Persisting speech difficulties at 7-8 years of age - a longitudinal study of speech production in internationally adopted children with cleft lip and palate.

AIM: To longitudinally investigate speech production (consonant proficiency, consonant errors and perceived velopharyngeal competence) in 17 internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) at three time points. METHOD: Consonant proficiency (percent consonants correct, consonant inventory) and number and type of consonant errors were calculated based on blind phonetic transcriptions of words from the Swedish Test of Articulation and Nasality (SVANTE). Velopharyngeal competence was perceptually rated by three blinded experienced speech-language pathologists at the ages of 3, 5 and 7-8 years. RESULTS: A significant positive development of speech production was found, although most children still scored very low for consonant proficiency at the age of 7-8 compared with normative values: the median for percent consonants correct was 79.7 and many children still had persisting cleft-related and developmental consonant errors. At the age of 7-8, almost half of the children were rated as having a competent velopharyngeal function and only three as having an incompetent velopharyngeal function. CONCLUSION: Persisting speech difficulties at school age in IA children with UCLP were found in the present study, which is one of the very few longitudinal studies. Our results highlight the need for detailed follow-up of speech production in clinical settings. Speech disorders may have a severe impact on a child's intelligibility and participation with peers, and there is a need for more studies investigating the actual everyday effect of the difficulties found.

A validation study of the Swedish version of the Glasgow hearing aid benefit profile evaluated in otosclerosis subjects.

Objectives: The aim of this study was to translate the Glasgow Benefit Hearing Aid Profile (GHABP) to Swedish, and to analyze its validity and reliability in patients undergoing rehabilitation with surgery or hearing aids. Methods: The GHABP was translated to Swedish following published guidelines. One version of the questionnaire was adapted to fit the surgical intervention. A modification was made to the questionnaire by removing the answer option "not applicable" (N/A) since it was found confusing by the subjects. A prospective multicenter cohort study was performed to validate the questionnaire. One hundred and twenty-three individuals diagnosed with otosclerosis were included in the study prior to the intervention. The individuals were divided into three groups based on the intervention and previous hearing aid experience. Pure tone audiometry was performed 1 month prior and 1 year after the intervention. The Swedish version of the GHABP was completed by the individuals prior to the intervention, as well as 6 and 12 months after the intervention. Validity and reliability were assessed. Results: The Swedish versions of the GHABP were well accepted by the included individuals. The questionnaires showed good psychometric properties, with comparable results for the two different interventions and three separate intervention groups. Initial disability was more pronounced in more challenging listening situations. Disability was reduced after the intervention. The "Use," "Benefit," and "Satisfaction" domains demonstrated beneficial results; however, a ceiling effect was noted in the same domains. The reliability was overall very high. Conclusion: The Swedish version of the GHABP had good psychometric properties, with high validity and reliability. The same outcomes were found for the hearing aid and surgery groups. A ceiling effect was observed that can affect the questionnaire's ability to distinguish between subjects and measures over time. Level of evidence: 2c.

Tinnitus in immigrants attending Swedish language education classes.

Objectives: The aim of this study was to investigate the prevalence of tinnitus in immigrants attending Swedish language education classes in comparison with data from the general population and tinnitus's relation to hearing in this specific population. Methods: The study was based on prospectively collected data regarding hearing and health status in newcomers attending language classes. The examination consisted of pure tone audiometry, an otoscopic examination, and a study-specific questionnaire including questions from the Swedish National Health Survey. Data from the Swedish general population were retrieved from the National Health Survey. Grading of hearing according to the World Health Organization was applied. Results: A total of 188 study participants were included in the study. Tinnitus was reported by 38% of the immigrants, and severe tinnitus was reported by 8%. Corresponding percentages from the general population were 17% and 3%. High-frequency hearing loss (PTAh3 > 25 worse ear) was found to be a significant predictor for tinnitus (p = 0.032, odds ratio (OR): 2.74 [95% confidence interval (CI): 1.40-5.35]). Additionally, self-reported general health significantly predicted tinnitus, with an increased risk of tinnitus relating to worse general health (p < .001, OR: 2.43 [95% CI: 1.66-3.57]). Conclusion: Severe tinnitus was more than three times as common in the immigrant participants compared to the Swedish population. High-frequency hearing loss and self-reported worse general health were predictors for tinnitus. Level of Evidence: 1b.

Psychometric properties of the Swedish version of the Glasgow Benefit Inventory in otosclerosis subjects.

OBJECTIVE: To evaluate the psychometric properties of the Swedish version of the Glasgow Benefit Inventory (GBI). METHODS: A prospective multicenter cohort study was conducted. A total of 123 otosclerosis subjects were included in the study. The subjects were divided in three groups based on the following interventions: (a) stapedotomy without any prior hearing-aid rehabilitation (n = 60); (b) hearing-aid rehabilitation without any prior stapedotomy (n = 33); and (c) stapedotomy with prior hearing-aid rehabilitation (n = 30). Pre- and post-operative pure tone audiometry were measured. The Swedish version of the GBI was completed by the subjects 6 months after the intervention. Test-retest reliability and internal consistency, factor analysis, construct validity, and criterion validity, was assessed. RESULTS: The Swedish version of the GBI was well accepted by the subjects. It showed good psychometric properties with an overall high reliability. Factor analysis resulted in a 5-factor solution explaining 66.6% of the variance where factors 1 and 2 represented the general health domain. CONCLUSIONS: Overall, the Swedish version of the GBI showed good psychometric properties. Based on the factor analyses, there is the possibility that the general health domain should be divided in two separate domains: general health and psychosocial health. LEVEL OF EVIDENCE: 2c.

Understanding minds: early cochlear implantation and the development of theory of mind in children with profound hearing impairment.

