Wim Soede

Depression in hearing-impaired children

OBJECTIVE The purpose of this study was to examine the levels of depressive symptoms and the unique contribution of two aspects of emotion regulation (coping and mood states) to the development of depression in hearing-impaired children and a control group. METHODS In order to compare the groups, self-report questionnaires concerning symptoms of depression, coping strategies, and mood states were used. The study group consisted of 27 children with cochlear implants, 56 children with conventional hearing aids, and 117 normally hearing children. RESULTS Hearing-impaired children reliably reported more symptoms of depression than their normally hearing peers. Degree of hearing loss, socioeconomic status, gender, and age were unrelated to the level of depressive symptoms. But attending mainstream schools or using exclusively speech for communication were related to fewer depressive symptoms. The associations with depressive symptoms differed between the groups. For hearing-impaired children, the cognitive aspects (coping) and the affective aspects (mood states) of emotional functioning contributed separately to the prediction of depressive symptoms. For normally hearing children an integration of cognitive and affective aspects was detected: adequate coping skills prevented the development of negative mood states and in turn depressive symptoms. CONCLUSIONS Hearing-impaired children reported more depressive symptoms than normally hearing children. Prevention and treatment of depression in hearing-impaired children could focus on the use of coping strategies adequately, because these strategies have a direct relation with the level of depression.

Psychopathology and Its Risk and Protective Factors in Hearing-Impaired Children and Adolescents: A Systematic Review

IMPORTANCE Pediatric hearing impairment is a chronic handicap that can potentially lead to the development of psychopathology. Yet, for hearing-impaired children and adolescents, the exact occurrence of various forms of psychopathology and its causes are unclear, while this knowledge is essential to enable targeted screenings and interventions. OBJECTIVE To investigate the level of psychopathological symptoms in hearing-impaired children and adolescents as compared with normally hearing peers. Second, the influence of type of hearing device and possible risk and protective factors on psychopathology were examined. EVIDENCE REVIEW A systematic literature search was performed covering relevant databases, including PubMed, Embase, and Web of Science. Two independent researchers identified the relevant articles. The final search was performed on May 2, 2013, and resulted in a total of 35 articles. FINDINGS Literature consistently demonstrated that hearing-impaired children and adolescents were more prone to developing depression, aggression, oppositional defiant disorder, conduct disorder, and psychopathy than their normally hearing peers. Levels of anxiety, somatization, and delinquency were elevated in some, but not all, hearing-impaired participants, for reasons related to sex, age, and type of school. Divergent results were obtained for the level of attention-deficit/hyperactivity disorder and the influence of type of hearing device on psychopathology. Possible risk and protective factors were identified, including age at detection and intervention of hearing loss, additional disabilities, communication skills, intelligence, type of school, and number of siblings. CONCLUSIONS AND RELEVANCE Literature on psychopathology in hearing-impaired children and adolescents is scarce and sometimes inconsistent. To define a more precise occurrence of psychopathology, more studies are needed. These studies should have a longitudinal design to draw firmer conclusions on causality. Hopefully, this will lead to more knowledge in the future to help and support each hearing-impaired individual.

Anxiety in children with hearing aids or cochlear implants compared to normally hearing controls

The objectives of this study were to examine the levels of anxiety in hearing‐impaired children with hearing aids or cochlear implants compared to normally hearing children, and to identify individual variables that were associated with differences in the level of anxiety.

Low Empathy in Deaf and Hard of Hearing (Pre)Adolescents Compared to Normal Hearing Controls

Objective The purpose of this study was to examine the level of empathy in deaf and hard of hearing (pre)adolescents compared to normal hearing controls and to define the influence of language and various hearing loss characteristics on the development of empathy. Methods The study group (mean age 11.9 years) consisted of 122 deaf and hard of hearing children (52 children with cochlear implants and 70 children with conventional hearing aids) and 162 normal hearing children. The two groups were compared using self-reports, a parent-report and observation tasks to rate the children’s level of empathy, their attendance to others’ emotions, emotion recognition, and supportive behavior. Results Deaf and hard of hearing children reported lower levels of cognitive empathy and prosocial motivation than normal hearing children, regardless of their type of hearing device. The level of emotion recognition was equal in both groups. During observations, deaf and hard of hearing children showed more attention to the emotion evoking events but less supportive behavior compared to their normal hearing peers. Deaf and hard of hearing children attending mainstream education or using oral language show higher levels of cognitive empathy and prosocial motivation than deaf and hard of hearing children who use sign (supported) language or attend special education. However, they are still outperformed by normal hearing children. Conclusions Deaf and hard of hearing children, especially those in special education, show lower levels of empathy than normal hearing children, which can have consequences for initiating and maintaining relationships.

