LittlEARS Auditory Questionnaire Research Articles

Correlation between cortical auditory evoked potential and auditory speech performance in children with cochlear implants.

This study aimed to explore the correlation between the characteristics of cortical auditory evoked potential (CAEP) of children with cochlear implants (CIs) and auditory and speech rehabilitation performance by an objective evaluation technique and subjective auditory and speech skills measurements. All participants were recruited from Beijing Children's Hospital, Beijing, China. 19 children with CIs had their responses to the CAEP and MMN recorded. The LittlEARs® Auditory Questionnaire (LEAQ), Categories of Auditory Performance (CAP), Speech Intelligibility Rating Scale (SIR), Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), and Meaningful Use of Speech Scale (MUSS) measures were taken to assess the children's speech and hearing abilities. P1 and MMN of CAEP were negatively related to the duration of CI usage. The duration of CI usage and scores of auditory-verbal assessment questionnaires all showed significant relationships. Additionally, scores of these questionnaires were significantly inversely associated with the latency of P1 and MMN. P1 and MMN could be used as objective methods to evaluate the effectiveness of hearing and speech rehabilitation in children with CIs. In particular to those who cannot give effectively feedback of auditory and verbal effects, these methods might have a certain guiding significance.

Simultaneous Bilateral Cochlear Implantation in Very Young Children Improves Adaptability and Social Skills: A Prospective Cohort Study.

To investigate the value of using the Gesell Development Diagnosis Scale (GDDS) to predict developmental outcomes in very young children who undergo simultaneous bilateral cochlear implantation. In this prospective cohort study, a repeated-measures investigation was conducted in a tertiary referral hospital. A total of 62 children receiving simultaneous bilateral cochlear implantations were enrolled from April 2017 to August 2018. They were divided into 2 groups depending on the operative age: "Infants" group (6 to 12 months, N = 38) or "Children" group (12 to 36 months, N = 24). Data on the surgical outcomes, auditory development, speech production, and developmental indicators were collected until 2 years after the initial fitting. The primary outcome measure was the GDDS, a neuropsychological development examination. Secondary outcomes included the following: complication rate, aided pure-tone average, Infant-Toddler Meaningful Auditory Integration Scale, Categories of Auditory Performance-II, Meaningful Use of Speech Scale, Speech Intelligibility Rating, and the LittlEARS Auditory Questionnaire. The mean ages at implantation in infants and children groups were 9.2 ± 1.17 and 16.6 ± 3.60 months, respectively. Significant differences were found in the social skills ( p = 0.001) and adaptability ( p = 0.031) domains of GDDS. The younger the age of bilateral cochlear implants surgery, the higher developmental quotient of language, social skills, and adaptability the child could achieve after 2 years. The complication rates in the infants and children groups were 0% versus 2.1% ( p = 0.57). There was no surgical complication in the infants group. In the children group, 1 case with enlarged vestibular aqueduct and Mondini malformation had a receiver-implant misplacement on the right side (2%, 1/48). In the two groups, auditory performance and speech production had improved similarly. In the infants group, social skills developmental quotient at baseline had a significant positive relationship with Meaningful Use of Speech Scale after 2 years. Simultaneous bilateral cochlear implantation in younger children improves adaptability and social skills. GDDS is a sensitive tool of evaluating short-term effect of bilateral cochlear implants in neuropsychological development and constitutes a reliable predictor of speech production for the very younger pediatric cochlear implant users.

Longitudinal assessment of listening skills in UK infants with hearing aids using the LittlEARS® auditory questionnaire

Objective To investigate listening skills in infant hearing aid users using the LittlEARS® Auditory Questionnaire (LEAQ). Design Caregivers completed the LEAQ, and hearing aid data logging was recorded, at infant age 3–7 months and 7–21 months. Study sample Seventy infant hearing aid users with permanent bilateral hearing loss, no developmental comorbidities, aged 3–7 months at first visit. Results Infants with mild and moderate losses tended to have scores within the normative range at the early time point (88%), but 29% were below the normative range when older. Thirty percent of infants with severe hearing loss were outside the normative range at the early time point and 60% outside the normative range when older. Infants with profound loss were almost always (95%) outside the normative range. At the later time point, and for infants with severe-to-profound loss, low LEAQ scores were associated with fewer daily hours hearing aid use. Scores were poorer than previous reports in the literature for infant hearing aid users. Conclusions This study provides further knowledge on infant listening performance and hearing aid use over time that can be used to guide management of individual cases and to develop and audit service quality improvements.

