Abstract 3 - 9/22/2009

Abstract written by Salima Barrister

Reference:
- Name: francis H, Buchman C, Visaya J, Niparko J
- Name of Article: Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes
- Journal Title: The Journal of Deaf Studies and Deaf Education

Purpose of Study:
To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first years of cochlear implantation.

Subjects:
188 cochlear implant candidates aged 5 or yo9jnger at the time of enrollment were recruited.

Method:
Auditory behavior and language comprehension were assessed within a month before cochlear implantation and at 6 month intervals after CI activation. Auditory behavior was measured by family report using the Infant Toddle Meaningful Auditory Integration Scale, administered for participants aged 1–3 and 4 years of age and older.

Results:
Most children had minimal or no experience with hearing loss or verbal language before cochlear implantation as demonstrated by low IT MAIS and Reynell scores. The cause of herain gloss was unknown 57% of children, whereas 28% were due to genetic cause, and 4% were due to meningitis. Hearing loss was reported to be congenital in 60% of subjects and progressive or sudden 40%.

Discussion:
A satisfactory surgical outcome with cochlear implantation entails atrumatic placement of a functional device and array of electrodes that provides a robust and stable neural interface. This report models the effect of satisfactory surgical implantations a necessary prerequisite for maximal auditory benefit from cochlear implantation.

Opinion:
This information shows the importance of early intervention with hearing aids because longer periods without hearing aids were associated with smaller gains in auditory behavior.

Abstract written by Mallory Boteler

Reference
Emmorey, K., Thompson, R., & Colvin, R. “Eye Gaze During Comprehension of American Sign Language by Native and Beginning Signers.”Journal of Deaf Studies and Deaf Education, Vol. 18, June 2009, pg. 14-23. Accessed on Monday, September 21, 2009 from http://jdsde.oxfordjournals.org/cgi/content/full/14/2/237

Purpose of Study
The purpose of the study was to determine whether eye gaze behavior during sign language comprehension is affected by information content, which has been found for eye movements during reading and in “the visual word” experiments. The study examined where native and beginning signers look while comprehending an ASL narrative and spatial description, examining the location of fixation on the face, the frequency of gaze shifts away from the face, and the content of signing when gaze shifted away from the face.

Subjects
9 deaf native ASL signers participated in the study and 10 hearing beginning signers participated. The beginning signers had completed between 9 and 15 months of ASL instruction at the time of testing. 9 of the beginning signers and 7 of the native signers were given a general test of ASL comprehension.

Method
The participants wore a head-mounted eye tracker while they watched one of five native signers producing two narratives (Town description & Paint Story narrative). Their eye movements were monitored using the iView system from SensoMotoric Instruments. The instrument measures gaze position using real-time imaging processing. The percentage of time that they fixated on or near the face of the signer was calculated. This included the upper face, the eyes, the mouth, and the lower face.


Results
Results show that deaf signers primarily looked at the signer’s face. The beginning and native signers did not differ from each other with respect to the amount of time that gaze remained on the face, 87.9% and 88.8%. Both signers spent more time looking off the face during the Town description than during the Paint Story narrative. Both participant groups focused more often on or near the eyes and mouth than above the forehead and below the face.

Discussion
This article demonstrates the overall difference and similarities between the deaf and hearing and beginning and native signers. It shows what the deaf signers primarily focus on during sign, and native and beginning signers also kept their gaze around the face.

Opinion
In my opinion, this study gave me an insight to adults that sign and their eye gaze, but they could have done the study on children that sign, including beginning and native signers.

Abstract written by Jason Chapman

Reference
Hicks, C., Tharpe, A., “Listening Effort and Fatigue in School-Aged Children With and Without Hearing Loss”. Journal of Speech, Language, and Hearing Research, 45, June, 2002, 573-584. Accessed on Monday, September, 21, 2009.

Purpose of Study
The purpose of the study was to examine the effort required and subsequent fatigue for children with hearing loss in adverse acoustic conditions as compared to their peers with normal hearing.

Subjects
Experiment 1: Fatigue
The subjects consisted of 10 children with hearing loss between the ages of 5 and 11 years old with mild to moderate or high-frequency sensorineural hearing loss and 10 children with normal hearing bilaterally between the ages of 5 and 11 years old.
Experiment 2: Effort
The subjects consisted of 14 children with hearing loss between the ages of 6 and 11 years old with mild to moderate or high-frequency sensorineural hearing loss and 14 children with normal hearing bilaterally between the ages of 5 and 11 years old.



Method

Experiment 1: Fatigue
Cortisol levels were determined by taking saliva samples. The samples were taken twice a day on two days. The 2nd day was scheduled within 2 weeks of the first sample. One was taken at the beginning of the school days and the other was taken at the end of the school day. All samples were taken at least one hour after the child ate breakfast or lunch. The samples were not taken when the child or teacher reported excitement or stress. The child deposited 1 ml of saliva into a test tube. The samples were then compared to a standard sample. After the second sample on the first day, the child completed the Dartmouth Primary Care Cooperative Information Project Scales. The scoring was on a scale from 1 to 5.

Experiment 2: Effort
A primary and secondary task was performed simultaneously under a dual-task paradigm. The primary task consisted of speech-recognition testing with varying level of background noise. The secondary task consisted of pushing a button in response to random presentations of a probe. Each child was test individually. They sat in front of a table and placed their hands in designated areas. Secondary-task baselines were taken. Then a baseline was taken for the primary-task. Four 25-word lists were used for the experimental sessions. A light was prevented randomly during 25% of the probe words, 25% of the time intervals between the probe word and the next carrier phrase, and 25% of the carrier phrases. For 25% of the word lists, no light was presented. An incentive of tickets was introduced to ensure performance.

Results
Experiment 1: Fatigue
There was no significant difference between the levels of cortisol in children with hearing loss or children with normal hearing. There was also no significant difference between self-rated measures of fatigue in children with hearing loss or children with normal hearing.

Experiment 2: Effort
It showed that children with hearing loss expend more effort in listening than children with normal hearing. This was demonstrated by longer reaction times on the secondary tasks.

Discussion
Experiment 1: Fatigue
It could be that the children with hearing loss may be slightly more stressed but not fatigued. The anecdotal reports of fatigue in hearing impaired children may be due to inattention or boredom. Also, the measure of using cortisol may not be the right measure to assess fatigue. The small sample size may have affected the results of the COOP because previous studies have shown children who have a hearing impairment report lower self-esteem and having less energy.

Experiment 2: Effort
One explanation for the results on the 2nd experiment could be that children with hearing loss have poorer language skills which require more effort. Another explanation is that children that are hearing impaired require a greater output in effort due to the fact that noise has a greater effect on speech perception.


Opinion

I thought it was an interesting study but I don’t know if their choice of measures to assess fatigue were adequate. I would like to see another study with a different measure.

Abstract written by Ashley Cummings

Reference
Phillips, Lucy, Saeid Hassanzadeh, Julie Kosaner, Jane Martin, Martina Deibl, and Ilona Anderson. "Comparing auditory perception and speech production outcomes: Non-language specific assessment of auditory perception and speech production in children with cochlear implants." Cochlear Implants International: An Interdisciplinary Journal 10, no. 2: 92-102. Accessed on Sunday, 20, 2009 https://libproxy.library.unt.edu:9443/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=40121402&site=ehost-live&scope=site

Purpose of Study
This study aimed to assess the development of auditory perception and speech production skills in children who received a cochlear implant. The children were taken from three different language groups (English, Turkish and Farsi) and countries and were followed for a period of five years.

Subjects
This study was conducted in three countries, with two clinics located in the United Kingdom, one clinic in Iran and one clinic in Turkey. One hundred and seventeen children who received a MED-EL cochlear implant (either the COMBI 40 or COMBI 40+, using the TEMPO+ speech processor) participated in the study. Forty-one children were included in the United Kingdom, 54 in Iran and 22 in Turkey. Six of the children speak more than one language and two have additional needs. The average age at cochlear implantation was 5.4 years (range: 1.8 to 17.8). One hundred and eight children were congenitally deaf; only nine children had acquired hearing loss.

Method
The CAP quantifies the auditory receptive abilities of linguistically compromised profoundly deaf children in a clinical setting. The CAP is an eight-point rating scale ranging from ‘displays no awareness of environmental sounds’ to ‘can use a telephone with a familiar talker’. The SIR is a scale that quantifies the speech production abilities of linguistically compromised profoundly deaf children in a clinical setting. The SIR is a five-point rating scale ranging from ‘pre recognizable words in spoken language. The child’s primary mode of everyday communication may be manual’ to ‘connected speech is intelligible to all listeners. The child is understood easily in everyday contexts.’ The children were assessed pre-operatively and then at first fitting, three, six and12 months after first fitting then annually up to five years on the two rating scales. The child’s clinician noted where the child was performing on the rating scale, according to predefined guidelines, as suggested by the authors of the rating scales.

Results
There is a significant improvement over time for the Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) measures. There was a significant difference between scores for different language groups: accounted for by the differences in age at implantation. There was a significant effect of age at implantation up to three years of device use. There were high correlations between the CAP and SIR scores. A longer duration of deafness resulted in a higher score for both scales; however, there was no relationship when correlated for age. Finally, the CAP pre-operative score allowed the prediction of the post-operative SIR scores. The scales are validated; reliable measures which can be used across countries and languages. This allows greater ability to pool data allowing data to be generalized across population groups, providing more power to prove that cochlear implantation is a viable treatment for children with bilateral severe to profound hearing loss.

Discussion
Children who receive a cochlear implant show significant improvement in auditory perception and speech intelligibility skills over time. Age at implantation has a significant benefit, particularly for speech intelligibility. The study can be used to show evidence for implant children as earliest as possible to increase the likelihood that the children will have the best possible auditory perception and speech intelligibility skills.

Opinion
I think that the study was very well documented and the evidence can be used to generalize to other peer groups that are served in the United States. The article was well detailed when talking about limitations and oversights that may have had an effect on the studies outcome.

Abstract written by Laure Eysermans

Reference

Nicholas, Johanna. “Expected Test Scores for Preschoolers With a Cochlear Implant Who Use Spoken Language”. American Journal of Speech-Language Pathology, 17, May, 2008, 121-138. Accessed on Sunday, September 20, 2009:
http://ajslp.asha.org/cgi/content/full/17/2/121

Purpose of Study

The purpose of this study was to (1.) gain information regarding the expected range of spoken language skills in pre-school children who are deaf and have cochlear implants, (2.) create a criterion reference according to age at implantation, (3.) investigate whether parent-checklists parallel child scores on standardized tests, (4.) and look for a correlation between age of implantation, duration of use, and standardized test scores.

