Communicating Emotion: Vocal Expression of Linguistic and Emotional Prosody in Children With Mild to Profound Hearing Loss Compared With That of Normal Hearing Peers.

OBJECTIVES: Emotional prosody is known to play an important role in social communication. Research has shown that children with cochlear implants (CCIs) may face challenges in their ability to express prosody, as their expressions may have less distinct acoustic contrasts and therefore may be judged less accurately. The prosody of children with milder degrees of hearing loss, wearing hearing aids, has sparsely been investigated. More understanding of the prosodic expression by children with hearing loss, hearing aid users in particular, could create more awareness among healthcare professionals and parents on limitations in social communication, which awareness may lead to more targeted rehabilitation. This study aimed to compare the prosodic expression potential of children wearing hearing aids (CHA) with that of CCIs and children with normal hearing (CNH). DESIGN: In this prospective experimental study, utterances of pediatric hearing aid users, cochlear implant users, and CNH containing emotional expressions (happy, sad, and angry) were recorded during a reading task. Of the utterances, three acoustic properties were calculated: fundamental frequency (F0), variance in fundamental frequency (SD of F0), and intensity. Acoustic properties of the utterances were compared within subjects and between groups. RESULTS: A total of 75 children were included (CHA: 26, CCI: 23, and CNH: 26). Participants were between 7 and 13 years of age. The 15 CCI with congenital hearing loss had received the cochlear implant at median age of 8 months. The acoustic patterns of emotions uttered by CHA were similar to those of CCI and CNH. Only in CCI, we found no difference in F0 variation between happiness and anger, although an intensity difference was present. In addition, CCI and CHA produced poorer happy-sad contrasts than did CNH. CONCLUSIONS: The findings of this study suggest that on a fundamental, acoustic level, both CHA and CCI have a prosodic expression potential that is almost on par with normal hearing peers. However, there were some minor limitations observed in the prosodic expression of these children, it is important to determine whether these differences are perceptible to listeners and could affect social communication. This study sets the groundwork for more research that will help us fully understand the implications of these findings and how they may affect the communication abilities of these children. With a clearer understanding of these factors, we can develop effective ways to help improve their communication skills.

A systematic review on the impact of auditory functioning and language proficiency on psychosocial difficulties in children and adolescents with hearing loss.

OBJECTIVE: Approximately 20% to 40% of children with hearing loss encounter psychosocial difficulties. This prevalence may be outdated, given the advancements in hearing technology and rehabilitation efforts to enhance the psychosocial well-being of these children. A systematic review of up-to-date literature can help to identify factors that may contribute to the children's psychosocial well-being. DESIGN/STUDY SAMPLE: A systematic review was conducted. Original articles were identified through systematic searches in Embase, Medline, PsychINFO, and Web of Science Core Collection. The quality of the papers was assessed using the Newcastle-Ottawa Quality Assessment Scale and custom Reviewers' Criteria. RESULTS: A search was performed on 20 October 2022. A total of 1561 articles were identified, and 36 were included for review. Critical appraisal led to 24 good to fair quality articles, and 12 poor quality articles. CONCLUSION: Children with hearing loss have a twofold risk of experiencing psychosocial difficulties compared to normal hearing peers. Estimates for functioning in social interactions, like speech perception (in noise) or language proficiency, have proven to be more adequate predictors for psychosocial difficulties than the degree of hearing loss. Our findings can be useful for identifying children at risk for difficulties and offering them earlier and more elaborate psychological interventions.

First results of the Strengths and Difficulties Questionnaire, applied as a screening tool for psychosocial difficulties in pediatric audiology.

PURPOSE: Despite major improvements in rehabilitation possibilities, children with sensorineural hearing loss are at risk for psychosocial difficulties. These difficulties can impact their educational and career achievements and may be two to three times more common in children with hearing loss compared to those with normal hearing. Early identification of psychosocial difficulties can be facilitated using the Strengths and Difficulties Questionnaire (SDQ) and may improve outcomes and quality of life. We implemented the SDQ into the clinical follow-up of children with hearing loss in a tertiary referral hospital. With this, prevalence and severity of difficulties in specific psychosocial domains and several predictors were investigated. METHODS: A retrospective, cross-sectional investigation was performed of the following factors in association with the SDQ results: type of hearing device, type and degree of hearing loss, speech perception in quiet and in noise, and type of schooling. RESULTS: Between June 2020 and January 2022, parents of 312 children (age 4-18) completed the SDQ. An additional 113 child-reports were completed. The response rate of the parents was 69%. Problems with peer relationships and prosocial behavior were the most affected areas with clinically elevated scores in 22% of the children. Psychosocial difficulties were distributed similarly across types of hearing device, nature and degrees of hearing loss, and educational settings. Better speech perception in quiet was significantly associated with fewer parent-reported conduct problems. CONCLUSION: The results of the present study suggest that children with hearing loss may be at risk of experiencing challenges with social interactions and attachment in social contexts. Using the SDQ in clinical follow-up may improve the chances for early psychological assessment and intervention. In addition, the study found that children's mental health may be impacted by their communication abilities.

