Best ear hearing level, time factors and language outcome in Swedish children with mild and moderate hearing loss with hearing aids.

AIM: The risk for language disorder is high in children with all levels of hearing loss (HL). Early identification and intervention should be as important for children with mild HL as for those with more severe HL. Despite new-born hearing screening, a recent survey of speech language therapist services in southern Sweden indicates that children with mild and moderate HL are severely neglected when it comes to language assessment and language intervention. In this study we explore associations between Best Ear Hearing Level (BEHL), time factors and language skills in Swedish children with HL with hearing aids (HA). METHOD: Participants were 19 children with mild HL (BEHL 23-39) and 22 children with moderate HL (BEHL 40-70) aged 5-15 years. Information on age at diagnosis and at HA fitting were collected. The children performed a nonword repetition and a sentence comprehension task. RESULTS: The time elapsed between diagnosis and fitting with HA was longer for the children with mild HL.Participants with mild HL received their HA significantly later than children with moderate HL. No association between BEHL and the two language measures was found, and language skills were not better in children with mild than moderate HL. 17% of participants performed below cut-off for language disorder on both language measures. CONCLUSION: Given the risk for long-term academic and social consequences of even mild HL delayed HA intervention for children with HLleads to serious concerns by families, clinicians, and pedagogues.

The effect of repeated measurements and working memory on the most comfortable level in the ANL test.

OBJECTIVE: To study the effect of a large number of repetitions on the most comfortable level (MCL) when doing the acceptable noise level (ANL) test, and explore if MCL variability is related to central cognitive processes. DESIGN: Twelve MCL repetitions were measured within the ANL test using interleaved methodology during one session using a non-semantic version. Phonological (PWM) and visuospatial working memory (VSWM) was measured. STUDY SAMPLE: Thirty-two normal-hearing adults. RESULTS: Repeated measures ANOVA, intraclass correlations, and the coefficient of repeatability (CR) were used to assess the repeatability. Repeated measures ANOVA and CR indicated poor agreement between the two first repetitions. After excluding the first repetition, analyses showed that the MCL in the ANL test is reliable. A negative association was found between PWM and MCL variability indicating that subjects with higher PWM show less variability. CONCLUSIONS: The findings suggest that, after excluding the first repetition, the MCL in the ANL test is reliable. A single repetition of the MCL in the ANL test should be avoided. If an interleaved methodology is used, a single ANL repetition should be added prior to the actual testing. The findings also suggest that MCL variability is associated to PWM but not VSWM.

Factors affecting severity of tinnitus - a follow-up study of tinnitus subjects at an Ear Nose Throat clinic in Sweden.

OBJECTIVE: The aim of the present study was to examine whether perceived tinnitus severity changes over time, and if so what factors contribute to this change. DESIGN: A modified Swedish version of tinnitus severity questionnaire (MS-TSQ) was used to examine changes in tinnitus severity over a period of time. STUDY SAMPLE: The MS-TSQ questionnaire was completed by 455 subjects visiting an Ear, Nose and Throat (ENT) clinic in Sweden as part of baseline assessment (Sb). The same questionnaire was completed during follow-up assessment (Sf) by 174 of these subjects to examine changes in tinnitus severity, if any. The difference in scores obtained from the two assessments was calculated and was termed as difference scores (Sd). RESULTS: RESULTS of analyses of variance (ANOVA) indicated significant reduction in tinnitus severity from Sb to Sf scores (p < 0.001). Subjects with noise induced hearing loss showed significantly lower Sd scores than subjects with unspecified sensorineural hearing loss (p < 0.01). The group who received psychological treatment for tinnitus obtained significantly higher Sd than those who did not (p < 0.01). CONCLUSIONS: RESULTS provide valuable framework for understanding the factors that affect tinnitus severity over a period of time.

Acceptance of background noise, working memory capacity, and auditory evoked potentials in subjects with normal hearing.