Subjects

Participants in this study included 76 children from across the nation. All participants were severely or profoundly congenitally deaf, had cochlear implants, were implanted before 3;2, and had received an English oral education. They also scored within or above the expected range on tests of non-verbal intelligence. Of the 38 girls and 38 boys who participated, 47 used a Nucleus 24, 28 had a Clarion 1.2, and 1 child had a Med-El implant.

Method

Parent checklists from the MacArthur-Bates Communicative Development Inventory (CDI) were administered when children were age 3;5 and again at 4;5 (give or take two months). The CDI looked at vocabulary, irregular words, sentence complexity, and the child’s three longest sentences. At around age 4;5, the Auditory Comprehension and Expressive Communication subtests of the PLS-3 were administered orally and without deviation from the standardized protocol, as was the PPVT-III.

Results

Results from the CDI (parent checklist) and scores on the standardized PPVT-III and PLS-3 were moderately to highly correlated. Also, scores across language categories inventoried in the CDI were also highly correlated. All test scores showed a significant linear decrease in language scores with as the age at implantation increased with the exception of the Expressive Communication subtest of the PLS-3 and the Irregular Words and Sentence Complexity categories of the CDI. In these cases, the correlation was linear before leveling off in children with older ages at implantation. Finally, benchmark ranges for expected language scores were established for the purposes of helping clinicians gauge child progress in therapy. These benchmarks are appended at the end of the study.

Discussion

This study proved useful on several counts. First, the correlation between language scores and age of implantation is useful to consider when counseling parents regarding language outcomes in children with cochlear implants. Second, the parallel between parent inventory and standardized language measures means clinicians can use parent inventories as part of the assessment or between assessments to help gauge child progress. Finally, perhaps the most useful component of the study, the benchmark ranges of expected language development in children with cochlear implants provide a criterion reference, which may aid early identification of compounding learning disabilities in children with implants.

Opinion

I was very impressed with the care with which this study was conducted and reported. I also appreciated how the data collected was used to answer a variety of important questions. This study not only produced useful information regarding the difficulty of applying standardized testing to children with implants, but it also provided a useful criterion-reference tool. This is invaluable in the field of speech-pathology, since it requires precious time for an SLP to read a study and design therapy techniques that apply similar results. This study bridges the gap and provides a tool available for immediate use.

On the other hand, it is important to note that the expected ranges given are only criterion-referenced measures and not norm-referenced. Ranges provided in this study do not diagnose, but they do provide useful guidelines. SLPs are still responsible for exercising independent clinical judgment on an individual basis when working with children with cochlear implants.

Abstract written by Rachel Foster

Abstract written by Anna Loza

Reference
Yucel, Esra., Derim, Deray., and Celik, Demet. “The needs of hearing impaired children's parents who attend to auditory verbal therapy-counseling program”. International Journal of Pediatric Otorhinolaryngology, 72, 7, 2008, 1097-1111. Accessed on Sunday, September 20, 2009 from http://dq4wu5nl3d.search.serialssolutions.com


Purpose of Study

The purpose of the study was to examine the necessary information and support needs of parents of children with hearing impairment in the habilitation process, namely, auditory –verbal therapy. Factors were examined such as duration of hearing aid use, duration of intervention, and the number of hearing impaired family members. Parental needs such as general information, hearing loss, communication—services and educational resources, family and social support, childcare and community services were also evaluated.

Subjects
Sixty-five parents, ranging from low to middle SES were randomly selected among those who joined in the parent–child counseling run by the Hacettepe University Auditory–Verbal Therapy and Counseling Program in Turkey. Their children ranged in age from 24 to 348 months of age (median 80 mos); all of whom were born deaf or were deafened by the age of two years. The duration of hearing aid use ranged from 8 to 252 mos (median 24 mos), and the duration of intervention ranged from 2-176 mos (median 36 mos).

Method

Examiners assessed participants using The Family Needs Survey (adapted version for hearing impaired families of children who are deaf or hard of hearing). The survey, which lists some needs commonly expressed by families, helps to identify services which might be helpful. It evaluates the domains of general information, information about hearing and hearing loss, communication, services and educational resources, family and social support, child care-community services and financial issues. They were instructed to check the topics for which they would like more information or to discuss with a member of staff from the program. There were four choices (no, not sure, yes-discuss, yes-info) from which they were expected to choose the most appropriate answer in each statement. Family dynamics such as type and amount of parental needs, number of siblings, and presence of hearing impaired family members was also asked of the participants.



Results

Questions for each of the six domains of the Family Needs surveyed were analyzed separately. Findings revealed a significant correlation between the duration of intervention with the amount of information needs related with other conditions their children may have, explaining their children's hearing problem to others, locating good baby-sitters and day-care programs for their children and transportation (p ≤ 0.05). Overall, 66% of parents felt as though they were weak in these areas and requested more information. However, those who requested more information had participated in the intervention for much longer than those who answered ‘not sure’ or ‘yes discuss’. The parents who had been involved in their child’s intervention and counseling for a longer period of time were interested in and conscious of the other condition possibilities that may help their children's progress. They were also more acceptant of the child’s hearing loss and were willing to discuss how to explain their child’s hearing loss to others, babysitters, and day care programs. Adversely, those who had been in therapy for a shorter duration were not yet open to more information in these areas. Additionally, long-term intervention was found to add additional psychotherapeutic, social and financial needs for the parents. The correlation found between hearing impaired individuals existence with the type and amount of family needs was found to be insignificant.
Furthermore, it was found that 78% of the parents felt inadequate in helping the family accept the hearing loss, presenting a need for active information for both creating an alternative educational-care and psychosocial support.


Discussion

The findings, supporting the positive effects of long-term Auditory-Verbal Therapy and Counseling, indicate that parents are crucial members in intervention. Not only are they necessary to ensure success in the therapy room, but the more they come to fully accept the child’s hearing loss, they are more likely to seek information to advocate for their child. They are willing to discuss all avenues and possibilities. For this reason, it is important that the caretakers are inalienable members of the intervention process. However, it is also important not to bombard parents with too much information at once, as this study shows how much information the parents still need, most likely having been presented with it at some point in the intervention process.

Opinion

I felt this was a good study in terms of quantifying the emotional aspect of having a child with hearing loss. It demonstrated how important family members are in facilitating success and how greater involvement in intervention allows parents to be open to new information for their child.

Abstract written by Lauren Pfieffer

Reference

Flipson Jr., P, Parker, R. “Phonological patterns in the conversational speech of children with cochlear implants”. Journal of Communication Disorders, 41, 2008, 337-357. Accessed on Monday, September 21, 2009. http://libproxy.library.unt.edu:2656/science?_ob=MImg&_imagekey=B6T85-4RSYC9H-1-5&_cdi=5077&_user=452995&_orig=search&_coverDate=08%2F31%2F2008&_sk=999589995&view=c&wchp=dGLbVzz-zSkWz&md5=08ae84a2d4b5119015f32d39c56b835f&ie=/sdarticle.pdf

Purpose of Study

This was a descriptive, longitudinal study that observed the developmental and non-developmental patterns of children with cochlear implants. The goal of this particular article was to increase the reader’s knowledge of developmental and non-developmental phonological patterns, identify the patterns that can be seen in the speech of children fitted with cochlear implants, and to understand the direction of occurrence over time with this population.

Subjects

The conversational speech of six young children (five girls and one boy) with cochlear implants was analyzed for the different types of phonological patterns. They were tested every three months, for up to 21 months. Developmental and non-developmental patterns were examined in terms of overall frequency along with any changes in chronological age, hearing age, or post implantation age.

Method

Forty conversational speech samples were obtained by graduate student clinicians. The speech samples were recorded in a sound-treated booth. The first author kept a running tally of intelligible words, while sitting outside the booth. The goal was to obtain a minimum of 90 intelligible words. Only one of the recorded sessions failed to reach 90. Overall intelligibility of the recorded speech samples ranged from 65-96%. The speech samples were analyzed using the Natural Process Analysis approach.

Results

The most common developmental pattern was stopping-initial with an average frequency of 36.8%. The most commonly occurring non-developmental pattern was vowel substitution with an average frequency of 2.4%. Relative to chronological age, almost 1/3 (12.5/40 or 31%) of the samples included pattern occurrence frequencies that were below the normal range. This value decreased to 26% relative to hearing age and 18% relative to post implantation age.

Discussion

The current study found that, similar to children with normal hearing and children with hearing loss who wear hearing aids, both developmental and non-developmental phonological patterns occur in the speech of children with cochlear implants. Developmental patterns tended to occur with greater frequency than non-developmental patterns. Up to one-third of samples included patterns that were behind developmental expectations. Finally, pattern occurrence decreased over time with trends across the individual participants mirroring that of the group as a whole

Opinion

I feel as if the information in this study has little applicable information. It is good information to know, but honestly I wonder what they were expecting to find. I guess if there was something that differentiated this population for normal hearing children or from children with hearing aids, then I think it would be very valuable information.

Abstract written by Reshma Rao

Keats, Bronya. “Genes and Syndromic Hearing Loss”. Journal of Communication Disorders. July-August 2002 35(4): 355-366. Accessed on Monday, September 22, 2009
http://libproxy.library.unt.edu:2656/science?_ob=ArticleURL&_udi=B6T85-45YJ9K8-2&_user=452995&_coverDate=08%2F31%2F2002&_alid=1019186495&_rdoc=33&_fmt=high&_orig=search&_cdi=5077&_sort=r&_docanchor=&view=c&_ct=33&_acct=C000007818&_version=1&_urlVersion=0&_userid=452995&md5=2cb8009b5a2a133c95f63cc218a95e4d

Purpose of Study
1) To describe the human genome and patterns of inheritance. 2) To discuss the genes that are associated with some of the syndromes for which hearing loss is a common finding.


Human Genome and Patterns of Inheritance
The human genome consists of 24 different types of chromosomes, each of which consist of one molecule of DNA. Humans inherit pairs of chromosome and thus pairs of genes. When both the genes of the pair are mutated, then the protein that the gene encodes is not produced in its normal form. When this happens, the individual may have an abnormal prototype, such as hearing loss. The pattern of inheritance is probably autosomal dominant if some of the individuals in each generation are hearing impaired, and both males and females are affected. The affected individuals usually have one normal (N) and one abnormal (D) copy of the gene for the hearing loss. Thus, each offspring of an affected individual has a 50% chance of inheriting the abnormal copy. Examples of dominantly inherited syndromes are Waardenburg and STL. The mode of inheritance is autosomal recessive if the hearing loss is found only in individuals who have two copies of the abnormal gene (genotype DD). If both parents are carriers of the same D copy (that is, both have the genotype ND), their child may inherit two copies of the D allele, one from each parent. In this situation the child is hearing impaired, but neither of the parents are affected. Examples of recessively inherited syndromes are Jervell and Lange-Nielsen, and USH.

