[Clinical protocol: audiological assessment of infants in Russian Federation. Part II]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' II.

This is the second part of the previously published clinical protocol of audiological assessment in infants. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The following sections were included in the second part of the protocol: behavioral testing in infants, testing sequence, duration of the examination and necessity in follow-up, hearing assessment in special cases (premature children, children with congenital infections, after meningitis, with external ear abnormalities, single-sided deafness, with hydrocephalus and shunts, with auditory neuropathy spectrum disorder, with mild hearing loss and otitis media with effusion), medical report.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part I]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' I.

The clinical protocol of audiological assessment in infants was prepared by the workgroup of Russian pediatric audiologists from different regions. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The protocol has been developed according the evidence based medicine principles, by reviewing current scientific publications on the topic and taking into account the order of providing medical services and other clinical practice guidelines. When direct evidence was not available, both indirect evidence and consensus practice were considered in making recommendations. This guideline is not intended to serve as a standard to dictate precisely how the child should be diagnosed. This guideline is meant to provide the evidence base from which the clinician can make individualized decisions for each patient. The first part of the protocol covers following sections: equipment, staff requirements, timing of the diagnostics, case history and risk factors, preparing the child for the appointment, sedation and general anesthesia, otoscopy, tympanometry and acoustic reflex, otoacoustic emissions, skin preparing, electrode montage, choosing the stimulators, auditory brainstem responses on broadband and narrow-band stimuli, on bone conducted stimuli, auditory steady-state responses, masking, combined correction factors.

[Epidemiological characteristics of the pediatric population of cochlear implant users in St. Petersburg]. / Epidemiologicheskaya kharakteristika detskoi populyatsii pol'zovatelei kokhlearnykh implantatov Sankt-Peterburga.

An epidemiological analysis of the pediatric population of cochlear implant (CI) users in St. Petersburg, the second largest metropolis of Russian Federation, was carried out. CI users are 14% of the total number of hearing impaired children, and 26% of children with hearing devices. Only 43% of children who are candidates for cochlear implantation in according to audiological criteria use CI. Since 2012, unilateral cochlear implantation has been carried out for all children in need - their annual number ranges from 25 to 45. Bilateral implantation, mostly sequential with an interval of 1-3 years, was performed in 21% of children The average age at the time of the surgery was 3 years, more than 50% of children were implanted between 1 and 3 years. In recent years, the number of children implanted before 2 years has increased, as well as the number of children implanted at school age. 27% of children with CI continue wearing a hearing aid on the opposite ear. 23% of implanted children have additional disabilities. It has been established that the proportion of children attending mainstream educational institutions is significantly higher among children with CI, compared with children using hearing aids. Some directions have been developed to improve care for CI children and to increase the effectiveness of cochlear implantation as a medical-technical-pedagogical technology for hearing restoration in a regional centre for hearing impaired children.

[Results of the audit of the first stage newborn hearing screening in St. Petersburg]. / Rezul'taty audita pervogo etapa audiologicheskogo skrininga novorozhdennykh v Sankt-Peterburge.

OBJECTIVE: Analysis of the first stage of universal newborn hearing screening in St. Petersburg and increasing its effectiveness. RESULTS: In result of the audit, it was found that screening performs in all maternity wards, children's hospitals and at the majority of pediatric clinics. Meanwhile only 14% of institutions meet criteria of good practice in providing screening. In other clinics improving the procedure of screening is needed: equipment update and calibration, correction of the method and conditions of examination, results documenting, etc. The set of activities for increasing the effectiveness of newborn hearing screening is proposed. The work which carried out with institutions during and after audit allowed to reach 100% involving clinics in screening system in 6 months. Due to information support of institutions coverage of newborns by the first stage of screening increased on 8.5% (matched to target) and the number of referred children who come to the second stage of screening increased on 18%. Results suggest that the audit of the first stage of newborn hearing screening by the district pediatric audiological centers is an effective tool for finding problems in the screening system and its solving.

[Telerehabilitation of hearing-impaired children during COVID-19 pandemic]. / Distantsionnaya reabilitatsiya detei s tugoukhost'yu v period pandemii COVID-19 v usloviyakh surdologicheskogo tsentra.

