Lenore Holte

Aging Effects in Multifrequency Tympanometry

Objective: The objective of this investigation was to determine the effect of the aging process on various measures derived from multifrequency tympanograms. Design: Tympanograms were recorded at 226 Hz and at one‐sixth octave intervals from 250 through 2000 Hz from 136 adult male subjects; 20 in each decade of life from age 20 through age 79 and 16 older than 79 yr of age. Analyses were performed on two measures of resonant frequency of the middle ear, two measures of static admittance at 226 Hz, and tympanometric width at 226 Hz. Results: No systematic effect of age on any of these measures was evident in this population except for a small, but significant, correlation between tympanometric width and age. Analyses of variance indicated no significant difference among mean values on any measure when subjects were grouped by decade of life. Values of these tympanometric variables are reported to add to the growing base of data from normal low‐frequency and multifrequency tympanograms. Conclusions: The main finding of this investigation indicates that normative values of middle ear resonance, admittance, and tympanometric width obtained from groups of adults of various ages can be applied to elderly men.

The Influence of Hearing Aid Use on Outcomes of Children With Mild Hearing Loss

PURPOSE This study examined the effects of consistent hearing aid (HA) use on outcomes in children with mild hearing loss (HL). METHOD Five- or 7-year-old children with mild HL were separated into 3 groups on the basis of patterns of daily HA use. Using analyses of variance, we compared outcomes between groups on speech and language tests and a speech perception in noise task. Regression models were used to investigate the influence of cumulative auditory experience (audibility, early intervention, HA use) on outcomes. RESULTS Full-time HA users demonstrated significantly higher scores on vocabulary and grammar measures compared with nonusers. There were no significant differences between the 3 groups on articulation or speech perception measures. After controlling for the variance in age at confirmation of HL, level of audibility, and enrollment in early intervention, only amount of daily HA use was a significant predictor of grammar and vocabulary. CONCLUSIONS The current results provide evidence that childrens language development benefits from consistent HA use. Nonusers are at risk in areas such as vocabulary and grammar compared with other children with mild HL who wear HAs regularly. Service providers should work collaboratively to encourage consistent HA use.

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

Objectives: 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. Design: 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. Results: 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. Conclusions: 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.

Issues in the Evaluation of Infants and Young Children Who Are Suspected of or Who Are Deaf-Blind

Young children who are deaf-blind have unique communication, developmental, emotional, and educational needs that require special knowledge, expertise, technology, and assistance far beyond that required by other children with disabilities. The etiology of deaf-blindness is often multifactorial, with the most common causes being genetic and chromosomal syndromes, congenital infections, prenatal and postnatal environmental exposures, and postnatal trauma or diseases. Early identification is key, and begins with understanding the factors in medical and family histories that predispose a child to deaf-blindness. Assessment requires the skills of a team of clinicians. Coordinated early identification and intervention can ensure that the child who is deaf-blind receives the support needed to learn to communicate effectively with others and to develop conceptual skills necessary to support future learning. This article focuses on the evaluation of infants and young children who are suspected of being deaf-blind or who have already been determined to have this dual sensory impairment.

Diagnosis and Evaluation of Children Who Are Not Talking.

“My child is not talking” is a concern voiced by many parents and families. Possible etiologies for developmental language disorders and articulation disorders are many: mental retardation, craniofacial disorders, cerebral palsy, autism, traumatic brain injury, hearing loss. Sometimes there will be a single etiology; however, most times there are multiple etiologies, mild in nature, that come together to produce speech and language delay. As health care providers, therapists, and educators it is essential that we assist the childs family in finding answers to their questions. We are wise to seek the advice of an interdisciplinary team of professionals to determine whether the childs communication abilities are developing normally or whether professional intervention is needed. It has been well documented that early diagnosis and treatment for speech and language problems greatly improve the childs overall prognosis, and can often prevent the development of additional disorders in the areas of behavior, learning, reading, and social development.

The relative loudness of third‐octave bands of speech

The purpose of this experiment was to determine the relative loudness of various spectral portions of speech. The loudness of each of seven third‐octave bands of speech was determined for ten normal‐hearing listeners who matched the loudness of an unfiltered speech sample to that of each of the filtered speech bands. The results suggested that the loudness of third‐octave bands of speech is approximately constant from 500 through 3150 Hz, and perhaps through 4000 Hz.

Issues in the Management of Infants and Young Children Who Are Deaf-blind

Young children with major auditory and visual impairments are identified as “deaf-blind.” They have unique communication, developmental, emotional, and educational needs that require special knowledge, expertise, technology, and assistance. Having a child with this dual sensory impairment can create emotional and financial stress on a family. Programs that provide consultative training and technical assistance for families, educators, and service providers are key in meeting the needs of such children and their families. Behavioral concerns, circadian rhythm disturbances, amplification, and special education needs all require expert and prompt attention. New research is adding to our knowledge of cochlear implants, cortical stimulators, and augmentative communication, which have the potential to improve the quality of life for the child who is deaf-blind. This article is intended to introduce professionals from a variety of disciplines to current practices and important considerations in intervention with infants and young children who are deaf-blind. It also includes discussion of the crucial role of family support in optimizing outcomes for these children. A companion article on evaluation of infants and young children who are suspected of or who are determined to be deaf-blind previously appeared in Infant & Young Child.

Contemporary research in tympanometry

Tympanometry has widespread clinical use in the diagnosis of middle ear pathology. Low static admittance and high tympanometric width are highly correlated with the presence of effusion. Negative tympanometric peak pressure is not clearly associated with otitis media but can predict which children may be at risk for developing otitis. Age-specific norms have been published for these tympanometric quantities.Conventional tympanometry with a probe tone of 226 Hz has not proven useful in newborns, but there is evidence that high-frequency tympanograms, particularly at a probe frequency of 1000 Hz, can detect the presence of middle ear effusion in very young infants. Alternatives to tympanometry, such as wide-band reflectance, are also under investigation for this population.

Communication disorders in children.

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Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions

Purpose This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL). Method Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children. Results Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit. Conclusions Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.