Hearing Loss In Young Children Research Articles

Risk factors for Australian school-age children in socio-economically disadvantaged populations not passing ear and hearing screening.

Retrospective study. This study describes the outcomes of an ear and hearing screening program for children from lower socio-economic backgrounds (n = 2489; mean age 11.0 years, standard deviation 1.74 years) in New South Wales (NSW), Australia, between 2013 and 2016. Screening was conducted in a quiet room, and the test protocol included otoscopy, 226 Hertz (Hz) tympanometry, and pure tone screening at octave frequencies from 500 Hz to 4000 Hz with a referral criterion of 20 decibels hearing level (dB HL) at any one frequency. Outcomes were categorised into 1) pass; 2) middle ear dysfunction only; and 3) did not pass hearing screen (with or without middle ear dysfunction). Multinomial logistic regression was used to investigate risk factors for hearing loss and middle ear dysfunction. The factors examined were age, gender, socio-educational advantage, quarter of year assessed, non-English speaking background (NESB), Aboriginal status and region. Higher risks of middle ear dysfunction were associated with younger age and seasonal variation, with higher risk in winter and spring months (July-September and October-December, compared with January-March). There were no differences between those from NESB and those with English as a first language, between the Aboriginal population and non-Aboriginal population, or between those who resided within or outside a major city. More than one in 10 school-age children from lower socio-economic backgrounds experience hearing loss (11.5%). Targeted ear and hearing screening programs offer an opportunity to identify hearing loss during critical learning years and seasons, mitigating longer-term effects on education, and social and mental health.

The cumulative incidence of cisplatin-induced hearing loss in young children is higher and develops at an early stage during therapy compared with older children based on 2052 audiological assessments.

Ototoxicity is a common adverse event of cisplatin treatment. The authors investigated the development of cisplatin-induced hearing loss (CIHL) over time in children with cancer by age and examined the influence of other clinical characteristics on the course of CIHL. Data from Canadian patients with childhood cancer were retrospectively reviewed. Hearing loss was graded according to International Society of Pediatric Oncology criteria. The Kaplan-Meier method was applied to estimate the cumulative incidence of CIHL for the total cohort and according to age. Cox regression models were used to explore the effects of independent variables on CIHL development up to 3 years after the start of therapy. In total, 368 patients with 2052 audiological assessments were included. Three years after initiating therapy, the cumulative incidence of CIHL was highest in patients aged ≤5 years (75%; 95% confidence interval [CI], 66%-84%), with a rapid increase observed to 27% (95% CI, 21%-35%) at 3 months and to 61% (95% CI, 53%-69%) at 1 year, compared with patients aged >5 years (48%; 95% CI, 37%-62%; P < .001). The total cumulative dose of cisplatin at 3 months (per 100 mg/m2 increase: hazard ratio [HR], 1.20; 95% CI, 1.01-1.41) vincristine (HR, 2.87; 95% CI, 1.89-4.36) and the total duration of concomitantly administered antibiotics (>30 days: HR, 1.85; 95% CI, 1.17-2.95) further influenced CIHL development over time. In young children, the cumulative incidence of CIHL is higher compared with that in older children and develops early during therapy. The course of CIHL is further influenced by the total cumulative dose of cisplatin and other ototoxic (co-)medication. These results highlight the need for audiological monitoring at each cisplatin cycle.

Non-syndromic hearing loss: clinical and diagnostic challenges

Abstract Hereditary hearing loss is clinically and genetically heterogeneous. There are presently over 120 genes that have been associated with non-syndromic hearing loss and many more that are associated with syndromic forms. Despite an increasing number of genes that have been implemented into routine molecular genetic diagnostic testing, the diagnostic yield from European patient cohorts with hereditary hearing loss remains around the 50 % mark. This attests to the many gaps of knowledge the field is currently working toward resolving. It can be expected that many more genes await identification. However, it can also be expected, for example, that the mutational signatures of the known genes are still unclear, especially variants in non-coding or regulatory regions influencing gene expression. This review summarizes several challenges in the clinical and diagnostic setting for hereditary hearing loss with emphasis on syndromes that mimic non-syndromic forms of hearing loss in young children and other factors that heavily influence diagnostic rates. A molecular genetic diagnosis for patients with hearing loss opens several additional avenues, such as patient tailored selection of the best currently available treatment modalities, an understanding of the prognosis, and supporting family planning decisions. In the near future, a genetic diagnosis may enable patients to engage in preclinical trials for the development of therapeutics.

