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04/07/2014 Are there any differences of speech and language development in children with sensorineural hearing loss vs. conductive hearing loss? Annette Limberger [email protected] 4th July 2014 British Society of Audiology, Birmingham Contents ● Types of hearing loss ● Conductive hearing loss Sensorineural hearing loss Combined hearing loss Central auditory processing disorders Therapy of hearing loss Surgery Assistive listening devices ● Speech and language development …. and conductive HL …. and sensorineural HL ● Conclusion 4th July 2014 British Society of Audiology, Birmingham 1 04/07/2014 Types of hearing loss Inner ear Outer ear Middle ear WebMD, LLC, 2014 4th July 2014 British Society of Audiology, Birmingham Conductive hearing loss ● Common causes for a conductive hearing loss Outer ear • Impacted cerumen • Otitis externa Tympanic membrane • Tympanic membrane perforation • Tympanic membrane retraction Source: en.wikipedia.org Middle ear • Acute otitis media • Serous otitis media (OME) 4th July 2014 British Society of Audiology, Birmingham 2 04/07/2014 Conductive hearing loss ● Poor Eustachian tube function (adenoids) ● Allergies (serous otitis media) ● Absence or malformation of the outer ear, ear canal or middle ear Source: https://www.luks.ch/uploads/media/Atresie.pdf 4th July 2014 British Society of Audiology, Birmingham Sensorineural hearing loss ● Congenital hearing loss Genetic • Non-syndromic, syndromic Lack of development (aplasia) of the cochlea Congenital rubella syndrome Human Cytomegalovirus (HCMV) 4th July 2014 British Society of Audiology, Birmingham 3 04/07/2014 Sensorineural hearing loss ● Acquired hearing loss Inflammatory • • • • • Meningitis Mumps (epidemic parotitis) Measles Virus infection Syphilis 4th July 2014 British Society of Audiology, Birmingham Sensorineural hearing loss ● Ototoxic drugs ● Aminoglycosides (most common, e.g. tobramycin) ● Loop diuretics (e.g. furosemide) ● Antimetabolites (e.g. methotrexate) ● Salicylates (e.g. aspirin) ● Physical trauma ● Noise-induced ● Presbycusis 4th July 2014 British Society of Audiology, Birmingham 4 04/07/2014 Sensorineural hearing loss ● Sudden sensorineural hearing loss (SSHL) ● Idiopathic ● Vascular ischemia of the cochlea ● Perilymph fistula ● Autoimmune ● Acoustic neuroma ● Meningeoma ● Menière`s disease 4th July 2014 British Society of Audiology, Birmingham Other types of hearing loss ● Combined hearing loss ● Auditory neuropathy spectrum disorders ● Central auditory processing disorders (CAPD) 4th July 2014 British Society of Audiology, Birmingham 5 04/07/2014 Therapeutic options ● For conductive hearing loss Antibiotic therapy in case of bacterial infection, like acute otitis media or external otitis Surgical procedures • • • • • 4th July 2014 Tympanostomy with or without insertion of tubes Myringoplasty or Tympanoplasty Otoplasty in case of malformations or atresia de.wikipedia.org Adenoidectomy British Society of Audiology, Birmingham Tympanostomy tubes in children ● Rosenfeld RM et al., 2013: Clinical practice giudeline: Tympanostomy tubes in children Topical antibiotic eardrops, without oral antibiotics, for children with uncomplicated acute tympanstomy tube otorrhea Ventilation tubes only in OME histories of more than 3 months Appropriate hearing tests prior to surgery Bilateral tubes for bilateral OME Re-evaluation at 3- to -6 month intervals Early insertion for at-risk children for speech and/or language problems ent-info.nhs.uk 4th July 2014 British Society of Audiology, Birmingham 6 04/07/2014 Therapeutic options ● For conductive hearing loss Bone-anchored hearing systems (Farnoosh et al. 2014) Active implantable devices like e.g. the bonebridge, now available for children from age 5 www.oticonmedical.de www.medel.com 4th July 2014 British Society of Audiology, Birmingham Therapeutic options ● For sensorineural hearing loss Hearing aids • With new technologies, e.g. frequency-lowering Cochlear implants • Also with new technologies, e.g. directional microphones and reduction of background noise www.welches-hoergeraet.de 4th July 2014 British Society of Audiology, Birmingham 7 04/07/2014 Speech and language development ● Very different approaches in many studies ● Many studies with older children, like 8 or 9 years ● Influence of reading and writing skills? ● Examination of children with delayed speech and language development or without 4th July 2014 British Society of Audiology, Birmingham OME affects the language development ● Expressive language delay in children with early otitis media (e.g. Abraham SS et al., 1996, Lehmann MD et al., 1979, Teele, DW et al., 1984, Schoenweiler R et al., 1998, Van Cauwenberge P et al., 1985, Wallace IF et al., 1988, Haapala S et al., 2014, Uclés P, et al., 2012, Gouma P et al. 2011) Otitis-positive group significant fewer initial consonant phones and produced them less accurately otitis-positive group acquired significantly fewer consonants with back place of articulation Effects on intelligence, attention and activity, manual skills and social behaviour Expressive language delay already at the age of one year Aberrant preattentive discrimination of sound patterns Right chronic OM impairs phonetic and phonological coding of sounds Patients with OME had more anxiety/depression related disorders 4th July 2014 British Society of Audiology, Birmingham 8 04/07/2014 … in