Universal newborn hearing screening in the Lazio region, Italy

Background: The introduction of Universal Newborn Hearing Screening (UNHS) programs has drastically contributed to the early diagnosis of hearing loss in children, allowing prompt intervention with significant results on speech and language development in affected children. UNHS in the Lazio region has been initially deliberated in 2012; however, the program has been performed on a universal basis only from 2015. The aim of this retrospective study is to present and discuss the preliminary results of the UNHS program in the Lazio region for the year 2016, highlighting the strengths and weaknesses of the program. Methods: Data from screening facilities in the Lazio region for year 2016 were retrospectively analyzed. Data for Level I centers were supplied by the Lazio regional offices; data for Level II and III centers were provided by units that participated to the study. Results: During 2016, a total of 44,805 babies were born in the Lazio region. First stage screening was performed on 41,821 children in 37 different birth centers, with a coverage rate of 93.3%. Of these, 38.977 (93.2%) obtained a "pass" response; children with a "refer" result in at least one ear were 2844 (6.8%). Data from Level II facilities are incomplete due to missing reporting, one of the key issues in Lazio UNHS. Third stage evaluation was performed on 365 children in the three level III centers of the region, allowing identification of 70 children with unilateral (40%) or bilateral (60%) hearing loss, with a prevalence of 1.6/1000. Conclusions: The analysis of 2016 UNHS in the Lazio region allowed identification of several strengths and weaknesses of the initial phase of the program. The strengths include a correct spread and monitoring of UNHS among Level I facilities, with an adequate coverage rate, and the proper execution of audiological monitoring and diagnosis among Level III facilities. Weakness, instead, mainly consisted in lack of an efficient and automated central process for collecting, monitoring and reporting of data and information

EEG activity as an objective measure of cognitive load during effortful listening: A study on pediatric subjects with bilateral, asymmetric sensorineural hearing loss

Objectives: Deaf subjects with hearing aids or cochlear implants generally find it challenging to understand speech in noisy environments where a great deal of listening effort and cognitive load are invested. In prelingually deaf children, such difficulties may have detrimental consequences on the learning process and, later in life, on academic performance. Despite the importance of such a topic, currently, there is no validated test for the assessment of cognitive load during audiological tasks. Recently, alpha and theta EEG rhythm variations in the parietal and frontal areas, respectively, have been used as indicators of cognitive load in adult subjects. The aim of the present study was to investigate, by means of EEG, the cognitive load of pediatric subjects affected by asymmetric sensorineural hearing loss as they were engaged in a speech-in-noise identifi- cation task. Methods: Seven children (4F and 3M, age range ¼ 8e16 years) affected by asymmetric sensorineural hearing loss (i.e. profound degree on one side, mild-to-severe degree on the other side) and using a hearing aid only in their better ear, were included in the study. All of them underwent EEG recording during a speech-in-noise identification task: the experimental conditions were quiet, binaural noise, noise to the better hearing ear and noise to the poorer hearing ear. The subjects' Speech Recognition Thresholds (SRT) were also measured in each test condition. The primary outcome measures were: frontal EEG Power Spectral Density (PSD) in the theta band and parietal EEG PSD in the alpha band, as assessed before stimulus (word) onset. Results: No statistically significant differences were noted among frontal theta power levels in the four test conditions. However, parietal alpha power levels were significantly higher in the “binaural noise” and in the “noise to worse hearing ear” conditions than in the “quiet” and “noise to better hearing ear” conditions (p < 0.001). SRT scores were consistent with task difficulty, but did not correlate with alpha and theta power level variations. Conclusion: This is the first time that EEG has been applied to children with sensorineural hearing loss with the purpose of studying the cognitive load during effortful listening. Significantly higher parietal alpha power levels in two of three noisy conditions, compared to the quiet condition, are consistent with increased cognitive load. Specifically, considering the time window of the analysis (pre-stimulus), parietal alpha power levels may be a measure of cognitive functions such as sustained attention and selective inhibition. In this respect, the significantly lower parietal alpha power levels in the most challenging listening condition (i.e. noise to the better ear) may be attributed to loss of attention and to the subsequent fatigue and “withdrawal” from the task at hand

Neurophysiological characterization of normal hearing and unilateral hearing loss children: a comparison among EEG-based indices for information processing and decision-making levels.

