Fred H. Bess

Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status.

Objective: This study was designed to determine the prevalence of minimal sensorineural hearing loss (MSHL) in school‐age children and to assess the relationship of MSHL to educational performance and functional status. Design: To determine prevalence, a single‐staged sampling frame of all schools in the district was created for 3rd, 6th, and 9th grades. Schools were selected with probability proportional to size in each grade group. The final study sample was 1218 children. To assess the association of MSHL with educational performance, children identified with MSHL were assigned as cases into a subsequent case‐control study. Scores of the Comprehensive Test of Basic Skills (4th Edition) (CTBS/4) then were compared between children with MSHL and children with normal hearing. School teachers completed the Screening Instrument for Targeting Education Risk (SIFTER) and the Revised Behavior Problem Checklist for a subsample of children with MSHL and their normally hearing counterparts. Finally, data on grade retention for a sample of children with MSHL were obtained from school records and compared with school district norm data. To assess the relationship between MSHL and functional status, test scores of all children with MSHL and all children with normal hearing in grades 6 and 9 were compared on the COOP Adolescent Chart Method (COOP), a screening tool for functional status. Results: MSHL was exhibited by 5.4% of the study sample. The prevalence of all types of hearing impairment was 11.3%. Third grade children with MSHL exhibited significantly lower scores than normally hearing controls on a series of subtests of the CTBS/4; however, no differences were noted at the 6th and 9th grade levels. The SIFTER results revealed that children with MSHL scored poorer on the communication subtest than normal‐hearing controls. Thirty‐seven percent of the children with MSHL failed at least one grade. Finally, children with MSHL exhibited significantly greater dysfunction than children with normal hearing on several subtests of the COOP including behavior, energy, stress, social support, and self‐esteem. Conclusions: The prevalence of hearing loss in the schools almost doubles when children with MSHL are included. This large, education‐based study shows clinically important associations between MSHL and school behavior and performance. Children with MSHL experienced more difficulty than normally hearing children on a series of educational and functional test measures. Although additional research is necessary, results suggest the need for audiologists, speech‐language pathologists, and educators to evaluate carefully our identification and management approaches with this population. Better efforts to manage these children could result in meaningful improvement in their educational progress and psychosocial well‐being.

Hearing Impairment as a Determinant of Function in the Elderly

This clinical, practice‐based study explores the research question: Is there a relationship between hearing loss and functional disturbance in elderly patients? We analyzed the impact of hearing impairment on 153 patients over 65 years of age screened in primary care practice. Functional and psychosocial impairment were measured using the Sickness Impact Profile (SIP), a standardized measure for assessing sickness related dysfunction. Hearing level was determined with pure tone audiometry.

Optimal Outcome Measures, Research Priorities, and International Cooperation

&NA; The participants in the Eriksholm Workshop on “Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids” debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self‐report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health‐care delivery systems. A set of seven core items is proposed for further study.

Auditory performance of children with unilateral sensorineural hearing loss.

Horizontal sound localization and syllable recognition skills were examined in a group of children with unilateral sensorineural hearing loss and a matched group of normal hearers. The results showed that the unilaterally hearing-impaired children performed more poorly than the normal counterparts in both localization and speech recognition of nonsense syllables. The unilaterally hearing-impaired children had considerable difficulty understanding in a background of noise. The clinical implications of these findings are discussed.

Diagnostic performance of the hearing handicap inventory for the elderly (screening version) against differing definitions of hearing loss.

The diagnostic performance of the Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S) was evaluated against five definitions of hearing loss in 178 elderly subjects screened in primary care. Hearing loss was assessed by pure-tone audiometry. Using a score of greater than 8 as a cut point, the HHIE-S had sensitivities ranging from 53 to 72% and specificities ranging from 70 to 84% with the different definitions. The HHIE-S receiver-operating characteristics and likelihood ratios were similar regardless of hearing loss definition used. The HHIE-S is a valid, robust test for identifying hearing-impaired elderly, irrespective of the audiometric definition used to finally diagnose hearing difficulties.

