Hearing-impaired Children Research Articles

Adaptation of mothers of hearing-impaired children to cochlear implantation: A qualitative study for identification of effective factors

Adaptation of mothers of hearing-impaired children to cochlear implantation: A qualitative study for identification of effective factors

DEVELOPMENT OF FLEXIBILITY IN 9-10 YEARS-OLD HARD-HEARING SCHOOLCHILDREN ENGAGED IN AIR STRETCHING

The article discusses the eff ectiveness of using a set of exercises, including stretching in hammocks or aerostretching, as an innovative way to correct fl exibility in hearing-impaired schoolchildren aged 9–10 years. Relevance. According to the World Health Organization for 2022, there are about 10% of hearing-impaired people in Russia, which is 14.6 mil-lion people, of which 220 thousand people are hearing-impaired. According to forecasts, by 2050 the number of people with hearing impairments will reach 900 million. The lack of auditory information worsens the perception of space, af-fects the violation of regulation and coordination of movements, reduces the indicators of general physical development, activity and dexterity. According to N. A. Bernstein, the most important task of education is physical improvement. The decrease in the child’s motor capabilities, confi dence in the successful execution of movements, is primarily associated with the development of fl exibility. Moreover, fl exibility is a favorable prerequisite for improving other psychological and speed-strength qualities. Evseev S. P., summarizing the available research, noted that in hard-of-hearing children, compared with their peers, fl exibility indicators are lower, which justifi es the goal: to develop a set of exercises aimed at developing fl exibility in hard-of-hearing schoolchildren 9–10 years old. Research methods: In the process of research, methods of scientifi c literature analysis, logical modeling, pedagogical experiment and methods of mathematical statis-tics. Conclusion. The data obtained as a result of the study prove the eff ectiveness of the use of aero stretching for the development of fl exibility in hearing-impaired schoolchildren. The introduction of a set of exercises in extracurricular stretching classes in hammocks for hearing-impaired children, allows to increase fl exibility, improve mobility of the shoulder, hip, ankle joints and spine.

Exploring The Efficacy Of Self-Concept And Psychosocial Skill Enhancement Interventions In Hearing-Impaired Children: A Comparative Analysis

This comparative study aimed to measure the impact of social skills training on the self-perception and psychosocial challenges experienced by school children with hearing impairment. The participants were divided into two groups: one received social skills training, and other was a control group, and self-report measures were used to evaluate their self-concept and psychosocial problems before and after the training. The outcomes displayed a significant upgrading in self-concep[1]t scores and a decline in psychosocial problem scores following the training. Gender differences were observed, with girls go through greater self-concept improvement, while boys displayed higher psychosocial problem scores post-training. In addition, a multivariate analysis proved a significant relation between gender and treatment group, suggesting potential gender-specific effects of social skills training. Conversely, the study was subject to certain limitations, including a small sample size and reliance on self-report measures. Future research should address these limitations and investigate the mechanisms and long-term effects of social skills training in hearing-impaired children, while considering gender-specific factors. Overall, this study contributes valuable insights to the existing literature on the effectiveness of social skills training in enhancing the well-being of hearing-impaired school children.

Application of speech induced ABR in rehabilitation intervention for hearing impaired children

Objective:Exploring the electrophysiological changes of auditory rehabilitation in young children with hearing impairment, providing more methods for early assessment and intervention. Methods:Twenty children aged 2-4 were enrolled, with moderate hearing loss and no other abnormalities in the ears. Divide them into group 1 with normal hearing, group 2 with abnormal hearing, group 3 with abnormal hearing receiving hearing aid intervention for one year, and group 4 with abnormal hearing receiving hearing aid and language training rehabilitation for one year. The SmartEP auditory evoked potential instrument was used to detect speech induced ABR and conduct screening for 'Standards and Evaluating Hearing and Language Abilities of Children with Hearing Impairment in 80 enrolled children after rehabilitation training, and the latency、amplitude of speech induced ABR waveform and evaluation scale scores for each group after rehabilitation intervention were compared. Results:Compared with the normal group, the latency of each wave in the other three groups was prolonged. The differences in each wave between Group 2 and Group 3 were statistically significant, while the differences in D and F waves between Group 3 and Group 4 were statistically significant. Compared with the normal group, the maximum amplitude at F0 decreased in the other three groups, and the differences in maximum amplitude between Group 2 and Group 3, Group 2 and Group 4, and Group 3 and Group 4 were statistically significant. Compared with the normal group, the scores of the auditory language assessment scale in the hearing intervention group and the hearing aid plus language training group were significantly higher than those in the abnormal group in terms of recognition rate. The recognition rates of hearing impaired children with language training foundation are similar to those of the normal group of children. Conclusion:Auditory rehabilitation can alter the electrophysiological aspects of hearing and serve as a basis for early assessment and intervention in young children.