OBJECTIVE: To evaluate advantages and effectiveness of remote rehabilitation services for hearing-impaired children at Center of Pediatric Audiology during COVID-19 pandemic. MATERIAL AND METHODS: 181 children with different types and degrees of permanent hearing loss, their parents and 10 hearing care professionals (audiologists, speech-language therapists) were included in the study. 2115 rehabilitation services were provided during 3 months: video- and text consultations, video lessons with child, sending homework to parents, etc. RESULTS: The results of questionnaires showed that, on specialists' and parents' opinion, remote rehabilitation care is effective tool for hearing impaired children during emergency situations. TeleCare allowed to improve parents' abilities to manage with children by themselves, their understanding goals and methods of rehabilitation, improving child's hearing and speech skills. 95% of parents were satisfied by remote rehabilitation. Advantages and problems of remote hearing rehabilitation were analyzed from the sides of professionals and parents. The most challenging activities for professionals during TeleCare were: evaluation of HA/CI effectiveness, diagnosis and developing of hearing and speech. CONCLUSIONS: The experience of remote hearing rehabilitation in emergency situation allows to conclude that this type of care could be useful in clinical practice after pandemic for parents consulting and for children with motor problems.

[Hearing function in children after new coronavirus infection (COVID-19)]. / Sostoyanie slukha u detei, perenesshikh novuyu koronavirusnuyu infektsiyu (COVID-19).

The information about hearing status of patients who have had a COVID-19 is scattered. There are no studies among children population. OBJECTIVE: To evaluate hearing function in children after coronavirus infection. MATERIAL AND METHODS: 87 children aged from 5 months to 17 years who have had a new coronavirus infection were examined in three cities of Russia (St. Petersburg, Novosibirsk and Surgut). Audiologic examination depended on the age and included: otoscopy, TEOAE and DPOAE, ABR, impedansometry, pure tone audiometry, speech audiometry in quiet and noise. Fisher, LittlEARS and PEACH questionnaires were used as well. An evaluation of central auditory processing was performed in case of indications. RESULTS: In 80 children (92%) otoscopy didn't revealed any problems. All children had type A tympanogram. Acoustic reflex was registered in 49 children (56%), wasn't registered on 1-2 frequencies in 27 (31%) children, was registered on only 1 frequency or wasn't registered at all in 11 (13%) children. OAE was present in 83 (95%) children. Audiometric thresholds in all children were within a normal range. Speech intelligibility in quiet and noise in most cases was normal. 7 children with poor speech intelligibility or low Fisher questionnaire results got an extended examination. Binaural fusion speech test, dichotic test, RuMatrix test, gap detection test data showed no signs of central auditory processing disorders. CONCLUSION: There are no cases of hearing loss or central auditory processing disorders were found in children after new coronavirus infection. Due to variety of symptoms and long-term consequences of COVID-19 further hearing examination is required in this group of patients.

[Epidemiological study of hearing impairments in children: prevalence, structure, amplification, and social factors]. / Epidemiologiya narushenii slukha u detei: rasprostranennost', struktura, aspekty slukhoprotezirovaniya i sotsial'nye faktory.

For the first time, a detailed epidemiological study of hearing impairments (HI) in the children's population of St. Petersburg (n=3098) was conducted. The data on the incidence of HI in children, the distribution of children depending on the degree of hearing loss, HI type, the presence of additional disorders, risk factors for hearing loss were obtained. Only 19% of children with HI were diagnosed in accordance with modern requirements of early care - at the age of 3 months. In children who underwent universal newborn hearing screening the average age of diagnosis was significantly lower than in children who were not screened. Only 54% of HI children use hearing aids (HA) or cochlear implants. Among the children who do not use HA, the main number is children with mild and moderate hearing loss, unilateral hearing loss and otitis media with effusion. A significant part of them should be considered as candidates for amplification according to current recommendations. The average interval between diagnosis and amplification was 15.7 months. Only 5% of children from the entire population of children with HI received early intervention in accordance with the modern time standard: 1 month (detection) - 3 months (diagnosis) - 6 months (amplification). The problems of organizing an effective care for HI children and the directions of its development are discussed: improving newborn hearing screening; introduction the system of informing the citizens and doctors of related specialties (pediatricians, neurologists) in the field of prevention, diagnosis and rehabilitation of HI in children; expansion of genetic testing of children; reducing time of waiting and improving the quality of HA provided to handicapped children.

The benefits of underwater vibrostimulation in the rehabilitation of children with impaired hearing.