Translation and validation of the speech, spatial, and qualities of hearing scale (SSQ) and the hearing environments and reflection on quality of life (HEAR-QL) questionnaire for children and adolescents in Dutch.

OBJECTIVE: To date, no hearing-specific self-report tool is available in Dutch to give insight into how deficits in auditory skills are experienced by a child in daily life or to examine the impact of hearing loss on children's quality of life. Therefore, we aimed to translate and validate the Speech, Spatial, and Qualities of Hearing Scale (SSQ) and the Hearing Environments and Reflection on Quality of Life (HEAR-QL) Questionnaire for children and adolescents into Dutch. DESIGN: Translation of the questionnaires into Dutch was conducted by means of the forward-backward procedure. Participants were invited to complete the questionnaires digitally. We examined discriminant validity, internal consistency, and test-retest reliability. STUDY SAMPLE: A total of 121 subjects between 7 and 18 years old were included, of which 54 normal hearing and 67 bilaterally hearing-impaired subjects. Hearing-impaired subjects were fitted with hearing aids, bone conductive devices and/or cochlear implants. RESULTS: All questionnaires were shown to significantly discriminate between the normal hearing and the hearing-impaired group. Satisfying internal consistency and good test-retest reliability were found. CONCLUSIONS: The Dutch SSQ and HEAR-QL questionnaires for children and adolescents appear to be valid and reliable self-report tools for management and follow-up of those with hearing loss.

Risk Factors For Hearing Decline From Childhood To Early Adolescence.

OBJECTIVE: To identify risk factors of hearing decline between 9 and 13 years of age. The risk factors examined included sociodemographic, health, and lifestyle-related factors. METHODS: This study was embedded within a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone audiometry and tympanometry were performed at the age of 9 and 13 years. The hearing decline was defined as an increase in low-frequency or high-frequency pure-tone average of at least 5 dB in one of both ears. Multivariable logistic regression was performed to examine the association of possible risk factors with hearing decline. The study was conducted from April 2012 to October 2015, and from April 2016 to September 2019. RESULTS: Of the 3,508 participants included, 7.8% demonstrated a hearing decline in the low frequencies, and 11.3% in the high frequencies. Participants who reported alcohol consumption were more likely to have a hearing decline in the low frequencies (OR 1.5, 95% CI 1.1; 2.0). Moreover, a lower educational level was associated with an increased odds of having a hearing decline in the high frequencies (OR 1.4, 95% CI 1.0; 1.8). Age, sex, household income, personal music player use, and body mass index were not associated with hearing decline. CONCLUSION: Educational level and risky behavior were significantly associated with hearing decline from childhood to early adolescence. The findings of the present study can help in the design of public health interventions to prevent hearing loss at a young age. LEVEL OF EVIDENCE: 2 (prospective cohort study) Laryngoscope, 133:389-395, 2023.

The association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents.

Many young people are potentially at risk of noise-induced hearing loss due to unsafe use of personal listening devices. The aim of this cross-sectional study was to examine the association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents to identify a target group for prevention. A smartphone application was developed to objectively measure music listening habits among 314 adolescents with a mean age of 13 years and 7 months (SD ±5 months). Listening habits were characterized as safe or unsafe based on the weekly noise dose. Data on sociodemographic factors and traditional health risk behaviors were obtained by questionnaires. Within the study group, 10.5% of the participants exceeded the 50%, and 4.8% the 100% recommended weekly noise dose. Adolescents with a lower socioeconomic status were more likely to engage in unsafe listening habits as compared to adolescents with a higher socioeconomic status. Additionally, risk behavior was associated with higher odds of having unsafe listening habits as compared to no risk behavior. Age, sex and educational levels were not significantly associated with unsafe listening habits. The findings of the present study indicate that interventions to promote safe listening habits should target adolescents with a lower socioeconomic status and higher risk behavior. Future research is needed to investigate how these adolescents can be motivated to adopt safe listening habits.

A retrospective analysis of hearing after cholesteatoma surgery: the bony obliteration tympanoplasty versus canal wall up and canal wall down without mastoid obliteration.

