A preliminary account of phonological and morphophonological perception in young children with and without otitis media.

This investigation examined the effects of otitis media with effusion (OME) and its associated fluctuating conductive hearing loss on the perception of phonological and morphophonological /s/ and /z/ in young children. We predicted that children free of OME (OME-) would perform better than children with histories of OME (OME+). We also predicted that for the OME+ group morphological perception would be harder than phonological perception, because the former category carries an additional linguistic load (i.e., plurality). Sixteen children, ages 26 to 28 months (M = 26.5, SD = 0.6) were divided into two groups, the OME- (n = 8) and OME+ (n = 8) based on OME history during the first year of life. Subjects in the OME- group were free of the disease for 4/5 visits and pure tone average (PTA) was 12.6 dB HL (SD = 4.8). Subjects in the OME+ group had the disease on 3/5 visits and PTA was 23 dB HL (SD = 2.7). Experimental stimuli were six monosyllabic novel word-pairs. Members of each word-pair differed only in the presence of final voiced or voiceless fricative, marking the targets phonologically (e.g., [g [symbol: see text]]/[g [symbol: see text] s] as in 'law', 'loss') or morphophonologically (e.g., [daep]/[daeps] as in 'map' 'maps'). Subjects were taught the unfamiliar word pairs using a fast mapping procedure. Perception was tested with the bimodal preferential looking paradigm. Children in the OME- group performed significantly better than their OME+ counterparts. Individual word-pair analyses showed that OME+ group performed more poorly than the OME- group on one phonological and on two morphological targets, all ending with [s]. For the OME+ group, targets with final [s] posed greater difficulty than those with final [z], especially on morphophonological plural-(s) targets. The results suggested that the fluctuating hearing loss associated with OME might have a negative impact on speech perception.

Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society.

Autism is a common disorder of childhood, affecting 1 in 500 children. Yet, it often remains unrecognized and undiagnosed until or after late preschool age because appropriate tools for routine developmental screening and screening specifically for autism have not been available. Early identification of children with autism and intensive, early intervention during the toddler and preschool years improves outcome for most young children with autism. This practice parameter reviews the available empirical evidence and gives specific recommendations for the identification of children with autism. This approach requires a dual process: 1) routine developmental surveillance and screening specifically for autism to be performed on all children to first identify those at risk for any type of atypical development, and to identify those specifically at risk for autism; and 2) to diagnose and evaluate autism, to differentiate autism from other developmental disorders.

Effects of otitis media with effusion on hearing in the first 3 years of life.

Hearing sensitivity was examined prospectively in young children as a function of otitis media with effusion (OME) status in Years 1, 2, and 3. Hearing and OME status were sampled bimonthly from 5 to 36 months of age. Behavioral thresholds were obtained at 4 test frequencies (500, 1000, 2000, and 4000 Hz) using visual reinforcement audiometry and conditioned play audiometry techniques. The majority of children's audiograms were obtained using a computer-controlled test procedure. Thresholds for the test frequencies were averaged for each visit and then averaged across all visits in each year. Reference values were developed for infants and children in Years 1, 2, and 3 who were OME free. Results reveal that children who were classified as bilaterally OME positive in Years 1, 2, and 3 had significantly poorer hearing than children classified as bilaterally OME free in each of these time periods. There was no difference in hearing as a function of gender, socioeconomic status, or birth-risk status.

Effect of neonatal test environment on recording transient-evoked otoacoustic emissions.

