Hearing Loss Determining Eligibility for Social Security Benefits (2005) / Chapter Skim
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7 Hearing Loss in Children
7 Hearing Loss in Children
Pages 180-223
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From page 180... ...
Consequently, if appropriate early intervention does not occur within the first 6-12 months, hearing loss or deafness, even if mild, can be devastating to the development of spoken communication with hearing family and peers, to the development of sophisticated language use, and to many aspects of educational development, if environmental compensation does not occur. Hearing loss can affect the development of children's ability to engage in age-appropriate activities, their functional speech communication skills, and their language skills.
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From page 181... ...
We give details of the special nature of assessments and rehabilitation strategies appropriate for infants and children with hearing loss and finally discuss how considerations for disability determination need to be tailored to the special needs of this population. DEVELOPMENT OF PERCEPTION, SPEECH PRODUCTION, AND LANGUAGE Children with Normal Hearing Speech Skills Infants begin to differentiate among various sound intensities almost immediately after birth and, by 1 week of age, can make gross distinctions between tones.
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From page 182... ...
. In summary, by age 41/2 years, children with normal hearing are producing complex sentences.
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From page 183... ...
Natural acquisition of speech and spoken language is not often seen in individuals with profound hearing loss unless appropriate intervention is initiated early. One of the primary goals in fitting deaf or hard-ofhearing children with auditory prostheses (hearing aid or cochlear implant)
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From page 184... ...
Thus, reduced speech intelligibility can result. Language Skills Vocabulary knowledge in children with hearing loss may be age appropriate or reduced, with results showing large variability (Gilbertson and Kamhi, 1995; Seyfried and Kricos, 1996; Yoshinaga-Itano, 1994)
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From page 185... ...
. Unilateral Hearing Loss A study published in 1998 estimated that the prevalence of unilateral hearing loss in school-age children ranged from 6.4 to 12.3 per 1,000 and at that time there were 391,000 school-age children with unilateral hearing loss (Lee, Gomez-Marin, and Lee, 1998)
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From page 186... ...
, the importance of early intervention, including suitable amplification or cochlear implantation, can be seen. It is generally agreed that such intervention procedures are most effective when initiated as early as possible after the identification of the hearing loss (Silverman, 1983)
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From page 187... ...
The primary communication mode in educational settings is strongly related to degree of hearing loss. Specifically, those with profound losses are typically educated in programs that use signing or signing with speech, while students with milder hearing losses are most typically in speech-based programs.
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From page 188... ...
It is known that poor classroom acoustics (Acoustical Society of America, 2000) exacerbate difficulties in development of speech perception and eventually contribute to language and cognitive problems (Nelson, Soli, and Seltz, 2002)
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From page 189... ...
Currently all 50 states have legislation either passed or pending to mandate universal newborn hearing screening, or they are conducting screening for most newborns without legislation. Neonatal hearing screening programs have proven effective as the first step in early identification of infants with congenital hearing loss.
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From page 190... ...
. The goal of early hearing detection and intervention programs is to identify hearing loss and begin intervention including fitting of hearing aids at or before 6 months of age.
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From page 191... ...
. Other physiological measures that correlate with hearing levels and support the test battery include tympanometry, acoustic middle ear muscle reflex, and OAEs.
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From page 192... ...
This procedure limits the conclusions of the tests to hearing in the better ear and cannot determine a unilateral hearing loss. Generally, normally hearing 6-month-old infants will respond to stimuli of 20 dB HL or better (Widen and O'Grady, 2002)
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From page 193... ...
When this condition exists, neither the ABR nor the OAE can be used to predict hearing levels. The hearing loss in patients with auditory neuropathy can be of any degree, and their speech perception ability is severely disordered.
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From page 194... ...
. This would make it impossible to distinguish between mild hearing loss and normal hearing, which is critically important for determination of amplification needs.
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From page 195... ...
Spoken Word Recognition Tests utilizing speech stimuli can help to determine the extent to which a hearing loss affects the ability to perceive, recognize, and discriminate speech sounds. This information can be useful in diagnosing the type and severity of the hearing disorder, in assessing candidacy for sensory aid use (hearing aid versus cochlear implant)
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From page 196... ...
In fact, this age guideline for recorded test administration has been adopted in recent clinical trials of cochlear implant use in children. Open-Set Versus Closed-Set Test Formats Open-set tests are those in which listeners theoretically have an unlimited number of response possibilities.
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From page 197... ...
Whenever possible, it is best to evaluate word recognition using tests containing multiple talkers or competing stimuli. Multimodal Spoken Word Recognition Information in the speech signal is conveyed through both the auditory and the visual modalities in face-to-face conversation.
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From page 198... ...
By the time children reach the age of 3 years, they may be able to participate in formal spoken word recognition testing. Many measures of spoken word recognition have been developed over the years.
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From page 199... ...
of spoken word recognition (Luce and Pisoni, 1998)
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From page 200... ...
was developed to assess spoken word recognition in children with limited vocabularies who could not read. The test consists of six-picture plates that can be used to evaluate recognition of four different lists of 25 monosyllabic words.
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From page 201... ...
Finally, spontaneous samples provide a representative sample of the child's usual speech and expressive language skills. When assessing speech production skills, it is common for the examiner to score children's responses on-line, or to record the responses for later transcription by another clinician.