Establishment of Reference Values for Early Auditory Preverbal Skills of Children with Cochlear Implants.

Auditory and verbal abilities of children with early cochlear implant (CI) surgery usually take some time to develop, and a reference index of early development for horizontal comparisons is urgently needed to guide the mapping process and adjust rehabilitation programs. Therefore, the aim of this study was to establish a reference value for early auditory preverbal skills development in children with CI and investigate the developmental curve and influencing factors for these children. The LittlEARS® Auditory Questionnaire (LEAQ) scores of 287 eligible Chinese participants were obtained at 1, 2, 3, 6, 9, 12, 18, 24, 28, and 36 months interval after CI activation. The median and standard deviation of the LEAQ score of each hearing stage for these children with different activation ages were calculated to establish the reference values. Quadratic regression was conducted to fit the expected developmental curve of the LEAQ score ( [0 to 20 months]). With a linear mixed-effects model, we found that the receptive auditory behavior increased rapidly after CI activation, while expressive language skills developed at a steady rate. We also found that the following factors all significantly influenced the LEAQ: the duration of CI use, the development quotient, age of implantation and activation, and the presence of large vestibular aqueduct syndrome or auditory neuropathy spectrum disorder. The reference values and the expected developmental curve for the LEAQ in children with CI established by the present study provides guidance to clinicians and parents as well as realistic expectations regarding language and speech outcomes.

Waardenburg syndrome as a challenging experience in pediatric cochlear implantation

Background Waardenburg syndrome (WS) is a major cause of symptomatic sensorineural hearing loss, which accounts for 2–5% of patients with congenital hearing loss. Cochlear implantation (CI) has shown improvement in auditory perception and language skills of syndromic sensorineural hearing-impaired children and is now accepted as a gold standard treatment. Aim The aim of the present study was to evaluate the outcome of CI in cases with WS and to compare the results with nonsyndromic CI cases. Participants and methods A total of 268 children of less than 7 years of age underwent CI in the National Hearing and Speech Institute, and of these, six children, as group A, had WS, whereas the control group, as group B, consisted of 16 congenitally deaf children without any other comorbidities or inner ear anomalies. The following assessments were done: intraoperative impedance and auditory response threshold, and then at 3 and at 12 months, impedance, aided average pure tone threshold, Meaningful Auditory Integration Scale questionnaire, LittlEARS Auditory Questionnaire, and language assessment using modified Arabic preschool language scale-4. Results Intraoperative impedance, auditory response threshold, and neural response impedance were measured. Aided free field response at 500–4000 kHz and speech detection threshold were measured for both groups at 3 and 12 months after initiation. There was no statistically significant difference between both groups at all measured parameters. Meaningful Auditory Integration Scale questionnaire, LittlEARS Auditory Questionnaire, and language assessment using modified Arabic preschool language scale-4 revealed improvements in speech perception and production; however, comparison of the results between the WS group and the control group was insignificant. Conclusion CI is a good rehabilitation option for children with WS. The study indicates that children with WS benefit from CI similar to typically developing CI children.

Translation and validation of the LittlEars auditory questionnaire in Kannada

ObjectiveThe aim of the study was to translate and validate the LittlEARS Auditory Questionnaire (LEAQ) in Kannada. MethodThe translation procedure followed a traditional translation, back translation, and content validity process before administering. The finalized version was administered on 87 children with 67 normal hearing children and 20 hearing-impaired children. ResultsThe tool had good internal consistency, good reliability, and a norm curve could be established. The Cronbach alpha value for item correlation ranged from 0.26 to 0.79. A significant difference was found between normal hearing individuals and hearing impaired. ConclusionThe LEAQ tool has been translated and validated for the Kannada speaking population and can be used as a screening tool for children up to two years of age and as a subjective outcome measuring tool for hearing aid and Cochlear Implant user.