OBJECTIVE: To examine the effect of test environment on recording transient-evoked otoacoustic emissions (TEOAE) in neonates. METHODS: Thirty-two infants from the newborn nursery (NBN) who passed a screening auditory brainstem response (SABR) test and were at least 34 weeks' postconceptional age were studied. One ear of each newborn was tested using TEOAE in 5 different test environments: open bassinet in the NBN (E1), working isolet located in the NBN (E2), nonfunctioning isolet in the NBN (E3), nonfunctioning isolet in a quiet room off the NBN (E4), and open bassinet in a quiet room (E5). The number of high noise samples (HNS), the test duration (in seconds), the signal-to-noise ratio (SNR; in dB) measured at bandwidths centered at 1.6, 2.4, 3.2, and 4.0 kHz, and the percentage of neonates with a fail screening outcome based on a common pass-fail screening criteria were compared in the 5 test environments. RESULTS: There were statistically significant differences in the number of HNS accumulated in the 5 test environments (F = 6.79). The use of a nonfunctioning isolet in both the NBN and within a room off the NBN (E3 and E4, respectively) resulted in significantly fewer HNS than when TEOAEs were recorded in the other 3 test environments (E1, E2, and E5). Mean test duration was significantly different among the 5 locations (F = 6. 53). Posthoc analyses revealed that test time in E3 and E4 was significantly shorter than in E1 and E2. The percentage of newborns with a fail (

Assessing growth of loudness in children by cross-modality matching.

This study examined the clinical feasibility, validity, and reliability of loudness growth assessment using cross-modality matching (CMM) between line length and loudness in 16 children 4 to 12 years old with normal hearing or bilateral sensorineural hearing losses ranging from moderate to severe in degree. Eight adult listeners with normal hearing were used as a comparison group. Loudness growth functions and real-ear measures were obtained for 500-Hz and 2,000-Hz narrowband noise stimuli for each individual. No significant differences were found between the loudness slope values for the adults and children with normal hearing. Loudness growth functions of the children with sensorineural hearing loss were significantly steeper (larger) than the slopes obtained from children with normal hearing. The numeric slope value of the loudness growth function became larger and more variable as children's hearing threshold increased and differed for children with similar thresholds. The loudness functions obtained for retested participants at two different test sessions were highly correlated. Real-ear measurements revealed that for equivalent input stimulus levels, significantly higher stimulus levels were present in the ear canals of children versus adults. Although adults and children with normal hearing had similar overall rates of loudness growth, discrete points along the loudness growth function were judged to be louder by the children. This preliminary study suggests that measures of loudness growth using CMM between line length and loudness are feasible, valid, and reliable in children with normal hearing or sensorineural hearing loss. The individual variability noted in slope values for children with hearing loss attests to the importance of subjective assessments of loudness. The protocol used in this study may have potential as a clinical tool for selecting and fitting amplification technology for children with hearing loss as young as 6 years.

Speech perception and verbal memory in children with and without histories of otitis media.

Two groups of children, with (n = 7) and without (n = 7) first-year histories of otitis media, were participants in a longitudinal study that included periodic audiological and medical evaluations during the first year of life. At age 9, these children were tested on a series of speech perception and verbal short-term memory tasks using stimuli of varying degrees of phonetic contrast. Although the otitis-positive group performed less accurately than the otitis-free group, the pattern of errors was the same for the two groups. The performances of the children with and without positive histories of otitis media were negatively affected by an increase in phonetic similarity of the stimulus items. The two groups, however, did not differ on identification or on temporal-order recall when the speech sounds were differentiated by multiple features. These findings provide evidence of subtle, long-term effects of early episodes of otitis media on phonological representations and on working memory.

Children's speech recognition in noise using omni-directional and dual-microphone hearing aid technology.