Can You Hear What I Think? Theory of Mind in Young Children With Moderate Hearing Loss.

The first aim of this study was to examine various aspects of Theory of Mind (ToM) development in young children with moderate hearing loss (MHL) compared with hearing peers. The second aim was to examine the relation between language abilities and ToM in both groups. The third aim was to compare the sequence of ToM development between children with MHL and hearing peers. Forty-four children between 3 and 5 years old with MHL (35 to 70 dB HL) who preferred to use spoken language were identified from a nationwide study on hearing loss in young children. These children were compared with 101 hearing peers. Children were observed during several tasks to measure intention understanding, the acknowledgement of the other's desires, and belief understanding. Parents completed two scales of the child development inventory to assess expressive language and language comprehension in all participants. Objective language test scores were available from the medical files of children with MHL. Children with MHL showed comparable levels of intention understanding but lower levels of both desire and belief understanding than hearing peers. Parents reported lower language abilities in children with MHL compared with hearing peers. Yet, the language levels of children with MHL were within the average range compared with test normative samples. A stronger relation between language and ToM was found in the hearing children than in children with MHL. The expected developmental sequence of ToM skills was divergent in approximately one-fourth of children with MHL, when compared with hearing children. Children with MHL have more difficulty in their ToM reasoning than hearing peers, despite the fact that their language abilities lie within the average range compared with test normative samples.

Saving Deaf Children? Screening for Hearing loss as a Public-interest Case.

New-born screening programs for congenital disorders and chronic disease are expanding worldwide and children "at risk" are identified by nationwide tracking systems at the earliest possible stage. These practices are never neutral and raise important social and ethical questions. An emergent concern is that a reflexive professionalism should interrogate the ever earlier interference in children's lives. The Flemish community of Belgium was among the first to generalize the screening for hearing loss in young children and is an interesting case to study the public justification of early interventions for families with deaf children. This article uses a critical lens to study the archive of the government child healthcare organization in Flanders in order to uncover underlying constructions of childhood, deafness, and preventive health. We focus on two interrelated themes. The first is the notion of exclusion of the human factor through the mediation of technology. The second is the idea of deafness as endangering a healthy development, an impairment that can nevertheless be treated if detected early enough. It is argued that, since deafness cannot be viewed as a life-threatening condition, the public interest which is implicitly defended is not the rescue of deaf children rather the exclusion of otherness.

Hearing loss in Down Syndrome revisited – 15 years later

ObjectiveIn 2001, the senior authors published a study investigating hearing loss in young children (ages 11 months to 3.8 years) with Down Syndrome (DS). We re-visit this same study population to review current audiologic status, the incidence of pressure equalization tube (PET) placement(s), and rate of tympanic membrane (TM) perforations. We aim to better understand the natural history of ear disease and hearing loss in DS and assess potential complications. MethodsThis retrospective chart review included 57 children with DS who previously completed in 2006, a 5 year, longitudinal study investigating otolaryngologic problems in DS. Updated audiologic data was available for 54. Audiograms, age of ear specific testing, PET placement(s), and tympanic membrane(TM) descriptions were reviewed. ResultsAges ranged from 14 to 18 years (mean 16.34 years). PET placement occurred in 88.8%, with mean of 3.5 procedures. 30% of PET's were placed after age 6. Ear specific testing was obtained in 92.5% (mean age 4.54 years). Normal hearing was present in 44% (right ear) and 38% (left ear). “Functional” hearing levels, defined as normal or mild hearing loss and speech reception threshold ≤ 30 dB, occurred in 83.3%. Sensorineural/mixed hearing loss was present in 11% (right ear) and 9% (left ear). TM perforations rate was 17%. No cholesteatomas were found. ConclusionChronic otitis media and indications for PET's persist as children with DS age. Although functional hearing occurred in 83.3%, there was an overall decrease in hearing levels as the children aged. Tympanic membrane perforations occurred in 17%. Continued surveillance of otologic and audiologic status in patients with Down syndrome is recommended.

Unilateral Hearing Loss in Young Children: Developing Best Practices with Limited Evidence

Substantial evidence exists to highlight the difficulties that children with UHL can experience. Unfortunately, the research regarding effective intervention for this population of children remains limited, particularly for young children. Professional perspectives vary widely regarding best choices and timing of interventions. As a result, clinicians are currently in a position of integrating the available scientific evidence with their clinical expertise to develop “best practice” recommendations for the management of their patients.

