Viktor Weichbold

Universal Newborn Hearing Screening and Postnatal Hearing Loss

OBJECTIVE. The goal of this study was to determine the percentage of children who have a postnatal permanent childhood hearing impairment (PCHI) and the percentage thereof who have risk indicators for a postnatal hearing loss. METHODS. Data were drawn retrospectively from the clinical charts of children who had bilateral PCHI (>40 dB hearing level, better ear, unaided) and had undergone universal newborn hearing screening (UNHS) between 1995 and 2000 in various Austrian hospitals. A hearing loss was recognized as postnatal when a child passed UNHS but was later found to have a hearing impairment. The presence of risk indicators, as suggested by the Year 2000 Statement of the American Joint Committee on Infant Hearing (JCIH), was assessed by reviewing the childrens clinical charts. RESULTS. Of a total of 105 children with bilateral PCHI, 23 (22%) showed postnatal impairment. After correction of this number for underascertainment, postnatal impairment was estimated to account for 25% of all bilateral PCHI at age 9 years. Risk indicators were found in 17 children but did not fully correspond to those proposed by the JCIH. The risk factors found were a family history of hearing loss (3 children), meningitis (2), craniofacial malformation (2), persistent pulmonary hypertension (1), congenital cytomegaly infection (1), extracorporeal membrane oxygenation (1), recurrent otitis media with effusion (1), and, in addition to the JCIH list, ototoxic therapy (5), and birth before 33rd gestational week (2) (1 child had a combination of the last 2). Six children showed no risk indicators for the postnatal hearing loss. CONCLUSIONS. Our findings suggest that ∼25% of bilateral childhood hearing loss is postnatal, which supports the leading role of UNHS in detecting PCHI. Provisions for also identifying postnatal cases nevertheless are justified. Because in some of these children no risk indicators are detectable and in others the hearing deterioration starts after age 3 years, audiologic monitoring of at-risk children up to this age may not be sufficient. Additional methods, such as hearing screening at nursery schools or schools, are recommended.

Effects of a hearing protection campaign on the discotheque attendance habits of high-school students.

This study investigated whether a hearing education campaign would prompt adolescents to display hearing-protective behaviour when attending a discotheque. A sample of 169 high-school students participated in the campaign. A questionnaire was administered to them before and 1 year after the campaign, asking for the frequency of discotheque attendance within the past 6 months, and whether they used earplugs in the discotheque. The percentage of subjects who went to discotheques more than 10 times within 6 months decreased from 34% to 24% after the campaign. The overall difference between pre-and postcampaign frequencies of discotheque attendance, however, was not significant. The percentage of subjects using earplugs in the discotheque rose from 0% before to 3.7% after the campaign. In essence, the campaign had little effect in inducing hearing-protective behaviour in adolescents when attending discotheques. The need for sound level limitations in discotheques is highlighted. Sumario El estudio investigó si una campaña educativa podia motivar a los adolescenles para adopter una conducta de protección auditiva al asistir a una discoteca. Participó en la campaña una muestra de 169 alumnos de educaeión media. Se les aplicó un cuestionario antes y un año despucs de la campaña, en el que se les preguntó la frccuencia con la que asistieron a discotecas en el curso de los últimos seis meses y si usaron tapones dc oidos. El porcentaje de sujetos que fucron a discotecas más de 10 veces en esos últimos seis meses descendió dc 34 a 24% después de la campaña. No obstante, la difercncia global dc la frecucncia de asistencia a discotecas antes y después de la campaña, no fue significativa. El porcentaje de sujetos que usaron tapones de oido en las discotecas aumentó del 0% antes, al 3.7% despucs de la campaña. En eseneia, la campaña tuvo sólo un minimo efecto en la inductión de conductas de protección auditiva en adolescentes que van a discotecas. Se destaca la necesidad de limitar los niveles sonoros en las discotecas.

