children who subjectively performed as "good" gradually increased with age, reaching the peak at 2 years old, and decreased with age after 2 years old. In play audiometry, the proportion of children who subjectively performed as "good" gradually increased with age, peaking at 4-5 years of age. The children who did not finish the test were mainly 1-3 years old. The reasons included uncooperation for 148 ears, crying for 95 ears, refusing to wear headphones for 57 ears, fatigue for 42 ears, lack of interest for 20 ears, not understanding for 14 ears, and distraction for 1 ear. Conclusion:Behavioral audiometry was helpful to assess children's subjective hearing, and children's subjective performance was good. In clinical work, more novel and attractive test materials and methods should be adopted or developed according to the physical and mental characteristics of young children.

Auditory Steady-State Response (ASSR) in hearing-impaired children with absent Auditory Brainstem Response (ABR) waves

Objectives: The aim of this work was to evaluate the residual hearing in children with sensorineural hearing loss and absent ABR waves by ASSR to select the appropriate way for intervention either the use of hearing aid or cochlear implant. Patients and methods: Forty children (80 ears) were included in this study in the period from May 2019 up to April 2020. All children had detailed complete history taking, otoscopic examination, immittancemetry, hearing assessment to get an accurate frequency specific threshold with play audiometry, behavioral observation audiometry, and evoked audiometry including ABR, TEOAEs, and ASSR. Results: Forty hearing impaired children with ages ranged from 1 to 5 years old, 22 were males and 18 were female. ASSR response was obtained from 53 ears, and 27 ears showed no response. The ASSR showed a better response at low-frequency regions when compared to the high-frequency regions but with no statistically significant difference. Conclusions: The absence of click-ABR waves and behavioral free-field responses do not rule out the presence of residual hearing. ASSR was done to estimate the residual hearing mainly at low-frequency regions.

Comparison of Pure-Tone Thresholds and Cochlear Microphonics Thresholds in Pediatric Cochlear Implant Patients.

In adult cochlear implant patients, conventional audiometry is used to measure postoperative residual hearing which requires active listening and patient feedback. However, audiological measurements in pediatric cochlear implant patients are both challenging as well as time consuming. Intracochlear electrocochleography (ECOG) offers an objective and a time-efficient method to measure frequency-specific cochlear microphonic or difference thresholds (CM/DIF) thresholds that closely approximate auditory thresholds in adult cochlear implant patients. The correlation between CM/DIF and behavioral thresholds has not been established in pediatric cochlear implant patients. In the present study, CM/DIF thresholds were compared with audiometric thresholds in pediatric cochlear implant patients with postoperative residual hearing. Thirteen (11 unilateral and 2 bilateral) pediatric cochlear implant patients (mean age = 9.2 years ± 5.1) participated in this study. Audiometric thresholds were estimated using conventional, condition play, or visual reinforcement audiometry. A warble tone stimulus was used to measure audiometric thresholds at 125, 250, 500, 1000, and 2000 Hz. ECOG waveforms were elicited using 50-msec acoustic tone-bursts. The most apical intracochlear electrode was used as the recording electrode with an extra-cochlear ground electrode. The ECOG waveforms were analyzed to determine CM/DIF thresholds that were compared with pediatric cochlear implant patients' audiometric thresholds. The results show a significant correlation (r = 0.77, p < 0.01) between audiometric and CM/DIF thresholds over a frequency range of 125 to 2000 Hz in pediatric cochlear implant patients. Frequency-specific comparisons revealed a correlation of 0.82, 0.74, 0.69, 0.41, and 0.32 between the audiometric thresholds and CM/DIF thresholds measured at 125, 250, 500, 1000, and 2000 Hz, respectively. An average difference of 0.4 dB (±14 dB) was measured between the audiometric and CM/DIF thresholds. Intracochlear ECOG can be used to measure CM/DIF thresholds in pediatric cochlear implant patients with residual hearing in the implanted ear. The CM/DIF thresholds are similar to the audiometric thresholds at lower test frequencies and offer an objective method to monitor residual hearing in difficult-to-test pediatric cochlear implant patients.