The identification of measurable indices of cerebral functions to be applied in clinical settings is ever more felt as necessary for a more thorough and objective evaluation of patients cognitive performance. In the present paper, the electroencephalographic-based indices of mental workload (WL = frontal θ/parietal α) and of mental engagement (ME = β/(α+θ)), calculated along the brain midline, have been employed to characterize the eventual specific patterns of cerebral activations during a speech in noise perception task in normal hearing (NH) and unilateral hearing loss (UHL) children. Results showed no differences between the groups for the frontal bilateral noise condition (in which both signal and noise were emitted by two loudspeakers placed +45° and -45° in relation to the participant), while in lateralized noise conditions the UHL group showed higher parietal ME values for the Noise to the Deaf Ear condition). Finally, the NH group showed a different distribution of ME values among frontal, central and parietal electrodes, with higher ME values in the central and parietal ones in correspondence of the Noise to the Left Ear condition. The WL index analysis did not provide any significant differences. Results suggest the relevance of including the analysis of the beta rhythm in the neurophysiological assessment of the neural processing of speech in noise stimuli in normal hearing and hearing impaired participants

Neuroelectrical imaging study of music perception by children with unilateral and bilateral cochlear implants

Objective: To investigate by means of non-invasive neuroelectrical imaging the differences in the perceived pleasantness of music between children with cochlear implants (CI) and normal-hearing (NH) children. Methods: 5 NH children and 5 children who received a sequential bilateral CI were assessed by means of High-Resolution EEG with Source Reconstruction as they watched a musical cartoon. Implanted children were tested before and after the second implant. For each subject the scalp Power Spectral Density was calculated in order to investigate the EEG alpha asymmetry. Results: The scalp topographic distribution of the EEG power spectrum in the alpha band was different in children using one CI as compared to NH children (see figure). With two CIs the cortical activation pattern changed significantly, becoming more similar to the one observed in NH children. Conclusions: The findings support the hypothesis that bilateral CI users have a closer-to-normal perception of the pleasantness of music than unilaterally implanted children. © W. S. Maney & Son Ltd 2014

Music identification skills of children with specific language impairment

BACKGROUND: To date very few studies have investigated the musical skills of children with specific language impairment (SLI). There is growing evidence that SLI affects areas other than language, and it is therefore reasonable to hypothesize that children with this disorder may have difficulties in perceiving musical stimuli appropriately. AIMS: To compare melody and song identification skills in a group of children with SLI and in a control group of children with typical language development (TD); and to study possible correlations between music identification skills and language abilities in the SLI group. METHODS & PROCEDURES: This is a prospective case control study. Two groups of children were enrolled: one meeting DSM-IV-TR(\uae) diagnostic criteria for SLI and the other comprising an age-matched group of children with TD. All children received a melody and a song identification test, together with a test battery assessing receptive and productive language abilities. OUTCOMES & RESULTS: 30 children with SLI (mean age = 56 \ub1 9 months) and 23 with TD (mean age = 60 \ub1 10 months) were included. Melody and song identification scores among SLI children were significantly lower than those of TD children, and in both groups song identification scores were significantly higher than melody identification scores. Song identification skills bore a significant correlation to chronological age in both groups (TD: r = 0.529, p = 0.009; SLI: r = 0.506, p = 0.004). Whereas no other variables were found explaining the variability of melody or song identification scores in either group, the correlation between language comprehension and song identification in the SLI group approached significance (r = 0.166, p = 0.076). CONCLUSIONS & IMPLICATIONS: The poorer music perception skills of SLI children as compared with TD ones suggests that SLI may also affect music perception. Therefore, training programmes that simultaneously stimulate via language and music may prove useful in the rehabilitation of children affected by SLI

Neuroelectrical imaging investigation of cortical activity during listening to music in prelingually deaf children with cochlear implants