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From page 202... ...
In those cases, surgically administered cochlear implants can be used to sample environmental sounds, transduce sounds into a series of electrical impulses, and present these representations of the sound to the auditory nerve directly through the inner ear. Fitting of prosthetic devices to children is a complex process.
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From page 203... ...
Hearing aids equipped with direct audio input connectors can be adapted for this application. Infants and children may not have the sophistication to participate in loudness discomfort measures or to manipulate a volume control to avoid loud sounds.
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From page 204... ...
. As children develop, speech perception ability is monitored as a metric of aided performance.
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From page 205... ...
These scales probe for hearing aid use, acceptance, and basic auditory development. The Listening Inventories for Education (LIFE)
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From page 206... ...
Boothroyd and colleagues have developed an imitative speech perception test that allows for evaluation of speech feature perception in toddlers and has the added attraction of allowing a comparison of visual, auditory, and auditory + visual perception ability (Kosky and Boothroyd, 2003)
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From page 207... ...
, published data on communication outcomes (language, speech perception, speech production) that confirm the utility of early amplification are not currently available.
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From page 208... ...
demonstrated that children with hearing loss ages 8 to 20 performed better on speech perception when using their own amplification devices than when evaluated with amplified speech presented through an audiometer. She attributes much of this finding to the fact that the children had accommodated to their amplification and were familiar with the amplification characteristics.
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From page 209... ...
Cochlear Implant Communication Outcomes in Children Spoken Word Recognition In early investigations, children who used previous generations of cochlear implant systems demonstrated significant improvement in closed-set word identification but very limited open-set word recognition (Miyamoto et al., 1989; Staller, Beiter, Brimacombe, Meckelenburg, and Arndt, 1991)
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From page 210... ...
The speech perception abilities of pediatric cochlear implant recipients met or exceeded those of their peers with unaided pure-tone average thresholds 90 dB HL who use hearing aids (Meyer, Svirsky, Kirk, and Miyamoto, 1998; Svirsky and Meyer, 1999)
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From page 211... ...
Speech Intelligibility and Language Improvements in speech perception are the most direct benefit of cochlear implantation. However, if children with cochlear implants are to be fully integrated into the hearing world, they must also acquire the language of their surrounding community and be able to produce it intel
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From page 212... ...
The researchers reported that the children with cochlear implants differed from children with normal hearing in their ability to utilize correct grammatical structures and verb forms. This information should be useful in designing appropriate educational models for children with cochlear implants.
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From page 213... ...
With earlier implantation and improved cochlear implant systems come continued increases in the benefits of cochlear implantation. Although wide variability in outcomes is noted, cochlear implant use by children with severe to profound hearing loss promotes the development of speaking and listening skills and the development of a spoken language system beyond what previously could be achieved with hearing aids.
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From page 214... ...
. Presentation of the speech perception test is via sound field using personal amplification or cochlear implant if such is used by the child.
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From page 215... ...
215 norm norm norm standard standard standard below below below 1.64 age.
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From page 216... ...
Although the hearing level criterion for disability is less stringent at this age for a child than for an adult, it should be noted that a child with a moderate hearing loss whose speech perception skills and language ability are normal for his or her age may not be considered disabled. As these communication skills emerge, more emphasis is placed on them and the criterion for hearing level is raised.
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From page 217... ...
Therefore, the determination of disability requires assessment of a variety of communication skills. We chose the domains of speech perception and language processing because they are directly affected by childhood hearing loss and provide an important foundation for spoken language communication, reading, and multiple facets of educational achievement.
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From page 218... ...
Table 7-4 summarizes the characteristics of the spoken word recognition measures described in this chapter. The committee has not recommended assessment of speech perception in noise for children, although to do so in our view would increase the sensitivity of the testing for disability.
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From page 219... ...
For each checklist item, a response in the shaded box indicates that the response is invalid or needs explanation, as discussed below. Test Items per Score significantly Stimuli List / # of Lists Response < 90 percent correcta Monosyllabic words 50 / 4 Picture pointing < 40 words correct Monosyllabic words 20 / 1 Picture pointing < 15 words correct Sentences 10 / 1 Not applicable Monosyllabic words 25 /4 Picture pointing < 19 words correct 2-3 syllable words 24 /2 Imitation < 18 words correct Monosyllabic words 50 / 2 Imitation < 40 words correct Sentences 10 / 6 Imitation Not applicable Sentences 10 / 13 Imitation Not applicable
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From page 220... ...
Yes No 7. Does the child use personal amplification or a cochlear implant?
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From page 221... ...
Item 7. Speech testing should be performed with the child using the hearing aid or cochlear implant if it is regularly used.
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From page 222... ...
Many studies have documented the expected outcomes for children using cochlear implants, yet documenting benefits and outcomes of amplification use in children is a more complex task, and few controlled studies exist. More prospective studies of children using amplification are needed to determine related outcomes for communication, socialization, and educational achievement.
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From page 223... ...
There is a need to understand the effects of slight and unilateral hearing loss on the development of communication skills, educational performance, and social adjustment. Studies are needed to reveal the true nature of the dysfunction these children experience, especially in educational settings, and the possibilities for intervention that may help to mitigate such disturbances.
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