Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi.

BACKGROUND: Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems. METHODS: A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation. RESULTS: Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed. CONCLUSIONS: The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.

The Use of Telepractice to Administer Norm-Referenced Communication and Cognition Assessments in Children With Hearing Loss: A Rapid Review.

PURPOSE: Telepractice administration of norm-referenced assessments of communication and cognition is relatively new, and evidence to support this practice for children with hearing loss is limited. This rapid review examines the validity, reliability, feasibility, and common features of telepractice-administered norm-referenced assessments of communication and cognition for children with hearing loss to determine whether results via telepractice-administration are usable. METHOD: This rapid review was conducted in accordance with the Cochrane Collaboration Rapid Reviews Methods Group recommendations. Rayyan software was used for initial and full-text screening, and the Quality Assessment of Diagnostic Accuracy Studies was used to measure study quality. RESULTS: Electronic databases searches identified two studies that met the eligibility criteria. The findings of this rapid review provide some evidence to indicate that results of norm-referenced assessments do not differ depending on test administration conditions or hearing group status. Although both studies were of sufficient quality, replicability of these studies is uncertain due to the limited description of telepractice administration procedures. Participants indicated that sound levels provided by inbuilt computer speakers were adequate for them to be able to participate in telepractice assessment. CONCLUSION: Telepractice administration of the norm-referenced assessments in the included studies may be valid, reliable, and feasible; however, the generalizability of these findings to other norm-referenced assessments is uncertain due to the limited amount of research.

Routine ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: a national consensus statement.

This consensus statement provides new recommendations for primary care assessment of ear health and hearing status of young Aboriginal and Torres Strait Islander children who are not known to have, or are not being actively managed for, ear health and hearing problems. Any child identified with otitis media should be actively managed. This national consensus statement extends existing treatment and management guidelines. MAIN RECOMMENDATIONS: Undertake checks at least 6-monthly, commencing at 6 months until 4 years of age, then at 5 years. Undertake checks more frequently in high risk settings for children under 2 years, when acceptable to families, or in response to parent/carer concerns. Ask parents/carers about concerns, signs, and symptoms; check children's listening and communication skills; and assess middle ear appearance and mobility. Otoacoustic emissions testing is suggested when equipment is available, primary health practitioners have capability and confidence to use the equipment, and there is local preference for its use. Video otoscopy is suggested for health promotion purposes, and/or for sharing images with other health practitioners. Audiometry should be done as per existing guidelines: when there are parent/carer concerns, signs of persistent/recurrent otitis media, or when listening and communication development is not yet on track. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Key practice changes include routine use of tympanometry, and listening and communication skills checklists. Implementation will require access to equipment and training; clear information on immediate, practical actions for families; timely pathways to referral services; and a change management process that shifts perception and tolerance of otitis media and its impacts and raises expectations that Aboriginal and Torres Strait Islander children can have healthy ears and hearing.

'Sometimes they're gammin, playing tricks, but sometimes it's ears.' The perspectives of urban parents and carers of young Aboriginal and Torres Strait Islander children on their journey to diagnosis of persistent ear health and hearing problems.

OBJECTIVES: Data presented in this paper were gathered during the Urban Hearing Pathways study. The objective of the study was to investigate how access to, and availability of, ear health and hearing services contributes to the burden of avoidable hearing loss experienced by young, urban Aboriginal and Torres Strait Islander children and their families. The objective of this paper is to present the perspectives of parents and carers about awareness and concern in their community, detection and diagnosis of children's ear health and hearing problems in primary care, and impacts of delays in diagnosis on children and families. These perspectives are complemented by those of health professionals. Importance of study: The study findings address an evidence gap relating to factors that prompt an ear health and hearing check for young, urban Aboriginal and Torres Strait Islander children. They reveal the difficulties families experience in establishing a diagnosis of chronic ear disease and receiving the care they perceive will effectively addresses their child's needs. STUDY TYPE: Qualitative study with surveys. METHODS: The project team consisted of six Aboriginal researchers and 10 non-Indigenous researchers. Data collection tools and methods were designed by the project team. A total of 33 parents and carers completed surveys, and most also took part in interviews (n = 16) or focus groups (n = 16); 23 described their child's ear health journey. Fifty-eight service providers from the health, early childhood and community service sectors completed anonymous surveys and 26 were interviewed. Descriptive statistics were generated from survey data and thematic analysis was conducted for interview and focus group data. RESULTS: Five main themes emerged from the analysis of parent and carer interviews: community knowledge and parent/carer recognition of signs of ear health and hearing problems; parent and carer action-taking; getting ear health and hearing checks; recognition of persistent problems; and impacts of delays on children and families. CONCLUSIONS: Reiterating previous findings, there is no evidence of a systematic approach to ear checks for this at-risk population. A significant proportion of parents and carers are noticing problems by watching their child's listening behaviours: early and reliable indicators of hearing status that can be harnessed. Some persistent ear health problems are being managed in primary care as acute episodes, thus delaying specialist referral and increasing developmental impacts on the child. Parents' and carers' practical recommendations for improving hearing health services are presented.

Listener characteristics modulate the semantic processing of native vs. foreign-accented speech.