STL Syndrome
Characteristic features of STL syndrome include a flat midface, cleft palate, severe myopia with retinal detachment and cataracts, hearing loss, joint hypermobility, mild spondyloepiphyseal dysplasia, and mitral valve prolapse. Progressive sensorineural high frequency hearing loss is found in about 80% of cases, and conductive hearing loss has been reported in some patients. The phenotypic expression of this autosomal dominant syndrome is highly variable both within and between families, but penetrance is close to complete. Mutation is found in gene COL2A1 on chromosome 12.

Wardenburg Syndrome
The most common features of Waardenburg syndrome type I (WS1) are widely spaced medial canthi (dystopia canthorum), synophrys (joined eyebrows), and a broad nasal root. Heterochromia irides and a white forelock are seen in about 30% of patients. Two clinical types have been described; the major phenotypic characteristic differentiating WS2 from WS1 is the lack of dystopia canthorum in WS2. The frequency of sensorineural hearing impairment is about 20% in WS1 and 50% in WS2. The degree of impairment varies from minimal to severe and may be unilateral or bilateral. Gorlin et al., 1995. Gorlin, R. J., Toriello, H. V., & Cohen, M. M. (1995). Hereditary hearing loss and its syndromes. Oxford: Oxford University Press.Klein–Waardenburg syndrome (type III) is the combination of the clinical findings of WS1 together with upper limb abnormalities while Waardenburg–Shah syndrome (type IV) is WS2 with Hirschsprung disease. Waardenburg syndrome is usually autosomal dominant and most individuals with a defective gene show some signs of the disease. Mutations of chromosome 2 and 3 were noted.

Jervell and Lange-Nielsen syndrome (JLNS)
Congenital profound sensorineural hearing loss and an electrocardiogram that has a prolonged Q–T interval characterize this syndrome. Fainting spells of variable frequency and severity begin by the age of 3 years, and, if untreated, cardiac arrhythmia leads to sudden death by the age of 15 years in more than 70% of patients. The percentage of profoundly hearing impaired individuals with JLNS may be as high as 1%. Thus, an electrocardiogram is warranted in all congenitally deaf children to rule out this syndrome. Mutations in the KVLQT1 gene on chromosome 11 cause the recessive JLNS and mutations in KCNE1 on chromosome 21 have been shown.

Alport Syndrome
The bilateral sensorineural hearing loss in Alport syndrome is progressive and is associated with nephritis. Patients show ultrastructural abnormalities in basic membranes due to defective type IV collagen, encoded by the COL4A5 gene. Males who have the abnormal gene on their X chromosome are affected. The mode of inheritance is X-linked dominant meaning that females with one abnormal and one normal copy of the gene have symptoms of the disease, but they are generally less severely affected and have later ages of onset than males. Hearing loss generally begins in the first or second decades and is found in 55% of males and 40% of females.

USH Syndrome
The USH syndromes are a group of clinically and genetically heterogeneous autosomal recessive disorders. They are characterized by congenital sensorineural hearing loss and pigmentary retinopathy, which usually manifests in late childhood or adolescence and may lead to total blindness. USH accounts for 3–6% of congenital deafness. Three clinical types of USH (USH1–3) have been defined. USH1 is characterized by severe to profound hearing loss across all frequencies. Hearing aids are not helpful for USH1 patients, but cochlear implants for these patients are often successful. Complete loss of vestibular function distinguishes USH1 from the other clinical forms of the disease.

Mitochondrial Inheritance
The typical symptoms found in mitochondrial disorders are muscle weakness, nervous system disorders, visual problems, hearing loss, and dementia.

Discussion/Opinion
It is important to know the molecular and genetic basis of hearing loss as these findings can be used to develop more treatment options, such as gene or molecular therapy. It is also important to know the signs/symptoms of a syndrome to get a better picture of the child/patient’s extent of disability and to design treatment/intervention approaches.

Abstract written by Clary Rondan

Reference
Antia, Shirin D.; Jones, Patricia B.; Reed, Susanne; & Kreimeyer, Kathryn H. “Academic Status and Progress of Deaf and Hard-of-Hearing Students in General Education Classrooms”. Journal of Deaf Studies and Deaf Education, 14, Summer, 2009, 293-311. Accessed on Monday, September 21, 2009 http://jdsde.oxfordjournals.org/cgi/reprint/14/3/293.

Purpose of study
The purpose of this longitudinal study was to report on the academic progress of deaf and hard-of-hearing students who attend general education classrooms in public schools across a 5-year period. There has been an increase of children with hearing impairments attending general education classrooms, and little information on this subgroup has been compiled.

Subjects
The participants in this study included 197 deaf or hard-of-hearing students from Colorado and Arizona with mild to profound hearing loss who did not have additional severe cognitive disabilities. They attended general education classes for a minimum of 2 hours per day, and they received direct or consultative services from teachers of deaf and hard-of-hearing or had an individual education plan (IEP).

Method
Researchers obtained data about the students by using teacher’s ratings of students’ communication, students’ self-ratings of classroom participation, and preferred communication mode. Normative academic status was measured using standardized achievement tests normally administered as part of the state of Arizona’s accountability system. All the data and scores were compiled and compared.

Results
The results from this study demonstrated that 63-79% of students scored in the average or above-average range in math, 48%-68% in reading, and 55%-76% in language/writing in standardized achievement tests over a 5-year period. They are half an SD behind norms on standardized tests, but still within normal limits.

Discussion
The majority of the students achieved within the normal range of hearing students on standardized tests of math, reading, and language/writing. Most of the students were perceived by their teachers as performing comparably to hearing students in this academic setting. However, the deaf and hard-of-hearing students were, as a group, half an SD behind the norms in standardized tests and may not be closing the gap particularly in reading.

Opinion
The methodology of this study was appropriate and encompassed several aspects of the classroom environment such as testing in different subjects, teachers’ opinions, student opinions’, etc. The results and discussion were extensive and explained the researcher’s conclusions and theories well.

Abstract written by Laena Schuman


Reference
Samileh, Noorbakhs; Ahmad, Siadati; Mohammad, Farhadi; Framarz, Memari; Azardokht; Jomeht, Emam. “Role of cytomegalovirus in sensorineural hearing loss of children: A case-control study Tehran, Iran”. International Journal of Pediatric Otorhinolaryngology, 72, 2008, 203-208.

Purpose of study
To verify the role of cytomelagovirus in sensorineural hearing loss in children.

Subjects
The study group (cases) consisted of 95 children with SNHL and the control group consisted of 63 children with normal hearing and all children were less than 14 years of age (59-males, 35-females). 80% had profound hearing loss, 15% had moderate hearing loss, and 5% had mild hearing loss. All children with SNHL who had a known etiology were excluded from the study.

Method
A questionnaire was completed by a physician for each child (case and control group) followed by a complete clinical exam. Following was a comprehensive audiological evaluation (including pure tone audiometry, EOAE’s, ABR, and tympanometry) performed on all children. Blood samples of each child were taken for a serological test and were also screened for CMV-specific IgM and IgG antibodies.

Results
Serologic results in the cases group found acute infection in 33 children while the remainder had previous immunity. The serologic results in the control group found acute infection in 2 children, and 57 children had previous immunity. The amount of cases found with acute CMV infection was higher in the study/cases group and the amount of children with previous immunity was higher in the control group (normal hearing group). As a result, acute CMV is seen as a common cause of SNHL in children.

Discussion
When reading this article, I found it interesting that most children who are infected with congenital CMV show no signs/symptoms at birth. This information is valuable to us as speech-language therapists in knowing what to expect during the progression of therapy in children who have CMV. Progressive hearing loss is a major red flag in the audiological evaluation and diagnostic assessment in children.

Opinion
I chose to analyze this study because I am interested in learning about CMV and its effects on children’s hearing loss. The study was well written and simple to understand and also contained pertinent information regarding the subject of CMV and pediatric hearing loss.

Abstract written by Hayley Simpson

Reference
-Uchanski, R., Davidson, L., Quadrizuis, S., Reeder, R., Cadieux, J., Kettel, J., & Chole, R. “Two Ears and Two (or More?) Devices: A Pediatric Case Study of Bilateral Profound Hearing Loss”. Trends in Amplification, Vol. 13, No. 2, June, 2009, pgs. 107-123.
Accessed on Sunday, September 20, 2009 http:tia.sagepub.com/cgi/content/abstract/13/2/107.

Purpose of study
-The authors of this study sought to explore what the benefits are, if any, of using a hearing aid and cochlear implant in one ear with a hearing aid in the other; they wanted to see the benefits specifically in a child with high frequency hearing loss but preserved low frequency hearing.

Subjects
-This case study used one female participant with Turner’s syndrome. She was fitted bilaterally with BTE hearing aids at the age of three and attended an oral school for the deaf for 5 years. Her hearing deteriorated and she was implanted at age eight with a cochlear implant (Med-EL Pulsar) in her right ear and continued to use a BTE aid in her left ear.

Method
-An alternating ‘baseline’ and ‘treatment’ schedule was used. In the ‘baseline’ device condition, the subject wore her HA in the left ear and her CI in the right ear. In the ‘treatment’ condition, she wore her HA in her left ear and both the CI and HA in the right ear. Each phase lasted 2-3 weeks and a battery of speech perception tests were given at the end of each phase. The following test battery was used:
-Frequency modulated (FM) tones: ranging from 125 Hz to 6 kHz were used to attain aided and unaided thresholds during conditioned-play audiometry.
-Consonant-nucleus-consonant word test: fifty monosyllabic word lists were used to measure open-set word recognition, presented at 60 dB SPL in quiet and in noise (SNR +10 dB).
-Bamford-Kowal-Bench speech-in-noise test: sentences were presented at 65 dB SPL with the noise level increasing in 3 dB steps.
-Emotion perception: two types of emotion perception tasks were used: emotion identification and emotion discrimination.
-Talker discrimination: eight female and eight male recordings were used and the subject had to discriminate male vs. female, within-female and within male.
-Speaker localization: the subject was seated in a sound room with 15 speakers and she was asked to identify the position of the speaker.

Results
-Across the outcome measures, the results were very similar or somewhat improved when using a HA in the implanted ear and a HA in the opposite ear. She had slightly better performance under this treatment condition on the consonant-nucleus-consonant word test (in quiet), localization and the Bamford-Kowal-Bench speech-in-noise test; these improvements were not found to be clinically significant. The researchers also reported that the subject preferred wearing all three devices and now wears them daily. While there was not a clear result as to which combination of devices provided the best outcome for daily use (because the combinations of devices had varied improvement across different tasks) the researchers suggest using bilaterally hearing aids with a unilateral implant unless performance with the three indicates poorer performance.