OBJECTIVE: The purpose of this study was to examine children's speech recognition abilities for words and sentences presented in background noise when the children used omni-directional and dual-microphone hearing aid technology. DESIGN: Twenty children (ten 4- to 6-yr olds; ten 7- to 11-yr-olds) with bilateral cochlear hearing loss (average four-frequency hearing loss = 57.25 dB HL; range: mild to severe) were included in the study. An adaptive test procedure was used to estimate a signal to noise ratio (SNR) that reduced individual speech recognition ability to 50% in multi-talker background competition. Testing was completed with the child seated in a conventional audiologic test suite. A fixed level of the speech signal was delivered through a loudspeaker located at 0 degrees; noise varying in 2 dB steps was presented at 180 degrees. SNR was estimated for two types of speech materials (closed-set words and sentences). Children wore binaural programmable hearing aids (Phonak PiCS) and were tested in conventional omni-directional and dual-microphone ("Audio Zoom") conditions. RESULTS: Significant effects of microphone condition, speech material type (words and sentences), and age group ("younger" and "older") were revealed by mixed design analysis of variance. Overall, children received a mean advantage of 4.7 dB from listening in the dual-microphone condition. Children's performance was correlated with their chronological age and language age (receptive vocabulary) but not with their degree of hearing loss (except in one condition). Younger children required a more advantageous SNR to achieve the same performance criteria as older children. CONCLUSIONS: Under the specific test conditions used in this investigation, dual-microphone hearing aid technology provided a significant listening advantage in background competition over conventional omni-directional microphones for children with mild to severe cochlear hearing loss for both word and sentence test materials.

The screening and diagnosis of autistic spectrum disorders.

The Child Neurology Society and American Academy of Neurology recently proposed to formulate Practice Parameters for the Diagnosis and Evaluation of Autism for their memberships. This endeavor was expanded to include representatives from nine professional organizations and four parent organizations, with liaisons from the National Institutes of Health. This document was written by this multidisciplinary Consensus Panel after systematic analysis of over 2,500 relevant scientific articles in the literature. The Panel concluded that appropriate diagnosis of autism requires a dual-level approach: (a) routine developmental surveillance, and (b) diagnosis and evaluation of autism. Specific detailed recommendations for each level have been established in this document, which are intended to improve the rate of early suspicion and diagnosis of, and therefore early intervention for, autism.

Language, speech, and educational outcomes of otitis media.

OBJECTIVE: This article, through a summary of the current literature available, studies the relationship between recurrent otitis media (OM) and communication (speech and language) and educational development. Areas discussed include historical and current views of their relationship, hearing loss and auditory abilities, language and speech development, and educational (cognitive and academic) performance of children with histories of OM. As well, the authors present a model for the use of physicians, communications specialists, and educators when dealing with such children. CONCLUSION: Despite significant advances in our understanding of OM-related communication and educational development, more prospective studies that also consider the role of other mediating and moderating variables affecting language in children with OM histories are needed.

Cross-modality matching and the loudness growth function for click stimuli.

Loudness-intensity functions for click stimuli were obtained from 30 adult listeners having normal (n = 10), flat (n = 10), or sloping (n = 10) high-frequency cochlear hearing loss configurations. The procedure of cross-modality matching (CMM) between loudness and perceived line length [R. P. Hellman and C. H. Meiselman, J. Speech Hear. Res. 31, 605-615 (1988); J. Acoust. Soc. Am. 88, 2596-2606 (1990); J. Acoust. Soc. Am. 93, 966-975 (1993)] was used to validate their loudness growth functions. Mean group loudness exponents were similar to those reported in recent investigations that utilized pure tone stimuli, further supporting the validity and reliability of the CMM task as an estimate of the loudness growth function. The results also suggest that the mean loudness function for clicks is similar to the function obtained with tonal stimuli at least for listeners with moderately impaired hearing or better. Moreover, CMM produced less variability than the more conventional psychophysical methods of magnitude estimation and production for the groups with cochlear hearing loss. Toward direct application of the CMM technique, in lieu of absolute exponential slope values, the individually determined loudness growth function over a range of intensities should be compared to the normal mean functions for calculations of deviations.

The relationship between loudness intensity functions and the click-ABR wave V latency.