Can Differences in Early Hearing Development Be Distinguished by the LittlEARs Auditory Questionnaire?

This study asks whether the LittlEARs Auditory Questionnaire (LEAQ), a caregiver measure, can differentiate between the early auditory development of children with bilateral cochlear implants (CIs), bilateral hearing aids (HAs), and children with Auditory Neuropathy Spectrum Disorder (ANSD) who wear CIs or HAs. The LEAQ is sensitive to impaired auditory development but has not previously been used to distinguish developmental changes between groups of children using different hearing technologies or with different types of hearing loss. We collected retrospective longitudinal LEAQ results from 43 children with HAs, 43 with CIs, and 18 with ANSD. The children with ANSD wore hearing technology. They were a similar age to the children without ANSD (23 months; SD = 15), while the CI group (14 months; SD = 8) was younger than the HA group (24 months; SD = 18) [F(2,98.48) = 3.4; p = 0.04]. The CI group often participated in their first LEAQ pretreatment. Participants completed between one and seven LEAQs. Scores ranged between zero and 35 (mean = 18.36). We conducted a linear mixed-effects analysis, which included age or time since device fitting, hearing type (HA, CI, or ANSD), and presence of a comorbidity as fixed effects. A secondary analysis assessed effects of device audibility, measured by the Speech Intelligibility Index or Articulation Index, and consistency of device use obtained from device datalogs. Children with CIs progressed faster than their peers with HAs or ANSD [χ2(8) = 24.51; p = 0.002]. However, within a subsample that included consistency of device use (β7 = -0.20 ± 0.38, t = -0.52; β8 = 0.93 ± 0.82, t = 1.13) and audibility (β6 = -0.70 ± 1.45, t = -1.87; β7 = 0.87 ± 0.89, t = 0.98), study group did not significantly influence rate of improvement on the LEAQ. In addition, children with developmental delays in all three study groups demonstrated significantly slower LEAQ score improvement [χ2(6) = 23.60; p < 0.001] and a trend toward decreased consistency of device use [F(1) = 3.31; p = 0.07]. As we expected, children in the CI and HA groups were more likely to achieve auditory skills indicated in early rather than later LEAQ questions. There was less variability in the responses of the ANSD group [CI: interquartile range (IQR) = 9; HA: IQR = 8; ANSD: IQR = 1]. There was no connection between LEAQ growth and speech perception outcomes in a subsample [r(6) = 0.42; p = 0.30]. The LEAQ is a useful tool for monitoring initial auditory development in very young children and can inform early treatment decisions.

Clinical evaluation of cochlear implantation in children younger than 12 months of age.

ABSTRACTImportanceCochlear implantation (CI) is an effective therapy for patients with severe to profound sensorineural hearing loss. It remains controversial whether children younger than 12 months of age should undergo CI.ObjectiveTo evaluate the safety and effectiveness of CI in children younger than 12 months of age.MethodsWe performed a retrospective study of clinical data of pediatric patients younger than 12 months of age who underwent CI and were followed up for 1 to 2 years. Patients’ developmental levels were evaluated by the Gesell score before CI. Intraoperative and postoperative complications were recorded to evaluate the safety of CI. Auditory and speech abilities were scored by the LittlEARS® auditory questionnaire (LEAQ), categories of auditory performance (CAP), speech intelligibility rating (SIR), infant‐toddler meaningful auditory integration scale (IT‐MAIS), and meaningful use of speech scale (MUSS) at 1, 2, 3, 6, 9, and 12 months after CI. The associations between clinical characteristics before CI and postoperative scores at 1 year after CI were analyzed by the linear mixed‐effects model.ResultsEighty‐nine children (47 boys and 42 girls) were included in this study (mean age at CI, 9.2 ± 1.6 months). Sixteen patients were diagnosed with cochlear malformation and 16 underwent bilateral CI. No severe complications occurred in any patients. The mean developmental quotient of the Gesell score was 78.00 ± 10.03. The median LEAQ scores were 0, 5, 10, 16, 22, 26 and 30 before and at 1, 2, 3, 6, 9, and 12 months after CI, respectively. These findings implied that the LEAQ score greatly improved in the first year after CI. The overall CAP, SIR, IT‐MAIS, and MUSS scores also increased with increasing duration after CI. No significant associations were detected between clinical characteristics (age, sex, implant number, pre‐CI Gesell score, and inner ear malformation) and LEAQ outcomes at 12 months after CI.InterpretationWith increasing duration after CI, auditory and speech behavior dramatically improve in young children. Our findings indicate that CI is feasible for children younger than 12 months of age.