Discussion
-I think that this information found in the study is important for doctors, audiologists, SLPs and parents. We need to be educated on the current research when counseling parents about the paths that are available in devices for hearing. If their child is not a candidate at the time for a cochlear implant and wears hearing aids but then later suffers a progressive hearing loss and can be implanted, would it be beneficial for the child to continue using bilateral hearing aids as well as a unilateral CI? More research in this area is warranted but is important for parents to consider not only for their child’s success but also financially.

Opinion
-Personally I thought that the study was well-executed and had many cross references for combinations of the devices being worn. I would like to see similar studies done that use a larger sample. Also, this study was looking at a child with preserved low frequency hearing. I’d be interested to see if similar results would be found in other types of hearing loss.

Abstract written by Blaire Staggs

Reference:

Antia, S.D., Jones, P.B., Reed, S., & Kreimeyer, K.H. “Academic status and progress of deaf and hard-of-hearing students in general education classrooms”. Journal of Deaf Studies and Deaf Education, 14(3), June, 2009, 293-311. Accessed on Monday, September 21, 2009 http://www.ncbi.nlm.nih.gov/pubmed/19502625?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Purpose of Study:

The purpose of this study was to determine the academic status of children who were deaf or hard of hearing and were enrolled in general education classrooms.

Subjects:

The subjects consisted of 197 deaf or hard-of-hearing students with mild to profound hearing loss who were enrolled in general education classes for at least 2 hours per day.

Method:

Scores were obtained from standardized tests in math, reading and language/writing as well as standardized teacher’s ratings regarding academic competence each year. These were collected every school year for five years and were coupled with other demographic and communication data.

Results:

Results of this study are illustrated in the following chart:


Standardized Scores (Students with Average or Above Average Progress)
Math
63%-79%
Reading
48-68%
Language/Writing
55-76%
The standardized test scores were half a Standard Deviation below that of the normal hearing group. However, the average progress of students in each subject area was consistent with or better than that of the normal hearing students. Teacher ratings showed that 89% of students made average or above average progress each year.

Discussion:

This study provides great insight into the capabilities of deaf/hard or hearing students when mainstreamed into general education classrooms. It shows that just because a child has a hearing deficit, they can still be successful under the right circumstances.

Opinion:

I would have preferred for the study to have included more information about the students, such as what kind of special accommodations the children might have had, how many were receiving services outside of the classrooms, how many had aided technology that would have contributed to their success.

Abstract written by Kayla Thumann

Reference:
Scharr, Efrat A., Roth, Froma P., Fox, Nathan A.“Quality of Life for Cochlear Implants: Perceived Benefits and Problems and Perception of Single Words and Emotional Sounds.” Journal of Speech, Language, and Hearing Research, Vol. 52, February, 2009, 141-152. Accessed on Friday, September 18, 2009 https://libproxy.library.unt.edu:9443/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ826741&site=ehost-live&scope=site
Purpose of study:
The purpose of the study was to examine the quality of life that children with cochlear implant reported compared to the children’s actual understanding of the emotional information around them that is conveyed by sound. The effects of age of amplification of hearing aids and cochlear implants were also looked at in reference to the child’s perceived quality of life because of their cochlear implant.
Subjects:
The study consisted of 37 children (16 boys; 21 girls), who ranged from 5-14 years and met the following criteria: a) were deaf from birth b) had no additional disability c) were English as their first language d) used English as their primary mode of communication e) had a normal to above-normal IQ f) had the cochlear implant for at least 1 year and g) had a minimum language proficiency of at least 5 years. There was a wide range of age between the children of when they received their cochlear implant.
Method:
The children were given a quality of life questionnaire to fill out there were such questions as “The cochlear implant helps you understand what others are saying” as well as “You are embarrassed by how it looks”. There were combinations of benefit and problem statements depending on the age of the child. The children were then asked to rate these statements on a 5-point Likert scale. The parents of the children were also given a questionnaire to provide the child’s audiological, educational and family background. Along with these 2 questionnaires the children were administered an emotional identification test and 2 apeech perception tests, the Lexical Neighborhood Test (LNT) and the Multisyllabic Lexical Neighborhood Test (MLNT) were given to the children as well.
Results:
The children reported a high benefit rating from their cochlear implant. The statement that receives the highest score stated that “it helps you hear sounds in the environment” the lowest stated “getting less mad/frustrated or upset when others do not understand you.” The children reported a low severity of problems that may arise from use of the cochlear implant. The study found that there was no correlation to the child’s reported quality of life and the speech recognition abilities. However, this data did show a correlation of age of amplification and speech perception increased quality or life. There was a positive correlation between the ability to perceive emotion accurately and quality of life of the children. Another interesting finding was that age of implant did not seem to be a predictor of quality of life.
Discussion:
The study set out to determine the children’s perception of their quality of life and determine if that could be correlated to any specific skill. The results of the study do support that children with cochlear implants are happy and they feel that they have a high quality of life. This is important because there is “consumer satisfaction” with the cochlear implant and this is important for parents to know. The study does have some limitations; there was a small sample size. The study would have been more powerful had it been a longitudinal study. The researchers only have the child’s perception of their implant at one point in the child’s life.
Opinion:
I thought this study was interesting. I enjoyed that the study looked at the quality of life for these children. It was interesting to find out that a particular skill or factor does not have an overwhelming effort on quality of life for these children. But simply getting a cochlear implant can improve the quality of life for these children.

Abstracts week 2 - 9/14/2009

Abstract written by Salima Barrister

Reference:
Name: Derek Jason Stiles, Ruth A. Bentler, and Karla K. McGregor
Name of Article: “Effects of a directional mic on children’s word recognition and novel-word learning”
Journal Title: The Hearing Journal, Vol 61, No. 11, 2008, 22-25, accessed on line – Accessed on Monday, September 14, 2009, http://www.audiologyonline.com/theHearingJournal/pdfs/HJ2008_11_p22-25.pdf


Purpose of Study:
The purpose of this study was to determine if off-axis placed speech is negatively affected by fixed directional microphone hearing aids in two situations that children face daily—recognizing old words and learning new words.


Subjects:
Twenty-four children (7 females; 17 males) between the ages of 6 and 10 years were enrolled in this component of the study, with the consent of their parents/guardians. They were screened for normal hearing and normal vision.

Method:
A behind-the-ear hearing aid was programmed for a moderate, flat sensorineural hearing loss. Noise-reduction and feedback-management algorithms
were disengaged. Using a custom-built standard ear mold, the hearing aid was fitted to the right ear of a pediatric acoustic research manikin placed in the center of an anechoic space. A speaker was placed 1 meter from the manikin. The output from the hearing aid was recorded to both left and right tracks using Adobe Audition 1.0 software, once with the hearing aid in omni-directional mode and once with it in a fixed cardioid directional mode.
Lists from the Auditec of St. Louis recording of the Phonetically-Balanced Kindergarten (PB-K) test10 were recorded through the hearing aid in both omni-directional and fixed directional modes following the protocol described above. Each PB-K list consists of 50 monosyllabic words considered familiar to children 5 years and older.
Testing took place in a 6’ × 6’ double-walled soundtreated (IAC) audiometric booth. For three conditions, acoustic stimuli were presented via ER-3A insert earphones so that target words would be output at 60 dB SPL (re: 2-cm3 coupler; ANSI S3.6-2003). For the remaining one condition, words were presented from a Tannoy 10-inch speaker located at 180° azimuth, also calibrated for 60 dB SPL at the ear level of the subject. For 12 of the children, the original PB-K word-recognition material was presented directly from a CD, once with insert phones and once with a soundfield speaker located behind the subject. For the remaining 12 children, the PB-K material as recorded through KEMAR was presented with insert earphones, once with the omni-directional recording and once with the fixed directional recording. Full 50-word lists were presented and percent correct was recorded. Lists and conditions were counterbalanced.
The Peabody Picture Vocabulary Test (PPVT),11 a measure of receptive vocabulary level, was used to roughly gauge each subject’s existing language ability.
Twelve novel words were created for use as targets in the novel-word-learning
Procedure. The words were created based on two factors shown to be related to word learning in children: phonotactic probability and lexical neighborhood
density.


Results:
Average word-recognition performance was significantly poorer in the directional via insert phones condition than in the other three listening conditions. Performance between the original via insert phones, original via soundfield, and omni-directional via insert phones listening conditions were not significantly different. Results of the novel-word-learning study were analyzed using paired t-tests. Performance did significantly improve from the first expressive test to the second expressive test for both omni-directional and directional conditions. No significant differences between microphone conditions were found in the receptive test. The effect of receptive vocabulary as a predictor of performance on the expressive novel-word learning measure failed to reach significance. However, there was a significant relationship between the standard score on the PPVT and performance on the receptive test.

Discussion:
The purpose of this investigation was to determine the effect of a directional microphone (cardioid pattern) on two ubiquitous childhood experiences: the recognition of familiar words and the learning of new words. As speech perception underlies both experiences, we predicted that listening under the omni-directional microphone condition would yield better performance for both when the primary
talker was located behind the child. This hypothesis was partially supported.


Abstract written by Mallory Boteler

Reference
Moeller, M.P., Hoover, B., Peterson, B., & Stelmachowicz, P. “Consistency of Hearing Aid Use in Infants With Early-Identified Hearing Loss.” American Journal of Audiology, Vol. 18, June 2009, pg. 14-23. Accessed on Sunday, September 13, 2009 from http://libproxy.library.unt.edu:2055/ehost/pdf?vid=4&hid=108&sid=a692aa2c-3ef6-4862-8d85-da4d4ea8bf97%40replicon103.

Purpose of Study
The purpose of the study was to assess how often hearing aids are used by infants and identify maternal, child, and situational factors that affected the regularity of hearing aid use.
Subjects
The subjects involved in the study were mothers of 7 infants who had mild to moderately severe hearing loss who were all referred from newborn hearing screening programs. Mean age of identification for the group was 1.64 months, age at fitting was 5 months, and entry into the study ranged from 9 to 13 months.
Method
The mothers of the 7 infants were interviewed at least three out of four times (required for the study to interview at least three out of four times) at 4-6 month intervals (10.5-12 months, 16.5 months, 22.5 months, and 28.5 months). This was done so that there would be samples in the stages of infant development and behavior that could influence device use. During the interview, the mothers were given a questionnaire that included 5-point Likert scale items and open ended questions. The mothers were asked about their children’s hearing aid habits across a variety of common daily situations including riding in the car, eating at mealtime, playing with parents, playing alone, looking at books, playing outside, etc. Questions were also asked about evidence of benefit from the hearing aids, daily schedule, strategies they used to encourage device use, and the situations which made device use challenging.
Results
On average, consistency of hearing aids improved with age during the 2nd year. However, device use fell short of the ideal consistency for most situations. Ideal would be full time use during waking hours.
Monitored versus difficult to supervise situations
Three patterns of hearing aid use within the 7 families were observed over time:
-full time use was accomplished and maintained consistently by at least 16.5 months
-consistency of use fluctuated across the ages
-frequent but not full time use was apparent across most ages and situations
Device adjustment and management
A high level of comfort in handing and maintaining the devices was reported by all of the mothers. The study also found that some families had trouble managing transition times and results suggested that family routines and schedules influenced device use in some cases.
Perception of Benefit
All 7 mothers in the study perceived that their children were benefitting from the amplification of hearing aids.

