P. Matulat

Atypical organisation of the auditory cortex in dyslexia as revealed by MEG

Neuroanatomical and -radiological studies have converged to suggest an atypical organisation in the temporal bank of the left-hemispheric Sylvian fissure for dyslexia. Against the background of this finding, we applied high temporal resolution magnetoencephalography (MEG) to investigate functional aspects of the left-hemispheric auditory cortex in 11 right-handed dyslexic children (aged 8-13 years) and nine matched normal subjects (aged 8-14 years). Event-related field components during a passive oddball paradigm with pure tones and consonant-vowel syllables were evaluated. The first major peak of the auditory evoked response, the M80, showed identical topographical distributions in both groups. In contrast, the generating brain structures of the later M210 component were located more anterior to the earlier response in children with dyslexia only. Control children exhibited the expected activation of more posterior source locations of the component that appeared later in the processing stream. Since the group difference in the relative location of the M210 source seemed to be independent of stimulus category, it is concluded that dyslexics and normally literate children differ as to the organisation of their left-hemispheric auditory cortex.

Responsive parenting intervention after identification of hearing loss by Universal Newborn Hearing Screening: The concept of the Muenster Parental Programme

BACKGROUND Parents of newborns with hearing loss (HL) identified by Universal Newborn Hearing Screening (UNHS) programmes wish for educational support soon after confirmation and for contact with other affected families. Besides pedaudiological care, a high level of family involvement and an early start of educational intervention are the best predictors for successful oral language development in children with HL. The implementation of UNHS has made it necessary to adapt existing intervention concepts for families of children with HL to the needs of preverbal infants. In particular, responsiveness has proven to be a crucial skill of intuitive parental behaviour in early communication between parents and their child. Since infants with HL are being fitted earlier with hearing devices, their chances of learning oral language naturally in daily communication with family members have noticeably improved. OBJECTIVES The Muenster Parental Programme (MPP) aims at empowering parents in communicating with their preverbal child with HL and in (re-)building confidence in their own parental resources. Additionally, it supplies specific information about auditory and language development and enables exchange with other affected parents shortly after the diagnosis. CONCEPT The MPP is a responsive parenting intervention specific to the needs of parents of infants with HL identified by UNHS or through other indices and testing within the first 18 months of life. It is based on the communication-oriented Natural Auditory Oral Approach and trains parental responsiveness to preverbal (3-18 months) infants with HL. The MPP has been developed for groups of 4-6 families and comprises six group sessions (without infants), two single training sessions with video feedback, and two individual counselling sessions. At the age of 24-30 months, an individual refresher training session is offered to the parents for adapting their responsiveness to the current verbal level of the child via dialogic book reading. The programme also benefits parents of paediatric cochlear implant (CI) candidates preimplantation and postimplantation. CONCLUSIONS The MPP is evidence-based (see Glanemann et al., this volume) and meets the current need for effective family-centred educational intervention after UNHS.

Spontaneous Otoacoustic Emission Enhancement in Children with Reduced Speech-in-Noise Intelligibility

Reduced speech-in-noise intelligibility is one of the main difficulties experienced by children with auditory processing disorder (APD). Previous studies have established a relationship between the function of the medial olivocochlear system (MOCS) and reduced inhibition of otoacoustic emissions (OAE) in children with APD. This study measured spontaneous OAE (SOAE) in 27 children with reduced speech-in-noise intelligibility, and those of a control group matched by gender and age. A significantly higher prevalence of SOAE was found: 85% of the study group presented SOAE, 44% in the control group. An abnormally functioning MOCS with reduced inhibition could lead to an increase in SOAE. Identifying a higher prevalence and number of SOAE may be a helpful objective mean to include in an APD diagnosis test battery.