Comparison of the development of early auditory and preverbal skills in Mandarin-Speaking children with cochlear implants with and without additional disabilities

Background: Few studies had assessed the auditory and preverbal skills of very young cochlear implant (CI) children with additional disabilities (AD) over a long period, especially in China.Aims/Objectives: The aim of this study was to compare the early auditory and preverbal developmental trajectories in CI children with and without AD.Material and Methods: The LittlEARS® Auditory Questionnaire (LEAQ) was employed. 29 typically developing (TD) children and 17 with AD were involved (age at implantation less than 2 years).Results: All children showed significant improvement in total LEAQ scores with CI use. Children with cerebral palsy (CP), developmental delay (DD) and white matter lesions (WML) scored lower than TD children since 3 months of CI use; a decreasing trend was observed from 24, 18 and 18 months of CI use, respectively. Children with higher nonverbal developmental quotients exhibited superior early auditory and preverbal skills.Conclusions and significance: The development of early auditory and preverbal skills among CI-using children progressed more slowly in those with AD (CP, DD or WML) than in TD children, but the differences between the two groups gradually diminished over time. Nonverbal cognitive status has a positive effect on early auditory and preverbal abilities.

Paediatric hearing loss: a community-based survey in peri-urban Kumasi, Ghana.

Paediatric hearing loss rates in Ghana are currently unknown. A cross-sectional study was conducted in peri-urban Kumasi, Ghana; children (aged 3-15 years) were recruited from randomly selected households. Selected children underwent otoscopic examination prior to in-community pure tone screening using the portable ShoeBox audiometer. The LittlEars auditory questionnaire was also administered to caregivers and parents. Data were collected from 387 children. After conditioning, 362 children were screened using monaural pure tones presented at 25 dB. Twenty-five children could not be conditioned to behavioural audiometric screening. Eight children were referred based on audiometric screening results. Of those, four were identified as having hearing loss. Four children scored less than the maximum mark of 35 on the LittleEars questionnaire. Of those, three had hearing loss as identified through pure tone screening. The predominant physical finding on otoscopy was ear canal cerumen impaction. Paediatric hearing loss is prevalent in Ghana, and should be treated as a public health problem warranting further evaluation and epidemiology characterisation.

Validation of the Swedish version of the LittlEARS® Auditory Questionnaire in children with normal hearing – a longitudinal study

Objective: To externally validate the Swedish version of the LittlEARS® Auditory Questionnaire (LEAQ) in children with normal hearing followed longitudinally, and to examine to what extent the LEAQ correlates to other measures of auditory and language development.Design: The Swedish version of the LEAQ was completed every other month over a 2-year period and correlated with the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) and McArthur-Bates Communicative Development Inventory (CDI) to examine overlapping areas of development. Normative curve was derived through linear mixed models and the effect of time investigated with repeated measures ANOVA.Study sample: Parents of 25 typically developing children with normal hearing (13 girls, 12 boys).Results: The norm curve of the Swedish LEAQ showed a similar equation as the original German version and the effect of time was significant. Correlations between LEAQ and CDI were moderate to high, and between LEAQ and PEACH weak or non-existing.Conclusion: The Swedish version of the LEAQ is a reliable tool in accordance with the original version. However, results indicate that this questionnaire to a large extent measures language skill rather than audition specifically.