Discussion
This article gives me as a clinician, a good idea of what parents are experiencing at home with children that use amplification devices. I have had a client for speech therapy that wore a hearing aid and had a cochlear implant. He was young too, before the age of two, and the main focus in therapy was to expand his language and see the benefits he was receiving from the aids. Reading this article makes me curious about how consistently he was wearing his aid and if he was/was not, how it was affecting his language growth. This knowledge will aid speech pathologist and parents alike. This article would definitely help during counseling with a parent who has a child who had received hearing aids. It would give parents an idea of what other parents of hearing impaired children have gone through as their children received amplification devices.

Opinion
In my opinion, this study gives insight into the lives of just a small handful of parents who have hearing impaired children, and the difficulties and strengths that they have of maintaining consistent use of hearing aids.

Abstract written by Jason Chapman

Reference
Pittman, A., Vincent, K., Carter, L. “Immediate and long-term effects of hearing loss on the speech perception of children”. Journal of Acoustical Society of America, 126, September, 2009, 1477-1485. Accessed on Monday, September, 14, 2009.

Purpose of Study
The study was designed to assess the immediate and long-term effects of hearing loss on the speech perception of children.

Subjects
The subjects consisted of 5 children with hearing loss between the ages of 8 and 10 years old with mild to moderate sensorineural hearing loss and 11 children with normal hearing between the ages of 7 and 10 years old.

Method
The testing administered was all conducted in a sound-treated booth which met ANSI standards for ambient noise. The stimuli were processed through custom software specifically designed to use with children. The stimuli were controlled by a standard PC computer. The stimuli were presented to one ear at a time having a flat frequency response through 10 kHz. During the sentence perception task, the child was instructed to: “You will hear a woman say a sentence. Some of the sentences will be normal and some will be silly. Listen to each sentence and repeat as much of it as you can. It’s ok to guess. If you don’t know, just say so.” The children were then presented with six sentences that consisted of 4 words each. The sentences were presented at 5 presentation levels and two listening conditions (quiet and masked). The progression of sentences went from highest to lowest. The sentences were meaningful and nonsense. The subjects then responded to examiner at their own pace. The examiner then entered the number of words that the child repeated correctly. The order of the words and the addition of extra words were not taken into consideration. A second examiner recorded the child’s responses while standing outside of the room. The children were not given feedback as to whether or not the responses were correct.

Results
The results showed that the correlations between the predicted and observed scores for the children with hearing loss were similar to those with noise-masked normal hearing children for the meaningful and nonsense sentences. They assessed the effects of immediate hearing loss on the perception of speech by comparing the performances of the normal hearing children in quiet to the children with simulated hearing loss. They found no significant differences observed for the meaningful sentences. However, it was observed that there was a significant difference between the scores of the nonsense sentences. Effects of hearing loss on the perception of speech were also assessed over the long-term. This was done by comparing the performance of children with hearing loss in a quiet environment with the results of the normal hearing children who had simulated hearing loss. The comparison showed that there was no significant difference between the two groups concerning the meaningful or nonsense sentences. Finally, the performance of the children with hearing loss in quiet and the performance of the normal hearing children in quiet for nonsense sentences was conducted. There was no significant difference between the two groups.

Discussion
The study was designed to examine the immediate and long-term effects of hearing loss on the speech perception of children. It was thought that there would be a significant difference between the simulated hearing loss subjects and the normal hearing subjects without simulated hearing loss despite equivalent audibility. However, there was only a significant difference between the nonsense sentences but not for the meaningful sentences. It is thought that this is a result of the contextual information that can be gleaned from meaningful sentences. The poor performance on nonsense sentences did not have the context cues. Long-term effects were assessed by comparing the performances on people with hearing loss and children with simulated hearing loss. It was predicted that the actual hearing loss would make certain acoustic elements inaudible over time. However, the results showed that they did not have a significant difference between groups for either type of sentences. This could show that children with hearing loss could develop compensatory strategies to stop the degenerative effects of hearing loss on speech perception.

Opinion
The study did a good job of examining the short and long term effects hearing loss has on speech perception. The researchers stated that the lack of difference between the scores between the nonsense sentences for the children with hearing loss and normal hearing children suggests that children with hearing loss develop compensatory strategies. It would be interesting if they suggested what those compensatory strategies may be.

Abstract written by Ashley Cummings

Reference
Olusanya, B. “Hearing impairment in children with impacted cerumen”. Annals of Tropical Paediatrics, 23(2) June, 2003, 121-128. Accessed on Saturday, 12, 2009. https://libproxy.library.unt.edu:9443/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=9750918&site=ehost-live&scope=site

Purpose of Study
The aim of this study was to determine whether children in whom impacted cerumen had been removed were at greater risk of hearing impairment than those without a history of impacted cerumen. This study therefore sought to evaluate the auditory status of school children after removal of impacted to establish whether such children were at greater risk of hearing impairment than those without a history of impacted cerumen.

Subjects
The study was conducted in Mushin, a high-density, inner-city area of cosmopolitan Lagos, Nigeria with a population of 986,847 at the time of the study. There were 76 public primary schools in the area with a total of 11,689 school entrants. For a representative sample, eight (10%) of the primary schools in the area were randomly selected. The sample size was calculated at 95% confidence level for the proportion of the target population based on the available prevalence rate of 2.8% at the time of the study. In each selected school, the first child in each class and every third child thereafter were chosen. A total of 361 children were selected for the study and parental consent was obtained for 359 of them. There were190 (52.4%) girls and 169 (47.6%) boys whose ages ranged from 4.5 to 10.9 years (mean 6.7). Most of these children (349, belonged to social classes III–V based on mother’s education and father’s occupation.
Method
A complete physical examination was carried out on all the 359 children followed by otophysiology and scopic examination by an otolaryngologist. Cerumen was recorded only when it was impacted, i.e. when no part of the tympanic membrane was seen in at least one ear owing to occlusion of the external auditory meatus. A total of 189 cases were thus identified. The otolaryngologist curetted the impacted cerumen with a Jobson–Horne probe and removed any foreign object or debris. The external canals and tympanic membranes were then inspected for exostoses, atresia, diffused or localized external canal infections, perforations and tympanosclerosis. The tympanic membrane was recorded as normal only when the anatomical landmarks were clearly visualized. Thereafter, audiometric and tympanometry tests were performed on all the children.

The author performed audiometric tests in the quietest area of each school using a calibrated pure-tone audiometer with TDH-39 earphones and audiocups for extra attenuation. Tests were carried out only two-tailed. Odds ratios (OR) are given with when the noise level meter reading was <45>15 dB HL at the same frequencies of 0.5–4 kHz was considered as failure. Tympanometry evaluation was similarly conducted in two stages at an interval of 6 weeks to allow for resolution of any transient middle-ear condition. In the first stage, children with non-type A tympanograms were referred for repeat assessment.
Those with persistent non-type A tympanograms at the end of the second stage were considered have failed the Tympanometry test. Among this group, those with type B tympanograms were classified as having otitis media with effusion (OME).

Results
It was found that children from whom impacted cerumen had been removed were more likely to have hearing loss and of a more permanent nature. They were also likely to have more otitis media with effusion (OME). Children with a history of impacted cerumen are therefore at greater risk of subsequent hearing problems and of a more permanent nature than those without, notwithstanding the removal of such impacted cerumen. The prevention of cerumen impaction should be of significant public health concern in the management of hearing impairment in children, especially where there is no routine and systematic screening for hearing disorders.

Discussion
This study interested me because I wanted to know the effects of earwax on hearing in general because I think that parents and clinicians don’t pay enough attention to this naturally accruing substance that can cause conductive hearing loss if allowed to build up. Many children was wax buildup and not enough attention is placed on the cleaning and management of earwax to prevent hearing loss.
Opinion
Additional studies are needed to investigate the causal relationship between hearing loss, middle-ear disorders and impacted cerumen across races and social classes in the United States. Further development of cerumen buildup prevention programs is needed.


Abstract written by Laure Eysermans

Reference

Fitzpatrick, Elizabeth. “Parents’ Needs Following Identification of Childhood Hearing Loss”. American Journal of Audiology, 17, June, 2008, 38-49. Accessed on Sunday, September 7, 2009:
http://aja.asha.org/cgi/content/full/aja;17/1/38?maxtoshow=&HITS=150&hits=150&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=pediatric+hearing+loss&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2000&resourcetype=HWCIT

Purpose of Study

The purpose of this study was to identify the components of service delivery most important to the parents of children newly diagnosed with hearing loss. This study also explored how available support systems for parents influence the success of programs for intervention and early detection of hearing loss.

Subjects

Participants in this study included 21 parents from 17 families. Inclusion criteria consisted of having a child under age 5 with permanent hearing loss diagnosed before 6 months, who had no additional disabilities, and who was enrolled in an oral program. Of these children, 1 child had mild hearing loss, 5 had moderate, 6 had severe, and 5 had profound hearing loss.

Method

A single interviewer collected data over a 4-month span using a semistructured interview approach, conducting 16 of the 17 face-to-face interviews in the participants’ home environment. Two main questions were posed during each interview, and follow-up questions were used as needed to clarify parent answers. The interviews were recorded and transcribed before being analyzed by the interviewer using computer software and a structured approach adopted from a previous published experiment. The interviewer looked for key concepts across interviews, which were later categorized and then reviewed by a second researcher with experience in pediatric hearing loss. Finally, information was obtained to look at the effects of demographics on parent views expressed during the interviews.

Results

Parents unanimously expressed the importance of newborn hearing screenings and audiology and therapy services (although whether these included speech services was not described). Other concerns included the frustration of dealing with multiple organizations throughout the process of obtaining services for their children. Parents had mixed views regarding the importance of social support (namely social workers) and did not express desire for psychological services beyond the initial interview for obtaining a cochlear implant. Parental concerns included access to services in terms of distance, and frustration with models that did not include a streamlined, team-oriented approach. Some parents explained their frustration stemmed from poor communication between adults providing services to their child. Support from other parents was also deemed helpful. Finally, a major concern for parents was access to ongoing information regarding their child’s diagnosis and therapy. Parents expressed a desire for a prepared, organized “kit” containing all the information they would need regarding their child’s initial diagnosis.