INTRODUCTION: Early intervention is crucial for the optimal speech and language development of children with impaired hearing. Underwater vibrostimulation could help develop behavioural reactions to low-frequency stimuli immediately after diagnosis and facilitate aural rehabilitation after hearing aid (HA) or cochlear implant (CI) activation. GOALS: To determine the limits of underwater vibrotactile stimuli perception and to measure the effect of vibrostimulation training on the aural rehabilitation of young children. METHODS: Two adults and three children with congenital hearing loss participated in the first part of the study. Pure tones between 100 and 4000 Hz and natural broadband sounds were delivered under water while the participants were sitting in a pool. The lower thresholds of perception and the maximum comfortable levels were measured and the subjective sensations were recorded. In the second part of the study, 15 children <3 years old were presented with the same stimuli until they developed stable conditioned reactions to the stimuli. The time until the development of "hearing behaviour" and the number of fitting sessions after HA or CI activation were compared between the vibrostimulation group and a control group who did not receive such training. RESULTS: In the first part of the study, participants were most sensitive to 100-400 Hz stimuli, while the stimuli >1000 Hz did not evoke any sensations. The vibrations were felt across all body parts and produced hearing-like sensations in the ear. In the second part of the study, children in the vibrostimulation group required fewer fitting sessions and developed "hearing behaviour" sooner than the control group. CONCLUSIONS: Underwater vibrostimulation is a promising new method of early aural rehabilitation that could be recommended for implementation in paediatric audiology centres.

[Russian version of PEACH scale (validation and normative data)]. / Russkoyazychnaya versiya oprosnika PEACH (validatsiya i normativnye dannye).

PEACH is an important tool for evaluation of children's hearing development, used in age 2-7 years. It is also appropriate for amplification outcomes measurements. PEACH scale includes 13 questions. Parents fill the questionnaire after week observation of child's hearing behavior in different situations. The goal of the study was validation of Russian version of PEACH scale. Translation and cross-cultural adaptation were performed following international guidelines. 50 children with normal hearing and 50 hearing impaired children were involved in the validation process. All of the hearing-impaired children used hearing aids or cochlear implants. PEACH scores of the children with normal hearing have strong correlation with data of original version (ρ=0.998; p<0.05) and can be used as a normative data for Russian version. PEACH scores of the hearing-impaired children were worse in higher degrees of hearing loss, which shows sensitivity of the method. Test-retest reliability in children with normal hearing was ρ=1.0 (p<0.05), in hearing impaired children ρ=0.976 (p<0.05). Russian PEACH scale is free available at the official site of Center of Pediatric Audiology: https://dgsc.kzdrav.gov.spb.ru.

[The optimal stimulation parameters of the free-field auditory steady-state responses]. / Vybor optimal'nykh parametrov stimulyatsii pri registratsii statsionarnykh slukhovykh vyzvannykh potentsialov v zvukovom pole.

Studies of the recent years are devoted to using the auditory steady-state responses (ASSR) as an evaluation method of amplification outcomes. In this case stimulation is performed in the sound field via loudspeaker with a hearing aid (HA) in patient's ear. GOAL: Estimation the optimal stimulation parameters of ASSR in free field, which provide maximum correlation with behavioral thresholds. MATERIALS AND METHODS: 26 subjects were included in the study: 10 with normal hearing (4 adults and 6 children) and 16 children (1-16 years old) with sensorineural hearing loss (SNHL). Aided and unaided ASSR thresholds were compared with corresponding behavioral thresholds (BT). All recordings were conducted in free sound field. We used mono-frequency stimulation method at 500-4000 Hz career frequencies. Modulation frequency was set as 40 Hz. Types of stimuli modulation: AM/FM modulation, exponential modulation (AM2), three carrier frequencies and modulated Chirp-tone (Chirp). RESULTS: In normal hearing subjects the difference between ASSR and BT varied from 0 dB to 35 dB, and the significant correlation between them was observed (p<0.05). The maximum difference between ASSR and BT in children with SNHL was at 500 Hz (15.6±4.3 dB), minimum - at 2 and 4 kHz (8±2.9 dB and 7±3 dB respectively). In aided condition maximum difference was detected at 500 Hz (10.2±3.8 dB), minimum - at 1 and 2 kHz (7.8±2.8 and 7.3±3.1 dB respectively). We got significantly less difference between ASSR and BT in all test conditions using following types of stimuli: at 500 Hz and 1000 Hz - AM2 (p<0.01); at 2 and 4 kHz - Chirp (p<0.05 and p<0.01 respectively). Thereby, free field ASSR might be used as an objective method of evaluation the amplification outcomes in children with SNHL.