BACKGROUND: The acceptable noise level (ANL) test is a method for quantifying the amount of background noise that subjects accept when listening to speech. Large variations in ANL have been seen between normal-hearing subjects and between studies of normal-hearing subjects, but few explanatory variables have been identified. PURPOSE: To explore a possible relationship between a Swedish version of the ANL test, working memory capacity (WMC), and auditory evoked potentials (AEPs). RESEARCH DESIGN: ANL, WMC, and AEP were tested in a counterbalanced order across subjects. STUDY SAMPLE: Twenty-one normal-hearing subjects participated in the study (14 females and 7 males; aged 20-39 yr with an average of 25.7 yr). DATA COLLECTION AND ANALYSIS: Reported data consists of age, pure-tone average (PTA), most comfortable level (MCL), background noise level (BNL), ANL (i.e., MCL - BNL), AEP latencies, AEP amplitudes, and WMC. Spearman's rank correlation coefficient was calculated between the collected variables to investigate associations. A principal component analysis (PCA) with Varimax rotation was conducted on the collected variables to explore underlying factors and estimate interactions between the tested variables. Subjects were also pooled into two groups depending on their results on the WMC test, one group with a score lower than the average and one with a score higher than the average. Comparisons between these two groups were made using the Mann-Whitney U-test with Bonferroni correction for multiple comparisons. RESULTS: A negative association was found between ANL and WMC but not between AEP and ANL or WMC. Furthermore, ANL is derived from MCL and BNL, and a significant positive association was found between BNL and WMC. However, no significant associations were seen between AEP latencies and amplitudes and the demographic variables, MCL, and BNL. The PCA identified two underlying factors: One that contained MCL, BNL, ANL, and WMC and another that contained latency for wave Na and amplitudes for waves V and Na-Pa. Using the variables in the first factor, the findings were further explored by pooling the subjects into two groups according to their WMC (WMClow and WMChigh). It was found that the WMClow had significantly poorer BNL than the WMChigh. CONCLUSIONS: The findings suggest that there is a strong relationship between BNL and WMC, while the association between MCL, ANL, and WMC seems less clear-cut.

'You sometimes get more than you ask for': responses in referential communication between children and adolescents with cochlear implant and hearing peers.

BACKGROUND: This study investigates responses to requests for clarification in conversations between children/adolescents with cochlear implant (CI) and normally hearing peers. Earlier studies have interpreted a more frequent use of requests of confirmation (yes/no interrogatives) in the CI group as a conversational strategy used to prevent communication breakdowns and control the development of the conversation. This study provides a continuation of this line of research, now focusing on responses to requests for clarification. AIMS: The aim was to examine the type and distribution of responses to requests for clarification in a referential communication task. In addition, we analysed the compliance between the type of response and the type of request as a measure of mutual adaptation. METHODS & PROCEDURES: Twenty-six conversational pairs aged 10-19 years participated: 13 pairs consisting of a child/adolescent with CI (CI) and a conversational partner (CIP); and 13 pairs consisting of a normally hearing control (NH) and a conversational partner (NHP). The pairs performed a referential communication task requiring the description of faces. All occurrences of requests for clarification and their responses in the dialogues were identified and categorized. We also analysed how the different types of requests and responses were combined and the type-conformity of the responses to requests for confirmation. OUTCOMES & RESULTS: The results showed no significant group differences regarding type, distribution or type-conformity of responses. In all four groups (CI, CIP, NH and NHP), a discrepancy between the request and the response was found, indicating that the response provided information that was not explicitly requested. Requests for confirmation constituted 78-90% of the requests, whereas only 54-61% of responses were confirmations. Conversely, the proportion of requests for elaboration was 6-15%, whereas the proportion of elaborated responses was 34-40%. CONCLUSIONS & IMPLICATIONS: The children/adolescents with CI contribute equally to the conversation regarding type and distribution of responses to requests for clarification. The frequent use of elaborated responses indicates common ground for the conversational partners and a shared understanding of the objective of the task. The context creates facilitative conditions, with positive interactional consequences. The results have implications for the design of intervention, where tasks such as this can be used to make children with CI more aware of the role of questioning strategies in interaction.

Vowel spaces in Swedish adolescents with cochlear implants.

This paper examines vowel production in Swedish adolescents with cochlear implants. Twelve adolescents with cochlear implants and 11 adolescents with normal hearing participated. Measurements were made of the first and second formants in all the nine long Swedish vowels. The values in hertz were bark-transformed, and two measures of the size of the vowel space were obtained. The first of them was the average Euclidean distance in the F1-F2 plane between the nine vowels and the mean F1 and F2 values of all the vowels. The second was the mean Euclidean distance in the F1-F2 plane between all the vowels. The results showed a significant difference for both vowel space measures between the two groups of adolescents. The cochlear implant users had a smaller space than the adolescents with normal hearing. In general, the size of the vowel space showed no correlations with measures of receptive and productive linguistic abilities. However, the results of an identification test showed that the listeners made more confusions of the vowels produced by speakers who had a small mean distance in the F1-F2 plane between all the vowels.

Cognitive development, reading and prosodic skills in children with cochlear implants.

