The Effect of Universal Newborn Hearing Screening on Spoken Language after Cochlear Implantation.

BACKGROUND: The universal newborn hearing screening (UNHS) was fully implemented across New Zealand by 2010 to improve outcomes for children with prelingual deafness. A previous audit undertaken by our center, the Southern Cochlear Implant Programme (SCIP), demonstrated that UNHS has significantly reduced the time to referral and surgery for cochlear implants in these children. AIMS: This study aims to evaluate the relationship between earlier implantation and language development, the time taken to achieve age-appropriate language, and the effect of socioeconomic status on language skills. METHODS: This is a retrospective cohort study comparing prelingual children with severe to profound bilateral hearing loss who underwent cochlear implantation in SCIP before and after the introduction of the UNHS. The language outcomes were assessed using the Preschool Language Scale and/or the Peabody Picture Vocabulary Test. For the purpose of our study, the standard scores of these tests were expressed as global language scores (GLS). GLSs between 85 and 115 are considered within normal range for age. The socioeconomic status was categorized based on the New Zealand Index of Deprivation (NZDep). RESULTS: Children in the post-UNHS group (46/95 children) were referred to SCIP and received CI at a significantly earlier age (mean = 7 vs 20 mo, p = 8.95E-10, and mean = 13 vs. 24.7 mo, p = 1.43E-07). At 2 years postimplantation, the GLS was significantly higher in the post-UNHS group (mean scores = 93.3 vs. 79.1, p = 0.0213). The scores remained statistically higher in the post-UNHS group when assessed at 3 and 4 years postimplantation. At 2, 3, and 4 years postimplantation, there is a significant linear decrease in GLS with increasing age at cochlear implantation. We found no correlation between NZDep and GLS. CONCLUSION: Children identified through UNHS have the advantage of earlier diagnosis, earlier hearing intervention, and longer duration with the implants, and they can achieve age-appropriate spoken language after 2 years of implantation.

Classification of cochlear implant complications using a modified Clavien-Dindo classification.

OBJECTIVES: Cochlear implantation (CI) surgery is a highly effective procedure for severe to profound hearing loss, with a low complication rate. There are currently multiple grading systems for CI surgery complications, making comparison of outcomes difficult. We propose a modification to the Clavien-Dindo classification of complications, and use this modified classification to analyse our complications. METHODS: Complications were classified as: I - Self-limiting complications requiring no treatment or simple pharmacological therapies; II - Complications requiring pharmacological interventions other than those permitted under the criteria for Grade I, or non-invasive radiological imaging; IIIa - Complications necessitating surgical, radiological or endoscopic intervention, but excluding implant explantation and/or reimplantation. IIIb - Complications necessitating implant explantation and/or reimplantation. RESULTS: 1053 patients were recorded as having had at least one cochlear implant inserted with 114 complications reported in 90 patients. The 114 complications were classified into the proposed classification with 18 (15.7%) as Grade I, 36 (31.5%) as Grade II, 17 (14.9%) as Grade IIIa and 43 (34.2%) as Grade IIIb. DISCUSSION: We found a low complication rate, and were able to use the modified Clavien-Dindo classification system to analyse our data. We would strongly advocate for a uniform reporting system and propose this modification of a widely used system.

Educational, employment, and social participation of young adult graduates from the paediatric Southern Cochlear Implant Programme, New Zealand.

OBJECTIVES: The purpose of this study is to observe the education and vocational achievements and social participation of cochlear implant recipients as they graduate from a paediatric cochlear implant programme and identify any significant associations that might exist. METHOD: This study identified 56 patients from the Southern Cochlear Implant Programme (SCIP) who received cochlear implants before the age of 19 (paediatric) and are now over the age of 19 (adult). A questionnaire investigated their education, employment, and identity with the hearing and deaf communities. Also included were the satisfaction with life scale and Hearing Participation Scale (HPS). Subjects ranged in age from 19 to 32. RESULTS: Twenty-six patients responded to the questionnaire, including one non-user. Twenty identified strongly or very strongly with the hearing community. There was weak evidence of a linear association between strong identity with the hearing community and a higher HPS score. No other statistically significant associations were detected. Interestingly, 12 out of 26 participants found employment through family. CONCLUSION: Positive outcome trends in education and employment were seen in this study although no statistical significance was achieved. There is a strong bias for those who use their cochlear implants regularly, and there are no data available for those who do not use their cochlear implants for comparison as only one non-user completed the survey, despite efforts to include this group. This study shows that there is perceived benefit in implantation for patients who use it regularly but further research is needed with a more diverse group of cochlear implant recipients.