Evaluation strategies of emotional hearing and the level of language development in preschoolers with hearing disabilities

Emotions and feelings are manifested in language through suprasegmental elements: timbre, rhythm, tempo, and intonation of the voice in the form of pauses, raising and lowering of the voice. Perceiving a person’s emotional information by voice under normal conditions is possible due to emotional hearing. To date, this important aspect in the assessment of emotional hearing and impressive and expressive language of hearing-impaired children remains understudied. Knowing the structural content and determining effective strategies for evaluating emotional hearing and impressive and expressive language will later serve as scientific-methodological support in the sense of establishing a comprehensive approach to the development of emotional hearing and verbal language (the lexical-semantic side). The article summarizes the results of the experimental research carried out in 2022–2023 regarding the evaluation of emotional hearing and the level of language development in preschoolers with hearing disabilities and presents significant data in comparison with the control group (preschoolers with typical development).

THE POSITIVE EFFECT OF DIRECTING THE CHILDREN WITH HEARING DEFECT IN THE SPECIAL BOARDING SCHOOL TO SOCIAL HOME LIFE

The article examines the content of the orientation of a special boarding school for hearing-impaired children towards social and everyday life. An analysis of the positive effect of the orientation of a special boarding school for hearing-impaired children on social and everyday life was carried out.

Does CISS MRI Reliably Depict the Endolymphatic Duct in Children with and without Vestibular Aqueduct Enlargement?

High-resolution CT is the mainstay for diagnosing an enlarged vestibular aqueduct (EVA), but MR imaging may be an appealing alternative, given its lack of ionizing radiation exposure. The purpose of this study was to determine how reliably MR imaging demonstrates the endolymphatic duct and endolymphatic duct enlargement in hearing-impaired children. We performed a retrospective review of temporal bone high-resolution CT and MR imaging of hearing-impaired children evaluated between 2017 and 2020. Vestibular aqueduct diameter was measured on high-resolution CT. The vestibular aqueducts were categorized as being enlarged (EVA+) or nonenlarged (EVA-) using the Cincinnati criteria. The endolymphatic ducts were assessed on axial high-resolution CISS MR imaging. We categorized endolymphatic duct visibility into the following: type 1 (not visible), type 2 (faintly visible), and type 3 (easily visible). Mixed-effect logistic regression was used to identify associations between endolymphatic duct visibility and EVA. Interreader agreement for the endolymphatic duct among 3 independent readers was assessed using the Fleiss κ statistic. In 196 ears from 98 children, endolymphatic duct visibility on MR imaging was type 1 in 74.0%, type 2 in 14.8%, and type 3 in 11.2%; 20.4% of ears were EVA+ on high-resolution CT. There was a significant association between EVA+ status and endolymphatic duct visibility (P < .01). Endolymphatic duct visibility was type 1 in 87.1%, type 2 in 12.8%, and type 3 in 0% of EVA- ears and type 1 in 22.5%, type 2 in 22.5%, and type 3 in 55.0% of EVA+ ears. The predicted probability of a type 3 endolymphatic duct being EVA+ was 0.997. There was almost perfect agreement among the 3 readers for distinguishing type 3 from type 1 or 2 endolymphatic ducts. CISS MR imaging substantially underdiagnoses EVA; however, when a type 3 endolymphatic duct is evident, there is a >99% likelihood of an EVA.

