Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral® group (p = 0.01). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.Peer reviewe

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes. Design:Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance. Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA(0.5-4 kHz), had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills. Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.</p

Speech perception and auditory performance in hearing-impaired adults with a multichannel cochlear implant

Abstract This work was aimed at studying speech perception and auditory performance in the everyday lives of Finnish-speaking postlingually severely or profoundly hearing-impaired adults before and after receiving a multichannel cochlear implant. The association between the formal speech perception results and auditory performance in everyday life was also determined, and an effort was made to define how well a smaller sample represents the nationwide results. The patient series comprised a nationwide retrospective survey (N = 67), in which data on hearing level and word recognition were requested from the hospitals, and a prospective sample from the city of Oulu (N = 20), in whom hearing level, sentence, word and phoneme recognition and phoneme confusions were examined using standardised audiometric measures and formal speech perception tests in a study with a prospective repeated measure design. Categories of auditory performance in everyday life were assessed in both samples. The median sound field hearing level at frequencies of 0.5, 1, 2 and 4 kHz for the subjects in the nationwide survey one year after the switch-on of the implant was comparable to the level of mild hearing impairment. All the subjects achieved at least some open-set word recognition auditorily only (mean 71%, 95% CI 61-81%). The results in the Oulu sample were in line with the nationwide survey. A majority of the subjects (31/40) was able to understand conversation without speechreading one year after switch-on. Sentence recognition by the subjects in the Oulu sample improved most during the initial six months after the switch-on of the implant, whereas word and phoneme recognition improved steadily during the two-year follow-up period. Estimated average sentence recognition after two years was 89% (95% CI 71 to 106%), word recognition 73% (95% CI 58 to 87%), syllable recognition 53% (95% CI 42 to 63%), vowel recognition 80% (95% CI 68 to 92%) and consonant recognition 67% (95% CI 57 to 76%). Confusion of phonemes took place more in the direction a spectral energy distribution at higher frequencies. The association between auditory performance in everyday life and the formal speech perception tests was high (rs > 0.81, p &lt; 0.0001). Systematic prospective assessment of speech perception with tests of differing difficulty is recommended for the follow-up of adult cochlear implant users.Tiivistelmä Tämän työn tarkoituksena oli tutkia suomenkielisten, kielen oppimisen jälkeen vaikean tai erittäin vaikean kuulovian saaneiden aikuisten kuulon tasoa, puheen vastaanottoa ja kuulon toiminnallista tasoa monikanavaisen sisäkorvaistutteen avulla. Tutkimuksessa selvitettiin myös, miten puheen vastaanottoa mittaavat testit kuvaavat selviytymistä arkipäivän elämässä sisäkorvaistutteen mahdollistaman kuulon avulla. Tarkoituksena oli myös määrittää, millä tavalla pieni otos edustaa kansallisia tuloksia. Tutkimuksessa on retrospektiivinen kansallinen otos (N=67) ja prospektiivinen Oulun otos (N=20). Kansallisessa otoksessa tiedot kuulon tasosta ja sanojen tunnistuskyvystä kerättiin yliopistosairaaloista koehenkilöiden sairauskertomuksista. Oulun otoksessa kuulon tasoa, sekä lauseiden, sanojen ja äänteiden tunnistuskykyä ja äänteiden sekoittuvuuksia tutkittiin audiometrian ja puheenvastaanottoa mittaavien testien avulla kahden vuoden seurannan aikana. Kuulon toiminnallista tasoa arvioitiin kuulon toiminnallisen tason luokituksella molemmissa otoksissa. Kansallisen otoksen koehenkilöiden kuulokynnysten mediaani äänikentässä sisäkorvaistutteella taajuuksilla 0,5, 1, 2 ja 4 kHz oli verrattavissa lievän kuulovian tasoon vuosi sisäkorvaistutteen käyttöönoton jälkeen. Kaikki koehenkilöt kykenivät tunnistamaan vähintään joitain sanoja pelkästään kuulonvaraisesti (keskiarvo 71 %, 95 %:n luottamusväli 61-81 %). Oulun otoksen ja kansallisen otoksen tulokset olivat yhteneväiset. Vuosi sisäkorvaistutteen käyttöönoton jälkeen suurin osa (31/40) koehenkilöistä pystyi keskustelemaan ilman huulioluvun tukea hiljaisessa ympäristössä. Oulun otoksen koehenkilöiden lauseiden tunnistuskyky parani eniten ensimmäisten kuuden kuukauden aikana. Sanojen ja äänteiden tunnistuskyky parani koko kahden vuoden seurannan ajan. Kaksi vuotta sisäkorvaistutteen käyttöönoton jälkeen, estimoitu keskimääräinen lauseiden tunnistusprosentti oli 89 % (95 %:n luottamusväli 71-106 %), sanojen tunnistusprosentti oli 73 % (95 %:n luottamusväli 58-87 %), tavujen tunnistusprosentti oli 53 % (95 %:n luottamusväli 42-63 %), vokaalien tunnistusprosentti oli 80 % (95 %:n luottamusväli 68-92 %) ja konsonanttien tunnistusprosentti oli 67 % (95 %:n luottamusväli 57-76 %). Koehenkilöt sekoittivat vokaaleja ja konsonantteja useimmiten spektraaliselta energialtaan läheisimpään suuremmille taajuuksille sijoittuvaan äänteeseen. Kuulon toiminnallisen tason luokituksen ja puheen vastaanottoa mittaavien testien välinen korrelaatio oli korkea (rs > 0.81, p &lt; 0.0001). Sisäkorvaistutteen saavien aikuisten kuulon tason ja puheen vastaanottokyvyn systemaattinen seuranta vaikeudeltaan eritasoisten testien avulla on tärkeää monipuolisen kuntoutuksen suunnittelun tueksi