LittlEARS auditory questionnaire as an infant hearing screening in Germany after the newborn hearing screening

Objective: To investigate the feasibility of using the LittlEARS® Auditory Questionnaire (LEAQ®) as part of the infant hearing screening programme in Germany.Design: LEAQ®s were distributed to 47 paediatric practices and were completed by the parents/guardians of the infants (aged between 9-14 months) involved in the study (= LEAQ® screening). The infants who failed the LEAQ® screening were invited to a LEAQ rescreening. Infants who failed the LEAQ® rescreening were sent to a paediatric ENT specialist. After 3 years, a follow-up was performed on two groups: the first group comprised infants who failed the LEAQ screening; the second group (control group) comprised 200 infants who passed the LEAQ screening.Study Sample: 5316 questionnaires were returned.Results: Six infants with permanent hearing loss were identified using the LEAQ® as a screening tool.Conclusions: An infant hearing screening using the LEAQ® is easily implementable in paediatric practices and may be a good alternative in countries where no objective screening instruments are available. The LEAQ® was suitable for monitoring hearing development in infants in general and could help to identify a late-onset or progressive hearing loss in infants.

Validation of the Persian version of the LittlEARS® auditory questionnaire for assessment of auditory development in children with normal hearing

ObjectivesTo adapt the LittlEARS® Auditory Questionnaire into Persian and evaluate the psychometric properties of the Persian version of the questionnaire for children with normal hearing. MethodsA “back-translation” method was used to translate and adapt the LittlEARS Auditory Questionnaire into Persian. The translated version was first evaluated by means of an expert-appraisal method. After having improved the Persian version of LittlEARs with the results obtained from that evaluation, various psychometric analyses were carried out to determine the validity and reliability. A group of 240 Persian speaking parents of children below 24 months of age with normal hearing completed the LittlEARS® Auditory Questionnaire. Various psychometric analyses (scale analysis and item analysis) were conducted. ResultsIn the current study, the following scale and item characteristics were investigated: Corrected item-total correlations ranged from 0.14 to 0.74; Cronbach's alpha coefficient value was 0.960; the split-half reliability r was 0.734; predictive accuracy Guttman's lambda was 0.965; the correlation between the overall score and age of the children was 0.808 (p < 0.001). The regression curve, which reflects the age-dependence of auditory behavior, was produced. The regression analysis that was conducted to obtain normative data showed that 80% of the variance in the total scores could be explained by age. ConclusionThe data obtained from psychometric analysis support the use of the Persian version of the LittlEARS Auditory Questionnaire as a reliable and valid tool to assess the development of auditory behavior in Persian speaking children who are 24 months old or younger.

Early auditory skills development in Mandarin speaking children after bilateral cochlear implantation

ObjectivesThe purpose of the present study was: (1) to investigate the early auditory preverbal behaviors of infants/toddlers with bilateral cochlear implants (BCI), and to compare their performance with that of unilateral cochlear implant (UCI) peers; (2) to investigate effects of age of implantation, education level of caregivers, living environment, and unaided behavioral threshold before operation on early auditory preverbal development. MethodsThe evaluation material of the present study was the Mandarin version of the LittlEARS® Auditory Questionnaire (LEAQ). Assessments were administrated at 0, 1, 2, 3, 6, 9, 12 and 24 months after cochlear implants (CIs) were switched on. A one-way ANOVA was used to analyze the differences of early auditory preverbal performance between each two contiguous test intervals. A two-sample t-test was used to analyze the difference of behaviors between infants/toddlers with BCI and UCI. Non-parametric tests were used to analyze the effects of potential affecting factors on auditory preverbal skills. ResultsNineteen subjects aging from 9 to 54 months (Mean = 22.7, SD = 13.7) were recruited in the study. At each evaluation time, the average scores of LEAQ were 4.58, 9.00, 16.00, 18.56, 22.00, 31.50, 29.67, and 34.35 respectively. The total score and semantic auditory behavior score increased significantly during the second months after CIs activation (the total score: LSD-t = 3.157, p = 0.030; semantic auditory behavior score: LSD-t = 1.972, p = 0.034). The score of BCI group was significantly higher than UCI group after 1, 3 and 6 months of CI use (1 month: t = 3.257, p = 0.002; 3 months: t = 5.042, p = 0.000; 6 months: t = 4.054, p = 0.000). Education level of caregivers had a positive effect on receptive auditory behavior (H = 6.538, p = 0.035) after CIs switched on for 3 months. The LEAQ performance was not significantly correlated with pre-operative behavioral threshold although they showed a trend of negative correlation in the first 3 months after activation. ConclusionThe study indicated that infants and toddlers who underwent BCI had better auditory preverbal skills than their UCI peers. Higher caregivers' education level positively correlated with the early development of auditory preverbal skills. Better pre-operative behavioral threshold might also benefit early auditory preverbal skills development for BCI children.