contrast ● There are no significant differences to a normal hearing population without history of recurrent OME (Timms L, et al. 2014, Browning, GG et al., 2010, Zumach A et al., 2010, Baxter JD et al., 1979, Grievenik EH et al., 1993, Harsten G et al., 1993, Lous J et al., 1988, Roberts JE et al., 1991, Zielhuis GA et al., 1989) No differences in speech development between groups Negative consequences of early-life OM will be resolved at the age of 7 4th July 2014 British Society of Audiology, Birmingham Nittrouer S., Burton L.T. J Comm Disorders, 2005 Percentages of items correct for the same-different intial-consonant-the-same task. The dashed line shows the upper limit of chance performance 4th July 2014 British Society of Audiology, Birmingham 9 04/07/2014 Nittrouer S., Burton L.T. J Comm Disorders, 2005 Percentages of items correct for the three-choice initial-consonant-the-same task. The dashed line shows the upper limit of chance performance. 4th July 2014 British Society of Audiology, Birmingham 4th July 2014 British Society of Audiology, Birmingham Schoenweiler et al. (1998): Int J Ped ORL 10 04/07/2014 Schoenweiler et al. (1998): Int J Ped ORL 4th July 2014 British Society of Audiology, Birmingham Differences conductive vs. sensorineural HL Schoenweiler et al. (1998): Int J Ped ORL 4th July 2014 British Society of Audiology, Birmingham 11 04/07/2014 Conductive hearing loss and auditory perception disorders ● Zargi and Boltezar (1992) made an investigation in children in Slovenia Follow-up over 2 years (children aged 0 – 2 years) Control 2 years later The children, who had recurrent (more than 3 times) OME in their first two years of life had a higher incidence of some auditory processing disorders like sound discrimination and sequential memory 4th July 2014 British Society of Audiology, Birmingham Summary on language development and conductive HL ● Children with conductive HL have problems in the acquisition of language skills ● The earlier the impairment, the greater the influence on the language development ‘mild’ hearing loss does not mean ‘mild’ language impairment (Furukawa) ● Conductive HL affects nearly all levels of language development (e.g. extent of vocabulary, grammatical structure, phonetic synthesis, auditory discrimination) 4th July 2014 British Society of Audiology, Birmingham 12 04/07/2014 Summary on language development and conductive HL ● The differences between children are much higher than in sensorineural HL this may be due to (according to Hall & Hill, 1986): 4th July 2014 The age at which the disorder occurs The duration of the episodes The severity of hearing loss Intrinsic qualities of the child The child’s environment British Society of Audiology, Birmingham Comparison SNHL and SLI Briscoe et al. (2001): J Child Psychol Psychiat 4th July 2014 British Society of Audiology, Birmingham 13 04/07/2014 Briscoe et al. (2001): J Child Psychol Psychiat Hearing thresholds in relation to phonological impairment status in SNHL group. Error bars show standard error. 4th July 2014 British Society of Audiology, Birmingham 4th July 2014 British Society of Audiology, Birmingham Briscoe et al. (2001): J Child Psychol Psychiat 14 04/07/2014 Summary on sensorineural HL ● Sensorineural HL leads to a delay the speech and language development ● It’s dependent on the degree of the HL ● More phonological problems than in children with conductive HL ● The problems are less severe than expected maybe because of the educational programs 4th July 2014 British Society of Audiology, Birmingham Conclusions I ● It is mandatory to check the hearing more often than only in the newborn period and (in Germany) at the age of 4 ● In children who have already a delayed speech and language development it is always necessary to check the hearing 4th July 2014 British Society of Audiology, Birmingham 15 04/07/2014 Conclusions II ● Special attention and follow-up for children with recurrent ear infection ● Children with conductive hearing loss have better chances to catch up with their language development ● One of the main influences is the socio-economic status, therefore early intervention like nursery, kindergarten ect. is useful 4th July 2014 British Society of Audiology, Birmingham Case report ● 9 year old boy ● Difficulties in school (3rd degree), especially reading and writing 4th July 2014 British Society of Audiology, Birmingham 16 04/07/2014 Case report ● On examination: Normal peripheral hearing Speech in quiet 100 % monosyllables Speech in noise SNR for SRT: 5 dB Massive limited auditory memory (2 items sequentially) Significantly low phoneme discrimination 4th July 2014 British Society of Audiology, Birmingham Case report ● Mother reported of nearly two year period of recurrent conductive hearing loss due to OME, which was not treated by the paedatrician ● Insufficient hearing testing ● Overextended mother with two other exhausting children with special needs, one of them preterm baby at the 25th week of pregnancy 4th July 2014 British Society of Audiology, Birmingham 17 04/07/2014 Case report ● First private lessons and auditory training ● Then referral to a special school for children with hearing handicaps, also auditory processing disorders ● Now: one of the best in his class 4th July 2014 British Society of Audiology, Birmingham Although careful assessment of these children is essential, it is still far from universal (Hall and Hill 1986) 18