Objective: To date, no objective measure of the pleasantness of music perception by children with cochlear implants has been reported. The EEG alpha asymmetries of pre-frontal cortex activation are known to relate to emotional/affective engagement in a perceived stimulus. More specifically, according to the "withdrawal/approach" model, an unbalanced de-synchronization of the alpha activity in the left prefrontal cortex has been associated with a positive affective state/approach toward a stimulus, and an unbalanced de-synchronization of the same activity in the right prefrontal cortex with a negative affective state/withdrawal from a stimulus. In the present study, High-Resolution EEG with Source Reconstruction was used to compare the music-induced alpha asymmetries of the prefrontal cortex in a group of prelingually deaf implanted children and in a control group of normal-hearing children. Methods: Six normal-hearing and six age-matched deaf children using a unilateral cochlear implants underwent High-Resolution EEG recordings as they were listening to a musical cartoon. Musical stimuli were delivered in three versions: Normal, Distort (reverse audio flow) and Mute. The EEG alpha rhythm asymmetry was analyzed: Power Spectral Density was calculated for each Region of Interest, together with a right-left imbalance index. A map of cortical activation was then reconstructed on a realistic cortical model. Results: Asymmetries of EEG alpha rhythm in the prefrontal cortices were observed in both groups. In the normal-hearing children, the asymmetries were consistent with the withdrawal/approach model, whereas in cochlear implant users they were not. Moreover, in implanted children a different pattern of alpha asymmetries in extrafrontal cortical areas was noticed as compared to normal-hearing subjects. Conclusions: The peculiar pattern of alpha asymmetries in implanted children's prefrontal cortex in response to musical stimuli suggests an inability by these subjects to discriminate normal from dissonant music and to appreciate the pleasantness of normal music. High-Resolution EEG may prove to be a promising tool for objectively measuring prefrontal cortex alpha asymmetries in child cochlear implant users. (C) 2014 Elsevier Ireland Ltd. All rights reserved

"One-shot" CO2 versus Er:YAG laser stapedotomy: is the outcome the same?

To assess and compare the functional results obtained by means of multiple-shot Erbium: yttrium-aluminum-garnet (Er:YAG) laser to those obtained using "one-shot" CO(2) laser stapedotomy in patients affected by otosclerosis. A retrospective case review was performed. Of the total number of 123 patients (114 ears) who underwent primary small-fenestra stapedotomy from January 2006 to September 2008, seven patients who received multiple-shot laser CO(2) stapedotomy were excluded from the study. The remaining 116 patients (104 ears) were sorted, and "one-shot" CO(2) laser stapedotomy (group A) was performed in 35/104 and Er:YAG laser stapedotomy (group B) in 69/104. After surgery, air conduction-pure tone average (AC-PTA) and air-bone gap (ABG) improved significantly in both groups, whereas sensorineural hearing loss (SNHL) and bone conduction (BC)-PTA did not change in both the groups. In group A, the postoperative ABG was significantly better (12.63 vs. 14.86 dB). Moreover, after "one-shot" stapedotomy, the AC-PTA significantly improved in all tested frequencies. On the contrary, in group B the AC-PTA improved significantly only in two frequencies (0.5 and 1 kHz). Consistent with previous reports, our findings confirm that laser stapedotomy is a safe and effective surgery, regardless of the technique. Based on our functional results, the "one-shot" CO(2) laser technique seems to be associated with a significantly better postoperative ABG if compared to Er:YAG laser stapedotomy

Early Hearing Assessment After "One Shot" CO2 Laser Stapedotomy: Is It Helpful to Predict Inner Ear Damage and the Functional Outcome?

OBJECTIVE:: Auditory testing is not routinely performed within 4 to 6 weeks after stapedotomy because hearing acuity is thought to be transiently depressed. The early postoperative effects of the 1-shot carbon dioxide (CO2) laser have never been reported. The purpose of this study is to present data for auditory thresholds measured within 2 days of laser stapedotomy and at the last follow-up. STUDY DESIGN:: The study was prospective and unblinded. SETTING:: The study was conducted at the "A. Gemelli" University Hospital. METHODS:: From January to December 2008, 58 subjects underwent "1-shot" CO2 laser stapedotomies for otosclerosis. Pure-tonal audiometric test was performed preoperatively 2 days after surgery and at least 1 month after surgery during the follow-up. RESULTS:: The closure of air-bone gap began in the early postoperative period and continued to improve through the late postoperative period. Bone-conduction hearing thresholds were stable even in the early postoperative follow-up and remained stable trough all the course of the study. CONCLUSION:: Our data, supported by the literature, suggest that 1-shot CO2 laser stapedotomy is an effective and safe procedure for the treatment of otosclerosis

Safe use of bipolar radiofrequency induced thermotherapy (RFITT) for nasal surgery in patients with cochlear implants

Treatment of nasal turbinate hypertrophy with bipolar radiofrequency-induced thermotherapy (RFITT) is a common indication in patients affected by chronic vasomotor rhinitis. Nonetheless, there are no reports about the safety of such a surgical procedure in cochlear implant (CI) users, due to concerns that the spread of electrical current and heat could damage the CI inner component. We report two cases of CI recipients successfully and safely undergoing RFITT performed by means of the Olympus® Celon-ProBreath bipolar coagulation electrode