Studies on stigma regarding hearing impairment and hearing aid use among adults of working age: a scoping review.

PURPOSE: Research on stigma has been criticized for centering on the perceptions of individuals and their effect on social interactions rather than studying stigma as a dynamic and relational phenomenon as originally defined by Goffman. This review investigates whether and how stigma has been evaluated as a social process in the context of hearing impairment and hearing aid use. MATERIALS AND METHODS: Systematic literature searches were conducted within four major databases for peer-reviewed journal articles on hearing impairment and hearing aid rehabilitation. In these, 18 studies with stigma, shame or mental wellbeing as the primary research interest were identified. The reports were examined for their methodology, focus and results. RESULTS: The reviewed studies used both quantitative and qualitative methodologies, questionnaires and interviews being the most common methods. All studies concentrated on the participants' experiences or views concerning stigma. Studies examining the social process of stigmatization were lacking. Most studies pointed out the negative effect of stigma on the use of hearing aids. CONCLUSIONS: In order to understand the process of stigmatization, more studies using observational methods are needed. Moreover, additional research should also focus on how stigma as a social and relational phenomenon can be alleviated. IMPLICATIONS FOR REHABILITATION Low adherence in hearing aid use is connected to fear of stigma related to hearing impairment and hearing aids. Hearing health services should include counseling to deal with individual's experiences and fear of stigma. Stigmatization is a social process that concerns individuals with hearing impairment in contact with their social environment. Hearing health professionals should consider including close relatives and/or partners of hearing impaired individuals in discussions of starting hearing aid rehabilitation. In consulting patients with hearing impairment professionals should give advice about how to deal with questions of hearing aid, hearing impairment and fear of stigma at work.

Discussing Hearing Aid Rehabilitation at the Hearing Clinic: Patient Involvement in Deciding upon the Need for a Hearing Aid.

The quality of interaction between hearing health professionals and patients is one prominent, yet under-studied explanation for the low adherence in acquiring and using a hearing aid. This study describes two different ways of introducing hearing aid to the patients at their first visits at the hearing clinic: an inquiry asking patients opinion followed by offer, and an expert evaluation of the necessity of a hearing aid; and shows two different trajectories ensuing from these introductions. The trajectories represent two extreme ends of a continuum of practices of starting a discussion about hearing aid rehabilitation, in terms of how these practices affect patient participation in decision-making. The analysis shows how granting different degrees of deontic and epistemic rights to professionals and patients has different consequences with regard to the activity of reaching shared understanding on the treatment. The data consist of 17 video-recorded encounters at the hearing clinic. The method used is conversation analysis.

Early vocabulary development in children with bilateral cochlear implants.

BACKGROUND: Children with unilateral cochlear implants (CIs) may have delayed vocabulary development for an extended period after implantation. Bilateral cochlear implantation is reported to be associated with improved sound localization and enhanced speech perception in noise. This study proposed that bilateral implantation might also promote early vocabulary development. Knowledge regarding vocabulary growth and composition in children with bilateral CIs and factors associated with it may lead to improvements in the content of early speech and language intervention and family counselling. AIMS: To analyse the growth of early vocabulary and its composition during the first year after CI activation and to investigate factors associated with vocabulary growth. METHODS & PROCEDURES: The participants were 20 children with bilateral CIs (12 boys; eight girls; mean age at CI activation = 12.9 months). Vocabulary size was assessed with the Finnish version of the MacArthur Communicative Development Inventories (CDI) Infant Form and compared with normative data. Vocabulary composition was analysed in relation to vocabulary size. Growth curve modelling was implemented using a linear mixed model to analyse the effects of the following variables on early vocabulary growth: time, gender, maternal education, residual hearing with hearing aids, age at first hearing aid fitting and age at CI activation. OUTCOMES & RESULTS: Despite clear vocabulary growth over time, children with bilateral CIs lagged behind their age norms in receptive vocabulary during the first 12 months after CI activation. In expressive vocabulary, 35% of the children were able to catch up with their age norms, but 55% of the children lagged behind them. In receptive and expressive vocabularies of 1-20 words, analysis of different semantic categories indicated that social terms constituted the highest proportion. Nouns constituted the highest proportion in vocabularies of 101-400 words. The proportion of verbs remained below 20% and the proportion of function words and adjectives remained below 10% in the vocabularies of 1-400 words. There was a significant main effect of time, gender, maternal education and residual hearing with hearing aids before implantation on early receptive vocabulary growth. Time and residual hearing with hearing aids had a significant main effect also on expressive vocabulary growth. CONCLUSIONS & IMPLICATIONS: Vocabulary development of children with bilateral CIs may be delayed. Thus, early vocabulary development needs to be assessed carefully in order to provide children and families with timely and targeted early intervention for vocabulary acquisition.

The MMN as a viable and objective marker of auditory development in CI users.

In the present article, we review the studies on the use of the mismatch negativity (MMN) as a tool for an objective assessment of cochlear-implant (CI) functioning after its implantation and as a function of time of CI use. The MMN indexes discrimination of different sound stimuli with a precision matching with that of behavioral discrimination and can therefore be used as its objective index. Importantly, these measurements can be reliably carried out even in the absence of attention and behavioral responses and therefore they can be extended to populations that are not capable of behaviorally reporting their perception such as infants and different clinical patient groups. In infants and small children with CI, the MMN provides the only means for assessing the adequacy of the CI functioning, its improvement as a function of time of CI use, and the efficiency of different rehabilitation procedures. Therefore, the MMN can also be used as a tool in developing and testing different novel rehabilitation procedures. Importantly, the recently developed multi-feature MMN paradigms permit the objective assessment of discrimination accuracy for all the different auditory dimensions (such as frequency, intensity, and duration) in a short recording time of about 30 min. Most recently, such stimulus paradigms have been successfully developed for an objective assessment of music perception, too.

