Socio-Economic Status and Language Development in Hearing Loss: A Critical Appraisal

The impact of language input on children’s speech, language, and brain development was borne out of Hart and Risley’s famous “30-million-word gap”. A perspective bolstered by many studies in the last decade relates higher socio-economic status (SES) to better qualitative and quantitative differences in children’s speech. The logic chains found in these studies suggest that literacy development depends on language and brain development. Thus, brain building develops based on environmental experience and language input depends on the brain’s perception of the auditory information. This essay uses the latest published peer-reviewed research to outline the current landscape of the role of SES in the development of speech and language skills among children with hearing loss (HL) who are enrolled in auditory-driven habilitation programs. This essay argues that low SES families may provide sufficient input for their children. The outcome of auditory-driven programs implemented by speech-language pathologists (SLPs) seems to be detached from SES. The role of SES on this developmental trajectory remains unclear, and clinical practice may be related to other validated and robust parameters related to hearing loss

How effective Auditory-Verbal Therapy (AVT) is for building language development of children with cochlear implants? A systematic review.

This systematic review was designed to investigate the effectiveness of Auditory-Verbal Therapy (AVT) based on research findings of the last ten years. The systematic review was designed based on PRISMA guidelines. Search terms were chosen based on the research question and used in a search on PubMed database. Last decade’s published peer-reviewed papers meeting inclusion criteria were reviewed based on. The results revealed AVT as an important clinical approach that improves young cochlear implant (CI) children to outperform peers in bilingual-bicultural pro-grams in receptive vocabulary and speech perception or at the least be at a similar level on speech, language and self-esteem. Other aspects related with voice seemed also benefited, placing young CIs in the normal range for receptive vocabulary development. Less improvement noted in the ar-ea of reading. AVT approach can positively assist infants develop spoken language and support full integration into mainstream society despite the limited evidence presented. This position is supported by research findings of young CIs comparable to their hearing peers. Overall studies suggest AVT as a positive clinical approach for spoken language of young CIs and provide evi-dence that there is no advantage for the use of other alternative communication models before or after CI

Consonant Repertoire of a Prelinguistically Deaf Child with Late-Mapping Cochlear Implants

Objective: The present case study aims to report on the consonant repertoire during the pre-linguistic and first linguistic stage of a Greek-Cypriot speaking child bilaterally implanted with multichannel Cochlear Implants (CIs). Background: Children with Hearing Loss (HL) produce canonical babble later, and consonantal inventories of HL children are smaller. However, the consonant repertoire of CI Greek-speaking children has not been examined thus far and research on types of consonantal errors during phonological acquisition is scant. Clinical Case: A pre-linguistically deaf child (CY, 7;0 years old) received the first CI at 7 months of age, but the external part of the device was fitted at 2;7 years. An investigation of the child’s speech at 7;0 years was conducted through auditory analysis. The child’s canonical utterances were transcribed in IPA and his consonants were classified into subcategories, depending on articulation place, articulation manner and resonance. Regarding place, alveolar consonants were the main category produced. As regards manner, closed consonants was the first category to appear, while in terms of voicing, voiceless consonants were recorded more often than voiced ones. The analysis also showed that consonants /t/, /s/ and /p/ were dominant in the child’s speech and revealed several phonological processes. Conclusion: The present case holds special interest as the child’s phonological system is still between the pre-linguistic/first linguistic stages due to the delayed CI mapping. The results agree in part with several studies in the literature, while specific phonological error patterns observed, remain to be verified in other CI Greek-speaking children

Duration measurement of vocants in infants with Cochlear Implants

Vocants are precursors to speech and are facially neutral. The presence of these speech-like vocalizations was evident during the precursors to mature phonology called “protophones”. The prosodic feature of the duration of the nuclei plays a crucial role in the shift of prelexical to mature speech since speech intelligibility is closely related to the control of duration. The aim of this work is to determine whether cochlear implants (CIs) positively trigger language acquisition and the development of verbal skills. Recent literature findings are compared and discussed with the performance of two Greek congenitally hearing-impaired infants who were matched with three normal-hearing (NH) infants. This work highlighted an important weakness of the prosodic abilities of young infants with CIs

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities

An acoustic and auditory analysis of vocants in infants with cochlear implants

Introduction: The duration of the nuclei is a crucial factor for the shift of prelexical to mature speech, since control of duration is closely related with improved speech intelligibility. Objectives: This work records the suprasegmental feature of duration in infants with normal hearing (NH) compared to those with cochlear implants (CI) based on vocant productions (quasivowels and full vowels). Materinals and Methods: In this longitudinal study, 102 vocant productions were analyzed from cases of congenitally hearing-impaired infants (implantation ages 1:4 and 1:11 years; post-implant ages 0:6 months and 1:3 years) who were matched with three NH infants of similar hearing experience (ages 0:8–0:11 months). Current methodology analyzes vocants using a combination of acoustical and auditory analyses. Vegetative data or reflexive sounds were excluded. Participants had had unknown deafness etiology and no other disabilities. Duration was measured using wideband spectrographic analysis, from voice onset to the loss of audible signal and the decrease of higher formant’s energy. Results: The results showed that the mean vocant duration of young CI users was longer, compared to hearing matched peers during the first six months after cochlear implantation. Conclusions: This recorded weakness for CI users' speech production is a challenge for future work in speech processing strategies. This is the first study measuring production of vocants during the pre-linguistic stage in CI recipients