An audit of paediatric referrals to the Southern Cochlear Implant Programme (2009-2014).

AIM: To determine the effect of the Universal Newborn Hearing Screening and Early Intervention Programme on the age of referral and implantation of prelingually deaf children in the Southern Cochlear Implant Programme. METHOD: A retrospective review of data collected prospectively from March 2003 to August 2014. RESULTS: 123 children were referred to the programme with prelingual deafness in the time period. There was a significant decrease in the age of referral (median 6.23 months vs. 21.50 months) and age at implantation (12.66 months vs. 24.0 months) in those that underwent newborn hearing screening. Reasons for delay in referral and implantation were identified. CONCLUSION: The introduction of universal newborn hearing screening has significantly reduced the age at referral and implantation of prelingually deaf children. However, the screening programme must continue to undergo monitoring and regular audit. Efforts must also be made to reduce the time to referral, including reducing non-attendance rates, education for parents and service providers, and earlier referral of those with comorbidities so as to reduce the time to implantation.

Folic acid food fortification prevents inadequate folate intake among preschoolers from Ontario.

OBJECTIVE: Folic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers. DESIGN: Cross-sectional data were used from the NutriSTEP validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes. SETTING: Canada. SUBJECTS: Two hundred and fifty-four preschoolers (aged 3-5 years). RESULTS: All participants (130 girls, 124 boys) ate folic acid-fortified foods and 30% (n 76) used folic acid-containing supplements. Mean (SE) fortificant folic acid intake was 83 (2) microg/d, which contributed 30% and 50% to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was <1%; however, excluding fortificant folic acid, the prevalence was 32%, 54% and 47% for 3-, 4- and 5-year-olds, respectively. The overall prevalence of folic acid (fortificant and supplemental) intakes above the Tolerable Upper Intake Level was 2% (7% among supplement users). CONCLUSIONS: Folic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.

Zinc-fortified foods do not improve intake of total dietary zinc for Ontario preschoolers.

OBJECTIVE: To examine if zinc food fortification makes a significant contribution to dietary zinc intake and to describe zinc-fortified food usage, amongst Canadian preschoolers. METHODS: Cross-sectional data were used from the NutriSTEP validation project for which preschoolers (3-5 years) from across Ontario were recruited using convenience sampling. Three-day food records were used to estimate mean daily zinc intake and children were stratified by age group for analysis. Comparisons were then made to the Dietary Reference Intakes, whilst accounting for zinc from zinc-fortified foods and supplements and also whilst excluding zinc from zinc-fortified foods, to determine the prevalence of inadequate (< Estimated Average Requirement (EAR)) and excessive (> Tolerable Upper Intake Level (TUL)) zinc intakes. The contributions (%) made to total zinc intake by zinc-fortified foods, unfortified foods and zinc-containing supplements were determined as were contributions made to zinc intake by zinc-fortified foods, categorized by fortified-food type. RESULTS: Fewer than a third (30%, n = 76) of participants ate zinc-fortified foods and only 3% (n = 7) used a zinc-containing supplement. Including the contribution from zinc-fortified foods, 25% (n = 32) of 3-year-olds (n = 128) had mean zinc intake (range 7.0-7.6 mg/day) marginally above the TUL (7 mg/day). Zinc-fortified foods contributed only 2.3 +/- 5.8% (mean% +/- SD) to total zinc intake. The mean intake of the 25% of 3-year-olds above the TUL is attributed to their higher mean energy and protein intakes (p < 0.001) as compared to 3-year-olds not consuming zinc at levels above the TUL. Even excluding zinc-fortified foods, the prevalence of inadequate zinc intakes (