Discussion

This article certainly has an impact on service delivery in terms of counseling and potentially the type of intervention provided to families with children affected by hearing loss. For example, the need for ongoing clinician report and counseling plays an important role in parent satisfaction with services, even within the field of speech pathology. Parents may appreciate take-home materials to reinforce information provided during counseling, so clinicians should have these handy. Additionally, parents may feel more satisfied if they are included in service delivery, so serious consideration should be given to emphasizing parent training as an important component of the therapy process.

Opinion

While this study reveals important parent insights, it is important to note that some concerns can be realistically addressed –some cannot. Information streamlining is difficult because under the current system of service delivery, a variety of fields overlap, setting the stage for a variety of opinions and resulting in a disorganized presentation of information to parents. Also, travel distance to clinics cannot readily be remedied; however, providing services outside of traditional business hours may be a viable alternative. In the meantime, the article sheds light on small, realistic steps that individual clinicians can make to ease the burden placed on parents. Overall, the study was beneficial in terms of revealing the most sought-after aspects of service delivery, and even the small steps clinicians take are important components in meeting client needs.

Abstract written by Rachel Foster

Resource:
Young, Alys; Tattersall, Helen. “Universal Newborn Hearing Screening and Early Identification of Deafness: Parent’ Responses to Knowing Early and Their Expectations of Child Communication Development. Journal of Deaf Studies and Deaf Education, 12:2, Spring 2007, p 209-220. Accessed on Monday, September 14, 2009, http://jdsde.oxfordjournals.org/cgi/search?fulltext=Universal+Newborn+Hearing+Screening.

Purpose
The article focuses only on hearing families with deaf children and the overall impact of early identification of deafness on the hearing families. Two aspects of parental experience are the primary interests in this study: a) how parents describe the significance and impact of knowing early that their child is deaf and b) parents’ very earliest assumptions about the impact of early identification on their deaf children’s development and in particular their communication. The article aims to 1) evaluate the impact of the screening process and the consequence for intervention, 2) explore personal, family, and sociodemographic influences on that experience, and 3) enable parent to contribute to the identification and definition of new born hearing screenings.

Subjects
All participating families had a child who had been correctly identified as deaf following the newborn hearing screening. Further requirements indicated that the child had to meet the criteria of having “a permanent bilateral hearing loss with hearing threshold > 40 dB HL based on the average in the better hearing ear at 0.5. 1, 2, and 4 kHz. Out of 91 families 27 were interviewed. The families were to choose who should be present at the interviews based on overall level of involvement with the child and the experience of the screening process. The 27 interviews equated participation from 45 parents/caregivers/extended family members. Six babies were from the Neonatal Intensive Care Unit population, two of the families had other deaf children, and 22% of the 27 infants had been diagnosed with a diagnosed with disabilities/illnesses.

Method
A qualitative methodological approach was taken in this study. Parents were not required to answer a set of predefined questions in which to explain their experience, but were given the scope to make decisions themselves about what is meaningful and important about their experience within some consistent limits applied to all interviews. All parents chose to be interview at home, with the length of interview averaging 1.5 hrs. Parents also completed a simple questionnaire to collect sociodemographic information. A cross-sectional technique was used from both “within-case” and “cross-case” perspectives (case refers to interview). Within-case views the similarity and difference of response between participants within the same interview. Cross-case analysis looks at shared and disputed perspectives between the experiences the family had.

Results
The majority of parents (21 of 27) were clearly positive about their child’s deafness being identified early. The parents believed that knowing early did not take away the shock, grief, or loss they associated with having a deaf child. Most of the parents expressed their feeling that regardless of when you find out it will hurt just as badly. The positive group of parents expressed the wanting the advantages for their child that come with finding out earlier. Early identification was also positively associated with having more time to come to terms with their grief. Some parents said that by finding out early they miss out on the guilt that would have been felt when the whole time they thought they had a hearing baby and then later found out this was not so. Without the early identifications parents feel that their child may have missed out on supports that they needed. The five parents that did not share the same positive feeling as the other parents had been eclipsed by a perceived lack of action from professional services. Two of the mothers were clear in the fact that they wished they wouldn’t have found out early because this hindered their ability to enjoy their babies.
Ten of the parents interviewed expressed expectations that their child would reach normal or near normal developmental milestones. In eight of the other parent interviews, the parents made the point that they rather avoid abnormal development as opposed to reaching normal development. In another eight interviews, one case the parents did not offer comments on their child’s development; three has broad positive expectations of their children; one child had developmental disabilities and the deafness was not their primary concern; and another felt that deafness was such a big developmental disadvantage that there really isn’t much that can be said in regard to their future development.

Discussion
It is enlightening to see that most of the parents were able to see the positive advantages to finding out their child was deaf through early identification. As a speech pathologist this study provides you with self proclaimed statements that may be beneficial for parents to hear during the counseling session. Parents may relate better to information that has been stated by other individuals who have experienced the same situation they are experiencing. This article also helps the speech pathologist see the effects of such news on families.

Opinion
I think this study outlines and describes parents/families feelings about early identification for deafness and shows the varying degrees of responses. I think it would have been interesting to see a larger sample size in order to get more of an idea of what kind of reactions one may have when receiving such a diagnosis. The article does a good job describing/summarizing the study, while also putting in personal quotes that help to understand how real the feelings are that the families are having.

Abstract written by Anna Loza

Reference
Archbold, Susan., Nikolopoulos, Thomas., Lloyd-Richmond, Hazel . “Long-term use of cohlear implant systems in paediatric recipients and factors contributing to non-use”. Cochlear Implant International, 10, 2009, 25-40. Accessed on Saturday, September 12, 2009. http://libproxy.library.unt.edu:2055/ehost/pdf?vid=7&hid=3&sid=2bc02e8b-6faa-4fbc-9488-ee8de2babfc6%40sessionmgr4

Purpose of Study

The purpose of the study was to examine long-term use of cochlear implant systems in children, and factors that contribute to the amount of daily usage. Factors included age of implantation, predominant mode of communication, family issues, learning difficulties, and pain upon stimulation.

Subjects
The participant pool consisted of 138 deaf children who had been implanted for seven years with the Nucleus 22 cochlear implant system, all of whom had hearing thresholds greater than 95 dB across the speech frequencies prior to implantation. After implantation, none of the subjects received intensive, clinic-based rehab. Rather, follow-up support was provided via educational outreach programs from the clinic, allowing the children to spend the maximum amount of time possible at school and in the home. They received regular home and school visits from teachers and SLPs to offer support on a daily basis. Parents and teachers were involved in ongoing monitoring of the implant, and the participants only came to the clinic for tuning of the system.

Method

Both the teachers and parents of the participants completed an annual questionnaire regarding the child’s use of the implant system and rated their use with the following categories: Category 1 = All of the time (A), Category 2 = Most of the time (M), Category 3 = Some of the time (S), and Category 4 = None of the time (N). Additionally, the teachers completed annual questionnaires about the child’s chosen mode of communication and educational placement, whether the child attended a school for the deaf, a resource class based in mainstream school, or full-time placement in mainstream school. Children were then assigned into two groups : F, those who used their systems all of the time and N, those who were non-full-time users. Groups F and N were then compared with regard to age at implantation, any additional difficulties, mode of communication, and educational placement, in order to examine any correlations between these issues and cochlear implant use.


Results

Seven years following implantation, 115 children (83%) were full-time users, 16 (12%) wore their devices most of the time, 3 (2%) were some of the time users, and 4 (3%) were non-users. Upon comparison of group F (full-time users) and N (non full-time users), the mean age at implantation was 4.4 years for group F versus 5.5 years for group N. Of the children implanted under age 5, 92% were full-time users compared with 67% of those implanted over age five. This is a statistically significant difference, and there were no children not using their devices who had been implanted below age five. Additional disorders (cognitive, physical, visual, etc.) did not significantly impact usage, as 47% of the full-time users had concomitant disorders. A statistically significant difference was identified when looking at communication mode. In group F, 40% used sign language to some degree and 60% strictly used oral communication. In group N, 74% used sign communication and 26% used oral language. In the four children not using their systems at all, they used only sign language and had always done so. Educational placement also revealed a statistically significant difference. In group F, 78% were in mainstream education as compared to 57% in group N.

Discussion

Based on the aforementioned results, it puts into perspective the importance of auditory verbal therapy. Because much more success was seen in oral communicators, speech and hearing intervention should be introduced as early as possible once a child is identified as DHH. Additionally, parents should be encouraged to consider implantation early in the child’s life to ensure the best results from a cochlear implant system.

Opinion

I felt the study was valid and reliable, considering it was a longitudinal study spanning seven years following implantation, so it adequately observed trends and/or changes in the child’s communication and usage of their system. However, though the children were continuously being monitored by professionals, the results may have been better (more children using their devices full-time) had they received intensive clinical intervention. Because their only visits to the clinic were for tuning purposes, parents may not have been properly educated in the best techniques to enhance their child’s device usage and oral communication.

Abstract written by Lauren Pfeiffer

Reference
Steinberg, A., Kaimal, G., Ewing, R., Soslow, L., Lewis, K., Krantz, I. “Parental Narratives of Genetic Testing for Hearing Loss: Audiologic Implications for Clinical Work with Children and Families”. American Journal of Audiology, 16, June, 2007, 57-67. Accessed on Monday, September 14, 2009 http://dq4wu5nl3d.search.serialssolutions.com/?sid=CSA:cddsetc&pid=%3CAN%3Epmid%2D17562755%3C%2FAN%3E%26%3CPY%3E2007%3C%2FPY%3E%26%3CAU%3ESteinberg%2C%20Annie%3B%20Kaimal%2C%20Girija%3B%20Ewing%2C%20Rachel%3B%20Soslow%2C%20Lisa%20P%3B%20Lewis%2C%20Kathleen%20M%3B%20Krantz%2C%20Ian%3B%20Li%2C%20Yuelin%3C%2FAU%3E&issn=1059%2D0889&volume=16&issue=1&spage=57&epage=67&date=2007%2D06&genre=article&aulast=Steinberg&aufirst=Annie&title=American%20journal%20of%20audiology&atitle=Parental%20narratives%20of%20genetic%20testing%20for%20hearing%20loss%3A%20audiologic%20implications%20for%20clinical%20work%20with%20children%20and%20families%2E

Purpose of Study
The article looks at the possibility of parents personalizing the idea of genetic hearing loss in their children and whether they will pursue genetic testing. This article also highlights the important role of an audiologist in helping the parents with the genetic testing referral and with the follow up process.

Subjects
Twenty four parents of varying races, ethnicities, and socioeconomic backgrounds were chosen for this study. Sixteen were hearing, English-speaking parents; 5 hearing, Spanish-speaking parents; and 3 deaf, ASL-using parents.