This report summarizes some of the results of studies in our laboratory exploring the development of cognitive, reading and prosodic skills in children with cochlear implantation (CI). The children with CI performed at significantly lower levels than the hearing comparison group on the majority of cognitive tests, despite showing levels of nonverbal ability. The differences between children with CI and hearing children were most pronounced on tasks with relatively high phonological processing demands, but they were not limited to phonological processing. Impairment of receptive and productive prosody was also evident in children with CI. Despite these difficulties, 75% of the children with CI reached a level of reading skill comparable to that of hearing children. The results are discussed with respect to compensation strategies in reading.

Deaf teenagers with cochlear implants in conversation with hearing peers.

BACKGROUND: This study investigates the use of requests for clarification in conversations between teenagers with a cochlear implant (CI) and hearing peers. So far very few studies have focused on conversational abilities in children with CI. AIMS: The aim was to explore co-construction of dialogue in a referential communication task and the participation of the teenagers with CI in comparison with individually matched hearing children and teenagers (HC) by studying the use of requests for clarification. METHODS & PROCEDURES: Sixteen conversational pairs participated: eight pairs consisting of a child with CI and his/her hearing conversational partner (CIP); and eight pairs consisting of an HC and a conversational partner (HCP). The conversational pairs were videotaped while carrying out a referential communication task requiring the description of two sets of pictures depicting faces. The dialogues were transcribed and analysed with respect to the number of words and turns, the time it took for each pair to complete the tasks, and the occurrence and different types of requests for clarification that were used in each type of conversational pair and in each type of dialogue. OUTCOMES & RESULTS: The main finding was that the teenagers with CI produced significantly more requests for clarification than the HCs. The most frequently used type of request for clarification in all dialogues was request for confirmation of new information. Furthermore, there was a trend for the teenagers with CI to use this type of request more often than the HC. In contrast, the teenagers with CI used significantly fewer requests for confirmation of already given information and fewer requests for elaboration than the HC. CONCLUSIONS & IMPLICATIONS: The deaf teenagers with CI in the study seem to be equally collaborative and responsible conversational partners as the hearing teenagers. The interpretation is that certain conditions in this study facilitate their participation in conversation. Such conditions might be a calm environment, a task that is structured and without time limits and that the partner is well known to the teenager with CI.

Cognitive development in children with cochlear implants: relations to reading and communication.

The purpose of the present article is to present an overview of a set of studies conducted in our own laboratory on cognitive and communicative development in children with cochlear implants (CI). The results demonstrate that children with CIs perform at significantly lower levels on the majority of the cognitive tasks. The exceptions to this trend are tasks with relatively lower demands on phonological processing. A fairly high proportion of the children can reach a level of reading comprehension that matches hearing children, despite the fact that they have relatively poor phonological skills. General working memory capacity is further correlated with the type of questions asked in a referential communication task. The results are discussed with respect to issues related to education and rehabilitation.

Cognitive and linguistic skills in Swedish children with cochlear implants - measures of accuracy and latency as indicators of development.

The purpose of the present study was to examine working memory (WM) capacity, lexical access and phonological skills in 19 children with cochlear implants (CI) (5;7-13;4 years of age) attending grades 0-2, 4, 5 and 6 and to compare their performance with 56 children with normal hearing. Their performance was also studied in relation to demographic factors. The findings indicate that children with CI had visuospatial WM capacities equivalent to the comparison group. They had lower performance levels on most of the other cognitive tests. Significant differences between the groups were not found in all grades and a number of children with CI performed within 1 SD of the mean of their respective grade-matched comparison group on most of the cognitive measures. The differences between the groups were particularly prominent in tasks of phonological WM. The results are discussed with respect to the effects of cochlear implants on cognitive development.

A methodological contribution to the assessment of nonword repetition-a comparison between children with specific language impairment and hearing-impaired children with hearing aids or cochlear implants.

Poor nonword repetition is considered as a clinical marker of specific language impairment (SLI). In children with expressive language problems, the analysis and scoring procedures are often insufficiently described. We argue for a combined analysis of segmental and suprasegmental accuracy in nonword repetition tasks as well as an appreciation of gender differences. The view is taken based on empirical findings in a comparison between children with specific language impairment, children with mild/moderate hearing impairment and hearing aids (HI), and children with severe to profound hearing impairment with cochlear implants (CI). With age and gender taken into consideration, the main effects of both group and syllable level on a combined measure of segmental and suprasegmental accuracy remained. Although not necessarily an index of limited working memory capacity, persistently poor imitation of nonwords might be an indication of language impairment in children with mild/moderate HI and in children with CI.