Self-esteem in hearing-impaired children: the influence of communication, education, and audiological characteristics.

Objective Sufficient self-esteem is extremely important for psychosocial functioning. It is hypothesized that hearing-impaired (HI) children have lower levels of self-esteem, because, among other things, they frequently experience lower language and communication skills. Therefore, the aim of this study was to compare HI childrens self-esteem across different domains with those of normal hearing (NH) children and to investigate the influence of communication, type of education, and audiological characteristics. Methods This large (N = 252) retrospective, multicenter study consisted of two age- and gender-matched groups: 123 HI children and 129 NH controls (mean age  = 11.8 years). Self-reports were used to measure self-esteem across four domains: perceived social acceptance by peers, perceived parental attention, perceived physical appearance, and global self-esteem. Results HI children experienced lower levels of self-esteem regarding peers and parents than NH controls. Particularly HI children who attended special education for the deaf were at risk, even after correcting for their language development and intelligence. Yet, levels of global self-esteem and self-esteem involving physical appearance in HI children equalled those of NH controls. Furthermore, younger age at implantation and longer duration of having cochlear implants (CIs) were related to higher levels of self-esteem. Conclusion HI children experience lower levels of self-esteem in the social domains. Yet, due to the heterogeneity of the HI population, there is high variability in levels of self-esteem. Discussion Clinicians must always be aware of the risk and protective factors related to self-esteem in order to help individual patients reach their full potential.

Better speech perception in noise with an assistive multimicrophone array for hearing AIDS.

Objective: To evaluate the improvement in speech intelligibility in noise obtained with an assistive real-time fixed endfire array of bidirectional microphones in comparison with an omnidirectional hearing aid microphone in a realistic environment. Design: The microphone array was evaluated physically in anechoic and reverberant conditions. Perceptual tests of speech intelligibility in noise were carried out in a reverberant room, with two types of noise and six different noise scenarios with single and multiple noise sources. Ten normal-hearing subjects and 10 hearing aid users participated. The speech reception threshold for sentences was measured in each test setting for the omnidirectional microphone of the hearing aid and for the hearing aid in combination with the array with one and three active microphones. In addition, the extra improvement of five active array microphones, relative to three, was determined in another group of 10 normal-hearing listeners. Results: Improvements in speech intelligibility in noise obtained with the array relative to an omnidirectional microphone depend on noise scenario and subject group. Improvements up to 12 dB for normal-hearing and 9 dB for hearing-impaired listeners were obtained with three active array microphones relative to an omnidirectional microphone for one noise source at 90°. For three uncorrelated noise sources at 90°, 180°, and 270°, improvements of approximately 9 dB and 6 dB were obtained for normal-hearing and hearing-impaired listeners, respectively. Even with a single noise source at 45°, benefits of 4 dB were achieved in both subject groups. Five active microphones in the array can provide an additional improvement at 45° of approximately 1 dB, relative to the three-microphone configuration for normal-hearing listeners. Conclusions: These improvements in signal-to-noise ratio can be of great benefit for hearing aid users, who have difficulties with speech understanding in noisy environments.

Evaluation of the benefit for cochlear implantees of two assistive directional microphone systems in an artificial diffuse noise situation.

Objective: People with cochlear implants have severe problems with speech understanding in noisy surroundings. This study evaluates and quantifies the effect of two assistive directional microphone systems compared to the standard headpiece microphone on speech perception in quiet surroundings and in background noise, in a laboratory setting developed to reflect a situation whereby the listener is disturbed by a noise with a mainly diffuse character due to many sources in a reverberant room. Design: Thirteen postlingually deafened patients, implanted in the Leiden University Medical Centre with the Clarion CII device, participated in the study. An experimental set-up with 8 uncorrelated steady-state noise sources was used to test speech perception on monosyllabic words. Each subject was tested with a standard headpiece microphone, and the two assistive directional microphones, TX3 Handymic by Phonak and the Linkit array microphone by Etymotic Research. Testing was done in quiet at a level of 65 dB SPL and with decreasing signal-to-noise ratios (SNR) down to –15 dB. Results: Using the assistive directional microphones, speech recognition in background noise improved substantially and was not affected in quiet. At an SNR of 0 dB, the average CVC scores improved from 45% for the headpiece microphone to 67% and 62% for the TX3 Handymic and the Linkit respectively. Compared to the headpiece, the Speech Reception Threshold (SRT) improved by 8.2 dB SNR and 5.9 dB SNR for the TX3 Handymic and the Linkit respectively. The gain in SRT for TX3 Handymic and Linkit was neither correlated to the SRT score with headpiece nor the duration of CI-use. Conclusion: The speech recognition test in background noise showed a clear benefit from the assistive directional microphones for cochlear implantees compared to the standard microphone. In a noisy environment, the significant benefit from these assistive device microphones may allow understanding of speech with greater ease.

