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.