OBJECTIVE: To assess the relationship of loudness growth and the click-evoked auditory brain stem response (ABR) wave V latency-intensity function (LIF) in listeners with normal hearing or cochlear hearing loss. The effect of hearing loss configuration on the intensity functions was also examined. DESIGN: Behavioral and electrophysiological intensity functions were obtained using click stimuli of comparable intensities in listeners with normal hearing (Group I; n = 10), and cochlear hearing loss of flat (Group II; n = 10) or sloping (Group III; n = 10) configurations. Individual intensity functions were obtained from measures of loudness growth using the psychophysical methods of absolute magnitude estimation and production of loudness (geometrically averaged to provide the measured loudness function), and from the wave V latency measures of the ABR. RESULTS: Slope analyses for the behavioral and electrophysiological intensity functions were separately performed by group. The loudness growth functions for the groups with cochlear hearing loss approximated the normal function at high intensities, with overall slope values consistent with those reported from previous psychophysical research. The ABR wave V LIF for the group with a flat configuration of cochlear hearing loss approximated the normal function at high intensities, and was displaced parallel to the normal function for the group with sloping configuration. The relationship between the behavioral and electrophysiological intensity functions was examined at individual intensities across the range of the functions for each subject. A significant relationship was obtained between loudness and the ABR wave V LIFs for the groups with normal hearing and flat configuration of cochlear hearing loss; the association was not significant (p = 0.10) for the group with a sloping configuration of cochlear hearing loss. CONCLUSION: The results of this study established a relationship between loudness and the ABR wave V latency for listeners with normal hearing, and flat cochlear hearing loss. In listeners with a sloping configuration of cochlear hearing loss, the relationship was not significant. This suggests that the click-evoked ABR may be used to estimate loudness growth at least for individuals with normal hearing and those with a flat configuration of cochlear hearing loss. Predictive equations were derived to estimate loudness growth for these groups. The use of frequency-specific stimuli may provide more precise information on the nature of the relationship between loudness growth and the ABR wave V latency, particularly for listeners with sloping configurations of cochlear hearing loss.

Screening infants and young children for hearing loss: examination of the CAST procedure.

A computer-mediated visual reinforcement audiometry (VRA) screening procedure, the Classification of Audiograms by Sequential Testing (CAST), was used with 59 infants and young children who received both CAST screening and conventional audiologic assessment. Approximately one-third of the children had normal hearing, one-third had conductive hearing loss, and the remaining one-third had previously diagnosed sensorineural hearing loss. The sensitivity and specificity of CAST were calculated and the relationship between the predicted CAST pattern and the child's actual audiogram was examined. CAST outcome was also considered along with the results of tympanometry and pneumatic otoscopy to formulate proposed follow-up strategies. CAST appears to be a useful tool for the behavioral screening of infants and young children: one component of a screening program designed to maximize the efficient identification and follow-up of infants and children with hearing loss.

Early otitis media and phonological development at age 2 years.

The effect of early otitis media on phonology and articulation in the presence of expressive language delay was investigated in 16 2-year-olds followed prospectively from birth. Eight of the children were designated otitis-positive and 8 were considered otitis-negative as determined by bilateral pneumatic otoscopy outcomes during year 1 of life. The groups differed significantly on measures of expressive, not receptive, language development. All members of the otitis-positive group were expressive language delayed. Phonological analyses were completed on spoken language samples elicited from each child at age 24 months. Results showed similar developmental tendencies in speech sound acquisition between the groups, but the otitis-positive group had established significantly fewer initial consonant phones and produced them less accurately than the otitis-negative subject group. The otitis-positive group acquired significantly fewer consonants with back place of articulation. Similar phonological error patterns of deletion and phoneme class deficiency were used by the groups, but the otitis-positive group used the error patterns more frequently. Findings here lend support to the otitis media effect as one of interaction among risk factors.

Auditory consequences of early mild hearing loss associated with otitis media.