Pediatric Speech Audiometry Web Application for Hearing Detection in the Home Environment

This paper describes the development of the speech audiometry application for pediatric patients in Slovak language and experiences obtained during testing with healthy children, hearing-impaired children, and elderly persons. The first motivation behind the presented work was to reduce the stress and fear of the children, who must undergo postoperative audiometry, but over time, we changed our direction to the simple game-like mobile application for the detection of possible hearing problems of children in the home environment. Conditioned play audiometry principles were adopted to create a speech audiometry application, where children help the virtual robot Thomas assign words to pictures; this can be described as a speech recognition test. Several game scenarios together with the setting condition issues were created, tested, and discussed. First experiences show a positive influence on the children’s mood and motivation.

Auditory Characteristics in Patients With Mucopolysaccharidosis

The purpose of the study was to evaluate audiologic findings according to mucopolysaccharidosis (MPS) subtypes and to estimate hearing changes as the disease progressed, as well as the therapeutic effect of enzyme replacement therapy on the hearing apparatus. A total of 124 patients who were diagnosed with MPS between September 1994 and December 2016 were retrospectively analyzed. Play audiometry or pure-tone audiometry was performed for hearing assessment, and auditory brainstem response was conducted in patients with poor compliance. In total 124 patients were identified, ranging in age at diagnosis from 0 to 33 years. Fourteen of the patients had been diagnosed with type I, while 91 had type II, 2 had type III, 14 had type IV, and 3 had type VI. Mean bone conduction and air conduction for the better ear were 26.13±16.95 dB and 34.77 ± 20.00 dB in all patients, and 34.20±7.64 dB and 40.70±9.67 dB in patients with MPS II. The average auditory brainstem response threshold was 68.96 ±21.93 dB nHL. The most common type of hearing loss was pure sensorineural hearing loss in all subtypes, and the degree of hearing loss was variable mostly within the mild to severe range. The increase in the hearing threshold was also significantly correlated with the disease duration. However, the change in hearing level was not correlated with the duration of enzyme replacement therapy. Hearing impairment in MPS patients is common and is aggravated as the disease progresses. Thus, adequate intervention and hearing rehabilitation might play an important role in managing hearing disabilities in MPS patients.

The Time Required for Play Audiometry in Children Affected by Age and Developmental Level

The Time Required for Play Audiometry in Children Affected by Age and Developmental Level

Vestibular and radiological evaluation of hearing impaired children with delayed Motor development

Background: Combined hearing and vestibular loss in children pose potentially significant problems. Children and infants with vestibular problems are faced with motor problems that could limit their normal development.Objectives: the aim of the study is to assess the relationship between the vestibular disorders and the delayed motor development in hearing impaired children as well as to assess the integrity of the vestibular system through clinical testing and radiological imaging in those children with delayed motor development.Methods: Thirty hearing impaired children with history of delayed motor milestones, and a control group of 10 hearing impaired children with normal motor development were included with variable degree of hearing loss. Each child was subjected to careful history taking, general examination, otoscopic examination, motor and balance questionnaires were answered by the parents or caregivers, audiological evaluation either through conditioned play audiometry or conventional audiometry, speech audiometry and Immittancemetry. Vestibular evaluation through cVEMP and caloric tests and finally the radiological studies through CT and MRI of the petrous bone.Results: There were variable degrees of hearing loss among both groups. In the control group (10 HI children, 20 ears), 18 ears (90%) had VEMP response, while two ears (10%) had absent VEMP, while in the study group (30 HI children, 60 ears), 48 ears (80%) had VEMP response, while 12 ears (20%) had absent VEMP. All children in the control group had normal caloric response, while in the study group, 23 children (77%) had normal response, and seven children (23%) had abnormal caloric response, 4 children had bilateral weakness and 3 had unilateral weakness. CT and MRI study of petrous bone was done for the control group and revealed normal radiology, while in the study group, 21 children had normal imaging (70%) and the last 9 children (30%) had abnormal findings, the most common abnormalities was enlarged vestibular aqueduct (13%), followed by common cavity (7%).Conclusion: Children with hearing loss, irrespective of the degree of hearing loss, the vestibular system should be screened, assessed as it may be responsible for co-morbidities in fine and gross motor difficulties. Early intervention and effective therapy will be the proper way to get good outcome.