Early identification: Language skills and social functioning in deaf and hard of hearing preschool children.

OBJECTIVE Permanent childhood hearing impairment often results in speech and language problems that are already apparent in early childhood. Past studies show a clear link between language skills and the childs social-emotional functioning. The aim of this study was to examine the level of language and communication skills after the introduction of early identification services and their relation with social functioning and behavioral problems in deaf and hard of hearing children. STUDY DESIGN Nationwide cross-sectional observation of a cohort of 85 early identified deaf and hard of hearing preschool children (aged 30-66 months). METHODS Parents reported on their childs communicative abilities (MacArthur-Bates Communicative Development Inventory III), social functioning and appearance of behavioral problems (Strengths and Difficulties Questionnaire). Receptive and expressive language skills were measured using the Reynell Developmental Language Scale and the Schlichting Expressive Language Test, derived from the childs medical records. RESULTS Language and communicative abilities of early identified deaf and hard of hearing children are not on a par with hearing peers. Compared to normative scores from hearing children, parents of deaf and hard of hearing children reported lower social functioning and more behavioral problems. Higher communicative abilities were related to better social functioning and less behavioral problems. No relation was found between the degree of hearing loss, age at amplification, uni- or bilateral amplification, mode of communication and social functioning and behavioral problems. CONCLUSION These results suggest that improving the communicative abilities of deaf and hard of hearing children could improve their social-emotional functioning.

Symptoms of Psychopathology in Hearing-Impaired Children

Objectives: Children with hearing loss are at risk of developing psychopathology, which has detrimental consequences for academic and psychosocial functioning later in life. Yet, the causes of the extensive variability in outcomes are not fully understood. Therefore, the authors wanted to objectify symptoms of psychopathology in children with cochlear implants or hearing aids, and in normally hearing peers, and to identify various risk and protective factors. Design: The large sample (mean age = 11.8 years) included three subgroups with comparable age, gender, socioeconomic status, and nonverbal intelligence: 57 with cochlear implants, 75 with conventional hearing aids, and 129 children who were normally hearing. Psychopathology was assessed by means of self- and parent-report measures. Results: Children with cochlear implants showed similar levels of symptoms of psychopathology when compared with their normally hearing peers, but children with hearing aids had significantly higher levels of psychopathological symptoms, while their hearing losses were approximately 43 dB lower than those of children with implants. Type of device was related with internalizing symptoms but not with externalizing symptoms. Furthermore, lower age and sufficient language and communication skills predicted less psychopathological symptoms. Conclusions: Children who are deaf or profoundly hearing impaired and have cochlear implants have lower levels of psychopathological symptoms than children with moderate or severe hearing loss who have hearing aids. Most likely, it is not the type of hearing device but rather the intensity of the rehabilitation program that can account for this difference. This outcome has major consequences for the next generation of children with hearing loss because children with profound hearing impairment still have the potential to have levels of psychopathology that are comparable to children who are normally hearing.

Missing Data in the Field of Otorhinolaryngology and Head & Neck Surgery: Need for Improvement.

Objective: Clinical studies are often facing missing data. Data can be missing for various reasons, for example, patients moved, certain measurements are only administered in high-risk groups, and patients are unable to attend clinic because of their health status. There are various ways to handle these missing data (e.g., complete cases analyses, mean substitution). Each of these techniques potentially influences both the analyses and the results of a study. The first aim of this structured review was to analyze how often researchers in the field of otorhinolaryngology/head & neck surgery report missing data. The second aim was to systematically describe how researchers handle missing data in their analyses. The third aim was to provide a solution on how to deal with missing data by means of the multiple imputation technique. With this review, we aim to contribute to a higher quality of reporting in otorhinolaryngology research. Design: Clinical studies among the 398 most recently published research articles in three major journals in the field of otorhinolaryngology/head & neck surgery were analyzed based on how researchers reported and handled missing data. Results: Of the 316 clinical studies, 85 studies reported some form of missing data. Of those 85, only a small number (12 studies, 3.8%) actively handled the missingness in their data. The majority of researchers exclude incomplete cases, which results in biased outcomes and a drop in statistical power. Conclusions: Within otorhinolaryngology research, missing data are largely ignored and underreported, and consequently, handled inadequately. This has major impact on the results and conclusions drawn from this research. Based on the outcomes of this review, we provide solutions on how to deal with missing data. To illustrate, we clarify the use of multiple imputation techniques, which recently became widely available in standard statistical programs.