SWOT analysis of Russian universal newborn hearing screening program

Introduction. The negative impact of congenital hearing loss on child’s development, education and socialization can be reduced by early identification and intervention as a result of universal newborn hearing screening. The screening program needs continuous improvement by monitoring of outcomes and correction of algorithms. The SWOT analysis can be applied to make effective decisions. &#x0D; The purpose of the study is to identify strategies for the improvement of the Russian newborn hearing screening program based on SWOT analysis.&#x0D; Materials and methods. The study was based on the experience of two pediatric audiological centres in Novosibirsk and St. Petersburg. &#x0D; At the first stage, in accordance with the SWOT methodology, internal and external factors, the strengths and weaknesses of the Russian hearing screening program were identified, as well as the opportunities and threats that can affect the audiological care for children. At the second stage, pairwise analysis of strengths, weaknesses, opportunities and threats was carried out.&#x0D; Results. The strengths of the Russian hearing screening program are national level implementation, high coverage of newborns in maternity hospitals, the use of modern objective audiological methods. Weaknesses are associated with a lack of medical personnel, need to equipment replacement, number of cases lost to follow-up. Opportunities are the availability of high-quality domestic diagnostic equipment, possibility for active interaction of specialists and families. The threats are caused by an imperfect legal framework and funding mechanisms, low awareness of parents, related professionals and society about the problem of congenital hearing loss. &#x0D; Limitations. The study results are limited by the expertise of the authors without involving the wide range of stakeholders.&#x0D; Conclusion. The developed strategies can increase timely audiological service to hearing impaired children and their families and to plan the necessary resources in the face of modern challenges.

AUDITORY REHABILIATION DURING THE COVID-19 PANDEMIC – THE PARENTS’ PERSPECTIVE

The Covid-19 pandemic has affected numerous aspects of human existence, thus increasing psychological stress in the overall population worldwide. Healthcare and social support systems have suffered extreme challenges and pressures. The welfare, protection, and rights of socially vulnerable groups, such as children with loss of hearing and their families, were challenged. The system of auditory rehabilitation encountered numerous problems due to the Covid-19 pandemic, because of the compromised access to rehabilitation facilities and therapists. The objective of the study was to investigate the parents’ perspective on the influence of the Covid-19 pandemic on auditory rehabilitation. A questionnaire was developed to gather the parents’ answers to the research questions. The sample consisted of fifty-one parents of deaf children and children hard of hearing enrolled in the auditory rehabilitation process. The results showed a considerable impact of the pandemic on the accessibility of rehabilitation, with periods of two to three months of complete disruption for most children, due to lockdown. A vast number of parents experienced psychological stress due to those changes, accompanied by the fear of contracting Covid-19 when attending rehabilitation facilities. Most of the parents observed changes in their child’s behaviour, and communication difficulties due to face masks during the pandemic. Numerous studies support these findings. The results of our research show that the improvement and an increase in the flexibility of the auditory rehabilitation system are necessary. Auditory rehabilitation should be supported by state-of-the-art technologies (e.g., telecommunication) in order to ensure the continuity of the rehabilitation process and support for hearing-impaired children and their parents, even in extreme circumstances.

Hearing impairment in children – otolaryngologist’s perspective, causes, diagnosis, rehabilitation and hearing prosthetics

Hearing impairment in children – otolaryngologist’s perspective, causes, diagnosis, rehabilitation and hearing prosthetics

Consistency of hearing aid use, speech perception and vocabulary in hearing impaired children.

To verify the relationship between consistency in the use of hearing aids, auditory speech perception and vocabulary in children using hearing aids. The population of Pereira's (2023) study was resumed and the database was analyzed containing information about the Speech Intelligibility Index (SII) for input sounds of 65 dBSPL (with or without hearing aids) of 29 children with neurosensorial hearing loss and hearing aid users bilaterally, with oral language, the number of hours per day of use of the device, four-tone average, results of the repetition of words with or without meaning in 65 dBSPL, Peabody Picture Vocabulary Test - PPVT. The consistency of the use was analyzed through measuring the auditory dosage which takes into account the average of use hours and the audibility with or without the device. The PPVT has a positive correlation with the SII with the device at 65 dBSPL. The four-tone average has a significant negative correlation with the SII in both conditions; and the same happens with the hours on daily usage. The dosage has a significant positive correlation with the SII and negative with the PTA. The receptive vocabulary tends to grow alongside with the audibility dosage increment. Results suggest that listening experience, involving the audibility with or without the device and the consistency of the device daily use must be considered throughout the whole process of the rehabilitation.

Establishment of the Norwegian hearing register for children.

