Roanne K. Karzon

Unilateral Hearing Loss Is Associated With Worse Speech-Language Scores in Children

OBJECTIVE: To determine whether children with unilateral hearing loss (UHL) demonstrate worse language skills than their siblings with normal hearing, and whether children with UHL are more likely to receive extra assistance at school. PATIENTS AND METHODS: We conducted a case-control study of 6- to 12-year-old children with UHL compared with sibling controls (74 pairs, n = 148). Scores on the oral portion of the Oral and Written Language Scales (OWLS) were the primary outcome measure. Multivariable analysis was used to determine whether UHL independently predicted OWLS scores after we controlled for potential confounding variables. RESULTS: Children with UHL had worse scores than their siblings on language comprehension (91 vs 98; P = .003), oral expression (94 vs 101; P = .007), and oral composite (90 vs 99; P < .001). UHL independently predicted these OWLS scores when multivariable regression was used with moderate effect sizes of 0.3 to 0.7. Family income and maternal education were also independent predictors of oral expression and oral composite scores. No differences were found between children with right- or left-ear UHL or with varying severity of hearing loss. Children with UHL were more likely to have an individualized education plan (odds ratio: 4.4 [95% confidence interval: 2.0–9.5]) and to have received speech-language therapy (odds ratio: 2.6 [95% confidence interval: 1.3–5.4]). CONCLUSIONS: School-aged children with UHL demonstrated worse oral language scores than did their siblings with normal hearing. These findings suggest that the common practice of withholding hearing-related accommodations from children with UHL should be reconsidered and studied, and that parents and educators should be informed about the deleterious effects of UHL on oral language skills.

Identification of Noise Sources That Influence Distortion Product Otoacoustic Emission Measurements in Human Neonates

Objective: The objective of this study was to identify individual sources of noise and their contribution to the overall noise that influences valid measurement of otoacoustic emissions in neonates. The hypothesis was that careful selection of eliciting signals and signal processing parameters, unique analysis of measured results, and control of certain subject characteristics would allow isolation of these individual noise sources and determine their relative influence. Design: Eliciting signal parameters were optimized and held constant to minimize equipment noise. Analysis of noise floors in relation to signal level was used to identify equipment‐related noise associated with changes in signal parameters. Analysis of noise floor distributions was used to determine whether environmental noise entered the measurements via inadequate coupling of the probe to the ear. The acoustic characteristics of the middle ear were varied via subject selection to determine the influence of middle‐ear characteristics on noise floor levels. Results: The two sources of noise associated with the measurement equipment need not contribute to the noise floor for biologically relevant otoacoustic emissions measurements (eliciting signal levels between 30 and 75 dB SPL). Of the two pathways identified for environmental noise, the pathway resulting from an inadequate seal between the probe and the ear canal can be eliminated. One of the two sources of noise related to the subject, noise resulting from biologic activity unrelated to the ear can be minimized. However, the remaining factor, the status of the middle ear, has been shown to contribute as much as 6 dB to the overall noise floor. Conclusions: Careful selection of signal parameters and additional data analyses and procedural variables can isolate or control several sources of noise that influence distortion product otoacoustic emission measurements in neonates. Tight coupling between the probe unit and the external ear canal should be maintained for all measurements. Middle ear abnormalities can increase noise floors up to 6 dB.

Do audiologic characteristics predict outcomes in children with unilateral hearing loss

Objective To determine whether audiologic characteristics of unilateral hearing loss in children were associated with language, cognitive, or achievement scores. Study Design Case-control study Setting Pediatric otolaryngology ambulatory practice Patients Cases (n = 109) were children aged 6 to 12 years with permanent unilateral hearing loss; controls (n = 95) were siblings with normal bilateral hearing. Interventions Audiologic characteristics measured included side and severity of hearing loss and word recognition scores in quiet and in noise. Main Outcome Measures Cognitive abilities were measured using the Wechsler Abbreviated Scale of Intelligence; reading, math, and writing achievement was measured with the Wechsler Individual Achievement Test – Second Edition – Abbreviated; and oral language skills were measured with the Oral Written and Language Scales. Results Children with unilateral hearing loss had worse verbal cognitive and oral language scores than children with normal hearing, but there were no differences in achievement scores. Children with profound unilateral hearing loss tended to have worse cognitive scores and had significantly lower oral language scores. Higher word recognition scores of the normal hearing ear in quiet were associated with higher cognitive, oral language, and reading achievement scores. Higher word recognition scores in noise were slightly correlated with higher oral language scores. Conclusion As expected, children with unilateral hearing loss had worse language scores than their siblings with normal hearing, with trends toward worse cognitive scores. Children with profound unilateral hearing loss tended to have worse outcomes than children with normal hearing or less severe unilateral loss. However, there were no differences in outcomes between children with right or left unilateral hearing loss.

Audiologic and vestibular findings in wolfram syndrome

Objectives: Assessment of auditory and vestibular function in Wolfram Syndrome (WS) patients, using a standardized protocol. Design: Prospective cohort study of 11 patients using otoscopic inspection, tympanometry, otoacoustic emissions, pure tones, speech in noise (SIN), the Speech Intelligibility Index, and rotational chair testing. Results: Mean SNHL diagnosis was 7.3 years with 55% prevalence. Four patients with a Speech Intelligibility Index less than 0.75 (better ear) routinely used bilateral amplification devices. Two patients with normal-hearing sensitivity exhibited abnormal SIN scores. The only patient with significant vestibular dysfunction also had a distinctive low-frequency component to her SNHL. Conclusions: Hearing loss may occur earlier than previously suspected, and comprehensive testing including SIN testing may reveal deficits not apparent with pure-tone testing. Particular configurations of hearing loss may indicate a need for comprehensive vestibular assessment. Because SNHL can be the first symptom of WS, audiologists and otolaryngologists should be vigilant about referring patients with hearing loss for ophthalmologic examination.

Efficacy of earphones for 12- to 24-month-old children during visual reinforcement audiometry.

Abstract Objective: Efficacy of insert and supra-aural earphones during visual reinforcement audiometry (VRA) was investigated for 12- to 24-month-old children. Design: VRA testing began in the soundfield and transitioned to either insert or supra-aural earphones. Audiologists recorded threshold estimates, participant behaviors, and an overall subjective rating of earphone acceptance. Study sample: One hundred and eighty-six 12- to 24-month-old children referred to the Department of Audiology at St. Louis Children’s Hospital for a variety of reasons. Results: Subjective ratings indicated high acceptance of insert earphones (84%) and supra-aural earphones (80%) despite negative behaviors. There was no significant difference in the number of threshold estimates based on earphone type for 12- to 17-month-old participants. Participants in the 18- to 24-month-old age group provided significantly more threshold estimates with insert earphones (mean = 5.3 threshold estimates, SD = 3.5) than with supra-aural earphones (mean = 2.9 threshold estimates, SD = 2.9). All seven participants who rejected earphone placement were successfully reconditioned for soundfield testing. Conclusions: Data support the use of insert earphones during VRA, especially with 18-to 24-month-old children, to obtain ear-specific information.