Behavioural performance and self-report measures in children with unilateral hearing loss due to congenital aural atresia.

OBJECTIVE: To explore the behavioural and functional performance of a group of children with conductive unilateral hearing loss (UHL) due to congenital aural atresia. METHOD: Twelve children aged 7 to 16 years (Mage 10.0, SD 3.1 years) formed the UHL group and 15 age-matched children (Mage 9.5, SD 3.6 years) with normal hearing formed the control group. Auditory skills were assessed using tests of sound localisation, spatial speech perception in noise, and self-ratings of auditory abilities (Listening Inventory for Education; LIFE and Speech, Spatial and Qualities of Hearing scale; SSQ). RESULTS: When speech was directed to the good ear, performance was poorer than for normal hearing controls. Sound localisation abilities were impaired in children with UHL. Children with UHL reported higher levels of difficulties in classroom settings compared to children with normal hearing, particularly for activities involving listening in noise and focused listening activities. Older children self-report and parents report difficulties for their children across all SSQ scales. CONCLUSIONS: Children with UHL showed a wide range of auditory difficulties. As expected, speech recognition in noise differed from controls. Sound localisation abilities were variable; greater variability was seen for right ear hearing losses suggesting that some of these children may have developed compensatory mechanisms. Younger children identified listening difficulties for school situations where focussed auditory attention was needed. Older children and parents reported greatest difficulty for activities requiring perception of the direction, distance, and movement of sound. Higher levels of effort and inability to ignore sounds were reported as major difficulties.

Impact of Unilateral Hearing Loss on Behavioral and Evoked Potential Measures of Auditory Function in Adults.

BACKGROUND: A unilateral hearing loss (UHL) can have a significant functional and social impact on children and adults, affecting their quality of life. In adults, UHL is typically associated with difficulties understanding speech in noise and sound localization, and UHL increases the self-perception of auditory disability for a range of listening situations. Furthermore, despite evidence for the negative effects of reduced unilateral auditory input on the neural encoding of binaural cues, the perceptual consequences of these changes are still not well understood. PURPOSE: Determine effects of UHL on auditory abilities and speech-evoked cortical auditory evoked potentials (CAEPs). RESEARCH DESIGN: CAEPs, sound localization, speech perception in noise and self-perception of auditory abilities (speech, spatial, and qualities hearing scale) were assessed. STUDY SAMPLE: Thirteen adults with UHL with a range of etiologies, duration of hearing loss, and severity and a control group of eleven binaural listeners with normal hearing. RESULTS: Participants with UHL varied greatly in their ability to localize sound and reported speech recognition and listening effort were the greatest problem. There was a greater effect of right ear than left ear hearing loss on N1 amplitude hemispheric asymmetry and N1 latencies evoked by speech syllables in noise. As duration of hearing loss increased, contralateral dominance (N1 amplitude asymmetry) decreased. N1 amplitudes correlated with speech scores, larger N1 amplitudes were associated with better speech recognition in noise scores. N1 latencies are delayed (in the better ear) and amplitude hemisphere asymmetry differed across UHL participants as function of side of deafness, mainly for right-sided deafness. CONCLUSION: UHL affects a range of auditory abilities, including speech detection in noise, sound localization, and self-perceived hearing disability. CAEPs elicited by speech sounds are sensitive enough to evidence changes within the auditory cortex due to an UHL.

Comparing audiological outcomes between the Bonebridge and bone conduction hearing aid on a hard test band: Our experience in children with atresia and microtia.

INTRODUCTION: To compare the audiological results of Bone Conduction Hearing Aid (BCHA) on hard test band and Bonebridge (BB) implant among children with microtia and atresia. METHODS: This is a retrospective review of patients with microtia and atresia who underwent BB implant insertion from September 2014 to February 2017 in Starship Children's Hospital. Preoperative audiological testing using a powered BCHA (Oticon Medical Ponto Pro Power) on a hard test band was used to compare post-operative hearing assessments with the BB. RESULTS: Ten microtia and atresia patients were treated with a BB of whom three were treated bilaterally The children were aged between 5 and 15 and all had moderate to moderately severe conductive hearing loss. For each ear tested and subsequently implanted, BB aided speech scores were equivalent to that obtained by a BCHA. The mean improvement of speech reception threshold level between unaided and BB was statistically significant (p > 0.0001). Subjective questionnaire data indicated that BB implanted patients were performing within the norms of overall listening, both in quiet and in noise. Aided Speech In Noise (SIN) testing values were found to range from 0.8-6.5 for BCHA and 0.2-1.2 for BB and the difference was not statistically significant with a p value of 0.143. CONCLUSION: In audiologic assessments BB performs comparably to BCHA among children with microtia and atresia.