Human Leukocyte Antigen (HLA) Influence on Prognosis of Autoimmune Hearing Loss

Background: To evaluate the effect of human leukocyte antigen (HLA) on hearing outcome in patients suffering from autoimmune hearing loss (AIHL). Materials and Methods: The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden, fluctuating, or quickly progressing (<12 months) sensorineural hearing loss (uni-/bilateral). The molecular typing of HLA alleles was achieved by using polymerase chain reaction procedures. Patients underwent a tapering schema of steroid treatment and audiometric features were recorded. A logistic regression model was used to identify which HLA typing alleles were statistically significant in patients’ response to treatment. Results: Forty patients with AIHL were found to be carriers of HLA B27, B35, B51, C4, C7, and DRB1*04 alleles. No statistically significant influence of HLA B27, B35, B51, C4, C7, DRB1*04 HLA alleles typing was detected for the prognosis of AIHL. In these patients, the onset of AIHL was mainly progressive (53.8%), 29.2% of them had moderate hearing loss, and most of the cases had both bilateral hearing loss (62.5%) and downsloping audiogram (40%). Conclusion: The presence of HLA B27, B35, B51, C4, C7, and DRB1*04 alleles had no significant effect on a favorable outcome of AIHL. However, larger samples of patients are necessary in order to improve the knowledge about the HLA influence on the clinical course of AIHL

Audiological Patterns in Patients with Autoimmune Hearing Loss

Introduction: The aim of this study was to illustrate clinical and audiological patterns of hearing impairment in patients with autoimmune hearing loss (AIHL). Methods: Fifty-three patients with AIHL were retrospectively recruited, and a tapering schema of steroid treatment was administered in all these patients. The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden (sensorineural hearing loss [SSHL]), fluctuating, or quickly progressing (<12 months) SSHL (uni-/bilateral), in association with the coexistence of autoimmune diseases, high antinuclear antibodies (ANA) and the presence of human leukocyte antigen (HLA) B27, B35, B51, C04, and C07. Logistic regression analysis was applied to correlate the clinical data and laboratory features of AIHL with final outcomes. Results: The onset of AIHL was mainly progressive (49%), followed by SSHL (39.6%) or fluctuating (11.3%). The pure-tone audiogram showed more commonly a downsloping pattern (42.6% of ears), but also an upsloping, flat, cookie-bite, or inverse cookie-bite shape. Bilateral progressive AIHL was more frequently simultaneous (23 patients) than heterochronous (4 patients). Nineteen patients (35.8%) showed a favorable response to steroid therapy. The presence of recurrent, bilateral SSHL versus recurrent, unilateral SSHL had statistically negative effect on hearing recovery (OR = 0.042, p < 0.05). The heterochronous bilateral SSHL may have better prognosis than simultaneous bilateral SSHL (OR = 10.000, p = 0.099). The gender, age, concomitant autoimmune disease, high ANA, HLA alleles, tinnitus, and vestibular symptoms had no statistical effect on a favorable outcome of AIHL. Conclusions: A bilateral, simultaneous, and progressive hearing loss combined with downsloping audiogram occurred more often in patients with AIHL. Bilateral simultaneous SSHL with recurrences represents the worse prognostic form of AIHL

Duplication of the External Auditory Canal: Two Cases and a Review of the Literature

The objective of the present paper is to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of 2 patients with first branchial cleft anomaly. The first case was an 8-year-old girl presented with an elastic lesion located in the left infra-auricular area, in close relation with the lobule, duplicating the external auditory canal. The magnetic resonance imaging revealed a lesion, appearing as a rather well-circumscribed mass within the left parotid gland and duplicating the ear canal. A superficial parotidectomy was subsequently performed, with total excision of the cyst. The second patient was a 15-year-old girl presented with a congenital fistula of the right lateral neck. At superficial parotidectomy, a total excision of the fistula was performed. During the operation the tract was recorded to lay between the branches of the facial nerve, extending with a blind ending canal parallel to the external acoustic meatus. Conclusively, first branchial cleft anomalies are rare malformations with cervical, parotid, or auricular clinical manifestations. Diagnosis of first branchial cleft lesions is achieved mainly through careful physical examination. Complete surgical excision with wide exposure of the lesion is essential in order to achieve permanent cure and avoid recurrence