Vocal development in infants and toddlers with bilateral cochlear implants and infants with normal hearing

Abstract Purpose: The purpose of this study was to investigate the time course of vocal development in infants and toddlers with bilateral cochlear implants (CIs; bilateral CI group) who are acquiring Finnish and to compare their progress to that of infants with normal hearing and typical development (TD group). Method Five thousand nine hundred sixty-four spontaneous utterances of 30 infants and toddlers (15 in both groups) were classified as either precanonical (PC) vocalizations, basic canonical syllables (BCS), or advanced forms (AF) levels. Time course of development and group differences were analyzed in a prospective longitudinal study during a time course of 1 year: before implantation and 1, 3, 6, 9, and 12 months after CI activation for the bilateral CI group and at 6, 9, and 12 months of age for the TD group. Method: Five thousand nine hundred sixty-four spontaneous utterances of 30 infants and toddlers (15 in both groups) were classified as either precanonical (PC) vocalizations, basic canonical syllables (BCS), or advanced forms (AF) levels. Time course of development and group differences were analyzed in a prospective longitudinal study during a time course of 1 year: before implantation and 1, 3, 6, 9, and 12 months after CI activation for the bilateral CI group and at 6, 9, and 12 months of age for the TD group. Results: The least mature PC vocalizations decreased and the BCS and AF vocalizations increased for both the bilateral CI and TD groups during the follow-up period of 1 year. The bilateral CI group produced a lower percentage of PC vocalizations (effect size, ηp² = .35) and a higher percentage of BCS (effect size, ηp² = .16) and AF vocalizations (effect size, ηp² = 0.24) than the TD group. Conclusions: The findings of this study showed that vocal development of infants and toddlers with early-identified profound hearing loss is delayed before CI activation. Findings also showed that infants and toddlers with bilateral CIs make rapid advancements in vocal development after implantation compared to infants with typical development. However, their vocal development seems to remain delayed at least during the 1st year of bilateral CI use as compared to the well-documented milestones of infants and toddlers with typical development. Information about the vocal development time course following bilateral CI activation helps parents recognize progress in auditory-guided speech development before the emergence and the use of spoken words in communication

Communication abilities in children with hearing loss:views of parents and daycare professionals

