The fine art of conversation: the pragmatic skills of school-aged children with hearing loss

This chapter synthesizes the findings of a number of recent studies conducted by the authors. The focus will be on spoken interactions between school-aged students who are deaf and hard of hearing, and their hearing peers. Many of the participants in these studies have worn hearing aids and/or cochlear implants since infancy and have been educated in inclusive settings. The context of these studies includes face-to-face interactions during a question/answer game, in free conversation, and during an expository task. This chapter will examine the verbal and nonverbal conversational skills 'of these students within these different contexts. Using a range of quantitative and qualitative analyses, the development of pragmatic skills in students with hearing loss will be documented, and possible implications for language support and the development of social skills will be discussed.

Population outcomes of three approaches to detection of congenital hearing loss

BACKGROUND: Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost.

METHODS: Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (>25 dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003-2005, n = 69; (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003-2005, n = 65; and (3) largely opportunistic detection, Victoria 1991-1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression.

RESULTS: Children were diagnosed younger with universal than risk factor screening (adjusted mean difference -8.0 months, 95% confidence interval -12.3 to -3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P < .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P < .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P < .001); these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected.

CONCLUSIONS: With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.

The communication skills used by deaf children and their hearing peers in a question-and-answer game context

Communication is frequently characterized by a sequence of questions and answers. Little is known about how well students who are deaf or hard of hearing (deaf/HH) understand their hearing classmates in the context of an inclusive setting. This study explored the communication skills used by deaf/HH children when asking and answering questions in a “trivia” game with their hearing peers. Thirty-four children with normal hearing and 34 children with a hearing loss ranging from mild to profound (>90 dB HL) participated in this study. Each of the 34 dyads included 1 child with normal hearing and 1 child with hearing loss, matched by gender and grade level at school. Dyads were videotaped and analyzed. Pairs were compared in terms of their capacity to repeat the question, strategies used to seek information, and accuracy of responses. Results showed that the group of hearing children was able to repeat more questions verbatim compared to the deaf/HH children. The deaf/HH group required a significantly greater number of repetitions, sought a greater number of general clarifications, and correctly answered more questions compared with the group of hearing children. The implications of these findings are discussed in terms of peer communication and pragmatic skill development.

Hearing in athletes with intellectual disabilities : the need for improved ear care

Background The Special Olympics offer the opportunity for athletes with intellectual disabilities to participate in a range of sports at regional, national and international level. A parallel Healthy Athletes programme was introduced to ensure safety at the games but also to collect data on the health needs of those with intellectual disabilities (ID).

Method This study reports on the introduction of a hearing screen for the first time at national games in Great Britain. Given the availability of free local healthcare it was unclear whether the screen would simply duplicate services already accessed locally.

Results Of the 996 athletes who went though the hearing screen 40% were identified with a previously unrecognised hearing loss, 52% required medical ear care and 43% required wax removal. Despite complex competing stimuli within the screening area only 15 of the subjects were unable to complete the full screen. Local clinical services are carried out in more controlled environments therefore it is reasonable to presume that it would be possible for them to provide assessment of ear care and ongoing audiological assessments where needed. It was found that carers and sports coaches were generally unaware of the hearing needs of the athletes, in spite of the fact that they worked so closely with them.

Conclusions The importance of imparting information to carers and coaches, together with the need for access to regular ear care locally is underlined in this study.

The mathematical and science skills of students who are deaf or hard of hearing educated in inclusive settings

This study examined the science and mathematics achievements of 16 Year 9 students with hearing loss in an inclusive high-school setting in Western Australia. Results from the Monitoring Standards in Education (MSE) compulsory state tests were compared with state and class averages for students with normal hearing. Data were collected from three cohorts of Year 9 students across a 3-year period (2005‐2007). Results from mathematics MSE9 and the MSE9 science assessments showed that the majority of students with hearing loss performed below the state average (88%). Findings in this study suggest that students with hearing loss demonstrated more mathematical strength in the areas of space and measurement, which use visuo-spatial skills. Results for students with hearing loss in the five sections of the science assessment suggest more consistency across the different areas tested in the MSE. Comparisons with the MSE9 English paper for the 2005 cohort of students with hearing loss suggest a strong relationship between reading and writing skills and performance on mathematics and science assessment. In particular, questions with high language content created difficulty. On the science assessment, questions requiring a written explanation appeared to be particularly challenging. These findings have implications for teaching and learning in these crucial areas for students with hearing loss in inclusive secondary school settings. Greater attention to the interpretation of the language of mathematics and to writing about science concepts may help to improve outcomes for students with hearing loss on statewide assessments

The cost-effectiveness of universal newborn screening for bilateral permanent congenital hearing impairment : systematic review

Objective - Universal newborn hearing screening for bilateral permanent congenital hearing impairment is standard practice in many developed economies, but until there is clear evidence of cost-effectiveness, it remains a controversial use of limited health care resources. We conducted a formal systematic review of studies of newborn hearing screening that considered both costs and outcomes to produce a summary of the available evidence and to determine whether there was a need for further research.