Using the ‘Whisper Test’ to Identify Hearing Loss in Young Children

A hearing impediment or loss can have profoundly negative effects on a child's personal, social and academic growth if it is not identified at an early age. This study used a bio-ecological model of development with an asset-based approach to assessment. The focus was on identifying the strengths of learners and assets in the environment with a view to providing appropriate intervention. During a pilot study, the teachers of the Unisa Centre for Early Childhood Education (UCECE) used the whisper test to assess the hearing of the children in their classes. The results were verified by audiologists using formal hearing tests. As a result of the findings of the whisper test, checklist and formal hearing tests affected children could be referred for further medical diagnosis and interventions. The main aim of this study was to provide training guidelines for early childhood teachers on how to screen children with hearing loss with the assistance of audiologists. DOI: 10.5901/mjss.2014.v5n14p511

The hearing environment

Glue ear, a condition resulting in intermittent hearing loss in young children, affects about 80% of young children under seven years old. About 60% of children will spend a third of their time unable to hear within normal thresholds. Teachers are unlikely to consider the sound quality in classrooms. In my research young people provided suggestions to help them hear, identifying the benefits of using their insight in improving the hearing environment. This article identifies five aspects from the literature which impact the hearing environment in classrooms. The focus is on practical low‐cost actions that teachers can implement in their classrooms, thus reducing stress levels in students and teachers.

Universal newborn hearing screening in Zefat, Israel: The first two years

ObjectiveUnidentified hearing loss at birth can adversely affect speech and language development as well as academic achievement and social-emotional development. Historically, moderate-to-severe hearing loss in young children was not detected until well beyond the newborn period. Around 0.5 to 5 in every 1000 neonates and infants have congenital or early childhood onset sensorineural hearing impairment. When identification and intervention occur at no later than 6 months of age, the infants perform much higher on school-related measures. Therefore, early detection is vitally important. Toward the end of 2009, the Israeli ministry of health issued a directive establishing a universal newborn hearing screening program in all hospitals in the country from 01.01.10. The objectives of this study are to evaluate a newly established universal newborn hearing screening program, to assess performance and to compare measurements of performance to performance benchmarks representing a consensus of expert opinion. The benchmarks are the minimal requirements that should be attained by high-quality early hearing detection programs. MethodsAs specified by the ministry of health, a two-stage screening protocol was implemented using otoacoustic emissions and automated auditory brainstem response. Screening results of all neonates born from the initiation of the program on 15th March 2010 until the end of 2011 were reviewed. ResultsThe total number of live births during the study period was 5496. Of these, 5334 (97%) started screening for hearing loss but only 5212 completed the screening process, giving a screening coverage of 94.8%. Of the 5212 neonates completing the screening process, 270 (5.18%) were referred for full diagnostic testing. ConclusionsThe newly established universal newborn hearing screening program at the Ziv Medical Center in Zefat closely approaches, but does not yet meet the minimal requirements that should be attained by high-quality early hearing detection programs. Every effort should be made to complete the screening tests before discharge from hospital. Screening staff should actively encourage parents to participate in all stages of early detection.

Regenerating Hearing: Researchers Begin First-Ever Study of Stem Cells to Treat Hearing Loss

Regenerating Hearing: Researchers Begin First-Ever Study of Stem Cells to Treat Hearing Loss

Listen very carefully

Dr Lin Day examines the causes and effects of ear infections, which are the commonest form of hearing loss in young children, with most babies having at least one such episode before they are two-years-old.

Long-Term Courses of Hearing Loss in Young Children

Purpose: The purpose of this study was to clarify the long-term prognosis of young children with congenital or acquired hearing loss. Patients: The subjects consisted of 9 young children (18 ears) in whom auditory training was performed in the Kochi Prefectural Center for Hearing Impaired Children, and the course of hearing could be observed until the age of at least 10 years. Methods: The annual course of hearing was evaluated based on the results of play audiometry and pure-tone audiometry that facilitated the differentiation of hearing between the left and right ears. In the first examination, stable values were obtained after some tests and used as reference values. As the representative value at each age, the arithmetic mean of the pure-tone averages obtained by all hearing tests performed during the year was used. Results: The course of hearing was observed from 2 to 24 years of age, and the observation period was 6–18 years (mean 13.2 years). Hearing was aggravated in 13 ears, of which 8 (4 patients) showed marked and 5 (3 patients) showed slight aggravation. Hearing was unchanged in 5 ears (3 patients). Conclusions: Hearing loss often progressed bilaterally. There were two progression patterns: rapid aggravation during early childhood, followed by gradual aggravation, and gradual aggravation over the entire course. The aggravation of hearing may be associated with the degree of impairment and vulnerability of the auditory organs.