The Role of Cognitive Evaluation in Predicting Successful Audiometric Testing among Children.

To determine the role of cognitive testing in predicting age-appropriate audiometric responses among children aged 30 to 42 months. Prospective. Tertiary care audiology clinic. Subjects included primary English-speaking children aged 30 to 42 months. A certified pediatric audiologist performed the cognitive aspect of the Developmental Assessment of Young Children-Second Edition (DAYC-2). A second, blinded audiologist performed age-appropriate audiometry. The raw, age-equivalent, percentile, and standard DAYC-2 scores were compared by agreement between speech reception threshold (SRT) and pure tone average (PTA). Optimal DAYC-2 thresholds were also calculated for prediction of SRT-PTA agreement and assessed for sensitivity, specificity, and positive and negative predictive values. P < .05 was considered significant. Complete data were obtained from 37 children. The mean age was 34.9 months (95% CI, 33.5-36.2), and 15 (41%) were female. Among the 37 children, 24 (65%) and 13 (35%) underwent visual reinforcement audiometry and conditioned play audiometry, respectively. SRT-PTA agreement was seen in 32 (87%) tests. Mean DAYC-2 raw score grouped by SRT-PTA agreement was 39.4 versus 33.4 for nonagreement (2.8-9.3, P < .001). The mean age-equivalent score grouped by SRT-PTA agreement was 29.6 versus 23.0 for nonagreement (2.7-10.6, P = .002). Optimal cut points based on DAYC-2 scores achieved moderate overall prediction performance (area under the curve, 0.73-0.77) with a positive predictive value of 100%. The DAYC-2 is a useful screen to identify children likely to complete an age-appropriate audiogram.

Use of otoacoustic emissions to improve outcomes and reduce disparities in a community preschool hearing screening program.

IntroductionHearing loss substantially impacts pediatric development, and early identification improves outcomes. While intervening before school-entry is critical to optimize learning, early-childhood hearing screening practices are highly variable. Conditioned play audiometry (CPA) is the gold standard for preschool hearing screening, but otoacoustic emission (OAE) testing provides objective data that may improve screening outcomes.ObjectivesTo compare outcomes of a community-based low-income preschool hearing program before and after implementation of OAE in a single-visit, two-tiered paradigm. We hypothesized that this intervention would reduce referral rates and improve follow-up while maintaining stable rates of diagnosed sensorineural hearing loss.MethodsWe performed a cohort study of 3257 children screened from July 2014-June 2016. Department of Public Health data were analyzed pre- and post-implementation of second-line OAE testing for children referred on CPA screening with targeted follow-up by DPH staff.Primary outcomes included referral rates, follow-up rates, and diagnosis of sensorineural hearing loss.ResultsDemographics, pure-tone pass rates, and incidence of newly-diagnosed permanent hearing loss were similar across years. After intervention, overall pass rates increased from 92% to 95% (P = 0.0014), while only 0.7% remained unable to be tested (P<0.0001). 5% of children were unable to be tested by CPA screening but passed OAE testing, obviating further evaluation. Referral rate decreased from 8% to 5% (P = 0.0014), and follow-up improved from 36% to 91% (P<0.0001). Identification of pathology in children with follow-up increased from 19% to over 50%. Further, disparities in pass rates and ability to test seen in Year 1 were eliminated in Year 2.Conclusion and relevanceIn a community setting, implementation of second-line OAE screening for CPA referrals reduced referral rates, increased identification of hearing loss, reduced outcome disparities, and improved follow-up rates. This study provides lessons in how to improve outcomes and reduce disparities in early-childhood hearing screening.