The Yoruba version of LittlEARS Auditory Questionnaire: Evaluation of auditory development in children with normal hearing

The goal of this study was to translate the LittlEARS Auditory Questionnaire into Yoruba language for use with Yoruba-speaking parents and to evaluate the psychometric properties of the Yoruba version of questionnaire. Translation of the LittlEARS Auditory Questionnaire into Yoruba language was done using a back-translation method. The study participants included 423 parents of normal hearing children aged 6–24 months. Psychometric analyses (scale analysis and item analysis) of the translated questionnaire was done. The scale characteristics in the dataset are: Internal consistency: Cronbach's alpha = 0.907; reliability; Split-half = 0.701; predictive accuracy; Guttman's lambda = 0.583; correlation between total score and children's age = 0.783. The regression analysis showed that 75.3% of the variance in the total scores can be explained by age. The Yoruba version of the LittlEARS Auditory Questionnaire is a dependable and valid tool as evidenced by the results of psychometric analyses. The tool is useful for assessing auditory development in children between 6 and 24 months of age.

The use of the LittlEARS Auditory Questionnaire in assessing children before and after cochlear implantation

BackgroundThe age of cochlear implant (CI) is a crucial factor that affects auditory skills and speech outcome in children after CI. Speech and auditory skills outcome using the Arabic form of the LittlEARS Auditory Questionnaire (LEAQ) on Arabic-speaking cochlear-implanted children is not sufficiently studied.ObjectiveThe aim of the present study was to assess. the use of the Arabic form of the LEAQ to determine the effect of age of CI on the outcome of auditory skills in children with CIs, to enhance better intervention protocols for children in need of CI and to achieve the best communicative skills for those children.Patients and MethodsA total of 45 children with CI were classified into three groups according to their ages, and they were assessed using the Arabic version of LEAQ preoperatively as well as 6 and 18 months after mapping.ResultsSignificant improvement in auditory skills and speech was reported in the three groups. The improvement was highly significant in the youngest group in comparison with the other two groups 6 and 18 months after mapping. In addition, speech and auditory skills were highly significant in each group after CI.ConclusionThe age of the child at which CI is placed is a crucial factor in speech and auditory skills development. The earlier the age of CI, the better the result.

Validation of the LittlEARS Auditory Questionnaire in cochlear implanted infants and toddlers