Method
All twenty four parents were interviewed in depth. These interviews were coded and analyzed using qualitative methods. Parents of newly identified children with hearing loss were interviewed on their perspectives on genetic testing in general and specifically for hearing loss, experiences with health care professionals, and values regarding the presence of hearing loss in their children.

Results
Several parental associations were found, ranging from feeling personally responsible to a feeling of relief. Parental attitudes were related to their perceptions and their experiences with deafness. Misconceptions about genetics were also found among the parents.

Discussion
Audiologists need to be more sensitive when it comes to parents’ personal and sociocultural contexts concerning genetic testing. The need to be flexible is important for audiologists to practice, in order to tailor information and emotional support for each unique set of circumstances presented by each client.

Opinion
I believe that this study holds valuable information for audiologists. Sometimes patients complain that doctors lack empathy for the situation that they are in. This article allows the audiologists to take an inside look at the thoughts and emotions of parents who are considering genetic testing for their children with hearing loss.


Abstract written by Reshma Rao

Burch-Sims, P & Matlock, V. “Hearing loss and auditory function in sickle cell disease”. Journal of Communication Disorders February 2005 38(4): 321-329. Accessed on Tuesday, September 8, 2009 http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T85-4G2BG9J-1&_user=452995&_coverDate=08%2F31%2F2005&_alid=1004887016&_rdoc=6&_fmt=high&_orig=search&_cdi=5077&_sort=r&_docanchor=&view=c&_ct=162&_acct=C000007818&_version=1&_urlVersion=0&_userid=452995&md5=8957386d7c322808c0bbd6cefff06984
Purpose
(1)Genetic characteristics and pathophysiology of sickle cell disease.(2)Link between sickle cell and auditory dysfunction/hearing loss. (3)Model for appropriate audiological assessment and treatment of sickle cell disease patients.
Genetic characteristics and pathophysiology of sickle cell disease
This is a genetic disease characterized by an abnormality of hemoglobin (a protein) in the red blood cell. Normal red blood cells are soft, disc-shaped cells that flow easily through the smallest blood vessels and live about 120 days. Sickle-shaped cells are hard, often get stuck in small blood vessels and live about 20 days. They interrupt blood flow (due to their shape) by blocking small blood vessels, which impedes blood flow to tissues. This causes significant tissue damage. Sickle cell disease is a significant problem in the US affecting 1 in 400 African Americans. One in 10 African Americans in the US has a sickle cell trait, making it the most common genetic disease in this country. Medical complications of the disease include splenic sequestion, hemolytic anemia, acute and chronic pain episodes, stroke, brain damage, kidney failure, pneumonia or chest syndrome.
Link between sickle cell and auditory dysfunction/hearing loss

Investigators believe that vaso-occlusive nature of sickle cell disease may cause the potential for hearing loss. Studies have shown that hearing impairment ranged from 0 to 66% with a wide range of severity as well. Extensive blood flow to the cochlea is critical and it has been speculated that sickling and slugging of blood in the cochlea is associated with auditory impairment. The relationship between sickle cell disease and hearing was investigated in a study.

Subject and Methods
183 sickle cell subjects (86 males and 97 females). Each received routine audiological and electrophysiological and otologic assessments in a non-crisis or steady state. The subjects had hemoglobin electrophoresis diagnosis of SS, SC, SB-thalassemia or EF.

Results

Significant relationship between high frequency senorineural hearing loss and distortion product otoacoustic emissions (DPOAE). DPOAEs were consistently present in frequency regions exhibiting normal pure tone hearing sensitivity. DPOAE amplitudes were reduced as pure tone thresholds increased, and they were absent at frequencies where thresholds were greater than 50 dB for 251 out of 255 ears tested. For four ears, the DPOAEs and pure tone audiograms were not correlated. Further investigation revealed these DPOAEs were from tow patients scheduled for chelation therapy due to iron overload. Reevaluation prior to chelation therapy showed normal pure tone audiogram with significantly reduced or absent DPOAEs in the presence of normal middle ear function. There was a significant in the amplitude of the DPOAEs when comparing pre and post chelation measures. The results suggest that, although sickle cell subjects are a heterogeneous population, they are at significant risk for auditory damage, and the auditory deficit associated with sickle cell appears to be cochlear in nature.

A model for appropriate audiological assessment of treatment of patients with sickle cell disease.

The assessment should include the following tests:
· Pure tone thresholds from 250 Hz to 8000 Hz, including half octaves about 2000 Hz.
· Speech reception testing, word recognition testing, and immitance audiometry, including tympanometry and acoustic reflex testing.
· Auditory Brainstem response and Otoacoustic Emissions.
· Comprehensive otologic/medical examination to rule out hearing loss due to etiologies other than sickle cell disease.

Discussion

The article highlighted some of the auditory consequences of sickle cell disease along with the potential causes of the auditory damage. Although the age range of the subjects is not mentioned, it is clear that sickle cell disease can affect persons of any age and thus, may cause auditory damage in a patient of any age. It is important to highlight the importance of getting their child tested, if you have a client with the disease. Additionally, the parents can be given a guideline of what kind of audiological testing needs to get a complete picture of the child’s hearing function.

Opinion

It will be interesting to find out the extent of auditory damage in children as compared to damage in adults.


Abstract written by Clary Rondan

Reference
Sininger, Yvonne S.; Martinez, Amy; Eisenberg, Laurie; Christensen, Elizabeth; Grimes, Alison; & Hu, Jasmine. “Newborn Hearing Screening Speeds Diagnosis and Access to Intervention by 20-25 Months”. Journal of the American Academy of Audiology, 20, January, 2009, 49-57. Accessed on Monday, September 19, 2009 http://docserver.ingentaconnect.com.ezproxy.lib.utexas.edu/deliver/connect/aaa/10500545/v20n1/s7.pdf?expires=1253047837&id=52054320&titleid=72010016&accname=University+of+Texas%2C+Austin&checksum=49AAD1C78D6160E7383AAF72F353F749.

Purpose of study
The purpose of this study was to compare children with hearing loss, some who had a newborn hearing screening at birth and some who did not. This longitudinal study compares the children using specific benchmarks set by the Joint Committee on Infant Hearing, which is a committee that judges the quality of newborn hearing screening programs.

Subjects
A total of 63 children were recruited to participate in this study. Each subject was recruited no more than six months following diagnosis of bilateral permanent hearing loss and around the time of fitting with amplification. The children did not present with any significant motor, vision, or developmental deficits. There were 33 males and 30 females. A total of 46 children were screened during the neonatal period, and of these, 39 failed the screening, and 7 passed. The other 17 children were not screened.

Method
Data was gathered with the use of questionnaires, enrollment forms, and audiologic chart records. Specific areas of data gathered included screening status, age at diagnosis (months), age at fitting of amplification (months), delay of fitting (months), age of intervention (months), delay of intervention (months), level of hearing loss (dB HL).

Results
Children who were screened at birth were diagnosed with hearing loss, fitted for hearing aids, and received intervention at earlier ages than those who were not screened at birth. However, delays in fitting of amplification and initiation of intervention after diagnosis are completely independent of screening status in all comparisons. The children with hearing loss who passed the newborn hearing screening as infants reached their benchmarks slightly earlier than those who were not screened.

Discussion
The cases of the children in this study make it clear that newborn hearing screenings are very important in early identification of hearing loss in children; however, it is not the only answer. There were several children who passed the newborn hearing screening and were not diagnosed until later. Several standards have been set in newborn hearing screening training and education so that healthcare personnel and parents are more educated about the topic and less mistakes are made when the screenings are conducted.

Opinion
The results of this study were obvious. As expected, the children who received a newborn hearing screening at birth were diagnosed, received amplification and intervention, and reached the benchmarks earlier than those who did not receive the newborn hearing screening. It is a well-written article, however, that further proves this information and compares children over several years and not at one given time.


Abstract written by Laena Schuman

Reference
Shirin D. Antia, Patricia B. Jones, Susanne Reed, and Kathryn H. Kreimeyer. “Academic Status and Progress of Deaf and Hard-of-Hearing Students in General Education Classrooms”. Journal of Deaf Studies and Deaf Education, 14, 6, 2009, 293-311. Accessed on Tuesday, 15, 2009 http://jdsde.oxfordjournals.org/cgi/reprint/14/3/293

Purpose of study
Due to the rising movement of inclusion in public schools, there has been a steady increase in the number of deaf and hard-of-hearing (DHH) students into the general education classroom. The purpose of this study was to analyze the academic status and progress of deaf and hard-of-hearing students in a general education classroom over a period of 5 years.

Subjects
The subjects of this study were 197 deaf or hard-of-hearing students with a range of mild to profound hearing loss and who met the following requirements: (1) already diagnosed with uni/bilateral hearing loss, (2) did not have any cognitive disabilities, (3) received services from DHH teachers or had an IEP, (4) attended general education classrooms in public schools for at least 2 hours daily, and (5) in grades 2-8 at the beginning of the study. Spoken language was the main means of communication for most children, while 24% used some sign.

Method
The teachers of the DHH students received a packet of information regarding the instruments and directions for administration for the study. The following instruments were used: demographic information, teacher’s ratings of communication, classroom communication participation, preferred communication mode, and academic status.
Demographic status gathered information regarding degree of hearing loss, amplification, parental participation in the school, and services received. Parental participation was based on involvement in: attending IEP meetings, parent-teacher conferences, and school events, taking sign language classes, communicating with school employees, volunteering, and taking parent classes or workshops.
The teachers of DHH completed a rating of each student’s expressive and receptive communication through the Functional Rating Scale developed for the Annual Survey of Deaf and Hard of Hearing Children and Youth. The purpose of the scale was to obtain information regarding how the students function within the school setting in the areas of audiology, communication, cognition, behavior, and social.
Classroom participation information was analyzed through the Classroom Participation Questionnaire (CPQ) which measured student’s perceptions of their success in receiving and giving information in the classroom and how they feel about participating in the classroom.
The student’s preferred communication mode was measured in 4 questions on the CPQ and asked them to rate their expressive and receptive mode of communication with their hearing peers and the general education teacher. They had to choose from the following options: interpreter, sign, speech, speech and sign, and writing notes.
Academic status was measured through standardized state tests. The areas assessed were math, reading, and language/writing tests at each grade level. Classroom academic status was measured through the norm-referenced rating scale Academic Competence Scale of the SSRS. Scores were obtained within 3 areas: social skills, problem behaviors, and academic competence.

