Factors influencing parents' decisions about communication choices during early education of their child with hearing loss: a qualitative study.

OBJECTIVE: To explore the factors influencing parents' choice of communication mode during early education of their child with hearing loss. DESIGN: Qualitative descriptive analysis of semi-structured interviews of parents of children with hearing loss. STUDY SAMPLE: Fourteen parents of children who participated in the Longitudinal Outcomes of Children with Hearing Impairment study. RESULTS: Four themes emerged from thematic analysis of the interview data: (1) parents draw on a variety of experiences and information to make decisions; (2) parents' preferred outcomes for their children drive their choices; (3) child's preference and proficiency drive parental choice; and (4) parents' fears and worries influence decisions. Parents required unbiased, descriptive information as well as evaluative information from professionals, so that they could consider all options in making a decision that met their needs. They required continual support for implementation of their choices as they adjusted to their children's changing needs. CONCLUSIONS: Decisions around communication mode are rarely made in isolation, but occur within a larger decision-making matrix that include device choices, early intervention agency choices and "future-proofing" the child's future communication options.

Cortical Auditory-Evoked Potentials in Response to Multitone Stimuli in Hearing-Impaired Adults.

PURPOSE: To determine if one-octave multitone (MT) stimuli increase the amplitude of cortical auditory-evoked potentials (CAEPs) in individuals with a hearing loss when compared to standard pure-tone (PT) stimuli and narrow-band noise (NBN). RESEARCH DESIGN: CAEPs were obtained from 16 hearing-impaired adults in response to PT and MT auditory stimuli centered around 0.5, 1, 2, and 4 kHz and NBN centered around 1 and 2 kHz. Hearing impairment ranged from a mild to a moderate hearing loss in both ears. Auditory stimuli were monaurally delivered through insert earphones at 10 and 20 dB above threshold. The root mean square amplitude of the CAEP and the detectability of the responses using Hotelling's T² were calculated and analyzed. RESULTS: CAEP amplitudes elicited with MT stimuli were on average 29% larger than PT stimuli for frequencies centered around 1, 2, and 4 kHz. No significant difference was found for responses to 0.5-kHz stimuli. Significantly higher objective detection scores were found for MT when compared to PT. For the 1- and 2-kHz stimuli, the CAEP amplitudes to NBN were not significantly different to those evoked by PT but a significant difference was found between MT stimuli and both NBN and PT. The mean detection sensitivity of MT for the four frequencies was 80% at 10 dB SL and 95% at 20 dB SL, and was comparable with detection sensitivities observed in normal-hearing participants. CONCLUSIONS: Using MT stimuli when testing CAEPs in adults with hearing impairment showed larger amplitudes and a higher objective detection sensitivity compared to using traditional PT stimuli for frequencies centered around 1, 2, and 4 kHz. These findings suggest that MT stimuli are a clinically useful tool to increase the efficiency of frequency-specific CAEP testing in adults with hearing impairment.

When expectation meets experience: parents' recollections of and experiences with a child diagnosed with hearing loss soon after birth.

OBJECTIVE: To examine parents' recollections of and their experiences with bringing up a child diagnosed with hearing loss at a very young age. DESIGN: Based on the analysis of informal parent discussion groups, four open-ended questions were formulated to solicit information about parents' expectations following diagnosis, as well as experiences and challenges when raising a child with a hearing loss. STUDY SAMPLE: Forty parents of children, aged between three to five years, who were diagnosed with hearing loss before the age of three years. RESULTS: Parents' responses revealed strong support for early intervention, high expectations for their child's development, and desire for information tailored to individual needs. Parents also reported anxiety relating to their perceptions of the significance of consistent device usage on their child's development. Further concerns arose from their observations of the difficulties experienced by their child in real-world environments despite consistent device usage, and their perception of their child's language delay despite early intervention. CONCLUSIONS: The findings point to a need to support parents to form realistic expectations based on current knowledge. Implications for clinicians to provide improved management of children with hearing loss are discussed.

Etiology and audiological outcomes at 3 years for 364 children in Australia.

Hearing loss is an etiologically heterogeneous trait with differences in the age of onset, severity and site of lesion. It is caused by a combination of genetic and/or environmental factors. A longitudinal study to examine the efficacy of early intervention for improving child outcomes is ongoing in Australia. To determine the cause of hearing loss in these children we undertook molecular testing of perinatal "Guthrie" blood spots of children whose hearing loss was either detected via newborn hearing screening or detected later in infancy. We analyzed the GJB2 and SLC26A4 genes for the presence of mutations, screened for the mitochondrial DNA (mtDNA) A1555G mutation, and screened for congenital CMV infection in DNA isolated from dried newborn blood spots. Results were obtained from 364 children. We established etiology for 60% of children. One or two known GJB2 mutations were present in 82 children. Twenty-four children had one or two known SLC26A4 mutations. GJB2 or SLC26A4 changes with unknown consequences on hearing were found in 32 children. The A1555G mutation was found in one child, and CMV infection was detected in 28 children. Auditory neuropathy spectrum disorder was confirmed in 26 children whose DNA evaluations were negative. A secondary objective was to investigate the relationship between etiology and audiological outcomes over the first 3 years of life. Regression analysis was used to investigate the relationship between hearing levels and etiology. Data analysis does not support the existence of differential effects of etiology on degree of hearing loss or on progressiveness of hearing loss.

Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study.

OBJECTIVE: To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment. DESIGN: All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes. RESULTS: Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age. CONCLUSIONS: Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.