The Norwegian Directorate of Health approved the Norwegian Hearing Register for Children in 2022. The main objective of the register is to improve the quality of treatment for children with permanent hearing loss, by measures, follow-ups and monitoring the quality and results of the health care system. Inclusion criteria are children who do not pass universal newborn hearing screening and/or children with permanent hearing loss <18 years of age. Hearing loss is defined as pure-tone audiometry threshold of (PTA4) > 20 dB in at least one ear. Data are registered at the Ear, Nose and Throat departments at inclusion and at follow-ups at the age of 3, 6, 10, and 15 years. The register collects information about the child within a holistic perspective. The key elements of the register are (a) data concerning newborn hearing screening; (b) data concerning hearing, medical information, hearing amplification and intervention (c) patient reported outcome measures registered by caregivers using three questionnaires; Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire and Parents' Evaluation of Aural/Oral Performance of Children. The register has established four quality indicators regarding newborn hearing screening and early intervention (a) the rate of false positive neonatal screens; (b) testing for congenital cytomegalovirus within 3 weeks of age for children who do not pass newborn hearing screening; (c) audiological evaluation to confirm the hearing status no later than 3 months of age and (d) initiated intervention within 3 months after confirmation of hearing status. The register will include the total population of hearing impaired children over long time periods. Thus, the register enables each hospital to monitor their quality indicator scores continuously and compare them with national levels in real time. This facilitates and accelerates identification of improvement areas in the hospitals and will be an important contributor for quality improvement in NHS, diagnostics and hearing intervention for children in Norway. In addition, data from the register will be a unique source for research, and study designs with a long follow-up time can be applied.

Communication skills in preschool children with normal hearing and cochlear implant users

Pragmatic language development encompasses a range of skills that are necessary for communication to take place, such as initiating and maintaining communication, following rules and taking turns, but these skills can take time to develop in children with hearing loss. The aim of this study was to compare the communication skills of 5-6-year-old children with normal hearing and cochlear implant users. The study included 7 females and 14 males aged 60-72 months (M: 68.66±4.27) with cochlear implants and 8 females and 16 males aged 60-72 months (M: 68.41±4.65) with normal hearing. Responses to the 5-6 Years Communication Skills Scale, consisting of 4 subfactors and 46 items, were collected from the parents of all children. The mean scores of the 4 sub-dimensions of the scale, namely active communication, consideration, following rules and positive response, and the mean total score of the children with normal hearing were significantly higher than their peers with cochlear implants (p&lt;0.05). In conclusion, it is important to evaluate hearing-impaired children not only for language development but also for development in all stages of communication, especially in the pragmatic aspect.

DEVELOPMENT OF AN INDIGENOUS SELF-CONCEPT SCALE FOR HEARING-IMPAIRED SCHOOL CHILDREN: AN EXPLORATORY APPROACH

This study aimed to develop &amp; validate comprehensive Self-Concept Scale for the Hearing-Impaired School Children (SCSHISC) by employing rigorous methodology. The unique challenges faced by hearing-impaired children in communication and interpersonal engagement underscored the need for accurate measurement tool. The study's purposive sampling approach included 230 participants, ensuring representativeness. The factor analysis revealed two distinct factors: "Discomfort within self" and "Incompetence," capturing feelings of unease, inferiority &amp; communication challenges. The scale exhibited high internal consistency (α = .78 for "Discomfort within self" and α= .65 for "Incompetence"). SCSHISC confirmed robust psychometric properties, making it a valid tool for assessing the self-concept in SCSHISC. While limitations include a small sample size &amp; potential response bias, this study contributes significantly to field by providing reliable measurement instrument that boosts understanding of self-concept dynamics among hearing-impaired students. Therefore, the SCSHISC can facilitate targeted interventions to foster positive self-perceptions &amp; psychological well-being in this population.

