Background. Permanent childhood hearing loss has a negative impact on children’s development. Early detection via universal newborn hearing screening makes early intervention possible. Evidence on how and why early intervention influences outcomes of children with hearing loss at school age is lacking. This paper draws on findings from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study, a prospective population-based study in Australia.

Objective. To examine the influence of early hearing intervention on the outcomes of children who are deaf or hard of hearing.

Method. Three-hundred and sixty-seven children completed assessments at earlier time points and at 9 years of age. In the cohort, 231 were using hearing aids and 158 were using cochlear implants. Standardized measures of language, cognitive abilities, and speech perception were directly administered. Quality of life was assessed using standardized questionnaires. The relationships among demographic characteristics, age at fitting of hearing aids or cochlear implants, and children’s outcomes were examined using multiple regression analysis and structural equation modelling. 

Result. The modelling is consistent with verbal short-term memory having a mediating effect on multiple outcomes. Better verbal short-term memory is associated with no additional disabilities, earlier age at cochlear implant activation, use of an oral communication mode in early intervention, and higher maternal education. In turn, verbal short-term memory directly and positively affects speech perception, language and quality of life.

Conclusion. This study found evidence consistent with early hearing intervention having a positive effect on speech perception and language via its effect on verbal short-term memory. Children who had better language also had better quality of life. The importance of early hearing for cognitive development lends support to early detection and early hearing intervention, including streamlining pathways for early CI activation. The implications for evidence-based clinical practice will be discussed.

Panel presentation of Current Approach to Auditory Neuropathy Spectrum Disease

Background: Approximately 10% of children born with a permanent hearing loss have auditory neuropathy. Implementation of universal newborn hearing screening has led to early detection and intervention. An increased understanding of the long-term achievements of children with auditory neuropathy is essential to developing a comprehensive account of expected outcomes of children for improving counselling and clinical management.

Objective. This study examined language and speech outcomes in a population-based cohort of 9-year-old children with hearing loss and auditory neuropathy, and investigated factors influencing outcomes.

Method. Receptive and expressive language skills, speech output accuracy, and a diverse set of cognitive, demographic and audiological, variables (including age at device fitting) were evaluated at 3-, 5- and 9-years of age using direct assessment and caregiver report. Multiple regression analyses were used to address two questions: 1) Do language and speech outcomes at earlier ages predict language and speech outcomes at 9 years of age? 2) Which cognitive, demographic and audiological variables measured at 9 years of age predict concurrent language and speech outcomes after controlling for early language and speech outcomes?

Result and Discussion. The influence of cognitive, demographic and audiological variables, including auditory neuropathy, on 9-year outcomes was quantified. The implications of results on clinical best-practice management of children with hearing loss and auditory neuropathy will be discussed.

In a world with many choices for hearing rehabilitation, this panel will address common themes in cochlear implantation. We will review several cases which highlight the decision making for diagnostic testing and patient selection. Additional cases will highlight the various electrode choices and strategies for post operative care, including programming options. Panelist will share tips on patient pre and post operative counseling to maximize patient satisfaction. Finally,  panelists will also discuss the option of cochlear implantation within the context of local resources and ways to maximize patient outcomes in under resourced environments.  

Permanent childhood hearing loss (PCHL) impacts negatively on children’s development and lives. Improved outcomes are associated with newborn hearing screening and early intervention. However, not all hearing loss manifests itself during the newborn period. The prevalence of childhood hearing loss increases from 1-1.2/1000 during the newborn period to about 2-4/1000 by 9 years of age. Global surveys revealed that only 33% of the world’s newborns have access to universal newborn hearing screening. Little is known about the status of screening and surveillance of hearing beyond the newborn period. The Coalition for Global Hearing Health Hearing Care Pathways Working Group (CGHH) conducted a survey to increase understanding of the status of hearing screening during early childhood, with a view to developing recommendations for establishing evidence-based programs in different resource settings to mitigate the negative impact of PCHL. 

Objective. This study aimed to explore current practice in hearing screening and intervention during early childhood in countries around the world.

Method. A custom-designed survey was conducted online using REDCap to gather information on the status of hearing screening, surveillance and intervention in early childhood before school entry, and on hearing screening for children at school age. Professionals, medical practitioners, allied health workers and educators were invited to participate to provide information about the region/country in which they provide services.

Result and Discussion. A total of 315 responses were received from respondents across 85 countries on current practice. We examined the diversity of service availability across regions/countries by population size and income level. Findings on current practice were summarized and reported according to WHO regions. The implications for developing new programs for detecting hearing loss during early childhood, and for fine-tuning existing programs will be discussed.