Foreign accents have been shown to have considerable impact on how language is processed [1]. However, the impact of a foreign accent on semantic processing is not well understood. Conflicting results have been reported by previous event-related potential (ERP) studies investigating the impact of foreign-accentedness on the N400 effect elicited by semantic violations. Furthermore, these studies have only examined a subset of the four characteristics of the N400 (i.e. onset latency, latency, amplitude, and scalp distribution), and have been conducted in linguistic environments where foreign-accented speech is relatively uncommon. The current study therefore compared the N400 effect elicited by semantic violations in native Australian English vs. Mandarin-accented English, in a context where foreign-accented speech is common. Factors which may be responsible for individual variability in N400 amplitude were also investigated. The results showed no differences between the N400s elicited by native and foreign-accented speech in any of the four aforementioned characteristics. However, the analysis of individual variability revealed an effect of familiarity with foreign-accented speech on the amplitude of N400 effects for semantic violations. An effect of working memory capacity on N400 amplitude was also found. These findings highlight the relevance of the ambient linguistic environment for studies of speech processing, and demonstrate the interacting influences of both speaker- and listener-related factors on semantic processing.

Effects of Type of Agreement Violation and Utterance Position on the Auditory Processing of Subject-Verb Agreement: An ERP Study.

Previous ERP studies have often reported two ERP components-LAN and P600-in response to subject-verb (S-V) agreement violations (e.g., the boys (*) runs). However, the latency, amplitude and scalp distribution of these components have been shown to vary depending on various experiment-related factors. One factor that has not received attention is the extent to which the relative perceptual salience related to either the utterance position (verbal inflection in utterance-medial vs. utterance-final contexts) or the type of agreement violation (errors of omission vs. errors of commission) may influence the auditory processing of S-V agreement. The lack of reports on these effects in ERP studies may be due to the fact that most studies have used the visual modality, which does not reveal acoustic information. To address this gap, we used ERPs to measure the brain activity of Australian English-speaking adults while they listened to sentences in which the S-V agreement differed by type of agreement violation and utterance position. We observed early negative and positive clusters (AN/P600 effects) for the overall grammaticality effect. Further analysis revealed that the mean amplitude and distribution of the P600 effect was only significant in contexts where the S-V agreement violation occurred utterance-finally, regardless of type of agreement violation. The mean amplitude and distribution of the negativity did not differ significantly across types of agreement violation and utterance position. These findings suggest that the increased perceptual salience of the violation in utterance final position (due to phrase-final lengthening) influenced how S-V agreement violations were processed during sentence comprehension. Implications for the functional interpretation of language-related ERPs and experimental design are discussed.

The interaction of lexical tone, intonation and semantic context in on-line spoken word recognition: an ERP study on Cantonese Chinese.

In two ERP experiments, we investigate the on-line interplay of lexical tone, intonation and semantic context during spoken word recognition in Cantonese Chinese. Experiment 1 shows that lexical tone and intonation interact immediately. Words with a low lexical tone at the end of questions (with a rising question intonation) lead to a processing conflict. This is reflected in a low accuracy in lexical identification and in a P600 effect compared to the same words at the end of a statement. Experiment 2 shows that a strongly biasing semantic context leads to much better lexical-identification performance for words with a low tone at the end of questions and to a disappearance of the P600 effect. These results support the claim that semantic context plays a major role in disentangling the tonal information from the intonational information, and thus, in resolving the on-line conflict between intonation and tone. However, the ERP data indicate that the introduction of a semantic context does not entirely eliminate on-line processing problems for words at the end of questions. This is revealed by the presence of an N400 effect for words with a low lexical tone and for words with a high-mid lexical tone at the end of questions. The ERP data thus show that, while semantic context helps in the eventual lexical identification, it makes the deviation of the contextually expected lexical tone from the actual acoustic signal more salient.

An ERP study of good production vis-à-vis poor perception of tones in Cantonese: implications for top-down speech processing.

This study investigated a theoretically challenging dissociation between good production and poor perception of tones among neurologically unimpaired native speakers of Cantonese. The dissociation is referred to as the near-merger phenomenon in sociolinguistic studies of sound change. In a passive oddball paradigm, lexical and nonlexical syllables of the T1/T6 and T4/T6 contrasts were presented to elicit the mismatch negativity (MMN) and P3a from two groups of participants, those who could produce and distinguish all tones in the language (Control) and those who could produce all tones but specifically failed to distinguish between T4 and T6 in perception (Dissociation). The presence of MMN to T1/T6 and null response to T4/T6 of lexical syllables in the dissociation group confirmed the near-merger phenomenon. The observation that the control participants exhibited a statistically reliable MMN to lexical syllables of T1/T6, weaker responses to nonlexical syllables of T1/T6 and lexical syllables of T4/T6, and finally null response to nonlexical syllables of T4/T6, suggests the involvement of top-down processing in speech perception. Furthermore, the stronger P3a response of the control group, compared with the dissociation group in the same experimental conditions, may be taken to indicate higher cognitive capability in attention switching, auditory attention or memory in the control participants. This cognitive difference, together with our speculation that constant top-down predictions without complete bottom-up analysis of acoustic signals in speech recognition may reduce one's sensitivity to small acoustic contrasts, account for the occurrence of dissociation in some individuals but not others.