Communication skills for interviewing hearing-impaired patients.

completion of the surgical rotation. Evaluation of results and impact The mean Likert score of the Year 4 medical students, an indicator of student satisfaction, was poor, at 29.5 (range: 19–41). Mean Likert scores of the Year 3 students were 29.0 (range: 19–38) for students in the control group and 57.0 (range: 45–60) for students in the study group (p < 0.001). Median TFQ scores for the control and study groups were 58% and 88%, respectively (p < 0.005). This new approach to theatre education helps the student to develop a global appreciation of the surgical patient. Appropriate preoperative preparation and patient interaction help the student to develop links between clinical presentation, investigation, treatment and postoperative care. These links are generic and can be applied to different patients. The results of our study would indicate that this new approach is educationally sound and acceptable to students.

Zentral-auditive Verarbeitungsstörungen bei Lese- und Rechtschreibschwäche – Ergebnisse einer retrospektiven Erhebung

Spezifische phonologische und temporale auditive Verarbeitungsstörungen werden als Hauptursachen für eine Lese-Rechtschreib-Schwäche angesehen. Vor diesem Hintergrund werden die klinischen Daten zur zentral-auditiven Verarbeitung bei 53 Kindern mit Lese-Rechtschreib-Schwäche dargestellt. Mit einer Häufigkeit von 84,9% zeigt sich in dieser Gruppe ein sehr hoher Prozentsatz auffälliger Befunde in mindestens einer der audiologischen oder logopädischen Untersuchungen. Entgegen der Erwartung konnten jedoch in der Untersuchungsgruppe nur geringe Häufigkeiten pathologischer Befunde in der auditiven Synthese (8,3%) sowie im Gap-Detection-Test (11,4%) nachgewiesen werden.

Development and evaluation of the new module ‘communication disorders’ in medical education

Background: Communication disorders are not taught as a self-contained topic in medical education, despite their high incidence and the similarities in the way in which they present clinically. Aims: This article describes the development of an elective subject ‘Phoniatrics and Pediatric Audiology’ covering five topics: hearing, language, and voice as well as psychometric tests and swallowing, with the objective of teaching a basic knowledge of the anatomy, physiology, and pathophysiology of the hearing and language system as well as symptoms, diagnostics, examination, and therapy of communication disorders. It contains theoretical background, practical exercises, and demonstrations of patient examinations. Methods: After initial modifications to the course, a statistical evaluation of the last two half-years in 2006 was performed. Results: The majority of students believe that the subject will be useful in their subsequent studies (94.2%) and medical practice (51.9%). All students affirmed that their expectations had been met by the course and they would choose it again. Conclusions: Uniting several communication disorders within a self-contained topic provides the opportunity to understand pathophysiological principles, similarities, and differences between normal and impaired function of the hearing and language system and voice production. In the authors’ opinion, it is a reasonable inclusion in medical training recognizing the importance of communication in todays service society.

Langzeitergebnisse von Patienten mit einem Cochlea-Implantat

Die Dokumentation der Ergebnisse einer Cochlea-Implantat (CI)-Versorgung ist Bestandteil der postoperativen Rehabilitation mit Hör-Sprach-Therapie und Kontrolluntersuchungen. In der vorliegenden Arbeit werden die audiometrischen und logopädischen Testergebnisse von vierzehn CI-Patienten sowie ihre kommunikativ-pragmatische Kompetenz dargestellt. Das Alter der Erwachsenen lag zwischen 53 und 68 Jahren (Mittelwert 61 Jahre), das der Kinder zwischen 9 und 16 Jahren (Mittelwert 11 Jahre 8 Monate). Die Patienten wurden postoperativ mehrfach je nach Alter und aktuellem Stand der Rehabilitation mit dem Mainzer Kindersprachtest I bis III, dem Göttinger Kindersprachverständnistest 1 und 2 und/oder dem Freiburger Sprachverständnistest (Zahlen, Einsilber) untersucht. Zusätzlich wurden Differenzierungstests zur Bestimmung der Unterscheidungsfähigkeit von Logatomen und zur Zeitauflösung durchgeführt. Bei Überprüfungen der sprachlichen und kommunikativen Leistungen der Patienten wurden die sprachsystematischen und kommunikativ-pragmatischen Fähigkeiten der Patienten bestimmt. Die aktuellen Ergebnisse streuen interindividuell stark. Die sprachaudiometrischen Daten liegen zwischen 40% Wortverständnis im Mainzer Kindersprachtest II und 90% Einsilberverständnis im Göttinger Kindersprachverständnistest 2 bei den Kindern und zwischen 35 und 85% Einsilberverständnis bei den Erwachsenen. Die Logatome /da/ und /di/ werden von 77% der Patienten als unterschiedlich wahrgenommen. Die Zeitauflösung, ausgedrückt als Unterscheidbarkeit zweier Lücken im Rauschen, beträgt für 85% der Patienten mehr als 20 ms. Die in den Sprachuntersuchungen erhobenen Daten ergeben bei den postlingual ertaubten Patienten durchweg Normalbefunde, bei den prälingual ertaubten Kindern streuen die Ergebnisse stark. Die kommunikativ-pragmatische Kompetenz hat sich bei allen Patienten im Verlaufe der Rehabilitation nach Cochlea-Implantation teilweise erheblich verbessert.

