John K. Niparko

Spoken Language Development in Children Following Cochlear Implantation

CONTEXT Cochlear implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). OBJECTIVE To prospectively assess spoken language acquisition following cochlear implantation in young children. DESIGN, SETTING, AND PARTICIPANTS Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent cochlear implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. MAIN OUTCOME MEASURES Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). RESULTS Children undergoing cochlear implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preimplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at cochlear implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to cochlear implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. CONCLUSION The use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.

Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004.

BACKGROUND Hearing loss affects health and quality of life. The prevalence of hearing loss may be growing because of an aging population and increasing noise exposure. However, accurate national estimates of hearing loss prevalence based on recent objective criteria are lacking. METHODS We determined hearing loss prevalence among US adults and evaluated differences by demographic characteristics and known risk factors for hearing loss (smoking, noise exposure, and cardiovascular risks). A national cross-sectional survey with audiometric testing was performed. Participants were 5742 US adults aged 20 to 69 years who participated in the audiometric component of the National Health and Nutrition Examination Survey 1999-2004. The main outcome measure was 25-dB or higher hearing loss at speech frequencies (0.5, 1, 2, and 4 kHz) and at high frequencies (3, 4, and 6 kHz). RESULTS In 2003-2004, 16.1% of US adults (29 million Americans) had speech-frequency hearing loss. In the youngest age group (20-29 years), 8.5% exhibited hearing loss, and the prevalence seems to be growing among this age group. Odds of hearing loss were 5.5-fold higher in men vs women and 70% lower in black subjects vs white subjects. Increases in hearing loss prevalence occurred earlier among participants with smoking, noise exposure, and cardiovascular risks. CONCLUSIONS Hearing loss is more prevalent among US adults than previously reported. The prevalence of US hearing loss differs across racial/ethnic groups, and our data demonstrate associations with risk factors identified in prior smaller-cohort studies. Our findings also suggest that hearing loss prevention (through modifiable risk factor reduction) and screening should begin in young adulthood.

Hearing Loss Prevalence in the United States

Author Affiliations: Department of Epidemiology, EviMed Research Group, LLC, Goshen, Massachusetts (Dr Zilberberg); School of Public Health and Health Sciences, University of Massachusetts, Amherst (Dr Zilberberg); Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Zilberberg); and School of Medicine, University of Massachusetts, Worcester (Dr Tjia). Correspondence: Dr Zilberberg, Department of Epidemiology, EviMed Research Group, LLC, PO Box 303, Goshen, MA 01032 (evimedgroup@gmail.com). Author Contributions: Dr Zilberberg had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Zilberberg. Acquisition of data: Zilberberg. Analysis and interpretation of data: Zilberberg and Tjia. Drafting of the manuscript: Zilberberg. Critical revision of the manuscript for important intellectual content: Zilberberg and Tjia. Statistical analysis: Zilberberg. Financial Disclosure: None reported. Online-Only Material: The eAppendix and eTables are available at http://www.archinternmed.com.

THE SOCIETAL COSTS OF SEVERE TO PROFOUND HEARING LOSS IN THE UNITED STATES

Objective: Severe to profound hearing impairment affects one-half to three-quarters of a million Americans. To function in a hearing society, hearing-impaired persons require specialized educational, social services, and other resources. The primary purpose of this study is to provide a comprehensive, national, and recent estimate of the economic burden of hearing impairment. Methods: We constructed a cohort-survival model to estimate the lifetime costs of hearing impairment. Data for the model were derived principally from the analyses of secondary data sources, including the National Health Interview Survey Hearing Loss and Disability Supplements (1990–91 and 1994–95), the Department of Educations National Longitudinal Transition Study (1987), and Gallaudet Universitys Annual Survey of Deaf and Hard of Hearing Youth (1997–98). These analyses were supplemented by a review of the literature and consultation with a four-member expert panel. Monte Carlo analysis was used for sensitivity testing. Results: Severe to profound hearing loss is expected to cost society

Transcranial Contralateral Cochlear Stimulation in Unilateral Deafness

297,000 over the lifetime of an individual. Most of these losses (67%) are due to reduced work productivity, although the use of special education resources among children contributes an additional 21%. Life time costs for those with prelingual onset exceed

Consensus statements on the BAHA system: where do we stand at present?

1 million. Conclusions: Results indicate that an additional

Impact of Cochlear Implants on the Functional Health Status of Older Adults

4.6 billion will be spent over the lifetime of persons who acquired their impairment in 1998. The particularly high costs associated with prelingual onset of severe to profound hearing impairment suggest interventions aimed at children, such as early identification and/or aggressive medical intervention, may have a substantial payback.

Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002.

OBJECTIVES: The purpose of this study is to evaluate the effectiveness of Bone Anchored Cochlear Stimulator (BAHA) in transcranial routing of signal by implanting the deaf ear. STUDY DESIGN AND SETTINGS: Eighteen patients with unilateral deafness were included in a multisite study. They had a 1-month pre-implantation trial with a contralateral routing of signal (CROS) hearing aid. Their performance with BAHA was compared with the CROS device using speech reception thresholds, speech recognition performance in noise, and the Abbreviated Profile Hearing Benefit and Single Sided Deafness questionnaires. RESULTS: Patients reported a significant improvement in speech intelligibility in noise and greater benefit from BAHA compared with CROS hearing aids. Patients were satisfied with the device and its impact on their quality of life. No major complications were reported. CONCLUSION AND SIGNIFICANCE: BAHA is effective in unilateral deafness. Auditory stimuli from the deaf side can be transmitted to the good ear, avoiding the limitations inherent in CROS amplification.

ULTRASTRUCTURAL ANALYSIS OF PRIMARY ENDINGS IN DEAF WHITE CATS : MORPHOLOGIC ALTERATIONS IN ENDBULBS OF HELD

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification.

Objectives To assess the impact of cochlear implantation on quality of life changes in older adults aged 50 years and above.