ObjectivesThe LittlEARS Auditory Questionnaire (LEAQ) has so far been validated to assess auditory development in groups of normal-hearing children in over 20 different languages. Considering the huge variability in auditory development of CI children, especially since candidacy criteria have been relaxed, additional evidence to validate the use of LEAQ scores in this particular population is needed. The aim of this study is to provide evidence for the reliability and validity of LEAQ scores for assessing the auditory development of CI infants and toddlers based on an evaluation of LEAQ's internal structure and its relation to other variables. MethodsThe study was prospective, with sequential enrolment and within-subject repeated measures. It included 122 children with profound bilateral sensorineural hearing loss implanted at 6–22 months of age. All children were evaluated with the Polish version of LEAQ on the first day of CI activation and at each of four follow-up visits related to sound processor fitting.The study was undertaken in the light of current psychometric thinking about how assessment instruments should be validated. The main aim of the study was to obtain evidence for the validity of interpreting LEAQ measures from CI children in terms of auditory development. First, in order to collect evidence for score reliability and validity based on LEAQ's internal structure, the psychometric properties of LEAQ scores from CI children were determined. A second step was to confirm validity by investigating the effect of concomitant variables on LEAQ scores. Correlations between LEAQ score and duration of hearing aid (HA) use, and between LEAQ score and duration of CI use, were investigated. Additionally, group differences in LEAQ scores between: 1) early and late implanted children; 2) children with long and short HA experience prior to implantation; and 3) children who showed responses over a wide frequency range from using their HAs (prior to implantation) vs those who did not. ResultsOn each of the five administrations of LEAQ, the item difficulty indices increased (meaning the items became easier) and over the series they progressively increased with a range of: 0.01–0.62, 0.03–0.92, 0.09–1.00, 0.26–1.00, and 0.52–1.00. At the same time, item–total correlations were in the ranges: 0.09–0.77, 0.26–0.62, 0.00–0.65, 0.00–0.65, and 0.00–0.67. Cronbach's alpha values were above 0.80 for all administrations. A positive correlation between LEAQ score and duration of HA use, and subsequent duration of CI use (hearing experience) was found. When the children were stratified into groups according to age at cochlear implantation, duration of HA use before implantation, and audibility provided by HAs prior to implantation, the differences between the groups were reflected in both their rate of auditory development and their LEAQ score. ConclusionThe interpretation of LEAQ scores from CI children in terms of auditory development was supported by the validity evidence of internal structure and from a logical relationship to other variables. (1) Psychometric properties – item difficulty, item–total correlations, and Cronbach's alpha values – indicate that LEAQ measures are highly consistent and reliably gauge the level of a CI child's auditory development. (2) There was a positive correlation between LEAQ scores and the duration of hearing experience with HAs and a later CI; similarly, there were significant differences between groups of children stratified according to the age at cochlear implantation, duration of HA use before implantation, and audibility provided by HAs prior to implantation, all of which demonstrate the expected relation between LEAQ score and concomitant variables.

Production and evaluation of a Spanish version of the LittlEARS® Auditory Questionnaire for the assessment of auditory development in children

Background and aimsTo adapt the LittlEARS® Auditory Questionnaire (LEAQ) into Spanish and evaluate the psychometric properties of the Spanish version of the questionnaire. MethodsThe LEAQ was translated into Spanish by a back-translation design. Following the Guidelines for Adapting Tests of the International Test Commission (ITC), for the first time with the LEAQ adaptations, two qualitative methods were used to evaluate the translated version of the LEAQ: an expert appraisal method followed by cognitive interviewing. Having improved the Spanish version of the LEAQ with these evaluations, a psychometric analysis was conducted. 215 parents of children with normal hearing aged between 1.7 and 24.0 months participated in the study. Corrected item-total correlations were calculated to analyze to what extent items distinguish levels of auditory development of assessed children. Cronbach's alpha coefficient – to evaluate internal consistency across items – was also calculated. To obtain validity evidence, correlations between item-total score and age were calculated. A non-linear regression model was also estimated to obtain normative data for expected and minimum value of total scores from the questionnaire according to age. ResultsExpert appraisal and cognitive interviewing pointed out some translation errors and difficulties parents had while responding to the Spanish LEAQ. Such errors and difficulties were fixed in the Spanish LEAQ version applied for psychometric analysis. Corrected item-total correlations ranged from 0.15 to 0.75. Cronbach's alpha coefficient value was 0.92, indicating that the measurements are highly reliable. The value of the correlation between total scores and age was 0.86 (p<001). The regression analysis conducted to obtain normative data shows that 79% of the variation in the total scores can be explained by age. ConclusionsThe results of psychometric analyses provide evidence supporting the use of the Spanish version of the LEAQ as a valid and culturally appropriate tool to assess the development of auditory behaviour in Spanish children who are 24 months old or younger.

Speech Recognition and Parent Ratings From Auditory Development Questionnaires in Children Who Are Hard of Hearing.