Methods - A search was conducted of medical and nursing databases and gray literature websites by the use of multiple keywords. The titles and abstracts of studies were examined for preliminary inclusion if reference was made to newborn hearing screening, and to both costs and outcomes. Studies of potential relevance were independently assessed by 2 health economists for final inclusion in the review. Studies that met inclusion criteria were appraised by the use of existing guidelines for observational studies, economic evaluations and decision analytic models, and reported in a narrative literature review.

Results - There were 22 distinct observational or modeled evaluations of which only 2 clearly compared universal newborn hearing screening to risk factor screening for bilateral permanent congenital hearing impairment. Of these, the single evaluation that examined long-term costs and outcomes found that universal newborn hearing screening could be cost-saving if early intervention led to a substantial reduction in future treatment costs and productivity losses.

Conclusions - There are only a small number of economic evaluations that have examined the long-term cost-effectiveness of universal newborn hearing screening. This is partly attributable to ongoing uncertainty about the benefits gained from the early detection and treatment of bilateral permanent congenital hearing impairment. There is a clear need for further research on long-term costs and outcomes to establish the cost-effectiveness of universal newborn hearing screening in relation to other approaches to screening, and to establish whether it is a good long term investment.

Examining potential barriers to early intervention access in Australian hearing impaired children

Early intervention for children with hearing loss involves assistance in oral speech development, optimal use of hearing devices and fostering a holistic partnership between allied health and the children's families. Adequate access to early intervention has been shown to be vital in the positive development of long term language and social outcomes. However, there has been limited research to identify the factors which may influence access. This study aimed to explore whether access to early intervention by children with hearing loss is affected by: geographical location, socio-economic status and ethnic-minority family status.

Spoken language and speech perception abilities in deaf children

Despite early diagnosis, early fitting of more advanced sensory aids, early intervention, and intensive educational management, many children with severe to profound hearing loss are delayed in their acquisition of spoken language compared with their peers with normal hearing. More...Some of the greatest challenges facing educators of deaf children include determining where to focus intervention in order to maximise benefit, and establishing the most effective strategies for the development of age-appropriate language. The experimental research in this book examined the relationship between hearing, speech production, and vocabulary knowledge, and investigated the contributions of these factors to the overall speech perception performance of deaf children. This research also investigated the areas in which intervention would be most beneficial, and examined the effects of different types of intervention on the development of spoken language and speech perception skills in deaf children. The evaluation, analysis and intervention methods reported in this book provide an experimentally validated program for improving speech perception, speech production and spoken language skills of deaf children.

Beliefs, practices, and expectations of oral teachers of the deaf

This study investigated the beliefs and practices of 28 teachers of the deaf about their practices. The teachers were all working in oral settings either as visiting teachers or teachers in a mainstream school facility supporting groups of students with hearing loss. Teachers who used an Auditory Verbal approach largely adopted a positivist paradigm, whereas those using an Auditory Oral approach were more likely to adopt a constructivist paradigm. Those using a mixed approach (AV/AO) adopted a paradigm that was a mix of both positivist and constructivist. Results suggest that there is a strong relationship between the underlying beliefs of teachers and the model of practice that they adopt, and that professional experience, professional development and the inclusion movement exert an influence on those beliefs and practices.

Investigating question types used in conversation between school-aged deaf children and their peers.

Children learn about turn-taking and develop sensitivity to conversational partners. Anecdotal reports suggest that children who are D/HH may have difficulties with some pragmatic skills that lead to difficulties interacting with hearing children. This study investigated the conversational skills of children with hearing loss who use spoken language when communicating with their hearing peers. A comparison of the conversational skills of children who are D/HH conversing with hearing peers with the conversational skills of hearing dyads was conducted. Specifically, this paper will present results relating to how each dyad member asked questions including question types, question purpose, and the role of questions in conversation.

Ear wax removal interventions : a systematic review and economic evaluation

Excessive ear wax can lead to symptoms such as hearing loss, tinnitus, itching, vertigo, and pain. Treatment to remove ear wax is generally carried out in primary care, and recent estimates suggest that up to 2 million ear irrigations are performed in England and Wales each year.1 This places a considerable demand on GP surgeries. A range of simple and often inexpensive remedies and proprietary drops can be used either to dissipate the wax orsoften it prior to removal. Although removal through irrigation usually occurs in primary care, some people may self-treat. Treatments offered often appear to be based on custom and local practice, rather than an awareness of the comparative effectiveness and costs of the different alternatives. Although evidence on the efficacy of different treatments has been published, no study has examined both clinical and cost-effectiveness. This report summarises a systematic review and economic evaluation of different approaches to ear wax removal taken from a UK perspective.

Silk films as a repair material for perforations of the tympanic membrane

Large, chronic perforations of the tympanic membrane or eardrum can cause hearing loss as well as a range of secondary health problems. Current methods of repair usually involve grafting a material such as cartilage from another site on the body across the perforation. However, given problems such as possible infections at the graft donor site and the inability to see through the graft to assess infection within the middle ear, there is a need to develop an alternative material that is strong, readily available and transparent. Such a material would allow for less invasive surgery and potentially result in a superior hearing outcome for the patient. Our recent work has identified silk fibroin films as a promising material for this application. This paper reviews the repair of large perforations and compares the mechanical properties of silk with some existing graft materials. It also briefly discusses the difficulties in defining and comparing these properties with such different materials.