Abstract Introduction: Today, children with hearing loss (HL) are diagnosed and fitted with hearing devices at an early age. However, HL may still influence their communicative development. Thus, we need up-to-date research on how children perform in their everyday environments, such as at home or daycare. This study provides an overview of the communication abilities of early-diagnosed children with HL reported by parents and daycare professionals. The first aim of the study is to compare the results of children with bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) with those of children with normal hearing (NH) and with each other. The second aim of the study is to compare the views of the two respondents, parents and the daycare professionals. In addition, the effects of gender and nonverbal intelligence quotient (IQ) on the responses are explored. Methods: The participants, aged 4;0–6;9, were 25 children with BiHAs, 29 children with BiCIs, and 64 children with NH. The Finnish version of the Children’s Communication Checklist-2 (CCC-2) was used to assess the communication skills of the participants. Results: Group and nonverbal IQ had a significant effect on the General Communication Composite (GCC) score. Both groups of children with HL had poorer GCC scores than the children with NH, apart from the respondent. The BiHA-group had significantly lower scores than the NH-group on Speech, Syntax, Semantics, and Coherence subscales. The BiCI-group had significantly lower scores than the NH-group across all subscales of the CCC-2. The parents rated the participants significantly higher than the daycare professionals in Speech and Social Relations. In contrast, the daycare professionals rated the participants higher than the parents in Coherence, Inappropriate Initiation, Stereotyped Language, and Use of Context. Furthermore, gender influenced Coherence, Nonverbal Communication, Social Relations, and Interests, for which the girls performed better than the boys. The nonverbal IQ had an effect on Syntax, Semantics, and Use of Context, for which higher nonverbal IQ was associated with better performance. Conclusions: On average the children with HL had poorer communication skills than the children with NH. Pragmatic difficulties were more common in the BiCI-group than in the BiHA-group. The respondents were not completely unanimous, which may be because of the different demands of different environments

Early vocabulary development in children with bilateral cochlear implants

Abstract Background: Children with unilateral cochlear implants (CIs) may have delayed vocabulary development for an extended period after implantation. Bilateral cochlear implantation is reported to be associated with improved sound localization and enhanced speech perception in noise. This study proposed that bilateral implantation might also promote early vocabulary development. Knowledge regarding vocabulary growth and composition in children with bilateral CIs and factors associated with it may lead to improvements in the content of early speech and language intervention and family counselling. Aims: To analyse the growth of early vocabulary and its composition during the first year after CI activation and to investigate factors associated with vocabulary growth. Methods &amp; Procedures: The participants were 20 children with bilateral CIs (12 boys; eight girls; mean age at CI activation = 12.9 months). Vocabulary size was assessed with the Finnish version of the MacArthur Communicative Development Inventories (CDI) Infant Form and compared with normative data. Vocabulary composition was analysed in relation to vocabulary size. Growth curve modelling was implemented using a linear mixed model to analyse the effects of the following variables on early vocabulary growth: time, gender, maternal education, residual hearing with hearing aids, age at first hearing aid fitting and age at CI activation. Outcomes &amp; Results: Despite clear vocabulary growth over time, children with bilateral CIs lagged behind their age norms in receptive vocabulary during the first 12 months after CI activation. In expressive vocabulary, 35% of the children were able to catch up with their age norms, but 55% of the children lagged behind them. In receptive and expressive vocabularies of 1–20 words, analysis of different semantic categories indicated that social terms constituted the highest proportion. Nouns constituted the highest proportion in vocabularies of 101–400 words. The proportion of verbs remained below 20% and the proportion of function words and adjectives remained below 10% in the vocabularies of 1–400 words. There was a significant main effect of time, gender, maternal education and residual hearing with hearing aids before implantation on early receptive vocabulary growth. Time and residual hearing with hearing aids had a significant main effect also on expressive vocabulary growth. Conclusions &amp; Implications: Vocabulary development of children with bilateral CIs may be delayed. Thus, early vocabulary development needs to be assessed carefully in order to provide children and families with timely and targeted early intervention for vocabulary acquisition

Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP) Three-Month Interim Results

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral (R) dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral (R) treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral (R)-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral (R)-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral (R)-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral( )(R) group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral (R)-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral (R) group (p = 0.01). In conclusion, adjunctive use of Lumoral (R) in NSPT results in improved treatment outcomes at three months post-therapy.Peer reviewe