Cytomegalovirus Blood Viral Load and Hearing Loss in Young Children With Congenital Infection

This study was designed to determine whether elevated viral load in infants and young children is associated with congenital cytomegalovirus (CMV)-related hearing loss. Blood samples were obtained from 135 children with congenital CMV infection. CMV DNA in the peripheral blood was quantitated with a real-time polymerase chain reaction assay. Viral load measurements were analyzed in 3 different age groups (<2 months, 2-12 months, 12-36 months). In children with symptomatic and asymptomatic infection, CMV DNA levels were not different between children with hearing deficit and those with normal hearing in all 3 age groups. In children with asymptomatic infection, the positive predictive value of a peripheral blood viral load >3500 genomic equivalents per milliliter (ge/mL) at <2 months and 2 to 12 months of age is 8%, and at 12 to 36 months of age is 11.8%. However, the negative predictive value of a viral load <3500 ge/mL is 94.4% at <2 months of age, and 100% at 2 to 36 months of age. Peripheral blood viral load is not associated with hearing loss in children with congenital CMV infection. However, a viral load of <3500 ge/mL is associated with a lower risk of hearing loss in children born with asymptomatic congenital infection.

Cochlear implantation in the very young child: Long‐term safety and efficacy

Widespread universal newborn hearing screening has led to increased identification of infant hearing loss. Supported by improved diagnostic tools allowing more definitive diagnosis of profound sensorineural hearing loss in young children, cochlear implantation in children <12 months of age is now common. Literature supports short-term safety and improved auditory outcomes in these young children, however long-term data is lacking. The study examines issues of long-term safety and efficacy in cochlear implant patients implanted <1 year of age. Retrospective chart review. Fifty children who received cochlear implants before 1 year of age were followed for up to 7 years. Age at implantation ranged from 5 to 11 months with a mean of 9.1 months. Three patients had simultaneous bilateral implantation at 8 to 9 months of age. Medical records were reviewed for complications incurred during length of device usage, including time of complication, management, and resolution. Auditory assessment included both the Infant-Toddler Meaningful Auditory Integration Scale and tests of speech perception. All 50 patients had full insertions of the electrode array. There were a total of eight complications (16%) in seven patients, three major (6%) and five minor (10%), which occurred at or before 10 months postoperatively. There were no perioperative anesthetic complications. Cochlear implantation in children <12 months of age is safe and efficacious over an extended period of time. Rates and nature of both major and minor complications are comparable to studies in adults and older children and support continued monitoring of these patients over the long-term.

Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up

Congenital cytomegalovirus infection is the leading identified nongenetic cause of congenital sensorineural hearing loss. Most of the infections are asymptomatic but may be detected from umbilical cord vein and/or newborn serum positivity for human cytomegalovirus immunoglobulin M, and from urine positivity (on polymerase chain reaction) for human cytomegalovirus deoxyribonucleic acid in the newborn period. Children infected by cytomegalovirus may later develop sensorineural hearing loss. In symptomatically infected infants, ganciclovir therapy administered in the neonatal period prevents hearing deterioration. However, preventative therapy of asymptomatic congenital cytomegalovirus disease with ganciclovir is controversial, as side effects such as severe neutropenia may occur during treatment. The study population consisted of 23 asymptomatic children with congenital cytomegalovirus infection. Twelve children were treated just after diagnosis of cytomegalovirus infection in the newborn period, with ganciclovir 10 mg/kg bodyweight for 21 days. The other 11 children were observed without therapy. Over a four to 10 year follow-up period, we evaluated all the children's hearing status using pure tone audiometry. All 23 children had normal sensorineural hearing at one year follow up. Five of the 23 children (21.7 per cent) were lost to follow up over the four to 11 year follow-up period. Of the remaining 18 children, sensorineural hearing loss occurred in two (11.1 per cent). Neither child had been treated with ganciclovir in the newborn period. An eight-year-old boy showed bilateral high frequency loss and a 10-year-old girl showed severe unilateral sensorineural hearing loss. In the ganciclovir-treated group (nine children), none showed sensorineural hearing loss. During ganciclovir therapy, moderate neutropenia occurred as a side effect in two out of 12 (16.6 per cent) treated children. Speech and general development were normal in all children. Asymptomatic congenital cytomegalovirus infection is likely to be a leading cause of sensorineural hearing loss in young children. Intravenous ganciclovir therapy seems to offer a medical option to prevent subsequent sensorineural hearing loss. Further studies including a greater number of children are needed. Cytomegalovirus screening models are mandatory if medical therapy is to be implemented in time.

