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.