OBJECTIVE: To evaluate and compare the hearing outcome after the bony obliteration tympanoplasty (BOT), canal wall up (CWU) without mastoid obliteration and canal wall down (CWD) without mastoid obliteration in a large patient cohort. As the aeration of the middle ear is associated with hearing outcome, we hypothesized that the post-operative hearing after the BOT may be better compared to CWU and CWD without obliteration. METHODS: This is a retrospective cohort study on all adult patients who underwent the BOT, CWU without obliteration or CWD without obliteration for primary or revision cholesteatoma between January 2003 and March 2019 with audiological follow-up at our institution. Pre-operative, short-term post-operative and long-term post-operative hearing tests were analyzed and potential factors influencing post-operative hearing were assessed. RESULTS: 626 ears were included. We found no significant differences between the short-term and long-term post-operative audiometry. The pre-operative air-bone gap (ABG) was the factor with the largest effect size on change in air-bone gap (ABG) between pre- and post-operative. When stratifying for this factor along with the type of ossicular chain reconstruction to account for differences at baseline, no significant differences in post-operative ABG were found between BOT and non-obliteration CWU and CWD. CONCLUSION: In this large retrospective cohort study, we found no significant differences in post-operative ABG between the BOT and the non-obliteration CWU and CWD. A solid comparison of hearing between groups remains very challenging as hearing outcome seems to be dependent on many different factors. Hearing outcome seems to be no additional argument to choose for BOT over non-obliteration surgery.

Objective Measurement of Listening Device Use and Its Relation to Hearing Acuity.

OBJECTIVES: To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds. STUDY DESIGN: Cross-sectional study. SETTING: This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019. METHODS: A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears. RESULTS: Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds. CONCLUSIONS: The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.

The Effect of Hearing Aid Use on the Association Between Hearing Loss and Brain Structure in Older Adults.

OBJECTIVES: Recent studies have shown an association between poorer hearing thresholds and smaller brain tissue volumes in older adults. Several underlying causal mechanisms have been opted, with a sensory deprivation hypothesis as one of the most prominent. If hearing deprivation would lead to less brain volume, hearing aids could be hypothesized to moderate this pathway by restoration of hearing. This study aims to investigate whether such a moderating effect of hearing aids exists. DESIGN: The authors conducted a cross-sectional study involving aging participants of the population-based Rotterdam Study. Hearing aid use was assessed by interview and hearing loss was quantified using pure-tone audiometry. Total brain volume, gray matter and white matter volume and white matter integrity [fractional anisotropy (FA) and mean diffusivity] were measured using magnetic resonance imaging. Only participants with a pure tone average at 1, 2, and 4 kHz (PTA1,2,4) of ≥35 dB HL were included. Associations of hearing loss with brain volume and global measures of white matter integrity were analyzed using linear regression, with hearing aid use and interaction between hearing aid use and PTA1,2,4 included as independent variables. Models were adjusted for age, sex, time between audiometry and magnetic resonance imaging, level of education, and cardiovascular risk factors. RESULTS: Out of 459 included participants with mean age (range) 70.4 (52 to 92) 41% were female. Distributions of age and sex among hearing aid users (n = 172) did not significantly differ from those without hearing aids. PTA1,2,4 was associated with lower FA, but not with a difference in total brain volume, gray matter volume, white matter volume, or mean diffusivity. Interaction between hearing aid use and PTA1,2,4 was not associated with FA or any of the other outcome measures. Additional analysis revealed that interaction between hearing aid use and age was associated with lower FA. CONCLUSIONS: We found no evidence for a moderating effect of hearing aids on the relationship between hearing loss and brain structure in a population of older adults. However, use of hearing aids did appear as an effect modifier in the association between age and white matter integrity. Future longitudinal research is needed to clarify these results.

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery.

PURPOSE: To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction. METHODS: This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing. RESULTS: 79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques. CONCLUSION: We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

Bidirectional Associations of Childhood Stuttering With Behavior and Temperament.