A two-step scenario for hearing assessment with otoacoustic emissions at compensated middle ear pressure (in children 1–7 years old)

Otoacoustic emissions (OAEs) are widely used for assessing congenital and early-acquired sensorineural hearing loss in young children. Middle ear pathology has a negative effect on the presence of OAEs. In this study we investigated whether measuring OAEs at compensated middle ear pressure (CMEP) resulted in a higher pass rate than at ambient pressure. Secondly, we analysed the influence of 12 different pass definitions on the pass rates. One hundred and eleven children (age 1-7 years, mean 4 years and 5 months) were measured twice in one session: first at ambient pressure and then at CMEP. The study showed a higher pass rate of OAEs at CMEP than at ambient pressure. A two-step scenario reduced the number of fails by 18-26%, depending on the pass/fail definition used. Measuring OAEs at CMEP results in higher pass rates. Secondly, pass/fail definitions have a large influence on pass rates and this issue deserves further attention. Further studies must be done, before this method is readily applicable to universal neonatal screening.

Ototoxicity of cisplatin in children

The ototoxicity of cisplatin has long been well known for its damage to hair cells. However, the results of published studies vary widely with respect to the intensity and frequency of auditory damage. We analyzed the data of 13 young children that have been treated with cisplatin for varying tumor diseases in established combination chemotherapy. The study focused on these major questions: How high is the rate of cisplatin-related incidents of hearing loss in relation to age, sex, nature of tumor, and total dosage of the administered cisplatin? How much does the supplementary application of further ototoxic medications affect the ototoxicity itself? Eight of 13 children examined showed regular hearing capacities in conformity with their age-group, 3 showed a bilateral, and one child showed an one-sided loss of auditory capacity. Deterioration of preexisting auditory damage was observed in one child. No relation to age, sex, nature of tumor, or dosage of administered cisplatin was established. Bilateral hearing loss occurred in three of these children, which indicates that possible synergy of aminoglycoside antibiotics and cisplatin should be investigated with respect to ototoxicity. The results indicate that cisplatin, especially in combination with other ototoxic drugs, can lead to severe hearing loss in young children. Since factors other than the possible synergy discusses above favorable to the development of auditory damage cannot be specified, every child under cisplatin therapy should undergo auditory checkups at brief intervals.

Age of suspicion, identification, and intervention for infants and young children with hearing loss: a national study.

This study was designed to seek a nationwide perspective on the status of identification and intervention for infants and young children with hearing loss. Three hundred thirty-one parents, whose children ranged from infancy to 5 yr of age, returned a mail survey that included respondents from 35 states. Parents were asked to report the approximate age of suspicion, diagnosis, hearing aid fitting, and initiation of early intervention services. Demographic information, risk factors, if known, and reasons for delay were also investigated. Results revealed substantial delays between parental suspicion, audiologic-medical diagnosis, fitting of acoustic amplification, and initiation of early intervention services; however, the pattern of delay was different for children with known risk factors than it was for those without known risk factors. The median age of identification and intervention was lower than that reported by some previous investigators, although a considerable range was reported for each category. The median age of identification and intervention, although still higher than optimal, may be improving. Further research is needed to identify the many factors that continue to delay the timely management of hearing loss in young children.

Evaluation of the E2L Toy Test as a screening procedure in clinical practice

Early identification of hearing loss in young children is essential in order to avoid the potentially disabling effects of deafness. This necessitates effective screening measures with proven positive predictive value (McCormick 1977, 1988; Mahon et al., 1993). Previous studies (Marcuson et al., 1988; Bellman and Marcuson, 1991) have indicated that the E2L Toy Test, designed as a word discrimination test for evaluating the hearing of children who have English as a second language (E2L), could be such a measure. The results of diagnostic audiological testing, including the E2L test, are reported in 264 children. Comparison of E2L results with audiometric testing shows the E2L test to have a sensitivity of 87% and specificity of 90% in identifying children with an average hearing threshold of greater than 25 dB HL (and 78% sensitivity: 94% specificity where the average hearing threshold level is above 20 dB HL). This is the case for both E2L children and for children whose first language is English, suggesting that the E2L Toy Test would be useful in hearing screening test batteries throughout the UK. The results of screening hearing using the E2L Toy Test in 500 children aged 2-7 years from a wide geographical area in the UK are also presented.