Case History Data on Unilaterally Hearing-impaired Children

This paper presents the data from medical and educational case histories on a group of 60 unilaterally hearing-impaired children. The case history data revealed that approximately one-half of the 60 children with unilateral sensorineural hearing loss exhibited some difficulty in educational progress. More specifically, 35% had failed at least one grade and an additional 13% were in need of some special resource assistance. Similar findings were obtained on a subset of 25 unilaterally hearing-impaired children who satisfied rather stringent criteria for age, hearing level, intelligence, length of time the impairment was present, history of middle ear disease, and general growth and development.

The minimally hearing-impaired child

This paper reviews evidence which suggests that middle ear disease with effusion and associated hearing loss, unilateral sensorineural hearing impairment, and mild bilateral sensorineural hearing loss in children can result in far more educational and/or communicative difficulty than was previously supposed. The author rejects the notion that a decibel level on an audiogram truly reflects the degree of hardship the child experiences and argues for a more active identification and management program in the early years.

The role of generic health-related quality of life measures in establishing audiological rehabilitation outcomes.

Objective: To review the status of generic functional health measures used with hearing‐impaired adults and to summarize the findings of studies that have utilized these outcome measures to assess the benefit of amplification. Design: Four basic generic quality of life measures used with the hearing‐impaired population for determining hearing aid benefit are reviewed and discussed. The measures include the Sickness Impact Profile, the Self Evaluation of Life Function, the Medical Outcomes Study, and the Dartmouth COOP Functional Health Assessment Charts. Results: The review of studies concerned with quality of life measures revealed that present day functional health status tools lack the necessary sensitivity to detect clinically meaningful improvements in patients with hearing impairment. Conclusions: Although we have good reason to believe that hearing aids improve quality of life, available functional health status measures lack the appropriate sensitivity to be used for assessing the benefit of amplification in individuals with hearing impairment. There is an urgent need for additional research to address this important area.

An Introduction to Unilateral Sensorineural Hearing Loss in Children

This paper offers a general review of literature on issues pertinent to unilateral hearing loss in children. The paper focuses on such areas as demographic considerations, the importance of binaural hearing, the effects of noise on speech recognition, learning and educational factors, and auditory deprivation. It is concluded that there is sufficient evidence to suspect that children with unilateral sensorineural hearing loss can experience complications in communication and education. Finally, this paper presents the description of a research plan used in our study on unilateral sensorineural hearing loss in children.

Auditory characteristics of children with autism

Objectives: The objectives of this study were (1) to describe the auditory characteristics of children with autism relative to those of typically developing children and (2) to describe the test-retest reliability of behavioral auditory test measures with this population of children with autism. Design: Audiometric data were obtained from 22 children diagnosed with autism and 22 of their typically developing peers. The audiologic test battery consisted of behavioral measures (i.e., visual reinforcement audiometry, tangible reinforcement operant conditioning audiometry, and conditioned play audiometry) and physiological measures (auditory brain stem response audiometry, distortion product otoacoustic emissions, and acoustic reflexes). Results: Children with autism had physiologic test results equivalent to their typically developing counterparts. That is, no differences in auditory brain stem response audiometry, distortion product otoacoustic emissions, or acoustic reflex results were noted between the children with autism and typically developing children. However, behavioral measures revealed that about half of the children diagnosed with autism presented pure-tone averages outside of normal limits (i.e., >20 dB HL), although their response thresholds to speech were within normal limits. All behavioral test results were within normal limits (i.e., ≤20 dB HL) for the typically developing children. In addition, test-retest variability was typically 15 dB or greater for children with autism as compared with variability of 10 dB or less for most of the typically developing children. Conclusions: Children with autism demonstrated essentially equivalent results on a battery of physiological auditory tests as those obtained from typically developing children. However, on average, behavioral responses of children with autism were elevated and less reliable relative to those of typically developing children. Furthermore, approximately half of the children with autism demonstrated behavioral pure-tone averages outside of the normal hearing range (i.e., >20 dB HL) despite having normal to near-normal hearing sensitivity as determined by other audiometric measures.