Results
Over the course of 5 years, over 50% of the students in the study scored within the average or above average range for the 3 content areas of the standardized achievement test (math, reading, and language/writing). In math over 2/3’s of the students scored within the average or above-average range. The percentage of students who scored above average in each content area was lower than the expected 16%, and the percentage of students who scored in the below-average range was higher than expected. For a student to be improving at the expected pace along with other students at their grade level within a year’s time, a positive slope should be yielded on the NCE scores over time. The mean slope for 80% of the students in each content area was positive; indicating that DHH students progress was commensurate, or better than, that made by the norm group of hearing children.
In regards to classroom academic status and progress, the group, as a whole, made slightly greater achievements than expected (70%-80% of students rated by teachers fell in the average or above-average range each year) in terms of academic competence. However, some students decreased while others gained in reference to the norm group.

Discussion
It was interesting to read about the effects of inclusion on DHH students and that the majority of these students were achieving success within the normal range of their hearing peers on standardized tests. Their teachers perceived them as performing academically within the normal range of their classmates. This information could assist us in a clinical setting in having a general knowledge of how the majority of DHH students can perform in inclusion, which is a goal most families want to achieve with their children. The results of previous studies have shown that DHH students generally lag far behind their peers academically and that the average performance in reading comprehension is 6 grades below their hearing peers at the age of 15. The results of the DHH sample in this study help to minimize the gap of academic difference between hearing and DHH students by placing them about ½ a SD behind their hearing peers on standardized tests.

Opinion
I think this study was presented as very black and white with not much detail and was very dry. It attracted me to a certain point in that I found it interesting to see proof that DHH students in inclusion classrooms could perform better than previous studies have shown. In my experience, I always thought that DHH students lagged exceptionally far behind their normal hearing peers and received many extra services in order to help them catch up. Now, I am under the impression that DHH students who do still receive additional services are not as far behind as we thought, with some exceptions.


Abstract written by Hayley Simpson

Reference
Berrettini, S., Forli, F., Genovese, E., Santarelli, R., Arslan, E., Chilosi, A., & Cipriani, P. “Cochlear Implantation in Deaf Children with Associated Disabilities: Challenges and Outcomes”. International Journal of Audiology, Vol. 47, 2008, pgs. 199-208. Accessed on Sunday, September 13, 2009 http://libproxy.library.unt.edu:2055/chc/pdf?vid=6&hid=104&sid=506e55e8-8a46-4fe0-9cf3-9ffec650bfc3%40replicon103.

Purpose of Study
Currently research is undecided on whether or not to implant deaf children who have multiple impairments with cochlear implants. Implantation should be based on the expected benefits but with deaf children who have multiple impairments, the question then becomes ‘what constitutes benefit’ and ‘what outcome measures do we use to mark the benefit’? This study looked to comprehensively examine the perceived benefits in daily life vs. objective post-implant outcomes in children who use cochlear implants and have multiple disabilities.

Subjects
23 Italian children, 10 male and 13 females, with cochlear implants with additional neuropsychiatric disabilities were chosen for this study. All were implanted at the mean age of 6.3 years with pre-operative pure-tone average thresholds at 112 dB HL. All participants had worn hearing aids and received speech therapy prior to implantation. The children’s neuropsychiatric disorders were classified as follows: mental retardation (10), cerebral palsy (3), autism spectrum disorder (2), AD/HD (4), language and learning disorder (4), and epilepsy (1). 91% had been diagnosed prior to implantation.

Method
All the children participated in pre and post operative standardized testing for speech perception and based on those results were classified according to Geers and Moog’s six categories of speech perception skills. A questionnaire was also administered post-operatively to the parents of the children to assess the parent’s judgment about the seeming benefits of the CI in the areas of speech perception, social interaction, communication, overall mode of communication and their opinion of the CI in general.

Results
Pre-operatively, 74% of the children were classified in the lowest categories (0-1—no pattern of speech perception to some speech perception) of Geers and Moog’s speech perception categories, 26% were assigned to categories 2-5. After their implantation, 56% of the children saw an improvement in their speech perception skills and were classified in the highest category, 6—open set recognition of words; only 13% were still at categories 0-1.
-100% of the parents reported an improved awareness of environmental sounds, 74% indicated improvements in their child’s speaking skills, 96% noted improved interaction with peers and that their child was more likely to communicate his/her needs. 22/23 families stated that if they were given the option again to implant their child, they would choose to do so.
-Prior to implantation, 69% of the participants had a main communication mode of gestures or behaviors and only 28% used oral language. Post-implantation results show that the percentage of children using oral language increased to 69% and the percentage using only gestures and behaviors dropped to 28%.
-There was a significant correlation between post-implant speech perception category placement and post-implant communication modes. There was no significant correlation between the etiology of the disorder and the outcomes.

Discussion
There is currently no consensus on whether or not to implant a deaf child with additional disabilities. The majority of the literature has shown that these children will make progress but it will be at a slower rate and not match the level attained by deaf CI users that do not have additional disabilities. This is information that is paramount to relay to the parent as they are deciding what decision to make for their child and to ensure that their expectations are realistic. The researchers also discussed the dilemma between implanting at a younger age and the fact that many disorders are difficult to diagnose at such an age. This is a critical factor to keep in mind when counseling parents prior to implantation because there is a change that additional disabilities could be found when the child gets older; if they are discovered after implantation, it can affect the child’s performance with the cochlear implant and the perceived benefits.

Opinion
The goal for this study is one that I had never considered before. So often with deaf children parents are not only dealing with the profound hearing loss but also concomitant disabilities that will affect their child’s performance. I thought the use of objective speech perception measures in combination with subjectively perceived benefits through the opinions of the parents was an appropriate method for measuring the outcomes. This is a unique sample and subjective results are often as important, if not more so, than objective outcomes. A larger sample group and a more homogenous sample could have been more beneficial in finding any correlations between etiology and post-operative performance. I would be interested to read follow-up studies, perhaps from the United States with children who speak English seeing as this study was conducted in Italy.


Abstract written by Blaire Staggs

Reference
Nott, P., Cowan, R., Brown, P.M., & Wigglesworth, G. “Early language development in children with profound hearing loss fitted with a device at a young age: part I – the time period taken to acquire first words and first word combinations.” Ear and Hearing, October, 2009, pg. 526-540. Accessed on Sunday, 13, September . http://www.ncbi.nlm.nih.gov/pubmed/19739282?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Purpose of Study
The purpose of this study was to determine the effects of a hearing loss on the acquisition of a child’s first vocabulary lexicon (100 words) and the beginning use of word combinations.

Subjects
24 children with profound hearing loss (23 were fitted with a cochlear implant and one was fitted with bilateral implants) and 16 children with normal hearing were compared. Of the children with hearing loss, all of the devices were turned on before 30 months of age (with half of those devices being turned on at less than 12 months of age.

Methods
The Diary of Early Language was used by the parents of the subjects to collect data. Parents recorded the first 100 single words spoken by their children as well as any word combinations. The development of single words as well as the transition to word combinations was compared by the number of days it took to reach single word targets (50 words, 100 words). The development of word combinations was compared two ways: first, by recording the number of days from the first production of the first word to the first use of word combinations and second, the number of single words in the vocabulary at the time word combinations were first used.

Results
The normal hearing group required an average of 1.9 months to develop the first 50 words, while the group with hearing loss required 3.9 months. Additionally, the normal hearing group showed production of word combinations in significantly fewer days than that of the group with hearing loss (amount not specified). However, the size of single word vocabulary lexicons was comparable between the groups when word combinations were first demonstrated.

Discussion
I found it to be very interesting, although not surprising that the group with normal hearing acquired language at a more rapid rate than those children with a profound hearing loss. I would have liked to know more detail about the nature of the hearing loss (e.g., was the hearing loss bilateral, what was the hearing loss diagnosis in each ear). This information would be very important when counseling parents as to the future communication abilities that are likely for their children. It is likely that some of parents’ initial concerns will be regarding the potential for language development within their children.

Opinion
This study appeared to be valid and provided great information regarding the development of the initial 100 word vocabulary of children with profound hearing loss as compared to children with normal hearing.


Abstract written by Kayla Thumann

Reference
Foster, Susan & Cue, Katie. “Roles and Responsibilities of Itinerant Specialist Teachers of Deaf and Hard of Hearing Students”. American Annals of the Deaf, Volume 153, No 5, Winter 2008/2009, 435-449. Accessed on Thursday, September 10, 2009 from E-journals database.

Purpose of study
The purpose of this study was to determine the roles of itinerant teachers in there relationship to children who are deaf or hard of hearing. The study also focused on where they learned the tasks of their jobs and if they would be interested in continuing education that directly related to their role as itinerant teachers who work with children who are deaf or hard of hearing.

Subjects
The subjects of the study were itinerant teachers from several states. 270 returned the surveys, 8 participated in the focus group and 2 were used for observation and interview. Most had worked with or graduated from a teacher preparation program at the National Technical Institute for the Deaf. All were itinerant teachers, who worked in educational settings with children who had been mainstreamed. They had an experience range from 1 year to 39 years of work. Some of the teachers still followed a pullout model while others followed a more collaborative model of teaching with the general education teacher.

Method
Written and electronic surveys were sent out in several states. There were also observations and field interviews conducted with itinerant teachers. Finally, a focus group of itinerant teachers was created to confirm the results from the surveys and observations.

Results
210 surveys were included in the final set of analysis, 60 surveys had to be thrown out due to the subject not meeting the criteria for the study. There were 5 questions that guided the analysis of the information: 1. Which kinds of tasks did respondents list the most often? 2. How did respondents rank the importance? 3. Where did respondents learn these tasks? 4. Did respondents fell that these tasks should be part of preparation program or continuing education? 5. If a workshop were offered about a task would respondent take it? Results from task done most often work with students was the most frequent response. This includes working with the child’s academics, personal/social life, language arts and communication. Other tasks included working with general education teachers; planning, assessing, and keeping records for the child; work with parents; providing technical support including troubleshooting hearing aids, cochlear implants, and FM systems. However, when asked which tasks were most important, many said that several tasks were of the same importance, but that working with other professionals was ranked first, then work with students, third was technical support. As for where these skills were learned 65% of the teachers learned on the job, with only 17% learning in an educational preparation program. Finally, when asked if these teachers thought that these tasks should be included in continuing education there was an overwhelming “yes” response.

Discussion
The study presented an important point for children who are deaf or hard of hearing, in en educational setting more education is needed for teachers who work with children who are deaf or hard of hearing. This can be applied clinically by developing additional trainings for these teachers. 65% of teachers learn their task with these children on the job, which is a high percentage of teachers who should have additional educational programming to give the children they work with the best resources that are available.

Opinion
I found this article to be enlightening about the lack of education that is available for teachers who work with deaf and hard of hearing children. It is also useful to know that these teachers are willing to attend continuing education for an increased amount of information on how to work better with these children and give them the best possible education.