Screening of New-Born through Otoacoustic Emission Device in a Rural Setting for Early Detection of Hearing Impairment - An Observational Study

BACKGROUND&#x0D; Hearing is a special sense needed for proper speech, language, mental development and academic performance. The objectives of our study were to screen neonates at rural area with otoacoustic emission device for detecting hearing impairment and develop a comprehensive rehabilitation model for hearing impaired children in rural areas. Hearing loss initial signs are subtle and therefore for early detection routine neonatal hearing screening is the most effective tool. At first otoacoustic emissions are done, failing which neonates undergo BERA as final screening method to identify hearing impairment as a confirmatory test. In a country like India where neonatal hearing tests are not a part of the routine screening program, the chances of missing early detection and possible rehabilitation are large. In this context, the current project envisages to develop a practical and pragmatic screening model for detecting early neonatal hearing impairment using otoacoustic emission technique in a rural sector reaching every door step possible.&#x0D; METHODS&#x0D; From the government health records collected for a duration of one and half years, all babies delivered in PHC were included for the screening. The babies were screened every Thursday (Immunisation day) with OAE devices by an audiologist at the PHC. The total number of infants screened were 1737. The first screening test done was otoacoustic emission, failing which patient was referred for BERA as a confirmatory test.&#x0D; RESULTS&#x0D; The total number of babies screened by OAE in our study was 1737. Out of the total infants screened, 1st OAE referrals were 327 babies. All the 327 infants were screened by OAE for the 2nd time, out of which 10 infants were referred for the 2nd consecutive time. 317 infants were passed on 2nd OAE screening. All the 10 infants who were referred for the 2nd time were subjected to BERA at Ramaiah medical Hospital. Out of these 10 infants, BERA showed severe to profound bilateral hearing loss in 7 infants (Confirmed Hearing loss). Other 3 infants had normal BERA reading hence normal hearing. The statistics showed that the overall rate of hearing loss prevalence was 4.03 per thousand.&#x0D; CONCLUSIONS&#x0D; In order to diagnose hearing loss in neonates, it is critical to identify hearing loss at birth and provide a screening test for it. OAE screening of neonates should be done at the earliest to detect hearing impairment so that hearing and speech rehabilitation can be started at the earliest. It should be done at each &amp; every health care centre on a large-scale basis to cover all the babies.

PENGARUH METODE MODELLING TERHADAP KEMAMPUAN BAHASA RESEPTIF PADA ANAK GANGGUAN PENDENGARAN UMUR TUJUH SAMPAI SEPULUH TAHUN DI SLB B YAYASAN REHABILITASI ANAK TUNA RUNGU WICARA

Not all hearing impaired children can understand speech just by reading lips. That way, it requires the right way to improve receptive language skills, one of which is using the modeling method. By using the modeling method, it is hoped that children will more easily understand what other people are saying.The aim of this study was to determine the effect of the modeling method on receptive language skills in children with hearing loss aged seven to ten years. The type of research used is quantitative with a one-group pre and post test only design. The data collection technique uses total sampling with a sample of 8 respondents. The research instrument used was ROWPVT (Receptive One-Word Picture Vocabulary Test) and the modeling method module. The results of the pair t-test test obtained a significance of 0.000 which stated that there was an influence of the modeling method in improving receptive language skills in children with hearing loss. The correlation coefficient (r) obtained a result of 0.996 indicating a very strong influence between the modeling method and receptive language. Based on data analysis, the modeling method has an effect on improving receptive language skills in children with hearing loss.

Parental Satisfaction in Tele and Face-to-Face Listening Training: Insights from COVID-19 Pandemic

Background and Aim: The use of tele-intervention services in audiology has grown exponentially, as it has the potential to address many of the key challenges during the pandemic. The present study focused on the survey of parental satisfaction on listening therapy of their Hearing-Impaired (HI) children in tele and face-to-face mode during COVID-19 pandemic. Methods: Parents of children with Hearing Impairment (HI) who attended tele and face-to- face therapy sessions participated in the study. Group I participants were 25 parents of 0–3 years’ children with HI (mean age 1.8±0.25 y), while Group II had 25 parents of children with HI aged 3.1–5 years (mean age 4.1±0.33 y). The adapted and validated questionnaire was administered. Results: Frequency count and percentage were detailed for all questions across groups. The chi-square test of association revealed a significant difference between the tele and face-to-face therapy across the ratings in both groups, with parents rating better satisfaction and therapy efficacy in face-to-face therapy compared to tele-therapy. Principal Component Analysis (PCA) revealed that few questions can best categorize the variance in satisfactory ratings between the two therapy conditions. Conclusion: The findings of the study showed that tele-listening therapy appears to be a promising rehabilitative option in the COVID-19 pandemic when factors affecting its successful implementation are considered, although in the present conditions parental satisfaction ratings are higher for face-to-face therapy. Keywords: Parental satisfaction; COVID-19 pandemic; questionnaire; children; hearing- impaired