Validation of three adaptations of the Meaningful Auditory Integration Scale (MAIS) to German, English and Polish

The Meaningful Auditory Integration Scale (MAIS) is a parent-report questionnaire for assessing auditory behaviour in aurally habilitated children. This study addressed the reliability and convergent validity of three different language versions of the MAIS: English, German, and Polish. In total, 114 parents (English, n=27; Polish, n=37; German, n=50) completed the MAIS preoperatively and at 6 months after cochlear implantation. Internal reliability (Cronbachs alpha) ranged from 0.92 to 0.95 preoperatively, and from 0.87 to 0.93 at 6 months. Split-half reliability was at least 0.90 preoperatively, and ranged from 0.76 to 0.89 at 6 months. Corrected item-total correlation coefficients were significant (p<0.05) for all items except for item 1, which showed poor correlations in the Polish version. Correlation of the MAIS with the Listening Progress Profile (LiP), as a measure for convergent validity, yielded coefficients between 0.81 and 0.73 preoperatively, and between 0.79 and 0.61 at 6 months. These findings demonstrate high reliability and convergent validity of the three MAIS versions. Sumario La Escala de Integracio´n Auditiva Significativa (MAIS) es un cuestionario que se aplica a los padres para evaluar la conducta auditiva de nin˜os habilitados auditivamente. Este estudio analizo´ la utilidad y la validacio´n convergente del MAIS en tres versiones lingu¨i´sticas: ingle´s, alema´n y polaco. En total, 114 padres (ingle´s, n=27; polaco, n=37; alema´n, n=50) respondieron el MAIS antes de la operacio´n y 6 meses despue´s de implantacio´n coclear. La consistencia interna (alfa de Cronbach) vario´ de 0.92 a 0.95 en el preoperatorio y de 0.87 a 0.93 a los 6 meses. La consistencia de la mitad dividida fue de al menos 0.90 en el preoperatorio y vario´ de 0.76 a 0.89 a los 6 meses. El coeficiente de correlacio´n del total de los items correctos fue significativo (p<0.05) para todos los items excepto el nu´mero 1, que mostro´ una pobre correlacio´n en la versio´n polaca. La correlacio´n del MAIS con el Perfil de Progreso de Escucha (LiP), como medida de validez de convergencia, demostro´ coeficientes entre 0.81 y 0.73 en el preoperatorio y entre 0.79 y 0.61 a los 6 meses. Estos hallazgos demostraron alta consistencia y validez de convergencia de las tres versiones del MAIS.

Improvement in early detection of congenital hearing impairment due to universal newborn hearing screening.

OBJECTIVE The aim of this study was to determine whether universal newborn hearing screening (UNHS) is effective in increasing the number of children whose hearing impairment is detected early, i.e. within the first 6 months of life. It also investigated whether UNHS contributes most to the early detection of moderately and severely hearing-impaired newborns, as suggested by a recently published report. METHODS The study consisted of a retrospective analysis of the data of all children born in Tyrol between 1980 and 1999 and having an at least moderate permanent hearing loss in the better ear. RESULTS The findings are that since UNHS was introduced in some newborn nurseries in 1995, a substantially higher number of hearing-impaired children has been detected early. For the whole sample, the increase of the early detection rate is 39.9%, with a 95% confidence interval of 33.2-46.8% (P<0.0001). For moderate hearing loss the increase is 49.2 with a 95% confidence intervall of 39.6-58.8% (P=0.000). CONCLUSIONS On the whole, our findings lend support to the view that UNHS is effective in early detection of congenital hearing impairment. We conclude that UNHS provides the greatest benefit for moderately hearing-impaired children who, otherwise, would have been detected last.

Results from high-frequency hearing screening in 14- to 15-year old adolescents and their relation to self-reported exposure to loud music

Abstract Objective: Data from high-frequency hearing screening in adolescent students were analysed to investigate whether practices of listening to loud music are reflected in the hearing status of young people. Design: Students were screened for their hearing at frequencies 2, 4, and 6 kHz and at a level of 20 dB HL. Failure of the screening was defined by missing at least one frequency in one ear. In addition to hearing screening, the students filled out a questionnaire asking for practices related to exposure to loud music. Study sample: 1296 adolescents aged 14 to 15 years. Results: The overall rate of failing the hearing screening was 14.9% (95% CI: 13.0%–16.8%). The rate was similar in adolescents with no, little, or moderate exposure to loud music (10% to 15%), but significantly increased (22% to 25%) in adolescents with high exposure. Conclusions: The observed failing rate compares well to findings on the prevalence of hearing deficits in adolescents reported in other studies. In addition, our study suggests that the risk for hearing damage from loud music is not steadily increasing with increase of exposure, but exists only under conditions of extreme listening.