Progress has been made in recent years in the provision of amplification and early intervention for children who are hard of hearing. However, children who use hearing aids (HAs) may have inconsistent access to their auditory environment due to limitations in speech audibility through their HAs or limited HA use. The effects of variability in children's auditory experience on parent-reported auditory skills questionnaires and on speech recognition in quiet and in noise were examined for a large group of children who were followed as part of the Outcomes of Children with Hearing Loss study. Parent ratings on auditory development questionnaires and children's speech recognition were assessed for 306 children who are hard of hearing. Children ranged in age from 12 months to 9 years. Three questionnaires involving parent ratings of auditory skill development and behavior were used, including the LittlEARS Auditory Questionnaire, Parents Evaluation of Oral/Aural Performance in Children rating scale, and an adaptation of the Speech, Spatial, and Qualities of Hearing scale. Speech recognition in quiet was assessed using the Open- and Closed-Set Test, Early Speech Perception test, Lexical Neighborhood Test, and Phonetically Balanced Kindergarten word lists. Speech recognition in noise was assessed using the Computer-Assisted Speech Perception Assessment. Children who are hard of hearing were compared with peers with normal hearing matched for age, maternal educational level, and nonverbal intelligence. The effects of aided audibility, HA use, and language ability on parent responses to auditory development questionnaires and on children's speech recognition were also examined. Children who are hard of hearing had poorer performance than peers with normal hearing on parent ratings of auditory skills and had poorer speech recognition. Significant individual variability among children who are hard of hearing was observed. Children with greater aided audibility through their HAs, more hours of HA use, and better language abilities generally had higher parent ratings of auditory skills and better speech-recognition abilities in quiet and in noise than peers with less audibility, more limited HA use, or poorer language abilities. In addition to the auditory and language factors that were predictive for speech recognition in quiet, phonological working memory was also a positive predictor for word recognition abilities in noise. Children who are hard of hearing continue to experience delays in auditory skill development and speech-recognition abilities compared with peers with normal hearing. However, significant improvements in these domains have occurred in comparison to similar data reported before the adoption of universal newborn hearing screening and early intervention programs for children who are hard of hearing. Increasing the audibility of speech has a direct positive effect on auditory skill development and speech-recognition abilities and also may enhance these skills by improving language abilities in children who are hard of hearing. Greater number of hours of HA use also had a significant positive impact on parent ratings of auditory skills and children's speech recognition.

Early auditory preverbal skills development in Mandarin speaking children with cochlear implants

ObjectiveThe purpose of this study was to investigate the development of auditory preverbal skills in Mandarin speaking infants/toddlers with cochlear implants (CIs). MethodsParticipants were recruited from the Pediatric Audiology Center of Beijing Children's Hospital, Capital Medical University. A total of 33 children with severe-to-profound hearing loss who received CIs participated in the study. The evaluation tools were LittlEARS® Auditory Questionnaire (LEAQ) and self-designed demographic information questionnaire. Evaluations were administrated immediately after the CI was switched on (0-month), and at 1, 3, 6, 9, 12, 18, and 24-month intervals of CI use. ResultsThe mean total scores of the LEAQ in 0, 1, 3, 6, 9, 12, 18, and 24-month were 1, 5, 10, 15, 21, 24, 30, and 33 points, respectively. The developmental trajectory of early auditory preverbal skills in the CI children was consistent with the published norm data of the LEAQ, and the expected value even slightly higher than the norms. Analysis showed that the parents’ level of education and age of implantation influenced the final LEAQ score significantly (ANOVA, p<0.0001). ConclusionsAuditory preverbal skills improved dramatically after cochlear implantation in the first 2 years of implant use. Early implanted children exhibited a steeper and faster improvement in auditory preverbal developmental compared to the later implanted peers. This study described the developmental trajectories of preverbal auditory skills and confirmed the effectiveness of early implantation on the development of auditory preverbal skills. The results could provide guidance for auditory/speech rehabilitation in Mandarin speaking infants/toddlers who received CIs in their early age.