Lipreading Ability and Its Cognitive Correlates in Typically Developing Children and Children With Specific Language Impairment.

Purpose: Lipreading and its cognitive correlates were studied in school-age children with typical language development and delayed language development due to specific language impairment (SLI). Method: Forty-two children with typical language development and 20 children with SLI were tested by using a word-level lipreading test and an extensive battery of standardized cognitive and linguistic tests. Results: Children with SLI were poorer lipreaders than their typically developing peers. Good phonological skills were associated with skilled lipreading in both typically developing children and in children with SLI. Lipreading was also found to correlate with several cognitive skills, for example, short-term memory capacity and verbal motor skills. Conclusions: Speech processing deficits in SLI extend also to the perception of visual speech. Lipreading performance was associated with phonological skills. Poor lipreading in children with SLI may be, thus, related to problems in phonological processing.

Promoting lexical learning in the speech and language therapy of children with cochlear implants.

This study examines lexical intervention sessions in speech and language therapy for children with cochlear implants (CIs). Particular focus is on the therapist's professional practices in doing the therapy. The participants in this study are three congenitally deaf children with CIs together with their speech and language therapist. The video recorded therapy sessions of these children are studied using conversation analysis. The analysis reveals the ways in which the speech and language therapist formulates her speaking turns to support the children's lexical learning in task interaction. The therapist's multimodal practices, for example linguistic and acoustic highlighting, focus both on the lexical meaning and the phonological form of the words. Using these means, the therapist expands the child's lexical networks, specifies and corrects the meaning of the target words, and models the correct phonological form of the words. The findings of this study are useful in providing information for clinicians and speech and language therapy students working with children who have CIs as well as for the children's parents.

Dilemmatic group memberships of hard-of-hearing employees during the process of acquiring and adapting to the use of hearing aids.

We describe how hard-of-hearing (HOH) employees renegotiate both their existing and new group memberships when they acquire and begin to use hearing aids (HAs). Our research setting was longitudinal and we carried out a theory-informed qualitative analysis of multiple qualitative data. When an individual discovers that they have a hearing problem and acquire a HA, their group memberships undergo change. First, HOH employees need to start negotiating their relationship with the HOH group. Second, they need to consider whether they see themselves as members of the disabled or the nondisabled employee group. This negotiation tends to be context-bound, situational, and nonlinear as a process, involving a back-and-forth movement in the way in which HOH employees value different group memberships. The dilemmatic negotiation of new group memberships and the other social aspects involved in HA rehabilitation tend to remain invisible to rehabilitation professionals, occupational healthcare, and employers.

The mismatch negativity (MMN) brain response to sound frequency changes in adult cochlear implant recipients: a follow-up study.

CONCLUSION: Plasticity of auditory pitch discrimination driven by cochlear implant (CI) use uring a 2.5-year follow-up was indicated by an enhancement of the amplitude of mismatch negativity (MMN) event-related brain potential (ERP) to pure tone frequency changes. OBJECTIVES: To follow up changes in MMN elicited to frequency and duration changes in tones during 2.5 years of CI use and to compare MMN results with audiometric speech recognition scores (SRSs). METHODS: Postlingually deafened adults with Cochlear Nucleus CI-22 and spectra processor with SPEAK strategy were recruited. MMN was measured at 1 and 2.5 years after CI activation. Repetitive 100 ms standard tones with a frequency of 500, 1000, 2000 or 4000 Hz in separate sequences were delivered to participants concentrating on a silent movie. Deviant tones occurring infrequently among standard tones were 20% lower in frequency or 50% shorter in duration than the standards. Speech recognition ability was followed with SRSs. RESULTS: Both time from CI activation and the frequency range of tones had significant effects on the MMN amplitude. A significant enhancement was observed for the MMN elicited by 3200 Hz deviant tones among 4000 Hz standards. Also SRSs significantly increased with time and correlated with MMN amplitudes to the 3200 Hz deviants in both measurements.

Spoken language skills and educational placement in Finnish children with cochlear implants.

OBJECTIVE: This study reports the demographics, and the auditory and spoken language development as well as educational settings, for a total of 164 Finnish children with cochlear implants. METHODS: Two questionnaires were employed: the first, concerning day care and educational placement, was filled in by professionals for rehabilitation guidance, and the second, evaluating language development (categories of auditory performance, spoken language skills, and main mode of communication), by speech and language therapists in audiology departments. RESULTS: Nearly half of the children were enrolled in normal kindergartens and 43% of school-aged children in mainstream schools. Categories of auditory performance were observed to grow in relation to age at cochlear implantation (p < 0.001) as well as in relation to proportional hearing age (p < 0.001). The composite scores for language development moved to more diversified ones in relation to increasing age at cochlear implantation and proportional hearing age (p < 0.001). Children without additional disorders outperformed those with additional disorders. CONCLUSION: The results indicate that the most favorable age for cochlear implantation could be earlier than 2. Compared to other children, spoken language evaluation scores of those with additional disabilities were significantly lower; however, these children showed gradual improvements in their auditory perception and language scores.

Mismatch negativity brain response as an index of speech perception recovery in cochlear-implant recipients.

Speech-discrimination performance and the mismatch negativity (MMN) response elicited by vowel changes were used to track vowel-perception improvement of 5 adult cochlear-implant (CI) recipients. The MMN was recorded several times during the first 3 years after CI activation. Artefacts, presumably caused by CI, contaminated most of the brain responses until 1 year after CI activation. We found that speech discrimination improved over time and the MMN, observed in all patients after 2.5 years of CI use, was first seen for the larger vowel difference and later for the smaller one.