Investigating the Effect of Persian Phonemic Synthesis Program in Cochlear Implant Users with Phoneme Processing Dificulities

Background and Aim: Children with severe to profound sensory-neural hearing loss who use a hearing aid or a Cochlear Implant (CI) are likely to have Decoding (DEC) problems. Various studies recommend auditory processing training to improve auditory processing difficulties in CI users. The aim of the present study was to evaluate phoneme processing difficulties in CI users and to investigate the efficacy of the Persian version of the Phonemic Synthesis Program (P-PSP) in improving phonological abilities in this population. Methods: A total of 28 prelingually hearing-impaired children aged 8–12 who underwent unilateral (right ear) cochlear implantation were included in this study. They were divided into experimental and control groups. The P-PSP was implemented on the experimental group, and the results were analyzed over three phases: baseline, intervention, and follow- up. Results: The present study’s results indicate that P-PSP training is suitable for CI children, particularly for the DEC subcategory. Moreover, the Persian Phonemic Synthesis Test (P-PST) results significantly improved after the intervention phase compared to the baseline evaluations (p&lt;0.05). There was no significant difference between the intervention and follow-up phases’ results (p&gt;0.05), indicating no recurrence of auditory processing difficulties after discontinuing training. Conclusion: Based on the study’s findings, the Persian version of PSP enhances phonological processing abilities in CI users. Therefore, the use of auditory phonological training in post- implantation rehabilitation programs appears to be highly important. Keywords: Auditory processing; decoding disorder; cochlear implant; auditory training

Is Topical Nasal Steroid Useful for Treatment of Otitis Media with Effusion in Children?

Otitis media with effusion is a common and important pediatric clinical problem; it is the leading cause of hearing impairment in children. Medical treatment remains controversial. To evaluate the usefulness of using topical nasal steroids in the treatment of otitis media with effusion. Between November 2019 and October 2022, a prospective controlled clinical study was carried out in the department of otolaryngology at Al-Jerrahat Teaching Hospital in Medical City, Baghdad, Iraq. This study comprised 40 patients with bilateral otitis media with effusion (23 males, 17 females). Two groups were created for the patients. Patients in group A (20 patients) were treated with mometasone furoate nasal spray; 1 puff (50 µg) in each nostril daily for 2 weeks, while the 20 patients in group B were treated with saline nasal spray; 1 puff in each nostril daily for 2 weeks. At the end of the first and second weeks of treatment, otoscopic examination was used to monitor the patients. At the end of the second post-treatment week, pure tone audiometry and tympanometry were performed again. Normal otoscopic results, a type A tympanogram, and enhanced pure tone hearing threshold average to be ≤20 dB HL within 0, 5, 1, and 4 KHz were used to characterize resolution of OME. The association between two means was determined using an independent sample t-test, while the association between categorical variables was determined using an X2-test. At the end of 2nd post-treatment week, there was no significant difference regarding improvement of otitis media with effusion regarding otoscopic, audiometric, and tympanometric results in both groups (P-value >0.05). Topical nasal steroid is unuseful for the treatment of otitis media with effusion in the short-term.

Hubungan Kemampuan Sintaksis dengan Reading Comprehension pada Anak Gangguan Pendengaran di Surakarta

Abstract&#x0D; Background: Children with hearing impairment delays in aspects of language, one of which is written language. One of the most difficult written languages to mastered is reading comprehension. Low reading comprehension ability is often associated with low syntax ability. Sentences contained in a reading are quite complex which requires syntactical skills in reading comprehension. Objective: This research aim for knowing exists relationship between syntax ability and reading comprehension of hearing impairment children in Surakarta. Method: This research use quantitative research with cross-sectional data collection. Technique sample used on this research is purposive sampling with 30 respondens. The statistical test used is the Spearman Rank test. Results: The results of this study indicate a significance value (ρ) of 0.007 so that there is syntactic ability with reading comprehension in children with hearing loss in Surakarta. The strength indicates a correlation coefficient (r) of 0.481 which means that having a moderate category of correlation strength. Conclusion: There is relationship syntax ability with reading comprehension of hearing impairment children in Surakarta.&#x0D; Keywords : Syntax Ability, Reading Comprehension, Hearing Impairment Children