Techniques for Remotely Programming Children With Cochlear Implants Using Pediatric Audiological Methods via Telepractice.

The purpose of this report is to describe the equipment setup and techniques for successfully testing behavioral thresholds in young children with cochlear implants (CIs) using telepractice. We will also discuss challenges associated with pediatric CI programming that are unique to the use of distance technology, and we will describe ways to overcome those challenges. Last, we will review the results from 2 recent studies specifically targeted toward testing behavioral thresholds in young children with CIs. Conditioned play audiometry or visual reinforcement audiometry was used to measure behavioral thresholds (T levels) for 35 young children with CIs (n = 19 for conditioned play audiometry and n = 16 for visual reinforcement audiometry). Participants were tested in the traditional in-person condition and in the remote condition using an AB-BA study design over 2 visits. There was no significant difference in T levels between the in-person and remote conditions, indicating that it is feasible to test young children using conventional pediatric testing procedures via remote technology. The primary challenges encountered were in regard to proper camera and video monitor placement at the remote site and the timing of communication between the audiologist and test assistant. The results from studies to date suggest that distance technology can be used successfully to program CI sound processors for young children using standard, age-appropriate testing techniques. The alternative of remote testing has substantial implications for reducing time and travel burdens for families, potentially leading to the construction of appropriate maps for young children with CIs in a timelier manner.

A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study.

BackgroundHearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered.ObjectiveThis study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test.MethodsAn Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment.ResultsFor screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes).ConclusionsThis study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages.

Cochlear implantation in children with auditory neuropathy: Lessons from Brown–Vialetto–Van Laere syndrome

Objective: Brown–Vialetto–Van Laere syndrome (BVVL) is a rare neurodegenerative disorder associated with auditory neuropathy (AN). The decision process for CI in AN is evolving with increasing evidence of efficacy. We evaluated the benefit of CI in children with BVVL syndrome.Methods: A retrospective study reviewed the pre- and post-operative hearing outcomes of three patients with BVVL who presented for CI. A fourth patient with BVVL who was not suitable for CI is also discussed. The primary outcomes were hearing thresholds and auditory perception. Outcome measurement instruments included visual reinforcement audiometry (VRA) or Play Audiometry (PA), Categories of Auditory Performance (CAP) and Auditory Speech Sound Evaluation (ASSE). Secondary outcomes were parental report (BAPP questionnaire), the perception of our SaLT and compliance.Results: Patient 1 had ASSE levels of 40–45 dB HL 1 year post-operatively, and CAP score had improved from 2 to 5. At 2-year review, aided thresholds were 40 dB at 2–4 kHz. Three months following CI, the CAP score of Patient 2 had improved from 3 to 5. At 6 months, thresholds were 25–30 dB at 2–4 kHz. Single words/phrases are used by both patients and benefit is reported by both families. Patient 3 has recently undergone CI, having been previously rejected at another centre. Three months following CI, his thresholds were 35–40 dB at 2–4 kHz and increased use of sign and vocalization is reported.Conclusion: CI in children with AN complicating BVVL has a variable, but a positive effect. Other manifestations of BVVL make measuring benefit challenging, in the absence of a ‘bespoke’ measurement instrument for children with complex needs. This study provides further evidence for the benefit of CI in children with AN.

Audiologic Manifestations of Marshall Syndrome.

Marshall syndrome is a genetic disorder caused by mutations in the COL11A1 gene. This syndrome is characterized by skeletal, ophthalmologic, craniofacial, and auditory abnormalities. Hearing loss is among the main manifestations reported in this disorder being observed in approximately 80% of affected individuals.The present study aims to describe the audiologic characteristics of three members of a family with Marshall syndrome and also serves as a review of the literature. Family study. Tertiary care otology and skull base center. We report the audiologic findings in a family with Marshall syndrome consisting of a mother and her son and daughter. The audiologic evaluation included tympanometry, acoustic reflexes testing, auditory brainstem response, transient otoacoustic emissions, pure-tone audiometry, speech audiometry in quiet, and conditioned play audiometry. These methods were applied according to the age of the patients. In addition, we provide a review of the English-language literature in an attempt to clarify the auditory phenotype of this syndrome. All 3 affected individuals had heterozygous c.3816+1G>A mutation in the splicing donor site of intron 50 of the COL11A1 gene. All three patients in our study had bilateral sensorineural hearing loss. Hearing impairment ranged from mild to moderate in the daughter, moderate in the son, and from mild to moderate in their mother. The majority of individuals with Marshall syndrome present early-onset bilateral sensorineural hearing loss. Hearing impairment is usually detected in early childhood, progresses gradually, and becomes stable in late adulthood, with a severity ranging from mild to severe.