Population-based cross-sectional study to assess newborn hearing screening program in central Germany

OBJECTIVES Early diagnosis of congenital hearing loss is fundamental to minimize the negative consequences on the speech development. To lower the age at diagnosis and at intervention in hearing impaired children, not only universal newborn hearing screening (NHS) but also tracking is considered essential. The aim of the study was to evaluate the first six years after implementation of the population based newborn hearing screening program in Saxony-Anhalt, one German Federal State. METHODS The cross-sectional cohort study consisted of three cohort samples. Overall 102,301 infants born between January 2010 and December 2015 were included. NHS protocol was developed as dual target group protocol with two sub-protocols. The screening technique included Transient Evoked Otoacoustic Emissions (TEOAE) and Automated Auditory Brainstem Response (AABR) test. Newborns were assigned to the sub-protocols according to their audiological risk factors. Additionally, to evaluate the quality of NHS and tracking (false-negative screening) we were analysing data from a cohort of hearing impaired children diagnosed up to the age of three years. We calculated quality indicators and compared them with international guidelines. RESULTS 101,102 (98.8%) infants were screened. The prevalence of bilateral neonatal hearing loss was 2.32 per 1000 newborns. The median age was two days at first screening, three month at diagnostic testing, and four month at intervention onset. 2.6% infants were lost to follow-up. 56.3% had a final diagnosis of bilateral sensorineural hearing loss. The sensitivity of 0.85 (KI 95%: 0.76–0.91) and a specificity of 0.84 (KI 95%: 0.84–0.85) was calculated for the NHS program. CONCLUSIONS The analysis of benchmarks and outcomes of NHS demonstrated that the program reaches its main goal to identify the hearing impaired newborns in a timely manner.

The Newborn Hearing Screening Programme in Germany

This article presents an overview of legal, methodological, organisational, financial, structural and technical aspects of the initial audiological measurement of newborns (screening), follow-up (diagnosis) and tracking the results (tracking) within the German newborn hearing screening programme.

Abweichende Sprachentwicklung nach Cochleaimplantation?@@@Deviant language development following cochlear implantation?: Zur Anwendbarkeit des Elternfragebogens ELFRA-2@@@Applicability of the parent questionnaire ELFRA-2

BACKGROUND The parent questionnaire ELFRA-2 is considered a valid tool for early detection of delayed language development in 2-year-old children. Applicability for children treated with cochlear implants (CI) is to be investigated. METHODS By means of the ELFRA-2 we documented longitudinally for up to 24 months post implantation language development in 27 children treated before 3 years of age. The critical developmental criteria (related to age) were applied to CI children (related to duration of CI use) and gender-related normative data were taken as a reference. RESULTS Only two boys were identified as showing a language delay after 2 years of CI use. However, using normative data 11-44% of the children performed below average. Development in girls was faster than in boys. The influence of preoperative hearing experience declined over time. CONCLUSION The critical developmental criteria of ELFRA-2 have proved to be unreliable for the identification of varying development after CI. Modified and gender-related evaluation is necessary.