Stimmstörung und Lebensqualität: Die Münchner Lebensqualitätsdimensionen-Liste (MLDL) in der logopädischen Therapieforschung

Kosten-Nutzen-Analysen bilden zunehmend die Basis für die öffentliche Finanzierung des Gesundheitssystems, wodurch der Nachweis von Therapieeffekten an Bedeutung gewinnt. In der logopädischen Therapieforschung fehlen vielfach Instrumente zur Erhebung der Therapieeffekte. Ziel dieser Studie war es zu überprüfen, ob das Konzept «Lebensqualität», erhoben mit der Münchner Lebensqualitätsdimensionen-Liste (MLDL), dazu geeignet ist. 25 erwachsene Patienten mit Schlafstörung wurden zu Beginn und am Ende einer logopädischen Therapie (zirka 20 h) mit der MLDL befragt. Obwohl der Grossteil der Patienten mit der Therapie sehr zufrieden war, zeigten nur 2 der 19 MLDL-Items eine signifikante Verbesserung an («Entspannungsfähigkeit», p < 0,05; «Behandlung der Stimmstörung», p < 0,01). Die MLDL ist zu wenig sensitiv für Effekte der logopädischen Intervention. Die Entwicklung spezieller Skalen für die logopädische Therapieforschung wird angeregt.

Auditory and cognitive development in a partially deaf child with bilateral electro-acoustic stimulation: a case study

Abstract Objective: To study the long-term evolution of speech and intelligence in a child with partial deafness and normal hearing in the low frequencies after sequentially receiving cochlear implants in both ears. Design: Retrospective chart review. Study sample: Male child aged 6 years was followed over a time period of four years. Results: The paediatric patient had normal hearing up to 1 kHz and profound hearing loss at all higher frequencies symmetrical in both ears. Deprivation of high-frequency sounds resulted in retarded development of speech, language and cognitive skills. The choice for rehabilitation was cochlear implantation with the aim of preserving a considerable amount of low-frequency hearing. With natural hearing at low frequencies and electrical stimulation at high frequencies, the child was able to compensate most of his developmental deficits. Moreover, spatial hearing was almost normal. Conclusions: Electro-natural stimulation without amplification of the low frequencies (electro-natural hearing) provides access to the whole audible frequency range for children, who suffer from partial deafness in the high frequencies and are normal hearing at low frequencies. Such provision allows for regular speech development and favours the development of spatial hearing. The case report also demonstrates a strong impact on intellectual performance.

Improvement of sound source localization abilities in patients bilaterally supplied with active middle ear implants.

Abstract Conclusions: Patients, who are bilaterally supplied with active middle ear implants, perform slightly better in sound localization tasks than when unilaterally aided or unaided. Objectives: To investigate the impact of bilateral use of active middle ear implants on sound source localization in the horizontal plane in patients with a sloping moderate-to-severe hearing loss. Methods: Ten adults supplied with Med-EL Vibrant Soundbridge systems (VSB) in both ears participated in the study. Four listening conditions were tested: unaided, aided with VSB on left or right ear and on both sides. In each condition the subjects had to judge the direction of broadband noises delivered randomly across a semicircular array of 11 loudspeakers arranged in an anechoic chamber. Results: When unaided or bilaterally aided, the subjects localized on average 40% of the stimuli correct; when unilaterally aided (left or right), this rate dropped to 20–30% in either condition. Precision of sound localization was highest when bilaterally aided, i.e. the mean RMS angular error was 10°, and lowest when unilaterally aided, i.e. 15°. This is in line with bilateral hearing aid users, who show similar performance in sound localization tasks.

Book Review / Announcements

The author explores the impact of hearing loss on relationships. As old age is the leading aetiological factor in hearing impairment followed by noise-induced hearing loss, it is becoming increasingly important to study the ways in which hearing impairment makes its impact on intimate relationships, namely in families, couples and their children. For a better comprehension of this complex problem, the author used an in-depth interviewing technique for 150 hearing-impaired people including 11 couples where one partner is hearing and the other impaired. This original and interesting research leads to strategies for better communication, counselling, family therapy, social policy and psychology. A. Muller, Morges