Audiology Assistants: Results of a Multicenter Survey.

Although audiologists have been using support personnel for over 45 yr, controversy and variability continue with respect to the entry-level education, training methods, and scope of practice. As part of a larger clinical practices survey, this report focuses on use of audiology assistants (AAs) for pediatric settings and "life-span" facilities that had a significant population of pediatric patients. A questionnaire was sent to 116 facilities in geographically diverse locations. Of the 25 surveys returned, 22 had sufficient data to be included for analysis purposes. The majority of respondents assigned duties to AAs as follows: assisting with conditioned play audiometry and visual reinforcement audiometry, infection control, mail management, disposing of protected health information, ordering supplies, calling families, fielding family phone calls, and stocking supplies. In addition, of the nine pediatric facilities that used AAs and reported job duties, the majority assigned troubleshooting equipment and auditory brainstem response (ABR) screening. Two of the five life-span facilities that reported job duties assigned several duties not assigned by any of the pediatric facilities: pure-tone screening, earmold impressions, assisting with videonystagmography and ABR, and in-house hearing aid repairs. Of facilities that use AAs and reported staffing, the ratio of AAs to audiologists ranged from 0.03:1 to 1:0.37, with an average of 0.15 for life-span facilities and 0.17 for the pediatric facilities. Minimum educational levels required were reported as follows: high school (n = 8), college (n = 3), certificate (n = 1), and no requirement (n = 1). Within a small sample size of pediatric and life-span facilities, 14 of 22 centers used AAs to perform a variety of direct patient care, indirect patient care, and clerical duties. Based on the duties recommended within the American Speech-Language-Hearing Association guidelines and by many states, expanded employment of AAs, as well as expansion of assigned duties should be considered. Data are needed to determine the appropriate ratio of AAs to audiologists within different settings and to determine the impact of AAs for accessibility, productivity, and profitability.

Importance of early ventilation tubes insertion in chronic otitis media with effusion in children with congenital cleft palate

Background/Aim. Otitis media with effusion (OME) is almost universal in children with cleft palate with an incidence of more than 90%, but the approach to managing this problem varies significantly among authors. The Eustachian tube dysfunction is the main factor that leads to the presence of the middle ear effusion. This is especially prominent in children with congenital cleft palate and explains the prolonged course of this process. The objective of this study was to determine the effectiveness of early ventilation tubes insertion in children with cleft palate at the time of palatoplasty by monitoring the course and duration of the disease as well as development of complications. Methods. In the prospective study with predefined regular follow-up intervals and parameters, the two groups of children were observed. The group one (E) included 45 children with congenital cleft palate who underwent the early insertion of ventilation tubes during palatoplasty, and the group two (C) had the same number of children with cleft palate who were treated conservatively on an as-needed basis. Assessment parameters were findings of otomicroscopy, tympanometry, play and pure tone audiometry. Each child was followed-up for 5 full years at total of nine follow-up examinations. Results. Result analysis showed that there were no statistically important differences between the two study groups in terms of the course and duration of the presence of the middle ear effusion, or in terms of complications and speech development. Conclusion. Based on the results obtained, we can conclude that there is no significant benefit in early ventilation tubes insertion in children with cleft palate, therefore our recommendation is watchful waiting and a conservative treatment on an as-needed basis, with the ventilation tubes insertion when a surgeon, based on his or her experience and individual findings considers it necessary.

