Socioeconomic status and pediatric cochlear implant usage during COVID-19.

OBJECTIVE: COVID-19 (COVID) delayed access to speech and hearing services. The objective of this study was to identify interactions between socioeconomic status (SES) and cochlear implant (CI) usage during COVID. METHODS: Consecutive pediatric patients (age 0-17) with CI and audiology visits between 2019 and 2022 at a tertiary care children's hospital were reviewed. Age, sex, race, insurance type, and proxy measures for SES using zip code were recorded. Hours spent with CI on and in different listening environments were compared between pre-COVID (1/1/2019-12/31/2019), COVID (4/1/2020-3/31/2021), and most recent (6/1/2021-5/31/2022) time periods. RESULTS: Most patients were male (32/59, 54 % ears of 48 patients) and White, non-Hispanic (45/59, 76 %). Median age at implant was 2.0 years (range:0.6-12.2). There were no significant differences in hours spent with CI on during COVID compared with pre-COVID. However, children spent more time listening to louder noises (70-79 dB and ≥80 dB) recently compared with during COVID (p = 0.01 and 0.006, respectively). During COVID, children living in areas with greater educational attainment showed smaller reductions in total hours with CI on (ß = 0.1, p = 0.02) and hours listening to speech in noise (ß = 0.03, p = 0.005) compared with pre-COVID. In the most recent time period, children of minority race (ß = -3.94 p = 0.008) and those who were older at implant (ß = -0.630, p = 0.02) were more likely to experience reductions in total hours with CI on compared with during COVID. CONCLUSION: Interventions which mitigate barriers of implant use and promote rich listening home-environments for at risk populations should be implemented during challenging future social and environmental conditions.

A 15-year Review of 260 Children With Auditory Neuropathy Spectrum Disorder: II. Management and Outcomes.

OBJECTIVES: Following a review of the demographic and clinical characteristics of all pediatric patients diagnosed with auditory neuropathy spectrum disorder (ANSD) by a pediatric health care system from 2005 to 2020, the present report highlights the type and timing of intervention and outcomes in the same 260 patients with ANSD. DESIGN: This was a retrospective study reviewing the demographic data, medical history, imaging studies, audiological and speech language data, type of audiological intervention (hearing aids or cochlear implants), and mode of communication in 260 pediatric patients diagnosed with ANSD over a 15-year period. RESULTS: A significant decrease over time in the age at hearing aid fitting was observed. While a similar reduction in the age at implantation occurred over time, cochlear implantation is still rarely performed by 12 months of age in most ANSD patients. Among bilateral ANSD patients fitted with hearing aids, the majority (89.2%) did not benefit from conventional amplification and most received cochlear implants. Some hearing aid benefit for speech and language development was observed in 5.8%, though communication difficulties were persistent and most used a combination of oral and sign language for communication. Only six patients (5%) received significant benefit from their hearing aids for speech and language development. CONCLUSIONS: This review of ANSD management over a 15-year period reveals that hearing aids are not a viable option to develop speech and language for most infants and children with ANSD. This finding confirms previous reports and suggest that while hearing aid trials are warranted, children must be tracked closely so as to avoid delays in decision making. Cochlear implantation constitutes the major (if not only) rehabilitative intervention that allows for speech perception in patients who do not benefit from conventional amplification.

A 15-Year Review of 260 Children With Auditory Neuropathy Spectrum Disorder: I. Demographic and Diagnostic Characteristics.

OBJECTIVES: The aim of the study was to review the demographic and clinical characteristics of all pediatric patients diagnosed with auditory neuropathy spectrum disorder (ANSD) by a pediatric health care system from 2005 to 2020 and examine whether or not our diagnostic capabilities in an ANSD population have evolved as our institutional experience has grown and knowledge in the field has expanded. DESIGN: This was a retrospective study reviewing the demographic data, medical history, imaging studies, audiological and speech-language data, type of audiological intervention and mode of communication in 260 pediatric patients diagnosed with ANSD over a 15-year period. RESULTS: The study revealed that male and female children were equally affected with all levels of hearing detection being represented and that about 40% of affected children were premature and most were admitted to the neonatal intensive care unit. More than a third of our patients presented with a complex medical history and/or neural involvement while about 30% were full-term newborns with normal pregnancy, no prenatal complications or infections, normal birth weight, no neonatal intensive care unit need, no hyperbilirubinemia, no respiratory distress requiring ventilation, and no known syndrome. Review of audiological findings confirms that otoacoustic emissions are not always present in ANSD cases, and that the presence of an abnormal wave V on the auditory brainstem response tracings (only present at high intensities and with an absent intensity/latency function) is not a rare finding and should not immediately be dismissed as not being a case of ANSD. CONCLUSIONS: This review of ANSD diagnosis over a 15-year period clearly reveals the drastic improvements made in the identification of ANSD, with a drastic decrease in the age at diagnosis and a reduction in the percentage of misdiagnosed patients. The study also stresses the need for continued improvement in different areas such as genetic studies and physiological measures to help clinicians distinguish between pre- and postsynaptic ANSD.

Audiovisual Interactions in Stereo Sound Localization for Individuals With Unilateral Hearing Loss.

This study investigated the effects of unilateral hearing loss (UHL), of either conductive or sensorineural origin, on stereo sound localization and related visual bias in listeners with normal hearing, short-term (acute) UHL, and chronic UHL. Time-delay-based stereophony was used to isolate interaural-time-difference cues for sound source localization in free field. Listeners with acute moderate (<40 dB for tens of minutes) and chronic severe (>50 dB for more than 10 years) UHL showed poor localization and compressed auditory space that favored the intact ear. Listeners with chronic moderate (<50 dB for more than 12 years) UHL performed near normal. These results show that the auditory spatial mechanisms that allow stereo localization become less sensitive to moderate UHL in the long term. Presenting LED flashes at either the same or a different location as the sound source elicited visual bias in all groups but to different degrees. Hearing loss led to increased visual bias, especially on the impaired side, for the severe and acute UHL listeners, suggesting that vision plays a compensatory role in restoring perceptual spatial symmetry.

Binaural ambiguity amplifies visual bias in sound source localization.

Auditory spatial perception relies on more than one spatial cue. This study investigated the effects of cue congruence on auditory localization and the extent of visual bias between two binaural cues-interaural time differences (ITDs) and interaural level differences (ILDs). Interactions between these binaural cues were manipulated by stereophonic techniques. The results show that incoherent binaural information increased auditory response noise and amplified visual bias. The analysis further suggests that although ILD is not the dominant cue for low-frequency localization, it may strengthen the position estimate by combining with the dominant ITD information to minimize estimation noise.