OBJECTIVE: The present study investigates how auditory stimulation from cochlear implants (CI) is associated with the development of Theory of Mind (ToM) in severely and profoundly hearing impaired children with hearing parents. Previous research has shown that deaf children of hearing parents have a delayed ToM development. This is, however, not always the case with deaf children of deaf parents, who presumably are immersed in a more vivid signing environment. METHODS: Sixteen children with CI (4.25 to 9.5 years of age) were tested on measures of cognitive and emotional ToM, language and cognition. Eight of the children received their first implant relatively early (before 27 months) and half of them late (after 27 months). The two groups did not differ in age, gender, language or cognition at entry of the study. ToM tests included the unexpected location task and a newly developed Swedish social-emotional ToM test. The tests aimed to test both cognitive and emotional ToM. A comparison group of typically developing hearing age matched children was also added (n=18). RESULTS: Compared to the comparison group, the early CI-group did not differ in emotional ToM. The late CI-group differed significantly from the comparison group on both the cognitive and emotional ToM tests. CONCLUSION: The results revealed that children with early cochlear implants solved ToM problems to a significantly higher degree than children with late implants, although the groups did not differ on language or cognitive measures at baseline. The outcome suggests that early cochlear implantation for deaf children in hearing families, in conjunction with early social and communicative stimulation in a language that is native to the parents, can provide a foundation for a more normalized ToM development.

Identification of vowel length, word stress, and compound words and phrases by postlingually deafened cochlear implant listeners.

BACKGROUND: The accurate perception of prosody assists a listener in deriving meaning from natural speech. Few studies have addressed the ability of cochlear implant (CI) listeners to perceive the brief duration prosodic cues involved in contrastive vowel length, word stress, and compound word and phrase identification. PURPOSE: To compare performance in the perception of brief duration prosodic contrasts by CI participants and a control group of normal hearing participants. This study investigated the ability to perceive these cues in quiet and noise conditions, and to identify auditory perceptual factors that might predict prosodic perception in the CI group. Prosodic perception was studied both in noise and quiet because noise is a pervasive feature of everyday environments. RESEARCH DESIGN: A quasi-experimental correlation design was employed. STUDY SAMPLE: Twenty-one CI recipients participated along with a control group of 10 normal hearing participants. All CI participants were unilaterally implanted adults who had considerable experience with oral language prior to implantation. DATA COLLECTION AND ANALYSIS: Speech identification testing measured the participants' ability to identify word stress, vowel length, and compound words or phrases all of which were presented with minimal-pair response choices. Tests were performed in quiet and in speech-spectrum shaped noise at a 10 dB signal-to-noise ratio. Also, discrimination thresholds for four acoustic properties of a synthetic vowel were measured as possible predictors of prosodic perception. Testing was carried out during one session, and participants used their clinically assigned speech processors. RESULTS: The CI group could not identify brief prosodic cues as well as the control group, and their performance decreased significantly in the noise condition. Regression analysis showed that the discrimination of intensity predicted performance on the prosodic tasks. The performance decline measured with the older participants meant that age also emerged as a predictor. CONCLUSIONS: This study provides a portrayal of CI recipients' ability to perceive brief prosodic cues. This is of interest in the preparation of rehabilitation materials used in training and in developing realistic expectations for potential CI candidates.

The effect of emphasis and position on word identification by adult cochlear implant listeners.

This study examined the effect of emphasis and word position on word identification by postlingually deafened adult cochlear implant (CI) listeners (n = 20). These participants performed an identification task where Swedish (quasi-) minimal pairs were drawn from sentences and presented in a carrier sentence framework. It was found that emphasised stimuli were not identified more accurately than unemphasised stimuli. A regression analysis revealed a significant main effect for words drawn from the initial position in a sentence, however there was no interaction between original word position and emphasis. Post hoc analysis of the stimuli revealed that variations in the mean intensity of items arising from their original position in the sentence or emphasis status were unlikely to account for these results. These findings have implications for those who communicate regularly with CI listeners.

The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts.

OBJECTIVES: Children with cleft lip and palate universally present with otitis media with effusion. This prevalence has not been systematically studied. The purpose of the present study was to examine and compare the prevalence of otitis media with effusion, hearing sensitivity, and audiometry method utilised for assessment in children with and without clefts. METHODS: Two groups of children (children with unilateral cleft lip and palate, N=22, and children without clefts, N=20) were followed prospectively and longitudinally from 1 to 5 years of age. Data were collected at four points (1, 1.5, 3, and 5 years of age). Assessments at each of the four points included: (1) otomicroscopy, (2) tympanometry, and (3) hearing assessment. RESULTS: Overall the children with unilateral cleft lip and palate demonstrated a significantly higher prevalence of otitis media with effusion (121 ears, 74.7%) than children without clefts (31 ears, 19.4%) (p<0.001). This higher prevalence was also significant at 1, 1.5, 3, and 5 years of age (p<0.001). Of those ears with otitis media with effusion, 83.1% of the ears exhibited a hearing loss (PTA >20 dB), with this loss more prevalent in the cleft group (89.7% UCLP and 70.0% non-cleft). The hearing loss was significantly more pronounced in the cleft (group 35.71 dB HL UCLP and 26.41 dB HL non-cleft group). Children with unilateral cleft lip and palate utilised a lower age-appropriate audiometry testing method than age-matched children with no cleft at 1, 1.5, and 3 years of age. CONCLUSIONS: Children with unilateral cleft lip and palate present with a significantly higher prevalence of otitis media with effusion than children without cleft. Also, the hearing loss associated with otitis media with effusion is demonstrated in this study. Furthermore, the method of audiometry has been examined and children with unilateral cleft lip and palate had to be assessed with a lower level of method than children without cleft.