Measuring Sound-Processor Threshold Levels for Pediatric Cochlear Implant Recipients Using Conditioned Play Audiometry via Telepractice.

This study evaluated the use of telepractice for measuring cochlear implant (CI) behavioral threshold (T) levels in children using conditioned play audiometry (CPA). The goals were to determine whether (a) T levels measured via telepractice were not significantly different from those obtained in person, (b) response probability differed between remote and in-person conditions, and (c) the remote visit required more time than the in-person condition. An ABBA design (A, in-person; B, remote) was split across 2 visits. Nineteen children aged 2.6-7.1 years participated. T levels were measured using CPA for 3 electrodes per session. A "hit" rate was calculated to determine whether the likelihood of obtaining responses differed between conditions. Test time was compared across conditions. A questionnaire was administered to assess parent/caregiver attitudes about telepractice. Results indicated no significant difference in T levels between conditions. Hit rates were not significantly different between in-person and remote conditions (98% vs. 97%, respectively). Test time was similar between conditions. Questionnaire results revealed that 100% of caregivers would use telepractice for CI appointments either some or all of the time. Telepractice is a viable option for routine pediatric programming appointments for children using CPA to set behavioral thresholds.

Effect of Amplification on Speech and Language in Children With Aural Atresia.

There currently is no guideline regarding amplification or verification for children with aural atresia. This population, with the absence of the ear canal, has obvious congenital hearing loss. Research suggests that delayed treatment for hearing loss can result in speech and language impairments, including poor performance in school. In this study we examined the relationship between amplification and emerging speech and language development in children with aural atresia. Subjects included children, 3 to 6 years of age, with conductive hearing loss due to atresia. Clinical evaluations were used to determine relationships between amplification and speech and language development. Subjects underwent an audiology exam, including pure-tone or warble-tone air and bone conduction using play audiometry techniques, and a speech and language evaluation assessing language and vocabulary skills. Subjects who were fitted before 1 year of age showed better compliance with aid use and exhibited fewer delays in speech and language development. Children with right-sided atresia had significantly greater speech and language delays when compared with age norms from standardized tests. Our findings highlight a relationship between side of atresia, time of first amplification, compliance in aid use, and speech and language abilities.

Self-administered hearing loss screening using an interactive, tablet play audiometer with ear bud headphones

Background and objectiveThe timely diagnosis and treatment of acquired hearing loss in the pediatric population has significant implications for a child's development. Audiological assessment in children, however, carries both technological and logistical challenges. Typically, specialized methods (such as play audiometry) are required to maintain the child's attention and can be resource intensive. These challenges were previously addressed by a novel, calibrated, interactive play audiometer for Apple® iOS® called “ShoeBOX Audiometry”. This device has potential applications for deployment in environments where traditional clinical audiometry is either unavailable or impractical. The objective of this study was to assess the screening capability of the tablet audiometer in an uncontrolled environment using consumer ear-bud headphones. MethodsConsecutive patients presenting to the Audiology Clinic at the Children's Hospital of Eastern Ontario (ages 4 and older) were recruited. Participants’ hearing was evaluted using the tablet audiometer calibrated to Apple® In-Ear headphones. The warble tone thresholds obtained were compared to gold standard measurements taken with a traditional clinical audiometer inside a soundbooth. Results80 patients were enrolled. The majority of participants were capable of completing an audiologic assessment using the tablet computer. Due to ambient noise levels outside a soundbooth, thresholds obtained at 500Hz were not consistent with traditional audiometry. Excluding 500Hz threholds, the tablet audiometer demonstrated strong negative predictive value (89.7%) as well as strong sensitivity (91.2%) for hearing loss. ConclusionThresholds obtained in an uncontrolled setting are not reflective of diagnostic thresholds due to the uncalibrated nature of the headphones and variability of the setting without a booth. Nevertheless, the tablet audiometer proved to be both a valid and sensitive instrument for unsupervised screening of warble-tone thresholds in children.