Leif Hergils

Universal neonatal hearing screening--parental attitudes and concern.

Abstract This study addresses parental attitudes and concern in relation to universal neonatal hearing screening by otoacoustic emissions (OAE) testing. The parents of 87 children who had participated during the first year of the universal neonatal hearing screening programme at University Hospital, Linköping, Sweden were included in the study. These children were all tested during this period and later cared for at three well-baby clinics (part of their primary healthcare). A questionnaire was given to the parents during routine medical check-ups at the well-baby clinics when the infants were 5–6 months of age. Ninety-five per cent of parents stated that they had a positive attitude towards neonatal hearing screening, 1 % were ambivalent and 4% were negative about it. The parents wanted early detection of hearing loss and the possibility of early intervention. It was also found that screening did not disturb the children. A few parents were anxious due to repeated testing of their children. The information provided in connection with the test was found to be sufficient by 77% of parents, whereas 11% of parents had negative comments about it (e.g. they wanted more information about the otoacoustic emissions technique). The general attitude among parents towards universal neonatal hearing screening was very positive in that they felt reassured by it. The risk of disturbing the parent-child relationship by early screening seems to be small, and could be further minimized by improved information and rapid and effective follow-up.

Analysis of measurements from the first Swedish universal neonatal hearing screening program.

This study analyses results from the first Swedish UNHS program. It includes over 33 000 measurement files from 14 287 children at two maternity wards. The screening program uses a two-stage TEOAE test procedure. A database was created in MedLog after data transformation in Word and Excel. The coverage rate was 99.1%. Bilateral pass rate after retesting was 97.0%. A unilateral pass criterion would have resulted in 1268 fewer children (9.0% of target group) for retesting and 231 fewer children (1.6% of target group) for diagnostic evaluation. When the first test was performed on the day the child was born, the pass rate was 64.8%; the pass rate increased to 89.2% when testing≥3 days after birth. High coverage rates and pass rates were found to be possible, independent of the number of children born at the maternity ward. Learning curves were observed in the program with improvements distributed over time. Test performance was clearly better when the children were tested day two after birth or later.

A longitudinal study of the bilateral benefit in children with bilateral cochlear implants

Abstract Objective: To study the development of the bilateral benefit in children using bilateral cochlear implants by measurements of speech recognition and sound localization. Design: Bilateral and unilateral speech recognition in quiet, in multi-source noise, and horizontal sound localization was measured at three occasions during a two-year period, without controlling for age or implant experience. Longitudinal and cross-sectional analyses were performed. Results were compared to cross-sectional data from children with normal hearing. Study sample: Seventy-eight children aged 5.1–11.9 years, with a mean bilateral cochlear implant experience of 3.3 years and a mean age of 7.8 years, at inclusion in the study. Thirty children with normal hearing aged 4.8–9.0 years provided normative data. Results: For children with cochlear implants, bilateral and unilateral speech recognition in quiet was comparable whereas a bilateral benefit for speech recognition in noise and sound localization was found at all three test occasions. Absolute performance was lower than in children with normal hearing. Early bilateral implantation facilitated sound localization. Conclusions: A bilateral benefit for speech recognition in noise and sound localization continues to exist over time for children with bilateral cochlear implants, but no relative improvement is found after three years of bilateral cochlear implant experience.

Bilateral versus unilateral cochlear implants in children: Speech recognition, sound localization, and parental reports

Abstract Objective: To compare bilateral and unilateral speech recognition in quiet and in multi-source noise, and horizontal sound localization of low and high frequency sounds in children with bilateral cochlear implants. Design: Bilateral performance was compared to performance of the implanted side with the best monaural speech recognition in quiet result. Parental reports were collected in a questionnaire. Results from the CI children were compared to binaural and monaural performance of normal-hearing peers. Study sample: Sixty-four children aged 5.1–11.9 years who were daily users of bilateral cochlear implants. Thirty normal-hearing children aged 4.8–9.0 years were recruited as controls. Results and Conclusions: Group data showed a statistically significant bilateral speech recognition and sound localization benefit, both behaviorally and in parental reports. The bilateral speech recognition benefit was smaller in quiet than in noise. The majority of subjects localized high and low frequency sounds significantly better than chance using bilateral implants, while localization accuracy was close to chance using unilateral implants. Binaural normal-hearing performance was better than bilateral performance in implanted children across tests, while bilaterally implanted children showed better localization than normal-hearing children under acute monaural conditions.

How do we identify hearing impairment in early childhood

This review discusses the need for universal neonatal hearing screening. Historical background is given concerning conventional childhood hearing screening programmes in western countries. Direct studies on the effects of very early habilitation programmes on speech and language development are cited. Measurement of otoacoustic emissions (OAE) as a tool for neonatal hearing screening is presented. The state of neonatal hearing screening programmes in the US and in Europe, particularly in Sweden, is discussed.

Nasal gas composition in humans and its implication on middle ear pressure.

The amount and composition of gas that enters the middle ear by the Eustachian tube is of interest in the study of middle ear pressure regulation. We have studied the gas composition in the nasal cavity through the respiratory cycle in humans by mass spectrometry. The findings were correlated to earlier findings regarding synchronization of swallowing and breathing. The composition of the gas that may pass the Eustachian tube at openings during swallowing seems to be very close to expiratory values: nitrogen 79.19%, oxygen 14.69%, argon 1.00% and carbon dioxide 5.10%.