PURPOSE: Behavior and temperament (e.g., emotional reactivity, self-regulation) have been considered relevant to stuttering and its developmental course, but the direction of this relation is still unknown. Knowledge of behavior difficulties and temperament in childhood stuttering can improve screening and intervention. The current study examined both directions of the relationship between stuttering and behavior difficulties and temperament and between persistent stuttering and behavior difficulties and temperament across childhood. METHOD: This study was embedded in the Generation R Study, a population-based cohort from fetal life onward in the Netherlands. We analyzed data from 145 children (4.2%) with a history of stuttering (118 recovered, 27 persistent) and 3,276 children without such a history. Behavior and temperament were repeatedly assessed using parental questionnaires (Child Behavior Checklist) and Infant/Child Behavior Questionnaire between 0.5 and 9 years of age. Multiple logistic and linear regression analyses were performed. RESULTS: Six-month-old children who were less able to "recover from distress," indicating poor self-regulation, were more likely to develop persistent stuttering later in childhood (odds ratio = 2.05, 95% confidence interval (CI) [1.03, 4.05], p = .04). In the opposite direction, children with a history of stuttering showed more negative affectivity (ß = 0.19, 95% CI [0.02, 0.37], p = .03) at 6 years of age than children without such a history. Stuttering persistence was associated with increased internalizing behaviors (ß = 0.38, 95% CI [0.03, 0.74], p = .04) and higher emotional reactivity (ß = 0.53, 95% CI [0.09, 0.89], p = .02) at the age of 9 years. CONCLUSIONS: Behavior and temperament were associated with stuttering persistency-seemingly as both predictor and consequence-but did not predict a history of stuttering. We suggest that children who persist in stuttering should be carefully monitored, and if behavioral or temperamental problems appear, treatment for these problems should be offered. Supplemental Material https://doi.org/10.23641/asha.16869479.

Treatment Outcome of the Bony Obliteration Tympanoplasty Versus Nonobliterative Techniques in Cholesteatoma Surgery: A Retrospective Analysis.

OBJECTIVE: In cholesteatoma surgery, obliteration of the mastoid and epitympanic space (bony obliteration tympanoplasty, BOT) is an increasingly used technique with low recurrent and residual cholesteatoma rates. While factors as the postoperative hearing level and infection rate are important for the patient as well, these outcome parameters are not frequently reported on in current literature. The objective of this study is to evaluate the recurrent and residual cholesteatoma rates of the BOT technique and nonobliterative canal wall up (CWU) and canal wall down (CWD) mastoidectomy in a large patient cohort. Secondary objectives were to evaluate the infection rate and hearing outcome for all three techniques. DESIGN: Retrospective cohort study. SETTING: Single-center study. PATIENTS: All 337 adult patients (≥18 yrs) who underwent primary or revision cholesteatoma surgery between January 2013 and March 2019 were included. MAIN OUTCOME AND MEASURES: Recurrent cholesteatoma rates, residual cholesteatoma rates, postoperative infections and other complications, hearing outcome. RESULTS: The estimated combined rate of recurrent and residual cholesteatoma at 5 years follow-up was 7.6% in the BOT group, 34.9% in the CWU group, and 17.9% in the CWD group. The postoperative infection rate in the different groups ranged from 4.3% to 4.9%. The median gain in AC threshold level varied from 0.0 dB in the BOT and CWD group to 3.8 dB in the CWU group. CONCLUSIONS: We show that cholesteatoma recurrence rates after the BOT technique in our clinic are significantly lower compared to CWU surgery. There were no differences in infection rate and no clinically relevant differences in postoperative hearing between the BOT, CWU, and CWD technique.

A 4-year follow-up study of hearing acuity in a large population-based cohort of children and adolescents.

OBJECTIVES: To describe the prevalence of hearing loss among 13 year old adolescents, and to examine the change in prevalence between ages 9 and 13 years. METHODS: This study was embedded within Generation R, a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone thresholds were obtained at 0.5 to 8 kHz, and tympanometry was performed. Sensorineural hearing loss (SNHL) was defined as a low-frequency and/or high-frequency pure-tone average of more than 15 dB HL in one of both ears. Audiometric signs suggestive of noise-induced hearing loss (NIHL) included the presence of a notch and/or high-frequency hearing loss. The study was conducted from April 2012 to October 2015, and April 2016 to September 2019. RESULTS: A total of 4572 adolescents with a mean age of 13 years and 7 months (SD, 5 months) were included, of whom 2334 (51.0%) were girls. Within the cohort, 6.4% (95% CI, 5.7%-7.2%) were estimated to have SNHL, and 12.4% (95% CI, 11.5%-13.4%) met the criteria of NIHL. In total, 3675 participants were included in the longitudinal analysis. The prevalence of SNHL decreased from 8.0% to 5.3% between ages 9 and 13 years (P < .001). The prevalence of NIHL increased from 9.8% to 11.7% (P = .004), due to an increase in number of participants with a notch. CONCLUSIONS: The prevalence of SNHL significantly decreased by 2.7% (95% CI, 1.6%-3.9%) between ages 9 and 13 years, probably due to a change in alertness during assessment at the age of 13 years. Other possible explanations include the presence of selection bias or a decline in prevalence of conductive hearing loss. The number of participants with audiometric signs suggestive of NIHL increased by 1.9% (95% CI, 0.5%-3.3%). LEVEL OF EVIDENCE: Level 3.

