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SO U N D MAT T E R S 2015 • ISSUE 4 Audiology Newsletter of the Minnesota Early Hearing Detection & Intervention Program • • Unilateral hearing loss • • • New research on language outcomes A multi-state research project is providing new information about Language Outcomes of Children with Unilateral Hearing Loss. With the support of fourteen participating state EHDI programs, the National Early Childhood Assessment Project (Sedey et.al) summarized characteristics of 132 children with unilateral hearing loss, reviewed language outcome data, and hoped to identify characteristics of children with more successful language outcomes. Characteristics of the total study population included: • 79% of children were identified by 3 months • Just over half were utilizing amplification Assessment was completed on one to five occasions, and assessment tools included the Minnesota Child Development Inventory, and the MacArther-Bates Communicative Development Inventory. Data showed: • 25% to 35% of participants demonstrated delayed language • Language delays were evident as early as 2 years of age • No identifiable factors associated with language delays (including degree of loss or use of amplification) Current data (study is ongoing) suggests that children with unilateral hearing loss should have language reevaluated again just after age 2, so that evidence based decisions can be made regarding care delivery and early intervention. Another recent publication in Pediatrics, “Asymmetric Hearing During Development: The Aural Preference Syndrome and Treatment Options,” highlights that single sided deafness in early childhood reorganizes the auditory pathway toward the hearing ear, weakening central representation of the deaf ear. Providing early and effective stimulation with hearing aid or cochlear implant plays a large role in securing the auditory system’s potential for binaural/spatial hearing. did you know? Unilateral hearing loss and amplification During 2014, reports from audiologists for newly diagnosed children in Minnesota with unilateral hearing loss showed: • 42% were fit with amplification • 8% declined amplification at the time of diagnosis • 23% did not have amplification recommended at the time of diagnosis • 27% had unknown plan regarding amplification (e.g. status not reported, testing in process, family undecided) Tune IN! Trends in Audiology STAT Timeliness of amplification following diagnosis About 2/3 of Minnesota children are enrolled in Part C within 2 months of diagnosis. This number has remained relatively stable over time. Audiologists have helped by making consistent and direct referrals to Help Me Grow, Minnesota’s Part C program, soon after diagnosis. Per federal law (Department of Education, 34 CFR Part 303), referrals should be made within 7 days. • • • • • • • • • • Timeliness to early intervention (Part C) Minnesota’s EHDI goal is to fit children with amplification by one month following diagnosis. Data reported by audiologists for 2014 show one-third of Minnesota children were fit with amplification by one month following diagnosis, and another 39% were fit by 2 months after diagnosis. Thank you for your continuing efforts to streamline your processes in order to help Minnesota children access devices earlier! Timeliness of Amplification Fitting *includes children with bilateral hearing loss who did not decline For children with permanent hearing loss, MDH contacts each child’s primary care provider to provide just-in-time information about childhood hearing loss and recommend referrals to medical specialties. Data from 2014 suggest that most children see ENT (87%), but a significant number are still not being referred to genetics (36% evaluated) and ophthalmology (41% evaluated). Audiologists can help by counseling parents about the importance of specialty evaluations, recommending specialty evaluations in reports to primary care, and facilitate scheduling when possible. 34% 15% 5% ≤1 2 3 2% 3% 2% 5 6 >6 4 Months from diagnosis to fitting Q&A • • • • • Q A • • • • • Referrals to medical specialties 39% % of children By the Numbers Percent referred, Medical Specialty Percent Evaluated unknown if Percent declined Percent not referred 1% 2% evaluated ENT 87% 10% Referrals to Medical Specialties Genetic 36% 11% 10% 43% Ophthalmology 41% 9% 6% 44% 2% 10% How soon are infants contacted for parent-toparent support? Minnesota Hands and Voices is able to contact about 90% of families referred to them. In 2014, 46% of families were contacted within one month of diagnosis; up from 21% contacted within one month of diagnosis 2012. This was a significant increase from 2012 made through collaborative efforts. Audiologists are key to connecting families with parent support and can improve these timely connections even more by increasing the number of direct referrals. 1% 100% 87% 0% Not referred Evaluated ENT Declined 43% 44% 10% 11% 6% 9% 36% 41% Genetics Ophth. Referred, unknown if evaluated Have You Heard? • • • • • Improving outcomes for children with mild bilateral hearing loss Children with mild hearing loss may seem to hear sounds and conversation. They may have passed a hearing screening or have no audible delay in speech articulation. When audiologists recommend hearing aids, parents may question the fitting if they do not observe a big difference. A new article in JSLHR by Walker, et al, “The Influence of Hearing Aid Use on Outcomes of Children with Mild Hearing Loss” gives audiologists more evidence to show parents why consistent hearing aid use is important. Authors studied 5-7 year-olds, separated into groups based on hearing aid use ranging from full-time to non-use. They investigated effects of cumulative auditory experience (audibility, hearing aid use, and input over time) and found that consistent hearing aid use was a significant predictor of expressive morphosyntax(grammar), receptive vocabulary, and phonological awareness – high level cognitive tasks not routinely measured by audiologists. Children with mild hearing loss who were non-users of hearing aids were at risk for delays in these areas. Typical validation tools like speech perception in noise or speech articulation improvements may not show large improvements for children with mild hearing loss. This new evidence may help parents persevere with device use knowing they are supporting their child’s higher level cognitive and language outcomes. Last Words from the Advisory Committee • • • • • Meeting highlights... • Update on the MN Deaf Mentor Program • Minnesota Department of Education 2015 legislative report on outcomes for “Students who are Deaf or Hard of Hearing in Minnesota” is now available • Minnesota EHDI 2014 Annual Report review Next meeting: Contact Us: Newborn Screening Program 601 Robert St N, St Paul, MN 55155 Phone: (800) 664-7772 or (651) 201-5466 Fax: (651) 215-6285 Email: [email protected] Web: www.health.state.mn.us/newbornscreening EHDI Website: www.improveehdi.org/mn November 4, 2015 1:00 – 4:00 p.m. Wilder Foundation 451 Lexington Parkway North St. Paul, MN 55104