Two groups of children received periodic documentation of their middle ear status by pneumatic otoscopy in the first year of life and had hearing sensitivity estimated by multiple auditory brainstem response (ABR) assessments during the same period. One group was considered otitis media (OM)-positive, with repeated bilateral episodes of OM and mild conductive hearing loss. The second group was considered OM-free with normal middle ear function bilaterally and normal hearing sensitivity in the first year of life. Children's higher-order auditory abilities were examined at 4, 6 and 9 years of age. Various measures such as speech recognition-in-competition, visual-auditory learning, sound blending, auditory memory, and masking level difference estimates were utilized to probe the children's auditory abilities. Results show that children with a first-year history of otitis media demonstrate deficits in the long term in some aspects of higher-order auditory processing. Performance appears to be associated with the mild hearing loss experienced during an important period of early development.

Otitis media, communication style of primary caregivers, and language skills of 2 year olds: a preliminary report.

The association between early otitis media, styles of primary caregivers, and language development was prospectively examined in 26 2-year-old children from lower socioeconomic backgrounds (of mixed perinatal status) followed prospectively since birth. Based on otoscopic evaluations during the first year of life, there were 14 children who were classified as bilaterally otitis-free (OM-) and 12 children who were classified as bilaterally otitis-positive (OM+). At 2 years of age, all children were administered standardized measures of cognitive and language function along with a 20-minute videotaped play session with one of their primary caregivers. The language of both the children and caregivers was analyzed. Results indicate that caregivers of OM+ and OM- children used language nearly identically when interacting with their children. However, caregivers of OM+ children whose communication style was marked by a high percentage of directives and a corresponding low percentage of both questions and information-giving had the children with the lowest scores on all measures of naturalistic language. Controlling for neonatal illness did not alter the relationships found. The results suggest that caregiver language may compensate for some of the auditory deprivations associated with otitis media.

Thresholds for auditory brain stem responses to tones in notched noise from infants and young children with normal hearing or sensorineural hearing loss.

OBJECTIVE: To assess the accuracy of threshold estimates determined using the auditory brain stem responses (ABRs) to brief tones presented in notched noise in a group of infants and young children with normal hearing or sensorineural hearing loss (SNHL). DESIGN: The thresholds for ABRs to brief duration 500, 2000, and 4000 Hz tones presented in notched-noise masking were evaluated in infants and young children with normal hearing (N = 34) or SNHL (N = 54). Tone-evoked ABR thresholds were compared with behavioral thresholds obtained at follow-up audiologic assessments, for a total of 220 comparisons. RESULTS: ABR thresholds for the infants with bilateral normal hearing were 23.6, 12.9, and 12.6 dB nHL for 500, 2000 and 4000 Hz, respectively. Most (92 to 100%) infants with normal hearing showed ABRs to 30 dB nHL tones. Across all subjects (i.e., those with normal hearing and those with impaired hearing), high ( > or = 0.94) correlations were found between the ABR and behavioral thresholds. The mean differences between ABR (dB nHL) and behavioral (dB HL) thresholds across all subjects were 8.6, -0.4, and -4.3 dB for 500, 2000, and 4000 Hz, respectively. Overall, 98% of the ABR thresholds were within 30 dB of the behavioral thresholds, 93% were within 20 dB, and 80% were within 15 dB. CONCLUSIONS: These threshold results for the ABR to brief tones in notched noise obtained for infants and young children are similar to those obtained in similar studies of adults. The technique may be used clinically with reasonable accuracy to estimate pure-tone behavioral thresholds in infants and young children who are referred for diagnostic threshold ABR testing.

Early otitis media and later educational risk.

Fourteen children aged 6 years received screening for educational risk status and formal measures of academic performance. These children have been followed prospectively from birth for their otitis media status. Seven of the children were considered positive for otitis media in year one (recurrent episodes bilaterally), while 7 were considered otitis free. Academic status was related to early hearing acuity (as determined by repeated ABR assessment). Moreover, teachers' ratings of academic risk status were related to a measure at 4 years that examined the children's capacity to listen in background noise.