Identifying distinct trajectories of acute otitis media in children: A prospective cohort study.

OBJECTIVES: To identify possibly distinct acute otitis media (AOM) trajectories in childhood and identify determinants associated with specific AOM trajectories. To explore which child will become prone to recurrent AOM episodes and which will not. DESIGN: Population-based prospective cohort study among 7863 children from birth until 10 years and their mothers. METHODS: This study was embedded in the Generation R Study: a population-based prospective cohort study. Data on AOM and determinants were collected by repeated parental questionnaires. Distinct AOM trajectories within the population were identified with latent-class analyses. Next, using multivariate analysis we checked whether specific determinants were associated with specific trajectories. RESULTS: Three distinct trajectories were identified; that is, non-otitis prone, early AOM-that is children who suffered AOM episodes until 3 years of age but not beyond, and persistent AOM-that is children who remained otitis-prone. Male gender (OR: 1.26, CI: 1.11-1.43) and day-care attendance (OR: 1.31, CI: 1.06-1.60) were associated with increased odds of early AOM. Breastfeeding was beneficial for children in both the early-AOM and persistent-AOM trajectories (OR: 0.78 and 0.77, respectively). Birth in the summer or autumn as compared with birth in the spring decreased odds of AOM only in the persistent-AOM trajectory. Half of all AOM-prone children recovered after the age of 3 years. CONCLUSION: Specific determinants are associated with different AOM trajectories. Future research is needed to better predict which child will remain otitis-prone and which recovers after the age of 3 years to better tailor treatment towards the needs of the individual child.

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits.

BACKGROUND: Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits. METHODS: This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019. RESULTS: A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0-3.4), the median listening time 21.1 min a day (IQR 9.1-53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364). CONCLUSIONS: The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss.

OBJECTIVES: Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss. DESIGN: We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs. RESULTS: The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list. CONCLUSION: The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Child- and Environment-Related Factors Influencing Daily Cochlear Implant Use: A Datalog Study.

OBJECTIVES: To understand the varying levels of daily cochlear implant (CI) use in children, previous studies have investigated factors that may be of influence. The objective of this study was to investigate the degree with which new child-related and environment-related characteristics were associated with consistent CI use. DESIGN: The design of this study was retrospective. Data were reviewed of 81 children (51% females, mean age 6.4 years with a range of 1.3 to 17.7 years) who received a CI between 2012 and 2019. Developmental status, quantified burden of comorbidity, hearing experience, and hearing environment were investigated for correlation with consistency in daily CI use. The CIs datalog was used to objectively record the wearing times. Associations were examined using univariate correlation analyses and a linear regression analysis. RESULTS: On average, the CI was worn 8.6 hr per day and 59% of the children wore it more than 8 hr daily. The latter children's hearing performance was significantly higher than that of the others. Consistency in CI use correlated significantly with the child-related characteristics chronological age, nonverbal intelligence quotient (IQ), American Society of Anesthesiologists physical status class, pre CI acoustic experience, CI experience, and one of the environment related characteristics "parental communication mode." In a multivariate linear regression model, consistency in CI use was significantly dependent on nonverbal IQ and parental communication mode. These together accounted for 47% of the variation in daily CI use. CONCLUSIONS: The findings indicate that children with lower nonverbal IQ scores and low exposure to oral communication by their parents are at risk of inconsistent CI use.

Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival.

In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.

Environmental determinants associated with acute otitis media in children: a longitudinal study.

BACKGROUND: Acute otitis media (AOM) is a common pediatric disease and frequent reason for antibiotic treatment. We aimed to identify environmental and host factors associated with AOM and assess which determinants were associated with AOM at specific ages. METHODS: This study among 7863 children was embedded in the Generation R Study: a population-based prospective cohort study from fetal life onwards. Data on outcome and possible determinants were collected using questionnaires until 6 years. We used generalized estimating equation models to examine associations with AOM with longitudinal odds at different ages, considering correlations between repeated measurements. RESULTS: Male gender increased odds of AOM in children at 2, 3, and 4 years but not at other ages. Postnatal household smoking, presence of siblings, and pet birds increased odds of AOM. Breastfeeding decreased AOM odds, most notably in the first 2 months of life. No association was found for season of birth, maternal age, ethnicity, aberrant birth weight for gestational age, prenatal smoking, furry pets, and daycare attendance. CONCLUSIONS: Risk of childhood AOM varies with age. Significant association with AOM was found for gender and breastfeeding at specific ages and for household smoking, presence of siblings, and pet birds at all the studied ages.