Teresa C. Ching

Description:To conduct a systematic review of identified barriers and facilitators for ethnically diverse adults and children in accessing hearing health services. Searches were performed in electronic databases MEDLINE, EMBASE, CINAHL, Pychinfo, LLBA, and Scopus. The Strengthening of Reporting of Observational Studies in Epidemiology and Standards for Reporting Qualitative Research were used to assess quality of articles. Barriers and facilitators for ethnically diverse adults and children to access hearing services were summarised descriptively using Levesque et al.'s conceptual framework of access to healthcare. 25 articles met the inclusion criteria. Barriers and facilitators were identified for every domain of Levesque's framework for ethnically diverse adults, children, and their families. Personal barriers included health literacy, health beliefs, and stigma. Environmental barriers included language, limited cultural and interpreter training for clinicians, time constraints in appointments, direct and indirect costs. Facilitators included availability of translated and/or simplified information, cultural responsiveness training, outreach programs, and community health workers to engage with ethnically diverse communities. With increasingly multicultural societies globally, there is an increased need to provide culturally responsive care and accessible hearing health services. Understanding current barriers and facilitators to accessibility would facilitate global sustainable development goals around reduced inequality, health, and wellbeing.

Description:To investigate 1) the influence of electrical dynamic range (DR) in cochlear implants (CI) of children at 3 years of age on their speech perception, vocabulary, and health-related quality of life (HRQOL) at 9 years of age; and 2) changes in electrical stimulation levels and DR over the first 10 years of life. This is a prospective longitudinal study on outcomes of children with congenital hearing loss. Outcomes at 9 years were measured using standardised tests. Generalised linear models were used to examine the effects of DR in CIs at age 3 years on children's 9-year outcomes. One hundred and two children who received CIs before 3 years of age. On average, vocabulary and HRQOL were within the range of typically hearing peers. A wider DR at 3 years was associated with better self-rated HRQOL at 9 years of age. Parent-proxy ratings of HRQOL were higher for children with better vocabulary. Earlier CI activation was associated with better speech perception and vocabulary. DR was stable over time. The findings lend support to early cochlear implantation and emphasise the importance of optimising stimulation levels and DR at a young age to maximise longer-term outcomes.

Description:Objective: Early identification of congenital deafness enables early intervention, but evidence on the influence of age at fitting of hearing aids (HAs) or cochlear implants (CIs) on outcomes in school-aged children who are deaf or hard of hearing (DHH) is limited. This study (1) described developmental outcomes and health-related quality of life in DHH children; and (2) examined the relationships among demographic factors, including age at fitting of HAs or CIs, and outcomes. Methods: This prospective cohort study included participants in a population-based study who were followed up at 9 years of age. Children who are DHH and who first received hearing habilitation services before 3 years of age from the government-funded national hearing service provider in the states of New South Wales, Victoria, and Southern Queensland in Australia were invited to enroll in the study. At 9 years of age, enrolled children were assessed using standardized measures of language, cognitive abilities, and speech perception. The children also completed questionnaire ratings on their quality of life. Parents provided demographic information about their child, family, and education; and completed ratings on their child's quality of life. Audiological data were retrieved from the client database of the hearing service provider and records held at CI centers. Descriptive statistics were used to report quantitative outcomes. The relationships among demographic characteristics, including age at fitting of HAs or CIs, and children's outcomes were examined using structural equation modeling. Results: A total of 367 children, 178 (48.5%) girls, completed assessments at age 9.4 (SD = 0.3) years. On average, performance was within 1 SD of the normative mean for language, cognitive functioning, and health-related quality of life; but much below norms for speech perception. The modeling result is consistent with verbal short-term memory having a mediating effect on multiple outcomes. Better verbal short-term memory is significantly associated with no additional disabilities, earlier age at CI activation, use of an oral communication mode in early intervention, and higher maternal education. In turn, verbal short-term memory directly and positively affects speech perception, language, and health-related quality of life. Maternal education directly and positively affects language outcomes, and indirectly via its effects on nonverbal I.Q. and verbal short-term memory. Better language is directly associated with a better quality of life. Conclusions: This study found evidence consistent with early hearing intervention having a positive effect on speech perception and language via its effect on verbal short-term memory. Children who had better language also had better quality of life. The importance of early hearing for cognitive development lends support to early detection and early hearing intervention, including streamlining pathways for early CI activation. Strategies for intervention in language and communication development may benefit from tailoring programs to meet the needs of individuals with different memory profiles for optimizing outcomes.

Description:To investigate the effects of automatic scene classification (SCAN) on speech perception in noise and real-world functional performance in children using cochlear implants (CIs). We used a within-subjects repeated measures design in two studies. The first study assessed speech perception in noise with or without SCAN enabled in 25 school-aged children. The second study evaluated functional auditory performance in real life. Parents of 18 children provided ratings using the Parents' Evaluation of Aural/oral Performance of Children (PEACH) questionnaire; and children provided ratings using the Self Evaluation of Listening Function (SELF) questionnaire. Analyses of variance with repeated measures were used to examine the effect of SCAN. On average, speech perception in noise was significantly better with SCAN enabled (mean SRT: -4.1 dB; SD: 4.0), compared to SCAN disabled (mean SRT: 0.5 dB; SD: 3.5). Children's functional performance in real life was similar between the two device settings. Automatic auditory scene classification provides significant benefits for speech perception in noise (4.6 dB improvement). On average, there were no perceived detrimental or beneficial effects in real life. These findings support the use of SCAN in CIs for young children.

Description:Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.