Cortical auditory evoked potential (CAEP) and behavioural measures of auditory function in a child with a single-sided deafness.

OBJECTIVES: To study the changes in behavioural and cortical responses over time in a child with single-sided deafness fitted with a cochlear implant (CI). METHODS: Cortical auditory evoked potentials (CAEPs) in noise (+5 dB signal-to-noise ratio) were recorded and auditory skills were assessed using tests of sound localization, spatial speech perception in noise, and self-ratings of auditory abilities (Listening inventory for education, LIFE and Speech, spatial and qualities of hearing questionnaire, SSQ parental version). Measures were obtained prior to and after a CI fitting, including one, six, and 12 months after the CI switch on. RESULTS: Spatial speech recognition improved over time. At 12 months post-CI, word recognition scores were similar to those of normal hearing children. Signal-to-noise ratios for sentences decreased (i.e. improved) over time post-CI. Sound localization markedly improved at 12 months post-CI compared to baseline. Self-perception of difficulty scores decreased over time. Parental ratings of hearing abilities improved compared to baseline for all subscales. There were changes in the P1-N1-P2 complex at 12 months post-CI, which were clearer frontally across stimuli. Further research is needed to understand the significance of such changes after CI fitting for single-sided deafness. CONCLUSION: Although the changes observed could reflect maturational changes, the clinically significant improvement in recognition of speech in noise and improved questionnaire results suggest that the CI was beneficial, consistent with the feedback from the participant.

Experience of bone-anchored hearing aid implantation in children younger than 5 years of age.

OBJECTIVE: To assess the practicality and benefit of Bone-anchored hearing aid (BAHA(®)) implantation in children younger than 5 years of age. FDA approval for use of BAHA(®) only exists for children 5 years of age and older. Their use in Australia is also rare, however their use for younger children is approved by the European Union. We wish to share our experience of implantation in an antipodean setting in this age group. METHODS: Institutional board approval was obtained for this study. All children undergoing BAHA(®) implantation under 5 years old were included from our prospective database. We examined the variety of surgical techniques, (including skin grafting, limited soft tissue reduction and no soft tissue reduction), BAHA(®) implants and abutments used, and use of the new series 400 hydroxyapatite coatings. Demographic data obtained included age at surgery, follow up duration, gender, ethnicity and indication for surgery. Anonymous benefit questionnaires (Glasgow children's benefit inventory (GCBI) and parents' evaluation of aural performance of children (PEACH)) were completed online as well as a questionnaire on device use. Complications recorded included soft tissue reactions, implant loss/removal, abutment replacement/removal. We also assessed whether patient weight, ethnicity or socioeconomic status were risk factors for these complications. RESULTS: 24 Children (26 ears/26 implants) under five years were identified from the database and included in the study. There was a 14:10 male to female ratio. Patient caregivers reported subjective benefit and improved quality of life (QOL) despite setbacks and complications related to BAHA(®) usage. 10/24 (42%) of children required treatment for significant peri-implant skin reactions whilst 25% required replacement of their abutments and/or implants. An increased risk of major complication was associated with socioeconomic deprived backgrounds and in patients of New Zealand Maori and Pacific Island ethnicity but not in patients with increased weight centiles. CONCLUSIONS: The BAHA(®) implant and hearing aid system is of value to children under age 5 years. Parents tolerate the skin reactions and complications because of the perceived benefit in hearing and quality of life. Careful counselling of parents of potential young BAHA(®) implant candidates is necessary in light of this.

Survey on the use of ototopical medications by New Zealand otolaryngologist/head and neck surgeons.

AIM: There is increasing awareness of the potential for ototoxicity with the administration of aminoglycoside eardrops in the presence of a non-intact tympanic membrane, whether that is due to a perforation or due to the presence of a patent ventilating tube. Expert panels in the USA, Canada, UK, and Australia have all advocated the preferential use of non-ototoxic topical antibiotics for the discharging middle ear and/or mastoid cavity. The advent of non-ototoxic fluoroquinolone eardrops provides the first real opportunity to prescribe topical therapy in accordance with such guidelines. METHOD: We surveyed practicing otolaryngology/head and neck surgeons in New Zealand to ascertain their clinical preferences as well as to gauge any impediments to utilising safer medical therapies. RESULTS: The major results of this survey, with a 72% response rate, are presented. Notably, a total of 24 cases of sensorineural hearing loss were reported that may have been caused by the use of topical ototoxic medications. CONCLUSION: Based on our survey results and current evidence available in the broader scientific literature, recommendations are made for the prescription of non-ototoxic medications in at-risk situations. However clinicians may be prevented from following such guidelines by the increased costs of these medications, thus leading to decreased patient compliance. There was widespread support for subsidies to be available for the prescription of non-ototoxic fluoroquinolone eardrops for appropriate indications.