[Complex disorders in children with sensorineural hearing loss - influence on the diagnosis of hearing pathology and hearing aid]. / Kompleksnye narusheniya u detei s sensonevral'noi tugoukhost'yu ­ vliyanie na diagnostiku patologii slukha i slukhoprotezirovanie.

The presence of additional disabilities (AD) in children with sensorineural hearing loss (SNHL) and influence of AD on age of hearing loss diagnosis and amplification were investigated. It was shown that 41% children with SNHL have different AD - pathology of the central neural system (including mental retardation, autism spectrum disorders, attention deficits), vision, motor and articulation impairments, cardiovascular, respiratory, urinary, digestive, endocrine diseases etc. 59% children among them have 2-3 AD. The most often combination of AD was pathology of central neural and motor systems. The genetic factor was revealed rarely in the group of children with AD than in children with SNHL only. The diagnosis of hearing loss before age 4 months was rarely in the group of children with AD. Possibly it is because of the most of such children got treatment in neonatal intensive care unit and didn't have access to universal newborn hearing screening. Moreover, SNHL might develop later as the outcome of their AD or their treatment. Suggestion about more late amplification in children with SNHL was confirmed. The cause might be wary relation of audiologists to amplification of children with AD and difficulties of this process.

[Asymmetric sensorineural hearing impairment in the adult population]. / Asimmetrichnaia sensonevral'naia tugoukhost' vo vzrosloi populiatsii.

The relevance of the problem of a sensorineural hearing loss (ASNL) arises from the necessity of the special approaches to the diagnostics of this condition, the complications accompanying this pathology, and the difficulties encountered in the implementation of the methods designed for hearing rehabilitation of such patients. The objective of the present study was to estimate the prevalence of ASHL among the adult population. The sensorineural impairment of hearing was diagnosed in a total of 2456 (72%) examined patients presenting with hearing loss. To determine the presence of asymmetry of sensorineural hearing loss, we employed three counting techniques allowing (1) to calculate the difference between the average hearing thresholds at four frequencies within the range from 0.5 to 4 kHz (the difference was found to be 15 dB or more in 17% of the patients), (2) to calculate the difference between the degrees of hearing loss in the right and left ears (the difference was documented in 47% of the patients), (3) to calculate the difference between the hearing thresholds at least at a single frequency within the range from 0.125 to 8 kHz (he difference was found to be 15 dB or more in 71% of the patients). When using the third method to characterize asymmetry of hearing impairment, it was identified in most patients (53%) at one or two frequencies. Moreover, there was a large number of the patients (13%) with asymmetry apparent over the entire frequency range. A high degree of threshold asymmetry (in excess of 40 dB) was more often noted in the mid-frequency range. In the majority of the patients, the asymmetry manifested itself as the different degree of bilateral sensorineural hearing impairment (51%) or unilateral sensorineural hearing loss with the normal hearing ability preserved in the contralateral ear (35%). The results of the present study give evidence of the necessity of developing a reliable method for the identification of clinically significant ACNL.

[Validation of the Russian language version of the SSQ questionnaire].

The Speech, Spatial and Qualities of Hearing Scale (SSQ) is applied worldwide as a highly reliable tool for the characteristic of the quality of life and subjective sensations of the patients presenting with hearing impairment as well as for the estimation of the efficiency of hearing aids. The objective of the present study was to validate and adapt the Russian language version of the SSQ questionnaire (SSQrus) for its application in the audiological practice under conditions of this country. After the cultural and language adaptation of SSQrus, it was validated by means of repeat interviewing of three groups of the respondents (a total of 93 subjects with normal, moderately and severely impaired hearing). The results of the validation give evidence of the high reliability of the modified questionnaire. Specifically, high reproducibility of the data estimated from the results of the second interview has been demonstrated (r=0.85--0.99). High sensitivity of SSQruswas confirmed by the agreement between the results of the estimation (in scores) and the degree of the observed loss of hearing. The estimates obtained by the application of the SSQrus questionnaire are comparable with those reported by the foreign authors. It is concluded that the SSQrus questionnaire can be used in routine audiological practice as an additional diagnostic instrument for the estimation of hearing problems experienced by a patient, monitoring efficiency of therapy and surgical treatment of hearing impairment, improvement of hearing aids, and hearing dysfunction research.